Sleep and circadian rhythms in humans.

During the past 50 years, converging evidence reveals that the fundamental properties of the human circadian system are shared in common with those of other organisms. Concurrent data from multiple physiological rhythms in humans revealed that under some conditions, rhythms oscillated at different periods within the same individuals and led to the conclusion 30 years ago that the human circadian system was composed of multiple oscillators organized hierarchically; this inference has recently been confirmed using molecular techniques in species ranging from unicellular marine organisms to mammals. Although humans were once thought to be insensitive to the resetting effects of light, light is now recognized as the principal circadian synchronizer in humans, capable of eliciting weak (Type 1) or strong (Type 0) resetting, depending on stimulus strength and timing. Realization that circadian photoreception could be maintained in the absence of sight was first recognized in blind humans, as was the property of adaptation of the sensitivity of circadian photoreception to prior light history. In sighted humans, the intrinsic circadian period is very tightly distributed around approximately 24.2 hours and exhibits aftereffects of prior entrainment. Phase angle of entrainment is dependent on circadian period, at least in young adults. Circadian pacemakers in humans drive daily variations in many physiologic and behavioral variables, including circadian rhythms in alertness and sleep propensity. Under entrained conditions, these rhythms interact with homeostatic regulation of the sleep/wake cycle to determine the ability to sustain vigilance during the day and to sleep at night. Quantitative understanding of the fundamental properties of the multioscillator circadian system in humans and their interaction with sleep/wake homeostasis has many applications to health and disease, including the development of treatments for circadian rhythm and sleep disorders.