Sleep

Have you ever wondered why people have to sleep? They could get so much more work
done if they didn't have to sleep, and they would have more time to play and do creative
things.
THE BIOLOGY OF SLEEP

4.3 Describe the biological process of the sleep-wake cycle.

Sleep was once referred to as "the gentle tyrant" (Webb, 1992). People can try to stay
awake, and sometimes they may go for a while without sleep, but eventually they must
sleep. One reason for this fact is that sleep is one of the human body's biological rhythms,
natural cycles of activity that the body must go through. Some biological rhythms are
monthly, like the cycle of a woman's menstruation, whereas others are far shorter-the
beat of the heart is a biological rhythm. But many biological rhythms take place on a
daily basis, like the rise and fall of blood presure and body temperature or the produc
tion of certain body chemicals (Moore-Ede et al., 1982). The most obvious of these is the
sleep-wake cycde (Baehret al., 2000).
THE RHYTHMS OF LIFE: CIRCADIAN RHYTHMS Theesleep-wake cycle is a circadian
rhythm. The term actually comes from two Latin words, circa ("about")("a and diem
("day"). So a circadian rhythm is a cycle that takes "about a day" to complete.
For most people, this means that they will experience several hours of sleep at least
once during every 24-hour period. The sleep-wake cycle is ultimately controlled by the
brain, specifically by an area within the hypothalamus, the tiny section of the brain that
influences the glandular system.

There was a big fuss over something called melatonin a few years
ago-isn't melatonin supposed to make people sleep?

THE ROLE OF THE HYPOTHALAMUS: THE MIGHTY MITE Alot of people were buy
ing supplements of melatonin (a hormone normally secreted by the pineal gland)
several years ago, hoping to sleep better and perhaps even slow the effects of aging
(Folkard et al., 1993,; Herxheimer &Petrie, 2001; Young, 1996). The release of melatonin
is influenced by a structure deep within the tiny hypothalamus in an area called the
suprachiasmatic (SOO-prah-ki-AS-ma-tik) nucleus, the internal clock that tells people
when to wake up and when to fall asleep (Gandhi et al., 2015). The suprachiasmatic
nucleus, or SCN, is sensitive to changes in light. As daylight fades, the SCN tells the
pineal gland (located in the base of the brain) to secrete melatonin (Bondarenko, 2004;
Delagrarnge &Guardiola-Lemaitre, 1997). As melatonin accumulates, a person will feel
sleepy. As the light coming into the eyes increases (as it does in the morming), the SCN
tells the pineal gland to stop secreting melatonin, allowing the body to awaken. That's
a lot of control for such a small part of the brain.
Melatonin supplements are often used to treat a condition called jet lag, in which
the body's circadian hythm has been disrupted by traveling to another time zone. There
is some evidence that melatonin may be linked to a healthier metabolism (Cardinali
et al., 2013; Gandhi et al., 2015). It may help people who suffer from sleep problems
due to shift work. Shift-work sleep problems, often attributed to the custom of having
workers change shifts against natural circadian rhythms (e.g., from a day shift to
a night shift, and then back again to an evening shift), have been linked to increased
accident rates, increased absence from work due to illness, and lowered productivity
rates (Folkard & Tucker, 2003). In addition to melatonin supplements, it has been found
that gradually changing the shifts that workers take according to the natural cycle of
the day (e-g., from day shift to evening shift to night shift, rather than from day shift
directly to night shift) has significantly reduced the problems (Czeisler et al., 1982;
Folkard et al., 2006).
Melatonin is not the whole story, of course. Several neurotransmitters are associ
ated with arousal and sleep regulation, including serotonin. It was once theorized that
serotonin promoted sleepiness. However, it is not that simple. Serotonin-producing
neurons are most active during wakefulness, less active during deep sleep, and rel
atively inactive during the type of sleep in which dreams typically occur (Hornung,
2012; Siegel, 2011). Furthermore, effects differ based on which serotonin-producing
cells are firing and which brain structures are receiving those messages. Last, some
serotonin receptors are excitatory and others are inhibitory. For example, some recep
tors facilitate some stages of sleep, while others inhibit other stages (Siegel, 2011;
Zhang et al., 2015).
Body temperature plays a part in inducing sleep, too. The suprachiasmatic
nucleus, as part of the hypothalamus, controls body temperature. The higher the body
temperature, the more alert people are; the lower the temperature, the sleepier they are.
When people are asleep at night, their body temperature is at its lowest level. Be care
ful: The research on the effects of serotonin and body temperature on sleep is cor
relational, so we cannot assume causation, and there are many different factors
involved in sleep.
In studies in which volunteers spend several days without access to information
about day or night, their sleep-wake cycles lengthened (Czeisler, 1995). The daily activi
ties of their bodies- such as sleeping, waking, waste production, blood pressure rise and
fall, and so on-took place ower a period of 25 hours rather than 24 hours. Our circadian
rhythms are synchronized to a 24-hour day consistent with the day-night cycle due to the
suprachiasmatic nucleus, which receives direct input from some retinal ganglion cells
responding to light (McCormick & Westbrook, 2013).
In the same studies, body temperature dropped consistently even in the absence
of light (Czeisler et al., 1980). As body temperature dropped, sleep began, giving further
support to the importance of body temperature in the regulation of sleep.
WHY WE SLEEP
4.4 Explain why we sleep.
How much sleep is enough sleep? The answer varies from person to person because
of each person's age and possibly inherited sleep needs (Feroah et al., 2004), but most
young adults need about 7-9 hours of sleep each 24-hour period in order to function
well (see Figure 4.2). Some people are short sleepers, needing only 4or 5 hours, whereas
others are long sleepers and require more than 9 hours of sleep (McCann & Stewin,
1988). As we age, we seem to sleep less during each night until the average length of
sleep approaches only 6 hours. The amount of sleep that we get can have an impact
on our health.

