Stupor is the lack of critical mental function and a level of consciousness , in which an affected person is almost entirely unresponsive and responds only to intense stimuli such as pain . The word derives from the Latin stupor ("numbness, insensibility").
100-564: Stupor is characterised by impaired reaction to external stimuli. Those in a stuporous state are rigid, mute and only appear to be conscious, as the eyes are open and follow surrounding objects. If not stimulated externally, a patient with stupor will appear to be in a sleepy state most of the time. In some extreme cases of severe depressive disorders the patient can become motionless, lose their appetite and become mute. Short periods of restricted responsivity can be achieved by intense stimulation (e.g. pain, bright light, loud noise, shock). Stupor
200-407: A coma or disorders of consciousness . Sleep occurs in repeating periods , during which the body alternates between two distinct modes: REM 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. Dreams are a succession of images, ideas, emotions, and sensations that usually occur involuntarily in
300-405: A 24-hour cycle, whereas in monophasic sleep this 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
400-407: 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 ; an entrained rhythm persists even if the outside signals suddenly disappear. If an entrained human
500-524: A child's quality of sleep as well as prepare them to make and keep healthy sleep hygiene habits in the future. 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. Early in 2015, after a two-year study, the National Sleep Foundation in the US announced newly revised recommendations as shown in
600-648: A deregulation of the circadian rhythm based on core temperature. Increased beta activity and decreased delta wave activity has been observed on electroencephalograms ; however, the implication of this is unknown. Around half of post-menopausal women experience sleep disturbances, and generally sleep disturbance is about twice as common in women as men; this appears to be due in part, but not completely, to changes in hormone levels, especially in and post-menopause. Changes in sex hormones in both men and women as they age may account in part for increased prevalence of sleep disorders in older people. In medicine, insomnia
700-414: A factor which may exacerbate disruption of the circadian cycle. Scientific studies on sleep have shown that sleep stage at awakening is an important factor in amplifying sleep inertia . Determinants of alertness after waking up include quantity/quality of the sleep, physical activity the day prior, a carbohydrate-rich breakfast, and a low blood glucose response to it. Sleep timing is controlled by
800-517: A few hours before going to sleep is recommended, while exercise earlier in the day may be beneficial. Other practices to improve sleep hygiene may include: It is recommended to rule out medical and psychological causes before deciding on the treatment for insomnia. Cognitive behavioral therapy is generally the first line treatment once this has been done. It has been found to be effective for chronic insomnia. The beneficial effects, in contrast to those produced by medications, may last well beyond
900-616: 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 . Up to 90 percent of adults with depression are found to have sleep difficulties. Dysregulation detected by EEG includes disturbances in sleep continuity, decreased delta sleep and altered REM patterns with regard to latency, distribution across
1000-407: 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. The timing is correct when the following two circadian markers occur after the middle of the sleep episode and before awakening: maximum concentration of
1100-413: A good night's sleep. 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 . The whole period normally proceeds in the order: N1 → N2 → N3 → N2 → REM. REM sleep occurs as a person returns to stage 2 or 1 from a deep sleep. There is a greater amount of deep sleep (stage N3) earlier in the night, while
SECTION 10
#17328686613291200-437: A journal, restricting the time spent awake in bed, practicing relaxation techniques , and maintaining a regular sleep schedule and a wake-up time. Behavioral therapy can assist a patient in developing new sleep behaviors to improve sleep quality and consolidation. Behavioral therapy may include, learning healthy sleep habits to promote sleep relaxation, undergoing light therapy to help with worry-reduction strategies and regulating
1300-606: A month. The concept of the word insomnia has two distinct possibilities: insomnia disorder (ID) or insomnia symptoms, and many abstracts of randomized controlled trials and systematic reviews often underreport on which of these two possibilities the word refers to. Insomnia can occur independently or as a result of another problem. Conditions that can result in insomnia include psychological stress , chronic pain , heart failure , hyperthyroidism , heartburn , restless leg syndrome , menopause , certain medications , and drugs such as caffeine , nicotine , and alcohol . Insomnia
