Sleep deprivation, also known as sleep insufficiency or sleeplessness, is the condition of not having adequate duration and/or quality of
sleep
Sleep is a sedentary state of mind and body. It is characterized by altered consciousness, relatively inhibited sensory activity, reduced muscle activity and reduced interactions with surroundings. It is distinguished from wakefulness by a de ...
to support decent alertness, performance, and health. It can be either
chronic or
acute
Acute may refer to:
Science and technology
* Acute angle
** Acute triangle
** Acute, a leaf shape in the glossary of leaf morphology
* Acute (medicine), a disease that it is of short duration and of recent onset.
** Acute toxicity, the adverse eff ...
and may vary widely in severity.
Acute sleep deprivation is when an individual sleeps less than usual or does not sleep at all for a short period of time – usually lasting one to two days. Chronic sleep deprivation means when an individual routinely sleeps less than an optimal amount for ideal functioning. Chronic sleep deficiency is often confused with the term
insomnia
Insomnia, also known as sleeplessness, is a sleep disorder in which people have trouble sleeping. They may have difficulty falling asleep, or staying asleep as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, ...
. Although both chronic sleep deficiency and insomnia share decreased quantity and/or quality of sleep as well as impaired function, their difference lies in the ability to fall asleep. Sleep deprived individuals are able to fall asleep rapidly when allowed but those with insomnia have difficulty falling asleep.
The average adult needs seven or more hours of sleep per night to maintain health. The amount of sleep needed can depend on sleep quality, age, pregnancy, and level of sleep deprivation. Insufficient sleep has been linked to weight gain, high blood pressure, diabetes, depression, heart disease, and strokes. Sleep deprivation can also lead to high anxiety, irritability, erratic behavior, poor cognitive functioning and performance, and psychotic episodes.
A chronic sleep-restricted state adversely
affects the brain and cognitive function.
However, in a subset of cases, sleep deprivation can paradoxically lead to increased energy and alertness and enhanced mood; although its long-term consequences have never been evaluated, sleep deprivation has even been used as a
treatment for depression.
Few studies have compared the effects of acute total sleep deprivation and chronic partial sleep restriction.
A complete absence of sleep over a long period is not frequent in humans (unless they have
fatal insomnia
Fatal insomnia is an extremely rare genetic (and even more rarely, sporadic) disorder that results in trouble sleeping as its hallmark symptom. The problems with sleeping typically start out gradually and worsen over time. Eventually, the patien ...
or specific issues caused by surgery); it appears that brief
microsleep
A microsleep is a sudden temporary episode of sleep or drowsiness which may last for a few seconds where an individual fails to respond to some arbitrary sensory input and becomes unconscious.International Classification of Sleep Disorders, , pa ...
s cannot be avoided. Long-term total sleep deprivation has caused death in lab animals.
Causes
Insomnia
Insomnia
Insomnia, also known as sleeplessness, is a sleep disorder in which people have trouble sleeping. They may have difficulty falling asleep, or staying asleep as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, ...
, one of the six types of
dyssomnia
Dyssomnias are a broad classification of sleeping disorders involving difficulty getting to sleep, remaining asleep, or of excessive sleepiness.
Dyssomnias are primary disorders of initiating or maintaining sleep or of excessive sleepiness and ar ...
, affects 21–37% of the adult population.
Many of its symptoms are easily recognizable, including
excessive daytime sleepiness
Excessive daytime sleepiness (EDS) is characterized by persistent sleepiness and often a general lack of energy, even during the day after apparently adequate or even prolonged nighttime sleep. EDS can be considered as a broad condition encompass ...
; frustration or worry about sleep; problems with attention, concentration, or memory; extreme mood changes or irritability; lack of energy or motivation; poor performance at school or work; and tension headaches or stomach aches.
Insomnia can be grouped into primary and secondary, or
comorbid
In medicine, comorbidity - from Latin morbus ("sickness"), co ("together"), -ity (as if - several sicknesses together) - is the presence of one or more additional conditions often co-occurring (that is, concomitant or concurrent) with a primary ...
, insomnia.