Theta Waves
wmwwwwwwwwwwwm

W- awake, relaxed NI N2

12:C0

Figure 4.1 The Pattern of Theta Waves

 24

20

16 Waking

8 REM Sleep

4 NREM SIeep Total

-daily
sleep
10 20 30 40 50 60 70 90
Age in years

Figure 4.2 Sleep Patterns of Infants and Adults

Infants need far more sleep than older children and adults. Both REM sleep and NAEM sleep decrease dra
maticaly in the first 10 years of life, with the greatest decrease in REM sleep. Nearty 50 percent of an infant's
sleep is REM, compared to only about 20 percent for a normal, healthy adut (Rofwarg. 1966).

Although people can do without sleep for a while, they cannot do without it alto
gether. In one experiment, rats were placed on moving treadmills over water. They
couldn't sleep normally because they would then fall into the water and be awakened,
but they did drift repeatedly into microsleeps, or brief sidesteps into sleep lasting only
seconds (Goleman, 1982; Konowal et al., 1999). People can have microsleeps, too, and if
this happens while they are driving a car or a truck, it's obviously bad news (Akerstedt et
al., 2013; Dinges, 1995; Lyznicki et al., 1998; Thomas et al., 1998). Microsleep periods are
no doubt responsible for a lot of car accidents that occur when drivers have had very ittle
sleep.

Okay, so we obviously need to sleep. But what does it do for us?

Why do we have to sleep at all?

THEORIES OF SLEEP While it's clear that sleep is essential to life, theories about
why-the purpose of sleep-differ.
THE ADAPTIVE THEORY OF SLEEP Sleep is a product of evolution (Webb, 1992) accord
ing to the adaptive theory of sleep. It proposes that animals and humans evolved differ
ent sleep patterns to avoid being present during their predators' normal hunting times,
which typically would be at night. For example, if ahuman or aprey animal (one a pred microsleeps
ator will eat) is out and about at night, they are more at risk of being eaten. However, if brief sidesteps into sleep lasting only a
during active hunting hours the prey is in a safe place sleeping and conserving energy, it few seconds.
is more likely to remain unharmed. If this theory is true, then one would expect prey ani
mals to sleep mostly at night and for shorter periods of time than predator animals; you adaptive theory
would also expect that predators could sleep in the daytime-virtually as much as they theory of sleep proposing that animals
want. This seems to be the case for predators like lions that have very few natural preda and humans evolved sleep patterns
tors themselves. Lions will sleep nearly 15 hours a day, whereas animals such as gazelles to avoid predators by sleeping when
that are lions' prey sleep a mere 4 hours a day, usually in short naps. Nocturnal animals predators are most active.
 Animals and the Adaptive Theory of 5leep
Harephart Orattea skoth Drg CatenPtypn Tpmr Armailleenwn Ral

