Sleep physiology

Dating back to the 1800s, some of the earliest snccessfnl psychiatric medications were those nsed to promote sleep. Sleep-promoting medications, called sedative-hypnotics, have remained an important component of onr pharmacological armamentarium. Over the past 100-plus years, as we have learned more abont both pharmacology and sleep physiology, a series of refinements have improved the safety and effectiveness of sleep medications. 

One unexpected observation, which I will discuss in chapter 10, is that some SSRI drugs that potentiate the serotonin system in favor of enhanced mood in depression cause disturbingly long-lasting alterations in REM sleep physiology, and these alterations sometimes cross the border into the REM sleep behavior disorder. 

We don t know the basis of this loss of temperature control, but we do know that REM sleep is itself associated with failure of the central thermostat, and we know that REM sleep deprivation also causes a loss of temperature. A unifying hypothesis is that any condition that potentiates REM sleep physiology may also compromise the central regulation of body temperature. Relevant to this hypothesis is the fact that the two brain stem aminergic neuromodulators that are inactivated in REM sleep are active in responding to thermal stress. 

Van Dongen HP, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep 2003 26(2) 117-126. 

Webb WB. Partial and differential sleep deprivation. In Kales A, ed. Sleep Physiology and Pathology A Symposium. Philadelphia JB Lippincott, 1969 221-231. 

Matyka KA, Crawford C, Wiggs L, Dunger DB, Stores G. Alterations in sleep physiology in young children with insulin-dependent diabetes mellitus relationship to nocturnal hypoglycemia. J Pediatr 2000 137 233-238. 

Taub JM, Hawkins DR, Van de Castle RL. Temporal Relationships of napping behavior to performance, mood states and sleep physiology. Sleep Res 1978 7 164. 

Seifritz E (2001) Contribution of sleep physiology to depressive pathophysiology. Neuropsychopharmacology 25 S85-S88... 

Now, we have the facts of human sleep physiology. Now, we know -... 

This sounds very much like evidence for the one-to-one theory of dream psychophysiology, proof of which eluded experimenters in the 1960s. It also suggests that REM sleep physiology can be pathologically distorted by inherent degeneration of the brain. 

Briefly, evaluation of the effects of hypnotics on sleep physiology and sleep architecture, as measured by electroencephalography, has received increased attention. Continuous all-night electrophysiological measurement of sleep termed polysomnography (PSG) has made it possible to evaluate the action of hypnotics on sleep. PSG assessment as a means of evaluating the hypnotic effects of a drug candidate is now required by the U.S. FDA. 

I. Karacan, G. S. O Brien, R L. Williams, P. J. Salis, and J. I. Thornby in Sleep, Physiology, Biochemistry, Psychology, Pharmacology, Clinical Implications, Karger, Basel, 1973, pp. 463-476. 

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