Sleep

Sleep is associated with a state of muscle relaxation and reduced perception of environmental stimuli.

Sleep is a naturally recurring state of mind and body, characterized by altered consciousness, relatively inhibited sensory activity, inhibition of nearly all voluntary muscles, and reduced interactions with surroundings.[1] It is distinguished from wakefulness by a decreased ability to react to stimuli, but is more easily reversed than the state of being comatose.

Sleep occurs in repeating periods, in which the body alternates between two distinct modes: REM sleep and non-REM sleep. Although REM stands for "rapid eye movement", this mode of sleep has many other aspects, including virtual paralysis of the body. A well-known feature of sleep is the dream, an experience typically recounted in narrative form, which resembles waking life while in progress, but which usually can later be distinguished as fantasy.

During sleep, most of the body's systems are in an anabolic state, helping to restore the immune, nervous, skeletal, and muscular systems; these are vital processes that maintain mood, memory, and cognitive function, and play a large role in the function of the endocrine and immune systems.[2] The internal circadian clock promotes sleep daily at night. The diverse purposes and mechanisms of sleep are the subject of substantial ongoing research.[3]

Humans may suffer from various sleep disorders, including dyssomnias such as insomnia, hypersomnia, narcolepsy, and sleep apnea; parasomnias such as sleepwalking and REM behavior disorder; bruxism; and circadian rhythm sleep disorders. The advent of artificial light has substantially altered sleep timing in industrialized countries.[4]

Physiology

An artist's creative illustration depicting REM sleep.

The most pronounced physiological changes in sleep occur in the brain.[5] The brain uses significantly less energy during sleep than it does when awake, especially during non-REM sleep. In areas with reduced activity, the brain restores its supply of adenosine triphosphate (ATP), the molecule used for short-term storage and transport of energy.[6] In quiet waking, the brain is responsible for 20% of the body's energy use, thus this reduction has a noticeable effect on overall energy consumption.[7]

Sleep increases the sensory threshold. In other words, sleeping persons perceive fewer stimuli, but can generally still respond to loud noises and other salient sensory events.[7][5]

During slow-wave sleep, humans secrete bursts of growth hormone. All sleep, even during the day, is associated with secretion of prolactin.[8]

Key physiological methods for monitoring and measuring changes during sleep include electroencephalography (EEG) of brain waves, electrooculography (EOG) of eye movements, and electromyography (EMG) of skeletal muscle activity. Simultaneous collection of these measurements is called polysomnography, and can be performed in a specialized sleep laboratory.[9][10] Sleep researchers also use simplified electrocardiography (EKG) for cardiac activity and actigraphy for motor movements.[10]

Non-REM and REM sleep

Sleep is divided into two broad types: non-rapid eye movement (non-REM or NREM) sleep and rapid eye movement (REM) sleep. Non-REM and REM sleep are so different that physiologists identify them as distinct behavioral states. Non-REM sleep occurs first and after a transitional period is called slow-wave sleep or deep sleep. During this phase, body temperature and heart rate fall, and the brain uses less energy.[5] REM sleep, also known as paradoxical sleep, represents a smaller portion of total sleep time. It is the main occasion for dreams (or nightmares), and is associated with desynchronized and fast brain waves, eye movements, loss of muscle tone,[1] and suspension of homeostasis.[11]

The sleep cycle of alternate NREM and REM sleep takes an average of 90 minutes, occurring 4–6 times in a good night's sleep.[10][12] The American Academy of Sleep Medicine (AASM) divides NREM into three stages: N1, N2, and N3, the last of which is also called delta sleep or slow-wave sleep.[13] The whole period normally proceeds in the order: N1 → N2 → N3 → N2 → REM. REM sleep occurs as a person returns to stage 2 or 1 from a deep sleep.[1] There is a greater amount of deep sleep (stage N3) earlier in the night, while the proportion of REM sleep increases in the two cycles just before natural awakening.[10]

Awakening

"The Awakening", an illustration to writing by Leo Tolstoy

Awakening can mean the end of sleep, or simply a moment to survey the environment and readjust body position before falling back asleep. Sleepers typically awaken soon after the end of a REM phase or sometimes in the middle of REM. Internal circadian indicators, along with successful reduction of homeostatic sleep need, typically bring about awakening and the end of the sleep cycle.[14] Awakening involves heightened electrical activation in the brain, beginning with the thalamus and spreading throughout the cortex.[14]

During a night's sleep, a small amount of time is usually spent in a waking state. As measured by electroencephalography, young females are awake for 0–1% of the larger sleeping period; young males are awake for 0–2%. In adults, wakefulness increases, especially in later cycles. One study found 3% awake time in the first ninety-minute sleep cycle, 8% in the second, 10% in the third, 12% in the fourth, and 13–14% in the fifth. Most of this awake time occurred shortly after REM sleep.[14]

Today, many humans wake up with an alarm clock;[15] however, some people can reliably wake themselves up at a specific time with no need for an alarm.[14] Many sleep quite differently on workdays versus days off, a pattern which can lead to chronic circadian desynchronization.[16][15] Many people regularly look at television and other screens before going to bed, a factor which may exacerbate disruption of the circadian cycle.[17][18] Scientific studies on sleep have shown that sleep stage at awakening is an important factor in amplifying sleep inertia.[19]

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