The Drive States Explored: Sleep

Abstract

In order to ensure proper health, the body has a number of drives that can work to achieve optimal wellness. Drives such as sleep, reproductive, and ingestive have been found to be responsible for ensuring that humans, animals, and other organisms are able to meet their psychological needs. However, these drives may become disrupted, resulting in decreased levels of mental and physical health. When a disruption occurs, it can lead to an internal negative state, stress, tension, and other symptoms that can decrease the quality of life that can be achieved. Although one drive is not necessarily more important to overall health than another, the sleep drive appears to be one that is often overlooked, despite the growing body of literature that has emerged in support of the need for sleep throughout the lifespan.

The Drive States Explored: Sleep

            There are a number of internal drives that aim to maintain a homeostasis in the body, which include sleeping, eating, and reproducing. When there is an issue in one of the drives, it can lead to significant changes within the body, altering the mental and physical health of an individual. In order to understand the important role these drives play, it is essential to examine the different biological mechanisms, as well as the factors that may affect the drive. In this paper, the sleep drive will be examined, as well as the ethical implications that may be present when it comes to conducting research to expand the body of literature that pertains to the way sleep can affect mental and physical health.

Biological Mechanisms of Sleep

            Throughout life, there are stages in which the need for sleep varies, as the developmental phases are accompanied by either a greater or lesser need for sleep. As infants, there are a number of developmental processes that take place, which requires sufficient sleep that is often spread out throughout the day (Goel, Basner, Rao, & Dinges, 2013). As we age, the number of hours required decreases, with adults requiring approximately eight hours, which is often accomplished at night, in one block of time, rather than spread out over 24 hours as observed in newborns (Goel et al., 2013). However, individual characteristics may also influence the amount of sleep required, regardless of developmental stage.

            The circadian pacemaker that humans possess helps to encourage behavior, namely sleep, that can help to contribute to the homeostatic goal. The circadian rhythm includes changes in both body temperature, as well as the hormone melatonin (Duffy et al., 2011). The light-dark, sleep-wake cycle may also be influenced by gender-related biological aspects, with some research indicating that women may require more sleep than men when allowed to have a self-selected sleep-wake cycle (Duffy et al., 2011). Again, this sleep pattern of increased sleep required by women can be influenced by several variables, including pregnancy.

            The change in hormone and body temperature levels that have been noted to occur as a trigger for the sleep-wake cycle is dependent upon a number of biological influences, including varying levels of different neurotransmitters. It is thought that histamine, dopamine, norepinephrine, serotonin, glutamate, orexin, and acetylcholine all play a role in the sleep-wake cycle and sleep drive (Coulon, Budde, & Pape, 2012). High levels of histamine and serotonin have been linked to wakefulness, with the lowest levels associated with the rapid eye movement (REM) stage of sleep. When it comes time to sleep, messages that signal wakefulness is interrupted by the thalamus, leading to a slowdown in brain waves, with the brainstem and hypothalamus associated with sleep drive-related actions (Coulon et al., 2012).

How the Drive State of Sleep Affects Behavior

            If there is a lack of homeostasis in regards to the sleep-wake cycle, there can be significant behavior changes. For example, in individuals who are chronically sleep deprived, it can lead to weight gain, diabetes, and a reliance on stimulants to counteract the drowsiness that occurs as a result of a lack of sleep (Basner, 2011). There are other physical effects that occur due to the presence of sleep disturbances or a deficit in sleep, as organs and muscles often regenerate during rest or sleep (Fullagar et al., 2015). When it comes to neural activity, if there is an insufficient amount of time spent in certain stages of sleep, the regeneration of neurons, the formation of new memories, and establishing new synaptic connections can be affected (Fullager et al., 2015). Additionally, when sleep homeostasis is off balance, it can also lead to speech and performance activities, with slurred speech often associated with insufficient sleep (Williamson & Feyer, 2000). Some research has equated sleep deprivation to being under the influence of alcohol, as both slow down cognitive activities, with going 18 hours without sleep equating to a blood alcohol concentration (BAC) of 0.05, which is close to the 0.08 level that has been established as a threshold for driving under the influence in a number of states (Williamson & Feyer, 2000). Such conditions have been observed among over the road (OTR) truck drivers who are often tasked with driving long distances in a short amount of time.