1400-468: A normal sleep pattern once asleep, a circadian rhythm disorder is a likely cause. In many cases, insomnia is co-morbid with another disease, side-effects from medications, or a psychological problem. Approximately half of all diagnosed insomnia is related to psychiatric disorders. For those who have depression, "insomnia should be regarded as a co-morbid condition, rather than as a secondary one;" insomnia typically predates psychiatric symptoms. "In fact, it
1500-402: A number of conditions, it can also occur without any identifiable cause. This is known as Primary Insomnia. Primary Insomnia may also have an initial identifiable cause but continues after the cause is no longer present. For example, a bout of insomnia may be triggered by a stressful work or life event. However, the condition may continue after the stressful event has been resolved. In such cases,
1600-418: A particular frequency corresponds to various points in the sleep-wake cycle, such as being asleep, being awake, or falling asleep. Alpha, beta, theta, gamma, and delta waves are all seen in the different stages of sleep. Each waveform maintains a different frequency and amplitude. Alpha waves are seen when a person is in a resting state, but is still fully conscious. Their eyes may be closed and all of their body
1700-455: A polysomnogram and the multiple sleep latency test . Specialists in sleep medicine are qualified to diagnose disorders within the, according to the ICSD , 81 major sleep disorder diagnostic categories. Patients with some disorders, including delayed sleep phase disorder , are often mis-diagnosed with primary insomnia; when a person has trouble getting to sleep and awakening at desired times, but has
1800-461: A poor quality of sleep. Some cases of insomnia are not really insomnia in the traditional sense because people experiencing sleep state misperception often sleep for a normal amount of time. The problem is that, despite sleeping for multiple hours each night and typically not experiencing significant daytime sleepiness or other symptoms of sleep loss, they do not feel like they have slept very much, if at all. Because their perception of their sleep
1900-445: A screen before bed may interfere with sleep. 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
2000-823: A strong association with sleep duration and stronger evidence for an association with sleep duration between the ages of 6 and 15 years than for 5 years of age or younger, while evidence for associations between electronic media use with other sleep outcomes was more inconclusive. In December 2021, Frontiers in Neuroscience published a systematic review of 12 studies published from January 2000 to April 2020 that found that adult subjects with higher gaming addiction scores were more likely to have shorter sleep quantity, poorer sleep quality, delayed sleep timing, and greater daytime sleepiness and insomnia scores than subjects with lower gaming addiction scores and non-gamer subjects. In January 2022, Early Childhood Research Quarterly published
2100-438: A structured bedtime routine. This can look differently among families, but will generally consist of a set of rituals such as reading a bedtime story, a bath, brushing teeth, and can also include a show of affection from the parent to the child such a hug or kiss before bed. A bedtime routine will also include a consistent time that the child is expected to be in bed ready for sleep. Having a reliable bedtime routine can help improve
SECTION 20
#17328686613292200-611: 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. 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
2300-619: A systematic review and meta-analysis of 23 studies comprising 35,684 subjects that found a statistically significant odds ratio for sleep problems and reduced sleep duration for subjects with internet addiction. In February 2020, Psychiatry Research published a systematic review and meta-analysis of 14 studies that found positive associations between problematic smartphone use and poor sleep quality and between higher levels of problematic smartphone use and elevated risk of poor sleep quality. Also in February 2020, Sleep Medicine Reviews published
2400-576: A systematic review and meta-analysis of 26 studies that found a weak but statistically significant association with increased smartphone and tablet computer use and poorer sleep in early childhood. In May 2022, the Journal of Affective Disorders published a meta-analysis of 29 studies comprising 20,041 subjects that found a weak-to-moderate association between mobile phone addiction and sleep disorder and that adolescents with mobile phone addiction were at higher risk of developing sleep disorder. In August 2022,
2500-471: A systematic review and meta-analysis of 34 studies comprising 51,901 subjects that established significant associations between problematic gaming and sleep duration, poor sleep quality, daytime sleepiness, and other sleep problems. In September 2021, BMC Public Health published a systematic review of 49 studies investigating associations between electronic media use and various sleep outcomes among children and adolescents 15 years of age or younger that found
