The physiological regulatory process that ensures the appropriate balance between the need for sleep (sleep drive) and the duration and intensity of sleep achieved, operating independently of the circadian clock. Maintenance involves the precise management of the sleep-wake cycle’s regulatory substance, often conceptualized as adenosine, to guarantee sufficient restorative pressure and sleep continuity. Clinical efforts in maintenance aim to prevent sleep fragmentation and optimize the total time spent in restorative sleep stages.
Origin
This term is a core concept in the two-process model of sleep regulation, first proposed by Borbély, which posits that sleep is governed by the interaction of the homeostatic process (Process S) and the circadian process (Process C). ‘Homeostasis’ refers to the system’s inherent drive to maintain equilibrium. The focus on ‘maintenance’ highlights the therapeutic goal of supporting the resilience of this drive against disruptive external factors.
Mechanism
The homeostatic mechanism is thought to be driven by the accumulation of sleep-inducing substances, notably adenosine, in the basal forebrain during wakefulness. This increasing sleep pressure, or Process S, promotes the transition into and maintenance of deep, slow-wave sleep (SWS). Maintenance involves ensuring this sleep pressure is not artificially suppressed (e.g., by caffeine or certain medications) and that the SWS phase is protected, thereby guaranteeing the essential restorative functions linked to hormonal and metabolic repair.
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