Chapter 4 Consciousness

FROM THE INTERNET: Sleep learning is a way to harness the power of your subconscious while
you sleep, enabling you to learn foreign languages, pass exams, undertake professional studies
and implement self-growth by using techniques based on research conducted all over the world
with great success. The makers of subliminal tapes assert that their tapes contain embedded
information that is too faint or fleeting to reach conscious awareness

In order for a patient to maintain consciousness, two important neurological components must
function perfectly. The first is the cerebral cortex and the other is, the reticular activating
system (RAS), a more primitive structure in the brainstem that is needed for arousal
and sleep-wake cycles. The brainstem is the lower extension of the brain where it connects to
the spinal cord. The brain stem contains the medulla oblongata, midbrain, and pons.

Sarah Burke died at the age of 29 after tearing the artery that supplies blood to the brainstem
during a training run in the superpipe. As the result of a fall after completing a jump, she suffered
a ruptured vertebral artery, one of the four major arteries supplying blood to the brain
causing what's called a massive intercranial hemorrhage. The artery that ruptured is one of
the most critical blood vessels in the body, feeding oxygen-rich blood to the brain
stem. It's the brain stem, located at the bottom of the brain and tucked inside the back
of the skull that controls breathing and heart function. This caused her to go into cardiac
arrest. Emergency personnel responded and CPR was administered on the scene during which
time she remained without a pulse or spontaneous breathing. Burke was rushed to hospital, where
she was put on life support and therapeutic hypothermia was initiated to protect her brain. On Jan.
11, she had surgery to repair the torn artery, and had been in a medically induced coma until she
died a few days later.

Many characteristics of what we call consciousness are also gradually lost by people suffering
from Alzheimers disease. They become detached from everything going on around them and are
no longer even sure of their own identity. And there is something even more disturbing about
seeing someone in a coma after a traumatic brain injury, because there is a body, obviously alive,
yet displaying no signs of consciousness.

Locked-in syndrome is a condition in which a patient is aware and awake but cannot move or
communicate verbally due to complete paralysis of nearly all voluntary muscles in the body
except for the eyes. Patients who have locked-in syndrome are conscious and aware with no loss
of cognitive function. Those with locked-in syndrome may be able to communicate with others
through coded messages by blinking or moving their eyes, which are often not affected by the
paralysis. The symptoms are similar to those of sleep paralysis.

Caused by damage to specific portions of the lower brain and

brainstem with no damage to the upper brain (Brain injury, disease,
other causes). It is extremely rare for any significant motor function
to return...90% of those with this condition die. In persistent
vegetative state damage is to upper portion of brain not lower.

Parisian journalist Jean-Dominique Bauby suffered a stroke in December 1995, and, when he
awoke 20 days later, he found that his body was almost completely paralyzed: he could control
only his left eyelid. By blinking this eye, he slowly dictated one alphabetic character at a time and,
in so doing, was able over a great deal of time to write his memoir. Three days after it was
published in March 1997, Bauby died of pneumonia.

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Consciousness is defined as our awareness at any given timeour thoughts, feelings, sensations,
and perceptions of the external environment. But this awareness can also vary in degree or focus.
Consciousness is not an all or nothing process; we drift in and out of consciousness rapidly as
the degree of focus we place on one event or thought comes and goes as quickly as we shift our
attention to other issues. Clearly, there are times during which we place all our attention on a
specific issue. This is what happens when we are fully absorbed and our thoughts are fixed on the
details of what we are concentrating on, whether it is our studies or a basketball game on TV.
Other forms of attention are less effortful; for example, when we are daydreaming. And, of course,
attention is even less effortful when we sleep.
CIRCADIAN RHYTHMS: OUR HOUR HIGHS AND LOWS

Body temperature and the brain's sleep-wake cycle are closely

linked. People sleep best when body temperature is lowest...Most
alert when body temperature is at its daily high. To fall asleep we
must cool off. That's why hot summer nights can cause a restless
sleep.
As we wake up and become more and more alert, both blood pressure and body temperature
increase. From sunset onwards our bodies are designed to wind down and our bodies will increase
the production of growth and repair hormones. This is a very important phase especially for those
that have been doing any kind of physical exercise throughout the day. The physical repair cycle
is from about 10-2am. Your muscles need this time to get the best results for repair and growth.
So if you are someone that goes to bed at 12 then you will only get 2 hours of physical repair.
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The suprachiasmatic nucleus responds to the amount of light,

particularly sunlight reaching the eye and then transferred via the
optic nerve. The SCN then signals pineal gland to release
JET LAG: WHERE AM I AND WHAT TIME IS IT?
Suppose you fly from Toronto to Paris, and the plane lands at midnight Toronto time, about the
time you usually go to sleep. When it is midnight in Toronto, it is 6:00 a.m. in Paris, almost time to
get up. Everything in Paris, including the clocks and the sun, tells you it is early morning, but you
still feel as though it is midnight. You are experiencing jet lag. Exposure to bright sunlight during
the early morning and avoidance of bright lights during the evening (along with melatonin
supplements) may be an effective strategy to restore regular circadian rhythms.

