Wakefulness

and Sleep
BY: MARK CRISTIAN BERNABE
IRISH NICOLE FERRER
MARIA ALYSHIA PARREÑAS
 SLEEP
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Sleep is a subject that fascinates most people.
Many people today report that they do not get
enough sleep and yet there is still controversy
over the function of sleep and how much sleep is
‘enough’. Sleep is adapted depending on the
current environment and other competing
motivations.
The onset of sleep varies according to levels of
sleepiness, and the period of sleep can be
extended or shortened according to
circumstances. There are also consequences of
sleep deprivation, such as an increased likelihood
of having an accident while driving.
Sleep is a period of reduced activity during which
a person has their eyes closed and is not aware of
their immediate environment.
Provides a measure of overall brain activity. In
EEG, electrodes are attached to the scalp with a
special paste. These electrodes measure the
activity of large populations of neurons that are
recordable on the head surface.
The electrical signals detected by the scalp
electrodes are amplified and then passed to a
computer, and the resultant ‘brain waves’ can be
displayed. EEG can record spontaneous activity
and activity in response to a specific stimulus.
In 1924 Hans Berger, a German
neurologist, used ordinary radio
equipment to amplify the brain’s
electrical activity and depict it
graphically on a strip of paper. He
observed that the activity changed
in certain neural diseases, such as in
epilepsy. EEG recording procedures
are non-invasive, safe and painless.
EEG shows us that different levels of
responsiveness to external stimuli are associated
with specific patterns of brain activity. Therefore,
in humans, sleep is usually defined according to
electrophysiological criteria. Different states of
waking and sleep are also associated with
changes in the patterns.
DEFINING SLEEP
STAGES
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There are some areas of the brain that are more
active during sleep than waking. In addition, only
small reductions in cerebral blood flow have been
observed during sleep (Kety, 1956). Sleep
involves specific patterns of brain activity that we
will discover.
Electrical activity in the brain, muscles and eyes, which
can be measured by EEG, EMG and EOG, is characterized
by oscillating activity represented by waveforms that
vary in their frequency (the rhythm of the waves),
amplitude (the wave intensity or height) and shape.
When the pattern repeats, this is a regular or
synchronized waveform, and when there is no discernible
repeating pattern, this is an irregular waveform. We will
first describe the activity associated with the waking
state and then define sleep according to changes in this
pattern.
During the alert waking state, the EEG consists of what
is called beta activity. But when a person is relaxed but
still awake or resting with their eyes closed, the EEG
consists of alpha activity.

Beta activity - Irregular pattern, high-frequency but low-amplitude brain waves of

around 13–30 cycles per second, associated with waking.

Alpha activity - Regular pattern, a rhythm of 8–13 cycles per second. Indicates
relaxed wakefulness with eyes closed. During waking there is also evidence of
muscle and eye movement activity in the EMG and EOG.
The transition from waking to sleep is defined by the
presence of a different kind of EEG activity: theta wave
activity. Theta wave activity occurs at a frequency of 3–
7Hz, has slightly higher amplitude than alpha waves, and
is associated with Stage 1 sleep.
Stage 1 sleep is known as the transitional stage and it
usually lasts for a short period. A person may open and
close their eyes and the eyes may roll upward and
downwards during this period.
After about ten minutes of theta wave activity, the EEG
changes again and very distinctive patterns interrupt the
theta rhythms. These patterns take the form of sleep
spindles, which are a burst of high-frequency activity
lasting between 0.5 and 1.0 second, and K-complexes,
which consist of a sharp negative deflection in the
waves followed immediately by slower positive
deflection.
The presence of sleep spindles and K-complexes defines
Stage 2 of sleep. This is still a light phase of sleep when
a person may still be woken easily by noises and
changes in the environment and they may still deny
being asleep if roused.
As a person continues to sleep, it becomes more
difficult to wake them, and this coincides with another
change to the EEG pattern. When someone goes into
deep sleep, it is known as slow wave sleep.
When delta wave activity becomes apparent or seen in
the EEG, this defines Stage 3 of sleep. When the
proportion of the EEG taken up with delta waves is more
than 50%, then this defines Stage 4 sleep.

Delta wave activity – regular pattern, high-amplitude, and low-frequency

waveforms of about 1–4Hz. Associated with slow wave sleep (stages 3-4 sleep).
After a person has fallen asleep, they progress through
Stages 1–4 of sleep and this takes about an hour. They
then cycle back up to Stage 2 sleep and something
strange happens: REM sleep or known as Rapid Eye
Movement. The EEG shows patterns of activity that are
very similar to the beta waves or the waking state, but
the person will still look as if they are asleep.
The French researcher, Michel Jouvet, termed this stage
‘paradoxical’ sleep for this reason. It is a stage of sleep
in which the eyes are also seen to dart quickly back and
forth (Aserinsky and Kleitman, 1953).

Rapid eye movement (REM) sleep – A sleep phase characterized by eye

movements, paralysis, and a desynchronised EEG. Also called paradoxical sleep;
associated with dreaming.
After the first period of REM sleep, which lasts about 20
minutes, there is a cycling back down through the stages of non-
REM sleep and back up again to another period of REM. As sleep
continues, the cycling continues, but there is more Stage 2
sleep and less of Stage 3 and Stage 4 sleep and the bouts of
REM sleep become longer. Hence, during sleep there is
alternation between periods of REM and non-REM sleep taking
about 90 minutes. This kind of rhythm, which lasts less than 24
hours, is known as an ultradian rhythm.
Beta

Awake

Alpha
N1

Theta N2

N3

Delta
1 2 3 4 5 6
Hours
 THE BIOLOGICAL
BASES OF WAKING AND
SLEEP STATES
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Circadian rhythms direct a wide variety of functions from daily
changes in wakefulness to body temperature, metabolism, and the
release of hormones.

Sleep-wake homeostasis keeps track of your need for sleep.

