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sleep
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{{About|sleep in humans|non-human sleep|Sleep (non-human)|other uses}}{{redirect-multi|4|Sleep architecture|Waking up|Asleep|Slept||Waking Up (disambiguation)|and|Asleep (disambiguation)|and|SLEPT analysis}}{{Use dmy dates|date=May 2015}}{{pp|small=yes}}(File:Sleeping-girl.jpg|thumb|Sleep is associated with a state of muscle relaxation and reduced perception of environmental stimuli.)File:ASC Leiden - van de Bruinhorst Collection - Somaliland 2019 - 4666 - Sleeping dog on a street of Hargeysa (cropped).jpg|thumb|Sleeping dog on a street of Hargeysa, SomalilandSomalilandSleep is a naturally recurring state of mind and body, characterized by altered consciousness, relatively inhibited sensory activity, reduced muscle activity and inhibition of nearly all voluntary muscles during rapid eye movement (REM) sleep,Ferri, R., Manconi, M., Plazzi, G., Bruni, O., Vandi, S., Montagna, P., ... Zucconi, M. (2008). A quantitative statistical analysis of the submentalis muscle EMG amplitude during sleep in normal controls and patients with REM sleep behavior disorder. Journal of Sleep Research, 17(1), 89–100.weblink and reduced interactions with surroundings.WEB,weblink Brain Basics: Understanding Sleep, 2017, Office of Communications and Public Liaison, National Institute of Neurological Disorders and Stroke, US National Institutes of Health, Bethesda, MD, 10 December 2013,weblink" title="web.archive.org/web/20071011011207weblink">weblink 11 October 2007, live, dmy-all, It is distinguished from wakefulness by a decreased ability to react to stimuli, but more reactive than coma or disorders of consciousness, with sleep displaying very different and active brain patterns.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.WEB, 2006, Sleep-wake cycle: its physiology and impact on health,weblink National Sleep Foundation, 24 May 2017,weblink 30 August 2017, live, dmy-all, The internal circadian clock promotes sleep daily at night. The diverse purposes and mechanisms of sleep are the subject of substantial ongoing research.WEB,weblink Waking Up To Sleep, 25 January 2008, Bingham, Roger, Terrence, Sejnowski, Jerry, Siegel, Mark Eric, Dyken, Charles, Czeisler, February 2007, Several conference videos, The Science Network,weblink" title="web.archive.org/web/20110724132410weblink">weblink 24 July 2011, live, dmy-all, Sleep is a highly conserved behavior across animal evolution.JOURNAL, Joiner, William J., Unraveling the Evolutionary Determinants of Sleep, Current Biology, October 2016, 26, 20, R1073–R1087, 10.1016/j.cub.2016.08.068, 27780049, 5120870, 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.NEWS, Randall, David K., Book excerpt: How the lightbulb disrupted our sleeping patterns and changed the world,weblink 31 August 2016, National Post, 19 September 2012, "... the sudden introduction of bright nights during hours when it should be dark threw a wrench into a finely choreographed system of life.,weblink 6 April 2019, live, dmy-all,

Physiology

(File:REM-søvn.jpg|thumb|right|200px|An artist's creative illustration depicting REM sleep.)The most pronounced physiological changes in sleep occur in the brain.Pierre A. A. Maquet et al., "Brain Imaging on Passing to Sleep"; Chapter 6 in Parmeggiani & Velluti (2005). 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.Brown, pp. 1118–1119: "Compared with wakefulness, sleep reduces brain energy demands, as suggested by the 44% reduction in the cerebral metabolic rate (CMR) of glucose (791) and a 25% reduction in the CMR of O2 (774) during sleep." 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.JOURNAL, Siegel Jerome M, 2008, Do all animals sleep?, Trends in Neurosciences, 31, 4, 208–213, 10.1016/j.tins.2008.02.001, 18328577, 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.During slow-wave sleep, humans secrete bursts of growth hormone. All sleep, even during the day, is associated with secretion of prolactin.Eve Van Cauter & Karine Spiegel (1999). "Circadian and Sleep Control of Hormonal Secretions", in Turek & Zee (eds.), Regulation of Sleep and Circadian Rhythms, pp. 397–425.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.Brown, p. 1087.Rosa Peraita-Adrados, "Electroencephalography, Polysomnography, and Other Sleep Recording Systems"; Chapter 5 in Parmeggiani & Velluti (2005). Sleep researchers also use simplified electrocardiography (EKG) for cardiac activity and actigraphy for motor movements.

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. 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, and suspension of homeostasis.Parmeggiani (2011), Systemic Homeostasis and Poikilostasis in Sleep, pp. 12–15.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.JOURNAL, McCarley Robert W., Robert W. McCarley, 2007, Neurobiology of REM and NREM sleep, Sleep Medicine, 8, 4, 302–330, 10.1016/j.sleep.2007.03.005, 17468046, 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.JOURNAL, Silber MH, Ancoli-Israel S, Bonnet MH, Chokroverty S, Grigg-Damberger MM, Hirshkowitz M, Kapen S, Keenan SA, Kryger MH, Penzel T, Pressman MR, Iber C, The visual scoring of sleep in adults, Journal of Clinical Sleep Medicine, 3, 2, 121–131, March 2007, 17557422,weblink 17 March 2009,weblink" title="web.archive.org/web/20110724213444weblink">weblink 24 July 2011, live, dmy-all, 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. 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.

Awakening

{{Redirect|Waking up }}{{See|Wakefulness|Ascending reticular activating system}}File:1900 The Awakening.jpg|thumb|"The Awakening", an illustration to writing by Leo TolstoyLeo TolstoyAwakening 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.JOURNAL, Åkerstedt Torbjorn, Billiard Michel, Bonnet Michael, Ficca Gianluca, Garma Lucile, Mariotti Maurizio, Salzarulo Piero, Schulz Hartmut, 2002, Awakening from Sleep, Sleep Medicine Reviews, 6, 4, 267–286, 10.1053/smrv.2001.0202, Awakening involves heightened electrical activation in the brain, beginning with the thalamus and spreading throughout the cortex.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.Today, many humans wake up with an alarm clock;JOURNAL, Roenneberga Till, Kuehnlea Tim, Judaa Myriam, Kantermanna Thomas, Allebrandta Karla, Gordijnb Marijke, Merrow Martha, 2007, Epidemiology of the human circadian clock,weblink Sleep Medicine Reviews, 11, 6, 429–438, 10.1016/j.smrv.2007.07.005, 17936039, 11370/65d6f03a-88cd-405c-a067-4afbc1b9ba9d, however, people can also reliably wake themselves up at a specific time with no need for an alarm. Many sleep quite differently on workdays versus days off, a pattern which can lead to chronic circadian desynchronization.JOURNAL, Waterhouse Jim, Fukuda Yumi, Morita Takeshi, 2012, Daily rhythms of the sleep-wake cycle, Journal of Physiological Anthropology, 31, 5, 5, 10.1186/1880-6805-31-5, 22738268, 3375033, Many people regularly look at television and other screens before going to bed, a factor which may exacerbate disruption of the circadian cycle.JOURNAL, Basner Mathias, Dinges David F, 2009, Dubious Bargain: Trading Sleep for Leno and Letterman, Sleep, 32, 6, 747–752, 10.1093/sleep/32.6.747, 19544750, 2690561, Scientific studies on sleep have shown that sleep stage at awakening is an important factor in amplifying sleep inertia.JOURNAL, Sleep inertia, 4, 4, 341–353, National Center for Biotechnology Information, U.S. National Library of Medicine, 12531174, 2000, Tassi, P, Muzet, A, 10.1053/smrv.2000.0098,

Timing

Sleep timing is controlled by the circadian clock (Process C), sleep–wake homeostasis (Process S), and to some extent by individual will.

