Sleep is a naturally recurring state of relatively suspended sensory and motor activity, characterized by total or partial unconsciousness and the inactivity of nearly all voluntary muscles. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and it is more easily reversible than hibernation or coma. It is observed in all mammals, all birds, and many reptiles, amphibians, and fish. In humans, other mammals, and a substantial majority of other animals that have been studied (such as some species of fish, birds, ants, and fruit flies), regular sleep is essential for survival.
The purposes and mechanisms of sleep are only partially clear and are the subject of intense research.
Physiology
Stages of sleep
In mammals and birds, sleep is divided into two broad types: Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM or non-REM) sleep. Each type has a distinct set of associated physiological, neurological, and psychological features. The American Academy of Sleep Medicine (AASM) further divides NREM into three stages: N1, N2, and N3, the last of which is also called delta, or slow-wave, sleep (SWS).
Sleep proceeds in cycles of REM and NREM, the order normally being N1 → N2 → N3 → N2 → REM. There is a greater amount of deep sleep (stage N3) early in the night, while the proportion of REM sleep increases later in the night and just before natural awakening.
The stages of sleep were first described in 1937 by Alfred Lee Loomis and his coworkers, who separated the different EEG features of sleep into five levels (A to E), which represented the spectrum from wakefulness to deep sleep. In 1953, REM sleep was discovered as distinct, and thus William Dement and Nathaniel Kleitman reclassified sleep into four NREM stages and REM. The staging criteria were standardized in 1968 by Allan Rechtschaffen and Anthony Kales in the "R&K sleep scoring manual." In the R&K standard, NREM sleep was divided into four stages, with slow-wave sleep comprising stages 3 and 4. In stage 3, delta waves made up less than 50% of the total wave patterns, while they made up more than 50% in stage 4. Furthermore, REM sleep was sometimes referred to as stage 5.
In 2004, the AASM commissioned the AASM Visual Scoring Task Force to review the R&K scoring system. The review resulted in several changes, the most significant being the combination of stages 3 and 4 into Stage N3. The revised scoring was published in 2007 as The AASM Manual for the Scoring of Sleep and Associated Events . Arousals and respiratory, cardiac, and movement events were also added.
Sleep stages and other characteristics of sleep are commonly assessed by polysomnography in a specialized sleep laboratory. Measurements taken include electroencephalography (EEG) of brain waves, electrooculography (EOG) of eye movements, and electromyography (EMG) of skeletal muscle activity. In humans, each sleep cycle lasts from 90 to 110 minutes on average, and each stage may have a distinct physiological function. Drugs such as sleeping pills and alcoholic beverages can suppress certain stages of sleep, leading to sleep deprivation. This can result in sleep that exhibits loss of consciousness but does not fulfill its physiological functions (i.e., one may still feel tired after apparently sufficient sleep). REM and slow-wave sleep are both homeostatically driven; people and most animals selectively deprived of one of these stages will rebound once uninhibited sleep is allowed. This finding suggests that both of these stages are essential.
NREM sleep
Main article: Non-rapid eye movement sleepAccording to the 2007 AASM standards, NREM consists of three stages. There is relatively little dreaming in NREM.
Stage N1 refers to the transition of the brain from alpha waves having a frequency of 8 to 13 Hz (common in the awake state) to theta waves having a frequency of 4 to 7 Hz. This stage is sometimes referred to as somnolence or drowsy sleep. Sudden twitches and hypnic jerks, also known as positive myoclonus, may be associated with the onset of sleep during N1. Some people may also experience hypnagogic hallucinations during this stage, which can be troublesome to them. During N1, the subject loses some muscle tone and most conscious awareness of the external environment.
Stage N2 is characterized by sleep spindles ranging from 11 to 16 Hz (most commonly 12–14 Hz) and K-complexes. During this stage, muscular activity as measured by EMG decreases, and conscious awareness of the external environment disappears. This stage occupies 45% to 55% of total sleep in adults.
Stage N3 (deep or slow-wave sleep) is characterized by the presence of a minimum of 20% delta waves ranging from 0.5 to 2 Hz and having a peak-to-peak amplitude > 75 μV. (EEG standards define delta waves to be from 0 – 4 Hz, but sleep standards in both the original R&K, as well as the new 2007 AASM guidelines have a range of .5 to 2 Hz.) This is the stage in which such parasomnias as night terrors, bedwetting, sleepwalking, and sleep-talking occur.
REM sleep
Main article: Rapid eye movement sleepRapid eye movement sleep, or REM sleep, accounts for 20%–25% of total sleep time in most human adults. The criteria for REM sleep include rapid eye movements as well as a rapid low-voltage EEG. Most memorable dreaming occurs in this stage. At least in mammals, a descending muscular atonia is seen. Such paralysis may be necessary to protect organisms from self-damage through physically acting out scenes from the often-vivid dreams that occur during this stage.
Timing
Sleep timing is controlled by the circadian clock, sleep-wake homeostasis, and in humans, within certain bounds, willed behavior. The circadian clock — an inner timekeeping, temperature-fluctuating, enzyme-controlling device — works in tandem with adenosine, a neurotransmitter that inhibits many of the bodily processes associated with wakefulness. Adenosine is created over the course of the day; high levels of adenosine lead to sleepiness. In diurnal animals, sleepiness occurs as the circadian element causes the release of the hormone melatonin and a gradual decrease in core body temperature. The timing is affected by one's chronotype. It is the circadian rhythm that determines the ideal timing of a correctly structured and restorative sleep episode.
Homeostatic sleep propensity (the need for sleep as a function of the amount of time elapsed since the last adequate sleep episode) must be balanced against the circadian element for satisfactory sleep. Along with corresponding messages from the circadian clock, this tells the body it needs to sleep. Sleep offset (awakening) is primarily determined by circadian rhythm. A person who regularly awakens at an early hour will generally not be able to sleep much later than their normal waking time, even if moderately sleep-deprived.
Sleep duration is affected by circadian rhythm which is regulated by a gene named DEC2. Some people have a mutation of this gene; they sleep two hours less than normal. Neurology professor Ying-Hui Fu and his colleagues bred mice that carried the DEC2 mutation and slept less than normal mice.
Optimal amount in humans
Adult
The optimal amount of sleep is not a meaningful concept unless the timing of that sleep is seen in relation to an individual's circadian rhythms. A person's major sleep episode is relatively inefficient and inadequate when it occurs at the "wrong" time of day; one should be asleep at least six hours before the lowest body temperature. The timing is correct when the following two circadian markers occur after the middle of the sleep episode and before awakening:
- maximum concentration of the hormone melatonin, and
- minimum core body temperature.
The National Sleep Foundation in the United States maintains that seven to nine hours of sleep for adult humans is optimal and that sufficient sleep benefits alertness, memory, problem solving, and overall health, as well as reducing the risk of accidents. A widely publicized 2003 study performed at the University of Pennsylvania School of Medicine demonstrated that cognitive performance declines with six or fewer hours of sleep.
A University of California, San Diego, psychiatry study of more than one million adults found that people who live the longest self-report sleeping for six to seven hours each night. Another study of sleep duration and mortality risk in women showed similar results. Other studies show that "sleeping more than 7 to 8 hours per day has been consistently associated with increased mortality," though this study suggests the cause is probably other f
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