Homeostasis refers to a balance between systems in the body. The
homeostatic sleep drive reminds the body to sleep after a certain
time and regulates sleep intensity.
Factors that influence your sleep-wake needs include medical
conditions, medications, stress, sleep environment, age, and
what you eat and drink. Perhaps the greatest influence is the
exposure to light.

Specialized cells in the retinas of your eyes process light and

tell the brain whether it is day or night and can advance or delay
our sleep-wake cycle. Exposure to light can make it difficult to
fall asleep and get back to sleep if you wake up during the
night.
Night shift workers often have trouble falling asleep when they
go to bed, and also have trouble staying awake at work because
their natural circadian rhythm and sleep-wake cycle is disrupted.
Jet lag also interferes with a person's circadian rhythms,
creating a mismatch between their internal clock and the actual
clock.
Researchers have identified an ascending arousal system in the
brain consisting of two main pathways. These pathways project
from areas in the brainstem, hypothalamus and basal forebrain
to provide wide stimulation of the cortex that produces the
waking desynchronised EEG.

The first pathway projects from the brainstem to the thalamus

and is a major relay of sensory information from the external
world to the cortex. The source of this pathway is a group of
acetylcholine-containing neurons in the brainstem: the
pedunculopontine (PPT) and laterodorsal tegmental nuclei (LDT).
Pedunculopontine tegmental nuclei (PPT) - Regulates wakefulness and
REM. It also contains cholinergic, glutamatergic, and GABAergic neurons
that likely contribute to the regulation of cortical activity and sleep–wake
states (Kroger D, 2017

Glutamatergic neurons - When these are active, they release glutamate, which keeps us
awake and alert.

Cholinergic neurons - Release acetylcholine when activated; they disrupt deep sleep which
makes the brain more active even during sleep.

GABAergic neurons - When activated, it releases GABA which slightly reduces the amount
of REM sleep.
Laterodorsal tegmental nuclei (LDT) - is a brainstem nucleus
classically involved in REM sleep and attention. It modulates
dopamine release in the nucleus accumbens.

The second pathway originates from monoaminergic neurons in

the brainstem to the lateral hypothalamic area, basal forebrain,
and cortex (Jones, 2003). The important neurons are
noradrenergic, serotonergic, dopaminergic and histaminergic.
These neurons fire most during wakefulness and are silent
during REM sleep (Aston-Jones and Bloom, 1981).
Noradrenergic neurons - They release norepinephrine, which helps keep the brain
alert and ready to respond to stimuli, playing a big role in attention and wakefulness.

Serotonergic neurons - These neurons release serotonin, which helps regulate

mood, sleep, and overall calmness.

Dopaminergic neurons - These release dopamine, important for motivation, reward,

and movement control. Dopamine also affects wakefulness.

Histaminergic neurons - These neurons release histamine, which is involved in

promoting wakefulness and alertness.
There are also forebrain neuronal systems that maintain wakefulness. The
lateral hypothalamus contains melanin-concentrating hormone (MCH) and
orexin neurons that are involved in wakefulness. Using optogenetic technology
that enables the selective activation of specific neurons, it has been shown
that activation of orexin neurons also contributes to waking from sleep
(Adamantidis et al., 2007; Carter et al., 2009).

MCH neurons - These are active mostly during REM sleep. They help promote sleep
and are thought to reduce wakefulness, helping the brain and body rest.

Orexin neurons - These do the opposite by promoting wakefulness and keeping us

alert. They are important for staying awake and regulating stimuli.
Optogenetics is the use of genetics and optics to alter the
responses of specific cells or groups of cells within living tissue.
The technique involves inserting genes that confer light
responsiveness into cells. In optogenetics, ‘Opsin’ proteins are
used because they are photosensitive. The genes coding for these
proteins can be inserted into neurons using harmless viruses.
Baron Constantin von Economo, a
Viennese neurologist, who
documented the effects of a form of
encephalitis that resulted in extreme
sleepiness; it was named after him
(encephalitis lethargica, or von
Economo’s sleeping sickness). The
encephalitis patients, who could sleep
up to 20 hours a day, had lesions at
the junction of the midbrain and
forebrain (von Economo, 1930).
Non-REM sleep

The ventrolateral preoptic (VLPO) nucleus is more active during sleep.

The VLPO forms a sleep-promoting pathway that inhibits arousal
systems (Saper et al., 2010). This shuts off the transfer of information
from the thalamus to the cortex which stops sensory inputs. Imaging
studies have shown that sleep is associated with reduced activity in the
thalamus and prefrontal cortex (Maquet, 2000).
REM Sleep

