Sleep - Wikipedia, The Free Encyclopedia

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Sleep
FromWikipedia,thefreeencyclopedia
Thisarticleisaboutsleepmostlyinhumans.Fornonhumansleep,seeSleep(nonhuman).Forother
uses,seeSleep(disambiguation).
"Wakingup","Asleep",and"Slept"redirecthere.Forotheruses,seeWakingUp(disambiguation),
Asleep(disambiguation),andSLEPTanalysis.
Sleepisanaturallyrecurringstateofmindcharacterizedbyaltered
consciousness,relativelyinhibitedsensoryactivity,inhibitionof
nearlyallvoluntarymuscles,andreducedinteractionswith
surroundings.[1]Itisdistinguishedfromwakefulnessbyadecreased
abilitytoreacttostimuli,butismoreeasilyreversedthanthestate
ofhibernationorofbeingcomatose.Mammaliansleepoccursin
repeatingperiods,inwhichthebodyalternatesbetweentwohighly
distinctmodesknownasnonREMandREMsleep.REMstandsfor
"rapideyemovement"butinvolvesmanyotheraspectsincluding Sleepisassociatedwithastateof
virtualparalysisofthebody. musclerelaxationandreduced
perceptionofenvironmentalstimuli.
Duringsleep,mostsystemsinananimalareinananabolicstate,
buildinguptheimmune,nervous,skeletal,andmuscularsystems.
Sleepinnonhumananimalsisobservedinmammals,birds,reptiles,amphibians,andfish,and,insome
form,ininsectsandeveninsimpleranimalssuchasnematodes.Theinternalcircadianclockpromotes
sleepdailyatnightindiurnalspecies(suchashumans)andinthedayinnocturnalorganisms(suchas
rodents).However,sleeppatternsvarywidelyamonganimalsandamongdifferentindividualhumans.
Industrializationandartificiallighthavesubstantiallyalteredhumansleephabitsinthelast100years.
Thediversepurposesandmechanismsofsleeparethesubjectofsubstantialongoingresearch.[2]Sleep
seemstoassistanimalswithimprovementsinthebodyandmind.Awellknownfeatureofsleepinhumans
isthedream,anexperiencetypicallyrecountedinnarrativeform,whichresembleswakinglifewhilein
progress,butwhichusuallycanlaterbedistinguishedasfantasy.Humansmaysufferfromanumberof
sleepdisorders.Theseincludedyssomnias(suchasinsomnia,hypersomnia,andsleepapnea),parasomnias
(suchassleepwalkingandREMbehaviordisorder),bruxism,andthecircadianrhythmsleepdisorders.
Contents
1Physiology
2Stages
2.1NonREM
2.2REM
2.3Awakening
2.4Historicaldevelopmentofstagesmodel
3Circadiantiming
3.1Circadianclock
3.2Distribution
4Sleephomeostasis,deprivationandoptimization
4.1Duration
4.2Sleepdebt
https://en.wikipedia.org/wiki/Sleep#Physiology 1/32
4.2Sleepdebt
4.3Adulthumans
4.4Younghumans
4.5Recommendations
5Functions
5.1Increasedwasteclearanceofbrain
5.2Restoration
5.3Ontogenesis
5.4Memoryprocessing
5.5Preservation
5.6Emotionalimpacts
6Dreaming
7Evolution
8Genetics
9Insomnia
10Obstructivesleepapnea
11Othersleepdisorders
12Effectoffoodanddrugsonsleep
12.1Hypnotics
12.2Stimulants
12.3Nutritionaleffectsonsleep
13Anthropologyofsleep
14Sleepinnonhumananimals
15Seealso
15.1Positions,practices,andrituals
16References
16.1Sources
17Externallinks
Physiology
Inmammalsandbirds,sleepisdividedintotwobroadtypes:rapid
eyemovement(REMsleep)andnonrapideyemovement(NREM
ornonREMsleep).Eachtypehasadistinctsetofphysiologicaland
neurologicalfeaturesassociatedwithit.REMsleepisassociated
withdreaming,desynchronizedandfasterbrainwaves,lossof
muscletone,andsuspensionofhomeostasis.[3]REMandnonREM
sleeparesodifferentthatphysiologistsclassifythemasdistinct
behavioralstates.Inthisview,REM,nonREM,andwaking
Hypnogramshowingsleepcycles
representthethreemajormodesofconsciousness,neuralactivity,
frommidnightto6.30am,withdeep
andphysiologicalregulation.[4]AccordingtotheHobson& sleepearlyon.ThereismoreREM
McCarleyactivationsynthesishypothesis,proposedin19751977, (markedred)beforewaking.(Current
thealternationbetweenREMandnonREMcanbeexplainedin hypnogramsreflecttherecent
termsofcycling,reciprocallyinfluentialneurotransmittersystems.[5] decisiontocombineNREMstages3
&4intoasinglestage3.)
EspeciallyduringnonREMsleep,thebrainusessignificantlylessenergyduringsleepthanitdoesin
waking.Inareaswithreducedactivity,thebrainrestoresitssupplyofadenosinetriphosphate(ATP),the
moleculeusedforshorttermstorageandtransportofenergy.[6](Sinceinquietwakingthebrainis
responsiblefor20%ofthebody'senergyuse,thisreductionhasanindependentlynoticeableimpacton
overallenergyconsumption.)[7]Duringslowwavesleep,humanssecreteburstsofgrowthhormone.All
sleep,evenduringtheday,isassociatedwithsecretionofprolactin.[8]
Sleepincreasesanorganism'ssensorythreshold.Inotherwords,asleepingcreatureperceivesfewerstimuli.
However,itcangenerallystillrespondtoloudnoisesandothersalientsensoryevents.[7]
KeyphysiologicalindicatorsinsleepincludeEEGofbrainwaves,electrooculography(EOG)ofeye
movements,andelectromyography(EMG)ofskeletalmuscleactivity.Simultaneouscollectionofthese
measurementsiscalledpolysomnographyandcanbeperformedinaspecializedsleeplaboratory.[9]
Stages
Humansleepoccursinperiodsofapproximately90minutes,which
includeanincreasingproportionofparadoxical(REM)sleepasthey
repeat.Thisrhythmiscalledtheultradiansleepcycle.[10]Sleep
proceedsincyclesofREMandNREM,usuallyfourorfiveofthem
pernight.TheAmericanAcademyofSleepMedicine(AASM)
dividesNREMintothreestages:N1,N2,andN3,thelastofwhich
isalsocalleddeltasleeporslowwavesleep.[11]Thewholeperiod
normallyproceedsintheorder:N1N2N3N2REM.In
otheranimalsthesubdivisionbetweenphasesofnonREMsleepis
nottypicallyused,althoughanimalnonREMsleepcanbe 30secondsofdeep(stageN3)sleep.
describedaslighterordeeper.[12]Thereisagreateramountofdeep
sleep(stageN3)earlierinthenight,whiletheproportionofREM
sleepincreasesinthetwocyclesjustbeforenaturalawakening.
Eachstagemayhaveadistinctphysiologicalfunctionandthiscan
resultinsleepthatexhibitslossofconsciousnessbutdoesnotfulfill
itsphysiologicalfunctions(i.e.,onemaystillfeeltiredafter
apparentlysufficientsleep).
NonREM
AscreenshotofaPSGofapersonin
Mainarticle:NonREMsleep REMsleep.Eyemovements
highlightedbyredbox.
Asanawakeorganismfallsasleep,theactivityofitsbodyslows
down.Bodytemperature,heartrate,breathingrate,andenergyuse
alldecrease.Brainwavesgetslowerandbigger.Theexcitatoryneurotransmitteracetylcholinebecomesless
availableinthebrain.[13]Theorganismwillmaneuver,asbestitcan,tocreateathermallyfriendly
environmentforexample,bycurlingupintoaballifit'scoldout.Reflexesremainfairlyactive.These
characteristicsapplytosomedegreeduringallnonREMsleep,whichconstitutes~80%ofallsleepin
humans.[14]
NREM1
NREMStage1(N1lightsleep,somnolence,drowsysleep510%oftotalsleepinadults):Thisisa
stageofsleepthatusuallyoccursbetweensleepandwakefulness,andsometimesoccursbetweenperiodsof
deepersleepandperiodsofREM.Themusclesareactive,andtheeyesrollslowly,openingandclosing
moderately.Thebraintransitionsfromalphawaveshavingafrequencyof813Hz(commonintheawake
state)tothetawaveshavingafrequencyof47Hz.Suddentwitchesandhypnicjerks,alsoknownas
positivemyoclonus,maybeassociatedwiththeonsetofsleepduringN1.Somepeoplemayalsoexperience
hypnagogichallucinationsduringthisstage.DuringNonREM1,theorganismlosessomemuscletoneand
mostconsciousawarenessoftheexternalenvironment.
NREM2
NREMStage2(N24555%oftotalsleepinadults[15]):Inthisstage,thetaactivityisobservedand
sleepersbecomegraduallyhardertoawakenthealphawavesofthepreviousstageareinterruptedby
abruptactivitycalledsleepspindles(orthalamocorticalspindles)andKcomplexes.[16]Sleepspindlesrange
from11to16Hz(mostcommonly1214Hz).Duringthisstage,muscularactivityasmeasuredbyEMG
decreases,andconsciousawarenessoftheexternalenvironmentdisappears.