SHIFT WORK: WORKING DAY AND NIGHT

Shift workers are more likely to cut back on sleep, to spend less time with their spouse, and to
worry about not spending enough time with family, compared with regular day workers. Other
studies indicate that shift workers average two to four hours less sleep per night than non-shift
workers of the same age and also report more gastrointestinal and cardiovascular problems, use
more prescription drugs, have more emotional exhaustion and mood problems, and have higher
divorce rates than non-shift workers.
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What about performance on the job? Alertness and performance deteriorate if people work during
subjective night, when their biological clock is telling them to go to sleep. During subjective night,
energy and efficiency reach their lowest
point, reaction time is slowest, productivity is diminished and, in the long run, job stress increases.
Aside from the psychological and performance-related effects of shift work, much recent research
has shown that shift work significantly increases the risk of physical injury. Many air, rail, marine,
and highway accidents have occurred when the shift workers in charge suffered sleep loss and
fatigue because of the disruption of their circadian rhythms. University of British Columbia
psychologist Stanley Coren has demonstrated that even the one-hour sleep loss we experience
when we put our clocks forward in the spring for daylight saving time is associated with a
significant increase in traffic accidents and deaths.
SLEEP: THAT MYSTERIOUS ONE THIRD OF OUR LIVES
Over a lifetime, a person spends about 25 years sleeping. For decades, sleep researchers argued
about the function of sleep. Some believed sleep simply served a restorative function; others
argued that sleep evolved to keep animals out of harms way. But neither of these theories alone
accounts for many of the research findings about sleep.

Many people with the total blindness have sleeping problems

because their retinas are unable to detect light. These people have
a kind of permanent jet lag and insomnia.
Seasonal affective disorder...Short days of mid-winder can disrupt
circadian rhythms...seasonal form of depression. Bright light
therapy (equal to 8 fluorescent bulbs)... in front of the box with eyes
open but not staring at the light soure for 30-60 minutes. Produces
melatonin suppression.
British Ministry of Defence researchers have been able to reset soldiers' body clocks so they can
go without sleep for up to 36 hrs. Tiny optical fibres embedded in special spectacles project a ring
of bright white light (with a spectrum identical to a sunrise) around the edge of soldiers' retinas,
fooling them into thinking they have just woken up. The system was first used on US pilots during
the bombing of Kosovo.
The brain does not shut down during sleep. We are not totally unresponsive while asleepa
mother may ignore an airplane flying overhead but awake a slightest cry from her infant. In one
experiment people learned to avoid an electric shock by touching a switch each time a tone
sounded. Eventually they could do it without waking (like turning off an alarm clock without
waking). But dont expect to learn math, a foreign language, or other complex skills while asleep.

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NREM AND REM SLEEP: WATCHING THE EYES
In the 1950s, several universities set up sleep laboratories where peoples brainwaves, eye
movements, chin-muscle tension, heart rate, and respiration rate were monitored through a night
of sleep. From the data they gathered, researchers discovered that there are two major categories
of sleep: NREM (non-rapid eye movement) sleep and REM (rapid eye movement) sleep.
NREM sleepthere is no rapid eye movement. It is often called quiet sleep because heart rate and
respiration are slow and regular, there is little body movement, and blood pressure and brain
activity are at their lowest points of the 24-hour period. There are four stages of NREM sleep, with
Stage 1 being the lightest sleep and Stage 4 being the deepest. We pass gradually rather than
abruptly from one stage to the next. Each stage can be identified by its brainwave pattern.
Most of us envision sleep as a time of deep relaxation and calm. But REM sleep, sometimes called
active sleep, is anything but calm, and it constitutes 20 to 25 percent of a normal nights sleep in
adults. During the REM state, there is intense brain activity, and our body reacts as if to a
daytime emergency. Epinephrine (adrenalin) shoots into the system, blood pressure rises, heart
rate and respiration become faster and irregular, and temperature increases.
In contrast to this storm of internal activity, there is an external calm during REM sleep.

REM atonia...the large muscles of the body-arms, legs, trunk-become

paralyzed---the motor paralysis of REM sleep protect
Process of waking up might seem quite simple but actually a complex process involving many
physiological changesone is reversal of paralysis. Sometimes paralysis doesnt wear off fast
enough as we wake upremain paralyzed though conscious. Episode is often terminated by a
sound or a touch on the body. Victim in this state feels awake, but he cannot move or speak may
hear footsteps, see a ghost-like creature, feeling choked or suffocatedcause people anxiety and
terror, but there is no physical harm.
And if you awaken during REM sleep, you may not go back into this kind of sleep for at least 30
minutes. If you observe a sleeper during the REM state, you can see the eyes darting around
under the eyelids. Eugene Azerinsky discovered these bursts of rapid eye movement in 1952. Five
years later, William Dement and Nathaniel Kleitman made the connection between rapid eye
movement and dreaming. It is during REM periods that most of our vivid dreams occur. When
awakened from REM sleep, 80 percent of people report dreaming.

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SLEEP CYCLES: THE NIGHTLY PATTERN OF SLEEP
The brain generates tiny electrical signals that can be amplified and recorded using an
electroencephalograph (EEG). Sleep follows a fairly predictable pattern each night. We sleep in
cycles. The first sleep cycle begins with a few minutes in Stage 1 sleep, sometimes called light
sleep. Stage 1 is actually a transition stage between waking and sleeping. Then sleepers descend
into Stage 2 sleep, in which they are somewhat more deeply asleep and harder to awaken. About
50 percent of the total nights sleep is spent in Stage 2 sleep. Next, sleepers enter Stage 3 sleep,
the beginning of slow-wave sleep (or deep sleep). As sleep gradually becomes deeper, brain
activity slows and more delta waves (slow waves) appear in the EEG. When there are more than
50 percent delta waves on the EEG, people are said to be in Stage 4 sleep, the deepest sleep,
when people are hardest to awaken.

