SummarySleep is the most conspicuous alteration of cerebral function during the circadian rhythm. It is composed of a cyclic sequence of stages defined on the basis of electrophysiological parameters. The underlying functional activity of the human brain is reflected by sleep correlated changes of cerebral blood flow (CBF), CBF velocity and cerebral metabolism (CM). Transcranial Doppler sonography (TCD) allows to analyze the rapid adaptation processes of cerebral hemodynamics due to TCD capabilities for high temporal resolution and continuous recording during sleep using modern ultrasonic probes with special fixation devices. After the onset of sleep there is a significant progressive reduction of CBF velocity from the waking state to slow wave sleep. The beginning of REM sleep is accompanied by a marked increase in CBF velocity. Furthermore, TCD enables the assessment of perfusion changes in pathological sleep conditions. In sleep apnea syndrome an apnea-associated increase in CBF velocity occurs, which is attributed to apnea-related hypercapnia, whereas a rapid normalization of flow velocity occurs at the end of each apneic episode. TCD is a useful method for long-term and on-line monitoring of dynamic changes in cerebral perfusion during normal sleep and in sleep disorders.