10

American Acaderyof Sloep Medicine

Figure 4.3 Animals and the Adaptive Theory of Sleep

such as the opossum can afford to sleep during the day and be active at night (when their
food sources are available), because they are protected from predators by sleeping high
in trees (see Figure 4.3).
THE RESTORATIVE THEORY OF SLEEP The other major theory of why organisms sleep
is called restorative theory, which states that sleep is necessary to the physical health
of the body. During sleep, chemicals that were used up during the day's activities are
replenished, other chemicals that were secreted in excess and could become toxic if left in
the system are removed, and cellular damage is repaired (Adam, 1980; Moldofsky, 1995;
Xie et al., 2013). As discussed earlier, brain plasticity is enhanced by sleep, and there is
evidence that most bodily growth and repair occur during the deepest stages of sleep,
when enzymes responsible for these functions are secreted in higher amounts (Saper
et al., 2001).
Sleep is also important for forming memories. Studies have shown that the phys
ical changes in the brain that occur when we form memories are strengthened during
sleep, and particularly so for children (Racsmány et al., 2010; Wilhelm et al., 2013). This
memory effect is no doubt due, at least in part, to the finding that sleep enhances the syn
aptic connections among neurons, thus increasing the plasticity of the brain-the brain's
ability to adapt to experiences (Aton et al., 2009; Bushey et al., 2011; Cirelli et al., 2012;
Frank &Benington, 2006). Sleep may also reduce the activity of neurons associated with
forgetting, leading to memory retention (Berry et al., 2015), and people who learn tasks
right before they go to sleep are able to both recall and perform those tasks better than
if they had not slept after learning (Kurdziel et al., 2013; Stickgold &Ellenbogen, 2008).
Which of these theories is correct? The answer is that both are probably needed
to understand why sleep occurs the way it does. Adaptive theory explains why people
sleep when they do, and restorative theory (including the important function of memory
restorative theory formation) explains why people need to sleep.
theory of sleep proposing that sleep is
necessary to the physical health of the SLEEP DEPRIVATION While we've already discussed the importance of being able to
body and serves to replenish chemi sleep and the dangers of microsleeps, just how much sleep loss can occur before seri
cals and repair cellular damage. ous problems start to happen? What will losing out on just one night's sleep do to a
person? For most people, a missed night of sleep will result in concentration problems
and the inability to do simple tasks that normally would take no thought at all, such as
loading a DVD into a player. More complex tasks, such as math problems, suffer less
than these simple tasks because people know they must concentrate on a complex task
(Chee & Choo, 2004; Lim et al., 2007).
Even so, sleep deprivation, or loss of sleep, is a serious problem, which many peo
ple have without realizing it. Students, for example, may stay up all night to study for an
important test the next day. In doing so, they will lose more information than they gain, as
a good night's sleep is important for memory and the ability to think well (Gillen- Neel
et al., 2012). Even a few nights of poor sleep have serious consequences for mental and
physical functioning Jackson et al., 2013; Van Dongen et al., 2003). Some typical symp
toms of sleep deprivation include trembling hands, inattention, staring off into space,
droopy eyelids, and general discomfort (Naitoh et al., 1989), as well as emotional symp
toms such as irritability and even depression. Add to that list an increased risk of insulin
resistance, which can lead to diabetes (Matthews et al., 2012), and even possible delays
in the onset of puberty (Shaw et al., 2012). And if you are a Twitter user, beware-a study
found that users suffering from sleep deprivation tend to create more negative tweets,
a sign of increased risk for psychological issues (Mctver et al., 2015). As you will see in
the feature titled "Weight Gain and Sleep" later on in this chapter, one common cause of
sleep deprivation is a disturbance of the sleep-wake cycle, something that is a common
problem among college students.

THE STAGES OF SLEEP

4.5 ldentify the different stages of sleep.
sleep deprivation
any significant loss of sleep, result
So are there differernt kinds of sleep? Do you go from being ing in problems in concentration and
awake to being asleep and dreaming is it instant? iritability.