When you are awake and alert pattern of small, fast waves (alpha and beta). Deepest
level of normal sleep brain waves are almost pure delta...large and slow. Brainwaves
during REM sleep is similar to that of the subject when awake.
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After about 40 minutes in Stage 4 sleep, brain activity increases and the delta waves begin to
disappear from the
EEG. Sleepers make an ascent back through Stage 3 and Stage 2 sleep, then enter the first REM
period of the night, which lasts 10 or 15 minutes. At the end of this REM period, the first sleep
cycle is complete, and the second sleep cycle begins.
After the first two sleep cycles of about 90 minutes each, the sleep pattern changes and sleepers
usually get no more Stage 4 sleep. From this point on, during each 90-minute sleep cycle, people
alternate mainly between Stage 2 and REM sleep for the remainder of the night. With each sleep
cycle, the REM periods (the dreaming times) get progressively longer. By the end of the night,
REM periods may be 30 to 40 minutes long. In a night, most people sleep about five sleep cycles
(7.5 to 8 hours) and get about 1.5 hours of slow-wave sleep and 1.5 hours of REM sleep.
Several REM cycles per nightwhile we are asleep, our brains are on a bit of a "roller-coaster"
through different stages of sleep.
However, a period of at least 30 minutes of nonREM sleep between periods of REM sleep still seems to
be necessary even toward the end of the night. Over
the night as a whole, REM sleep accounts for about 20
25% of our sleep time.

to

Most people dream four or five times a night but not all
people remember their dreams. Dreams usually spaced about 90 minutes
apart. First
dream lasts only 10 minutes. Last dream averages 30 minutes and may last as long as 50.
INDIVIDUAL DIFFERENCES IN SLEEP PATTERNS: HOW WE DIFFER
There are great individual variations in sleep patterns. The major factor contributing to these
variations is agethe older we get, the less we sleep. As people age, they usually experience a
decrease in quality and quantity of sleep. Older people have more difficulty falling asleep, and
they typically have lighter sleep and more and longer awakenings than younger people. They
spend more time awake in bed but less time asleep, averaging about 6.5 hours of sleep. Their
percentage of REM sleep, however, stays about the same.
Larks and Owls: Early to Rise and Late to Bed
Some people awaken early every morning and leap out of bed with enthusiasm, eager to start the
day. Others fumble for the alarm clock and push in the snooze button to get a few more precious
minutes of sleep. Sleep researchers have names for these two typeslarks and owlsand there is
a physical explanation for the differences in how they feel. About 25 percent of people are larks
people whose body temperature rises rapidly after they awaken and stays high until about
7:30 p.m. Larks turn in early and have the fewest sleep problems. Then there are the 25 percent
who are owls and the 50 percent who are somewhere in between. The body temperature of an owl
rises gradually throughout the day, peaking in the afternoon and not dropping until later in the
evening. It is not surprising that larks have more difficulty than owls in adapting to night shifts.
REM SLEEP: A PART OF SLEEP THAT WE SHOULD NOT DO WITHOUT Sleep Deprivation: How Does It

Affect Us?
What is the longest you have ever stayed awakeone day, two days, three days, or four days?
According to the Guinness Book of World Records, Californian Robert McDonald stayed awake 453
hours and 40 minutes (almost 19 days) in a 1986 rocking-chair marathon. Unlike McDonald, most
of us have missed no more than a few consecutive nights of sleep, perhaps while studying for final
exams. If you have ever missed two or three nights of sleep, you may remember having
experienced difficulty concentrating, lapses in attention, and general irritability.
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Most people who try to stay awake for long periods of time will have microsleeps, two- to threesecond lapses from wakefulness into sleep. You may have experienced a microsleep if you have
ever caught yourself nodding off for a few seconds in class or on a long automobile trip.
The Function of REM Sleep: Necessary, but Why?
The fact that newborns have such a high percentage of REM sleep has led to the conclusion that
REM sleep is necessary for maturation of the brain in infants. Recent research has shown that REM
sleep aids in information processing, helping people sift through daily experiences in order to
organize and store in memory information that is relevant to them.
Have you ever pulled an all nighter to study for a final exam?

DREAMING: MYSTERIOUS MENTAL ACTIVITY WHILE WE SLEEP

Whether or not you remember them when you wake up, all of us have dreams during a regular
nights sleep. Not surprisingly, people have always been fascinated by dreams. The vivid dreams
we remember and talk about are REM dreamsthe type that occur almost continuously during
each REM period. But people also have NREM dreams, which occur during NREM sleep. REM
dreams have a story-like or surreal quality and are more visual, vivid, emotional,
and likely to include aggressive behavior. Have you ever heard that an entire dream takes place in
an instant? Do you find that hard to believe? In fact, it is not true. Sleep researchers have
discovered that it takes about as long to dream a dream as it would to experience the same thing
in real life.
Very few dreams are memorable enough to be retained very longroughly 10 minutesand what
tends to stand out are those parts that are bizarre or emotional. Sleep researchers have learned
that sleepers have the best recall of a dream
if they are awakened during the dream; the more time that passes after the dream ends, the
poorer the recall

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Some people are troubled by unpleasant recurring dreams. The two most common themes involve
falling or being chased, threatened, or attacked. School related dreams common among young
peoplestudying or failing an exam. Is there anything that can be done to prevent frightening
recurring dreams? Some people have been taught to deliberately control dream content in order
to stop unwanted, recurrent dreams. Some researchers argue that dreaming while exerting control
over ones dreams, called lucid dreams, is a learnable skill that can be perfected with regular
practice. Research suggests that individuals who are good at controlling their thoughts when
awake are also successful at lucid dreaming.

