SLEEPING CYCLE

Name: Nuno Miguel Adao Afonso

Group: 201a
Course: General Medicine
 index

Introduction

Definitionof sleep
Physiology

Mechanism of sleep

Functions of sleep

Disorders

Conclusion
 INTRODUCTION
Sleep plays a v ital role in good health and well-being
throughou t your life. Getting enough quality sleep at the
right times can help protect your mental health, physical
health, quality of life, and safety.
The way you feel while you're awake depends in part on
what happens while you're sleeping. During sleep, your
body is working to support healthy brain function and
maintain your physical health. In children and teens, sleep
also helps support growth and development.
The damage from sleep deficiency can occur in an instant
(such as a car crash), or it can harm you over time. For
example, ongoing sleep deficiency can raise your risk for
some chronic health problems. It also can affect how well
you think, react, work, learn, and get along with others.
Sleep is a naturally recurring state of mind and body, characterized by altered
consciousness, relatively inhibited sensory activity, inhibition of nearly all voluntary
muscles, and reduced interactions with surroundings It is distinguished from
wakefulness by a decreased ability to react to stimuli, but is more easily reversed than
the state of being comatose. Sleep occurs in repeating periods, in which the body
alternates between two distinct modes: REMsleep 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. The internal circadian clock promotes sleep daily at night. The
diverse purposes and mechanisms of sleep are the subject of substantial ongoing
research. The advent of artificial light has substantially altered sleep timing in
industrialized countries. Humans may suffer from various sleep disorders, including
dyssomnias, such as insomnia, hypersomnia, narcolepsy, and sleep apnea;
parasomnias, such as sleepwalkingand REM behavior disorder; bruxism; and circadian
rhythm sleep disorders.
 physiology

The most pronounced physiological changes in sleep occur in the brain. Especially
during non-REM sleep, the brain uses significantly less energy during sleep than it
does in waking. 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. Since in quiet waking the brain is responsible for 20% of the body's energy
use, this reduction has an independently noticeable impact on overall energy
consumption.) Sleep increases the sensory threshold. In other words, sleeping persons
perceive fewer stimuli. However, they 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. Key physiological
measurements indicators of sleep include EEG of brain waves, electrooculography
(EOG) of eye movements, electromyography (EMG) of skeletal muscle activity.
Simultaneous collection of these measurements is called polysomnography, and can be
performed in a specialized sleep laboratory. Sleep researchers also use simplified
electrocardiography (EKG) for cardiac activity and actigraphy for motor movements.
WHAT HAPPENS WHEN YOU SLEEP?
When we sleep well, we wake up feeling refreshed and
alert for our daily activities. Sleep affects how we look, feel
and perform on a daily basis, and can have a major impact
on our overall quality of life. To get the most out of our
sleep, both quantity and quality are important. Teens need
at least 8 hours—and on average 9¼ hours—a night of
uninterrupted sleep to leave their bodies and minds
rejuvenated for the next day. If sleep is cut short, the body
doesn’t have time to complete all of the phases needed for
muscle repair, memory consolidation and release of
hormones regulating growth and appetite. Then we wake
up less prepared to concentrate, make decisions, or engage
fully in school and social activities.
How Does Sleep Contribute to All of These Things?
Sleep architecture follows a pattern of alternating REM (rapid
eye movement) and NREM (non-rapid eye movement) sleep
throughout a typical night in a cycle that repeats itself about every
90 minutes.
What role does each state and stage of sleep play?
NREM (75% of night): As we begin to fall asleep, we enter NREM
sleep, which is composed of stages 1-4 N1 (formerly "stage 1") •
Between being awake and falling asleep • Light sleep N2
(formerly "stage 2") • Onset of sleep • Becoming disengaged
from surroundings • Breathing and heart rate are regular • Body
temperature drops (so sleeping in a cool room is helpful) N3
(formerly "stages 3 and 4") • Deepest and most restorative sleep
• Blood pressure drops • Breathing becomes slower • Muscles
are relaxed • Blood supply to muscles increases • Tissue growth
and repair occurs • Energy is restored
• Hormones are released, such as: Growth hormone, essential for
growth and development, including muscle development REM
(25% of night): First occurs about 90 minutes after falling asleep
and recurs about every 90 minutes, getting longer later in the
night • Provides energy to brain and body • Supports daytime
performance • Brain is active and Awakening
Awakening 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 episode. Awakening involves
heightened electrical activation in the brain, beginning with the
thalamus and spreading throughout the cortex. During a night's sleep, a
small portion 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. (Some people, however, can 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. Many people regularly
look at television and other screens before going to bed, a factor which
may exacerbate this mass circadian disruption.Scientific studies on
sleep have shown that sleep stage at awakening is an important factor in
amplifying sleep inertia.
The human "biological clock"
Sleep timing depends greatly on hormonalsignals 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. 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; the rhythm so established 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. The clock exerts constant influence on the body, effecting
sinusoidal oscillation of body temperature between roughly 36.2 °C and 37.2 °C. 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 nightThe circadian pacemaker in the suprachiasmatic nucleus has a direct neural connection to
the pineal gland, which releases the hormone melatonin at night. Cortisollevels typically rise throughout the
night, peak in the awakening hours, and diminish during the day. Circadian prolactin secretion begins in the
late afternoon, especially in women, and is subsequently augmented by sleepinduced 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. 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.
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.[43]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. 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.
Along with corresponding messages from the circadian clock, this
tells the body it needs to sleep. 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]. The timing is correct when the
following two circadian markers occur after the middle of the
sleep episode and before awakening: maximum concentration of
the hormone melatonin, and minimum core body temperature.
Human sleep needs vary by age and amongst individuals,
and 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,[50] and those
affected with sleep state misperception may typically report
having slept only four hours despite having slept a full eight
hours. 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. Sleep difficulties
are furthermore associated with psychiatric disorders such
as depression, alcoholism, and bipolar disorder.[58] Up to
90% of adults with depression are found to have sleep
difficulties. Dysregulation found on 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.
By the time infants reach the age of two, their brain size has
reached 90 percent of an adult-sized brain; 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. Children
who sleep through the night and have few night waking
episodes have higher cognitive attainments and easier
temperaments than other children. Sleep also influences
language development. To test this, researchers taught infants
a faux language and observed their recollection of the rules
for that language.[65] 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.
 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.[47] Early in 2015, after a two-year
study, the National Sleep Foundation in the US announced newly
revised recommendations as shown in the table below.
 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)
 8 to 10 hours
 Adults (18–64 years) 7 to 9 hours
 Older Adults (65 years and over) 7 to 8 hours
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 6AM, and wake up a few hours after
sunrise.
Distribution
In polyphasic sleep, an organism sleeps several times in a 24-
hour cycle. 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
revolutionl. 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.
Naps
The siesta habit has recently been associated with a 37% lower
coronary mortality, possibly due to reduced cardiovascular
stress mediated by daytime sleep.[35] 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. Many people have 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 "kicks in." 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 "kicks in" 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. 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. And the circadian clock has its
own set of genes.[38]Genes which may influence sleep
include ABCC9,[39] DEC2, and variants near PAX 8 and
VRK2.
 Functions of sleep
Restoration The human organism physically restores itself during sleep, healing itself
and removing waste which builds up during periods of activity. This restoration take s
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. While awake, metabolism generates reactive oxygen species,
which are damaging to cells. In 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. 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. Anabolic hormones such as growth hormones are secreted
preferentially during sleep. Sleep has also been theorized to effectively combat the
accumulation of free radicals in the brain, by increasing the efficiency of endogenous
antioxidant mechanisms.unreliable medical source?] The concentration of the sugar
compound glycogen in the brain increases during sleep, and is depleted through
metabolism during wakefulness. Wound healing has been shown to be affected by
sleep. It has been shown that sleep deprivation affects the immune sys tem. It is now
possible to state that "sleep loss impairs immune function and immune challenge
sleep,"
alters and it has been suggested that sleep increases white blood cell counts. A 2014
study found that depriving mice of sleep increased cancer growth and dampened the
immune system's ability to control cancers.
 The effect of sleep duration on somaticgrowth 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." 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 SWS (average
24%) also had high growth hormone secretion, while subjects with a
low percentage of SWS(average 9%) had low growth hormone
secretion. Memory processing Further information: Sleep and
learning, Sleep and creativity, and Sleep and memory
 Sleep enhances memory, with procedural memory benefiting from
late, REM-rich sleep, and explicit memory benefiting from early,
slow wave-rich sleep.
Dreaming