NREM3
Mainarticle:Slowwavesleep
NREMStage3(N3deepsleep,slowwavesleep1525%oftotalsleepinadults):Formerlydividedinto
stages3and4,thisstageiscalledslowwavesleep(SWS)ordeepsleep.SWSisinitiatedinthepreoptic
areaandconsistsofdeltaactivity,highamplitudewavesatlessthan3.5Hz.Thesleeperislessresponsive
totheenvironmentmanyenvironmentalstimulinolongerproduceanyreactions.Slowwavesleepis
thoughttobethemostrestfulformofsleep,thephasewhichmostrelievessubjectivefeelingsofsleepiness
andrestoresthebody.[17]
Thisstageischaracterizedbythepresenceofaminimumof20%deltawavesrangingfrom0.52Hzand
havingapeaktopeakamplitude>75V.(EEGstandardsdefinedeltawavestobefrom0to4Hz,but
sleepstandardsinboththeoriginalR&K,aswellasthenew2007AASMguidelineshavearangeof0.5
2Hz.)Thisisthestageinwhichparasomniassuchasnightterrors,nocturnalenuresis,sleepwalking,and
somniloquyoccur.ManyillustrationsanddescriptionsstillshowastageN3with2050%deltawavesanda
stageN4withgreaterthan50%deltawavesthesehavebeencombinedasstageN3.[15]
REM
Mainarticle:Rapideyemovementsleep
REMStage(REMSleep2025%oftotalsleepinadults[18]):Enteringrapideyemovement(REM)sleep
wheremostmusclesareparalyzed,andheartrate,breathingandbodytemperaturebecomeunregulated,the
sleepermayexperiencevividdreams.REMsleepisturnedonbyacetylcholinesecretionandisinhibitedby
neuronsthatsecretemonoaminesincludingserotonin.Thislevelisalsoreferredtoasparadoxicalsleep
becausethesleeper,althoughexhibitinghighfrequencyEEGwavessimilartoawakingstate,isharderto
arousethanatanyothersleepstage.[16]Vitalsignsindicatearousalandoxygenconsumptionbythebrainis
higherthanwhenthesleeperisawake.[19]AnadultreachesREMapproximatelyevery90minutes,and
remainsinREMsleepforlongerduringlatterhalfofsleep.REMsleepoccursasapersonreturnstostage1
fromadeepsleep.[3]
ThefunctionofREMsleepisuncertainbutalackofitimpairstheabilitytolearncomplextasks.One
approachtounderstandingtheroleofsleepistostudythedeprivationofit.[20]Functionalparalysisfrom
muscularatoniainREMmaybenecessarytoprotectorganismsfromselfdamagethroughphysicallyacting
outscenesfromtheoftenvividdreamsthatoccurduringthisstage.
Anewbornbabyspendsalmost9hoursadayjustinREMsleep.Bytheageoffiveorso,onlyslightlyover
twohoursisspentinREM.[21]
ThestudyofREMdeprivationbeganwithWilliamDementmorethanfiftyyearsago.Heconductedasleep
anddreamresearchprojectoneightsubjects,allmale.Foraspanofupto7days,hedeprivedthe
participantsofREMsleepbywakingthemeachtimetheystartedtoenterthestage.Hemonitoredthiswith
smallelectrodesattachedtotheirscalpandtemples.Asthestudywenton,henoticedthatthemorehe
deprivedthemenofREMsleep,themoreoftenhehadtowakethem.Afterwards,theyshowedmoreREM
sleepthanusual,laternamedREMrebound.[22][23]
Awakening
Awakeningcanmeantheendofsleep,orsimplyamomenttosurveytheenvironmentandreadjustbody
positionbeforefallingbackasleep.Sleeperstypicallyawakenfromslowwavesleep,soonaftertheendofa
REMphaseorsometimesinthemiddleofREM.Therisingorsettingofthesun,andinternalcircadian
indicators,alongwithsuccessfulreductionofhomeostaticsleepneed,typicallybringaboutawakeningand
theendofthesleepepisode.[24]
Today,manyhumanswakeupwithanalarmclock.[25](Somepeople,however,canreliablywake
themselvesupataspecifictimewithnoneedforanalarm.)[24]Peoplesleepquitedifferentlyonworkdays
versusdaysoff,apatternwhichcanleadtochroniccircadiandesynchronization.[17][25]Millionsof
Americansregularlywatchtelevisionbeforegoingtobed,afactorwhichmayexacerbatethismass
circadiandisruption.[26]
Awakeninginvolvesheightenedelectricalactivationinthebrain,beginningwiththethalamusand
spreadingthroughoutthecortex.[24]
Duringanight'ssleep,asmallportionisusuallyspentinawakingstate.Asmeasuredby
electroencephalography,youngfemalesareawakefor01%ofthelargersleepingperiodyoungmalesare
awakefor02%.Inadults,wakefulnessincreases,especiallyinlatercycles.Onestudyfound3%awake
timeinthefirstninetyminutesleepcycle,8%inthesecond,10%inthethird,12%inthefourth,and13
14%inthefifth.MostofthisawaketimeoccurredshortlyafterREMsleep.[24]
Scientificstudiesonsleephaveshownthatsleepstageatawakeningisanimportantfactorinamplifying
sleepinertia.Alarmclocksinvolvingsleepstagemonitoringappearedonthemarketin2005.[27]Using
sensingtechnologiessuchasEEGelectrodesoraccelerometers,thesealarmclocksaresupposedtowake
peopleonlyfromlightsleep.
Historicaldevelopmentofstagesmodel
Thestagesofsleepwerefirstdescribedin1937byAlfredLeeLoomisandhiscoworkers,whoseparated
thedifferentelectroencephalography(EEG)featuresofsleepintofivelevels(AtoE),whichrepresented
thespectrumfromwakefulnesstodeepsleep.[28]In1953,REMsleepwasdiscoveredasdistinct,andthus
WilliamC.DementandNathanielKleitmanreclassifiedsleepintofourNREMstagesandREM.[29]The
stagingcriteriawerestandardizedin1968byAllanRechtschaffenandAnthonyKalesinthe"R&Ksleep
scoringmanual."[12][30]
IntheR&Kstandard,NREMsleepwasdividedintofourstages,withslowwavesleepcomprisingstages3
and4.Instage3,deltawavesmadeuplessthan50%ofthetotalwavepatterns,whiletheymadeupmore
than50%instage4.Furthermore,REMsleepwassometimesreferredtoasstage5.In2004,theAASM
commissionedtheAASMVisualScoringTaskForcetoreviewtheR&Kscoringsystem.Thereview
resultedinseveralchanges,themostsignificantbeingthecombinationofstages3and4intoStageN3.The
revisedscoringwaspublishedin2007asTheAASMManualfortheScoringofSleepandAssociated
Events.[31]Arousals,respiratory,cardiac,andmovementeventswerealsoadded.[32][33]
Circadiantiming
Sleeptimingiscontrolledbythecircadianclock,sleepwakehomeostasis,andinhumans,withincertain
bounds,willedbehavior.Thecircadianclockaninnertimekeeping,temperaturefluctuating,enzyme
controllingdeviceworksintandemwiththeseothermechanisms.Circadiantiming,knownasprocessC,
iscyclical,basedonthetimeofdaysleepwakehomeostasis,orprocessS,operatesonamoreabsolute
scale.Thecircadianprocessisthoughttocounteractthehomeostaticdriveforsleepduringtheday(in
diurnalanimals)andtoenableitatnight.[15][17]
Humansarealsoinfluencedbyaspectsofsocialtime:thehourswhenotherpeopleareawake,thehours
whenworkisrequired,thetimeontheclock,etc.Timezones,standardtimesusedtounifythetimingfor
peopleinthesamearea,correspondonlyapproximatelytothenaturalrisingandsettingofthesun.The
approximatenatureofthetimezoneisnowheremoreapparentthaninChina,whereacountrywhichusedto
spanfivetimezonesnowusesonlyone(UTC+8).[25]
Circadianclock
Mainarticle:Circadianrhythm
Biologically,themostimportantcircadianclockcurrentlyknowntoscienceisadenseclusterofneuronsin
thesuprachiasmaticnucleus,apartofthebraindirectlyabovetheopticchiasm,wheretheopticnerves
crossontheirpathsfromthetwoeyestothevisualcortex.Thisclockmeasuresthetimeofday,primarily
basedoninputfromoutsidelightsignals.Anorganismwhosecircadianclockexhibitsaregularrhythm
correspondingtooutsidesignalsissaidtobeentrainedtherhythmsoestablishedpersistsevenifthe
outsidesignalssuddenlydisappear.Ifyoutakeanentrainedhumanandputtheminabunkerwithconstant
light(ordarkness),theywillcontinuetoexperiencerhythmicincreasesanddecreasesofbodytemperature
andmelatonin,onaperiodwhichslightlyexceeds24hours.Scientistsrefertosuchconditionsasfree
runningofthecircadianrhythm.(Undernaturalconditions,lightsignalsregularlyadjustthisperiod
downward,sothatitcorrespondsbetterwiththeexact24hoursofanEarthday.)[25][34][35]
Theclockexertsconstantinfluenceonthebody,effectingcontinuoussinusoidaloscillationofbody
temperaturebetween~36.2Cand~37.2C.[35][36]Thesuprachiasmaticnucleusitselfshowsconspicuous
oscillationactivity,whichintensifiesduringsubjectiveday(i.e.,thepartoftherhythmcorrespondingwith
daytime,whetheraccuratelyornot)anddropstoalmostnothingduringsubjectivenight.[37]Thecircadian
pacemakerinthesuprachiasmaticnucleushasadirectneuralconnectiontothepinealgland,whichreleases
thehormonemelatoninatnight.[37]Melatoninisanimportantcircadianindicatorbutitsmechanismsof
actionarenotwellunderstood.Nocturnalmammals,whichtendtostayawakeatnight,havehigher
melatoninatnightjustlikediurnalmammalsdo.[38]And,althoughremovingthepinealglandinmany
animalsabolishesmelatoninrhythms,itdoesnotstopcircadianrhythmsaltogetherthoughitmayalter
themandweakentheirresponsiveness
tolightcues.[39]Cortisollevelsin
diurnalanimalstypicallyrise
throughoutthenight,peakinthe
awakeninghours,anddiminishduring
theday.[8][40]Circadianprolactin
secretionbeginsinthelateafternoon,
especiallyinwomen,andis
subsequentlyaugmentedbysleep
inducedsecretion,topeakinthemiddle
ofthenight.Circadianrhythmexerts
someinfluenceonthenighttime
secretionofgrowthhormone.[8] Thehuman"biologicalclock"
Thecircadianrhythminfluencesthe
idealtimingofarestorativesleepepisode.[25][41]Indiurnalanimals,sleepinessincreasesduringthenight.
