Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Sleep physiology in children

Merrill S Wise, MD
Daniel G Glaze, MD
Section Editor
Ronald D Chervin, MD, MS
Deputy Editor
Alison G Hoppin, MD


Sleep is an active, dynamic physiologic process that has a critical impact on many aspects of health, daytime function, and development. During the first few years of life, a number of important developmental changes occur, leading to the expected adult sleep/wake pattern [1-3].

This topic review will describe normal sleep/wake patterns in infancy and childhood. This will provide background for an evaluative approach to sleep problems in children, which is discussed in a separate topic review. (See "Assessment of sleep disorders in children".)

Sleep stages and architecture in adults are discussed in detail separately. (See "Stages and architecture of normal sleep".)


Two distinct sleep states have been identified based on specific physiological variables: rapid eye movement (REM) sleep and nonrapid eye movement (NREM) sleep. Standardized methods have been developed with regard to scoring sleep states in infants, children, and adults [4,5].

REM sleep is a physiologically distinct state, characterized by an activated pattern on electroencephalogram (EEG; similar in some respects to wakefulness) associated with marked decrease in muscle tone and episodic bursts of REM. Most dreaming occurs during REM sleep [6,7].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 05, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Roffwarg HP, Muzio JN, Dement WC. Ontogenetic development of the human sleep-dream cycle. Science 1966; 152:604.
  2. ASERINSKY E, KLEITMAN N. A motility cycle in sleeping infants as manifested by ocular and gross bodily activity. J Appl Physiol 1955; 8:11.
  3. Anders TF, Sadeh A, Appareddy V. Normal sleep in neonates and children. In: Principles and Practice of Sleep Medicine in the Child, Ferber R, Kryger M (Eds), W.B. Saunders, Philadelphia 1995. p.7.
  4. Berry RB, Brooks R, Gamaldo CE, et al for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.4, www.aasmnet.org, American Academy of Sleep Medicine, Darien, IL 2017.
  5. Berry RB, Brooks R, Gamaldo CE, et al. Sleep staging rules: Rules for Infants. In: The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology, and Technical Specifications, version 2.4, American Academy of Sleep Medicine, Darien, IL 2017.
  6. DEMENT W, KLEITMAN N. Cyclic variations in EEG during sleep and their relation to eye movements, body motility, and dreaming. Electroencephalogr Clin Neurophysiol 1957; 9:673.
  7. DEMENT W, KLEITMAN N. The relation of eye movements during sleep to dream activity: an objective method for the study of dreaming. J Exp Psychol 1957; 53:339.
  8. ASERINSKY E, KLEITMAN N. Regularly occurring periods of eye motility, and concomitant phenomena, during sleep. Science 1953; 118:273.
  9. Iglowstein I, Jenni OG, Molinari L, Largo RH. Sleep duration from infancy to adolescence: reference values and generational trends. Pediatrics 2003; 111:302.
  10. Olds T, Maher C, Blunden S, Matricciani L. Normative data on the sleep habits of Australian children and adolescents. Sleep 2010; 33:1381.
  11. Blair PS, Humphreys JS, Gringras P, et al. Childhood sleep duration and associated demographic characteristics in an English cohort. Sleep 2012; 35:353.
  12. Paruthi S, Brooks LJ, D'Ambrosio C, et al. Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine. J Clin Sleep Med 2016; 12:785.
  13. Sadeh A, Dahl RE, Shahar G, Rosenblat-Stein S. Sleep and the transition to adolescence: a longitudinal study. Sleep 2009; 32:1602.
  14. Gastaut H, Broughton RJ. A clinical and polygraphic study of episodic phenomena during sleep. Biol Psychiatry 1965; 7:197.
  15. Keefauver SP, Guilleminault C. Sleep terrors and sleep walking. In: Principles and Practice of Sleep Medicine, 2nd ed, Kryger MH, Roth T, Dement WC (Eds), WB Saunders, Philadelphia 1994. p.567.
  16. Fisher C, Byrne J, Edwards A, Kahn E. A psychophysiological study of nightmares. J Am Psychoanal Assoc 1970; 18:747.
  17. Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW. Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep 1986; 9:293.
  18. Huang J, Karamessinis LR, Pepe ME, et al. Upper airway collapsibility during REM sleep in children with the obstructive sleep apnea syndrome. Sleep 2009; 32:1173.
  19. American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed, American Academy of Sleep Medicine, Darien 2014.