Sleep is a critical part of a healthy brain and body.

Light hours sleep is the most common sleep recommendation, however, it’s
well reported that you should get between 7 and 9 hours sleep. One sleep cycle
equates to roughly 90 minutes. During this period your brain goes through five
stages of sleep.
During an entire night of sleep, the brain goes through a number of sleep
cycles. The first four stages of sleep are called non-rapid eye
movement (NREM). After two stages of light sleep in which the body is drifting
and transitioning into dormancy, deep sleep arrives.
The fifth stage of sleep is called rapid eye movement (REM). The body
experiences bursts of rapid eye movements, and brain waves change to those we
experience while being awake.
All of the four stages of sleep are important. Sleep is a cycle, and your brain
must complete each to get the full benefit. However, how much light sleep you
get doesn’t seem to impact how tired you feel when you wake; how much deep
sleep or REM sleep you get is more vital for feeling well rested and replenished.

NREM Sleep Stages

Stage 1: is the lightest stage of NREM sleep. Often defined by the presence of
slow eye movements, it’s a drowsy level of sleep that can easily be disrupted,
causing awakenings or arousals.
Muscle tone throughout the body relaxes and brain wave activity begins to shift
from that of the waking state. People may experience hypnic jerks (abrupt
muscle spasms.) Others report a feeling of drifting or falling when moving in
and out of stage 1.
Characteristics of Stage 1 NREM Sleep:

▪ Waking up feeling like you didn’t sleep at all.

▪ Muscles are not inhibited yet: the eyes roll a little bit and eyelids
may be slightly open.
▪ Breathing slows down and your heartbeat becomes regular.
▪ Blood pressure and brain temperature decrease.
Stage 2: is the first deep stage of NREM sleep. Awakenings or arousals do not
occur as easily as in Stage 1 sleep, and slow moving eye rolls stop. Brain waves
slow with specific bursts of rapid activity known as sleep spindles, intermixed
with sleep structures known as K-complexes. Both sleep spindles and K
complexes are thought to protect the brain from awakening from sleep.
Characteristics of Stage 2 NREM sleep:

▪ Lasts about 20 minutes.

▪ A slowing heart rate and a decrease in body temperature. Cell
activity reduces to prepare you to go into a deep sleep.
▪ Blood pressure decreases and other metabolic functions slow down
too.
▪ It becomes harder to wake up.
▪ Your brain starts to emit slower, larger brain waves.
▪ The first two stages of NREM sleep together are often referred to as
light sleep.

Stages 3 & 4: are known as deep NREM sleep. These are the most restorative
stages of sleep. Stage 3 NREM sleep consists of delta waves or slow waves.
Awakenings or arousals are rare and often it is difficult to wake up someone in
Stage 3 sleep. Sleep conditions like parasomnias (which can include
sleepwalking, sleep talking and night terrors,) occur during the deepest NREM
stage of sleep.
Characteristics of Stage 3 & 4 NREM sleep:

▪ Starts 35-45 minutes after falling asleep.

▪ Brain waves slow down and become larger delta waves.
▪ People sleep through most disturbances (such as noises and
movements) without reaction.
▪ Waking during this stage brings a high probability of feeling
disoriented for the first few minutes.

REM Sleep
Rapid eye movement, or REM, is the stage of sleep in which
most dreaming occurs. The eyes are not constantly moving but they do dart
back, and forth, up and down. These eye movements may be related to visual
images of dreams, however, the full reason for rapid eye movements are still
under research.
The core muscles that run the heart and diaphragm continue, and while the eyes
move rapidly (hence the name), other muscles are paralyzed. Awakenings and
arousals can occur more easily in REM; being woken during a REM period can
leave one feeling groggy or overly sleepy.
Characteristics of Stage 5 REM Sleep:

▪ Eyes move rapidly in all directions.