2600-620: A systematic review and meta-analysis of 40 studies with 33,650 post-secondary student subjects that found a weak-to-moderate positive association between mobile phone addiction and poor sleep quality. In April 2021, Sleep Medicine Reviews published a systematic review of 36 cross-sectional studies and 6 longitudinal studies that found that 24 of the cross-sectional studies and 5 of the longitudinal studies established significant associations between more frequent social media use and poor sleep outcomes. In June 2021, Frontiers in Psychiatry published
2700-513: A systematic review of 12 studies investigating associations between exposure to video games, sleep outcomes, and post-sleep cognitive abilities that found the data present in the studies indicated associations between a reduction in sleep duration, increased sleep onset latency, modifications to rapid eye movement sleep and slow-wave sleep , increased sleepiness and self-perceived fatigue , and impaired post-sleep attention span and verbal memory . In October 2019, Sleep Medicine Reviews published
2800-430: A systematic review of 23 studies that found that excessive use of digital screens by adolescents was associated with poor sleep quality, nighttime awakenings, long sleep latency, and daytime sleepiness. In December 2022, Sleep Epidemiology published a systematic review of 18 studies investigating associations between sleep problems and screen time during COVID-19 lockdowns that found that the increased screen time during
2900-409: A systematic review of 31 studies examining associations between screen time and sleep outcomes in children younger than 5 years and found that screen time is associated with poorer sleep outcomes for children under the age of 5, with meta-analysis only confirming poor sleep outcomes among children under 2 years. In March 2020, Developmental Review published a systematic review of 9 studies that found
3000-540: A transitional period is called slow-wave sleep or deep sleep. During this phase, body temperature and heart rate fall, and the brain uses less energy. REM sleep, also known as paradoxical sleep, represents a smaller portion of total sleep time. It is the main occasion for dreams (or nightmares ), and is associated with desynchronized and fast brain waves, eye movements, loss of muscle tone, and suspension of homeostasis . The sleep cycle of alternate NREM and REM sleep takes an average of 90 minutes, occurring 4–6 times in
3100-547: A weak-to-moderate association between sleep quantity and quality and problematic smartphone use among adolescents. In October 2020, the International Journal of Environmental Research and Public Health published a systematic review and meta-analysis of 80 studies that found that greater screen time was associated with shorter sleep duration among toddlers and preschoolers, while the Journal of Behavioral Addictions published
Stupor - Misplaced Pages Continue
3200-425: A week (Gillette). Insomnia can be classified as transient, acute, or chronic. Prevention and treatment of insomnia may require a combination of cognitive behavioral therapy , medications, and lifestyle changes. Among lifestyle practices, going to sleep and waking up at the same time each day can create a steady pattern which may help to prevent insomnia. Avoidance of vigorous exercise and caffeinated drinks
3300-522: Is adenosine , a neurotransmitter that inhibits many of the bodily processes associated with wakefulness. Adenosine levels increase in the cortex and basal forebrain during prolonged wakefulness, and decrease during the sleep-recovery period, potentially acting as a homeostatic regulator of sleep. Coffee , tea, and other sources of caffeine temporarily block the effect of adenosine, prolong sleep latency, and reduce total sleep time and quality. Humans are also influenced by aspects of social time , such as
3400-448: Is a sleep disorder where people have trouble sleeping . They may have difficulty falling asleep, or staying asleep for as long as desired. Insomnia is typically followed by daytime sleepiness , low energy, irritability , and a depressed mood . It may result in an increased risk of accidents of all kinds as well as problems focusing and learning. Insomnia can be short term, lasting for days or weeks, or long term, lasting more than
3500-403: Is a result of, or cause of insomnia. Altered levels of the inhibitory neurotransmitter GABA have been found, but the results have been inconsistent, and the implications of altered levels of such a ubiquitous neurotransmitter are unknown. Studies on whether insomnia is driven by circadian control over sleep or a wake dependent process have shown inconsistent results, but some literature suggests
3600-552: Is accumulated against an individual's average sleep or some other benchmark. It is also unclear whether the prevalence of sleep debt among adults has changed appreciably in the industrialized world in recent decades. Sleep debt does show some evidence of being cumulative. Subjectively, however, humans seem to reach maximum sleepiness 30 hours after waking. It is likely that in Western societies , children are sleeping less than they previously have. One neurochemical indicator of sleep debt
3700-482: Is also common in people with ADHD , and children with autism . Other risk factors include working night shifts and sleep apnea . Diagnosis is based on sleep habits and an examination to look for underlying causes. A sleep study may be done to look for underlying sleep disorders. Screening may be done with questions like "Do you experience difficulty sleeping?" or "Do you have difficulty falling or staying asleep?" Although their efficacy as first line treatments
