What We Know About Sleep

Talje Hoene, Hailey Gilbreath, Edie Engelmann, & Brandon Casanas

Dr. Thomas E. Bitterwolf

Honors Chemistry 111

1 December 2017

Editor:

Talje Hoene

Peer Editors:

Orion Wheeler

Vincent Groner

Heath Thompson

Alessandra Kriz
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ABSTRACT

Sleep is a surprisingly complicated process that is vital to human survival. It is controlled

by the sleep-wake cycle, and although the true purpose of sleep is still unknown, many current

hypotheses have shown that sleep completes several important physiological functions. Among

these are physical and mental restoration, specifically synaptic pruning, and memory

consolidation. The lack of sleep, or sleep deprivation, is responsible for many “human error”

accidents and prompts both acute and chronic mental and physical deterioration. Finally, external

factors, such as environment and sleep position are considered to present opportunity for most

effective and efficient sleep.

What is Sleep?

Sleeping, like eating, is such an integral part of people's lives that people are often

unaware of how much time is actually spent asleep. The average human spends 1/3 of their life

asleep (2). Despite spending such a large amount of their lives unconscious, most humans do not

realize how little is empirically known about the process of sleep. Why humans, and even other

animals sleep, continues to be one of mankind’s greatest mysteries. As a result, it may come as

no surprise that there are numerous studies that analyze human sleep in an effort to find a driving

purpose. Researchers have come far in recent years, and much has been discovered about what

sleep is and how it works.

Sleep is defined as “a naturally-occurring state in which consciousness and muscular

activity is temporarily suspended or diminished, and responsiveness to outside stimuli is

reduced”(3). ​Contrary to popular belief, the brain is incredibly active in the periods of
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unconsciousness as humans sleep. ​When humans sleep, they go through sleep cycles, which are

sometimes referred to as ultradian rhythms. ​While the process itself is continuous, ​these sleep

cycles are made up of 2 distinct states of sleep. Non-rapid eye movement sleep or non-REM

(NREM) is made up of 3 different stages, and rapid eye movement, or REM, is a fourth stage

named after the physiological effect the state has on a subject’s eyes (12). Both NREM and REM

sleep have additional characteristics that are specific to each state.

When a human initially falls asleep, they fall into NREM sleep. ​During NREM sleep, the

body begins to calm down and the brainwave patterns, measured via electroencephalogram

(EEG), decrease in frequency. It is during this time that the body passes through the first 3 stages

of sleep (N1-N3). The first of these 3 stages is stage 1, commonly referred to as light sleep,

somnolence, or transitional sleep. In this phase, it is common for a person to drift in and out of

consciousness, and it is very easy to wake from this state. In stage 1, eye movement will begin to

slow and it is normal for subjects to experience small, sudden muscle contractions called hypnic

jerks, as well as a sensation of falling (13). During this stage, brain wave patterns transition from

beta and gamma waves at 13-30 Hz and 25-100 Hz respectively, to mostly alpha waves, which

typically range from 8-12 Hz as recorded with an EEG. Stage 1 is referred to as the transitional

sleep because it lasts for only about 10 minutes before shifting into stage 2, and represents only

about 5% of total sleep time (14).

As a subject transitions into deeper sleep and a majority of brain waves begin to slow to

a range of 4-7 Hz, a frequency associated with theta waves. The subject is then classified as

having transitioned to stage 2 of NREM sleep. This stage is still considered light sleep; however

all eye movement stops and almost all body movement is suspended. During stage 2, it is
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common for the brain to exhibit rapid bursts of activity which last for about a half a second, also

termed sleep spindles (13). These appear as brief EEG brain wave recordings of higher

frequency (12-24 Hz), and are referred to as sigma waves. K-Complexes also occur during the

second stage of sleep. Similar to spindles, K-complexes are changes in brain wave frequency, but

with greater variation. K-complexes start as short, negative, high voltage peaks, which are then

followed by slower positive complexes, and then a final negative peak lasting for about 1-2

minutes (14). Although these seemingly random bursts in mental activity may appear strange,

they have a specific purpose. Spindles and K-complexes play a key role in sleep based memory

consolidation and information processing. In stage 2 of sleep, there is a drop of body temperature

and heart rate from stage one, with an exception to the K-complexes and spindles. As a result of

these voltage and frequency jumps, it is common to see spontaneous bursts of muscle activity

and relaxation. Stage two constitutes of about 45%-50% of total sleep time in adults and even

more for young adults and children (15).

