FACULTY OD NATURAL SCIENCES, MATHEMATICS AND

EDUCATIONAL SCIENCES

MOSTAR

THE IMPORTANCE OF SLEEP

Student: Professor:

Tedi Penjak doc.dr.sc. Milea Ajduk Kurtovic

Mostar, May 2023.

CONTENTS

INTRODUCTION......................................................................................................................1

1 SLEEP DISORDERS..........................................................................................................2

1.1 Insomnia.......................................................................................................................2

1.2 Parasomnias..................................................................................................................3

1.2.1 NREM parasomnias.............................................................................................3

1.2.2 REM parasomnias.................................................................................................4

1.3 Hypersomnia................................................................................................................4

1.3.1 Sleep breathing disorders.....................................................................................4

1.3.2 Narcolepsy............................................................................................................5

1.4 Circadian rhythm disorders..........................................................................................6

1.4.1 Dysrhythmias........................................................................................................6

2 CONSEQUENCES OF LACK OF SLEEP.........................................................................7

2.1 Neurological consequences..........................................................................................7

2.2 Metabolic consequences...............................................................................................8

2.3 Immunological consequences......................................................................................8

CONCLUSION.........................................................................................................................10

LITERATURE..........................................................................................................................11
INTRODUCTION

Sleep is a reversible, unconscious state characterized by certain changes in brain

activity which can be determined by electroencephalography (EEG), electrooculography
(EOG) and electromyography (EMG). Sleep includes lack of movement, reduced response to
external stimuli, reduced cognitive activity and slower eye movements. Despite the reduced
cognitive activity, the brain is still active during sleep. Based on measurements of the
electrical activity of neurons using EEG, EOG and EMG sleep can be divided into two
phases, sleep with rapid eye movement (eng. rapid eye movement,REM) and sleep with slow
eye movements (eng. non-REM, NREM). These phases are cyclical they change during sleep
4 to 6 times.

The cycle begins with NREM sleep, which consists of three stages. The first phase
(N1) lasts a short time, from one to five minutes during which brain activity slowly decreases.
During this phase it is easiest wake. In case the person is not distracted, he goes to the second
phase (N2) for the time that comes to muscle relaxation, reduced breathing rate and reduced
heart rate. Brain activity it is characterized by the appearance of sleep spindles and K-
complexes. Sleep spindles are short outbreaks of alpha brain waves, while K-complexes are
longer delta waves of short duration, which they show the transition to deeper sleep. The third
stage (N3) includes the deepest sleep during which the limit of irritability is the highest. EEG
analysis shows a large amount of delta waves. In this during this period tissue renewal and
building of bones and muscles occurs.

The REM phase follows, whose EEG analysis gives results similar to those of the
awake brain. It comes to muscle atony, which is important in order to suppress movements
during dreaming, which mostly takes place at this stage. The only muscles that remain active
are the eye muscles and the muscles needed for the diaphragm breathing. This phase plays an
important role in the integration of new information. The first REM phase lasts ten minutes,
and in each subsequent cycle its duration is extended

Quality sleep is extremely important, as anyone can conclude after just one sleepless
night. For this reason, more and more medical research is devoted to the study of sleep
disorders and their consequences lack of sleep.

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 1 SLEEP DISORDERS

Sleep disorders can be divided into four basic categories: insomnia, hypersomnia,
parasomnias and circadian rhythm disorders.

1.1Insomnia

Insomnia is a disorder related to difficulty falling asleep and maintaining sleep.

Symptoms include insomnia, fatigue and early morning awakenings that repeat 3-4 times
weekly for a period longer than a month. If the cause of insomnia is not known, it is called
primary, and if it is, it is called secondary. Among the most common causes of secondary
insomnia include kidney diseases, nocturnal urination, cerebrovascular diseases, diseases of
the digestive system, diseases of the respiratory system, arthritis, menopause, cardiovascular
diseases and some mental disorders.

Excessive excitement is a possible cause of primary insomnia, and accelerated

metabolism during day and night in patients is one of the evidence that points to this. That's
exactly why, despite lack of sleep, people suffering from insomnia are often less sleepy than
people with a normal rhythm sleeping.

Insomnia is present in 4 to 5% of people, but this number increases to 40% in people

over 65. year. The reason for this is a large number of chronic diseases that directly or they
indirectly disturb sleep. Indirect influence is represented by the use of drugs such as beta
blockers and analgesics, which negatively affect the quality of sleep. Also, due to reduced
liver function, influence stimulants such as caffeine and alcohol increase and make sleep even
more difficult. After puberty, there is an increase in the prevalence of insomnia in women
compared to men. A possible cause of this is the hormonal changes associated with puberty.