REMsleepoccursmoreduringthelowpart(i.e.,nearbodytemperatureminimum)ofthecircadiancycle,
whereasslowwavesleepoccursrelativelyindependentlyofcircadiantime.[35]
Theinternalcircadianclockisprofoundlyinfluencedbychangesinlight,sincetheseareitsmainclues
aboutwhattimeitis.Exposuretoevensmallamountsoflightduringthenightcancansuppressmelatonin
secretion,increasebodytemperature,andincreasecognitiveability.Shortpulsesoflight,attheright
momentinthecircadiancycle,cansignificantly'reset'theinternalclock.[36]Bluelight,inparticular,exerts
thestrongesteffect.[17]
Modernhumansoftenfindthemselvesdesynchronizedfromtheirinternalcircadianclock,duetothe
requirementsofwork(especiallynightshifts),longdistancetravel,andtheinfluenceofwidespreadindoor
lighting.[35]Eveniftheyhavesleepdebt,orfeelsleepy,peoplecanhavedifficultystayingasleepatthe
peakoftheircircadiancycle.Converselytheycanhavedifficultywakingupinthetroughofthecycle.[24]A
healthyyoungadultentrainedtothesunwill(duringmostoftheyear)fallasleepafewhoursaftersunset,
experiencebodytemperatureminimumat6AM,andwakeupafewhoursaftersunrise.[35]
Nocturnalanimalshavehigherbodytemperatures,greateractivity,risingserotonin,anddiminishing
cortisolduringthenighttheinverseofdiurnalanimals.Nocturnalanddiurnalanimalsbothhave
increasedelectricalactivityinthesuprachiasmaticnucleus,andcorrespondingsecretionofmelatoninfrom
thepinealgland,atnight.[42]
Distribution
Inpolyphasicsleep,anorganismsleepsatmultipletimesduringa24hourcycle.Monophasicsleepoccurs
allatonce.Underexperimentalconditions,humanstendtoalternatemorefrequentlybetweensleepand
wakefulness(i.e.,exhibitmorepolyphasicsleep)iftheyhavenothingbettertodo.[35]Givena14hour
periodofdarknessinexperimentalconditions,humanstendedtowardsbimodalsleep,withtwosleep
periodsconcentratedatthebeginningandattheendofthedarktime.Bimodalsleepinhumanswasmore
commonbeforetheindustrialrevolution.[40]
Differentcharacteristicsleeppatterns,suchasthefamous"earlybird"and"nightowl",arecalled
chronotypes.Geneticsandsexhavesomeinfluenceonchronotype,butsododifferenthabits.Chronotypeis
alsoliabletochangeoverthecourseofaperson'slifetime.Sevenyearoldsarebetterdisposedtowakeup
earlyinthemorningthanarefifteenyearolds.[17][25]
Naps
Mainarticle:Nap
Thesiestahabithasrecentlybeenassociatedwitha37%reduction
incoronarymortality,possiblyduetoreducedcardiovascularstress
mediatedbydaytimesleep.[43]Nevertheless,epidemiological
studiesontherelationsbetweencardiovascularhealthandsiestas
haveledtoconflictingconclusions,possiblybecauseofpoorcontrol
ofmoderatorvariables,suchasphysicalactivity.Itispossiblethat
peoplewhotakesiestashavedifferentphysicalactivityhabits,e.g.,
Peoplesleepingonatrainatnight
wakingearlierandschedulingmoreactivityduringthemorning.
Suchdifferencesinphysicalactivitymaymediatedifferent24hour
profilesincardiovascularfunction.Evenifsucheffectsofphysicalactivitycanbediscountedfor
explainingtherelationshipbetweensiestasandcardiovascularhealth,itisstillunknownwhetheritisthe
daytimenapitself,asupineposture,ortheexpectancyofanapthatisthemostimportantfactor.Itwas
recentlysuggestedthatashortnapcanreducestressandbloodpressure(BP),withthemainchangesinBP
occurringbetweenthetimeoflightsoffandtheonsetofstage1.[44][45]
Sleepdurationinlongtermexperiencedmeditatorsislowerthaninnonmeditatorsandgeneralpopulation
norms,withnoapparentdecrementsinvigilance.[46]
Sleephomeostasis,deprivationandoptimization
Generallyspeaking,themoreanorganismisawake,themoreitfeelsaneedtosleep.Thebalancebetween
sleepingandwakingiscalledhomeostasis.Inducedorperceivedlackofsleepiscommonlycalledsleep
deprivation.
Sleepdeprivationtendstocauseslowerbrainwavesinthefrontalcortex,shortenedattentionspan,higher
anxiety,impairedmemory,andagrouchymood.Conversely,awellrestedorganismtendstohave
improvedmemoryandmood.[47]
Inrats,sleepdeprivationcausesweightlossandreducedbodytemperature.Ifpreventedfromsleepingfor
severalweeks,ratsdie.Inhumans,sleepdeprivationhasbeenstudiedupto11days,duringwhichsubjects
aremorelikelytogainweight.Humandeathsfromsleepdeprivationalonearenotknown.[7]
Duration
Homeostaticsleeppropensity(theneedforsleepasafunctionoftheamountoftimeelapsedsincethelast
adequatesleepepisode)mustbebalancedagainstthecircadianelementforsatisfactorysleep.[48]Along
withcorrespondingmessagesfromthecircadianclock,thistellsthebodyitneedstosleep.[49]Sleepoffset
(awakening)isprimarilydeterminedbycircadianrhythm.Apersonwhoregularlyawakensatanearlyhour
willgenerallynotbeabletosleepmuchlaterthanhisorhernormalwakingtime,evenifmoderatelysleep
deprived.
SleepdurationisaffectedbythegeneDEC2.PeoplewithacertainDEC2mutationsleeptwohoursless
thannormal.Thegenealsoaffectsthesleeppatternsofmice,andlikelydoessoforallmammals.[50][51]
Sleepdebt
Mainarticle:Sleepdebt
Sleepdebtistheeffectofnotgettingenoughsleepalargedebtcausesmental,emotionalandphysical
fatigue.
Sleepdebtresultsindiminishedabilitiestoperformhighlevelcognitivefunctions.Neurophysiologicaland
functionalimagingstudieshavedemonstratedthatfrontalregionsofthebrainareparticularlyresponsiveto
homeostaticsleeppressure.[52]
Scientistsdonotagreeonhowmuchsleepdebtitispossibletoaccumulatewhetheritisaccumulated
againstanindividual'saveragesleeporsomeotherbenchmarknoronwhethertheprevalenceofsleepdebt
amongadultshaschangedappreciablyintheindustrializedworldinrecentdecades.Sleepdebtdoesshow
someevidenceofbeingcumulative.Subjectively,however,humansseemtoreachmaximumsleepiness
after30hoursofwaking.[35]
ItislikelythatchildrenaresleepinglessthanpreviouslyinWesternsocieties.[53]
Oneneurochemicalindicatorofsleepdebtisadenosine,aneurotransmitterthatinhibitsmanyofthebodily
processesassociatedwithwakefulness.Adenosineisaningredientinadenosinetriphosphate(ATP)and
alsoaproductofATPmetabolism.ThusasthebrainusesstoredenergyintheformofATP,adenosine
buildsupandsubjectivesleepinessincreases.[54]Caffeineandtheophyllinetemporarilyblocktheeffectof
adenosine,thusallowingittobuildupfurtherbeforetheneedforsleepreassertsitself.[55]
Adulthumans
Theoptimalamountofsleepisnotameaningfulconceptunlessthetimingofthatsleepisseeninrelation
toanindividual'scircadianrhythms.Aperson'smajorsleepepisodeisrelativelyinefficientandinadequate
whenitoccursatthe"wrong"timeofdayoneshouldbeasleepatleastsixhoursbeforethelowestbody
temperature.[57]Thetimingiscorrectwhenthefollowingtwocircadianmarkersoccurafterthemiddleof
thesleepepisodeandbeforeawakening:[58]maximumconcentrationofthehormonemelatonin,and
minimumcorebodytemperature.
