Electroencephalographic sleep inertia of the awakening brain

Sleep inertia (SI) denotes a period of hypovigilance, confusion and impaired cognitive and behavioral performance that immediately follows awakening. Based on the observation that the reactivation of some cortical areas is faster than other upon awakening, here we examined regional differences between presleep and postsleep waking period. Moreover, we also compared rapid eye movements (REM) and stage 2 non-rapid eye movements (NREM) awakenings in a within-subject design. Presleep and postsleep waking electroencephalogram (EEG; 5 min with eyes-closed and 5 min with eyes-open) of 18 healthy subjects (12 males, mean age=23.8±2.3 years) were recorded from 19 derivations. Participants slept for two consecutive nights in the laboratory. In one night they were awakened from stage 2 NREM, while in the other from REM sleep. EEG power spectra were calculated across the following bands: delta (1-4 Hz), theta (5-7 Hz), alpha (8-12 Hz), beta-1 (13-16 Hz) and beta-2 (17-24 Hz). Moreover, a detailed hertz-by-hertz analysis has been repeated in the 2-4 Hz frequency range. Postsleep wakefulness, compared to presleep, is characterized by a generalized decrease of higher beta-1 and beta-2 EEG power over almost all scalp locations. A detailed analysis of topographical modifications in the low-frequency range showed that postsleep wakefulness is characterized by an increased delta activity in the posterior scalp locations, and by a concomitant frontal decrease compared to presleep. Moreover, it was found a prevalence of EEG power in the high frequency ranges (beta-1 and beta-2) upon awakening from stage 2 compared to REM awakenings over the left anterior derivations. Altogether these findings support the hypothesis that a generalized reduction in beta activity and increased delta activity in more posterior areas upon awakening may represent the EEG substratum of the sleep inertia phenomenon.