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Physiologic Changes during Sleep

NREM REM
Heart Heart rate decreases (tonic increase in parasympathetic activity) Bradycardia persists due to reduced sympathetic discharge
Heart rate more variable
Cardiac output Decrease Decrease (greatest decrease seen in last sleep cycle especially
during the REM episode)
Circulation Little change in cutaneous/muscular/mesenteric blood flow Increased flow in mesenteric and renal vascular beds (vasodilation)
Cerebral blood flow decreases (resting brain activity = reduced Decreased blood flow in skeletal muscular and cutaneous vascular
neuronal activity, decreased synaptic transmission, decreased beds (vasoconstriction)
cerebral metabolism) Cerebral blood flow increases (state of active brain = increased
neuronal activity, incrased cerebral metabolism)
Blood pressure BP falls BP fluctuates
Pulmonary artery BP slightly elevated during sleep
Respiration Controlled by autonomic system Controlled by behavior
Minute ventilation decreases Minute ventilation decreases
Respiratory pattern is stable, rhythmic Respiratory pattern is irregular
Response to CO2 and O2 levels decreases Response to CO2 and O2 levels decreases
Pupillary Pupilloconstriction (tonic parasympathetic drive) Pupilloconstriction (tonic parasympathetic drive)
Phasic REM: pupillodilation (central inhibition of parasympathetic
outflow)
Thermal Sweating and panting Thermoregulation inoperative
regulation Shivering
Neuromuscular Limb Muscles: muscle tone slightly decreased Limb Muscles: muscle tone markedly decreased/absent (muscle
Upper Airway Muscles: reduction of tone of dilator muscles atonia)
Upper Airway Muscles: further reduction of tone; increase in upper
airway resistance
Summary of Hemodynamic Changes
° Result from alteration in the ANS
° Parasympathetic activity predominates during both NREM and REM sleep
° Sympathetic inhibition during REM
° During phasic REM, blood pressure and heart rate are unstable due to phasic vagal inhibition and sympathetic activation
° Peripheral vascular resistance decreases slightly in NREM sleep with a further fall in REM sleep
Summary of Ventilatory/Respiratory Changes
° Decrease in ventilation and respiration
° Decrease in VCO2 and VO2 during sleep
° Metabolism slows at sleep onset and accelerates slowly at approximately 5:00 am
° During deep sleep ventilation decreases proportion to metabolism
° Increase in PaCO2 is due to alveolar hypoventilation
° Blunted hypoxic and hypercapnic responses
Endocrine Changes

Melatonin: begins to rise in evening and


reaches peak levels between 3 and 5 am

ADH: episodic secretion with no


relationship to sleep

Aldosterone: peaks just prior to sleep offset

Thyroid stimulating hormone: levels low in awake state,


increase in the evening and peak shortly before sleep onset
TSH secretion inhibited by sleep

Testosterone: rise at sleep onset and rise


throughout sleep

Prolactin: highest plasma concentrations during


sleep. Levels begin to rise after sleep onset (peak
levels about 5-7 am)

Gonadotropic hormone: during pre-puberty/puberty


stages, levels increase during sleep

Cortisol: levels lowest in early


part of sleep, highest from 4-8 am

Growth hormone: plasma concentrations peak


90 min after sleep onset; sleep deprivation
suppresses GH secretion