3800-499: Is associated with infectious diseases , complicated toxic states (e.g. heavy metals ), severe hypothermia , mental illnesses (e.g. schizophrenia , major depressive disorder ), epilepsy, vascular illnesses (e.g. hypertensive encephalopathy ), acute stress reaction (shock), neoplasms (e.g. brain tumors ), brain disorders (e.g. alzheimers , dementia , fatal insomnia ), B 12 deficiency , major trauma , alcohol poisoning, vitamin D excess, and other conditions. Lesions of
3900-653: Is dark. The diverse purposes and mechanisms of sleep are the subject of substantial ongoing research. Sleep is a highly conserved behavior across animal evolution, likely going back hundreds of millions of years. Humans may suffer from various sleep disorders , including dyssomnias , such as insomnia , hypersomnia , narcolepsy , and sleep apnea ; parasomnias , such as sleepwalking and rapid eye movement sleep behavior disorder ; bruxism ; and circadian rhythm sleep disorders . The use of artificial light has substantially altered humanity's sleep patterns. Common sources of artificial light include outdoor lighting and
4000-439: Is difficulty falling asleep at the beginning of the night, often a symptom of anxiety disorders . Delayed sleep phase disorder can be misdiagnosed as insomnia, as sleep onset is delayed to much later than normal while awakening spills over into daylight hours. It is common for patients who have difficulty falling asleep to also have nocturnal awakenings with difficulty returning to sleep. Two-thirds of these patients wake up in
4100-578: Is incomplete, they incorrectly believe it takes them an abnormally long time to fall asleep , and they underestimate how long they stay asleep. In August 2018, Sleep Science and Practice published a systematic review and meta-analysis of 19 studies comprising 253,904 adolescent subjects that found that excessive technology use had a strong and consistent association with reduced sleep duration and prolonged sleep onset latency for adolescents 14 years of age or older. Also in August 2018, Sleep Science published
Stupor - Misplaced Pages Continue
4200-488: Is intentionally disrupted during a sleep study. Studies of brain metabolism using positron emission tomography (PET) scans indicate that people with insomnia have higher metabolic rates by night and by day. The question remains whether these changes are the causes or consequences of long-term insomnia. Heritability estimates of insomnia vary between 38% in males to 59% in females. A genome-wide association study (GWAS) identified 3 genomic loci and 7 genes that influence
4300-399: 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 that 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
4400-450: Is known as a "natural short sleeper". This condition is not to be confused with intentional sleep deprivation, which leaves symptoms such as irritability or temporarily impaired cognitive abilities in people who are predisposed to sleep a normal amount of time but not in people with FNSS. The genes DEC2 , ADRB1 , NPSR1 and GRM1 are implicated in enabling short sleep. The quality of sleep may be evaluated from an objective and
4500-544: Is not unequivocally established, sleep hygiene and lifestyle changes are typically the first treatment for insomnia. Sleep hygiene includes a consistent bedtime, a quiet and dark room, exposure to sunlight during the day and regular exercise . Cognitive behavioral therapy may be added to this. While sleeping pills may help, they are sometimes associated with injuries , dementia , and addiction . These medications are not recommended for more than four or five weeks. The effectiveness and safety of alternative medicine
4600-422: Is observed to be a necessary behavior across most of the animal kingdom, including some of the least cognitively advanced animals which have no need for other functions of sleep, such as memory consolidation or dreaming. It has been widely accepted that sleep must support the formation of long-term memory, and generally increasing previous learning and experiences recalls. However, its benefit seems to depend on
4700-654: Is only recommended for short-term use because dependence with rebound withdrawal effects upon discontinuation or tolerance can develop. Non medication based strategies provide long lasting improvements to insomnia and are recommended as a first line and long-term strategy of management. Behavioral sleep medicine (BSM) tries to address insomnia with non-pharmacological treatments. The BSM strategies used to address chronic insomnia include attention to sleep hygiene , stimulus control , behavioral interventions, sleep-restriction therapy , paradoxical intention , patient education, and relaxation therapy . Some examples are keeping
4800-472: Is possible that insomnia represents a significant risk for the development of a subsequent psychiatric disorder." Insomnia occurs in between 60% and 80% of people with depression. This may partly be due to treatment used for depression. Determination of causation is not necessary for a diagnosis. The DSM-5 criteria for insomnia include the following: Predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of