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, despite their frequently bizarre qualities, seem realistic while in
progress. 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. People have proposed many hypothesesabout 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. Counterintuitively, penile erections during sleep are not more frequent
during sexual dreams than during other dreams. 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. John Allan Hobson and Robert McCarleypropose 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 storyin an attempt to reconcile
and make sense of the nonsensical sensory information presented to it. This would
explain the odd nature of many dreams.
Using antidepressants,[clarification needed]acetaminophen, ibuprofen, or alcoholic
beverages is thought to potentially suppress dreams, whereas melatonin may have the
ability to encourage them
 disorders
 Insomnia Insomnia is a general term for difficulty falling asleep and staying
asleep. Insomnia is the most common sleep problem, with many adults
reporting occasional insomnia, and 10–15% reporting a chronic condition.
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. 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.
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.
Obstructive sleep apnea is more common than central sleep
apnea. 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.
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.
Somnambulism, known as sleep walking, is also a
common sleeping disorder, especially among children. In
somnambulism the individual gets up from his/her sleep
and wanders around while still sleeping. Older people
may be more easily awakened by disturbances in the
environment and may to some degree lose the ability to
consolidate sleep.
 Conclusion
I could conclude that sleep is important, think of your body like a
factory that performs a number of vital functions. As you drift off to
sleep, your body begins its night-shift work:
Healing damaged cells
Boosting your immune system
Recovering from the day’s activities
Recharging your heart and cardiovascular system for the next day
We all know the value of sleeping well, and we’ve all experienced the
feeling of being refreshed after a good night’s sleep – and the feeling
of fatigue after a poor night’s sleep. But even though we know this, in
our busy society, many of us are not getting the quality sleep needed
to truly receive the health benefits of sleep.