Adage Medical Systems



Sleep Disease


Waking up", "Asleep", and "Slept" redirect here. For other uses, see Waking Up (disambiguation), Asleep (disambiguation), or SLEPT analysis. Sleeping is associated with a state of muscle relaxation and limited perception of environmental stimuli

In animals, sleep is a naturally recurring state characterized by altered consciousness, relatively inhibited sensory activity, and inhibition of nearly all voluntary muscles. It is distinguished from wakefulness by a decreased ability to react to stimuli, and it is more easily reversible than being in hibernation or a coma.

During sleep, most systems in an animal are in a heightened anabolic state, accentuating the growth and rejuvenation of the immune, nervous, skeletal, and muscular systems. Sleep in non-human animals is observed in mammals, birds, reptiles, amphibians, and fish, and in some form in insects and even in simpler animals such as nematodes, suggesting that sleep is universal in the animal kingdom.

The purposes and mechanisms of sleep are only partially clear and the subject of substantial ongoing research. Sleep is sometimes thought to help conserve energy, though this theory is not fully adequate as it only decreases metabolism by about 5–10%. Additionally it is observed that mammals require sleep even during the hypometabolic state of hibernation, in which circumstance it is actually a net loss of energy as the animal returns from hypothermia to euthermia in order to sleep.

Humans may suffer from a number of sleep disorders. These include dyssomnias (such as insomnia, hypersomnia, and sleep apnea), parasomnias (such assleepwalking and REM behavior disorder), and the circadian rhythm sleep disorders.

Physiology
In mammals and birds, sleep is divided into two broad types: rapid eye movement (REM sleep) and non-rapid eye movement (NREM or non-REM sleep). Each type has a distinct set of physiological and neurological features associated with it. REM sleep is associated with the capability of dreaming. 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.

Stages

Further information: Neural oscillation

NREM stage 1 : This is a stage between sleep and wakefulness. The muscles are active, and the eyes roll slowly, opening and closing moderately.

NREM stage 2 : In this stage, theta activity is observed and sleepers become gradually harder to awaken; the alpha waves of the previous stage are interrupted by abrupt activity called sleep spindles and K-complexes.[8]

NREM stage 3 : Formerly divided into stages 3 and 4, this stage is called slow-wave sleep (SWS). SWS is initiated in the preoptic areaand consists of delta activity, high amplitude waves at less than 3.5 Hz. The sleeper is less responsive to the environment; many environmental stimuli no longer produce any reactions.

REM : The sleeper now enters rapid eye movement (REM) where most muscles are paralyzed. REM sleep is turned on by acetylcholinesecretion and is inhibited by neurons that secrete serotonin. This level is also referred to as paradoxical sleep because the sleeper, although exhibiting EEG waves similar to a waking state, is harder to arouse than at any other sleep stage. Vital signs indicate arousal and oxygen consumption by the brain is higher than when the sleeper is awake. An adult reaches REM approximately every 90 minutes, with the latter half of sleep being more dominated by this stage. REM sleep occurs as a person returns to stage 1 from a deep sleep.

The function of REM sleep is uncertain but a lack of it impairs the ability to learn complex tasks. One approach to understanding the role of sleep is to study the deprivation of it. During this period, the EEG pattern returns to high-frequency waves that look similar to the waves produced while the person is awake

Sleep proceeds in cycles of REM and NREM, usually four or five of them per night, the order normally being N1 → N2 → N3 → N2 → REM. 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.

The stages of sleep were first described in 1937 by Alfred Lee Loomis and his coworkers, who separated the different electroencephalography (EEG) features of sleep into five levels (A to E), which represented the spectrum from wakefulness to deep sleep.[ In 1953, REM sleep was discovered as distinct, and thus William Dement and Nathaniel Kleitman reclassified sleep into four NREM stages and REM. The staging criteria were standardized in 1968 by Allan Rechtschaffen and Anthony Kales in the "R&K sleep scoring manual.

In the R&K standard, NREM sleep was divided into four stages, with slow-wave sleep comprising stages 3 and 4. In stage 3, delta waves made up less than 50% of the total wave patterns, while they made up more than 50% in stage 4. Furthermore, REM sleep was sometimes referred to as stage 5. In 2004, the AASM commissioned the AASM Visual Scoring Task Force to review the R&K scoring system. The review resulted in several changes, the most significant being the combination of stages 3 and 4 into Stage N3. The revised scoring was published in 2007 as The AASM Manual for the Scoring of Sleep and Associated Events. Arousals and respiratory, cardiac, and movement events were also added.

Sleep stages and other characteristics of sleep are commonly assessed by polysomnography in a specialized sleep laboratory. Measurements taken include EEG of brain waves, electrooculography (EOG) of eye movements, and electromyography (EMG) of skeletal muscle activity. In humans, the average length of the first sleep cycle is approximately 90 minutes and 100 to 120 minutes from the second to the fourth cycle, which is usually the last one. Each stage may have a distinct physiological function and this can result in sleep that exhibits loss of consciousness but does not fulfill its physiological functions (i.e., one may still feel tired after apparently sufficient sleep).

Scientific studies on sleep have shown that sleep stage at awakening is an important factor in amplifying sleep inertia.] Alarm clocks involving sleep stage monitoring appeared on the market in 2005.[18] Using sensing technologies such as EEG electrodes or accelerometers, these alarm clocks are supposed to wake people only from light sleep.

NREM Sleep

Main article : Non-rapid eye movement sleep

According to 2007 AASM standards, NREM consists of three stages. There is relatively little dreaming in NREM.

Stage N1 refers to the transition of the brain from alpha waves having a frequency of 8–13 Hz (common in the awake state) to theta waves having a frequency of 4–7 Hz. This stage is sometimes referred to as somnolence or drowsy sleep. Sudden twitches and hypnic jerks, also known as positivemyoclonus, may be associated with the onset of sleep during N1. Some people may also experience hypnagogic hallucinations during this stage. During N1, the subject loses some muscle tone and most conscious awareness of the external environment.

Stage N2 is characterized by sleep spindles ranging from 11 to 16 Hz (most commonly 12–14 Hz) and K-complexes. During this stage, muscular activity as measured by EMG decreases, and conscious awareness of the external environment disappears. This stage occupies 45–55% of total sleep in adults.

Stage N3 (deep or slow-wave sleep) is characterized by the presence of a minimum of 20% delta waves ranging from 0.5–2 Hz and having a peak-to-peak amplitude >75 μV. (EEG standards define delta waves to be from 0 to 4 Hz, but sleep standards in both the original R&K, as well as the new 2007 AASM guidelines have a range of 0.5–2 Hz.) This is the stage in which parasomnias such as night terrors, nocturnal enuresis,sleepwalking, and somniloquy occur. Many illustrations and descriptions still show a stage N3 with 20–50% delta waves and a stage N4 with greater than 50% delta waves; these have been combined as stage N3.

REM sleep

Main article : Rapid eye movement sleep

Rapid eye movement sleep, or REM sleep (also known as paradoxical sleep),[19] accounts for 20–25% of total sleep time in most human adults. The criteria for REM sleep include rapid eye movements as well as a rapid low-voltage EEG. During REM sleep, EEG patterns returns to higher frequency saw-tooth waves. Most memorable dreaming occurs in this stage. At least in mammals, a descending muscular atonia is seen. Such paralysis may be necessary to protect organisms from self-damage through physically acting out scenes from the often-vivid dreams that occur during this stage.


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