4900-443: Is profoundly influenced by changes in light, since these are its main clues about what time it is. Exposure to even small amounts of light during the night can suppress melatonin secretion, and increase body temperature and wakefulness. Short pulses of light, at the right moment in the circadian cycle, can significantly 'reset' the internal clock. Blue light, in particular, exerts the strongest effect, leading to concerns that use of
5000-400: Is regulated by a process called homeostasis . Induced or perceived lack of sleep is called sleep deprivation . Process S is driven by the depletion of glycogen and accumulation of adenosine in the forebrain that disinhibits the ventrolateral preoptic nucleus , allowing for inhibition of the ascending reticular activating system . Sleep deprivation tends to cause slower brain waves in
5100-443: Is resting and relatively still, where the body is starting to slow down. Beta waves take over alpha waves when a person is at attention, as they might be completing a task or concentrating on something. Beta waves consist of the highest of frequencies and the lowest of amplitude, and occur when a person is fully alert. Gamma waves are seen when a person is highly focused on a task or using all their concentration. Theta waves occur during
SECTION 50
#17328686613295200-485: Is unclear. Between 10% and 30% of adults have insomnia at any given point in time and up to half of people have insomnia in a given year. About 6% of people have insomnia that is not due to another problem and lasts for more than a month. People over the age of 65 are affected more often than younger people. Women are more often affected than men. Descriptions of insomnia occur at least as far back as ancient Greece . Symptoms of insomnia: Sleep onset insomnia
5300-496: Is widely measured using the Athens insomnia scale . It is measured using eight different parameters related to sleep, finally represented as an overall scale which assesses an individual's sleep pattern. A qualified sleep specialist should be consulted for the diagnosis of any sleep disorder, so the appropriate measures can be taken. Past medical history and a physical examination need to be done to eliminate other conditions that could be
5400-533: The International Journal of Environmental Research and Public Health published a systematic review and meta-analysis of 16 studies comprising 8,077 subjects that established a significant association between binge-watching and sleep problems and a stronger association between binge-watching and sleep problems was found during the COVID-19 pandemic than pre-pandemic. In October 2022, Reports in Public Health published
5500-488: The circadian clock (Process C), sleep-wake homeostasis (Process S), and to some extent by the individual will. Sleep timing depends greatly on hormonal signals 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),
5600-437: The frontal cortex , shortened attention span, higher anxiety, impaired memory, and a grouchy mood. Conversely, a well-rested organism tends to have improved memory and mood. Neurophysiological and functional imaging studies have demonstrated that frontal regions of the brain are particularly responsive to homeostatic sleep pressure. There is disagreement on how much sleep debt is possible to accumulate, and whether sleep debt
5700-432: The mind during certain stages of sleep. 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 , when it
5800-454: The HPA axis and arousal; second, increased global cerebral glucose utilization during wakefulness and NREM sleep in people with insomnia; and lastly, increased full body metabolism and heart rate in those with insomnia. All these findings taken together suggest a deregulation of the arousal system, cognitive system, and HPA axis all contributing to insomnia. However, it is unknown if the hyperarousal
5900-422: The ascending reticular activation system on height of the pons and metencephalon have been shown to cause stupor. The incidence is higher after left-sided lesions . Because stupors are caused by another health condition, treatment focuses on uncovering and treating the cause. Doctors may administer IV antibiotics or fluids to treat infections and nutritional deficits, or conduct an MRI to check for lesions on
6000-415: The brain and body, the reduced rate of metabolism enables countervailing restorative processes. The brain requires sleep for restoration, whereas these processes can take place during quiescent waking in the rest of the body. The essential function of sleep may be its restorative effect on the brain: "Sleep is of the brain, by the brain and for the brain." This theory is strengthened by the fact that sleep
6100-447: The brain plasticity. Alcohol is often used as a form of self-treatment of insomnia to induce sleep. However, alcohol use to induce sleep can be a cause of insomnia. Long-term use of alcohol is associated with a decrease in NREM stage 3 and 4 sleep as well as suppression of REM sleep and REM sleep fragmentation. Frequent moving between sleep stages occurs with; awakenings due to headaches,
SECTION 60