Circadian clock

{{see|Circadian rhythm sleep disorder}}
missing image!
- Biological clock human.svg|402px|thumb|The human "biological clock"]]Sleep timing depends greatly on hormonal signals from the circadian clock, or Process C, a complex neurochemical system which uses signals from an organism's environment to recreate an internal day–night rhythm. Process C counteracts the homeostatic drive for sleep during the day (in diurnal animals) and augments it at night.JOURNAL, Fuller Patrick M., Gooley Joshua J., Saper Clifford B., 2006, Neurobiology of the Sleep-Wake Cycle: Sleep Architecture, Circadian Regulation, and Regulatory Feedback, 10.1177/0748730406294627, 17107938, Journal of Biological Rhythms, 21, 6, 482–93, The suprachiasmatic nucleus (SCN), a brain area directly above the optic chiasm, is presently considered the most important nexus for this process; however, secondary clock systems have been found throughout the body.An organism whose circadian clock exhibits a regular rhythm corresponding to outside signals is said to be entrained; an entrained rhythm persists even if the outside signals suddenly disappear. If an entrained human is isolated in a bunker with constant light or darkness, he or she will continue to experience rhythmic increases and decreases of body temperature and melatonin, on a period which slightly exceeds 24 hours. Scientists refer to such conditions as free-running of the circadian rhythm. Under natural conditions, light signals regularly adjust this period downward, so that it corresponds better with the exact 24 hours of an Earth day.Phyllis C. Zee & Fred W. Turek (1999), "Introduction to Sleep and Circadian Rhythms", in Turek & Zee (eds.), Regulation of Sleep and Circadian Rhythms, pp. 1–17.Derk-Jan Dijk & Dale M. Edgar (1999), "Circadian and Homeostatic Control of Wakefulness and Sleep", in Turek & Zee (eds.), Regulation of Sleep and Circadian Rhythms, pp. 111–147'The circadian clock exerts constant influence on the body, effecting sinusoidal oscillation of body temperature between roughly 36.2 Â°C and 37.2 Â°C.Charles A. Czeisler & Kenneth P. Wright, Jr. (1999), "Influence of Light on Circadian Rhythmicity in Humans", in Turek & Zee (eds.), Regulation of Sleep and Circadian Rhythms, pp. 149–180. The suprachiasmatic nucleus itself shows conspicuous oscillation activity, which intensifies during subjective day (i.e., the part of the rhythm corresponding with daytime, whether accurately or not) and drops to almost nothing during subjective night.Piotr Zlomanczuk & William J. Schwartz (1999). "Cellular and Molecular Mechanisms of Circadian Rhythms in Mammals", in Turek & Zee (eds.), Regulation of Sleep and Circadian Rhythms, pp. 309–342. The circadian pacemaker in the suprachiasmatic nucleus has a direct neural connection to the pineal gland, which releases the hormone melatonin at night. Cortisol levels typically rise throughout the night, peak in the awakening hours, and diminish during the day.Thomas A. Wehr (1999). "The Impact of Changes in Nightlength (Scotoperiod) on Human Sleep", in Turek & Zee (eds.), Regulation of Sleep and Circadian Rhythms, pp. 263–285. Circadian prolactin secretion begins in the late afternoon, especially in women, and is subsequently augmented by sleep-induced secretion, to peak in the middle of the night. Circadian rhythm exerts some influence on the nighttime secretion of growth hormone.The circadian rhythm influences the ideal timing of a restorative sleep episode.JOURNAL, Wyatt JK, Ritz-De Cecco A, Czeisler CA, Dijk DJ, Circadian temperature and melatonin rhythms, sleep, and neurobehavioral function in humans living on a 20-h day, American Journal of Physiology, 277, 4, R1152–R1163, 1 October 1999, 10516257, 10.1152/ajpregu.1999.277.4.r1152, Sleepiness increases during the night. REM sleep occurs more during body temperature minimum within the circadian cycle, whereas slow-wave sleep can occur more independently of circadian time.The internal circadian clock is profoundly influenced by changes in light, since these are its main clues about what time it is. Exposure to even small amounts of light during the night can suppress melatonin secretion, and increase body temperature and wakefulness. Short pulses of light, at the right moment in the circadian cycle, can significantly 'reset' the internal clock. Blue light, in particular, exerts the strongest effect, leading to concerns that electronic media use before bed may interfere with sleep.JOURNAL, Chang, Anne-Marie, Aeschbach, Daniel, Duffy, Jeanne F., Czeisler, Charles A., 2015-01-27, Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness, Proceedings of the National Academy of Sciences of the United States of America, en, 112, 4, 1232–1237, 10.1073/pnas.1418490112, 0027-8424, 25535358, 2015PNAS..112.1232C, 4313820, Modern humans often find themselves desynchronized from their internal circadian clock, due to the requirements of work (especially night shifts), long-distance travel, and the influence of universal indoor lighting. Even if they have sleep debt, or feel sleepy, people can have difficulty staying asleep at the peak of their circadian cycle. Conversely they can have difficulty waking up in the trough of the cycle. A healthy young adult entrained to the sun will (during most of the year) fall asleep a few hours after sunset, experience body temperature minimum at 6 a.m., and wake up a few hours after sunrise.

Process S

Generally speaking, the longer an organism is awake, the more it feels a need to sleep ("sleep debt"). This driver of sleep is referred to as Process S. The balance between sleeping and waking is regulated by a process called homeostasis. Induced or perceived lack of sleep is called sleep deprivation.Process S is driven by the depletion of glycogen and accumulation of adenosine in the forebrain that disinhibits the ventrolateral preoptic nucleus, allowing for inhibition of the ascending reticular activating system.JOURNAL, Schwartz, Jonathan R.L, Roth, Thomas, Neurophysiology of Sleep and Wakefulness: Basic Science and Clinical Implications, Current Neuropharmacology, 24 January 2017, 6, 4, 367–378, 10.2174/157015908787386050, 1570-159X, 2701283, 19587857, Sleep deprivation tends to cause slower brain waves in the frontal cortex, shortened attention span, higher anxiety, impaired memory, and a grouchy mood. Conversely, a well-rested organism tends to have improved memory and mood.Brown, pp. 1134–1138. Neurophysiological and functional imaging studies have demonstrated that frontal regions of the brain are particularly responsive to homeostatic sleep pressure.JOURNAL, Gottselig JM, Adam M, Rétey JV, Khatami R, Achermann P, Landolt HP, Random number generation during sleep deprivation: effects of caffeine on response maintenance and stereotypy, Journal of Sleep Research, 15, 1, 31–40, March 2006, 16490000, 10.1111/j.1365-2869.2006.00497.x, There is disagreement on how much sleep debt it is possible to accumulate, and whether sleep debt is accumulated against an individual's average sleep or some other benchmark. It is also unclear whether the prevalence of sleep debt among adults has changed appreciably in the industrialized world in recent decades. Sleep debt does show some evidence of being cumulative. Subjectively, however, humans seem to reach maximum sleepiness after 30 hours of waking. It is likely that in Western societies, children are sleeping less than they previously have.JOURNAL, Iglowstein I, Jenni OG, Molinari L, Largo RH, Sleep duration from infancy to adolescence: reference values and generational trends, Pediatrics, 111, 2, 302–307, February 2003, 12563055, 10.1542/peds.111.2.302, Thus, the shift in the evening bedtime across cohorts accounted for the substantial decrease in sleep duration in younger children between the 1970s and the 1990s... [A] more liberal parental attitude toward evening bedtime in the past decades is most likely responsible for the bedtime shift and for the decline of sleep duration..., One neurochemical indicator of sleep debt is adenosine, a neurotransmitter that inhibits many of the bodily processes associated with wakefulness. Adenosine levels increase in the cortex and basal forebrain during prolonged wakefulness, and decrease during the sleep-recovery period, potentially acting as a homeostatic regulator of sleep.BOOK, Huang, Z.L., Zhan g, Z, Qu, W.M., 2014, Roles of Adenosine and Its Receptors in Sleep–Wake Regulation, Mori, Akihisa, Adenosine receptors in neurology and psychiatry, International Review of Neurobiology, 119, 349–371, 10.1016/B978-0-12-801022-8.00014-3, 978-0-12-801022-8, 25175972, WEB,weblink The brain from top to bottom: Molecules that build up and make you sleep, McGill University, Montreal, Quebec, Canada, 20 September 2012,weblink" title="web.archive.org/web/20130207001251weblink">weblink 7 February 2013, live, dmy-all, Coffee and caffeine temporarily block the effect of adenosine, prolong sleep latency, and reduce total sleep time and quality.JOURNAL, 26899133, 2017, Clark, I, Coffee, caffeine, and sleep: A systematic review of epidemiological studies and randomized controlled trials, Sleep Medicine Reviews, 31, 70–78, Landolt, H. P., 10.1016/j.smrv.2016.01.006,weblink 19 November 2018,weblink 4 November 2018, live, dmy-all,

Social timing

Humans are also influenced by aspects of social time, such as the hours when other people are awake, the hours when work is required, the time on the clock, etc. Time zones, standard times used to unify the timing for people in the same area, correspond only approximately to the natural rising and setting of the sun. The approximate nature of the timezone can be shown with China, a country which used to span five time zones and now officially uses only one (UTC+8).