▪ The deepest and most powerful dreams usually occur.
▪ This stage is also characterized by an increase in heart and
respiration rates, and their rhythms may become irregular.
▪ REM stages typically get longer and longer as the night goes by,
and the last REM stage can last an hour.
▪ Brain waves are smaller, like those experienced in waking periods.
▪ Sleepwalking may occur in these episodes.
▪ Bed wetting may happen because a larger percentage of REM sleep
makes it difficult for the brain to tune into the bladder’s night-time
signals. Children often mention that they had a dream about
urinating while this is going on.
SLEEP AND THERMOREGULATION
Body temperature regulation is subject to circadian system influence. An
individual’s body temperature is higher during the day than at night. At night
there is a gradual decline in body temperature, a decrease in heat production
(called the falling phase of the body temperature rhythm), and an increase in
heat loss, all which promote sleep onset and maintenance, as well as EEG slow-
wave activity. Conversely, there is a gradual increase in body temperature
several hours before waking. The brain sends signals to other parts of the body
that increase heat production and conservation in order to disrupt sleep and
promote waking (Szymusiak, 2005).

(Additional Info)
New-borns and Infants
New-borns sleep about 16 to 18 hours per day; however, it is discontinuous with
the longest continuous sleep episode lasting only 2.5 to 4 hours (Roffwarg et al.,
1966). New-borns have three types of sleep: quiet sleep (similar to NREM),
active sleep (analogous to REM), and indeterminate sleep. Sleep onset occurs
through REM, not NREM, and each sleep episode consists of only one or two
cycles. This distinctive sleep architecture occurs mostly because circadian
rhythms have not yet been fully entrained (Davis et al., 2004).
Circadian rhythms begin to arise around 2 to 3 months of age, leading to sleep
consolidation that manifests in greater durations of wakefulness during the day
and longer periods of sleep at night.
Young Children: (2-7 yrs)
Total sleep time decreases by 2 hours from age 2 to age 5 (13 hours to 11).
Socially, the decrease in time asleep may be a result of decreased daytime
napping, as most children discontinue napping between 3 and 5 years old (Jenni,
2000). Other social and cultural factors that begin to influence sleep include
how, with whom, and where children sleep and the introduction of school time
routines.
Physiologically, it has been suggested that by the time children enter school
(typically 6 years old) they begin to manifest circadian sleep phase preferences
—a tendency to be a “night owl” or “morning bird” (Jenni, 2000).
Older children, however, are significantly more likely to experience challenges
in initiating and maintaining sleep than younger children. In addition, older
children are more likely to have nightmares, which usually disrupt sleep,
making it discontinuous.
Adolescents
A complex and bidirectional relationship exists between pubertal development
and sleep. Studies underscore the importance of using pubertal stage, rather than
chronologic age as the metric in understanding sleep, as has been found for
other physiologic parameters in the second decade of life. It has been
determined that adolescents require 9 to 10 hours of sleep each night (Mercer et
al., 1998), though few adolescents obtain adequate sleep.
SWS and sleep latency time progressively declines with advancing pubertal
development; however, time spent in stage 2 increases (Carskadon, 1982).
These changes are likely in part due to pubertal and hormonal changes that
accompany the onset of puberty. For instance, at mid-puberty, there is
significantly greater daytime sleepiness than at earlier stages of puberty.
Afternoon sleepiness is greater than that in late afternoon and evening in more
mature adolescents than in younger subjects. With increasing age, the total time
spent sleeping decreases, as does REM sleep. However, if bedtime is fixed, the
duration of REM sleep remains constant.
Adults
A hallmark change with age is a tendency toward earlier bedtimes and wake
times. Older adults (approximately ages 65 to 75) typically awaken 1.33 hours
earlier, and go to bed 1.07 hours earlier, than younger adults (approximately
ages 20 to 30). the consequences of an advanced circadian rhythm are a 1-hour
advance in body temperature increase in the early morning and misaligned
melatonin and cortisol secretion rhythms with the circadian clock (Dijk et al.,
2000).
As an individual ages (between the ages of 20 to 60), SWS declines at a rate of
about 2 percent per decade (Ancoli-Israel, 2005). Because arousal thresholds are
typically highest during SWS, and because SWS declines with age, older adults
experience more frequent awakenings during a sleep episode.

Time (in minutes) for sleep latency, amount of time spent awake after initially falling asleep
(WASO), rapid eye movement (REM), non-rapid eye movement (NREM), stages 1, 2, and
slow-wave sleep (SWS).