There are actually two kinds of sleep: rapid eye movement sleep (R; REM) and rapid eye movement sleep (R, REM)
non-rapid eye movement sleep (N; NREM). REM sleep is a relatively psychologically stage of sleep in which the eyes move
active type of sleep when most of a person's dreaming takes place, whereas NREM sleep rapidly under the eyelids and the per
spans from lighter stages to a much deeper, more restful kind of sleep. In REM sleep, the son is typically experiencing a dream.
voluntary muscles are inhibited, meaning that the person in REM sleep moves very little,
whereas in NREM sleep the person's body is free to move around (including kicking non-REM (N, NREM) sleep
any of the stages of sleep that do not
one's bed partner!). There are also several different stages of sleep that people go through include REM.
each night in which REM sleep and NREM sleep occur. A machine called an electro
encephalograph allows scientists to record the brain-wave activity as a person passes beta waves
through the various stages of sleep and to determine what type of sleep the person has smaller and faster brain waves, typi
entered (Aserinsky &Kleitman, 1953).
cally indicating mental activity.
A person who is wide awake and mentally active will show a brain-wave pattern
on the electroencephalogram (EEG) called beta waves. Beta waves are very small and alpha waves
very fast. As the person relaxes and gets drowsy, slightly larger and slower alpha waves brain waves that indicate a state of
appear. The alpha waves are eventually replaced by even slower and larger theta waves. relaxation or light sleep.
In the deepest stages of sleep, the largest and slowest waves appear, called delta waves.
Before moving on to the topic of the stages of sleep, it is worth mentioning that the theta waves
terminology we now use for the various types and stages of sleep has changed in recent brain waves indicating the early stages
years, replacing older terminology that dated back to the 1960s (Carskadon &Dement, of sleep.
2011). If you find yourself reading older sleep research and see terms like REM (now R),
NREM (now N), or four stages of NREM sleep instead of the three stages we will exam delta waves
ine shortly, it is due to this change in the guidelines set forth by the American Academy long, slow brain waves that indicate
of Sleep Medicine (Tber et al., 2007). the deepest stage of sleep.
N1: LIGHT SLEEP As theta wave activity increases and alpha wave activity fades
away, people are said to be entering stage N1 sleep, or light sleep. Several rather inter
esting things can happen in this stage of sleep. If people are awakened at this point,
they will probably not believe that they were actually asleep. They may also experience
vivid visual events called hypnogogic images or hallucinations (Kompanje, 2008; Vitor
ovic & Biller, 2013). (The Greek word hypnos means "sleep.") Many researchers now
believe that people's experiences of ghostly visits, alien abductions, and near-death
experiences may be most easily explained by these hallucinations (Kompanje, 2008).
For more about hypnogogic experiences and the role they may play in "hauntings," see
the Applying Psychology sectiorn at the end of this chapter.
A much more common occurrence is called the hypnic jerk (Cuellar et al., 2015;
Mahowald & Schenck, 1996; Oswald, 1959). Have you ever been drifting off to sleep
when your knees, legs, or sometimes your whole body gives a big "jerk"? Although
experts have no solid proof of why this occurs, many believe that it has something to do
with the possibility that our ancestors slept in trees: The relaxation of the muscles as one
drifts into sleep causes a "falling sensation, at which point the body jerks awake to pre
vent the "fall" from the hypothetical tree (Coolidge, 2006; Sagan, 1977).
N2: SLEEP SPINDLES As people drift further into sleep, the body temperature con
tinues to drop. Heart rate slows, breathing becomes more shallow and irregular, and
the EEG will show the first signs of sleep spindles, brief bursts of activity lasting only a
second or two. Theta waves still predominate in this stage, but if people are awakened
during this stage, they will be aware of having been asleep.
N3: DELTA WAVEs ROLL IN In the third stage of sleep, the slowest and largest waves
make their appearance. These waves are called delta waves. These waves increase
during this stage from about 20 percent to more than 50 percent of total brain activity.
Now the person is in the deepest stage of sleep, often referred to as slow-wave sleep
(SwS) or simply deep sleep (Carskadon &Dement, 2011).
It is during this stage that growth hormones (often abbreviated as GH) are released
from the pituitary gland and reach their peak. The body is at its lowest level of func
tioning. Eventually, the delta waves become the dominant brain activity for this stage
of sleep. See Figure 4.4, which shows progression, including brain activity, through the
sleep stages throughout one night.
People in deep sleep are very hard to awaken. If something does wake them, they
may be very confused and disoriented at first. It is not unusual for people to wake up in
this kind of disoriernted state only to hear the crack of thunder and realize that a storm
has come up. Children are even harder to wake up when in this state than are adults.
Deep sleep is the time when body growth occurs. This may explain why children in
periods of rapid growth need to sleep more and also helps explain why children who
are experiencing disrupted sleep (as is the case in situations of domestic violence) suffer
delays in growth (Gilmour &Skuse, 1999; Swanson, 1994).
The fact that children do sleep so deeply may explain why certain sleep disorders
are more common in childhood. Indeed, many sleep disorders are more common in boys
than in girls because boys sleep more deeply than do girls due to high levels of the male
hormone testosterone (Thiedke, 2001).
R: RAPID EYE MOVEMENT After spending some time in N3, the sleeping person will
go back up through N2 and then into a stage in which body temperature increases
to near-waking levels, the eyes move rapidly under the eyelids, the heart beats much
faster, and brain waves resemble beta waves-the kind of brain activity that usually
signals wakefulness. The person is still asleep but in the stage known as rapid eye
movement sleep (R) and sometimes referred to as paradoxical sleep.
 Awake, alert: Beta Waves Awake, relaxed: Alpha Waves
Longest periods Brief
of deep sleep awakenings

