sleep

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Introduction

7-8 hours of sleep/night is considered optimal. Most adults sleep this much. Also see sleep deprivation.

Epidemiology

  • 1/3 of US adults do not get enough sleep[9]
    • adults >= 65 and older years most likely to get enough sleep (74%); adults 25-44 years least likely (62%)
    • sufficient sleep most common among whites (67%); least common among blacks & Native Hawaiian/Pacific Islanders (54%)
    • people in South Dakota sleep the most, those in Hawaii sleep the least[9]

Function

(benefits of sleep)

* increased risk of beta-amyloid deposition with reduced nighttime sleep occurs prior to onset of cognitive impairment or beta-amyloid deposition[31]

Histology

Genetics

Physiology

  • after sleep onset, sleep usually progresses through non-REM sleep stages 1-4 within 45-60 minutes
  • sleep cycles oscillate with lunar phases
    • nights before a full moon, people go to bed later & sleep less (assessed by wrist actigraphy)
  • brain regions most significantly underlying the benefit of optimal sleep duration include the precentral cortex, the lateral orbitofrontal cortex & the hippocampus[35]
  • accurate behavioral responses to instructions to smile or frown occur in most sleep stages in healthy people & patients with narcolepsy, except in slow-wave sleep in healthy people[36]

Diagnostic procedures

Electrophysiology: correlates of human sleep states & stages

* REM: rapid eye movement sleep EEG: electroencephalogram

Management

  • optimal sleep duration (National Sleep Foundation)[7]
    • newborns (0-3 months of age): 14-17 hours/day[22]
    • infants (4-12 months): 12-16 hours/day[10][22]
    • toddlers (1-2 years): 11-14 hours/day[22]
    • preschool children (3-5 years): 10-13 hours/day[22]
    • school-age children (6-12 years): 9-12 hours/day[10]
    • teenagers: 8-10 hours/day[10] (8.5-9.5 hours[6])
    • adults <= 25 years of age: 7-9 hours/day
    • adults 26-64 years of age: 7-9 hours//day
    • older adults >= 65 years of age: 7-8 hours/day
    • adults 38-73 years: ~7 hours/night[35]
  • naps, extending sleep on weekends, & caffeine do not restore optimal daytime alertness
  • middle school & high school should be started no earlier than 8:30 AM[6][12]
    • eighth graders starting school before 8 AM have decreased sleep duration, lower grades, & lower rates of homework completion[14]
    • delay of school start time of secondary schools from 7:50 to 8:45 a.m. results in longer sleep duration (6 hr 50 min to 7 hr 24 min) associated with less sleepiness & improved grades in high-school students
  • exercise & Tai chi may improve quality of sleep[27]

Comparative biology

Notes

Other sleep factors:

More general terms

More specific terms

Additional terms

References

  1. ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 163-165
  2. ↑ Pelayo, R Stanford University Sleep Disorder Clinic Gottleib D, Boston University Penn State College of Medicine Healthology Netscape News, 04/02/03
  3. ↑ 3.0 3.1 3.2 Journal Watch 24(5):43, 2004 Wagner U et al, Sleep inspires insight. Nature 427:351, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14737168
    Maquet P & Ruby P, Psychology: insight and the sleep committee. Nature 427:304, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14737153
  4. ↑ 4.0 4.1 Tabara Y, American Heart Association Conference, Chicago, 2004
  5. ↑ 5.0 5.1 5.2 Xie L et al. Sleep drives metabolite clearance from the adult brain. Science 2013 Oct 18; 342:373 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24136970 <Internet> http://www.sciencemag.org/content/342/6156/373
    Herculano-Houzel S. Sleep it out. Science 2013 Oct 18; 342:316. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24136954 <Internet> http://www.sciencemag.org/content/342/6156/316
  6. ↑ 6.0 6.1 6.2 Adolescent Sleep Working Group, Committee on Adolescence and Council on School Health. School start times for adolescents. Pediatrics 2014 Sep; 134:642. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25156998 <Internet> http://pediatrics.aappublications.org/content/134/3/642?ijkey=db9a67607d8aff76a03984171f966bbb7af9dfb8&keytype2=tf_ipsecsha
  7. ↑ 7.0 7.1 Hirshkowitz M et al National Sleep Foundation's sleep time duration recommendations: methodology and results summary. J Natl Sleep Foundation. Jan 14, 2015 Not indexed in PubMed http://www.sleephealthjournal.org/article/S2352-7218%2815%2900015-7/fulltext
  8. ↑ 8.0 8.1 Glymphatic Flow, Sleep, microRNA Are Frontiers in Alzheimer's Research. Zilkha Symposium on Alzheimer's Disease and Related Disorders May 6, 2014 http://www.alzforum.org/news/conference-coverage/glymphatic-flow-sleep-microrna-are-frontiers-alzheimers-research
  9. ↑ 9.0 9.1 9.2 Liu Y, Wheaton AG, Chapman DP et al Prevalence of Healthy Sleep Duration among Adults - United States, 2014 MMWR Weekly / February 19, 2016 / 65(6);137-141 http://www.cdc.gov/mmwr/volumes/65/wr/mm6506a1.htm
  10. ↑ 10.0 10.1 10.2 10.3 Paruthi S et al Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine. J Clin Sleep Med. 2016 May 25. 12(6):785 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27250809 <Internet> http://www.aasmnet.org/Resources/pdf/Pediatricsleepdurationconsensus.pdf
  11. ↑ Cantor RS. The evolutionary origin of the need to sleep: an inevitable consequence of synaptic neurotransmission? Front Synaptic Neurosci. 2015 Sep 22;7:15. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26441631 Free PMC Article
  12. ↑ 12.0 12.1 American Academy of Sleep Medicine Public Release: 14-Apr-2017 AASM position: Delaying middle school, high school start times is beneficial to students. https://www.eurekalert.org/pub_releases/2017-04/aaos-apd041317.php
    Watson NF, Martin JL, Wise MS et al Delaying Middle School and High School Start Times Promotes Student Health and Performance: An American Academy of Sleep Medicine Position Statement. Journal of Clinical Sleep Medicine. 13(4) April 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28416043 <Internet> http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=30998
  13. ↑ Mander BA, Winer JR, Walker MP Sleep and Human Aging. (Review) Neuron 94(1):19-36. April 5, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28384471 <Internet> http://www.cell.com/neuron/abstract/S0896-6273(17)30088-0
  14. ↑ 14.0 14.1 Lewin DS, Wang G, Chen YI et al. Variable school start times and middle school student's sleep health and academic performance. J Adolesc Health 2017 May 3 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28476283 <Internet> http://www.jahonline.org/article/S1054-139X(17)30104-0/fulltext
  15. ↑ 15.0 15.1 Pase MP, Himali JJ, Grima NA et al Sleep architecture and the risk of incident dementia in the community Neurology 2017; 89:1-7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28835407
  16. ↑ 16.0 16.1 Ju YS, Ooms SJ, Sutphen C, et al. Slow wave sleep disruption increases cerebrospinal fluid amyloid-beta levels. Brain 2017 Aug; 140:2104 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28899014
  17. ↑ 17.0 17.1 Cespedes Feliciano EM, Quante M, Rifas-Shiman SL Objective Sleep Characteristics and Cardiometabolic Health in Young Adolescents. Pediatrics. June 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29907703 <Internet> http://pediatrics.aappublications.org/content/early/2018/06/13/peds.2017-4085
  18. ↑ 18.0 18.1 Pennestri MH, Laganiere C, Bouvette-Turcot AA et al. Uninterrupted infant sleep, development, and maternal mood. Pediatrics 2018 Nov 12; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30420470 <Internet> http://pediatrics.aappublications.org/content/early/2018/11/08/peds.2017-4330
  19. ↑ Dunster GP, de la Iglesia L, Ben-Hamo M et al. Sleepmore in Seattle: Later school start times are associated with more sleep and better performance in high school students. Sci Adv 2018 Dec 12; 4:u6200. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30547089 Free PMC Article <Internet> http://advances.sciencemag.org/content/4/12/eaau6200
  20. ↑ 20.0 20.1 Dominguez F, Fuster V, Fernandez-Alvira JM et al Association of Sleep Duration and Quality With Subclinical Atherosclerosis. J Am Coll Cardiol. 73(2) Jan 2019 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30654884 <Internet> http://www.onlinejacc.org/content/73/2/134
    Gottlieb DJ, Bhatt DL More Evidence That We Could All Use a Good Night's Sleep. J Am Coll Cardiol. 73(2) Jan 2019 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30654885 <Internet> http://www.onlinejacc.org/content/73/2/145