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 Picture 1. Graphic representation of insomnia in certain age groups

1.2Parasomnias

Parasomnias are unpleasant and unwanted behaviors that occur during sleep. Include
the activation of the locomotor center, the inertia of sleep, the period of confusion during
awakening and sleep instability due to constant awakening. They are manifested due to
disturbances during the transition from one state of wakefulness, i.e. sleep, into another called
the dissociated state of sleep. The transition from one state to another requires compliance of
a large number of neurotransmitters and other physiological pathways, which is why the
frequency such disorders is not surprising. They can be divided based on the stage of sleep
from which they arise, that is, to NREM parasomnias and REM parasomnias.

1.2.1 NREM parasomnias

NREM parasomnias are the most common and mostly occur in the first third of sleep,
during the N3 phase sleep. They are common in children, and the frequency decreases with
age. The most intense triggers of disorders can be lack of sleep, sedatives and stress, but also
noise, external touch, alcohol, disorders in breathing and restless legs syndrome. These factors
increase the intensity of external and internal stimuli during sleep, which makes the
environment favorable for creating excitement in the brain. Triggers cannot be the cause of
the disorder on their own, but they can become so in people with predispositions which are
hereditary. Disorders include night terrors, somnabulism, induced confusion waking up,
sexsomnia and night eating syndrome.

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 1.2.2 REM parasomnias

The most common REM parasomnia is a behavioral disorder of the REM sleep phase.
Because of this of the disorder, the muscle atony that is normally present during the REM
phase of sleep does not occur and is thereby blocking its role in the prevention of the active
execution of dreams. Making dreams come true is possible manifest in smaller movements,
but also more complex ones, which can lead to dangerous situations. This disorder mostly
affects men, who make up 90% of patients. Disrupt yourself occurs in acute and chronic form.
The acute form can be caused as a side effect of drugs, most often antidepressants, selective
serotonin reuptake inhibitors. These drugs know can also be used to treat insomnia. The cause
of the chronic form itself is not known, but it is known link with various neurological
disorders. For example, it often appears as a wound harbinger of Parkinson's disease.

1.3Hypersomnia

Hypersomnia is marked daytime sleepiness that results in a lack of attention. Common

cause is a "voluntary" lack of sleep caused by socio-economic reasons. A large number of
people will put their academic or business success before their health. An indicator of this is
the fact that today's generations sleep 20% less than the previous ones, although the amount of
necessary sleep has remained unchanged. If this is not the case, hypersomnia can also be
caused by a disorder, most commonly sleep breathing disorders or narcolepsy.

1.3.1 Sleep breathing disorders

Breathing disorders during sleep can range from mildly irritating such as snoring to
extremely unpleasant, such as obstructive sleep apnea. To obstructive sleep apnea it occurs
due to the interruption of the air flow, caused by the complete or partial collapse of the upper
respiratory tract.

Respiratory disorders are divided into apneas if they are complete and hypopneas if
they are incomplete. The average number of apneas and hypopneas per hour is expressed by
the apnea-hypopnea index (AHI). AHI is used in diagnoses with the purpose of determining
the severity of the disorder. The older population is more common affected by this disorder, it
has been recorded in people aged 65 to 95 years a frequency of 62% for AHI ≥ 10. With
greater intensity of the disorder (AHI ≥ 40), this proportion drops to still a high 24%. In

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addition to age, the occurrence of this disorder is influenced by gender, obesity, alcohol,
smoking, neurological damage, medications, but there are also hereditary factors

The genetic influence on this disorder is manifested through the anatomical structure
of the respiratory system, reduced lung volume at the end of exhalation, reduced dilatation
muscle activity and instability ventilation controls.

1.3.2 Narcolepsy

Narcolepsy is one of the rarest neurological disorders and the only known disorder that
causes it dysfunction of the wakefulness and sleep generators. Every two thousand is affected
by it person. It is characterized by uncontrolled falling asleep during the day, especially
during the day sedentary or non-stimulating activities. It is particularly interesting that this
happens despite sufficient amount of sleep. Other symptoms include sudden muscle
weakness, i.e. cataplexy, hallucinations that occur at the transition from awake to sleep and
vice versa. Paralysis also occurs sleep, automatic behavior and disturbed sleep. During
paralysis, a person has only one option breathing and eye movement.