Distribution

In polyphasic sleep, an organism sleeps several times in a 24-hour cycle, whereas in monophasic sleep occurs all at once. Under experimental conditions, humans tend to alternate more frequently between sleep and wakefulness (i.e., exhibit more polyphasic sleep) if they have nothing better to do. Given a 14-hour period of darkness in experimental conditions, humans tended towards bimodal sleep, with two sleep periods concentrated at the beginning and at the end of the dark time. Bimodal sleep in humans was more common before the industrial revolution.Different characteristic sleep patterns, such as the familiarly so-called "early bird" and "night owl", are called chronotypes. Genetics and sex have some influence on chronotype, but so do habits. Chronotype is also liable to change over the course of a person's lifetime. Seven-year-olds are better disposed to wake up early in the morning than are fifteen-year-olds. Chronotypes far outside the normal range are called circadian rhythm sleep disorders.JOURNAL, Dagan Y, Circadian rhythm sleep disorders (CRSD), Sleep Medicine Reviews, 6, 1, 45–54, 2002, 12531141, 10.1053/smrv.2001.0190,weblink PDF: full text, 2016-06-05, Early onset of CRSD, the ease of diagnosis, the high frequency of misdiagnosis and erroneous treatment, the potentially harmful psychological and adjustment consequences, and the availability of promising treatments, all indicate the importance of greater awareness of these disorders., dead,weblink" title="web.archive.org/web/20080227161654weblink">weblink 27 February 2008, dmy-all,

Naps

File:Hombre echando una siesta en San Cristóbal, Cusco, Perú, 2015-07-31, DD 49.JPG
-
The siesta habit has recently been associated with a 37% lower coronary mortality, possibly due to reduced cardiovascular stress mediated by daytime sleep.JOURNAL, Naska A, Oikonomou E, Trichopoulou A, Psaltopoulou T, Trichopoulos D, Siesta in healthy adults and coronary mortality in the general population, Archives of Internal Medicine, 167, 3, 296–301, 2007, 17296887, 10.1001/archinte.167.3.296, Short naps at mid-day and mild evening exercise were found to be effective for improved sleep, cognitive tasks, and mental health in elderly people.JOURNAL, 4732678, 2015, Tanaka, H, Sleep education with self-help treatment and sleep health promotion for mental and physical wellness in Japan, Sleep and Biological Rhythms, 14, 89–99, Tamura, N, 10.1007/s41105-015-0018-6, 26855610, Many people experience a temporary drop in alertness in the early afternoon, commonly known as the "post-lunch dip". While a large meal can make a person feel sleepy, the post-lunch dip is mostly an effect of the circadian clock. People naturally feel most sleepy at two times of the day about 12 hours apart—for example, at 2:00 a.m. and 2:00 p.m. At those two times, the body clock is activated. At about 2 p.m. (14:00), it overrides the homeostatic buildup of sleep debt, allowing several more hours of wakefulness. At about 2 a.m. (02:00), with the daily sleep debt paid off, it is activated again to ensure a few more hours of sleep.

Genetics

It is hypothesized that a considerable amount of sleep-related behavior, such as when and how long a person needs to sleep, is regulated by genetics. Researchers have discovered some evidence that seems to support this assumption.JOURNAL, He Y, Jones CR, Fujiki N, Xu Y, Guo B, Holder JL, Rossner MJ, Nishino S, Fu YH, The Transcriptional Repressor DEC2 Regulates Sleep Length in Mammals, Science, 325, 5942, 866–870, 2009, 19679812, 2884988, 10.1126/science.1174443, 2009Sci...325..866H, Monozygotic (identical) but not dizygotic (fraternal) twins tend to have similar sleep habits. Neurotransmitters, molecules whose production can be traced to specific genes, are one genetic influence on sleep which can be analyzed. The circadian clock has its own set of genes.Brown, pp. 1138–1102. Genes which may influence sleep include ABCC9,WEB, The ABCC9 of Sleep: A Genetic Factor Regulates How Long We Sleep,weblink Science Daily, 21 August 2012,weblink" title="web.archive.org/web/20121030083247weblink">weblink 30 October 2012, live, dmy-all, DEC2,WEB,weblinkweblink" title="web.archive.org/web/20110714065601weblink">weblink 14 July 2011, Gene Cuts Need for Sleep – Sleep Disorders Including, Sleep Apnea, Narcolepsy, Insomnia, Snoring and Nightmares on MedicineNet.com, 11 June 2010, JOURNAL, He Y, Jones CR, Fujiki N, Xu Y, Guo B, Holder JL, Rossner MJ, Nishino S, Fu YH, The transcriptional repressor DEC2 regulates sleep length in mammals, Science, 325, 5942, 866–870, 2009, 19679812, 2884988, 10.1126/science.1174443, 2009Sci...325..866H, and variants near PAX 8 and VRK2.JOURNAL, Jones, Samuel E., Tyrrell, Jessica, Wood, Andrew R., Beaumont, Robin N., Ruth, Katherine S., Tuke, Marcus A., Yaghootkar, Hanieh, Hu, Youna, Teder-Laving, Maris, 2016-08-01, Genome-Wide Association Analyses in 128,266 Individuals Identifies New Morningness and Sleep Duration Loci, PLOS Genetics, 12, 8, e1006125, 10.1371/journal.pgen.1006125, 1553-7404, 4975467, 27494321, (File:CC-BY icon.svg|50x50px) This content is available under the (creativecommons:by/4.0/legalcode|Creative Commons Attribution License 4.0).

Quality

The quality of sleep may be evaluated from an objective and a subjective point of view. Objective sleep quality refers to how difficult it is for a person to fall asleep and remain in a sleeping state, and how many times they wake up during a single night. Poor sleep quality disrupts the cycle of transition between the different stages of sleep.JOURNAL, Barnes, C.M., Lucianetti, L., Bhave, D.P., Christian, M.S., 2015, You wouldn't like me when I'm sleepy: Leaders' sleep, daily abusive supervision, and work unit engagement, Academy of Management Journal, 58, 5, 1419–1437, 10.5465/amj.2013.1063, dmy-all, Subjective sleep quality in turn refers to a sense of being rested and regenerated after awaking from sleep. A study by A. Harvey et al. (2002) found that insomniacs were more demanding in their evaluations of sleep quality than individuals who had no sleep problems.JOURNAL, Harvey, A.G., Payne, S., 2002, The management of unwanted pre-sleep thoughts in insomnia: Distraction with imagery versus general distraction, Behaviour Research and Therapy, 40, 3, 267–277, 11863237, 10.1016/s0005-7967(01)00012-2, 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.JOURNAL, Zisapel N, Sleep and sleep disturbances: biological basis and clinical implications, Cellular and Molecular Life Sciences, 64, 10, 1174–1186, 2007, 17364142, 10.1007/s00018-007-6529-9, JOURNAL, Dijk DJ, Lockley SW, Functional Genomics of Sleep and Circadian Rhythm Invited Review: Integration of human sleep-wake regulation and circadian rhythmicity, Journal of Applied Physiology, 92, 2, 852–862, February 2002, 11796701, 10.1152/japplphysiol.00924.2001, Consolidation of sleep for 8 h or more is only observed when sleep is initiated ~6–8 h before the temperature nadir., Along with corresponding messages from the circadian clock, this tells the body it needs to sleep.WEB,weblink Understanding Sleep: Sleep Needs, Cycles, and Stages, 25 January 2008, de Benedictis, Tina, Heather, Larson, Gina, Kemp, Suzanne, Barston, Robert, Segal, 2007, Helpguide.org, dead,weblink" title="web.archive.org/web/20080124000744weblink">weblink 24 January 2008, A person who regularly awakens at an early hour will generally not be able to sleep much later than his or her normal waking time, even if moderately sleep-deprived{{Citation needed|date=June 2013}}. The timing is correct when the following two circadian markers occur after the middle of the sleep episode and before awakening:JOURNAL, Wyatt JK, Ritz-De Cecco A, Czeisler CA, Dijk DJ, Circadian temperature and melatonin rhythms, sleep, and neurobehavioral function in humans living on a 20-h day, American Journal of Physiology, 277, 4, R1152–R1163, 1 October 1999, 10516257, ... significant homeostatic and circadian modulation of sleep structure, with the highest sleep efficiency occurring in sleep episodes bracketing the melatonin maximum and core body temperature minimum, 10.1152/ajpregu.1999.277.4.r1152, maximum concentration of the hormone melatonin, and minimum core body temperature.