Researchers found that vivid, bizarre and emotionally intense dreams (the dreams that people
usually remember) are linked to parts of the amygdala and hippocampus. While the amygdala
plays a primary role in the processing and memory of emotional reactions.

Interpreting Dreams: Are There Hidden Meanings in Our Dreams?

Sigmund Freud believed that dreams function to satisfy unconscious sexual and aggressive
wishes. Because such wishes are unacceptable to the dreamer, they have to be disguised and
therefore appear in dreams in symbolic form. Freud asserted that objects like sticks, umbrellas,
tree trunks, and guns symbolize the male sex organ; objects like chests, cupboards, and boxes
represent the female sex organ. Freud differentiated between the manifest content of the dream
the dream as recalled by the dreamerand the underlying meaning of the dream, called the
latent content, which he considered more significant. In recent years there has been a major shift
away from the Freudian interpretation of dreams. The greater focus now is on the manifest
contentthe actual dream itselfrather than on the search for symbols that can be decoded to
reveal some inner conflict.
Hobson and McCarley (1977) advanced the activation-synthesis hypothesis of dreaming. This
hypothesis suggests that dreams are simply the brains attempt to make sense of the random
firing of brain cells during REM sleep. However, contemporary research on dreams now contradicts
the view that the content of dreams emerges from random signals. Brain-imaging studies suggest
that several brain structures such as the hippocampus and the amygdala play important roles in
dream activity.
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VARIATIONS IN SLEEP
When it comes to sleep, the expression one size fits all does not apply. Although adults average
about 7.5 hours of sleep daily, with an extra hour on weekends, this is too much for some people
and too little for others. Short sleepers are the 20 percent who require fewer than six hours; long
sleepers are the 10 percent who require more than nine. There seems to be a limit below which
most of us cannot go. In one study, not a single participant could get by with less than 4.5 hours
of sleep. It seems that 6.5 hours is the minimum for most people.
PARASOMNIAS: UNUSUAL BEHAVIOURSDURING SLEEP
Sleepwalking and sleep terrors are two parasomnias that occur during Stage 4 sleep and in which
the sleeper does not come to full consciousness. Typically, there is no memory of the episode the
following day. Most cases begin in childhood and are attributed primarily to a delayed
development of the nervous system. The disturbances are usually outgrown by adolescence, and
treatment is generally not advised.
Sleepwalkers have their eyes open with a blank stare, and rather than walking normally, they
shuffle about. Their coordination is poor, and if they talk, their speech is usually unintelligible. If an
EEG recording were made during a sleepwalking episode, it would show a combination of delta
waves, indicating deep sleep, and alpha and beta waves, signalling the waking state.
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Sleepwalkers are awake enough to carry out activities that do not require their full attention, but

asleep enough not to remember having done so the following day. Sleepwalkers may get up and
roam through the house or simply stand for a short time and then go back to bed. Occasionally
they get dressed, eat a snack, or go to the bathroom. The most important concern in sleepwalking
is safety. Because of their reduced alertness and coordination, sleepwalkers are at risk of hurting
themselves. They have been known to walk out of windows, accidentally run into objects, or fall
down.
SLEEP TERRORS: SCREAMS IN THE NIGHT
Sleep terrors usually begin with a piercing scream. The sleeper springs up in a state of panic
eyes open, perspiring, breathing rapidly, with the heart pounding at two to four times the normal
rate. Episodes usually last from five to
15 minutes, and then the person falls back to sleep.
If awakened, however, they may recall a single frightening image. Up to 5 percent of children have
sleep terrors, but only about 1 percent of adults experience them. Parents should not be unduly
alarmed by sleep terrors in young children, but episodes that continue through adolescence into
adulthood are more serious. Sleep terrors in adults often indicate extreme anxiety or other
psychological problems.
Nightmares: The Worst of Dreams
How do nightmares differ from sleep terrors?
The most common themes are being chased, threatened, or attacked. Nightmares can be a
reaction to traumatic life experiences.
Sleeptalking (Somniloquy): Might We Reveal Secrets?
Do you sometimes talk in your sleep? Are you afraid that you might confess to something
embarrassing, or reveal some deep, dark secret? Relax. Sleeptalkers rarely reply to questions, and
they usually mumble words or phrases that make no sense to the listener. Sleeptalking can occur
during any sleep stage and is more frequent in children than in adults. There is no evidence at all
that sleeptalking is related to a physical or psychological disturbancenot even to a guilty
conscience.
MAJOR SLEEP DISORDERS
Some sleep disorders can be so debilitating that they affect a persons entire life. These disorders
are narcolepsy, sleep apnea, and insomnia.
Narcolepsy is an incurable sleep disorder characterized by excessive daytime sleepiness and
uncontrollable attacks of REM sleep, usually lasting 10 to 20 minutes. People with narcolepsy are
often unfairly stigmatized as lazy, depressed, and uninterested in their work. Anything that causes
an ordinary person to be tired can trigger a sleep attack in a narcoleptica heavy meal,
sunbathing at the beach, or a college lecture.

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Narcolepsy is a physiological disorder caused by an abnormality in the part of the brain that
regulates sleep, and it appears to have a strong genetic component.
Sleep apnea consists of periods during sleep when breathing stops and the individual must

awaken briefly to breathe.