#17328686613296200-560: The brain restores its supply of adenosine triphosphate (ATP), the molecule used for short-term storage and transport of energy. In quiet waking, the brain is responsible for 20% of the body's energy use, thus this reduction has a noticeable effect on overall energy consumption. Sleep increases the sensory threshold . In other words, sleeping persons perceive fewer stimuli, but 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
6300-440: The brain. Sleep Sleep is a state of reduced mental and physical activity in which consciousness is altered and certain sensory activity is inhibited. During sleep, there is a marked decrease in muscle activity and interactions with the surrounding environment. While sleep differs from wakefulness in terms of the ability to react to stimuli , it still involves active brain patterns, making it more reactive than
6400-546: The cause of insomnia. After all other conditions are ruled out, a comprehensive sleep history should be taken. The sleep history should include sleep habits, medications (prescription and non-prescription), alcohol consumption, nicotine and caffeine intake, co-morbid illnesses, and sleep environment. A sleep diary can be used to keep track of the individual's sleep patterns. The diary should include time to bed, total sleep time, time to sleep onset, number of awakenings, use of medications, time of awakening, and subjective feelings in
6500-654: The day, is associated with the secretion of prolactin . Key physiological methods for monitoring and measuring changes during sleep include electroencephalography (EEG) of brain waves , electrooculography (EOG) of eye movements, and 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. The electrical activity seen on an EEG represents brain waves. The amplitude of EEG waves at
6600-530: The deepest levels of sleep. Stopping chronic alcohol use can also lead to severe insomnia with vivid dreams. During withdrawal, REM sleep is typically exaggerated as part of a rebound effect . Some people experience sleep disruption or anxiety if they consume caffeine. Doses as low as 100 mg/day, such as a 6 oz (170 g) cup of coffee or two to three 12 oz (340 g) servings of caffeinated soft-drink, may continue to cause sleep disruption, among other intolerances. Non-regular caffeine users have
6700-926: The deepest period of sleep. Napping too long and entering the slow wave cycles can make it difficult to awake from the nap and leave one feeling unrested. This period of drowsiness is called sleep inertia . The siesta habit has recently been associated with a 37% lower coronary mortality, possibly due to reduced cardiovascular stress mediated by daytime sleep. 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. 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 that can be analyzed. The circadian clock has its own set of genes. Genes which may influence sleep include ABCC9 , DEC2 , Dopamine receptor D2 and variants near PAX 8 and VRK2 . While
6800-712: The drugs disrupt sleep architecture : decreasing sleep time, delaying time to REM sleep, and decreasing deep slow-wave sleep (the most restorative part of sleep for both energy and mood). Opioid medications such as hydrocodone , oxycodone , and morphine are used for insomnia that is associated with pain due to their analgesic properties and hypnotic effects. Opioids can fragment sleep and decrease REM and stage 2 sleep. By producing analgesia and sedation , opioids may be appropriate in carefully selected patients with pain-associated insomnia. However, dependence on opioids can lead to long-term sleep disturbances. Insomnia affects people of all age groups, but people in
6900-505: The end of the dark time. Bimodal sleep in humans was more common before the Industrial Revolution . 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
7000-558: The end of the sleep cycle. Awakening involves heightened electrical activation in the brain, beginning with the thalamus and spreading throughout the cortex . On a typical night of sleep, there is not much time that is spent in the waking state. In various sleep studies that have been conducted using the electroencephalography, it has been found that females are awake for 0-1% during their nightly sleep while males are awake for 0-2% during that time. In adults, wakefulness increases, especially in later cycles. One study found 3% awake time in
7100-486: The exact 24 hours of an Earth day. The circadian clock exerts constant influence on the body, affecting 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 night. The circadian pacemaker in
7200-533: 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 ; however, people can also 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,
7300-399: The flesh in the oropharynx . Usually, the test is not needed to make a diagnosis, and insomnia especially for working people can often be treated by changing a job schedule to make time for sufficient sleep and by improving sleep hygiene . Some patients may need to do an overnight sleep study to determine if insomnia is present. Such a study will commonly involve assessment tools including
7400-498: The following groups have a higher chance of acquiring insomnia: Two main models exist as to the mechanism of insomnia, cognitive and physiological. The cognitive model suggests rumination and hyperarousal contribute to preventing a person from falling asleep and might lead to an episode of insomnia. The physiological model is based upon three major findings in people with insomnia; firstly, increased urinary cortisol and catecholamines have been found suggesting increased activity of