Ideal duration

File:Effects of sleep deprivation.svg|thumb|The main health effects of sleep deprivation,Reference list is found on image page in Commons: (:Commons:File:Effects of sleep deprivation.svg#References) indicating impairment of normal maintenance by sleep.]]Human sleep needs vary by age and amongst individuals; sleep is considered to be adequate when there is no daytime sleepiness or dysfunction. Moreover, self-reported sleep duration is only moderately correlated with actual sleep time as measured by actigraphy,JOURNAL, Lauderdale DS, Knutson KL, Yan LL, Liu K, Rathouz PJ, Self-Reported and Measured Sleep Duration: How Similar Are They?, Epidemiology, 19, 6, 838–845, 2008, 18854708, 2785092, 10.1097/EDE.0b013e318187a7b0, and those affected with sleep state misperception may typically report having slept only four hours despite having slept a full eight hours.Insomnia Causes {{Webarchive|url=https://web.archive.org/web/20101022083445weblink |date=22 October 2010 }}. Healthcommunities.com. Original Publication: 1 December 2000, Updated: 1 December 2007.Researchers have found that sleeping 6–7 hours each night correlates with longevity and cardiac health in humans, though many underlying factors may be involved in the causality behind this relationship.NEWS, Rhonda Rowland, Experts challenge study linking sleep, life span, 15 February 2002,weblink 29 October 2013, CNN,weblink" title="web.archive.org/web/20121005172421weblink">weblink 5 October 2012, live, dmy-all, JOURNAL, Patel SR, Ayas NT, Malhotra MR, White DP, Schernhammer ES, Speizer FE, Stampfer MJ, Hu FB, A prospective study of sleep duration and mortality risk in women, Sleep, 27, 3, 440–444, May 2004, 15164896, 10.1093/sleep/27.3.440, JOURNAL, Patel SR, Malhotra A, Gottlieb DJ, White DP, Hu FB, Correlates of long sleep duration, Sleep, 29, 7, 881–889, July 2006, 16895254, 3500381, 10.1093/sleep/29.7.881, ; cf. JOURNAL, Irwin MR, Ziegler M, Sleep deprivation potentiates activation of cardiovascular and catecholamine responses in abstinent alcoholics, Hypertension, 45, 2, 252–257, February 2005, 15642774, 10.1161/01.HYP.0000153517.44295.07, 10.1.1.535.7089, JOURNAL, Ferrie JE, Shipley MJ, Cappuccio FP, Brunner E, Miller MA, Kumari M, Marmot MG, A prospective study of change in sleep duration: associations with mortality in the Whitehall II cohort, Sleep, 30, 12, 1659–1666, December 2007, 18246975, 2276139,weblink University of Warwick, 10.1093/sleep/30.12.1659, JOURNAL, Cappuccio, Francesco P., Taggart, Frances M., Kandala, Ngianga-Bakwin, Currie, Andrew, Peile, Ed, Stranges, Saverio, Miller, Michelle A., 2008-05-01, Meta-analysis of short sleep duration and obesity in children and adults, Sleep, 31, 5, 619–626, 0161-8105, 2398753, 18517032, 10.1093/sleep/31.5.619, JOURNAL, Schmid, Sebastian M., Hallschmid, Manfred, Schultes, Bernd, 2015-01-01, The metabolic burden of sleep loss, The Lancet Diabetes & Endocrinology, 3, 1, 52–62, 10.1016/S2213-8587(14)70012-9, 2213-8595, 24731536, Sleep difficulties are furthermore associated with psychiatric disorders such as depression, alcoholism, and bipolar disorder.JOURNAL, Thase ME, Depression and sleep: pathophysiology and treatment, Dialogues in Clinical Neuroscience, 8, 2, 217–226, 2006, 16889107, 3181772,weblink 1294-8322, Free full text, 22 March 2018,weblink 4 July 2016, live, dmy-all, Up to 90 percent of adults with depression are found to have sleep difficulties. Dysregulation detected by EEG includes disturbances in sleep continuity, decreased delta sleep and altered REM patterns with regard to latency, distribution across the night and density of eye movements.BOOK, Mann, Joseph John, David J. Kupfer, Biology of Depressive Disorders: Subtypes of depression and comorbid disorders, Part 2,weblink Google books, 24 July 2009, 1993, Springer, 49, 978-0-306-44296-4,weblink 10 March 2017, live, dmy-all,

Children

File:WLA metmuseum Bronze statue of Eros sleeping 7.jpg|thumb|Bronze statue of ErosErosBy the time infants reach the age of two, their brain size has reached 90 percent of an adult-sized brain;JOURNAL, Dahl RE, The regulation of sleep and arousal: Development and psychopathology, Development and Psychopathology, 2009, 8, 1, 3–27, 10.1017/S0954579400006945, a majority of this brain growth has occurred during the period of life with the highest rate of sleep. The hours that children spend asleep influence their ability to perform on cognitive tasks.BOOK, Nelson CA, Luciana M, Handbook of developmental cognitive neuroscience, 2008, MIT Press, Cambridge, Mass., 978-0262141048, 2nd, Jenni OG, Dahl RE, Sleep, cognition, and neuron, and emotion: A developmental review., 807–817, JOURNAL, Scher A, Infant sleep at 10 months of age as a window to cognitive development, Early Human Development, 81, 3, 289–192, 2005, 15814211, 10.1016/j.earlhumdev.2004.07.005, Children who sleep through the night and have few night waking episodes have higher cognitive attainments and easier temperaments than other children.JOURNAL, Spruyt K, Aitken RJ, So K, Charlton M, Adamson TM, Horne RS, Relationship between sleep/wake patterns, temperament and overall development in term infants over the first year of life, Early Human Development, 84, 5, 289–96, 2008, 17707119, 10.1016/j.earlhumdev.2007.07.002, JOURNAL, Bernier A, Carlson SM, Bordeleau S, Carrier J, Relations between physiological and cognitive regulatory systems: infant sleep regulation and subsequent executive functioning, Child Development, 81, 6, 1739–1752, 2010, 21077861, 10.1111/j.1467-8624.2010.01507.x, Sleep also influences language development. To test this, researchers taught infants a faux language and observed their recollection of the rules for that language.JOURNAL, Hupbach A, Gomez RL, Bootzin RR, Nadel L, Nap-dependent learning in infants, Developmental Science, 12, 6, 1007–1012, 2009, 19840054, 10.1111/j.1467-7687.2009.00837.x, Infants who slept within four hours of learning the language could remember the language rules better, while infants who stayed awake longer did not recall those rules as well. There is also a relationship between infants' vocabulary and sleeping: infants who sleep longer at night at 12 months have better vocabularies at 26 months.

