While you rest, your body goes through different stages of the sleep cycle. Deep sleep, for example, is the stage of sleep you need to feel refreshed when you wake up in the morning. Unlike rapid eye movement (REM) sleep, deep sleep is when your body and brain waves slow down.

Sleep is divided into two categories: REM and non-REM sleep. You begin the night in non-REM sleep followed by a brief period of REM sleep. The cycle continues throughout the night about every 90 minutes.


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Sleep is important to a number of brain functions, including how nerve cells (neurons) communicate with each other. In fact, your brain and body stay remarkably active while you sleep. Recent findings suggest that sleep plays a housekeeping role that removes toxins in your brain that build up while you are awake.

Sleep is a complex and dynamic process that affects how you function in ways scientists are now beginning to understand. This booklet describes how your need for sleep is regulated and what happens in the brain during sleep.

The thalamus acts as a relay for information from the senses to the cerebral cortex (the covering of the brain that interprets and processes information from short- to long-term memory). During most stages of sleep, the thalamus becomes quiet, letting you tune out the external world. But during REM sleep, the thalamus is active, sending the cortex images, sounds, and other sensations that fill our dreams.

The basal forebrain, near the front and bottom of the brain, also promotes sleep and wakefulness, while part of the midbrain acts as an arousal system. Release of adenosine (a chemical by-product of cellular energy consumption) from cells in the basal forebrain and probably other regions supports your sleep drive. Caffeine counteracts sleepiness by blocking the actions of adenosine.

There are two basic types of sleep: rapid eye movement (REM) sleep and non-REM sleep (which has three different stages). Each is linked to specific brain waves and neuronal activity. You cycle through all stages of non-REM and REM sleep several times during a typical night, with increasingly longer, deeper REM periods occurring toward morning.

Stage 1 non-REM sleep is the changeover from wakefulness to sleep. During this short period (lasting several minutes) of relatively light sleep, your heartbeat, breathing, and eye movements slow, and your muscles relax with occasional twitches. Your brain waves begin to slow from their daytime wakefulness patterns.


Stage 2 non-REM sleep is a period of light sleep before you enter deeper sleep. Your heartbeat and breathing slow, and muscles relax even further. Your body temperature drops and eye movements stop. Brain wave activity slows but is marked by brief bursts of electrical activity. You spend more of your repeated sleep cycles in stage 2 sleep than in other sleep stages.

Stage 3 non-REM sleep is the period of deep sleep that you need to feel refreshed in the morning. It occurs in longer periods during the first half of the night. Your heartbeat and breathing slow to their lowest levels during sleep. Your muscles are relaxed and it may be difficult to awaken you. Brain waves become even slower.


REM sleep first occurs about 90 minutes after falling asleep. Your eyes move rapidly from side to side behind closed eyelids. Mixed frequency brain wave activity becomes closer to that seen in wakefulness. Your breathing becomes faster and irregular, and your heart rate and blood pressure increase to near waking levels. Most of your dreaming occurs during REM sleep, although some can also occur in non-REM sleep. Your arm and leg muscles become temporarily paralyzed, which prevents you from acting out your dreams. As you age, you sleep less of your time in REM sleep. Memory consolidation most likely requires both non-REM and REM sleep.

Sleep-wake homeostasis keeps track of your need for sleep. The homeostatic sleep drive reminds the body to sleep after a certain time and regulates sleep intensity. This sleep drive gets stronger every hour you are awake and causes you to sleep longer and more deeply after a period of sleep deprivation.

Factors that influence your sleep-wake needs include medical conditions, medications, stress, sleep environment, 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 return to sleep when awakened.

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. In the case of jet lag, circadian rhythms become out of sync with the time of day when people fly to a different time zone, creating a mismatch between their internal clock and the actual clock.

Millions of people are using smartphone apps, bedside monitors, and wearable items (including bracelets, smart watches, and headbands) to informally collect and analyze data about their sleep. Smart technology can record sounds and movement during sleep, journal hours slept, and monitor heart beat and respiration. Using a companion app, data from some devices can be synced to a smartphone or tablet, or uploaded to a PC. Other apps and devices make white noise, produce light that stimulates melatonin production, and use gentle vibrations to help us sleep and wake.

Your health care provider may recommend a polysomnogram or other test to diagnose a sleep disorder. A polysomnogram typically involves spending the night at a sleep lab or sleep center. It records your breathing, oxygen levels, eye and limb movements, heart rate, and brain waves throughout the night. Your sleep is also video and audio recorded. The data can help a sleep specialist determine if you are reaching and proceeding properly through the various sleep stages. Results may be used to develop a treatment plan or determine if further tests are needed.

Dr. Meir Kryger is an ABMS board certified internal medicine physician specializing in pulmonary and sleep medicine. He is a professor of medicine at Yale University and is also a practicing physician at Yale Medicine. He is on the board of directors of the National Sleep Foundation in Washington, D.C.

The first stage of the sleep cycle is a transition period during which the body and brain shift from a state of wakefulness to one of sleep. This period is relatively short, lasting only a few minutes, and the sleep is fairly light. People may wake up from this stage of sleep more easily than from other stages.

During stage one, the brain unwinds, along with the body. The monitoring of sleep reveals slow rolling eye movements. The brain waves start slowing down as brain activity and responses to sensory stimulation decrease.

The second stage of non-REM sleep is another lighter stage of sleep that occurs as the body starts transitioning to deeper sleep. Humans spend most of their time during the sleep cycle in this stage of sleep.

Deep sleep, or slow wave sleep, is the third stage of non-REM sleep. Although the body completes a few cycles throughout the night, the third stage occurs in longer periods during the first part of the night.

Importantly, a person has to get enough deep sleep to allow the brain and body to repair themselves. This will help the person feel restored. The amount of deep sleep an individual has will relate to how much overall sleep they get. Sleeping 7 or more hours is the recommendation for most adults, which will usually give the body plenty of time in the deeper states of sleep.

If the body does not get enough deep sleep one day, it will compensate the next time it can get sleep by quickly moving through the cycles to reach the deepest levels of sleep more quickly and stay there longer.

As the AASM notes, the most important thing that a person can do is to set aside more time for sleep. Doing so allows the body to go through more sleep cycles, which makes it possible to have more deep sleep.

The research comes after decades of observations linking poor sleep to long-term problems with memory and thinking, Walker says. "We are now learning that there is a significant relationship between sleep and dementia, particularly Alzheimer's disease."

So Walker and a team of scientists set out to answer a question: "Can I look into your future and can I accurately estimate how much beta-amyloid you're going to accumulate over the next two years, the next four years, the next six years, simply on the basis of your sleep tonight?"

To find out, Walker's team studied 32 people in their 70s who had taken part in a sleep study that looked for the slow electrical waves that signal deep sleep. None of the participants had memory problems.

The scientists used brain scans to monitor levels of beta-amyloid in each participant for up to six years. And the results, published in the Nov. 2 issue of the journal Current Biology, showed people who got less deep had more beta-amyloid.

"So things like amyloid beta, which are implicated in Alzheimer's disease, seem to actually be removed more rapidly from the brain when an animal is asleep versus when they're awake," says Laura Lewis, an assistant professor of biomedical research at Boston University.

Ju was part of a study of people with obstructive sleep apnea, which repeatedly blocks the airway. These patients "seem to have a change in their ability to clear proteins or waste products from their brain," she says. "And people with sleep apnea are at higher risk for dementia down the line."

So Ju's team looked to see what happened after patients had been treated successfully for apnea. The scientists found that treatment resulted in more deep sleep and more beta-amyloid cleared from the brain. 2351a5e196

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