Early studies of the controls of REM sleep by Jouvet and others showed
that large lesions made in the pons disrupted REM sleep, suggesting
that this brainstem area is important for REM sleep (Jouvet, 1962;
Webster and Jones, 1988).
The shift from waking to sleep state is controlled by a switching
mechanism that depends upon groups of neurons that inhibit each
other (Saper et al., 2001). The idea is based on electronic switches
called ‘flip-flops’ that enable fast and complete transitions
between different states.
CIRCADIAN INFLUENCES ON
SLEEP: THE IMPORTANCE
OF BIOLOGICAL RHYTHMS
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A circadian rhythm is an example of a biological rhythm.
Biological rhythms are periodic changes in a body’s
functioning. These rhythms help us distinguish between
day and night. There are different types of rhythms that are
defined by the amount of time it takes to complete one
cycle, known as period.
Sleep–wake and other daily patterns, including alertness,
mood, stress, heart function and immunity, corresponds to
a circadian rhythm. Several genes have been identified,
including the period (per), clock (clk) and timeless (tim)
genes. Variation in these genes has been linked to whether
someone is a morning-type person (lark) or a night-time-
preferring person (owl).
Humans are adapted to a diurnal pattern of behavior. Our
physiology is not the same at night as it is during the day.
Effectively, we have a biological day time and a biological
night time. The reason for this is that we have an internal
biological clock that keeps track of time.
The master body clock is responsible for orchestrating
biological rhythms, consists of a pair of nuclei, one nucleus
on either side of the brain, in the hypothalamus called the
suprachiasmatic nuclei (SCN) (Ralph et al., 1990). The SCN
does not make direct connections with sleep centers in the
brain. They communicate indirectly to the VLPO sleep-
promoting center.
Light cues are important for keeping the biological clock in
check and keeping it synchronized to the solar day. This is
because, in the absence of external cues to time of day,
the biological clock runs slightly longer than 24 hours.
Cues that reset the clock are called Zeitgebers, which
means ‘time-giver’ in German. It is a stimulus or event that
sets a biological clock.
Older adults tend to report a preference for earlier habitual
bedtime and getting-up time than do younger individuals (Duffy
and Czeisler, 2002). During adolescence, there is a shift in the
body clock which favors later sleep and waking times
(Roenneberg et al., 2004). This observation has led to the
suggestion that school start times should be delayed to avoid
the potentially detrimental effects of misalignment of sleep
patterns with the school day on academic performance
(Adolescent Sleep Working Group, 2014).
HOMEOSTATIC INFLUENCES
ON SLEEP: THE SEARCH FOR
SLEEP FACTORS
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Homeostatic theories suggest that there is an optimal level of
sleep that we require, so if we do not get enough sleep there are
mechanisms that work to compensate for this by increasing
sleep. Quite some time ago it was proposed that there are
sleep-promoting substances that accumulate in the body during
prolonged wakefulness. This idea was based on reports that
injections of cerebrospinal fluid (CSF) from sleep-deprived dogs
induces sleep in recipient dogs (see Kubota, 1989).
The main candidate for a sleep factor is adenosine. Production
of adenosine in the brain is linked to energy utilization by
cells.Injection of an adenosine agonist into the basal forebrain
wake-promoting area or near the VLPO sleep-promoting area
causes sleep (Scammell et al., 2001).
EMOTIONAL AND COGNITIVE
INFLUENCES ON SLEEP

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Sleep can be resisted in response to external factors. Sleep can
be put off to deal with an emergency. The ability to stay awake
even when other factors are pushing us towards sleep probably
involves activation of prefrontal cortical areas, perhaps driven
by emotional responses generated in the amygdala (Nofzinger et
al., 2004). Sleep can also be promoted by the presence of cues
previously associated with sleep. In other words, we learn that
some environments are good for sleep and these cues can make
one feel sleepy.
Stressful situations reduce the propensity to sleep and increase
levels of arousal. The stress neurotransmitter corticotropin-
releasing hormone (CRH) has been found to stimulate orexin
neurons and it has been proposed that arousal associated with
the stress response is mediated by release of orexins (Paneda
et al., 2005). Hunger is also associated with increased arousal
and reduced sleep, and this is probably also due to increased
levels of orexins during food deprivation (Sakurai et al., 1998).
FUNCTIONS OF
SLEEP
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There has been some debate about whether sleep is necessary for the
building and restoration of material used during wakefulness.
Biochemicals and body tissues may be depleted during waking and then
restored by sleep. In support of this idea, growth hormone is released
during sleep. Studies are consistent with the idea that wakefulness
exerts some stress on the body and brain and that the sleeping state
restores optimal functioning. Another core function of sleep seems to be
in facilitating learning and memory. There is evidence that both slow
wave sleep and rapid eye movement sleep support memory consolidation
(Diekelmann and Born, 2010).
The function of sleep may involve a combination of
restoration, predator avoidance, energy conservation
and memory consolidation. Although many people
can get by with small amounts of sleep, we all sleep,
suggesting that sleep has some essential function.
SLEEP DISTURBANCES AND
IMPLICATIONS FOR
HEALTH
 INTRODUCTION

We learnt that sleep is essential for brain functioning.

This begs the questions what happens when sleep is
disturbed and how much sleep does an individual need
to avoid these detrimental effects? What is the
optimum amount of sleep? Concerns that we do not get
enough sleep have been around for a long time.
 INTRODUCTION
Even back in 1894, scientists worried that
the ‘hurry and excitement’ of modern life
was causing insomnia. Similar concerns
abound today, especially in relation to the
amount of sleep that children get.
 INTRODUCTION
In this discussion, we will ask questions about how much
sleep we need. The answers to these questions are
important not only because they will guide practical advice
on sleep, but also because they might reveal something
about the function of sleep. We will also investigate the
relationships between sleep and mental and physical health
and find out about the complex links between sleep and
emotional processes.
 INTRODUCTION
Do sleep disturbances trigger emotional problems or do
mood and anxiety disorders lead to difficulty in sleeping?
The causal relationship between sleep and emotional
processing has yet to be fully worked out, but an
implication of this work is that sleep therapy could be a
novel way of tackling emotional disorders.
 INTRODUCTION
Lastly, we will examine the memory function of sleep. It has
been known for some time that sleep improves memory, but
recently, scientists have been uncovering the specific
mechanisms through which sleep establishes memories. This
research is important because it gives us insights into the
biological processes underlying memory formation. There are
also implications for understanding the relationship between
ageing, memory, and sleep. An exciting idea that is emerging
is that treatment to improve sleep in older adults could reduce
the cognitive decline experienced in later life.
 SLEEP
DISORDERS
 INSOMNIA

NARCOLEPSY

PARASOMNIAS
INSOMNIA
 INSOMNIA

Insomnia is a common sleep problem that causes difficulty falling and staying asleep.
Additionally, you can wake up too early and find it difficult to fall back asleep. When you
wake up, you can still feel exhausted. Your attitude and energy levels can be negatively
impacted by insomnia.