Recommendations

(File:"Plenty of sleep keeps him on the job" - NARA - 514792.jpg|thumb)Children need many hours of sleep per day in order to develop and function properly: up to 18 hours for newborn babies, with a declining rate as a child ages. Early in 2015, after a two-year study,JOURNAL, Hirshkowitz, Max, Whiton, Kaitlyn, National Sleep Foundation's sleep time duration recommendations: methodology and results summary, Sleep Health,weblink 14 January 2015, 29073412, 10.1016/j.sleh.2014.12.010, 4 February 2015, etal, 1, 1, 40–43,weblink" title="web.archive.org/web/20171114014645weblink">weblink 14 November 2017, live, dmy-all, the National Sleep Foundation in the US announced newly revised recommendations as shown in the table below.{| class="wikitable"! Age and condition! Sleep needs
| Newborns (0–3 months)| 14 to 17 hours
| Infants (4–11 months)| 12 to 15 hours
| Toddlers (1–2 years)| 11 to 14 hours
| Preschoolers (3–4 years)| 10 to 13 hours
| School-age children (5–12 years)    |   9 to 11 hours
| Teenagers (13–17 years)
ACCESSDATE=2 OCTOBER 2009 PUBLISHER=NATIONAL SLEEP FOUNDATION 1archive-url=https://web.archive.org/web/20100118093256weblink url-status=live |df=dmy-all }}
| Adults (18–64 years)|   7 to 9 hours
| Older Adults (65 years and over)
PUBLISHER=NATIONAL HEART, LUNG AND BLOOD INSTITUTE ARCHIVE-URL=HTTPS://WEB.ARCHIVE.ORG/WEB/20150725124206/HTTP://WWW.NHLBI.NIH.GOV/HEALTH/HEALTH-TOPICS/TOPICS/SDD/HOWMUCH URL-STATUS=LIVE, dmy-all,

Functions

Restoration

The human organism physically restores itself during sleep, healing itself and removing metabolic wastes which build up during periods of activity. This restoration takes place mostly during slow-wave sleep, during which body temperature, heart rate, and brain oxygen consumption decrease. The brain, especially, requires sleep for restoration, whereas in the rest of the body these processes can take place during quiescent waking. In both cases, the reduced rate of metabolism enables countervailing restorative processes.Raymond Cespuglio, Damien Colas, & Sabine Gautier-Sauvigné, "Energy Processes Underlying the Sleep Wake Cycle"; Chapter 1 in Parmeggiani & Velluti (2005).While awake, metabolism generates reactive oxygen species, which are damaging to cells. During sleep, metabolic rates decrease and reactive oxygen species generation is reduced allowing restorative processes to take over. The sleeping brain has been shown to remove metabolic waste products at a faster rate than during an awake state.WEB, Brain may flush out toxins during sleep,weblink National Institutes of Health, 25 October 2013, dead,weblink" title="web.archive.org/web/20140116200652weblink">weblink January 16, 2014, JOURNAL, Lulu Xie, Hongyi Kang1, Qiwu Xu, Michael J. Chen, Yonghong Liao, Meenakshisundaram Thiyagarajan, John O'Donne, Daniel J. Christensen, Charles Nicholson, Jeffrey J. Iliff, Takahiro Takano, Rashid Deane, Maiken Nedergaard, Sleep Drives Metabolite Clearance from the Adult Brain, Science, 2013, 342, 6156, 373–377, 10.1126/science.1241224, 24136970, 3880190, 2013Sci...342..373X, It is further theorized that sleep helps facilitate the synthesis of molecules that help repair and protect the brain from these harmful elements generated during waking.JOURNAL, Siegel JM, Clues to the functions of mammalian sleep, Nature, 437, 7063, 1264–1271, 2005, 16251951, 10.1038/nature04285, 2005Natur.437.1264S, Anabolic hormones such as growth hormones are secreted preferentially during sleep. The concentration of the sugar compound glycogen in the brain increases during sleep, and is depleted through metabolism during wakefulness.Studies suggest that sleep deprivation may impair the body's ability to heal wounds.JOURNAL, Gümüştekín K, Seven B, Karabulut N, Aktaş O, Gürsan N, Aslan S, Keleş M, Varoglu E, Dane S, Effects of sleep deprivation, nicotine, and selenium on wound healing in rats, International Journal of Neuroscience, 114, 11, 1433–1442, 2004, 15636354, 10.1080/00207450490509168,weblink Submitted manuscript, 10 September 2018,weblink 23 October 2018, live, dmy-all, It has been shown that sleep deprivation affects the immune system.JOURNAL, Zager A, Andersen ML, Ruiz FS, Antunes IB, Tufik S, Effects of acute and chronic sleep loss on immune modulation of rats, American Journal of Physiology. Regulatory, Integrative and Comparative Physiology, 293, 1, R504–509, 2007, 17409265, 10.1152/ajpregu.00105.2007, It is now possible to state that "sleep loss impairs immune function and immune challenge alters sleep," and it has been suggested that sleep increases white blood cell counts.JOURNAL, Opp MR, Sleeping to fuel the immune system: mammalian sleep and resistance to parasites, BMC Evolutionary Biology, 9, 1471–2148, January 2009, 19134176, 2633283, 10.1186/1471-2148-9-8, A 2014 study found that depriving mice of sleep increased cancer growth and dampened the immune system's ability to control cancers.Peres, Judy (14 March 2012) A good reason to get your zzz's {{Webarchive|url=https://web.archive.org/web/20140522213416weblink |date=22 May 2014 }} Chicago Tribune Health, retrieved 26 March 2014The effect of sleep duration on somatic growth is not completely known. One study recorded growth, height, and weight, as correlated to parent-reported time in bed in 305 children over a period of nine years (age 1–10). It was found that "the variation of sleep duration among children does not seem to have an effect on growth."JOURNAL, Jenni OG, Molinari L, Caflisch JA, Largo RH, Sleep duration from ages 1 to 10 years: Variability and stability in comparison with growth, Pediatrics, 120, 4, e769–e776, 2007, 17908734, 10.1542/peds.2006-3300, It is well established that slow-wave sleep affects growth hormone levels in adult men. During eight hours' sleep, Van Cauter, Leproult, and Plat found that the men with a high percentage of slow-wave sleep (SWS) (average 24%) also had high growth hormone secretion, while subjects with a low percentage of SWS (average 9%) had low growth hormone secretion.JOURNAL, Van Cauter E, Leproult R, Plat L, Age-related changes in slow-wave sleep and REM sleep and relationship with growth hormone and cortisol levels in healthy men, JAMA: The Journal of the American Medical Association, 284, 7, 861–868, 2000, 10938176, 10.1001/jama.284.7.861, slow-wave sleep,

Memory processing

{{Further|Sleep and memory|Neuroscience of sleep|Sleep and learning|Page 4=Neuroscience of sleep}}It has been widely accepted that sleep must support the formation of long-term memory, and generally increasing previous learning and experiences recalls. However, its benefit seems to depend on the phase of sleep and the type of memory.Plihal, Werner, & Born, Jan. (1997). Effects of early and late nocturnal sleep on declarative and procedural memory. Journal of Cognitive Neuroscience, 9(4), 534-547. For example, declarative and procedural memory recall tasks applied over early and late nocturnal sleep, as well as wakefulness controlled conditions, have been shown that declarative memory improves more during early sleep (dominated by SWS) while procedural memory during late sleep (dominated by REM sleep).Rasch, B., Büchel, C., Gais, S., & Born, J. (2007). Odor cues during slow-wave sleep prompt declarative memory consolidation. Science, 315(5817), 1426-9.Born, J., & Wilhelm, I. (2012). System consolidation of memory during sleep. Psychological Research, 76(2), 192-203.Regarding to declarative memory, the functional role of SWS has been associated with hippocampal replays of previously encoded neural patterns that seem to facilitate long-term memories consolidation. This assumption is based on the active system consolidation hypothesis, which states that repeated reactivations of newly encoded information in hippocampus during slow oscillations in NREM sleep mediate the stabilization and gradually integration of declarative memory with pre-existing knowledge networks on the cortical level.Susanne Diekelmann, & Jan Born. (2010). The memory function of sleep. Nature Reviews Neuroscience, 11(2), 114-126. It assumes the hippocampus might hold information only temporarily and in fast-learning rate, whereas the neocortex is related to long-term storage and slow-learning rate.Rasch, B., & Born, J. (2013). About sleep's role in memory. Physiological Reviews, 93(2), 681-766.Schreiner, T., & Rasch, B. (2015). Boosting Vocabulary Learning by Verbal Cueing During Sleep. Cerebral Cortex, 25(11), 4169-4179.Schreiner, & Rasch. (2017). The beneficial role of memory reactivation for language learning during sleep: A review. Brain and Language, 167, 94-105. This dialogue between hippocampus and neocortex occurs in parallel with hippocampal sharp-wave ripples and thalamo-cortical spindles, synchrony that drives the formation of spindle-ripple event which seems to be a prerequisite for the formation of long-term memories.Ngo, H., Martinetz, T., Born, J., & Mölle, M. (2013). Auditory Closed-Loop Stimulation of the Sleep Slow Oscillation Enhances Memory. Neuron, 78(3), 545-553.Reactivation of memory also occurs during wakefulness and its function is associated with serving to update the reactivated memory with new encoded information, whereas reactivations during SWS are presented as crucial for memory stabilization. Based on targeted memory reactivation (TMR) experiments that use associated memory cues to triggering memory traces during sleep, several studies have been reassuring the importance of nocturnal reactivations for the formation of persistent memories in neocortical networks, as well as highlighting the possibility of increasing people’s memory performance at declarative recalls.Klinzing, J., Kugler, S., Soekadar, S., Rasch, B., Born, J., & Diekelmann, S. (2018). Odor cueing during slow-wave sleep benefits memory independently of low cholinergic tone. Psychopharmacology, 235(1), 291-299.Furthermore, nocturnal reactivation seems to share the same neural oscillatory patterns as reactivation during wakefulness, processes which might be coordinated by theta activity.Schreiner, T., Doeller, C., Jensen, O., Rasch, B., & Staudigl, T. (2018). Theta Phase-Coordinated Memory Reactivation Reoccurs in a Slow-Oscillatory Rhythm during NREM Sleep. Cell Reports, 25(2), 296-301. During wakefulness, theta oscillations have been often related to successful performance in memory tasks, and cued memory reactivations during sleep have been showing that theta activity is significantly stronger in subsequent recognition of cued stimuli as compared to uncued ones, possibly indicating a strengthening of memory traces and lexical integration by cuing during sleep.Schreiner, T., Göldi, M., & Rasch, B. (2015). Cueing vocabulary during sleep increases theta activity during later recognition testing. Psychophysiology, 52(11), 1538-1543. However, the beneficial effect of TMR for memory consolidation seems to occur only if the cued memories can be related to prior knowledge.Groch, S., Schreiner, T., Rasch, B., Huber, R., & Wilhelm, I. (2017). Prior knowledge is essential for the beneficial effect of targeted memory reactivation during sleep. Scientific Reports, 7, Urn:issn:2045-2322.

