Sleep Health Article

Definition

Sleep is a biological imperative critical to the maintenance of mental and physical health. It is a state of lessened consciousness and decreased physical activity during which the organism slows down and repairs itself. The sleep cycle involves two distinct phases that alternate cyclically from light sleep to deep then deeper and deepest sleep throughout the sleep period. There are two main phases of sleep.

• rapid eye movement (REM) sleep, during which dreaming occurs
• non-rapid eye movement (NREM) or slow-wave sleep (SWS)

Description

The timing and progression of the sleep cycle and the total amount of nightly sleep required for optimal health varies from infancy to adulthood, depending on developmental stage and temperament. Children, particularly infants, require the most sleep during a 24-hour period. The natural sleep-wake cycle, governed by an internal "biological clock," tends toward a 25-hour day. It is affected by the relative balance of light and darkness in the environment. As darkness approaches, the hormone melatonin is secreted by the pineal gland and signals the brain that it is time to sleep.

NREM deep sleep

Sleep begins in stage one of the sleep phase known as NREM, or non-rapid eye movement, sleep. NREM sleep has four stages: light sleep, deeper sleep, and two stages of deepest sleep. Stage one is the "drifting off" period of light sleep in the transition between wakefulness and sleep and comprises about 5 percent of the entire sleep period. Stage two sleep involves a change in brain-wave patterns and increased resistance to arousal and accounts for 45–55 percent of total sleep time. Stages three and four are the deepest levels of sleep and occur only in the first third of the sleep period. NREM stage four sleep usually takes up 12 to 15 percent of total sleep time. Sleep terrors, sleep walking, and bedwetting episodes generally occur within stage four sleep or during partial arousals from this sleep stage.

It typically takes about 90 minutes to cycle through the four deepening stages of NREM sleep before onset of the second phase of sleep known as REM or dream sleep.

REM dream sleep

Rapid eye movement (REM) sleep is qualitatively different from NREM sleep. REM sleep is characterized by extensive central nervous system (CNS) activity with an increase in brain metabolism accompanied by the vivid imagery of dreams. During REM sleep the body is nearly paralyzed, a condition called "atonic," that serves to inhibit the dreamer from physical movement during active dreaming.

"Waking and dreaming are two states of consciousness, with differences that depend on chemistry," according to J. Allan Hobson, professor of psychiatry at Harvard Medical School. Physical activity and thought are suppressed in sleep, but the brain nonetheless remains active "processing information, consolidating and revising memory, and learning newly acquired skills." The brain self-activates, radically changing its chemical climate from wakefulness to sleep states.

REM sleep is also known as "paradoxical sleep" because muscle activity is suppressed even as the CNS registers intense brain activity and spontaneous rapid eye movements can be observed. Brain-wave monitoring of REM sleep with an electroencephalograph (EEG) reveals a low-voltage, fast-frequency, non-alpha wave record. Beyond infancy, REM sleep comprises 20–25 percent of the entire sleep period. This sleep phase is concerned with memory and the consolidation of new information.

Infancy

Newborn infants usually sleep for brief periods at a time around the clock, with the total of day and nighttime sleep roughly equal. A newborn's total sleep need is from 16 to 18 hours in every 24-hour period. Newborns spend approximately 50 percent of their sleep period in the REM phase. Infants are most easily awakened during this phase of sleep that is accompanied by yawning, squirming, and quiet vocalizations.

Infants move through REM and non-REM sleep stages in a 90 minute cycle, and they rise to a near-waking state every three to four hours, more often in breastfed infants. By about six months of age, babies usually will sleep through the night for 12 or more hours and will continue to nap several times throughout the day.

Researchers conducting a 2004 survey for the National Sleep Foundation discovered that children in every age group fail to meet even the low-end requirements for adequate sleep. By the third month of life, a child's sleep requirement is about 14 to 15 out of every 24 hours, a need that continues until about 11 months of age. However, research indicates that children age three months to 11 months sleep only 12.7 hours on average.