Your quality of life, productivity at work, and health may also be impacted.
INSOMNIA

The cause of insomnia is usually

secondary to other problems such as
mental health problems or illness and
pain. Also, ironically, insomnia can be
caused by withdrawal from some sleeping
medications.
NARCOLEPSY
 NARCOLEPSY

Narcolepsy is a neurological condition that usually appears in adolescence or

adulthood. Narcolepsy has four primary characteristics. The impulse to fall
asleep throughout the day, usually due to monotony, is known as a sleep
attack.
 NARCOLEPSY

Cataplexy is the second most common feature of

narcolepsy. It causes full paralysis when awake
and is typically induced by strong emotions or
physical exertion. A person with narcolepsy may
collapse while fully conscious and remain
motionless for a few seconds to many minutes.
Cataplexy is a form of REM sleep (loss of
muscular tone) that occurs at an unsuitable
moment.
 NARCOLEPSY
Sleep paralysis is a typical aspect of REM sleep. However, it is
classified as a problem when it happens outside of REM sleep. It can
affect generally healthy persons as well as those suffering from
narcolepsy, cataplexy, or hypnagogic hallucinations. When it happens
without narcolepsy, it is referred to as Isolated Sleep Paralysis (ISP).

Sleep paralysis can last anywhere from a few seconds to several

minutes; longer episodes are usually disconcerting and may even
cause a panic response. The paralysis may be accompanied by
intense hallucinations, which most patients mistake for dream-like
experiences.
 NARCOLEPSY
Hypnagogic hallucinations are those that occur while you fall
asleep. They are frequent and rarely cause worry. Up to 70% of
people have experienced them at least once. A hallucination is a
misleading experience of objects or events that involve your
five senses: sight, sound, smell, touch, and taste.

Hypnagogic hallucinations are usually brief and fleeting, but are

occasionally prolonged.
 NARCOLEPSY
Narcolepsy is caused by a particular mutation in the gene that
encodes for orexin. Studies have demonstrated that people with
narcolepsy have no orexin in their CSF and fewer orexin cells
(Thannickal et al., 2000). There is no treatment for narcolepsy,
however the medicine Modafinil can help reduce some of the
symptoms. Implanting orexin-secreting cells into the brains of
persons suffering from narcolepsy may be viable in the future,
but this is still a long way off.
PARASOMNIAS
 PARASOMNIAS
Some sleep disorders, known as parasomnias, cause
disturbances during regular sleep. One type of disorder is REM
behavior disorder in which muscular tone does not decrease
during REM.

Other parasomnias, including sleep walking (somnambulism)

and sleep talking are linked to slow wave sleep. They aren't
pathological. Children frequently outgrow these parasomnias.
 PARASOMNIAS
There are two main stages of sleep – non-rapid eye movement (Non-
REM) sleep and rapid eye movement (REM) sleep. There are other
parasomnias that fall into “other” category.

Non-REM parasomnias include both physical and verbal activity.

During these occurrences, you are not fully awake or aware, are
unresponsive to others' attempts to interact with you, and frequently
do not remember or just partially remember the incident the next day.
Non-REM parasomnias most commonly affect people aged five to
twenty-five. Non-REM parasomnias are common in those with a family
history of similar parasomnias.
 PARASOMNIAS
During REM sleep, your eyes move quickly beneath your eyelids,
and your heart rate, respiration, and blood pressure all rise. This
is the moment when vivid dreams occur. Your body cycles
between non-REM and REM sleep every 90 to 110 minutes.

Parasomnias typically occur late at night. If you were awakened

during the occurrence, you are likely to remember some or all of
the dream.
 Sleep Deprivation:
A Modern Problem?
 DO YOU THINK YOU
GET ENOUGH SLEEP?
WHAT IF I ASKED YOU IF
YOU NEED MORE SLEEP?
WHAT WOULD YOU SAY?
 DO YOU THINK YOU GET ENOUGH
SLEEP?
Many people today complain that they are sleep-deprived, and a
common refrain is that the hectic lifestyles we all tend to lead
nowadays mean we can’t possibly be getting enough sleep. Surely the
game playing and TV watching that children get up to before bedtime
must mean they are not getting enough sleep? But how much sleep do
we get on average?

How does this compare with how much sleep our grandparents or great-
grandparents got?
 DO YOU GET
ENOUGH SLEEP?

Most people are likely to say they could use more sleep.
However, the amount of sleep needed varies between
individuals, and it is important to assess one’s sleep needs
accurately. Current lifestyle trends and technology usage
before bed often interfere with the body’s natural need for
rest.
WHAT DO YOU THINK
IS THE AVERAGE
SLEEPING HOURS?
WHAT DO YOU THINK IS THE AVERAGE
SLEEPING HOURS?
Adults in the UK and USA typically sleep around 7 hours per night,
according to surveys (Groeger et al., 2004; Krueger and Friedman,
2009). However, this average conceals significant variation: while
some people report sleeping less than 6 hours, others sleep more
than 9 hours.

The relationship between work hours and sleep duration has been
noted, with longer workdays often resulting in less sleep (Basner
et al., 2007).
For adults, the average sleep duration is 7 hours, the reality for
many people deviates from this.

A small percentage of the population are short sleepers, getting

less than 6 hours, while another group are long sleepers, getting
over 9 hours of sleep each night. These variations depend on
individual circumstances, such as occupation, work hours, and
personal habits. So perhaps, the current culture of long work
hours and commuting are leading to people sleeping less today
than they used to sleep 50 years ago (Van Cauter et al., 2008;
Webb and Agnew, 1975).
 THE LINK BETWEEN
WORK HOURS AND SLEEP?