Figure 1: The image above presents an example of a subjects EEG results that show variations in brain

waves characterized by changes in amplitude/voltage over time, specifically sleep spindles and

K-complexes.
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The third and final stage of NREM sleep consists of brain waves of the lowest

frequencies, known as delta waves (<4 Hz). Stage 3 is also known as “slow wave sleep” (SWS),

or deep sleep, and is the deepest form of sleep. During this period in the sleep cycle, the sleeper

is the least responsive to their surrounding environment and completely unaware of sounds or

other stimuli (14). During this stage, blood pressure drops, breathing slows, and body

temperature falls further as the body becomes immobile. There is very little motion of any kind,

with little to no muscle contractions or eye movement. Parasomnias (sleep disorders associated

with abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling

asleep or between sleep stages) such as bedwetting, night terrors, or sleep talking are most likely

to occur in late stage 3 sleep (13). Stage 3 is also often associated with bodily recovery and

certain types of learning. The longer a person has stayed awake, the greater the need for stage

three sleep will be and the longer stage three sleep will last during rest. This stage makes up on

average 20% of sleep in adults, however children and young adults tend to have a longer stage 3

sleep, while the elderly may experience little to none (14).

Once the first 3 stages that compose NREM sleep have been achieved, the body enters

REM sleep. The brain is the most active in this stage and wave patterns mimic awake-levels of

activity, including theta waves, alpha waves, and even some high frequency beta waves which

are correlated to concentration and thinking. REM sleep is characterized with irregular and rapid

breathing and heart rate, along with elevated blood pressure and body temperature (13) and rapid

side-to-side eye movement for which REM is named after. The eye motion during REM is not

constant, but phasic. Although the cause of this eye movement is not completely known, the

current hypothesis is that the eye movement is a result of the dreams that occur during this sleep
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stage (14). Although dreams can occur in the stages of NREM sleep, the majority of dreams

occur in REM sleep. Humans in REM are completely paralyzed as a result of a disconnection

between the spinal cord and the lower nervous system. The result of this active mind but

paralyzed body has earned REM sleep the moniker “paradoxical sleep.” It has been found that

REM sleep aids memory consolidation, mood regulation, and general cognition, such as learning

certain mental skills (15). The first sleep cycle is finished after the REM stage.

Once the sleeper completes the REM stage of the sleep cycle, they begin the cycle again

with stage 1 of NREM. The first full cycle has a run time of about 90 minutes, but as the night

progresses and sleep continues uninterrupted, time spent in NREM shortens, as REM sleep

lengthens. After the first initial sleep cycle, the successive cycles average around 100-120

minutes and majority of deep sleep occurs in the first third of the night (12). On average, a

person will go through 4 to 6 of these sleep cycles in a one night period of rest.

Figure 2: The image above presents a hypnogram showing the change in cycles as the night progresses in

an average human adult. As each cycle progresses, time spent in NREM sleep shortens as REM sleep

lengthens.
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What Causes Sleep?

The general process of sleep, consisting of the sleep cycles REM and NREM, have been

observed for many years. Despite this, the biological processes controlling sleep were wildly

unknown until the late 1900s. Alexander Borbely, in the early 1980s, developed a model of sleep

termed the “Sleep-wake cycle,” or the “Two process model of sleep-wake regulation.” It is made

up of two different biological mechanisms, circadian rhythm also referred as process C and

sleep-wake homeostasis also referred as process S, and provides an underlying explanation as to

what causes sleep (4).

Circadian rhythms are physical, mental and behavioral changes in organisms that follow

roughly a 24 hour cycle. They are produced by the organism's biological clocks and influence

sleep-wake cycles, hormone release, cell regeneration, brain wave activity, hunger and digestion,

internal temperature and various other bodily functions (5). This internal clock is centered in the

hypothalamus region of the basal forebrain. This biological clock has an average of a 24 hour

cycle. The circadian periods vary for individuals ranging between 23.5 and 24.5 hours, with a

mean of 24.2 hours. About 75% of humans have a circadian rhythm greater than 24 hours, while

25% of humans have a rhythm that is less (4). Humans circadian rhythms also reflect their

diurnal characteristics. Humans are naturally most active during the day and, with melatonin

production beginning around 8:00-9:00 pm and concluding around 7:00-8:00 am. Melatonin is a

hormone released by the pineal gland that induces sleepiness (8). In regards to the sleep-wake

cycle, circadian rhythms induce feelings of wakefulness and sleepiness according to the 24 hour

cycle, but as with all circadian rhythms it can be influenced by external stimuli such as the

light-dark cycles. This is evident in the case of jet lag. Jet lag prompts circadian misalignment, or
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the internal clock being out of sync with the new time zone, and takes a few days for it to adapt

and return to normal alignment (9). This adjustment is possible due to the retinal ganglion cells

found in human eyes which react to external stimuli and consequently influence the light-dark

cycle.