Automatic behavior implies unwanted actions of various types, from wrong turns by
car to putting clothes in the fridge. It is caused by the mixing of wakefulness and NREM
sleep. Man is awake enough to perform complicated actions, but not awake enough to be
aware of these actions. This behavior further confirms the theory that wakefulness and sleep
are not mutually exclusive states and shows us what happens when elements of one pass into
the other.

Muscle atonia is normal for REM sleep, but if it occurs in the waking state then it
comes to cataplexy or sleep paralysis. In case atonia continues from REM sleep after
awakening the result is sleep paralysis, and if atony occurs in the middle of the waking state,
the result is cataplexy.

Hallucinations are dreams that mix with reality. We can notice that with all this
common to the symptoms is the inability to separate the waking state from the sleeping state.

Originally, narcolepsy was considered a psychological disorder. Uncontrolled sleep it

was explained as a way of avoiding extremely stressful situations. Today it is known that it is
narcolepsy is a neurological disorder caused by abnormalities in the central nervous system.

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 1.4Circadian rhythm disorders

The circadian rhythm and homeostasis are responsible for the regulation of the
alternation between wakefulness and sleep. Homeostasis reflects the need for sleep that
accumulates in the wakeful state after a long time periods of sleeplessness or poor quality
sleep. Circadian rhythm affects sleep through activity suprachiasmatic nuclei of the
hypothalamus. It represents the internal clock that plays a role in regulation of all circadian
processes, including the timing and integration of sleep and wakefulness. Aging causes
changes in various circadian factors. Reduction of physical temperature, amounts of
melatonin and cortisol are some of the factors that can lead to circadian rhythm disorders.

The main symptom of a circadian rhythm disorder is the inability to sleep at the
desired time, while when a person manages to fall asleep, there is no problem with sleep. The
biggest cause of this disorder is the inability to harmonize the individual's internal clock with
the demands of the environment. Accordingly, these disorders are divided into primary and
secondary. Primary ones are caused by malfunctioning of the internal clock itself, and
secondary clocks are caused by the influence of the environment on the internal clock. Correct
the causes of secondary disorders are easy to establish, for example jet-lag or shift work. But
primary disorders are often more difficult to diagnose because they can easily be mistaken for
another sleep disorders such as hypersomnia and insomnia.

1.4.1 Dysrhythmias

The most common primary disorder of this type is delayed sleep phase syndrome. It is
characterized inability to fall asleep at an earlier, more desirable time. It is caused by an
increase in nocturnal activities in today's society. At the other end is advanced sleep phase
syndrome, individuals affected by this disorder fall asleep earlier than desired and also wake
up earlier in the morning.

A disorder in which the wake-sleep cycle lasts longer than 24 hours is one of the rarer
disorders circadian rhythm. It most often affects blind people due to the inability to perceive
the outside the lights. It results in a gradual change in sleep time, which negatively affects
quality sleep.

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 Irregular sleep-wake rhythm disorder is characterized by a lack of features circadian
rhythm. This means that the sleep period is fragmented, but the total amount of sleep is the
same normal. Night sleep is shortened and consists of at least 3 shorter parts, and daytime
sleep consists of several shorter naps

2 CONSEQUENCES OF LACK OF SLEEP

Sleep puts all organisms in an extremely vulnerable position. Such a state would not
survive evolution that it does not play an extremely important role. Sleep plays a key role in
to restore the organism. From helping cognitive abilities, to a role in metabolism glucose,
quality sleep is necessary for a healthy life. Therefore, it is expected that lack of sleep leads to
significant consequences.

2.1Neurological consequences

Poor sleep causes problems with concentration and memory, lack of attention and
slower timing reactions. All this disrupts people's daily life, and can even endanger it.

Through experimental sleep restriction, it was discovered that people who sleep 4-6
hours, 14 nights in a row, they have significantly lower focus and results on cognitive tests.
It's a dream an important period for the integration of information because it allows the
reactivation of the neural network specific way. Certain types of slow-wave oscillations
organize the firing pattern of neurons which helps brain plasticity.

Sleep deprivation does not affect all cognitive functions equally. Functions based on
certain rules, for example decision-making and task planning, remain relative untouched by
lack of sleep, while the creative sides of cognition experience greater degeneration. It is
especially worrying that more and more research indicates that some parts of the higher levels
cognition remains permanently impaired even after returning to a normal sleep rhythm.