7500-588: The following symptoms: In addition: The DSM-IV TR includes insomnia but does not fully elaborate on the symptoms compared to the DSM-5. Instead of early-morning waking as a symptom, the DSM-IV-TR listed “nonrestorative sleep” as a primary symptom. The duration of the experience was also vague in the DSM-IV-TR. The DSM-IV-TR stated that symptoms had to be present for a month, whereas in the DSM-5, it stated symptoms had to be present for three months and occur at least 3 nights
7600-557: The future, feeling overstimulated, and overanalyzing past events. Poor sleep quality can occur as a result of, for example, restless legs , sleep apnea or major depression . Poor sleep quality is defined as the individual not reaching stage 3 or delta sleep which has restorative properties. Major depression leads to alterations in the function of the hypothalamic–pituitary–adrenal axis , causing excessive release of cortisol which can lead to poor sleep quality. Nocturnal polyuria , excessive night-time urination, can also result in
7700-412: 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
7800-448: The hormone melatonin, and minimum core body temperature. Human sleep-needs vary by age and amongst individuals; 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 , and those affected with sleep state misperception may typically report having slept only four hours despite having slept
7900-475: The hours when other people are awake, the hours when work is required, the time on clocks, etc. Time zones , standard times used to unify the timing for people in the same area, correspond only approximately to the natural rising and setting of the sun. An extreme example of the approximate nature of time zones is China, a country which used to span five time zones and now officially uses only one (UTC+8). In polyphasic sleep , an organism sleeps several times in
8000-494: The insomnia is usually perpetuated by the anxiety or fear caused by the sleeplessness itself, rather than any external factors. Symptoms of insomnia can be caused by or be associated with: Sleep studies using polysomnography have suggested that people who have sleep disruption have elevated night-time levels of circulating cortisol and adrenocorticotropic hormone . They also have an elevated metabolic rate, which does not occur in people who do not have insomnia but whose sleep
8100-489: The latter have been found in a GWAS study that primarily detects correlations (but not necessarily causation), other genes have been shown to have a more direct effect. For instance, mice lacking dihydropyrimidine dehydrogenase (Dpyd) had 78.4 min less sleep during the lights-off period than wild-type mice. Dpyd encodes the rate-limiting enzyme in the metabolic pathway that catabolizes uracil and thymidine to β- alanine , an inhibitory neurotransmitter . This also supports
8200-493: The least caffeine tolerance for sleep disruption. Some coffee drinkers develop tolerance to its undesired sleep-disrupting effects, but others apparently do not. Like alcohol, benzodiazepines , such as alprazolam , clonazepam , lorazepam , and diazepam , are commonly used to treat insomnia in the short-term (both prescribed and self-medicated), but worsen sleep in the long-term. While benzodiazepines can put people to sleep (i.e., inhibit NREM stage 1 and 2 sleep), while asleep,
8300-430: The lockdowns negatively impacted sleep duration, sleep quality, sleep onset latency, and wake time. In March 2023, the Journal of Clinical Sleep Medicine published a systematic review and meta-analysis of 17 studies comprising 36,485 subjects that found that smartphone overuse was closely associated with self-reported poor sleep quality, sleep deprivation , and prolonged sleep latency. While insomnia can be caused by
8400-485: The middle of the night, with more than half having trouble falling back to sleep after a middle-of-the-night awakening . Early morning awakening is an awakening occurring earlier (more than 30 minutes) than desired with an inability to go back to sleep, and before total sleep time reaches 6.5 hours. Early morning awakening is often a characteristic of depression . Anxiety symptoms may well lead to insomnia. Some of these symptoms include tension , compulsive worrying about
8500-422: 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. The internal circadian clock
8600-496: The morning than are fifteen-year-olds. Chronotypes far outside the normal range are called circadian rhythm sleep disorders. Naps are short periods of sleep that one might take during the daytime, often in order to get the necessary amount of rest. Napping is often associated with childhood, but around one-third of American adults partake in it daily. The optimal nap duration is around 10–20 minutes, as researchers have proven that it takes at least 30 minutes to enter slow-wave sleep,
8700-442: The morning. The sleep diary can be replaced or validated by the use of out-patient actigraphy for a week or more, using a non-invasive device that measures movement. Workers who complain of insomnia should not routinely have polysomnography to screen for sleep disorders. This test may be indicated for patients with symptoms in addition to insomnia, including sleep apnea , obesity, a thick neck diameter, or high-risk fullness of