Dreaming

(File:Glimpse of a dream (9391068364).jpg|thumb|Dreams often feel like waking life, yet with added surrealism.)During sleep, especially REM sleep, people tend to have dreams: elusive first-person experiences which seem realistic while in progress, despite their frequently bizarre qualities. Dreams can seamlessly incorporate elements within a person's mind that would not normally go together. They can include apparent sensations of all types, especially vision and movement.J. Alan Hobson, Edward F. Pace-Scott, & Robert Stickgold (2000), "Dreaming and the brain: Toward a cognitive neuroscience of conscious states", Behavioral and Brain Sciences 23.People have proposed many hypotheses about the functions of dreaming. Sigmund Freud postulated that dreams are the symbolic expression of frustrated desires that have been relegated to the unconscious mind, and he used dream interpretation in the form of psychoanalysis in attempting to uncover these desires.See Freud: The Interpretation of Dreams.Counterintuitively, penile erections during sleep are not more frequent during sexual dreams than during other dreams.BOOK, Pinel, John P.J., Biopsychology, 8th Edition, 2011, Pearson Education, Inc., 978-0-205-83256-9, 359, The parasympathetic nervous system experiences increased activity during REM sleep which may cause erection of the penis or clitoris. In males, 80% to 95% of REM sleep is normally accompanied by partial to full penile erection, while only about 12% of men's dreams contain sexual content.BOOK, Saladin, Kenneth S., Anatomy and Physiology: The Unity of Form and Function, 6th Edition, 2012, McGraw-Hill, 978-0-07-337825-1, 537, John Allan Hobson and Robert McCarley propose that dreams are caused by the random firing of neurons in the cerebral cortex during the REM period. Neatly, this theory helps explain the irrationality of the mind during REM periods, as, according to this theory, the forebrain then creates a story in an attempt to reconcile and make sense of the nonsensical sensory information presented to it. This would explain the odd nature of many dreams.JOURNAL, Hobson J. Alan, McCarley Robert W., 1977, The Brain as a Dream-State Generator: An Activation-Synthesis Hypothesis of the Dream Process, American Journal of Psychiatry, 134, 12, 1335–1348, 10.1176/ajp.134.12.1335, 21570, Using antidepressants,{{clarify|date=August 2017}} acetaminophen, ibuprofen, or alcoholic beverages is thought to potentially suppress dreams, whereas melatonin may have the ability to encourage them.MAGAZINE, Naiman, Rubin, 2007, How To Interpret Your Dreams, Allure, 17, 5, n/a,

Disorders

Insomnia

{{See also|Psychological stress and Sleep}}Insomnia is a general term for difficulty falling asleep and/or staying asleep. Insomnia is the most common sleep problem, with many adults reporting occasional insomnia, and 10–15% reporting a chronic condition.Brown, pp. 1146–1147. Insomnia can have many different causes, including psychological stress, a poor sleep environment, an inconsistent sleep schedule, or excessive mental or physical stimulation in the hours before bedtime. Insomnia is often treated through behavioral changes like keeping a regular sleep schedule, avoiding stimulating or stressful activities before bedtime, and cutting down on stimulants such as caffeine. The sleep environment may be improved by installing heavy drapes to shut out all sunlight, and keeping computers, televisions and work materials out of the sleeping area.A 2010 review of published scientific research suggested that exercise generally improves sleep for most people, and helps sleep disorders such as insomnia. The optimum time to exercise may be 4 to 8 hours before bedtime, though exercise at any time of day is beneficial, with the exception of heavy exercise taken shortly before bedtime, which may disturb sleep. However, there is insufficient evidence to draw detailed conclusions about the relationship between exercise and sleep.JOURNAL, Buman, M.P., King, A. C., Exercise as a Treatment to Enhance Sleep, American Journal of Lifestyle Medicine, 4, 6, 500–514, 10.1177/1559827610375532, 2010, Sleeping medications such as Ambien and Lunesta are an increasingly popular treatment for insomnia. Although these nonbenzodiazepine medications are generally believed to be better and safer than earlier generations of sedatives, they have still generated some controversy and discussion regarding side-effects. White noise appears to be a promising treatment for insomnia.JOURNAL, López HH, Bracha AS, Bracha HS, Evidence based complementary intervention for insomnia, Hawaii Medical Journal, 61, 9, 192, 213, 2002, 12422383,weblink 16 December 2010,weblink" title="web.archive.org/web/20150501085132weblink">weblink 1 May 2015, live, dmy-all,

Obstructive sleep apnea

Obstructive sleep apnea is a condition in which major pauses in breathing occur during sleep, disrupting the normal progression of sleep and often causing other more severe health problems. Apneas occur when the muscles around the patient's airway relax during sleep, causing the airway to collapse and block the intake of oxygen.WEB,weblink What is Sleep Apnoea? (Sleep Apnea), britishsnoring.co.uk, 6 April 2019,weblink" title="web.archive.org/web/20170701024719weblink">weblink 1 July 2017, live, dmy-all, Obstructive sleep apnea is more common than central sleep apnea.WEB,weblink Sleep Apnea, National Sleep Foundation, April 29, 2018,weblink 30 April 2018, live, dmy-all, As oxygen levels in the blood drop, the patient then comes out of deep sleep in order to resume breathing. When several of these episodes occur per hour, sleep apnea rises to a level of seriousness that may require treatment.Diagnosing sleep apnea usually requires a professional sleep study performed in a sleep clinic, because the episodes of wakefulness caused by the disorder are extremely brief and patients usually do not remember experiencing them. Instead, many patients simply feel tired after getting several hours of sleep and have no idea why. Major risk factors for sleep apnea include chronic fatigue, old age, obesity and snoring.

