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R are conjugate and occur in all directions (hor9 izontal more than vertical) Gross body C /A movements occur every 15 min or so in all stages of sleep but are maximal in the transition between REM and NREM sleep, at O /A Alpha Alpha which time the sleeping person changes poo sition, usually from side to side (most people sleep on their sides) On closer study, REM ROC/A sleep has been found to have phasic and tonic components In addition to the rapid eye movements, phasic phenomena include alterLOC/A Eyes closed nate dilatation and constriction of the pupils and an increase in the blood pressure as well as uctuation of the blood pressure, pulse, Chin EMG and respiration The phasic activities are related to bursts of neuronal activity in the pon- A tine, vestibular, and median raphe nuclei and are conducted through the corticobulbar and corticospinal tracts In the nonphasic periods Relatively low voltage, mixed frequency EEG of REM sleep, alpha and gamma spinal neurons are inhibited, the H responses diminish, and the tendon (phasic myotatic) and postural and exor re exes diminish or are abolished This accidity or atonia which is prominent in the abdominal, upper airway, and intercostal muscles may compromise breathing during REM sleep and pose a threat in infants with excessive respiratory dif culty Slow-rolling eye movements and in patients who are obese as well as in those with kyphoscoliosis, muscular dystroNormally active chin EMG phy, and other neuromuscular paralyses B (Guilleminault and Dement) It has long been known that body temperature falls slightly during sleep; however, C /A if sleep does not occur, there is still a drop in Sleep spindle K-complex body temperature as part of the circadian (24h) temperature curve This drop in temperaO /A ture is also independent of the 24-h recumbency-ambulatory cycle During sleep, the decline in temperature occurs mainly during ROC /A the NREM period, and the same is true of the heartbeat and respiration, both of which become slow and more regular in this period LOC /A Cerebral blood ow and oxygen consumption in muscle diminish during NREM sleep Chin EMG and increase during REM sleep Also, cereNormally active chin EM bral blood ow and metabolism are markedly C reduced across the entire brain during deep Figure 19-2 Representative polysomnographic recordings from adults in the awake state and various NREM sleep; however, during REM sleep, stages of sleep Recordings are made at conventional sleep-laboratory speed of 10 mm/s (ie, at the metabolism and blood ow are restored to the paper speed of one-third standard clinical EEG recordings) A Upper tracings: Awake state (with levels of the waking state (Madsen and Vor- eyes closed) Alpha rhythms are prominent in EEG Normally active chin EMG B Middle tracings: strup) Presumably as a result of increased Stage 1 sleep Onset of sleep is de ned by the diminished amplitude of alpha waves in the occipital blood ow, intracranial pressure rises during EEG channel ( at appearance) C Lower tracings: Stage 2 sleep, characterized by appearance of REM sleep Braun and colleagues, who used high-amplitude single-complex (K) waves and bursts of 13- to 16-Hz waves (sleep spindles) on a positron emission tomography (PET) to background of low frequency study REM sleep, observed selective activation of the extrastriate visual cortices and limerate independently of frontal lobe modulation, perhaps explaining bic-paralimbic regions, with concomitant attenuation of activity in the uncritical acceptance of the bizarre content and the disordered the primary visual cortex and frontal association areas These autemporal relationships and heightened emotionality that characterthors have speculated that dreaming activates the visual association ize dreams areas and their paralimbic connections and that these regions op3 2 2 1 1 2 3 2 2 1 1 2.

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