Humansleepneedsvarybyageandamongstindividuals,andsleep
isconsideredtobeadequatewhenthereisnodaytimesleepinessor
dysfunction.Moreover,selfreportedsleepdurationisonly
moderatelycorrelatedwithactualsleeptimeasmeasuredby
actigraphy,[59]andthoseaffectedwithsleepstatemisperception
maytypicallyreporthavingsleptonlyfourhoursdespitehaving
sleptafulleighthours.[60]
AUniversityofCalifornia,SanDiegopsychiatrystudyofmorethan Themainhealtheffectsofsleep
onemillionadultsfoundthatpeoplewholivethelongestselfreport
deprivation, [56]indicating
sleepingforsixtosevenhourseachnight.[61]Anotherstudyofsleep
impairmentofnormalmaintenance
durationandmortalityriskinwomenshowedsimilarresults.[62] bysleep.
Otherstudiesshowthat"sleepingmorethan7to8hoursperdayhas
beenconsistentlyassociatedwithincreasedmortality,"thoughthis
studysuggeststhecauseisprobablyotherfactorssuchasdepressionandsocioeconomicstatus,which
wouldcorrelatestatistically.[63]Ithasbeensuggestedthatthecorrelationbetweenlowersleephoursand
reducedmorbidityonlyoccurswiththosewhowakenaturally,ratherthanthosewhouseanalarm.
ResearchersattheUniversityofWarwickandUniversityCollegeLondonhavefoundthatlackofsleepcan
morethandoubletheriskofdeathfromcardiovasculardisease,butthattoomuchsleepcanalsobe
associatedwithadoublingoftheriskofdeath,thoughnotprimarilyfromcardiovasculardisease.[64]
ProfessorFrancescoCappucciosaid,"Shortsleephasbeenshowntobeariskfactorforweightgain,
hypertension,andType2diabetes,sometimesleadingtomortalitybutincontrasttotheshortsleep
mortalityassociation,itappearsthatnopotentialmechanismsbywhichlongsleepcouldbeassociatedwith
increasedmortalityhaveyetbeeninvestigated.Somecandidatecausesforthisincludedepression,low
socioeconomicstatus,andcancerrelatedfatigue...Intermsofprevention,ourfindingsindicatethat
consistentlysleepingaroundsevenhourspernightisoptimalforhealth,andasustainedreductionmay
predisposetoillhealth."
Furthermore,sleepdifficultiesarecloselyassociatedwithpsychiatricdisorderssuchasdepression,
alcoholism,andbipolardisorder.[65]Upto90%ofadultswithdepressionarefoundtohavesleep
difficulties.DysregulationfoundonEEGincludesdisturbancesinsleepcontinuity,decreaseddeltasleep
andalteredREMpatternswithregardtolatency,distributionacrossthenightanddensityofeye
movements.[66]
Younghumans
Bythetimeinfantsreachtheageoftwo,theirbrainsizehasreached90percentofanadultsizedbrain[67]a
majorityofthisbraingrowthhasoccurredduringtheperiodoflifewiththehighestrateofsleep.Thehours
thatchildrenspendasleepinfluencetheirabilitytoperformoncognitivetasks.[68][69]Childrenwhosleep
throughthenightandhavefewnightwakingepisodeshavehighercognitiveattainmentsandeasier
temperamentsthanotherchildren.[69][70][71]
Sleepalsoinfluenceslanguagedevelopment.Totestthis,researcherstaughtinfantsafauxlanguageand
observedtheirrecollectionoftherulesforthatlanguage.[72]Infantswhosleptwithinfourhoursoflearning
thelanguagecouldrememberthelanguagerulesbetter,whileinfantswhostayedawakelongerdidnot
recallthoserulesaswell.Thereisalsoarelationshipbetweeninfants'vocabularyandsleeping:infantswho
sleeplongeratnightat12monthshavebettervocabulariesat26months.[71]
Recommendations
Childrenneedmanyhoursofsleepperdayinordertodevelopandfunctionproperly:upto18hoursfor
newbornbabies,withadecliningrateasachildages.[49]Earlyin2015,afteratwoyearstudy,[73]the
NationalSleepFoundationintheUSannouncednewlyrevisedrecommendationsasshowninthetable
below.
Ageandcondition SleepNeeds
Newborns(03months) 14to17hours[73]
Infants(411months) 12to15hours[73]
Toddlers(12years) 11to14hours[73]
Preschoolers(35years) 10to13hours[73]
Schoolagechildren(613years) 9to11hours[73]
Teenagers(1417years) 8to10hours[73][74]
YoungAdults(18to25years)andAdults(26to64years) 7to9hours[73]
OlderAdults(65yearsandover) 7to8hours[73][75]
Functions
Furtherinformation:NeuroscienceofsleepSleepfunction
Themultiplehypothesesproposedtoexplainthefunctionofsleepreflecttheincompleteunderstandingof
thesubject.(Whenasked,after50yearsofresearch,whatheknewaboutthereasonpeoplesleep,William
C.Dement,founderofStanfordUniversity'sSleepResearchCenter,answered,"AsfarasIknow,theonly
reasonweneedtosleepthatisreally,reallysolidisbecausewegetsleepy.")[76]Itislikelythatsleep
evolvedtofulfillsomeprimevalfunctionandtookonmultiplefunctionsovertime(analogoustothelarynx,
whichcontrolsthepassageoffoodandair,butdescendedovertimetodevelopspeechcapabilities).
Ifsleepwerenotessential,onewouldexpecttofind:
Animalspeciesthatdonotsleepatall
Animalsthatdonotneedrecoverysleepafterstayingawakelongerthanusual
Animalsthatsuffernoseriousconsequencesasaresultoflackofsleep
Outsideofafewbasalanimalsthathavenobrainoraverysimpleone,noanimalshavebeenfoundtodate
thatsatisfyanyofthesecriteria.[77]Whilesomevarietiesofshark,suchasgreatwhitesandhammerheads,
mustremaininmotionatalltimestomoveoxygenatedwaterovertheirgills,itispossibletheystillsleep
onecerebralhemisphereatatimeasmarinemammalsdo.Howeveritremainstobeshowndefinitively
whetheranyfishiscapableofunihemisphericsleep.
Sleepissometimesthoughttohelpconserveenergy,thoughthistheoryisnotfullyadequateasitonly
decreasesmetabolismbyabout510%.[78][79]Additionallyitisobservedthatmammalsrequiresleepeven
duringthehypometabolicstateofhibernation,inwhichcircumstanceitisactuallyanetlossofenergyas
theanimalreturnsfromhypothermiatoeuthermiainordertosleep.[80]
Someofthemanyproposedfunctionsofsleepareasfollows:
Increasedwasteclearanceofbrain
ApublicationbyL.Xieandcolleaguesin2013exploredtheefficiencyoftheglymphaticsystemduring
sleepandprovidedthefirstdirectevidencethattheclearanceofinterstitialwasteproductsincreasesduring
therestingstate.UsingacombinationofdiffusionionophoresistechniquespioneeredbyNicholsonand
colleagues,invivo2photonimaging,andelectroencephalographytoconfirmthewakeandsleepstates,
XiaandNedergaarddemonstratedthatthechangesinefficiencyofCSFISFexchangebetweentheawake
andsleepingbrainwerecausedbyexpansionandcontractionoftheextracellularspace,whichincreasedby
60%inthesleepingbraintopromoteclearanceofinterstitialwastessuchasamyloidbeta.[81]Onthebasis
ofthesefindings,theyhypothesizedthattherestorativepropertiesofsleepmaybelinkedtoincreased
glymphaticclearanceofmetabolicwasteproductsproducedbyneuralactivityintheawakebrain.