Social and Cultural Factors that Affect the Drive State of Sleep

            It appears that society and culture have influence over a variety of behaviors that people carry out each day. This appears to include sleep, as certain cultures often include daily afternoon naps for adults of all ages, which are called siestas in Spanish-speaking cultures (Gicca, Axelsson, Mollicone, Muto, & Vitiello, 2010). These daily naps often occur during the warmest periods of the day, which is thought to correlate with the slowdown in the brain’s alerting systems, allowing the body to rest (Gicca et al., 2010). Due to the inclusion of daytime naps, the evening sleeping session is often pushed back an hour or two when compared to cultures that do not include daily siestas.

            On the other end of the spectrum, some cultures pride themselves on productivity around the clock, with sleep often pushed to the back burner in favor of more time awake to accomplish tasks (Foster & Wulff, 2005). Some research has indicated that the time at which an individual goes to sleep may be influenced more by one’s society, while the time at which one wakes may be driven more by one’s biological or circadian rhythm/clock (Walch, Cochran, & Forger, 2016). The overall pattern of the sleep-wake cycle appears to be influenced not only by society, but also by age and gender (Walch et al., 2016), suggesting that sleep is a much more complex activity and drive than how it appears on the surface.

Ethics and Research: Exploring Sleep

            Identified by Sehgal and Mignot (2011) as one of the least understood drives, sleep remains a topic that is in need of additional research. As such, ensuring that the approach to studying the sleep drive is conducted in an ethical manner is essential. Some recommendations that have been suggested in regards to carrying out ethical research on the topic of sleep includes ensuring that the safety of the human participant is of the utmost importance, with minimal, if any, threats present (Brown et al., 2011). This aspect is of particular interest when working with participants who have been diagnosed with obstructive sleep apnea, as it may be difficult to meet the criteria for a randomized controlled trial, as there may not be a control group suitable for the research study that does not place a group of participants at risk for injury, distress, or death (Brown et al., 2011). Other recommendations include obtaining informed consent, design strategies that include parallel group randomization when a control group is unavailable, and ensuring that exclusion criteria are developed to place the safety of the participant at the forefront of the research design (Brown et al., 2011).

Scenario Application: PTSD

            Sleep is an integral aspect to overall mental and physical health. However, in some instances, it may be challenging to fall and stay asleep. Sleep disturbances have been noted to occur in a number of psychiatric disorders, including individuals who have been diagnosed with posttraumatic stress disorder (PTSD). For example, a military veteran who has been diagnosed with PTSD has reported that he is having a hard time falling asleep. This symptom is common among individuals who have been diagnosed with this psychiatric disorder, which may be attributed to feeling as if they are “on alert,” the presence of negative thoughts, the use of substances such as drugs and alcohol as coping mechanisms, the presence of nightmares and flashbacks, and there might be an additional underlying physical issue, such as chronic pain and stomach or digestive issues that could contribute to a difficulty in falling or staying asleep (Sherin & Nemeroff, 2011).

            Imbalances in neurochemicals, such as serotonin, have been noted to occur in individuals who have been diagnosed with PTSD, which may help to explain some of the sleep disturbances experienced by this population of patients (Sherin & Nemeroff, 2011). Additionally, elevated levels of epinephrine and adrenaline, which are often found in patients with PTSD, can contribute to poor sleep patterns (Kung, Espinel, & Lapid, 2012). Low levels of adrenaline are required in order for an individual to achieve REM sleep, a sleep stage in which the brain can process the memories that are associated with the traumatic event, with a reduction of the emotional impact and toll these memories take on the individual (Kung et al., 2012). Recent research has suggested that through addressing the reduction in REM sleep via the prescription medication prazosin, which can help patients once again achieve REM sleep through the reduced sensitivity to adrenaline that is attributed to the medication (Kung et al., 2012). However, the use of this medication for the treatment of PTSD, sleep-related issues still require additional research.

Conclusion

            Based on the literature that has been published in peer-reviewed sources on the topic of sleep and the sleep drive, it appears that this aspect of human life is just as important as the drives responsible for eating, drinking, and mating. If there is insufficient sleep, an individual can experience a whole host of symptoms, both physical and emotional. Several mechanisms and influences have been revealed as contributing to the sleep-wake cycle, which can become impaired in the presence of physical or psychological conditions. Through treating the primary, secondary, and tertiary causes that may be present can improve the chances that an individual will once again obtain homeostasis in his or her sleep-wake circadian cycle.

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