8800-431: The need to urinate , dehydration , and excessive sweating . Glutamine rebound also plays a role as when someone is drinking; alcohol inhibits glutamine, one of the body's natural stimulants. When the person stops drinking, the body tries to make up for lost time by producing more glutamine than it needs. The increase in glutamine levels stimulates the brain while the drinker is trying to sleep, keeping them from reaching
8900-405: The night and density of eye movements. Sleep duration can also vary according to season. Up to 90% of people report longer sleep duration in winter, which may lead to more pronounced seasonal affective disorder . 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
9000-466: The period of a person being awake, and they continue to transition into Stage 1 of sleep and in stage 2. Delta waves are seen in stages 3 and 4 of sleep when a person is in their deepest of sleep. Sleep is divided into two broad types: non-rapid eye movement (non-REM or NREM) sleep and rapid eye movement (REM) sleep. Non-REM and REM sleep are so different that physiologists identify them as distinct behavioral states. Non-REM sleep occurs first and after
9100-430: The phase of sleep and the type of memory. For example, declarative and procedural memory-recall tasks applied over early and late nocturnal sleep, as well as wakefulness controlled conditions, have been shown that declarative memory improves more during early sleep (dominated by SWS) while procedural memory during late sleep (dominated by REM sleep) does so. Insomnia Insomnia , also known as sleeplessness ,
9200-451: The proportion of REM sleep increases in the two cycles just before natural 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 a successful reduction of homeostatic sleep need, typically bring about awakening and
9300-531: The risk of insomnia, and showed that insomnia is highly polygenic. In particular, a strong positive association was observed for the MEIS1 gene in both males and females. This study showed that the genetic architecture of insomnia strongly overlaps with psychiatric disorders and metabolic traits. It has been hypothesized that epigenetics might also influence insomnia through a controlling process of both sleep regulation and brain-stress response having an impact as well on
9400-435: The role of β-alanine as a neurotransmitter that promotes sleep in mice. Familial natural short sleep is a rare, genetic, typically inherited trait where an individual sleeps for fewer hours than average without suffering from daytime sleepiness or other consequences of sleep deprivation . This process is entirely natural in this kind of individual, and it is caused by certain genetic mutations. A person with this trait
9500-400: The rules for that language. 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 can greatly benefit from
9600-471: The screens of electronic devices such as smartphones and televisions, which emit large amounts of blue light, a form of light typically associated with daytime. This disrupts the release of the hormone melatonin needed to regulate the sleep cycle . The most pronounced physiological changes in sleep occur in the brain. The brain uses significantly less energy during sleep than it does when awake, especially during non-REM sleep. In areas with reduced activity,
9700-770: The stopping of therapy. Medications have been used mainly to reduce symptoms in insomnia of short duration; their role in the management of chronic insomnia remains unclear. Several different types of medications may be used. Many doctors do not recommend relying on prescription sleeping pills for long-term use. It is also important to identify and treat other medical conditions that may be contributing to insomnia, such as depression, breathing problems, and chronic pain. As of 2022, many people with insomnia were reported as not receiving overall sufficient sleep or treatment for insomnia. Non-medication based strategies have comparable efficacy to hypnotic medication for insomnia and they may have longer lasting effects. Hypnotic medication
9800-400: The suprachiasmatic nucleus has a direct neural connection to the pineal gland , which releases the hormone melatonin at night. Cortisol levels 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 sleep-induced secretion, to peak in
9900-561: The table below. Sleep may facilitate the synthesis of molecules that help repair and protect the brain from metabolic end products generated during waking. Anabolic hormones, such as growth hormones , are secreted preferentially during sleep. The brain concentration of glycogen increases during sleep, and is depleted through metabolism during wakefulness. The human organism physically restores itself during sleep, occurring mostly during slow-wave sleep during which body temperature, heart rate, and brain oxygen consumption decrease. In both
10000-421: 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 6 a.m., and wake up a few hours after sunrise. Generally speaking, the longer an organism is awake, the more it feels a need to sleep ("sleep debt"). This driver of sleep is referred to as Process S . The balance between sleeping and waking
#328671