Figure 3: The image above presents the melatonin production over a 24 hour period for an average adult

who has had a consistent sleep schedule for the the past 3 weeks.

Unlike the rods and cones found in the eye, the retinal ganglion cell, sends its information

directly to the pineal gland rather than the visual center. This is because the ganglion cell is its

own category of photoreceptor that is responsible for mediating the light and dark cycles. It was

first suspected that a non-rod and non-cone photoreceptor existed when an experiment using

transgenic mice, who lacked both their rods and cones, still had light-responsive clocks. This has
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also been observed in humans. Blind people who had pupils that reacted to light were found to

still have light-induced melatonin suppression and were therefore able to maintain a healthy

sleep-wake cycle. On the other hand, blind people whose pupils did not have light reflexes often

reported cases of insomnia (7). It became clear that blind people with the light-reflexive pupils

still had functioning ganglion cells located on the retinas of their eyes. These cells are

intrinsically photosensitive due to melanopsin, a light sensitive pigment found in the cells. When

they are stimulated by light melatonin excretion is suppressed, however, it has been found that

melanopsin is most sensitive to short wavelength “blue light”. Stimulation of specific portions of

the retinas that are located near the nose, called nasal hemiretinas, cause maximal melatonin

suppression in humans (6). These retinal ganglion cells are key to a functioning sleep-wake

cycle.

The second biological mechanism of the sleep-wake cycle is sleep-wake homeostasis. It

is often thought of as an internal timer that arouses a biological pressure for sleep based on the

amount of time elapsed since the last adequate sleep occurred. The longer the human is awake,

the greater the demand and likelihood of falling asleep becomes, and vice versa. The need to

sleep dissipates the longer the human sleeps, and the likelihood of waking up is increased (4).

This pressure build up is often referred to as sleep debt. Although the term sleep debt has had

various definitions throughout researcher’s study of sleep, in recent years, it has been used to

describe the increased demand for sleep that results from an inadequate amount of

physiologically normal sleep (10). As a result, it is often characterized by an increase in

propensity for sleep, and is also specific to a certain type of sleep. The sleep-wake homeostasis

pressure to sleep is a pressure to enter into a deep NREM sleep. Unlike circadian rhythms, the
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actual cause of this pressure buildup and release is not well understood. The current basic

understanding is that sleep regulating substances such as adenosine, build up in the body’s

cerebrospinal fluid during waking hours and is only released through sleeping. Although there

are other chemicals that have been considered as sleep regulating substances, adenosine is the

most well-understood.

As sleep debt is increased in a human, the adenosine levels in their basal forebrain rise

and then fall when a recovery sleep occurs. The accumulation of adenosine comes from the

usage of adenosine triphosphate (ATP), a molecule that functions as an energy source for the

majority of biological processes in the human body. Intracellularly, ATP is metabolized to

adenosine diphosphate (ADP), which is then metabolized to adenosine monophosphate (AMP).

Finally, AMP is metabolized by cytosolic ​5′-nucleotidase into adenosine (11). In other words, as

the human body uses energy, adenosine levels rise, which increases the body's need for sleep in

order to return these levels to a homeostatic baseline. Additionally, this supports the theory that

part of the need for sleep stems from the need to replenish low stores of energy, which was

proposed by Craig Heller and Joel Bennington in 1995. During wakefulness, the brain’s

glycogen energy stores are decreased to form ATP causing adenosine to build up. During sleep,

the adenosine is removed and replaced with new glycogen (4). Other studies have found that

many stimulants such as caffeine in teas and coffees used to keep humans awake, are actually

adenosine antagonists, or receptor blockers. It is conclusive that adenosine is fundamental in

regulating sleep-wake homeostasis.

