The process of falling asleep

Sleep Med Rev. 2001 Jun;5(3):247-270. doi: 10.1053/smrv.2001.0145.


The process of falling asleep can best be measured by considering a convergence of behavioural, EEG, physiological and subjective information. Doing so allows one to see sleep processes as they unfold, but relying on any single sleep index can bias the description of this complex process. The studies reviewed do not support the idea that sleep begins "in a moment", but rather that entry into sleep is a continuous, interwoven series of changes which begin in relaxed drowsiness and continue through stage 1, often into the first minutes of stage 2. The transition from waking brain to sleeping brain is traced accurately by Hori's nine-stage EEG system. Event-related potential (ERP) studies map complex changes in information processing as sleep begins, while quantitative EEG investigations have identified important spatiotemporal re-organisations of primary EEG frequencies which take place as one moves from waking to sleeping mode. To consider evidence from multiple levels of analysis, a three step electrophysiological model of central nervous system (CNS) regulation during sleep onset is proposed: initial processes appear to be alpha-related; intermediate processes, poorly studied to date, parallel the development of theta and vertex sharp wave activity, while the processes which terminate wakefulness are sigma sleep spindle-related. Clinical investigations of the sleep onset period in people with narcolepsy, insomnia, depression or sleep apnoea appear to indicate the presence of relatively unique electrophysiological signatures which may be of clinical significance. 2001 Harcourt Publishers Ltd