Recent research suggests that 3.4 percent of Canadian adultsmostly obese menhave been
professionally diagnosed with sleep apnea, while an additional 23.4 percent are at high risk for
this sleep disorder. The major symptoms of sleep apnea are excessive daytime sleepiness and
extremely loud snoring (as loud as a jackhammer), often accompanied by snorts, gasps, and
choking noises. In very severe cases, apnea may last throughout the night, with as many as 800
partial awakenings to gasp for air. Alcohol and sedative drugs aggravate the condition. Severe
sleep apnea can lead to chronic high blood pressure, heart problems, and even death. Physicians
sometimes treat sleep apnea by surgically modifying the upper airway. When this surgery is
effective, patients not only sleep better, but also exhibit higher levels of performance on tests of
verbal learning and memory.
Insomnia: When You Cant Fall Asleep What is insomnia?
People with insomnia suffer distress and impairment in daytime functioning owing to difficulty
falling or staying asleep or to experiencing sleep that is light, restless, or of poor quality. The rates
of insomnia in Canada are quite alarming, with more than 3.3 million Canadians (13.4 percent of
the population aged 15 or older) dealing with the disorder. Temporary insomnia, lasting three
weeks or less, can result from jet lag, emotional highs or lows, or a brief illness or injury that
interferes with sleep. Much more serious is chronic insomnia, which lasts for months or even
years. Chronic insomnia may begin as a reaction to a psychological or medical problem but persist
long after the problem has been resolved.
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HYPNOSIS: LOOK INTO MY EYES
Have you ever been hypnotized? Many people are fascinated by this unusual, somewhat
mysterious phenomenon. Other people doubt that it even exists.
Hypnosis is a trancelike state of concentrated and focused attention, heightened suggestibility,
and diminished response to external stimuli. In the hypnotic state, people suspend their usual
rational and logical ways of thinking and perceiving and allow themselves to experience
distortions in perceptions, memories, and thinking. About 80 to 95 percent of people are
hypnotizable to some degree, but only 5 percent can reach the deepest levels of trance. The
ability to become completely absorbed in imaginative activities is characteristic of highly
hypnotizable people. There are many misconceptions about hypnosis.
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Hypnosis has come a long way from the days when it was used mainly by entertainers. It is now
recognized as a viable technique to be used in medicine, dentistry, and psychotherapy and has
been particularly helpful in the management of pain and other side effects associated with cancer
care. However, hypnosis has been less effective in weight control and virtually useless in
overcoming drug and alcohol abuse or nicotine addiction.
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A psychoactive drug is any substance that alters mood, perception, or thought. Some of these
drugs are legal, but most are not. When these drugs are approved for medical use only, they are
called controlled substances. In Canada, there is considerable concern about the sale and use of
illicit drugs. But in terms of damage to users, harm to society, and numbers of addicts, alcohol and
tobacco are the most serious problem drugs by far. According to a report from the Canadian

Centre on Substance Abuse, tobacco and alcohol combined account for 79.3 percent of the $39.8
billion lost annually to the Canadian economy as a result of substance abuse. Why do so many
Canadians use psychoactive drugs?
There are many reasons for taking drugs, and users often do not recognize their real motives.
Some people take drugs to cope with or relieve anxiety, depression, or boredom.
Peer influence is the factor most highly correlated with adolescents use of illicit drugs, cigarettes,
and alcohol. The earlier that adolescents start using drugs, the more likely they are to progress to
more serious drug addictions. Moreover, adolescents who use drugs seek out peers who also use
and, in turn, are influenced by those peers. Research also suggests that parental drug attitudes
and sibling drug use also have a significant impact on the likelihood of illicit drug use as well as on
use of cigarettes and alcohol.
DRUG DEPENDENCE: SLAVE TO A SUBSTANCE
What is the difference between physical and psychological drug dependence?
The effects of drugs are not always predictable. Some drugs create a physical or chemical
dependence; others create a psychological dependence. Physical drug dependence comes about
as a result of the bodys natural ability to protect itself against harmful substances by developing
a drug tolerance. This means that the user becomes progressively less affected by the drug and
must take larger doses to get the same effect or same high. Tolerance grows because the brain
adapts to the presence of the drug by responding less intensely to it. The various bodily processes
adjust in order to continue to function with the drug in the system. Once drug tolerance is
established, a person cannot function normally without the drug. If the drug is taken away, the
user begins to suffer withdrawal symptoms. The withdrawal symptoms, both physical and
psychological, are usually the exact opposite of the effects produced by the drug. For example,
withdrawal from stimulants leaves a person exhausted and depressed; withdrawal from
tranquilizers leaves a person nervous and agitated.
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If physical dependence alone explained drug addiction, there would be no problem with drugs long
thought to be physically non-addictive. Once the period of physical withdrawal was over, the
desire for the drug would end along with the withdrawal symptoms. But this is not the casethere
is more to drug addiction than physical dependence.
Psychological drug dependence is a craving or irresistible urge for the drugs pleasurable effects,
and it is more difficult to combat than physical dependence. With the most addictive drugs, the
pleasurable effects are felt almost immediately but are short-lived. For example, the intensely
pleasurable effects of crack cocaine are felt in seven seconds but last only about five minutes.
Because the discomfort is intense after the pleasurable effects wear off, the user is highly
motivated to continue taking the drug. With any drug, the abuse potential is higher if the drug is
injected rather than taken orally, and higher still if it is smoked rather than injected.
STIMULANTS: SPEEDING UP THE NERVOUS SYSTEM
Stimulants, often called uppers, speed up the central nervous system, suppress appetite, and can
make a person feel more awake, alert, and energetic. Stimulants increase pulse, blood pressure,
and respiration rate; they also reduce cerebral blood flow. In higher doses, they make people feel
nervous, jittery, and restless, and they can cause shaking or trembling and can interfere with
sleep. No stimulant actually delivers energy to the body. Instead, a stimulant forces the body to
use some of its stored-up energy sooner and in greater amounts than it would naturally. When the
stimulants effect wears off, the bodys natural energy is depleted. This leaves the person feeling

exhausted and depressed.

