SLEEP

• Sleep is a basic human need.

• It is a universal biological process common to all people.
• Human spend about one – third of their lives asleep.
• Sleep is an important factor in a person’s quality of life.

• Somology : The study of sleep.

 DEFINITION
Sleep is a cyclical physiological process that alternates
with longer periods of wakefulness.

Sleep is characterised by minimal physical activity,

variable levels of consciousness, changes in the body’s
physiologic processes, and decreased responsiveness to
external stimuli.
• Sleep is considered as an altered state of consciousness
in which the individual’s perception of and reaction to the
environment are decreased.
 Physiology of sleep
• The cyclic nature of sleep is thought to be controlled by
centers located in the lower part of the brain.

• Neurons present in the reticular formation, located in the

brain stem, integrate sensory information from the
peripheral nervous system and relay the information to
the cerbral cortex.
• The upper part of the reticular formation consist of a
network of ascending nerve fibers called the reticular
activating system (RAS), which is involved with the sleep –
wake cycle.

• Neurotransmitters, located within the neurons in the brain,

affect the sleep – wake cycle. Serotonin lessen the
response to sensory stimulation and gamma aminobutyric
acid (GABA) to shut off the activity of neurons of the
reticular activating system.
• Another factor is exposure to darkness. Darkness and
preparing for sleep causes decrease in stimulation of
RAS. During this time the pineal gland in the brain
begins to actively secrete the natural hormone
melatonin, and the person feels less alert. During sleep,
the growth hormone is secreted and cortisol is inhibited.
Circadian Rhythms
• Biological rhythm exist in plants, animals and humans.

• In humans these are controlled within the body and synchronised

with environmental factors such as light and darkness.

• The most familiar biological rhythm is circardian rhythm.

• The term circardian is from Latin circa dies, meaning ‘about a day’.

• Sleep and wake cycles are the best well known circardian rhythms

• Circardian regularity begin to develop by the sixth week of life.

 Types of sleep
Two types of sleep

• NREM ( non – rapid – eye – movement ) SLEEP

• REM ( rapid eye movement ) SLEEP

During sleep, NREM sleep and REM sleep alternate in

cycles.
 NREM SLEEP
• NREM sleep occurs when activity in the RAS inhibited.
• NREM sleep is divided into 4 stages :

o Stage I

o Stage II

o Stage III

o Stage IV
Stages of NREM

Stage I : NREM
• Stage last for few minutes
• It include lightest level of sleep
• Decreased physiological activity begins
with gradual fall in vital signs &
metabolism
• Sensory stimuli such as noise easily arouse
person
• When awakened, person feels as though
Stage II : NREM
• Stage lasts for 10 to 20 minutes.
• It is the period of sound sleep
• Relaxation progress
• Body function continue to slow
• Arousal remain relatively easy
Stage III : NREM
• Stage lasts for 15 to 30 minutes.
• It involve initial stages of deep
sleep
• Muscles are completely relaxed.
• Vital signs decline but regular
• Sleeper is difficult to arouse and
rarely moves
Stage IV : NREM
• Stage lasts approximately 15 to 30
minutes
• It is the deepest stage of sleep.
• If sleep loss has occurred, sleeper spends
considerable part of night in the stage
• Vital signs are significantly lower than
during waking hours.
• Sleepwalking (somnambulism) and
enuresis (bedwetting) sometimes occur.
 REM sleep
• Stage usually begins about 90 minutes after sleep has
begun.
• Duration increases with each sleep cycle and average
20 minutes.
• Vivid full colour dreaming occurs
• Stage is typified by rapid moving eye, fluctuating heart
and respiratory rates, increased or fluctuating blood
pressure, loss of skeletal muscle tone and increased
gastric secretions.
• It is very difficult to arouse sleeper.
 Sleep cycle
The normal sleep pattern for an adult begins with a pre sleep period,
during which the person is aware only of a gradually developing
sleepiness. This perod normally lasts for 10 to 30 minutes.

Once asleep, the person usually passes through 4 to 5 complete

sleep cycles per night. Each consisting of 4 stages of NREM sleep and
a period of REM sleep. Each cycle lasts approximately 90 to 100 min.
 Sleep cycle
The cyclical pattern usually progesses from Stage 1 trough
stage 4 of NREM, followed by a reversal from stage 4 to 3
to 2, ending with a period of REM sleep. A person usully
reaches REM sleep about 90 minutes into the sleep cycle.
75 to 80 percentage of sleep time is spent in NREM sleep.
 Sleep cycle
With each successive cycle stage 3 and shorten and the
period of REM lengthens. REM sleep lasts upto 60 min
during the last sleep cycle. Not all people progress
consistently through the stages of sleep. The amount of time
spent in each stage varies over the life span.Newborn and
children spend more time in deep sleep. Sleep become
fragmented with aging.

The number of sleep cycles depends on the total amount

of time that the person spends sleeping.
 Sleep cycle
Pre-sleep sleepiness

NREM NREM NREM NREM

Stage 1 Stage 2 Stage 3 Stage 4

REM sleep

NREM NREM
Stage 2 stage 3
 Factors affecting sleep
1. Illness

2. Environment
3. Life style
4. Emotional stress

5. Stimulants and alcohol

6. Diet
7. Smoking
8. Motivation
9. Medication