Emotions have been shown to be a key factor in the impact of sleep deprivation on
cognitive abilities. Namely, more and more evidence points to the fact that the impact of lack
of sleep is much greater on cognitive systems which rely on emotional data.

People with poor sleep quality have a higher chance of developing depression.
Insomnia is frequent the first symptom of depression. However, the link between poor sleep

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and depression is not entirely clear. Such as already mentioned earlier, it is also possible that
poor mental health leads to sleep problems.

2.2Metabolic consequences

Continuous sleep deprivation causes a decline in the activity of protein kinase b

(AKT), which has key role in insulin signaling. Because of this, there is a drop in the level of
glucose in the blood and a reduction insulin secretion rates. By measuring the metabolism of
sugar, it was determined that it decreases by a third after lack of sleep.

People who have poor sleep quality also have a higher chance of obesity. The link
between the deficit sleep and obesity are made up of the hormones leptin and ghrelin. Leptin
is produced by fat cells, it signals satiety, while ghrelin is produced by stomach cells, and it
signals hunger.

Lack of sleep leads to a drop in levels leptin, and an increase in ghrelin levels. The
result is an increased appetite, especially for fatty and sweet foods with food. Lack of sleep
also leads to fat cell resistance to insulin which can cause type 2 diabetes. After only 4 nights
of sleep deprivation, there is a 30% lower fat sensitivity cells to insulin, which is equal to
metabolic aging of 10 to 20 years.

The amount of sleep is not the only important factor, the quality of sleep is also
important. Lack of deep, slow-wave sleep several nights in a row results in the same decline
in cell sensitivity to insulin as in continuous sleep deprivation. The reason lies in the fact that
they begin to be secreted at the beginning of slow-wave sleep various hormones, such as
growth hormone, whose effect is on glucose metabolism contrary to the action of insulin

The sympathetic nervous system is more active in stressful situations. Lack of sleep is
extremely stressful situation for the organism, which means that the sympathetic nervous
system will also be more active, his increased activity will inhibit digestion, and thus the
secretion of insulin from the pancreas.

2.3Immunological consequences

Long-term lack of sleep also affects the immune system. In one study, they were
measured elevated levels of interleukin-6 and C-reactive protein in the blood, which are

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signaling molecules associated with inflammatory diseases, such as coronary heart disease.
Multiple studies indicate that even small deviations from the required length of sleep lead to
an increase the amount of molecules related to atherosclerosis and heart disease.

Oversleeping also has its consequences. Sleeping more than 8 hours a day also leads to
increased levels of interleukin-6 and C-reactive protein, but also tumor necrosis factor alpha, a
cytokine that plays a role in inflammatory reactions.

One study found that a week of sleep deprivation caused a change in the activity of
711 genes. These genes play a role in stress responses, the immune system and cellular
metabolism. It has also been discovered that genes determine how much sleep deprivation
will affect an individual.

With all these attacks on the immune system, lack of sleep can also reduce the
effectiveness of vaccines.

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CONCLUSION

Sleep has several extremely important functions in the body, but in order to be able to
perform them successfully, it is necessary to maintain the quality and duration of sleep on a
daily basis.

Sleep disorders can occur for several reasons. Due to the correct diagnosis, and
therefore treatment, it is essential is to distinguish sleep disorders that are a symptom of other
diseases from disorders that occur independently appear. In addition to the treatment of the
disorders themselves, it is equally important to treat the consequences of the deficiency sleep
is on the body. Despite the fact that disorders are often predestined genetically, taking care of
the physical and mental health, it is possible to avoid or at least delay their onset.

It is important to understand that the brain remains active during sleep. Each stage of
sleep has a different one function for the organism. This is why the consequences of sleep
disorders are largely determined the stage of sleep on which they act.

There are still many unanswered questions related to the physiology of sleep, but more
and more research provides promising discoveries that in the future could help in treatment, as
well as in the treatment itself prevention of sleep disorders.

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LITERATURE

1. Bonnet, M. H., & Arand, D. L. (1997). Hyperarousal and insomnia. Sleep medicine
reviews, 97-108.
2. Chokroverty, S. (2010). Overview of sleep & sleep disorders. Indian J Med Res, 126-
140.
3. Killgore, W. D. (2010). Effects of sleep deprivation on cognition. Progress in brain
research, 105-129.

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