Restoration
Woundhealinghasbeenshowntobeaffectedbysleep.Sleepdeprivationhindersthehealingofburnson
rats.[82]
Ithasbeenshownthatsleepdeprivationaffectstheimmunesystem.Whencomparedwithacontrolgroup,
sleepdeprivedrats'bloodtestsindicateda20%decreaseinwhitebloodcellcount,asignificantchangein
theimmunesystem.[83]Itisnowpossibletostatethat"sleeplossimpairsimmunefunctionandimmune
challengealterssleep,"andithasbeensuggestedthatmammalianspecieswhichinvestinlongersleep
timesareinvestingintheimmunesystem,asspecieswiththelongersleeptimeshavehigherwhiteblood
cellcounts.[84]A2014studyfoundthatdeprivingmiceofsleepincreasedcancergrowthanddampenedthe
immunesystem'sabilitytocontrolcancers.TheresearchersfoundhigherlevelsofM2tumorassociated
macrophagesandTLR4moleculesinthesleepdeprivedmiceandproposedthisasthemechanismfor
increasedsusceptibilityofthemicetocancergrowth.M2cellssuppresstheimmunesystemandencourage
tumourgrowth.TRL4moleculesaresignallingmoleculesintheactivationoftheimmunesystem.[85]Sleep
hasalsobeentheorizedtoeffectivelycombattheaccumulationoffreeradicalsinthebrain,byincreasing
theefficiencyofendogeneousantioxidantmechanisms.[86]
Theeffectofsleepdurationonsomaticgrowthisnotcompletelyknown.Onestudyrecordedgrowth,
height,andweight,ascorrelatedtoparentreportedtimeinbedin305childrenoveraperiodofnineyears
(age110).Itwasfoundthat"thevariationofsleepdurationamongchildrendoesnotseemtohavean
effectongrowth."[87]Itiswellestablishedthatslowwavesleepaffectsgrowthhormonelevelsinadult
men.[8]Duringeighthours'sleep,VanCauter,Leproult,andPlatfoundthatthemenwithahighpercentage
ofSWS(average24%)alsohadhighgrowthhormonesecretion,whilesubjectswithalowpercentageof
SWS(average9%)hadlowgrowthhormonesecretion.[88]
Thereissomesupportingevidenceoftherestorativefunctionofsleep.Thesleepingbrainhasbeenshown
toremovemetabolicwasteproductsatafasterratethanduringanawakestate.[89]Whileawake,
metabolismgeneratesreactiveoxygenspecies,whicharedamagingtocells.Insleep,metabolicrates
decreaseandreactiveoxygenspeciesgenerationisreducedallowingrestorativeprocessestotakeover.Itis
theorizedthatsleephelpsfacilitatethesynthesisofmoleculesthathelprepairandprotectthebrainfrom
theseharmfulelementsgeneratedduringwaking.[90]Themetabolicphaseduringsleepisanabolicanabolic
hormonessuchasgrowthhormones(asmentionedabove)aresecretedpreferentiallyduringsleep.The
durationofsleepamongspeciesis,broadlyspeaking,inverselyrelatedtoanimalsizeanddirectlyrelatedto
basalmetabolicrate(BMR).Rats,whichhaveahighBMR,sleepforupto14hoursaday,whereas
elephantsandgiraffes,whichhavelowerBMRs,sleeponly34hoursperday.
Energyconservationcouldaswellhavebeenaccomplishedbyrestingquiescentwithoutshuttingoffthe
organismfromtheenvironment,potentiallyadangeroussituation.Asedentarynonsleepinganimalismore
likelytosurvivepredators,whilestillpreservingenergy.Sleep,therefore,seemstoserveanotherpurpose,
orotherpurposes,thansimplyconservingenergyforexample,hibernatinganimalswakingupfrom
hibernationgointoreboundsleepbecauseoflackofsleepduringthehibernationperiod.Theyaredefinitely
wellrestedandareconservingenergyduringhibernation,butneedsleepforsomethingelse.[80]Ratskept
awakeindefinitelydevelopskinlesions,hyperphagia,lossofbodymass,hypothermia,and,eventually,fatal
sepsis.[91]
Anotherpotentialpurposeforsleepcouldbetorestoresignalstrengthinsynapsesthatareactivatedwhile
awaketoa"baseline"level,weakeningunnecessaryconnectionstobetterfacilitatelearningandmemory
functionsagainthenextday.[92]
Ontogenesis
AccordingtotheontogenetichypothesisofREMsleep,theactivityoccurringduringneonatalREMsleep
(oractivesleep)seemstobeparticularlyimportanttothedevelopingorganism.[93]Studiesinvestigatingthe
effectsofdeprivationofactivesleephaveshownthatdeprivationearlyinlifecanresultinbehavioral
problems,permanentsleepdisruption,decreasedbrainmass,[94]andanabnormalamountofneuronalcell
death.[95]
REMsleepappearstobeimportantfordevelopmentofthebrain.REMsleepoccupiesthemajorityoftime
ofsleepofinfants,whospendmostoftheirtimesleeping.Amongdifferentspecies,themoreimmaturethe
babyisborn,themoretimeitspendsinREMsleep.ProponentsalsosuggestthatREMinducedmuscle
inhibitioninthepresenceofbrainactivationexiststoallowforbraindevelopmentbyactivatingthe
synapses,yetwithoutanymotorconsequencesthatmaygettheinfantintrouble.Additionally,REM
deprivationresultsindevelopmentalabnormalitieslaterinlife.
However,thisdoesnotexplainwhyolderadultsstillneedREMsleep.Aquaticmammalinfantsdonothave
REMsleepininfancy[96]REMsleepinthoseanimalsincreasesastheyage.
Memoryprocessing
Furtherinformation:Sleepandlearning,SleepandcreativityandSleepandmemory
Scientistshaveshownnumerouswaysinwhichsleepisrelatedtomemory.InastudyconductedbyTurner,
Drummond,Salamat,andBrown(2007),workingmemorywasshowntobeaffectedbysleepdeprivation.
Workingmemoryisimportantbecauseitkeepsinformationactiveforfurtherprocessingandsupports
higherlevelcognitivefunctionssuchasdecisionmaking,reasoning,andepisodicmemory.Thestudy
allowed18womenand22mentosleeponly26minutespernightoverafourdayperiod.Subjectswere
giveninitialcognitivetestswhilewellrested,andthenweretestedagaintwiceadayduringthefourdaysof
sleepdeprivation.Onthefinaltest,theaverageworkingmemoryspanofthesleepdeprivedgrouphad
droppedby38%incomparisontothecontrolgroup.[97]
Therelationbetweenworkingmemoryandsleepcanalsobeexploredbytestinghowworkingmemory
worksduringsleep.Daltrozzo,Claude,Tillmann,Bastuji,andPerrin,[98]usingEventRelatedPotentialsto
theperceptionofsentencesduringsleepshowedthatworkingmemoryforlinguisticinformationispartially
preservedduringsleepwithasmallercapacitycomparedtowake.
MemoryseemstobeaffecteddifferentlybycertainstagesofsleepsuchasREMandslowwavesleep
(SWS).Inonestudy,multiplegroupsofhumansubjectswereused:wakecontrolgroupsandsleeptest
groups.Sleepandwakegroupsweretaughtataskandwerethentestedonit,bothonearlyandlatenights,
withtheorderofnightsbalancedacrossparticipants.Whenthesubjects'brainswerescannedduringsleep,
hypnogramsrevealedthatSWSwasthedominantsleepstageduringtheearlynight,representingaround
23%onaverageforsleepstageactivity.Theearlynighttestgroupperformed16%betteronthedeclarative
memorytestthanthecontrolgroup.Duringlatenightsleep,whichentailsmoretimespentinREM,test
groupperformed25%betterontheproceduralmemorytestthanthecontrolgroup.Thissuggeststhat
proceduralmemorybenefitsfromlate,REMrichsleep,whereasdeclarativememorybenefitsfromearly,
slowwaverichsleep.[99]
AstudyconductedbyDattaindirectlysupportstheseresults.[100]Aboxwasconstructedwhereinasingle
ratcouldmovefreelyfromoneendtotheother.Thebottomoftheboxwasmadeofasteelgrate.Alight
wouldshineintheboxaccompaniedbyasound.Afterafiveseconddelay,anelectricalshockwouldbe
applied.Oncetheshockcommenced,theratcouldmovetotheotherendofthebox,endingtheshock
immediately.Theratcouldalsousethefiveseconddelaytomovetotheotherendoftheboxandavoidthe
shockentirely.Thelengthoftheshockneverexceededfiveseconds.Thiswasrepeated30timesforhalf
therats.Theotherhalf,thecontrolgroup,wasplacedinthesametrial,buttheratswereshockedregardless
oftheirreaction.Aftereachofthetrainingsessions,theratwouldbeplacedinarecordingcageforsix
hoursofpolygraphicrecordings.Thisprocesswasrepeatedforthreeconsecutivedays.Duringtheposttrial
sleeprecordingsession,ratsspent25.47%moretimeinREMsleepafterlearningtrialsthanaftercontrol
trials.[100]
AnobservationoftheDattastudyisthatthelearninggroupspent180%moretimeinSWSthandidthe
controlgroupduringtheposttrialsleeprecordingsession.[101]Thisstudyshowsthatafterspatial
explorationactivity,patternsofhippocampalplacecellsarereactivatedduringSWSfollowingthe
experiment.Ratswererunthroughalineartrackusingrewardsoneitherend.Theratswouldthenbeplaced
inthetrackfor30minutestoallowthemtoadjust(PRE),thentheyranthetrackwithrewardbasedtraining
for30minutes(RUN),andthentheywereallowedtorestfor30minutes.
Duringeachofthesethreeperiods,EEGdatawerecollectedforinformationontherats'sleepstages.The
meanfiringratesofhippocampalplacecellsduringprebehaviorSWS(PRE)andthreetenminuteintervals
inpostbehaviorSWS(POST)werecalculatedbyaveragingacross22trackrunningsessionsfromseven
rats.TheresultsshowedthattenminutesafterthetrialRUNsession,therewasa12%increaseinthemean
firingrateofhippocampalplacecellsfromthePRElevel.After20minutes,themeanfiringratereturned
rapidlytowardthePRElevel.TheelevatedfiringofhippocampalplacecellsduringSWSafterspatial
explorationcouldexplainwhytherewereelevatedlevelsofslowwavesleepinDatta'sstudy,asitalso
dealtwithaformofspatialexploration.