Aging and sleep

People over age 60 with prolonged sleep (8-10 hours or more; average sleep duration of 7-8 hours in the elderly) have a 33% increased risk of all-cause mortality and 43% increased risk of cardiovascular diseases, while those with short sleep (less than 7 hours) have a 6% increased risk of all-cause mortality.JOURNAL, Silva, Andressa Alves da, Mello, Renato Gorga Bandeira de, Schaan, Camila Wohlgemuth, Fuchs, Flávio D, Redline, Susan, Fuchs, Sandra C, Sleep duration and mortality in the elderly: a systematic review with meta-analysis, BMJ Open, 6, 2, 2016, 2044-6055, 10.1136/bmjopen-2015-008119, e008119, 26888725, 4762152, Sleep disorders, including sleep apnea, insomnia, or periodic limb movements, occur more commonly in the elderly, each possibly impacting sleep quality and duration. A 2017 review indicated that older adults do not need less sleep, but rather have an impaired ability to obtain their sleep needs, and may be able to deal with sleepiness better than younger adults.JOURNAL, Mander, Bryce A., Winer, Joseph R., Walker, Matthew P., Sleep and human aging (Review), Neuron, 94, 1, 2017, 0896-6273, 10.1016/j.neuron.2017.02.004, 19–36, 28384471, 5810920, Various practices are recommended to mitigate sleep disturbances in the elderly, such as having a light bedtime snack, avoidance of caffeine, daytime naps, excessive evening stimulation, and tobacco products, and using regular bedtime and wake schedules.WEB, Aging changes in sleep,weblink MedlinePlus, National Library of Medicine, US National Institutes of Health, 12 October 2019, 2 October 2019,

Other disorders

Sleep disorders include narcolepsy, periodic limb movement disorder (PLMD), restless leg syndrome (RLS), upper airway resistance syndrome (UARS), and the circadian rhythm sleep disorders. Fatal familial insomnia, or FFI, an extremely rare genetic disease with no known treatment or cure, is characterized by increasing insomnia as one of its symptoms; ultimately sufferers of the disease stop sleeping entirely, before dying of the disease.Max, D. T. The Secrets of Sleep {{Webarchive|url=https://web.archive.org/web/20120510044634weblink |date=10 May 2012 }} National Geographic Magazine, May 2010.Somnambulism, known as sleep walking, is a sleeping disorder, especially among children.Dugdale, David, C. (22 May 2011). Sleepwalking {{Webarchive|url=https://web.archive.org/web/20160705124905weblink |date=5 July 2016 }}. US National Institutes of Health.

Drugs and diet

Drugs which induce sleep, known as hypnotics, include benzodiazepines, although these interfere with REM;BOOK, Lee-chiong, Teofilo, Sleep Medicine: Essentials and Review, 24 April 2008, Oxford University Press, US,weblink 978-0-19-530659-0, 52, 25 September 2016,weblink 11 March 2017, live, dmy-all, Nonbenzodiazepine hypnotics such as eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien); Antihistamines, such as diphenhydramine (Benadryl) and doxylamine; Alcohol (ethanol), despite its rebound effect later in the night and interference with REM;Alcohol and Sleep {{Webarchive|url=https://web.archive.org/web/20090130201643weblink |date=30 January 2009 }}. Alcoholism.about.com (10 January 2011). Retrieved on 1 December 2011. barbiturates, which have the same problem; melatonin, a component of the circadian clock, and released naturally at night by the pineal gland;Fred W. Turek & Charles A. Czeisler (1999). "Role of Melatonin in the Regulation of Sleep", in Turek & Zee (eds.), Regulation of Sleep and Circadian Rhythms, pp. 181–195. and cannabis, which may also interfere with REM.Marijuana, Sleep and Dreams. psychologytoday.com. Retrieved on 10 February 2012.Stimulants, which inhibit sleep, include caffeine, an adenosine antagonist; amphetamine, MDMA, empathogen-entactogens, and related drugs; cocaine, which can alter the circadian rhythm,JOURNAL, Abarca C, Albrecht U, Spanagel R, Cocaine sensitization and reward are under the influence of circadian genes and rhythm, Proceedings of the National Academy of Sciences of the United States of America, 99, 13, 9026–9030, June 2002, 12084940, 124417, 10.1073/pnas.142039099, 2002PNAS...99.9026A, weblink" title="web.archive.org/web/20080714095916weblink">Primary hypersomnia: Diagnostic Features. mindsite.com and methylphenidate, which acts similarly; and other analeptic drugs like modafinil and armodafinil with poorly understood mechanisms.Dietary and nutritional choices may affect sleep duration and quality. One 2016 review indicated that a high carbohydrate diet promoted shorter onset to sleep and longer duration sleep than a high fat diet.JOURNAL, 5015038, 2016, St-Onge, M. P, Effects of Diet on Sleep Quality, Advances in Nutrition, 7, 5, 938–949, Mikic, A, Pietrolungo, C. E, 10.3945/an.116.012336, 27633109, A 2012 investigation indicated that mixed micronutrients and macronutrients are needed to promote quality sleep.JOURNAL, Peuhkuri Katri, Sihvola Nora, Korpela Riitta, 2012, Diet Promotes Sleep Duration and Quality, Nutrition Research, 32, 5, 309–319, 10.1016/j.nutres.2012.03.009, 22652369, A varied diet containing fresh fruits and vegetables, low saturated fat, and whole grains may be optimal for individuals seeking to improve sleep quality. High-quality clinical trials on long-term dietary practices are needed to better define the influence of diet on sleep quality.

In culture

Anthropology

File:Pieter Bruegel d. Ä. 037.jpg|thumb|The Land of Cockaigne by Pieter Bruegel the ElderPieter Bruegel the ElderResearch suggests that sleep patterns vary significantly across cultures.BOOK, Carol M. Worthman, Melissa K. Melby, A comparative developmental ecology, 6. Toward a comparative developmental ecology of human sleep,weblink Emory University, Slumber's Unexplored Landscape {{Webarchive|url=https://web.archive.org/web/20080220093516weblink |date=20 February 2008 }}. Science News Online (25 September 1999). Retrieved on 1 December 2011. The most striking differences are observed between societies that have plentiful sources of artificial light and ones that do not. The primary difference appears to be that pre-light cultures have more broken-up sleep patterns. For example, people without artificial light might go to sleep far sooner after the sun sets, but then wake up several times throughout the night, punctuating their sleep with periods of wakefulness, perhaps lasting several hours.The boundaries between sleeping and waking are blurred in these societies. Some observers believe that nighttime sleep in these societies is most often split into two main periods, the first characterized primarily by deep sleep and the second by REM sleep.Some societies display a fragmented sleep pattern in which people sleep at all times of the day and night for shorter periods. In many nomadic or hunter-gatherer societies, people will sleep on and off throughout the day or night depending on what is happening. Plentiful artificial light has been available in the industrialized West since at least the mid-19th century, and sleep patterns have changed significantly everywhere that lighting has been introduced. In general, people sleep in a more concentrated burst through the night, going to sleep much later, although this is not always the case.Historian A. Roger Ekirch thinks that the traditional pattern of "segmented sleep," as it is called, began to disappear among the urban upper class in Europe in the late 17th century and the change spread over the next 200 years; by the 1920s "the idea of a first and second sleep had receded entirely from our social consciousness."JOURNAL, Ekirch, A. Roger, Sleep we have lost: Pre-industrial slumber in the British Isles, The American Historical Review, 106, 2, 343–385, 10.2307/2651611, 18680884, 2001, 2651611, NEWS, Hegarty, Stephanie, The myth of the eight-hour sleep,weblink 22 February 2012, BBC News, 22 February 2012,weblink" title="web.archive.org/web/20120222172348weblink">weblink 22 February 2012, live, dmy-all, Ekirch attributes the change to increases in "street lighting, domestic lighting and a surge in coffee houses," which slowly made nighttime a legitimate time for activity, decreasing the time available for rest. Today in most societies people sleep during the night, but in very hot climates they may sleep during the day.Huntington, Ellsworth (1915) Civilization and Climate {{Webarchive|url=https://web.archive.org/web/20160817211746weblink |date=17 August 2016 }}. Yale University Press. p. 126 During Ramadan, many Muslims sleep during the day rather than at night.BOOK, The American Muslim Teenager's Handbook, Dilara Hafiz, Imran Hafiz, Yasmine Hafiz, 2009, 978-1416986997, In some societies, people sleep with at least one other person (sometimes many) or with animals. In other cultures, people rarely sleep with anyone except for an intimate partner. In almost all societies, sleeping partners are strongly regulated by social standards. For example, a person might only sleep with the immediate family, the extended family, a spouse or romantic partner, children, children of a certain age, children of specific gender, peers of a certain gender, friends, peers of equal social rank, or with no one at all. Sleep may be an actively social time, depending on the sleep groupings, with no constraints on noise or activity.People sleep in a variety of locations. Some sleep directly on the ground; others on a skin or blanket; others sleep on platforms or beds. Some sleep with blankets, some with pillows, some with simple headrests, some with no head support. These choices are shaped by a variety of factors, such as climate, protection from predators, housing type, technology, personal preference, and the incidence of pests.