  21. ↑ Consensus Conference Panel, Watson NF, Badr MS, Belenky G et al Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med. 2015 Jun 15;11(6):591-2. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25979105 Free PMC Article
  22. ↑ 22.0 22.1 22.2 22.3 22.4 World Health Organization (WHO). April 24, 2019 To grow up healthy, children need to sit less and play more. New WHO guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. https://www.who.int/news-room/detail/24-04-2019-to-grow-up-healthy-children-need-to-sit-less-and-play-more
    World Health Organization (WHO). 2019 GUIDELINES ONPHYSICAL ACTIVITY, SEDENTARY BEHAVIOUR AND SLEEPFOR CHILDREN UNDER 5 YEARS OF AGE https://apps.who.int/iris/bitstream/handle/10665/311664/9789241550536-eng.pdf
  23. ↑ 23.0 23.1 Fultz NE et al. Coupled electrophysiological, hemodynamic, and cerebrospinal fluid oscillations in human sleep. Science 2019 Nov 1; 366:628 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31672896 https://science.sciencemag.org/content/366/6465/628
  24. ↑ 24.0 24.1 Ma Y, Liang L, Zheng F et al Association Between Sleep Duration and Cognitive Decline. JAMA Netw Open. 2020;3(9):e2013573 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32955572 Free article. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770743
  25. ↑ 25.0 25.1 Li X, Xue Q, Wang M et al. Adherence to a healthy sleep pattern and incident heart failure: A prospective study of 408 802 UK biobank participants. Circulation 2021 Jan 5; 143:97 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33190528 PMCID: PMC7775332 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.050792
  26. ↑ Casiraghi L, Spiousas I, Dunster GP et al Moonstruck sleep: Synchronization of human sleep with the moon cycle under field conditions. Sci Adv. 2021. Jan 27. Vol. 7, no. 5, eabe0465 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33571126 Free article https://advances.sciencemag.org/content/7/5/eabe0465
  27. ↑ 27.0 27.1 Siu PM, Yu AP, Tam BT et al. Effects of tai chi or exercise on sleep in older adults with insomnia: A randomized clinical trial. JAMA Netw Open 2021 Feb 1; 4:e2037199. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776441 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33587135 Free article
  28. ↑ 28.0 28.1 Sabia S et al. Association of sleep duration in middle and old age with incidence of dementia. Nat Commun 2021 Apr 20; 12:2289. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33879784 PMCID: PMC8058039 Free PMC article https://www.nature.com/articles/s41467-021-22354-2
  29. ↑ 29.0 29.1 Da Mesquita S, Papadopoulos Z, Dykstra T et al. Meningeal lymphatics affect microglia responses and anti-Abeta immunotherapy. Nature 2021 Apr 28; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33911285 https://www.nature.com/articles/s41586-021-03489-0
  30. ↑ 30.0 30.1 He Y, Jones CR, Fujiki N et al The Transcriptional Repressor DEC2 Regulates Sleep Length in Mammals. Science 2009. 325(5942):866-870 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19679812 PMCID: PMC2884988 Free PMC article https://science.sciencemag.org/content/325/5942/866
  31. ↑ 31.0 31.1 Insel PS, Mohlenhoff BS, Neylan TC et al Association of Sleep and beta-Amyloid Pathology Among Older Cognitively Unimpaired Adults. JAMA Netw Open. 2021;4(7):e2117573 PMID: https://www.ncbi.nlm.nih.gov/pubmed/3429707 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2782215
  32. ↑ 32.0 32.1 Lucey BP, Wisch J, Boerwinkle AH et al Sleep and longitudinal cognitive performance in preclinical and early symptomatic Alzheimer's disease. Brain, Volume 144, Issue 9, September 2021, Pages 2852-2862 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34668959 PMCID: PMC8536939 (available on 2022-10-20) https://academic.oup.com/brain/article-abstract/144/9/2852/6401973
  33. ↑ Oh JY, Walsh CM, Ranasinghe K et al Subcortical Neuronal Correlates of Sleep in Neurodegenerative Diseases. JAMA Neurol. Published online April 4, 2022. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35377391 https://jamanetwork.com/journals/jamaneurology/fullarticle/2790494
  34. ↑ 34.0 34.1 Loveless G Waking Up at Night Could Be Your Brain Boosting Your Memory. Medscape. Aug 3, 2022 https://www.medscape.com/viewarticle/978566
    Kjaeby C et al Memory-enhancing properties of sleep depend on the oscillatory amplitude of norepinephrine. Nature Neuroscience. 2022 25:1059 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35798980 https://www.nature.com/articles/s41593-022-01102-9.epdf
  35. ↑ 35.0 35.1 35.2 35.3 Li Y, Sahakian BJ, Kang J et al The brain structure and genetic mechanisms underlying the nonlinear association between sleep duration, cognition and mental health. Nature Aging. 2022. 2:425-437. April 28 Not indexed in PubMed https://www.nature.com/articles/s43587-022-00210-2
  36. ↑ 36.0 36.1 Turker B et al Behavioral and brain responses to verbal stimuli reveal transient periods of cognitive integration of the external world during sleep. Nature Neuroscience 2023. Oct 12. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37828228 https://www.nature.com/articles/s41593-023-01449-7.epdf
  37. ↑ 37.0 37.1 37.2 West R et al Sleep duration, chronotype, health and lifestyle factors affect cognition: a UK Biobank cross-sectional study. BMJ Public Health. 2024. July 10 Nor yet indexed in PubMed https://bmjpublichealth.bmj.com/content/2/1/e001000
  38. ↑ National Institute of Neurological Disorders and Stroke (NINDS) Brain Basics: Understanding Sleep https://www.ninds.nih.gov/disorders/patient-caregiver-education/understanding-sleep
  39. ↑ Test Your Sleep I.Q. http://www.nhlbi.nih.gov/health/public/sleep/sleep_iq.htm

Patient information

sleep patient information

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