Studies have found a strong relationship between extended work

hours and reduced sleep time (Chatzitheochari and Arber, 2009).
People work longer hours, they tend to cut back on sleep to
accommodate their schedules.
can lead to chronic sleep deprivation for many individuals.
Studies that track adult sleep patterns indicate that sleep
times have remained fairly constant, challenging the notion
that a modern 24-hour lifestyle is significantly reducing the
amount of sleep people get (Van Cauter et al., 2008; Webb
and Agnew, 1975).
Children and adolescents sleep
for longer on average than adults,
with the average being about 11
hours for 6-year-olds and 10 hours
for 10-year-olds. In general, the
average amount of sleep declines
steadily from infancy to the age
of 11.
There is a wide range of sleep patterns among young children, particularly in infancy. Studies
show that infants can sleep anywhere between 10 and 17 hours per day, depending on
individual needs (Blair et al., 2012). This variability highlights the individual differences in
sleep needs that begin in early childhood and continue into adulthood.
 IS THIS SOMETHING WE SHOULD BE CONCERNED ABOUT?
Research indicates: children today are sleeping about one hour less than those in
previous generations. This reduction in sleep duration can largely be attributed to
later bedtimes, while waking times have remained relatively stable over the years.

Several factors contribute to these later bedtimes, with increased access to

technology being a significant influence.
Devices such as smartphones and tablets often keep children engaged and
entertained well into the evening.
Shifts in cultural norms, such as more flexible evening activities and social
engagements. (Keyes et al., 2015; Matricciani et al., 2012).

WE NEED TO CONSIDER HOW MUCH SLEEP WE ACTUALLY NEED.

HOW MUCH
SLEEP IS
ENOUGH?
 HOW MUCH SLEEP IS ENOUGH?

The National Sleep Foundation recommends

different amounts of sleep depending
on age. Adults aged 18-64 should aim for 7-9 hours of sleep each
night, while teenagers require 8-10 hours to function optimally
(Hirshkowitz et al., 2015).
Margaret Thatcher is known for functioning on as
little as 4 hours of sleep per night, these cases are
rare.
Getting fewer than 6 hours of sleep leads to
significant cognitive and health issues for most
people.

The human body generally requires more than

4-5 hours of sleep to maintain proper function,
and those who sleep this little for extended
periods are likely to suffer negative
consequences.
A survey of people in the UK suggests that many people are not getting
this amount of sleep. The average sleep time reported was 6.8 hours
(Royal Society of Public Health, 2016). A similar report in the USA
suggests that around 20% of US adults are getting less than six hours a
night (Ford et al., 2015).
• Sleep needs are unique for each individual.
• The average sleep recommendation for adults is 7-9 hours.
• Some people can function well with less sleep, while others need
more.
• Genetics, lifestyle, and environmental factors influence sleep needs.
• Recognizing these variations can help individuals tailor their sleep
habits.
• Genetics determines if a person is a “short sleeper” or a “long
sleeper.”
• Some individuals can adapt to less sleep without negative effects,
while others are more vulnerable to sleep deprivation.
• Research suggests that genetics influence tolerance to reduced
sleep and susceptibility to sleep loss (He et al., 2009).
 GENETIC VULNERABILITY TO SLEEP LOSS

Certain people are genetically predisposed to be more sensitive to

sleep deprivation, particularly during the early morning hours
(Viola et al., 2007). This increased sensitivity can make it difficult
for them to function after a poor night’s sleep, even if they have
only lost a small amount of sleep. Understanding this genetic
vulnerability can help explain why some people experience more
severe consequences from sleep deprivation than others.
Some individuals can adapt to shorter sleep durations, most
people experience negative effects when their sleep is reduced to
less than 5 hours per night. Prolonged sleep deprivation at this
level can lead to significant health problems. For the majority of
the population, consistently sleeping for less than 5 hours is
outside the limits of healthy adaptation (Horne, 2011).
SLEEP AND HEALTH
 It has been suggested that both very short (less than six hours a night)
and long sleeping times (more than nine hours a night) may be
associated with a greater risk of dying than is sleeping for around six
to nine hours a night (Ferrie et al., 2007; Gallicchio and Kalesan, 2009).

There is evidence from laboratory studies that extreme sleeping times

are associated with changes in metabolism and immune function that
could contribute to serious health conditions, such as heart disease,
diabetes and obesity (Spiegel et al., 1999).
IMPACT OF SLEEP
DEPRIVATION ON
METABOLISM
Sleep deprivation has been shown to affect the body’s metabolism,
leading to changes in insulin sensitivity and glucose regulation.

When healthy individuals are restricted to just 4 hours of sleep per

night, they exhibit signs of insulin resistance, a precursor to diabetes.
This finding underscores the importance of adequate sleep for
maintaining metabolic health.

For example, experimentally reducing the amount of sleep of healthy

volunteers to about four hours a night leads to signs of insulin
resistance, which may be a risk factor for the development of
diabetes (Spiegel et al., 2004).
HORMONAL EFFECTS OF SLEEP DEPRIVATION
Sleep deprivation also affects the release of hormones that regulate
appetite, such as leptin and ghrelin.

Leptin signals fullness

Ghrelin stimulates hunger

Studies show that when people don’t get enough sleep, their leptin
levels decrease, and ghrelin levels increase, leading to overeating and
potential weight gain.

Hormonal imbalance can contribute to obesity (Spiegel et al., 2004).

 SLEEP DEPRIVATION AND OBESITY

Large-scale studies have demonstrated a clear link between short sleep

duration and an increased risk of obesity.

People who sleep fewer than 6 hours per night are more likely to have a
higher body mass index (BMI) compared to those who get 7-9 hours of
sleep.
BMI- Body mass index is a measure of body fat based on height and
weight that applies to adult men and women.

This relationship between sleep loss and obesity may be driven by changes
in metabolism and increased caloric intake due to altered hormone levels
(Ayas et al., 2003; Taheri et al., 2004).
 HEALTH EFFECTS OF SLEEP DEPRIVATION

Chronic sleep deprivation can have long-term

health consequences.

The risk of obesity and metabolic disorders, it

has been linked to cardiovascular diseases,
including hypertension and heart disease. The
body’s inability to restore itself during sleep
may lead to the development of these
conditions, underscoring the importance of
prioritizing sufficient rest for long-term
health.
CRITICAL ANALYSIS
 CRITICAL ANALYSIS

Laboratory studies have been crucial in identifying the biological effects

of extreme sleep deprivation:
metabolic
cognitive impairments
The results from these controlled environments may not fully apply to
real-world conditions. (Horne, 2008).