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Caffeine: The Most Widely Used Drug
Caffeine is the worlds most widely used drug. If you cannot start your day without a cup of coffee
(or two, or more), you may be addicted to it. Coffee, tea, cola drinks, chocolate, and more than
100 prescription and over-the-counter drugs contain caffeine. They provide a mild jolt to the
nervous system, at least temporarily. Caffeine makes us more mentally alert and can help us stay
awake. Many people use caffeine to lift mood, but studies reveal that one hour after consuming
medium or high doses of caffeine, subjects show higher levels of anxiety, depression, and hostility.
Nicotine: A Deadly Poison
Nicotine is a poison so strong that the body must develop a tolerance for it almost immediately
in only hours, in contrast to days or weeks for heroin and usually months for alcohol. It is
estimated that 16.7 percent of Canadians smoke and that nearly half of them have tried to quit in
the past year. Despite the fact that the number of Canadian smokers has decreased steadily in the
past 40 years and is at an all-time low, 37 000 Canadians die each year from cigarette smoking
roughly five times the number of deaths caused by car accidents, suicides, drug abuse, murder,
and AIDS combined. The many health problems associated with smoking are discussed in Chapter
12.
Amphetamines: Energy to Burnat a Price
Amphetamines form a class of stimulants that increase arousal, relieve fatigue, suppress the
appetite, and give a rush of energy. In low to moderate doses, these stimulants may temporarily
improve athletic and intellectual performance.
A person who takes amphetamines becomes more alert and energetic, experiences mild euphoria,
and usually becomes more talkative, animated, and restless. In high doses100 milligrams or
moreamphetamines can cause confused and disorganized behaviour, extreme fear and
suspiciousness, delusions and hallucinations, aggressiveness and antisocial behaviour, and even
manic behaviour and paranoia. One powerful amphetamine, known as methamphetamine
(crank or speed), now comes in a smokable form, ice, which is highly addictive and can be
fatal. Withdrawal from amphetamines leaves a person physically exhausted, sleeping for 10 to 15
hours or more. The user awakens in a stupor, extremely depressed and intensely hungry. Victims
of fatal overdoses of stimulants usually have multiple hemorrhages in the brain
Cocaine: Snorting White Powder, Smoking Crack
Cocaine, a stimulant derived from coca leaves, can be sniffed (snorted) as a white powder,
injected intravenously, or smoked in the form of crack. The rush of well-being is dramatically
intense and powerful, but it is just as dramatically short-lived. In the case of cocaine, the euphoria
lasts no more than 30 to 45 minutes; with crack, the effect lasts no more than five to 10 minutes.
In both cases, the euphoria is followed by an equally intense crash that is marked by depression,
anxiety, agitation, and a powerful craving for more of the drug. Chronic cocaine use can also
result in holes in the nasal septum (the ridge of cartilage running down the middle of the nose)
and in the palate (the roof of the mouth).

Animal researchers have shown that animals addicted to multiple substances prefer cocaine when
offered a choice of drugs and will lose interest in everything elsefood, water, sexin order to
continually self-administer cocaine. The main withdrawal symptoms are psychologicalthe
inability to feel pleasure and the craving for more cocaine. Cocaine constricts the blood vessels,

raises blood pressure, speeds up the heart, quickens respiration, and can even cause epileptic
seizures in people who have no history of epilepsy. Over time, or even quickly in high doses,
cocaine can cause heart palpitations, an irregular heartbeat, and heart attacks. The cheapest and
perhaps the most dangerous form of cocaine, crack, can produce a powerful dependency in
several weeks.
HALLUCINOGENS: SEEING, HEARING, AND FEELING WHAT IS NOT THERE
The hallucinogens, or psychedelics, are drugs that can alter and distort perceptions of time and
space, alter mood, and produce feelings of unreality. Hallucinogens have been used for recreation
and in religious rituals and ceremonies in diverse cultures since ancient times. As the name
implies, hallucinogens also cause hallucinations, sensations that have no basis in external reality.
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Rather than producing a relatively predictable effect like most other drugs, hallucinogens usually
magnify the mood or the frame of mind of the user at the time the drug is taken. And contrary to
the belief of some, hallucinogens may actually reduce rather than enhance creative thinking. The
hallucinogens we will discuss are LSD, ecstasy, and marijuana.
LSD: Mind Altering, Not Mind Expanding
LSD, sometimes referred to simply as acid, is the acronym for lysergic acid diethylamide. The
average LSD trip lasts 10 to 12 hours and usually produces extreme perceptual changesvisual
hallucinations and distortions. Emotions can become very intense and unstable, ranging from
euphoria to anxiety, panic, and depression. LSD sometimes causes bad trips, which can leave
the user in a state of terror. Some bad LSD trips have ended in accidents, death, or suicide.
Sometimes a person who has taken LSD in the past experiences a flashbacka brief, sudden
recurrence of a trip. Flashbacks can occur as many as five years after LSD use.
Ecstasy: The Newest in Designer Drugs
Ecstasy (MDMA) is a designer druga laboratory creationthat is a cross between a hallucinogen
and an amphetamine. The drugs main appeal is its psychological effectusers of MDMA describe
a wonderfully pleasant state of consciousness, in which even the most backward, bashful, selfconscious people shed their inhibitions. However, research suggests that there is a price to be
paid for entering this joyous state. MDMA is known to impair a variety of cognitive functions,
including memory, sustained attention, analytical thinking, and self-control. Animal experiments
with MDMA have revealed some disturbing findingsirreversible destruction of serotonin-releasing
neurons. Ecstasy can also impair cognitive functions such as attention, analytical thinking, and
self-control.
Marijuana: More Harmful Than We Once Believed
In Canada, marijuana is probably the most widely used illicit drug. Statistics Canada (2004)
reported that 10 million
Canadians have used marijuana at least once in their lifetime, which represents just over 41
percent of the population aged 15 or older. Marijuana tends to produce a feeling of well-being,
promote relaxation, and lower inhibitions and anxiety. The user may experience giddiness; an
increased sensitivity to sights, sounds, and touch; and perceptual distortions and hallucinations
such as a slowing of time. THC (tetrahydrocannabinol), the ingredient in marijuana (and in
hashish) that produces the high, remains in the body for days or even weeks. Marijuana impairs
attention and coordination and slows reaction time; these effects make operating complex
machinery such as an automobile dangerous, even after the feeling of intoxication has passed.