Sleep-wake homeostasis and the circadian rhythm interact together either in synchrony,

or in opposition to each other, resulting in the sleep-wake cycle. Throughout a typical day,
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sleep-wake homeostasis or homeostatic sleep drive increases, meaning that the pressure or

sleepiness in humans grows as the day goes on. This gradual increase in drowsiness is moderated

by the circadian rhythm, and its arousal designates which times are appropriate for melatonin

production, and thus sleepiness, to occur. It is not until late evening that the melatonin

production occurs, and once melatonin production is induced, a “sleep gate” is opened (16). This

sleep gate marks a moment in which homeostatic sleep is at its greatest variance from the

circadian rhythm, and can be considered as the prime time for sleep initiation. As sleep is

experienced, the homeostatic sleep drive rapidly dissipates, even as the circadian-regulated

production of melatonin continues. Gradually, as morning approaches, melatonin production

slows to a stop, and the circadian alerting system begins, triggering wakefulness (4). The

sleep-wake cycle oscillations continue throughout life, however, as with both the sleep-wake

homeostasis and the circadian rhythm, it too can be influenced by external sources. Disrupting

the sleep-wake cycle can have detrimental effects on a human's health.

Figure 4: The image above presents the relationship between the circadian rhythm (yellow) and the

sleep-wake homeostasis (blue) over a 24 hour period. As sleep-wake homeostasis rises the drive for sleep

increases which is counteracted by the circadian rhythm's drive for arousal.

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Figure 5: The image above presents the relationship between the circadian rhythm (green) and the

sleep-wake homeostasis (blue) over a 24 hour period, as well indicating the location of the sleep gate. The

sleep gate is the point of the greatest variance between the two drives, and marks the moment when humans

fall asleep.

The Purpose Of Sleep

For millennia, it was believed that sleep was a passive state that humans experience to

rest the body or mind. It was often associated with hunger and thought of as an internal drive to

refuel or recharge. Aristotle often called it a period of unremarkable absence of the usual

perceptions that occurred while awake, similar to a pause from life. Studies into the subject have

shown this hypothesis to be far from the truth. Sleep is a “second state” in which many

physiological and biochemical processes take place (4). Although much has been learned about

sleep since then, some basic questions of sleep still remain an enigma. Humans still cannot

identify a clear purpose for sleep.

All organisms with complex brains experience some form of sleep for some period of

time. It seems to be an activity that no animal has been able to function without, which clearly

suggests that sleep must have some vital function to these organisms. Many animals in the past
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have seemed to function without sleep, but all have been found to have some form of sleeping.

The dolphin is an example of one of these organisms. It moves continuously, and seems never to

rest or sleep. Nevertheless, it was later discovered that dolphins are capable of engaging one

hemisphere of their brain in sleep while the other remains active. This is known as

“unihemispheric sleep” (17). In short, sleep is inescapable. Humans have processes such as the

sleep-wake cycle to pressure their bodies to sleep because as with other organisms, humans

without sleep function less efficiently, are irritable, and are less creative. If sleep is continually

denied, the human will eventually die (8). It is certain that sleep has an important function, even

if this function is so far unidentified. There are currently many running theories as to what this

purpose is, such as influence in physical and mental restoration, and memory processing and

learning.

The theory that sleep is just a passive state has been thoroughly debunked since studies

have shown that many bodily processes take place during this period of unconsciousness. The

idea that sleep is a time for physical restoration has far more support and evidence. This physical

restoration theory suggests that while we spend time in the unconscious hours of the night, our

brain takes time for housekeeping-type processes. It was suggested based on the processes of

repair and renewal of tissues and hormone levels, neutralization of neurotoxins, and the

restoration of chemical homeostasis, which all occur during sleep (4). This time of physical

repair and restoration occurs during NREM sleep. For example, during stage 3 of NREM, the

growth hormone levels are higher than in any other bodily state, which is key in regulating

muscle mass. Sleep also boosts the immune system and healing (8). In several studies, rats

deprived of sleep exhibited inferior healing abilities, and were more likely to develop skin
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lesions and lose body mass. Additionally, it was less likely for the sleep-deprived rats to

maintain a stable body temperature and proper levels of white blood cells, which are the body’s

main defense mechanism against infection and disease.