It is not known whether smaller reductions in sleep over longer periods

would have the same kinds of effects. Lab studies are important in
revealing the biological mechanisms that could explain why short sleep
may result in health problems, but they do not mimic conditions in the real
world.
HOW IS SLEEP
MEASURED?
There are various methods for measuring sleep,
each with its own strengths and limitations. Self-
reports are commonly used in large-scale
population studies, but they may not be as
accurate as objective measures such as activity
monitors or EEGs. These devices can track actual
sleep patterns, providing more reliable data on
sleep duration and quality (Kurina et al., 2013).

EEGs (electroencephalogram) - a recording of

brain activity.
Activity Monitors
One important distinction in sleep research:
perceived sleep duration
actual sleep duration

A person may believe they are not getting enough sleep.

stress or poor sleep quality.

Sleep deprivation may still impact health, particularly mental health, by

increasing feelings of fatigue and stress.

Different studies use different methods to measure sleep, which can lead to
inconsistencies in the findings. For example, some studies rely solely on
self-reported sleep data, while others use objective measures like EEGs or
actigraphy. This variability in methods may help explain why some studies
find a strong link between sleep and health outcomes, while others do not
(Magee et al., 2008).
 CONTROL FOR
CONFOUNDING VARIABLES
One of the challenges in sleep research is accounting for confounding
variables, which can distort the relationship between sleep and health
outcomes.

For example:
Alcohol consumption is associated with both short sleep duration
and obesity.

If alcohol use is not controlled for, it could create a spurious link

between short sleep and obesity. Properly controlling for these
confounding factors is essential for accurate study results (Nielsen et
al., 2011).
 LIFESTYLE FACTORS

ALCOHOL
POOR DIET POOR EXERCISE
CONSUMPTION
Lifestyle factors:
Poor diet
Exercise
Alcohol consumption

LIfe style can influence both sleep patterns and health outcomes. In
many cases, the relationship between short sleep and poor health
may be mediated by these factors.

It could be that people who consume alcohol a lot are more likely to
be obese and alcohol use just so happens also to be associated with
short sleeping. Controlling for alcohol consumption would then mean
that the relationship between short sleep duration and obesity
disappears, but not controlling for it in the analysis would give a
spurious result.
 REVERSE
CAUSATION
Reverse causation is another issue in sleep research.
In sleep research, reverse causation is the possibility that the
outcome of a study precedes the exposure, which is the opposite of
the typical cause-and-effect relationship. This can occur when the
effect of something is actually its cause.

It is possible that poor health leads to short sleep, rather than the other
way around.

For example:
People with chronic illnesses such as obesity or heart disease may
struggle with sleep problems like sleep apnea, which reduces sleep
duration.

This makes it difficult to determine whether short sleep causes poor

health or is a consequence of it (Magee and Hale, 2012).
 • Sleep apnea is a potentially serious sleep
disorder in which breathing repeatedly stops and
starts.

• Types: Obstructive (throat muscles relax) and

Central (brain fails to send signals to breathing
muscles).

• Symptoms: loud snoring, gasping for air,

daytime sleepiness, and difficulty staying asleep.

• Risk factors: obesity, aging, family history, and

nasal congestion.

• Complications: heart problems, high blood

pressure, daytime fatigue, and poor concentration.

Mayo Clinic. (2023, September 29). Sleep apnea -

Symptoms and causes.
SLEEP AND MORTALITY: REVERSE CAUSATION
The current state of play here is that studies in children appear to
support the idea that short sleep duration contributes to later increases
in body mass index (BMI) but the evidence is much less clear for adults
(Magee and Hale, 2012).

One recent study found that short sleeping was only associated with
greater risk of mortality for adults who had existing health problems at
baseline.

This suggests that the relationship between short sleeping and mortality
may be explained by preexisting disease, at least for adults (Magee et
al., 2013).
SLEEP QUALITY
RATHER THAN
QUANTITY?
IS SLEEP QUALITY MORE IMPORTANT THAN QUANTITY?

While much research focuses on sleep duration, sleep quality may be

equally, if not more, important for health outcomes.

A person might sleep for a long time but this sleep might be
interrupted, leading to reductions in the amount of REM sleep.
Rapid eye movement (REM) sleep is the stage of sleep.

Poor sleep has been associated with cardiovascular disease and

metabolic problems (Hoevenaar-Blom et al., 2011; Spiegel et al., 2009).

Sleep fragmentation, which interrupts the natural sleep cycle, can

reduce the amount of time spent in restorative stages of sleep, such as
REM sleep.
 REM SLEEP AND ITS HEALTH IMPLICATIONS

REM (Rapid Eye Movement) sleep is a critical stage of the sleep

cycle for cognitive function and mental health.

Disruptions to REM sleep have been linked to an increased risk:

Cardiovascular disease
Mental health disorders
*depression
*anxiety

Ensuring adequate REM sleep is essential for maintaining both

physical and mental health (Spiegel et al., 2009).
A disrupted pattern of sleeping has been associated with increases in
hunger and tendencies towards uncontrolled or binge-like patterns of
eating. (Chaput et al., 2011; Gonnissen et al., 2012; Kilkus et al., 2012).

increased hunger
impaired glucose metabolism
tendency toward binge eating.

Over time, these issues can contribute to weight gain and other health
problems, highlighting the importance of sleep quality in maintaining
overall well-being
SUMMING UP
It is possible that there is some risk associated with sleeping
around five hours a night over a long period for physiological
function (St-Onge, 2013)

This would suggest that increasing the sleep of short sleepers

should be beneficial for health. It will be important to examine in
randomized controlled trials whether extending the sleeping of
short sleepers has a positive impact on health markers and
conditions such as obesity.

