The importance of an appropriate combination of excitability for the higher (neocortex, basal ganglia, and limbic system) and lower (brainstem–spinal cord) motor systems could be necessary for normal behavior during wakefulness and REM sleep. Neurotransmitters such as acetylcholine, the monoamines, GABA, and the orexins regulate the background excitability of the higher and lower motor systems so that an interaction of these systems can be appropriately maintained. Pathophysiological mechanisms of sleep deficiency may be induced, not only by an organic disturbance of brain structures (hardware), but also by dysfunctioning of the neurotransmitter systems (software). From these considerations, this review provides a hypothetical model for "state-dependent interaction of the higher and lower motor systems" for understanding normal behavior and pathophysiological mechanisms of sleep-related disorders such as narcolepsy and the REM-sleep behavioral syndrome.
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The definitive version is available at www.blackwell-synergy.com
