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2 Human Sleep
Conceptual Overview
Sleep is a necessary part of life, and approximately one‐third of human life is spent in the sleep state. Disruption and/or deprivation of sleep may result in potentially adverse effects. These effects can impact one’s health, medical status, psychological state, and even one’s quality of life.
Despite large amounts of research and investigation into the true definition of sleep, the actual purpose of sleep remains one of nature's mysteries and is not fully understood. It is recognized that adequate sleep is needed to maintain alertness, support the immune system, and support memory and learning. The understanding of the physiologic and neurochemical activity needed for the sleep and wake state is now better understood. The complexity of sleep as well as the understanding of sleep requires a basic understanding of physiology, neuroanatomy, neurobiology, and the mechanisms by which these interact.
Normal Sleep
Normal sleep can be viewed from two aspects: (i) the actual distribution of the two main sleep states, non‐rapid eye movement (NREM) and rapid eye movement (REM) sleep, and (ii) an understanding of the neurotransmitters that regulate the sleep–wake states. The initial staging of sleep was proposed in 1957 [1], based on the work of Loomis in the 1930s [2]. In 1968, a manual was published that has been the basis for defining sleep staging [3]. The distribution of NREM and REM states, known as sleep architecture, is altered over time as the individual progresses from infancy, through adulthood to becoming elderly. These changes are dynamic and distinctly related to sleep onset, sleep maintenance, and the amount of time for each sleep stage.
Stages of Sleep
The determination of the sleep stage is dependent on brain wave activity or the electroencephalography (EEG) that is recorded during a sleep study, typically at an attended level I laboratory‐based study or polysomnography (PSG), recorded with surface electrodes over the skull. This will distinguish NREM from REM as well as the sleep stage during NREM sleep. NREM and REM sleep occur in varying proportions during sleep, and they also alternate in a cyclical fashion (Figure 2.1).
The typical pattern in normal sleep is for the individual to progress from wakefulness to the NREM sleep state, followed by the REM sleep state, and then alternating between REM and NREM stages. Overall, a night of sleep comprises about 75–80% of NREM sleep and 20–25% of REM sleep. A disturbance or alteration in the distribution of the sleep staging is typically associated with one of the