Healing: promotes healing directly or indirectly via restorative, immune, and other functions Inflammatory and immune response: acute phase response to infection, inflammatory cytokine production (e.g., interleukins, TNF) and immuno-regulation Protective sleep behavior: sleeping` at the right time in a secure place increases survival chances Waste removal: slowing metabolite buildup to enable cellular waste removal increased glymphatic clearance The four main categories of sleep functionsĮnergy balance: energy conservation by lowering metabolic rate and downscaling sensory and motor processes restoration of energy storesįunctional recovery: synthesis of proteins involved with neurotransmitter function, transport, membrane trafficking, lipid and myelin metabolism Although the list of sleep functions in Table Table1 1 is not exhaustive, the functions that are listed are adequate to convince us that it is not possible to survive and stay healthy without good sleep. Moreover, the most neural activity involves neurodynamic and metabolic processes such that separating these two facets of physiology in order to categorize sleep function is purely arbitrary. For example, sleep-induced neuroplasticity is also involved in acute functional recovery and response to injury. These functional categories are not mutually exclusive. The biological functions of sleep can be divided into four categories (Table (Table1): 1): (1) metabolic and functional recovery, (2) defense and response to injury, (3) neurodynamics and neuroplasticity, and (4) bioperiodicity and timing of biological processes. Evidently, certain physiologic processes involved in restoring homeostasis, molecular biosynthesis, and building neural circuits operate more efficiently during sleep. The fact that we must sleep to function effectively during wakefulness indicates that sleep is a biological necessity. Sleep is a physiologic state that is distinct from, but certainly not less important than, wakefulness. It is only by confronting ISS directly that we can hope to develop and implement effective educational and advocacy programs, along with more responsible public health policies and regulations. Acknowledging ISS as a public health priority is a necessary first step in our response to the global threat of CSD and CSD-related health consequences. The last three decades have seen a global rise in voluntary sleep curtailment such that ISS may already be the leading cause of CSD, not only in adults but also in school-aged children and adolescents. In this review, we will describe the biological importance of sleep, the ramifications of CSD on the individual and society, the nosological status and diagnostic features of ISS, and the apparent lack of attention to ISS in contemporary medical practice and public health programs. In the latest edition of the International Classification of Sleep Disorders (ICSD-3, 2014), ISS is considered a disorder of central hypersomnolence with diagnostic codes ICD-9-CM 307.44 and ICD-10-CM F51.12. Behaviorally induced CSD is currently referred to as insufficient sleep syndrome (ISS). The concept of behaviorally induced CSD has not changed much since it was first introduced four decades ago. Chronic sleep deficiency (CSD) poses a threat to physical health, mental well-being, and social functioning.
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