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Marijuana can interfere with concentration, logical thinking, and the ability to form new memories.
It can produce fragmentation in thought as well as confusion in remembering recent occurrences.
Many of the receptor sites for marijuana are in the hippocampus, which explains why memory is
affected. Chronic use of marijuana has been associated with loss of motivation, general apathy,
and decline in school performancereferred to as amotivational syndrome.
Surprisingly, recent studies have shown that marijuana does not increase rates of lung cancer.
However, marijuana abuse may affect the reproductive system (impotence & reduced sperm
count).
Marijuana shows some promise as a treatment for certain medical conditions. For instance,
marijuana is being prescribed
by doctors to treat the eye disease glaucoma and to control nausea and stimulate appetite in
patients receiving chemotherapy for cancer or AIDS. But there is a continuing controversy over
whether marijuana should be legalized, either for medical purposes or for recreational
consumption.
DEPRESSANTS: SLOWING DOWN THE NERVOUS SYSTEM
Depressants (sometimes called downers) decrease activity in the central nervous system, slow
down bodily functions, and reduce sensitivity to outside stimulation. Within this category of drugs
are the sedativehypnotics (alcohol, barbiturates, and minor tranquilizers) and the narcotics, or
opiates.
Alcohol: The Nations Number-One Drug Problem
Even though alcohol is a depressant, the first few drinks seem to relax and enliven at the same
time. But the more alcohol a person consumes, the more the central nervous system is depressed.
As drinking increases, the symptoms of drunkenness mountslurred speech, poor coordination,
staggering. Men tend to become more aggressive and more sexually aroused but less able to
perform sexually. Alcohol also decreases the ability to form new memories. Too much alcohol can
cause a person to lose consciousness, and extremely large amounts can kill. Deaths due to
extreme consumption of alcohol, usually over a short period of time, are quite common both in
Canada and the United States
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Barbiturates: Sedatives That Can Kill in Overdose
Barbiturates (sometimes called downers) depress the central nervous system and, depending on
the dose, can act as a sedative or a sleeping pill. Phenobarbital is an example. People who abuse
barbiturates become drowsy and confused. Their thinking and judgment suffer, and their
coordination and reflexes are affected. Barbiturates can kill if taken in overdose, and a lethal dose
can be as little as only three times the prescribed dose. The popular minor tranquilizers, the
benzodiazepines, came on the scene in the early 1960s and are sold under the brand names
Valium, Librium, Dalmane, and, more recently, Xanax (also used as an antidepressant).
Excessive use of tranquilizers is associated with both temporary and permanent impairment of
memory. Alcohol and benzodiazepines, when taken together, are a potentially fatal combination.
Narcotics: Drugs from the Opium Poppy
The word narcotic comes from a Greek word meaning stupor. Narcotics produce both a painrelieving and a calming effect. All narcotics originate from opium, a dark, gummy substance
derived from the opium poppy. Opium affects mainly the brain and the bowel. It paralyzes the
intestinal muscles, which is why it is used medically to treat diarrhea. Because opium suppresses

the cough centre, it is used in some cough medicines. Both morphine and codeine, two drugs
prescribed for pain, are natural constituents of opium. OxyContin and Vicodin are two highly
prescribed forms of these drugs that are also highly addictive. Due to its highly addictive
potential, the Canadian manufacturers of OxyContin pulled it off the market in February 2012
and replaced it with a less addictive version of the drug called OxyNEO.
Perhaps the most highly addictive narcotic derived from morphine is heroin. Heroin addicts
describe a sudden
rush, or euphoria, followed by drowsiness, inactivity, and impaired concentration. Withdrawal
symptoms begin about 6
to 24 hours after use, and the addict becomes physically sick. Nausea, diarrhea, depression,
stomach cramps, insomnia, and pain grow worse and worse until they become intolerableunless
the person gets another fix. Heroin use has doubled since the mid-1980s.
Unfortunately, most addicts experience a virtually irresistible compulsion to use drugs and are
apparently unable to consider the likely consequences of their actsthe loss of the love and
respect of family and friends, of money, of jobs, of health, and even of their lives.

