Functional anatomy of the sleep-wakefulness cycle: wakefulness.

Sleep is a necessary, diverse, periodic, and an active condition circadian and homeostatically regulated and precisely meshed with waking time into the sleep-wakefulness cycle (SWC). Photic retinal stimulation modulates the suprachiasmatic nucleus, which acts as the pacemaker for SWC rhythmicity. Both the light period and social cues adjust the internal clock, making the SWC a circadian, 24-h period in the adult human. Bioelectrical and behavioral parameters characterize the different phases of the SWC. For a long time, lesions and electrical stimulation of brain structures, as well as connection studies, were the main methods used to decipher the foundations of the functional anatomy of the SWC. That is why the first section of this review presents these early historical studies to then discuss the current state of our knowledge based on our understanding of the functional anatomy of the structures underlying the SWC. Supported by this description, we then present a detailed review and update of the structures involved in the phase of wakefulness (W), including their morphological, functional, and chemical characteristics, as well as their anatomical connections. The structures for W generation are known as the "ascending reticular activating system", and they keep and maintain the "thalamo-cerebral cortex unit" awake. This system originates from the neuronal groups located within the brainstem, hypothalamus, and basal forebrain, which use known neurotransmitters and whose neurons are more active during W than during the other SWC states. Thus, synergies among several of these neurotransmitters are necessary to generate the cortical and thalamic activation that is characteristic of the W state, with all the plastic qualities and nuances present in its different behavioral circumstances. Each one of the neurotransmitters exerts powerful influences on the information and cognitive processes as well as attentional, emotional, motivational, behavioral, and arousal states. The awake "thalamo-cerebral cortex unit" controls and adjusts the activation pattern through a top-down action on the subcortical cellular groups that are the origin of the "ascending reticular activating system".