It is suggested that people get a good night’s sleep other than

trying to avoid weight gain and it is these reasons we will consider
next.
SLEEP AND MENTAL
HEALTH
 HAVE YOU EVER FELT GRUMPY AND
MOODY AFTER A BAD NIGHT’S SLEEP?
Many of us are probably aware of the links between sleep and
emotional well-being, which have been substantiated by scientific
research. Intriguing new study into the underlying causes of the
complex interaction between sleep and mental health is opening up
new possibilities for treating those suffering from major
psychological diseases such as post-traumatic stress disorder and
depression.

Sleep disturbances are commonly associated with psychological

disorders such as depression.
 HAVE YOU EVER FELT GRUMPY AND
MOODY AFTER A BAD NIGHT’S SLEEP?

It has been claimed that up to 90% of patients suffering from

depression also experience sleeplessness (Riemann et al., 2001).
Depression is also connected with alterations in sleep
structure, such that people with depression enter REM
sleep faster and stay there longer than non-depressed
people (Gottesmann and Gottesman, 2007).
 HAVE YOU EVER FELT GRUMPY AND
MOODY AFTER A BAD NIGHT’S SLEEP?
These sleep disruptions are most likely caused by
depression, as the molecular pathways that underpin
both sleep and depression overlap (Wulff et al., 2010).
However, experts have recently investigated whether
sleep disorders may play a role in perpetuating or
possibly creating depression.
 THE IMPORTANCE OF EMOTIONAL
MEMORIES
Sleep problems can aggravate sadness by changing
emotional memories (Walker and van der Helm, 2009).
According to research, sleep is essential for memory
consolidation. Sleep has a strong effect on memory
processing, especially for emotional memories (Wagner et
al., 2006), and this has been connected to the amount of
REM sleep. One hypothesis is that greater REM sleep
leads to highly strong memories of emotional events.
 THE IMPORTANCE OF EMOTIONAL
MEMORIES

If this is combined with an existing predisposition for

processing negative information, as is the case with
depression (Mogg et al., 1993), it is clear that
enhanced processing of unpleasant emotional
memories during REM sleep may perpetuate negative
thinking, triggering or maintaining a depressive state.
 THE IMPORTANCE OF EMOTIONAL
MEMORIES
In a similar line, sleep has been demonstrated to
improve the learning of unpleasant recollections (Menz
et al., 2013), which has implications for the treatment of
post-traumatic stress disorder. This study predicts that
after a frightening incident, sleep should be avoided in
order to lessen the consolidation of the fearful memory.
As a result, sleep deprivation could be an effective
method of diminishing the power of memory for
traumatic situations such as natural disasters.
 THE IMPORTANCE OF EMOTIONAL
MEMORIES

Participants who saw emotionally unfavourable photos

had a weaker memory for them and reacted to them
less if they stayed awake in contrast to sleeping
(Baran et al., 2012). This method may also be
effective in the treatment of phobias.
 THE IMPORTANCE OF EMOTIONAL
MEMORIES

In conclusion, there are probably complex, bidirectional links

between sleep and mental health. Individuals are
predisposed to mental health and sleep problems due to
common underlying mechanisms, and these sleep disorders
most likely contribute to the condition's maintenance via
impacts on emotional processing. After discussing the
importance of sleep for learning and memory, let us now
delve deeper into current research on sleep and cognitive
performance.
SLEEP DEPRIVATION
AND COGNITIVE
FUNCTION
 HOW DOES SLEEP DEPRIVATION
AFFECT COGNITIVE FUNCTION?
We looked into the concept that a certain amount of core
sleep may be necessary for body restoration, and that
sleep disruption can have a negative impact on these
processes. However, sleep deprivation has been shown to
have a particularly significant effect on the brain, leading
some experts to say that sleep is 'of the brain, by the
brain, and for the brain' (Hobson, 2005).
 HOW DOES SLEEP DEPRIVATION
AFFECT COGNITIVE FUNCTION?

Sleep deprivation has been found to create impairments

in a hand-eye coordination test comparable to those
caused by alcohol consumption at or above the legal
limit (Dawson and Reid, 1997). Clearly, driving while sleep
deprived is quite risky.
 HOW DOES SLEEP DEPRIVATION
AFFECT COGNITIVE FUNCTION?

Sleep deprivation disrupts the ability to sustain

attention on monotonous yet challenging
activities (Lim and Dinges, 2008), but it has a
smaller effect on well-versed skills (Killgore,
2010), implying that sleep deprivation does not
degrade all cognitive functions equally.
 HOW DOES SLEEP DEPRIVATION
AFFECT COGNITIVE FUNCTION?

Several higher-level processes, such as

working memory and the ability to control
inappropriate reactions, are impacted,
potentially leading to dangerous decision
making and poor judgement (Chee and Chuah,
2008).
 HOW DOES SLEEP DEPRIVATION
AFFECT COGNITIVE FUNCTION?
Sleep deprivation also impairs one's ability to learn new
things. A study found that sleep-deprived participants
were less able to recognise previously viewed photos than
people who had a normal night's sleep, and this effect was
linked to a loss in hippocampal processing (Yoo et al.,
2007). This obviously has repercussions for people's
capacity to operate well in the workplace, particularly when
dealing with unexpected or crisis occurrences (Horne
2012).
 HOW DOES SLEEP DEPRIVATION
AFFECT COGNITIVE FUNCTION?

It is unclear why sleep deprivation hampers complex

cognitive activities, but adenosine could be one of the
underlying causes.

Adenosine accumulates during the day and promotes

sleep by inhibiting acetylcholine systems, which are
required to sustain a waking state.
 HOW DOES SLEEP DEPRIVATION
AFFECT COGNITIVE FUNCTION?

Acetylcholine systems are similarly critical for attention

and working memory, therefore the effects of sleep
deprivation on these functions could be explained by
the accumulation of adenosine following prolonged
wakefulness (McCoy and Strecker, 2011).