Coma
The patient in a coma cannot be aroused and has no awareness of self or his surroundings.
Coma may be the result of a wide variety of conditions (strokes, head trauma, accidents, drug
abuse or overdose, neurologic disease, etc). It may also be deliberately induced for medical
reasonsin order to preserve higher brain functions following brain injury (e.g. Sarah Burke,
Gabby Giffords), or to save the patient from extreme pain during healing of injuries or diseases.
Coma may have developed in humans as a response to injury to allow the body to pause bodily
actions and heal the most immediate injuries.

A coma is a state of unconsciousness, lasting more than 6 hours in which a person cannot be
awakened, fails to respond normally to painful stimuli, light or sound, lacks a normal sleep-wake
cycle and does not initiate voluntary actions. Coma outcomes range from recovery to death.
Comas can last from several days to several weeks. In more severe cases a coma may go beyond
five weeks, while some have lasted as long as several years. After this time, some patients
gradually come out of the coma, some progress to a vegetative state, and others die. Some
patients who have entered a vegetative state go on to regain a degree of awareness. Others
remain in a vegetative state for years or even decades (the longest recorded period being 37
years).
Minimally conscious state = partial consciousness. There is some evidence of environmental and
self-awareness. Behaviours must occur with some consistency and can be distinguished from
reflexes (which are possible without awareness). Is indicated if patient can follow simple
instructions, or can reach for and grasp objects, provide yes/no answers either verbally or through
gesturesthere is purposeful behavior that is reproducible and can be repeated.

Concussions Losing Consciousness

Woodpeckers and bighorn sheep are two kinds of animals that one would think should have a
constant concussion. A woodpeckers impact on a tree is 1000 times gravitational acceleration

and would be assumed to leave the woodpecker dead or unconscious; at least that is what would
occur in humans. A woodpecker is able to peck the tree so vigorously because the woodpeckers
brain is attached so well to the skull. Since it is attached so well to the skull there is little
movement of the brain. There is also less room in a woodpeckers head for the brain to move.
Bighorn sheep slam their horns together during mating season and they do not drop to the
ground. These animals have unique adaptations that allow them to slam their beak against a tree
or bang their horns together and not drop dead.

Traumatic brain injury (TBI) may occur in a motor vehicle accident, a fall or sudden blow or jolt to
the head. The severity can range from mild (a concussion) to severe (coma). No loss of
consciousnessfew seconds or minutes.20 minutes to six hours (moderate)
or coma
state for more than 6 hours (may last weeks, months, or years).
Concussion is the most common type of traumatic brain injury. The
terms
mild brain injury, mild traumatic brain injury (MTBI), mild head
injury
(MHI), minor head trauma, and concussion may be used
interchangeably.

Concussion typically involves temporary impairment of neurological function that heals by itself
within time, and neuroimaging normally shows no gross structural changes to the brain as the
result of the condition (in other words, usually no structural brain damage occurs). The debate
over whether concussion is a functional or structural phenomenon is ongoing.
Concussion may be caused by impact in which the head strikes or is struck by something, or
forces, in which the head moves without being subject to blunt trauma (for example, when the
chest hits something and the head snaps forward, as in a car accident). These forces may cause
linear, rotational, or angular movement of the brain, or a combination of these types of motion.

Included in many events unleashed in the brain by concussion is impaired neurotransmission (plus
many other changes). Excitatory neurotransmitters such as glutamate that serve to stimulate
nerve cells are released in excessive amounts as the result of the injury. The resulting cellular
excitation causes neurons to fire excessively.
Controversy exists about whether the definition of concussion should include only those injuries in
which loss of consciousness occurs. There are literally dozens of systems or methods used to
measure the severity, or grade, of a mild head injury, and there is little agreement among
professionals about which is the best. Several of the systems use loss of consciousness and
amnesia as the primary determinants of the severity of the concussion
Concussions and other brain injuries are fairly common. High-contact sports such as football,
boxing, and hockey pose a higher risk of head injury, even with the use of protective headgear.
Among adults, the most common cause of concussions is from falls or car accidents. Guys are
more likely to get concussions than girls.
How long you remain unconscious sign of the severity of the concussion.
Symptoms of a concussionheadache is the most common"seeing stars or lights " or blurred
vision and feeling dazed, dizzy, or lightheadedmemory loss, such as trouble remembering

things that happened right before and after the injuryconfusion or not thinking straightnausea
or vomitingheadachesblurred visionslurred speech or saying things that don't make sense
difficulty concentrating, thinking, or making decisionsdifficulty with coordination or balance
(such as being unable to catch a ball or other easy tasks. The following are emergency symptoms
of a concussion. Seek immediate medical care in case of unconsciousnessbleeding in the
brainconvulsions or seizuresmuscle weakness on one or both sides, or trouble walking

The second impact syndrome (SIS) is when a person gets a second concussion while still having
symptoms from a first one. This raises the risk for brain swelling, which can be deadly.

Usually concussion symptoms go away without treatment and no specific treatment exists. The
symptoms of most concussions resolve within weeks, but problems may persist. Problems are
seldom permanent, and outcome is usually excellent. In many cases the physical symptoms get
better before the symptoms related to thinking.
Repeated concussions and injuries incurred during the play of contact sports over a long period
can result in CTE (chronic traumatic encephalopathy), a progressive degenerative disease. CTE
has been most commonly found in professional athletes participating football, hockey, wrestling
and other contact sports, who have experienced head trauma, resulting in characteristic
degeneration of brain tissue. Individuals with CTE may show symptoms of dementia such as
memory loss, aggression, confusion and depression which may appear within months of the
trauma or many decades later. Autopsies of eleven professional American football players found
CTE in all cases. Professional wrestler Chris Benoit was discovered to have suffered from CTE
following his 2007 murders and suicide.