The mental restoration, memory processing and learning theory is one explanation of the

purpose of sleep. Like the physical restoration theory, it has a great deal of scientific backing and

evidence to support it. The mental restoration aspect of this idea works in tandem with the

physical restoration aspect. Physical restoration and repair is to NREM, as mental restoration and

repair is to REM sleep (4). REM sleep appears to be the time that the brain repairs and restores

itself and consolidates memories. Pavlides and Winson in 1989 were the first to record a

connection between REM sleep and long term potentiation (LTP). LTP is the persistent increase

of synaptic strength resulting from the firing of nerve cells. After LTP has occurred often

enough, synaptic consolidation occurs, which is one form of memory consolidation. In Pavlides

and Winson’s experiment, neuron firing in rats was studied during waking periods, and

throughout the sleep periods that immediately followed. They discovered an increased firing of

the same hippocampal neurons in REM sleep which had been active earlier during the awake

period, all of which were associated with episodic, semantic and long term memories (19). Since

the initial findings of Pavlides and Winson, many have replicated and even enhanced their

work.Wilson and McNaughton in 1994 found that the exact sequence of these neural firings

during the awake state were replayed during REM sleep (20). In 2001, Louie and Wilson found

that this immediate long term potentiation (LTP) occurs in the theta peaks of the theta

oscillations of REM sleep (21). This connection to theta oscillations were greater than first

anticipated. Acetylcholine (ACh) inputs allow the hippocampus to experience theta activity
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during awake periods and REM sleep. Ach is also important to the induction of LTP.

Acetylcholine induces theta waves when awake for initial learning and theta waves during REM,

allowing continuous processing of the information gained while awake. Vertes and Kocsis found

that disruption of Hippocampal theta waves impair learning (18). Although memory

consolidation is key to learning, synaptic depotentiation and depression is also key to the process

of learning, and occurs during NREM.

Multiple experiments and studies on flies, mice, rats, hamsters, and sparrows showed that

activity-dependent processes of synaptic potentiation occurred most while awake. During sleep,

synaptic depression and depotentiation of brain cells, in both synthesis of membranes and lipid

metabolism, were expressed more so than in the brain’s awake state. Depotentiation refers to the

reduction and removal of substances from cells, while synaptic depression is the balance between

cortical excitation, and inhibition to promote stability. As animals interact with the environment

and are forced to learn to overcome challenges, a net increase in synaptic strength occurs in

multiple areas of the brain. Sleep then uses the synaptic depotentiation and depression process to

renormalize the synapses (17). In other words, synapses are weakened during sleep through

depotentiation and depression, and therefore the memory associated is weaker. This is then

followed by pruning, a process that results in removal or extinction of the unused synapses. This

pruning process is essential to maintain mental homeostasis. If left unpruned, the increase in

synaptic strength results in higher energy consumption, and the synapses takes up more space

and saturation of learning capacity. The net strengthening of the synapses is directly correlated to

cellular stress and the need to synthesize and deliver cellular constituents from the mitochondria

to different proteins and lipids. Essentially, sleep is necessary to renormalize synapses to a

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regulated and sustainable state of homeostasis (18). Synaptic depression, depotentiation, and

pruning, are key in removing unneeded and useless memories to make room for more neuron

circuits during the awake periods, which are then consolidated during REM.

The physical restoration theory, and the mental restoration, memory processing, and

learning theory are only two of many current theories about the purpose of sleep. Unlike other

theories, these two have the most scientific backing and evidence to support them, however, it is

important to note that all of the running theories still hold one flaw. They all carry suggestions to

the purpose to sleep as well as sleep’s function, but cannot explain why these proposed functions

cannot occur during wakefulness. This lack of information is what continues to make sleep the

mysterious phenomenon that it is.

Sleep Deprivation

Although the reasons humans require sleep remain a mystery, it is evident that sleep is

essential, and sleep deprivation impairs humans ability to function. Sleep deprivation is a

growing problem in our modern world due to abundant sources of light, altered schedules, and

timekeeping devices. In comparing the average adult’s sleep patterns today to that of an adult in

1910, before the invention of the electric light bulb, there is a significant difference in duration.

Before 1910, the average person slept 9 hours each night, while today the average young adult

reports sleeping about 7-7.5 hours each night, about 1.5-2 hours less than in the past.

This decrease in sleep is not caused by any adaptation which allows humans to require

less sleep. Humans sleep less because they now have the ability to do so and can now keep track

of how long they sleep to prevent “oversleeping”. The minimal amount of sleep required by an

adult human is 7-7.5 hours, the majority requiring closer to 9 hours, which makes sleep
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deprivation extremely common. It has been found that humans have a similar sleep cycle to that

of primates, who sleep an average of 10 hours a day split into a long sleep in the night and a

shorter sleep in the afternoon. Some human cultures also display a tendency towards this cycle,

in the form of an additional “siesta”, or a mid afternoon nap. The average human, no matter their

culture, tends to fall back into the average sleep cycle of 10 hours a day when social schedules,

advanced technology, work, and clocks are removed (1).