In mythology and literature

File:Seven sleepers (Menologion of Basil II).jpg|thumb|upright=1.3|Medieval manuscript illumination from the Menologion of Basil II (985 AD), showing the Seven Sleepers of Ephesus sleeping in their cave]]Sleep has been seen in culture as similar to death since antiquity;BOOK, William, Simon J., Sleep and Society: Sociological Ventures Into the Un(known), 2005, Routledge, New York City, New York and London, England, 978-0-415-35419-6, 95–96,weblink harv, in Greek mythology, Hypnos (the god of sleep) and Thanatos (the god of death) were both said to be the children of Nyx (the goddess of night). John Donne, Samuel Taylor Coleridge, Percy Bysshe Shelley, and other poets have all written poems about the relationship between sleep and death. Shelley describes them as "both so passing, strange and wonderful!" Many people consider dying in one's sleep the most peaceful way to die. Phrases such as "big sleep" and "rest in peace" are often used in reference to death, possibly in effort to lessen its finality. Sleep and dreaming have sometimes been seen as providing the potential for visionary experiences. In medieval Irish tradition, in order to become a filí, the poet was required to undergo a ritual called the imbas forosnai, in which they would enter a mantic, trance-like sleep.JOURNAL, Chadwick, Nora K., Nora K. Chadwick, Imbas Forosnai, Scottish Gaelic Studies, 1935, 4, 97-135, BOOK, MacKillop, James, A Dictionary of Celtic Mythology, 1998, Oxford University Press, Oxford, England, 0-19-280120-1, Many cultural stories have been told about people falling asleep for extended periods of time.BOOK, Hansen, William, The Book of Greek & Roman Folktales, Legends & Myths,weblink 2017, Princeton University Press, Princeton, New Jersey, 9780691170152, 132–133, BOOK, Burstein, Andrew, The Original Knickerbocker: The Life of Washington Irving,weblink New York, Basic Books, 2007, 120–338, 978-0-465-00853-7, The earliest of these stories is the ancient Greek legend of Epimenides of Knossos.BOOK, Welch, Deshler, The Theater, 9 May 1887, Theatre Publishing Company, New York City, New York, 139,weblink 3, 21 June 2017, WEB, Thorn, John, Saint Rip,weblink nyfolklore.org, Voices: The Journal of New York Folklore, 21 June 2017,weblink" title="web.archive.org/web/20171018210936weblink">weblink 18 October 2017, live, dmy-all, BOOK, Bates, Alfred, The Drama; Its History, Literature and Influence on Civilization: American Drama, 1906, Historical Publishing Company, London, England, 121,weblink 20, 21 June 2017, According to the biographer Diogenes Laërtius, Epimenides was a shepherd on the Greek island of Crete.BOOK, Rothschild, Clare K., Paul in Athens: The Popular Religious Context of Acts 17, 2014, Mohr Siebeck, Tübingen, Germany, 978-3-16-153260-3, 40–42,weblink harv, One day, one of his sheep went missing and he went out to look for it, but became tired and fell asleep in a cave under Mount Ida. When he awoke, he continued searching for the sheep, but could not find it, so he returned to his old farm, only to discover that it was now under new ownership. He went to his hometown, but discovered that nobody there knew him. Finally, he met his younger brother, who was now an old man, and learned that he had been asleep in the cave for fifty-seven years.A far more famous instance of a "long sleep" today is the Christian legend of the Seven Sleepers of Ephesus, in which seven Christians flee into a cave during pagan times in order to escape persecution, but fall asleep and wake up 360 years later to discover, to their astonishment, that the Roman Empire is now predominantly Christian. The American author Washington Irving's short story "Rip Van Winkle", first published in 1819 in his collection of short stories The Sketch Book of Geoffrey Crayon, Gent.,BOOK, Jones, Brian Jay, Washington Irving: An American Original, New York, Arcade Books, 2008, 177–178, 978-1-55970-836-4, is about a man in colonial America named Rip Van Winkle who falls asleep on one of the Catskill Mountains and wakes up twenty years later after the American Revolution. The story is now considered one of the greatest classics of American literature.

In art

Writing about the thematical representations of sleep in art, physician and sleep researcher Meir Kryger noted: "[Artists] have intense fascination with mythology, dreams, religious themes, the parallel between sleep and death, reward, abandonment of conscious control, healing, a depiction of innocence and serenity, and the erotic."NEWS, Frank, Priscilla, Why Have Artists Always Found Sleep Such A Fascinating Subject?,weblink 14 July 2017, HuffPost, 24 June 2016,weblink" title="web.archive.org/web/20170725165747weblink">weblink 25 July 2017, live, dmy-all, File:Carel Fabritius - De poort bewaker (1654).jpg|The Sentry (1654) by Carel FabritiusFile:Museo del Prado - Goya - Caprichos - No. 43 - El sueño de la razon produce monstruos.jpg|The Sleep of Reason Produces Monsters (1799) by Francisco GoyaFile:Jérôme-Martin Langlois - Diana and Endymion - WGA12461.jpg|Diana and Endymion ({{circa}} 1822) by Jérôme-Martin LangloisFile:Honoré Daumier - The Second Class Carriage - Walters 371224.jpg|The Second Class Carriage (1864) by Honoré DaumierFile:Waterhouse-sleep and his half-brother death-1874.jpg|Sleep and his Half-brother Death (1874) by John William WaterhouseFile:William-Adolphe Bouguereau (1825-1905) - Lullaby (1875).jpg|Lullaby (1875) by William-Adolphe BouguereauFile:Илья Е. Репин - Отдых. Портрет В.А.Репинa (1882).jpg|Taking a Rest (1882) by Ilya RepinFile:George Hare - Victory of Faith.jpg|Victory of Faith (1889) by Saint George HareFile:Auf dem Ofen 1895.jpg|Zwei schlafende Mädchen auf der Ofenbank (1895) Albert AnkerFile:Flaming June, by Frederic Lord Leighton (1830-1896).jpg|Flaming June ({{circa}} 1895) by Frederic Lord LeightonFile:Noon, rest from work - Van Gogh.jpeg|Noon – Rest from Work (1890) by Vincent van Gogh (after Millet)File:Paul Klimsch Schlafender Jaguar.jpg|Sleeping Jaguar, by Paul KlimschFile:Albert Anker - Schlafendes Mädchen auf einer Holzbank.jpg|Sleeping Girl on a Wooden Bench by Albert AnkerFile:Chrapek, the Sleepy one... (3734650615).jpg|Chrapek (Snorer), Wrocław's dwarfs

See also

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Positions, practices, and rituals

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References

{{reflist}}

Sources

  • JOURNAL, Brown, Brown Ritchie E., Basheer Radhika, McKenna James T., Strecker Robert E., McCarley Robert W., 2012, Control of Sleep and Wakefulness, Physiological Reviews, 92, 3, 1087–1187, 10.1152/physrev.00032.2011, 22811426, 3621793,
  • Parmeggiani, Pier Luigi, & Ricardo A. Velluti, eds. (2005). The Physiologic Nature of Sleep. London: Imperial College Press. {{ISBN|1-86094-557-0}}.
  • Parmeggiani, Pier Luigi (2011). Systemic Homeostasis and Poikilostasis in Sleep: Is REM Sleep a Physiological Paradox? London: Imperial College Press. {{ISBN|978-1-94916-572-2}}
  • Turek, Fred W. & Phyllis C. Zee, eds. (1999). Regulation of Sleep and Circadian Rhythms. New York: Marcel Dekker, Inc. {{ISBN|0-8247-0231-X}}

External links

{{Commons category|Sleeping|Sleep}}{{Wiktionary}} {{Neuroscience}}{{Psychophysiology}}{{SleepSeries2}}{{Activities of daily living}}{{Authority control}}

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