Astudyhasalsobeendoneinvolvingdirectcurrentstimulationtotheprefrontalcortextoincreasethe
amountofslowoscillationsduringSWS.Thedirectcurrentstimulationgreatlyenhancedwordpair
retentionthefollowingday,givingevidencethatSWSplaysalargeroleintheconsolidationofepisodic
memories.[102]
Thedifferentstudiessuggestthatthereisacorrelationbetweensleepandthecomplexfunctionsof
memory.HarvardsleepresearchersSaper[103]andStickgold[104]pointoutthatanessentialpartofmemory
andlearningconsistsofnervecelldendrites'sendingofinformationtothecellbodytobeorganizedinto
newneuronalconnections.Thisprocessdemandsthatnoexternalinformationispresentedtothese
dendrites,anditissuggestedthatthismaybewhyitisduringsleepthatmemoriesandknowledgeare
solidifiedandorganized.
Recentstudiesexamininggeneexpressionandevolutionaryincreasesinbrainsizeoffercomplimentary
supportfortheroleofsleepinthemammalianmemoryconsolidationtheory.Evolutionaryadvancesinthe
sizeofthemammalianamygdala,(abrainstructureactiveduringsleepandinvolvedinmemory
processing),arealsoassociatedwithincreasesinNREMsleepdurations.[105]Likewise,nighttimegene
expressiondiffersfromdaytimeexpressionandspecificallytargetsgenesthoughttobeinvolvedinmemory
consolidationandbrainplasticity.[106]
Preservation
The"PreservationandProtection"theoryholdsthatsleepservesanadaptivefunction.Itprotectstheanimal
duringthatportionofthe24hourdayinwhichbeingawake,andhenceroamingaround,wouldplacethe
individualatgreatestrisk.[107]Organismsdonotrequire24hourstofeedthemselvesandmeetother
necessities.Fromthisperspectiveofadaptation,organismsaresaferbystayingoutofharm'sway,where
potentiallytheycouldbepreytoother,strongerorganisms.Theysleepattimesthatmaximizetheirsafety,
giventheirphysicalcapacitiesandtheirhabitats.
Thistheoryfailstoexplainwhythebraindisengagesfromtheexternalenvironmentduringnormalsleep.
However,thebrainconsumesalargeproportionofthebody'senergyatanyonetimeandpreservationof
energycouldonlyoccurbylimitingitssensoryinputs.Anotherargumentagainstthetheoryisthatsleepis
notsimplyapassiveconsequenceofremovingtheanimalfromtheenvironment,butisa"drive"animals
altertheirbehaviorsinordertoobtainsleep.
Therefore,circadianregulationismorethansufficienttoexplainperiodsofactivityandquiescencethatare
adaptivetoanorganism,butthemorepeculiarspecializationsofsleepprobablyservedifferentand
unknownfunctions.Moreover,thepreservationtheoryneedstoexplainwhycarnivoreslikelions,which
areontopofthefoodchainandthushavelittletofear,sleepthemost.Ithasbeensuggestedthattheyneed
tominimizeenergyexpenditurewhennothunting.
Preservationalsodoesnotexplainwhyaquaticmammalssleepwhilemoving.Quiescenceduringthese
vulnerablehourswoulddothesameandwouldbemoreadvantageous,becausetheanimalwouldstillbe
abletorespondtoenvironmentalchallengeslikepredators,etc.Sleepreboundthatoccursafterasleepless
nightwillbemaladaptive,butobviouslymustoccurforareason.Azebrafallingasleepthedayafterit
spentthesleepingtimerunningfromalionismore,notless,vulnerabletopredation.
Emotionalimpacts
Someresearchshowssleepclearsnegativeemotions.[108]
Dreaming
Mainarticle:Dream
Duringsleep,especiallyREMsleep,peopletendtohavedreams:
elusivefirstpersonexperienceswhichdespitetheirfrequently
bizarrequalitiesseemrealisticwhileinprogress.Dreamscan
seamlesslyincorporateelementswithinaperson'smindwhich
wouldnotnormallygotogether.Theycanincludeapparent
sensationofalltypes,especiallyvisionandmovement.[4]
Dreamscanalsobesuppressedorencouragedusinganti
depressants,acetaminophen,ibuprofen,oralcoholicbeveragesis BronzestatueofErossleeping,3rd
thoughttopotentiallysuppressdreams,whereasmelatoninmay centuryBCearly1stcenturyAD
havetheabilitytoencouragethem.[109]
Peoplehaveproposedmanyhypothesesaboutthefunctionsofdreaming.SigmundFreudpostulatedthat
dreamsarethesymbolicexpressionoffrustrateddesiresthathavebeenrelegatedtotheunconsciousmind,
andheuseddreaminterpretationintheformofpsychoanalysistouncoverthesedesires.[110]
Freud'sworkconcernsthepsychologicalroleofdreams,whichdoesnotexcludeanyphysiologicalrole
theymayhave.Recentresearchclaimsthatsleephastheoverallroleofconsolidationandorganizationof
synapticconnectionsformedduringlearningandexperience.[111]Assuch,Freud'sworkisnotruledout.
Nevertheless,Freud'sresearchhasbeenexpandedon,especiallywithregardtotheorganizationand
consolidationofrecentmemory.
Whilepenileerectionsduringsleeparecommonlybelievedtoindicatedreamswithsexualcontent,theyare
notmorefrequentduringsexualdreamsthantheyareduringnonsexualdreams.[112]Theparasympathetic
nervoussystemexperiencesincreasedactivityduringREMsleepwhichmaycauseerectionofthepenisor
clitoris.Inmales,80%to95%ofREMsleepisnormallyaccompaniedbypartialtofullpenileerection,
whileonlyabout12%ofmen'sdreamscontainsexualcontent.[19]
JohnAllanHobsonandRobertMcCarleyproposethatdreamsarecausedbytherandomfiringofneurons
inthecerebralcortexduringtheREMperiod.Neatly,thistheoryhelpsexplaintheirrationalityofthemind
duringREMperiods,as,accordingtothistheory,theforebrainthencreatesastoryinanattemptto
reconcileandmakesenseofthenonsensicalsensoryinformationpresentedtoit.Ergo,theoddnatureof
manydreams.[5]
Evolution
AccordingtoTsoukalas(2012)REMsleepisanevolutionarytransformationofawellknowndefensive
mechanism,thetonicimmobilityreflex.Thisreflex,alsoknownasanimalhypnosisordeathfeigning,
functionsasthelastlineofdefenseagainstanattackingpredatorandconsistsofthetotalimmobilizationof
theanimal:theanimalappearsdead(cf."playingpossum").Theneurophysiologyandphenomenologyof
thisreactionshowstrikingsimilaritiestoREMsleep,afactwhichbetraysadeepevolutionarykinship.For
example,bothreactionsexhibitbrainstemcontrol,paralysis,sympatheticactivation,andthermoregulatory
changes.Thistheoryintegratesmanyearlierfindingsintoaunified,andevolutionarywellinformed,
framework.[113][114]
Mammals,birdsandreptilesevolvedfromamnioticancestors,thefirstvertebrateswithlifecycles
independentofwater.ThefactthatbirdsandmammalsaretheonlyknownanimalstoexhibitREMand
NREMsleepindicatesacommontraitbeforedivergence.[115]Reptilesarethereforethemostlogicalgroup
toinvestigatetheoriginsofsleep.Daytimeactivityinreptilesalternatesbetweenbaskingandshortboutsof
activebehavior,whichhassignificantneurologicalandphysiologicalsimilaritiestosleepstatesin
mammals.ItisproposedthatREMsleepevolvedfromshortboutsofmotoractivityinreptileswhileSWS
evolvedfromtheirbaskingstatewhichshowssimilarslowwaveEEGpatterns.[116]
Earlymammalsengagedinpolyphasicsleep,dividingsleepintomultipleboutsperday.Whatthenexplains
monophasicsleepbehaviorwidelyobservedinmammalstoday?Higherdailysleepquotasandshortersleep
cyclesinpolyphasicspeciesascomparedtomonophasicspecies,suggestthatpolyphasicsleepmaybea
lessefficientmeansofattainingsleepsbenefits.SmallspecieswithhigherBMRmaythereforehaveless
efficientsleeppatterns.Itfollowsthattheevolutionofmonophasicsleepmayhithertobeanunknown
advantageofevolvinglargermammalianbodysizesandthereforelowerBMR.[117]
Genetics
Itishypothesizedthataconsiderableamountofsleeprelatedbehavior,suchaswhenandhowlonga
personneedstosleep,isregulatedbygenetics.Researchershavediscoveredsomeevidencethatseemsto
supportthisassumption.[118]Monozygotic(identical)butnotdizygotic(fraternal)twinstendtohavesimilar
sleephabits.Neurotransmitters,moleculeswhoseproductioncanbetracedtospecificgenes,areone
geneticinfluenceonsleepwhichcanbeanalyzed.Andthecircadianclockhasitsownsetofgenes.[119]
ABCC9isonegenefoundwhichinfluencesthedurationofhumansleep.[120]
Insomnia
Insomnia,adyssomnia,isageneraltermdescribingdifficultyfallingasleepandstayingasleep.Insomniais
themostcommonsleepproblem,withmanyadultsreportingoccasionalinsomnia,and1015%reportinga
chroniccondition.[121]Insomniacanhavemanydifferentcauses,includingpsychologicalstress,apoor
sleepenvironment,aninconsistentsleepschedule,orexcessivementalorphysicalstimulationinthehours
beforebedtime.Insomniaisoftentreatedthroughbehavioralchangeslikekeepingaregularsleepschedule,
avoidingstimulatingorstressfulactivitiesbeforebedtime,andcuttingdownonstimulantssuchascaffeine.