In an experiment conducted by three researchers Palinkas, Suedfeld, and Steel in 1995,

these natural sleep durations were empirically confirmed. The three researchers spent a summer

above the arctic circle. This location resulted in the the team being subjected to continuous light.

The team also removed all watches and other timekeeping devices. The summer was spent

working and sleeping according to their own bodies’ time, which was then recorded by the

computers in the station which tracked the times the researchers fell asleep and awoke. From this

experiment it was found that the average time spent asleep was 10.3 hours, the longest sleep

being almost 12 hours, and the shortest data entry reporting 8.8 hours. Each subject recorded an

increase in sleep in relation to their past habits (1). The researchers concluded that human

biology, when external controls are removed, naturally tends towards a ten hour sleep cycle even

if it can maintain normal function with 7-9 hours.

Since it is clear that humans have been sleeping less than the natural 10 hour sleep cycle,

and usually even less than what their body truly requires, sleep deprivation is a growing issue.

Many professional occupations require working shifts that lead to increasingly, and sometimes

excessively, sleep deprived workers. This is most common in medical professions, in which

residents, nurses, and physicians work on-call shifts that can last longer than 24 hours (22). Sleep
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deprivation is more than simply a slight irritation these workers can work through or ignore

without consequence. Even the slightest degree of sleep deprivation (partial-sleep deprivation)

has negative side effects, which only worsen as the subject becomes increasingly sleep deprived.

There are especially serious detrimental effects if not treated, such as cases of chronic

partial-sleep deprivation or long-term total sleep deprivation.

Most humans experience partial-sleep deprivation at multiple points throughout their life

due to various reasons. Partial-sleep deprivation, or sleep restriction, refers to a reduction of the

total sleep time in a 24 hour period, compared to the human's average sleep time in the same

period (23). Humans are quite sensitive to sleep loss; even an hour less sleep in a night can lead

to noticeable decreases in mood, energy, ability to cope with stress, and overall cognitive

functions. A practical example of this, recorded 7% increases in traffic accidents on the day

following the spring day lights savings, simply from losing an hour of sleep (1). Sleep

deprivation also has been found to induce reduced alertness and attention span, diminished

abilities to concentrate, memory lapses, impaired reaction time and reflexes, hand tremors,

increased risk taking, poor decision-making, irritability, increased stress and blood pressure, and

confusion (4). These symptoms, while temporary if treated, have been the result of countless

serious accidents and mistakes. Many major disasters in history have been attributed to sleep

deprivation such as the nuclear accidents in Chernobyl and Three Mile island, the oil spill of the

Exxon Valdez, and the loss of the space shuttle Challenger (1). Many clinical errors in hospitals

have also been attributed to sleep deprivation. Partial-sleep deprivation is easily treated with a

simple “rebound sleep,” but the mistakes made during the period of sleep-deprivation are not

always as easily fixed.

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Partial-sleep deprivation and chronic partial-sleep deprivation share the same symptoms,

only chronic partial-sleep deprivation increases the detrimental effects of the regular symptoms,

and is associated with higher risk for the subject. As sleep debt accumulates, there is a shift in the

balance of hormones, including leptin and ghrelin which regulate appetite, and can cause serious

problems. This often leads to overeating, higher glucose levels, and insulin resistance, often

resulting in weight gain, and an increased chance of developing Type 2 Diabetes (24). Memory

and learning are also inhibited since the processes of pruning and memory consolidation, which

usually occur during sleep, do not occur. Chronic partial-sleep deprivation has also been linked

to many serious and potentially life threatening conditions including ​fibromyalgia, psychosis,

depression, bipolar disorder, stroke, heart attack, impaired immune function, some cancers, high

blood pressure, and Alzheimer's.

When compared to partial-sleep deprivation, total sleep deprivation is far more

dangerous, as it enhances the symptoms as sleep debt increases. Total sleep deprivation refers to

the avoidance of sleep for a period of at least 24 hours (23). When a human is deprived of

enough sleep, their symptoms mimic those of psychosis. In the peculiar case of Randy Gardner, a

high school student in 1964, he managed to remain awake for 264 hours (11 days). Although

some researchers who visited Randy claimed that he suffered no serious mental or physical

problems during his sleepless marathon, Lt. Cmdr. John J Ross of the U.S. Navy Medical

Neuropsychiatric Research unit in San Diego who monitored Randy throughout the marathon

claimed quite differently. On Randy’s second day, he was reported showing signs of

astereognosis (difficult recognizing objects only by touch). On day four, Randy experienced his

first hallucination. On days seven and eight, Randy was constantly irritable, slurred his speech,
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and had increased memory lapses. On day ten, he displayed paranoia over a radio show host.

