The central medial thalamus is located in the common pathway of the ascending activation system and the descending facilitation pathway, and has extensive projective connections with the cortical and sub-cortical nuclei. The increasing evidence indicated that the central medial thalamus may play an important regulatory role in sleep, anesthesia and awakening. By summarizing the relevant experimental results in recent years, this review was to introduce the projective relationship and functional classification of the central medial thalamus, to highlight the regulatory role and mechanism of the thalamic central median nucleus in sleep, anesthesia and awakening, and to briefly introduce its application in promoting the transformation from vegetative state to wakefulness. We finally suggested that the central medial thalamus may be the key nucleus in maintaining the wakefulness and mediating the transition from wake state to sleep and anesthesia state.