Awak
Sleep Stage N1: Theta Waves
REM

Sleep Stage N2: Spindles (bursts of activity)

N2

N3
12a 1a 2a 3a 4a 5a Sleep spindle
Sleep Stage N3: Deep non-REM

Sleep Stage R

Bursts continud
ealof
eesynchronous
Lowv
vertical eye movements
move theta with minimal beta

Figure 4.4 Brain Activity During Sleep

The EEG reflects brain activity during both waking and siaep. This activity varies according to level of alertness while awake (top two segments) and the sto
presence of deBta activity,
of sleep. Stage N3 of sleep is characterized by the prese vity, which is much slower and accounts for the larger, slower waves on these graphs.
R sleep has activity that resembles alert wakefulness but has relatively no Uscle activity except rapid eye movernent. The graph shows the typical progression
through the night of Stages N1-N3 and R. The R sleep periods occur about every 90 minutes throughout the night (based on Dement, 1974). EEG data and
images in this figure are courtesy of Dr. Leslie Sherlin.

REM SLEEP: PERCHANCE TO DREAM? When a person in stage R is awakened, he or she

almost always reports being in a dream state (Shafton, 1995). REM sleep is, therefore, asso
ciated with dreaming, and 90 percent of dreams actually take place in REM sleep. People
do have dreams in the other non-REM sleep stages, but REM sleep dreams tend to be more
vivid, more detailed, longer, and more bizarre than the dreams of NREM sleep. NREM
sleep dreams tend to be more like thoughts about daily occurrences and far shorter than
REM sleep dreams (Foulkes &Schmidt, 1983;Takeuchi et al., 2003). Fortunately, the body is
unable to act upon these dreams under normal conditions because the voluntary muscles
are paralyzed during REM sleep, a condition known as sleep paralysis. (This is why you
sometimes have a dream in which you are trying to run or move and can't-you are par
tially aware of sleep paralysis.)
WHAT IS THE PURPOSE OF REM SLEEP? Why two kinds of sleep? And why would REM
sleep ever be considered restful when the body is almost awake and the brain is so
active? REM sleep seems to serve a different purpose than does NREM, or deep sleep. sleep paralysis
After a very physically demanding day, people tend to spend more time in NREM deep the inability of the voluntary muscles
sleep than is usual. But an emotionally stressful day leads to increased time in REM sleep to move during REM sleep.
(Horne &Staff, 1983). Perhaps the dreams people have in REM sleep are a way of dealing
with the stresses and tensions of the day, whereas physical activity would demand more
time for recovery of the body in NREM sleep. Also, if deprived of REM sleep (as would
occur with the use of sleeping pills or other depressant drugs), a person will experience
greatly increased amounts of REM sleep the next night, a phenomenon called REM
rebound (Lo Bue et al., 2014; Vogel, 1975, 1993).
An early study of REM sleep deprivation (Dement, 1960) seemed to suggest that
people deprived of REM sleep would become paranoid, seemingly mentally ill from lack
of this one stage of sleep. This is called the REM myth because later studies failed to reli
ably produce the same results (Dement et al., 1969).
early research attempted to link REM sleep with the physical changes that
occur during storing a memory for what one has recently learned, but the evidence today
suggests that no one particular stage of sleep is the "one" in which this memory process
occurs; rather, the evidence is mounting for sleep in general as necessary to the formation
of memory (Ellenbogen et al., 2006; Kurdziel et al., 2013; Maquet et al., 2003; Seehagen
et al., 2015; Siegel, 2001; Stickgold et al., 2001; Walker, 2005).
REM sleep in early infancy differs from adult REM sleep in several ways: Babies
spend nearly 50 percent of their sleep in REM sleep as compared to adults 20 percent,
the brain-wave patterns on EEG recordings are not exactly the same in infant REM sleep
when compared to adult REM sleep recordings, and infants can and do move around
quite a bit during REM sleep (Carskadon &Dement, 2005; Davis et al., 2004; Sheldon,
2002; Tucker et al., 2006). These differences can be explained: When infants are engaged
in REM sleep, they are not dreaming but rather forming new connections between neu
rons (Carskadon &Dement, 2005; Seehagen et al., 2015). The infant brain is highly plas
tic, and much of brain growth and development takes place during REM sleep. As the
infant's brain nears its adult size by age 5 or 6, the proportion of REM sleep has also
decreased to a more adult-like ratio of REM sleep to NREM sleep. For infants, to sleep is
perchance to grow synapses.