In other words, they could be related to 'sleepiness'.

 HOW DOES SLEEP DEPRIVATION
AFFECT COGNITIVE FUNCTION?

Alternatively, it is possible that areas of the brain

critical for decision making, such as the prefrontal
cortex, are prone to the effects of prolonged metabolic
activity and so become disproportionally 'tired' as a
result of sleep deprivation (Cirelli and Tononi, 2008).
SLEEP AND MEMORY
CONSOLIDATION
 BUT COULD GETTING A GOOD NIGHT’S SLEEP OR
TAKING A DAY-TIME NAP AFTER LEARNING
ACTUALLY IMPROVE MEMORY?

The first studies on the effects of sleep on memory were

undertaken about a century ago. Recall of nonsense
syllables was shown to be better after sleep than after the
same period of fully awake (Jenkins and Dallenbach, 1924).
Many more research have since produced similar findings.
In a typical experiment, some individuals are trained on a
task in the morning and then evaluated several hours later
in the evening, while others are trained in the evening and
tested the next morning following a night's sleep.
 BUT COULD GETTING A GOOD NIGHT’S SLEEP OR
TAKING A DAY-TIME NAP AFTER LEARNING
ACTUALLY IMPROVE MEMORY?

A consistent outcome is that participants who are given

the opportunity to sleep after learning do significantly
better when repeating the task than those who remain up
between training and testing. This is true for a wide range
of training tasks, including learning word lists, typing a
sequence of letters, and tracing a figure in a mirror (Rasch
and Born, 2013).
 BUT COULD GETTING A GOOD NIGHT’S SLEEP OR
TAKING A DAY-TIME NAP AFTER LEARNING
ACTUALLY IMPROVE MEMORY?
Early theories on the benefits of sleep for performance
on various memory tasks centered on the idea that sleep
allows for the consolidation of memory representations
that underpin learning in the absence of new information
input, which would disrupt the process.
 BUT COULD GETTING A GOOD NIGHT’S SLEEP OR
TAKING A DAY-TIME NAP AFTER LEARNING
ACTUALLY IMPROVE MEMORY?

More recent research indicates that sleep not only

protects memories from being disrupted by new
encoding, but also helps processes that enhance certain
memories. The notion is that memories are 'replayed'
during sleep, which aids in their transfer from a transitory
short-term store in the hippocampus to a more stable
long-term store in the cortex (Rasch and Born, 2013).
 SLEEP AND SELECTIVE MEMORY
CONSOLIDATION

Although we understand that emotional events have a

special place in our memory, we still have a lot to learn
about how they are processed, stored, and evolve over time.
Here, we demonstrate a link between REM sleep and the
selective consolidation of core, negative features of
complex scenes. Furthermore, we demonstrate that the
location of sleep is crucial for the selective emotional
memory effect.
 SLEEP AND SELECTIVE MEMORY
CONSOLIDATION
Emotional memories are the foundation of our personal
histories. They build our personalities by symbolising our
greatest accomplishments and our worst setbacks, serve as
milestones in our changing lives, and play an important role in
anxiety and mood disorders (Payne et al., 2004; Kensinger,
2009; Brewin et al., 2010). Although we know that emotional
experiences have a higher memory recall than most neutral
events, researchers are still learning how memories for
emotional events are processed and stored (McGaugh, 2004;
LaBar and Cabeza, 2006), as well as how they change over time
(Payne and Kensinger, 2010).
 SLEEP AND SELECTIVE MEMORY
CONSOLIDATION
Muller and Pilzecker (1900), who invented the phrase "memory
consolidation" (McGaugh, 2000; Dudai, 2004), first proposed
that memories are not static but rather form gradually. Memory
consolidation occurs in two stages: molecular and cellular
activities that enable synaptic strengthening over minutes and
hours ("cellular consolidation"), and system-wide modifications
that occur in the hours and days following learning ("systems
consolidation").
 SLEEP AND SELECTIVE MEMORY
CONSOLIDATION
Growing evidence suggests that the offline brain state
of sleep is appropriate for memory consolidation,
particularly at the system level (Stickgold, 2005;
Ellenbogen et al., 2006; Walker and Stickgold, 2006;
Diekelmann and Born, 2010; Payne, 2011).
 SLEEP AND SELECTIVE MEMORY
CONSOLIDATION
Several studies show that sleep strengthens emotional
episodic memories over neutral ones. Subjects who
sleep between training and testing preferentially
consolidate negative over neutral narratives (Wagner
et al., 2001, 2006), images (Hu et al., 2006), and scene
components (Payne and Kensinger, 2010).
 SLEEP AND SELECTIVE MEMORY
CONSOLIDATION
Although there is currently substantial discussion over
which aspects of sleep are most necessary for memory
consolidation, converging lines of evidence imply that
rapid eye movement sleep (REM) plays a critical role
in memory consolidation for highly arousing emotional
content.
 SLEEP, MEMORY AND THE
LIFESPAN
Sleep patterns vary as we age. Unfortunately, the way
our sleep habits shift is bad for our memory. 70% of
people over the age of 60 suffer from a lack of deep
sleep, which has been related to memory difficulties.
These findings suggest that enhancing sleep for older
persons could help avoid cognitive deterioration.
 SLEEP, MEMORY AND THE
LIFESPAN
Children, like adults, exhibit sleep-dependent memory
consolidation, but because children have greater SWS,
memory consolidation during sleep should be better
(Wilhelm et al., 2012).
 SLEEP, MEMORY AND THE
LIFESPAN
Naps at nursery may be beneficial: midday naps in
preschoolers improve memories accumulated earlier
in the day (Hupbach et al., 2009; Kurdziel et al.,
2013).
 SLEEP, MEMORY AND THE
LIFESPAN
Sleep helps to consolidate memories. Sleeping after
learning anything new helps cement that new
information into the brain, making it more likely to be
recalled, and this may be especially true for young
children.
THANK YOU FOR
LISTENING!