Finally on day eleven, Randy had a short attention span, an expressionless face, impaired

memory, and was hardly responsive. These symptoms can be easily related to Peter Tripp, who

stayed awake for 200 hours himself and also experienced irritability, paranoia, memory loss,

hallucinations, and overall mental deterioration. In both cases, the two were able to recover after

a couple of long sleeps the following days (1). Peter and Randy were lucky in their attempts, as

many others have died attempting to stay awake for such unnatural amounts of time. With this in

mind, not all cases of sleep deprivation are self induced.

Most Efficient Way To Sleep

It is clear that there are many external as well as internal factors that have an influence

over a person’s sleep. Circadian rhythm and sleep-wake homeostasis control a human's drive for

sleep and exist to maintain the subject's optimal functioning state. The sleep-wake cycle has

many concrete influences such as human genetics and age, both of which influence a human's

sleep patterns and needs. This system, however, can also be influenced by external factors. The

person's environment, and even the positions in which they sleep all can improve or worsen a

person's sleeping experience and functioning state. Humans have the power to provide

themselves the most optimal sleep conditions.

Although human age and genetics can not be changed, they do have an important role in

sleeping more efficiently. Each human’s sleep-wake cycle and amount of sleep required per

night is determined by their biology, and needs to be considered in order to achieve most

profitable sleep. The amount of sleep one needs generally depends on age with younger humans

needing more sleep. Sleep is essential for children and infant development due to rapid changes
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occurring both physically and mentally. Newborns (0-3 months) need the most sleep of any age

group, requiring 14-17 hours a day (25). Newborns are actually born without a circadian rhythm,

which doesn’t begin to develop until the baby is six weeks old. This explains why newborns

have such irregular sleep schedules. During these months, the infant’s body has no sense of when

to sleep, thus sleep is regulated only by sleep-wake homeostasis. By six months, infants’

circadian rhythm have developed, and they tend to develop a normal sleep-wake cycle (26). As a

child ages, certain systems and bodily functions such as the circadian rhythm finish

development, and the need for sleep decreases. Most significant mental and physical

development finishes by the age of 25, and therefore adults (26-64) require only 7-9 hours of

sleep (25). In order to have the most profitable sleep, it is important for humans to get the

required hours of sleep their bodies need to function determined by their biology. Few will need

more than the average and some less, in all cases how much sleep is needed can easily be

discerned through following the body's sleep-wake cycle. The second part of ensuring the most

efficient sleep takes more effort.

Figure 6: The image to the left

presents the sleep durations per day

recommended to maintain optimal

functioning suited to the age of the

individual.
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Environment has a much greater impact on a person's sleep than many realize. Sights,

sounds, touches, and even smells all influence a human's sleep. Light for example, can have a

profound detrimental effect on good sleep. Humans often use their cell phones for entertainment

right before bed, unaware of the aftermath of their decision. Phone usage has a direct correlation

to the a person’s quality of sleep. Dr. R. R. Patel, a psychiatrist at the Ohio State University,

researched the impact phone usage has on sleep. In a group of 532 students between the ages of

19-39, the mean media use per night was 46.6 minutes. Dr. Patel observed a direct correlation

between phone use and insomnia (28). The light of the phone suppresses the person’s melatonin

secretion, thus interfering with the circadian rhythm.

Sounds also influence the subjects sleep, although to a lesser degree. While asleep, the

brain continues to process sounds on a basic level. Sound can have both a positive and negative

influence depending on the type. Interestingly, researchers have actually found that whether or

not a sound bothers a subject depends on the subjects personal connection to the sound. This is

why a parent can sleep through their partners snoring but still be awoken when they hear their

baby cry. In all cases, however, it has been found that white noise machines can help people

sleep through noise disturbances by reducing the difference between the background sounds and

a “peak” (loud and sudden) sound.