Thesleepenvironmentmaybeimprovedbyinstallingheavydrapestoshutoutallsunlight,andkeeping
computers,televisionsandworkmaterialsoutofthesleepingarea.
A2010reviewofpublishedscientificresearchsuggestedthatexercisegenerallyimprovessleepformost
people,andhelpssleepdisorderssuchasinsomnia.Theoptimumtimetoexercisemaybe4to8hours
beforebedtime,thoughexerciseatanytimeofdayisbeneficial,withtheexceptionofheavyexercisetaken
shortlybeforebedtime,whichmaydisturbsleep.However,thereisinsufficientevidencetodrawdetailed
conclusionsabouttherelationshipbetweenexerciseandsleep.[122]SleepingmedicationssuchasAmbien
andLunestaareanincreasinglypopulartreatmentforinsomnia.Althoughthesenonbenzodiazepine
medicationsaregenerallybelievedtobebetterandsaferthanearliergenerationsofsedatives,theyhavestill
generatedsomecontroversyanddiscussionregardingsideeffects.Whitenoiseappearstobeapromising
treatmentforinsomnia.[123]
Obstructivesleepapnea
Obstructivesleepapneaisaconditioninwhichmajorpausesinbreathingoccurduringsleep,disruptingthe
normalprogressionofsleepandoftencausingothermoreseverehealthproblems.Apneasoccurwhenthe
musclesaroundthepatient'sairwayrelaxduringsleep,causingtheairwaytocollapseandblocktheintake
ofoxygen.[124]Obstructivesleepapneaismorecommonthancentralsleepapnea.[125]Asoxygenlevelsin
theblooddrop,thepatientthencomesoutofdeepsleepinordertoresumebreathing.Whenseveralofthese
episodesoccurperhour,sleepapnearisestoalevelofseriousnessthatmayrequiretreatment.
Diagnosingsleepapneausuallyrequiresaprofessionalsleepstudyperformedinasleepclinic,becausethe
episodesofwakefulnesscausedbythedisorderareextremelybriefandpatientsusuallydonotremember
experiencingthem.Instead,manypatientssimplyfeeltiredaftergettingseveralhoursofsleepandhaveno
ideawhy.Majorriskfactorsforsleepapneaincludechronicfatigue,oldage,obesityandsnoring.
Othersleepdisorders
Sleepdisordersincludenarcolepsy,periodiclimbmovementdisorder(PLMD),restlesslegsyndrome
(RLS),upperairwayresistancesyndrome(UARS),andthecircadianrhythmsleepdisorders.Fatalfamilial
insomnia,orFFI,anextremelyraregeneticdiseasewithnoknowntreatmentorcure,ischaracterizedby
increasinginsomniaasoneofitssymptomsultimatelysufferersofthediseasestopsleepingentirely,
beforedyingofthedisease.[76]
Somnambulism,knownassleepwalking,isalsoacommonsleepingdisorder,especiallyamongchildren.In
somnambulismtheindividualgetsupfromhis/hersleepandwandersaroundwhilestillsleeping.[126]
Olderpeoplemaybemoreeasilyawakenedbydisturbancesintheenvironment[127]andmaytosome
degreelosetheabilitytoconsolidatesleep.
Effectoffoodanddrugsonsleep
Hypnotics
Nonbenzodiazepinehypnoticssuchaseszopiclone(Lunesta),zaleplon(Sonata),andzolpidem
(Ambien)arecommonlyusedassleepaidsprescribedbydoctorstotreatformsofinsomnia.
Nonbenzodiazepinesarethemostcommonlyprescribedandoverthecountersleepaidsused
worldwideandhavebeengreatlygrowinginusesincethe1990s.TheytargettheGABAAreceptor.
BenzodiazepinestargettheGABAAreceptoralso,andassuch,theyarecommonlyusedsleepaidsas
well,thoughbenzodiazepineshavebeenfoundtodecreaseREMsleep.[128]
Antihistamines,suchasdiphenhydramine(Benadryl)anddoxylamine(foundinvariousOTC
medicines,suchasNyQuil)
Alcohol(ethanol)Often,peoplestartdrinkingalcoholinordertogettosleep(alcoholisinitiallya
sedativeandwillcausesomnolence,encouragingsleep).However,beingaddictedtoalcoholcanlead
todisruptedsleep,becausealcoholhasareboundeffectlaterinthenight.Asaresult,thereisstrong
evidencelinkingalcoholismandformsofinsomnia.[129]AlcoholalsoreducesREMsleep.[128]
Barbituratescausedrowsinessandhaveactionssimilartoalcoholinthattheyhaveareboundeffect
andinhibitREMsleep,sotheyarenotusedasalongtermsleepaid.
Melatoninisanaturallyoccurringhormonethatregulatessleepiness.Itismadeinthebrain,where
tryptophanisconvertedintoserotoninandthenintomelatonin,whichisreleasedatnightbythe
pinealglandtoinduceandmaintainsleep.Melatoninsupplementationmaybeusedasasleepaid,
bothasahypnoticandasachronobiotic(seephaseresponsecurve,PRC).[38]
Siestaandthe"postlunchdip"Manypeoplehaveatemporarydropinalertnessintheearly
afternoon,commonlyknownasthe"postlunchdip."Whilealargemealcanmakeapersonfeel
sleepy,thepostlunchdipismostlyaneffectofthecircadianclock.Peoplenaturallyfeelmostsleepy
attwotimesofthedayabout12hoursapartforexample,at2:00a.m.and2:00p.m.Atthosetwo
times,thebodyclock"kicksin."Atabout2p.m.(14:00),itoverridesthehomeostaticbuildupof
sleepdebt,allowingseveralmorehoursofwakefulness.Atabout2a.m.(02:00),withthedailysleep
debtpaidoff,it"kicksin"againtoensureafewmorehoursofsleep.
TryptophanTheaminoacidtryptophanisabuildingblockofproteins.Ithasbeenclaimedto
contributetosleepiness,sinceitisaprecursoroftheneurotransmitterserotonin,involvedinsleep
regulation.However,nosoliddatahaveeverlinkedmodestdietarychangesintryptophantochanges
insleep.
CannabisSomepeopleusecannabistoinducesleepiness.Usersoftenreportrelaxationand
drowsiness.Ithasbeenshownthattetrahydrocannabinol(THC),theprincipalpsychoactive
constituentincannabis,reducestheamountofREMsleep.[130]Frequentusersoftenreportbeing
unabletorecalltheirdreams.
Stimulants
Amphetamine(dextroamphetamine,andarelated,slightlymorepowerfuldrugmethamphetamine,
etc.)areusedtotreatnarcolepsy.Theirmostcommoneffectsareanxiety,insomnia,stimulation,
increasedalertness,anddecreasedhunger.
Caffeineisastimulantthatworksbyslowingtheactionofthehormonesinthebrainthatcause
somnolence,particularlybyactingasanantagonistatadenosinereceptors.Effectivedosageis
individual,inpartdependentonpriorusage.Itcancausearapidreductioninalertnessasitwearsoff.
CocaineandcrackcocaineStudiesoncocainehaveshownitseffectstobemediatedthroughthe
circadianrhythmsystem.[131]Thismayberelatedtotheonsetofhypersomnia(oversleeping)in
regardto"cocaineinducedsleepdisorder."[132]
MDMA,includingsimilardrugslikeMDA,MMDA,orbkMDMATheclassofdrugscalled
empathogenentactogenskeepusersawakewithintenseeuphoria.
MethylphenidateCommonlyknownbythebrandnamesRitalinandConcerta,methylphenidateis
similarinactiontoamphetamineandcocaineitschemicalcompositionmorecloselyresemblesthat
ofcocaine.
TobaccoTobaccohasbeenfoundnotonlytodisruptbutalsotoreducetotalsleeptime.Instudies,
usershavedescribedmoredaytimedrowsinessthannonsmokers.[133]
OtheranalepticdrugslikeModafinilandArmodafinilareprescribedtotreatnarcolepsy,idiopathic
hypersomnia,shiftworksleepdisorder,andotherconditionscausingexcessivedaytimesleepiness.
Theprecisemechanismofthesecentralnervoussystem(CNS)stimulantsisnotknown,buttheyhave
beenshowntoincreaseboththereleaseofmonoaminesandlevelsofhypothalamichistamine,
therebypromotingwakefulness.
Nutritionaleffectsonsleep
Dietaryandnutritionalchoicesaffectsleepdurationandquality.Researchisbeingconductedinanattempt
todiscoverwhatkindsofnutritionalchoicesresultinbettersleepquality.
AstudyintheWesternJournalofNursingResearchin2011[134]comparedhowsleepqualitywasaffected
byfourdifferentdiets:ahighproteindiet,ahighfatdiet,ahighcarbohydratediet,andacontroldiet.
Resultsindicatedthatthedietshighinproteinresultedinfewerwakefulepisodesduringnighttimesleep.