Surprisingly, smell can also impact a humans’ sleep. It has been found that the scent of

lavender decreases the heart rate and blood pressure, putting subjects in a more relaxed state. In a

study conducted by Dr. Hyungsoo Kim and Dr. Raymund P. Lao, it was found that subjects who

sniffed lavender before bed had deeper sleeps, and felt more vigorous in the morning (27).
 22

Finally touch, specifically temperature, also impacts a humans sleep. During an average

day, the body's temperature rises and falls slightly but stays around 97°F (36.1°C) to

99°F(37.2°C). This rise and fall of temperature is actually connected to the circadian rhythm. As

humans become drowsy due to the circadian rhythm oscillations, the body’s internal temperature

drops, and reaches its lowest temperature in the lowest ebb of the oscillation, usually around 5:00

am. This is why it is important that the environment you sleep in is also cooler, otherwise the

heat will interfere with the body’s natural dip, and induces more restlessness (29). REM sleep

can also be negatively impacted by uncomfortable temperatures. During REM the brain stops

regulating your body's temperature, and bodily temperature is then determined by the

environment, making it extremely sensitive to uncomfortable temperatures. Researchers suggest

keeping the sleeping environment between 60°F (15.6°C) and 67°F (19.4°C) for optimal sleep.

The sleeping environment has the power to determine whether it’s subjects get a good sleep or a

bad one. The position of humans while they rest also plays a role in obtaining the best sleep.

Sleeping position, which varies from person to person, is an important factor to consider

since good or bad positions can have a significant impact over time. The most common, and

natural of the sleeping positions, is sleeping lying on the back. This allows the spine and neck to

align and rest in a neutral position (31). Pain in the back is avoided by sleeping in this position,

nonetheless, as with all sleep positions its pros and cons are situational. People who experience

sleep apnea or snoring are less benefitted by this position. Sleep apnea is a condition in which

breathing during sleep has pauses, or is more shallow, and can result in suffocation as a result.

When sleeping on the back, gravity pushes the tongue farther back in the mouth. This results in a

more obstructed throat, and increases the severity of sleep apnea and snoring (32). It is also
 23

important to sleep with thin pillows in this position. Thick pillows can cause neck pain over time

by pushing the neck forward unnaturally. For the average human, sleeping on the back is the best

position, but those that struggle with sleep apnea and snorers will achieve better sleep when

sleeping on their sides.

By sleeping on the side of the body, people with conditions like sleep apnea, snoring,

back pain, and pregnancy are benefited. Sleeping on the side prevents the tongue from increasing

breathing problems, and also improves the condition of people suffering from back pain by

elongating the spine (31). Women who are pregnant are also advised to sleep on their sides to

prevent the new weight of the abdomen from causing back pain, breathing obstructions, and

blood flow and digestive issues (30). Due to the position of the organs in humans, the side

chosen to sleep on actually makes a difference. The right side worsens heart burn due to the

position of the stomach, while the left side puts strain on the liver, lungs and stomach, but boosts

digestion. For side sleepers the left is considered the best side, however it is often suggested to

switch sides occasionally to alleviate the drawbacks. Pregnant woman, on the other hand, are

suggested to sleep on the left side to maintain optimal blood flow.

Figure 7: The image above presents the impact of sleeping on one side of the body versus the other. Sleeping on the

right side allows gastric acid to flow up the esophagus, while by sleeping on the left side heartburn is avoided.
 24

Sleeping on the stomach is the worst position to sleep in and has very few advantages.

The symptoms of sleep apnea and snoring are reduced in this position as in the side position,

however it causes stress for the spine, neck, and the joints and muscles. It is almost always

advised against. This position does not support the natural curve of the spine and the gravity

pressing down often leads to overarching (32). The neck is also rotated to the side in a tight,

closed, and packed position which leads to neck pain, while the pressure on the joints and

muscles often causes tingling, numbness and in extreme cases, pain.

CONCLUSION

Although the fundamental function of sleep remains an enigma, researchers have come

far in the study of sleep. Sleep is an essential state for human survival. Made up of a total of four

stages, sleep cycles through three stages of NREM before a fourth stage of REM completing 1

full sleep cycle. The sleep-wake cycle functions as a homeostatic control, ensuring that humans

obtain enough sleep to maintain optimal function. Sleep-wake homeostasis and circadian rhythm

function as the 2 units of the sleep-wake cycle to drive the subject to sleep or arousal. Sleep also

has the important function of synaptic pruning and memory consolidation which improve

learning and memory. Sleep deprivation has many negative side effects that only escalates in

severity as sleep debt increases until ultimately resulting in death. Finally, the most efficient

sleep can be derived by generating an environment in consideration of sight, smell, sound and

touch, and by sleeping on the back or side of the body.

 25

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