Thehighcarbohydratedietwaslinkedtomuchshorterperiodsofquiescentorrestfulsleep.Theseresults
suggestthatingestednutrientsdoplayaroleindeterminingsleepquality.Anotherinvestigationpublished
inNutritionResearchin2012[135]examinedtheeffectsofvariouscombinationsofdietarychoicesinregard
tosleep.Althoughitisdifficulttodetermineoneperfectdietforsleepenhancement,thisstudyindicated
thatavarietyofmicroandmacronutrientsareneededtomaintainlevelsofhealthfulandrestfulsleep.A
varieddietcontainingfreshfruitsandvegetables,lowfatproteins,andwholegrainscanbethebest
nutritionaloptionforindividualsseekingtoimprovethequalityoftheirsleep.
Anthropologyofsleep
Researchsuggeststhatsleeppatternsvarysignificantlyacross
cultures.[136][137]Themoststrikingdifferencesarebetweensocieties
thathaveplentifulsourcesofartificiallightandonesthatdonot.[136]
Theprimarydifferenceappearstobethatprelightcultureshave
morebrokenupsleeppatterns.[136]Forexample,peoplewithout
artificiallightmightgotosleepfarsoonerafterthesunsets,but
thenwakeupseveraltimesthroughoutthenight,punctuatingtheir
sleepwithperiodsofwakefulness,perhapslastingseveralhours.[136]
TheLandofCockaignebyPieter
Theboundariesbetweensleepingandwakingareblurredinthese BruegeltheElder,1567.
societies.[136]Someobserversbelievethatnighttimesleepinthese
societiesismostoftensplitintotwomainperiods,thefirstcharacterizedprimarilybydeepsleepandthe
secondbyREMsleep.[136]
Somesocietiesdisplayafragmentedsleeppatterninwhichpeoplesleepatalltimesofthedayandnightfor
shorterperiods.Inmanynomadicorhuntergatherersocieties,peoplewillsleeponandoffthroughoutthe
dayornightdependingonwhatishappening.[136]Plentifulartificiallighthasbeenavailableinthe
industrializedWestsinceatleastthemid19thcentury,andsleeppatternshavechangedsignificantly
everywherethatlightinghasbeenintroduced.[136]Ingeneral,peoplesleepinamoreconcentratedburst
throughthenight,goingtosleepmuchlater,althoughthisisnotalwaystrue.[136]
HistorianRogerEkrichthinksthatthetraditionalpatternof"segmentedsleep,"asitiscalled,beganto
disappearamongtheurbanupperclassinEuropeinthelate17thcenturyandthechangespreadoverthe
next200yearsbythe1920s"theideaofafirstandsecondsleephadrecededentirelyfromoursocial
consciousness."[138]Ekrichattributesthechangetoincreasesin"streetlighting,domesticlightinganda
surgeincoffeehouses,"whichslowlymadenighttimealegitimatetimeforactivity,decreasingthetime
availableforrest.[138]Todayinmostsocietiespeoplesleepduringthenight,butinveryhotclimatesthey
maysleepduringtheday.[139]DuringRamadan,manyMuslimssleepduringthedayratherthanatnight[140]
andpeopleworkingnightstrytosleepinthedaytime.
Insomesocieties,peoplegenerallysleepwithatleastoneotherperson(sometimesmany)orwithanimals.
Inothercultures,peoplerarelysleepwithanyonebutamostintimaterelation,suchasaspouse.Inalmost
allsocieties,sleepingpartnersarestronglyregulatedbysocialstandards.Forexample,apersonmightonly
sleepwiththeimmediatefamily,theextendedfamily,aspouseorromanticpartner,children,childrenofa
certainage,childrenofspecificgender,peersofacertaingender,friends,peersofequalsocialrank,orwith
nooneatall.Sleepmaybeanactivelysocialtime,dependingonthesleepgroupings,withnoconstraints
onnoiseoractivity.[136]
Peoplesleepinavarietyoflocations.Somesleepdirectlyonthegroundothersonaskinorblanketothers
sleeponplatformsorbeds.Somesleepwithblankets,somewithpillows,somewithsimpleheadrests,some
withnoheadsupport.Thesechoicesareshapedbyavarietyoffactors,suchasclimate,protectionfrom
predators,housingtype,technology,personalpreference,andtheincidenceofpests.[136]
Sleepinnonhumananimals
Mainarticle:Sleep(nonhuman)
Neurologicalsleepstatescanbedifficulttodetectinsomeanimals.
Inthesecases,sleepmaybedefinedusingbehavioralcharacteristics
suchasminimalmovement,posturestypicalforthespecies,and
reducedresponsivenesstoexternalstimulation.Sleepisquickly
reversible,asopposedtohibernationorcoma,andsleepdeprivation
isfollowedbylongerordeeperreboundsleep.Herbivores,who
requirealongwakingperiodtogatherandconsumetheirdiet,
typicallysleeplesseachdaythansimilarlysizedcarnivores,who SleepingJapanesemacaques.
mightwellconsumeseveraldays'supplyofmeatinasitting.
Unicellularorganismsdonotnecessarily"sleep",althoughmanyofthemhavepronouncedcircadian
rhythms.Insectsgothroughcircadianrhythmsofactivityandpassivitybutsomedonotseemtohavea
homeostaticsleepneed.Drosophiladoesseemtohaveabehavioralstateanalogoustomammaliansleep,
butitisnotwellunderstood.InsectsdonotseemtoexhibitREMsleep.Fisharesimilar,exhibitingperiods
ofinactivitybutshowingnosignificantreactionstodeprivationofthiscondition.Amphibianshaveperiods
ofinactivitybutshowhighvigilance(receptivitytopotentiallythreateningstimuli)inthisstate.Reptiles
havequiescentperiodsmoresimilartomammaliansleep,butdonotexhibitREMormuscleatonia.Birds
dohaveaREMphasetheymaynotaccumulatesleepdebtbutsleepdeprivationmayaffecttheirnormal
wakingcondition.[7][77]
Mammalshavewidediversityinsleepphenomena.Generally,theygothroughperiodsofalternatingnon
REMandREMsleep,butthesemanifestdifferently.Inthemonotreme,REMelectricalactivationoccursin
thebrainstem,asitdoesinhumans,butdoesnotextendatalltotheforebrainsuggestingthatplatypido
notdream.Inverselytohumansandrats,malearmadillosgeterectionsduringnonREMsleep.[7]
Horsesandotherherbivorousungulatescansleepwhilestanding,butmustnecessarilyliedownforREM
sleep(whichcausesmuscularatony)forshortperiods.Giraffes,forexample,onlyneedtoliedownfor
REMsleepforafewminutesatatime.Batssleepwhilehangingupsidedown.Someaquaticmammalsand
somebirdscansleepwithonehalfofthebrainwhiletheotherhalfisawake,socalledunihemispheric
slowwavesleep.[141]BirdsandmammalshavecyclesofnonREMandREMsleep(asdescribedabovefor
humans),thoughbirds'cyclesaremuchshorterandtheydonotlosemuscletone(golimp)totheextentthat
mostmammalsdo.
Manymammalssleepforalargeproportionofeach24hourperiodwhentheyareveryyoung.[142]
However,killerwhalesandsomeotherdolphinsdonotsleepduringthefirstmonthoflife.[143]Instead,
youngdolphinsandwhalesfrequentlytakerestsbypressingtheirbodynexttotheirmotherswhileshe
swims.Asthemotherswimssheiskeepingheroffspringafloattopreventthemfromdrowning.This
allowsyoungdolphinsandwhalestorest,whichwillhelpkeeptheirimmunesystemhealthyinturn,
protectingthemfromillnesses.[144]Duringthisperiod,mothersoftensacrificesleepfortheprotectionof
theiryoungfrompredators.However,unlikeothermammals,adultdolphinsandwhalesareabletogo
withoutsleepforamonth.[144][145]
Alsounliketerrestrialmammals,dolphins,whales,andpinnipeds(seals)cannotgointoadeepsleep.The
consequencesoffallingintoadeepsleepformarinemammalianspeciescanbesuffocationanddrowning,
orbecomingeasypreyforpredators.Thus,dolphins,whales,andsealsengageinunihemisphericsleep,
whichallowsonebrainhemispheretoremainfullyfunctional,whiletheothergoestosleep.The
hemispherethatisasleep,alternatessothatbothhemispherescanbefullyrested.[144][146]Justliketerrestrial
mammals,pinnipedsthatsleeponlandfallintoadeepsleepandbothhemispheresoftheirbrainshutdown
andareinfullsleepmode.[147][148]
Sleepinginart
ZweischlafendeMdchen Lullaby,WilliamAdolphe FlamingJunebyFrederic

aufderOfenbank,Albert Bouguereau,1875 LordLeighton,~1895
Anker,1895
TheSentrybyCarel SleepingJaguar,Paul Shrapek(Snorer),

Fabritius,1654 Klimsch Wrocaw'sdwarfs
TheSleepofReason
ProducesMonstersby
Goya,1799
Seealso
Microsleep
Morvan'ssyndrome
Polyphasicsleep
Powernap
Segmentedsleep
Sleeparchitecture
Sleepdeprivation
Sleepepidemiology
Sleepmedicine
Sleepparalysis
Somnology
Suddeninfantdeathsyndrome
Suddenunexpecteddeathsyndrome
Ultradianandcircadianrhythms.
Nap
Positions,practices,andrituals
Sleepingpositions
Cosleeping
Hypnosis
Meditation
Neutralspine
Sleephygiene
Yoganidra
WorldSleepDay
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