Primary insomnia is a
sleep disorder
A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are test ...
not attributable to a medical, psychiatric, or environmental cause. There are three main types of primary insomnia. These include: psychophysiological, idiopathic insomnia, and
sleep state misperception
Sleep state misperception (SSM) is a term in the International Classification of Sleep Disorders (ICSD) most commonly used for people who mistakenly perceive their sleep as wakefulness,Minecan, Daniela, and Antonio Culebras. http://www.medlink.com ...
(paradoxical insomnia).
Psychophysiological insomnia is anxiety-induced. Idiopathic insomnia generally begins in childhood and lasts the rest of a person's life. It's suggested that idiopathic insomnia is a neurochemical problem in a part of the brain that controls the sleep-wake cycle, resulting in either under-active sleep signals or over-active wake signals. Sleep state misperception is diagnosed when people get enough sleep but inaccurately perceive that their sleep is insufficient.
Secondary insomnia, or comorbid insomnia, occurs concurrently with other medical, neurological, psychological and psychiatric conditions. Causation is not necessarily implied.
Sleep is known to be cumulative. This means that the fatigue and sleep one lost as a result, for example, staying awake all night, would be carried over to the following day. Not getting enough sleep a couple days cumulatively builds up a deficiency and that's when all the symptoms of sleep deprivation come in. A well rested and healthy individual will generally spend less time in the REM stage of sleep. Studies have shown an inverse relationship between time spent in the REM stage of sleep and subsequent wakefulness during waking hours.
Sleep apnea
Sleep apnea is a serious disorder that has symptoms of both insomnia and sleep deprivation, among other symptoms like excessive daytime sleepiness, abrupt awakenings, difficulty concentrating, etc.
Obstructive
sleep apnea
Sleep apnea, also spelled sleep apnoea, is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal. Each pause can last for a few seconds to a few minutes and they happen many times ...
is often caused by collapse of the upper airway during sleep, which reduces airflow to the lungs. Those with sleep apnea may experience symptoms such as awakening gasping or
choking
Choking, also known as foreign body airway obstruction (FBAO), is a phenomenon that occurs when breathing is impeded by a blockage inside of the respiratory tract. An obstruction that prevents oxygen from entering the lungs results in oxygen dep ...
, restless sleep, morning headaches, morning confusion or irritability and restlessness. This disorder affects between 1 and 10 percent of Americans. It has many serious health outcomes if untreated.
Positive airway pressure
Positive airway pressure (PAP) is a mode of respiratory ventilation used in the treatment of sleep apnea. PAP ventilation is also commonly used for those who are critically ill in hospital with respiratory failure, in newborn infants (neonates), ...
therapy using a CPAP (
Continuous positive airway pressure
Continuous positive airway pressure (CPAP) is a form of positive airway pressure (PAP) ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person. The ap ...
), APAP or BPAP devices is considered to be the first line treatment option for sleep apnea. Mandibular displacement devices in some cases can reposition the jaw and tongue to prevent the airway from collapsing. For some patients supplemental oxygen therapy may be indicated. Nasal problems such as a deviated septum will shut down the airway and increase swelling in the mucus lining and nasal turbinates. Corrective surgery (
septoplasty
Septoplasty sɛp.toˌplæ.sti(Etymology: L, saeptum, septum; Gk, πλάσσειν plassein – to shape), or alternatively submucous septal resection and septal reconstruction, is a corrective surgical procedure done to straighten a deviated ...
) in some cases may be an appropriate choice of treatment.
Central
sleep apnea
Sleep apnea, also spelled sleep apnoea, is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal. Each pause can last for a few seconds to a few minutes and they happen many times ...
is caused by a failure of the central nervous system to signal the body to breathe during sleep. Treatments similar to obstructive sleep apnea may be used as well as other treatments such as Adaptive Servo Ventilation and certain medications. Some medications such as opioids may contribute to or cause central sleep apnea.
Voluntary
Sleep deprivation can sometimes be self-imposed due to a lack of desire to sleep or the habitual use of
stimulant
Stimulants (also often referred to as psychostimulants or colloquially as uppers) is an overarching term that covers many drugs including those that increase activity of the central nervous system and the body, drugs that are pleasurable and inv ...
drugs. Sleep deprivation is also self-imposed to achieve personal fame in the context of
record-breaking stunts.
Mental illness
The specific causal relationships between sleep loss and effects on psychiatric disorders have been most extensively studied in patients with mood disorders. Shifts into mania in bipolar patients are often preceded by periods of
insomnia
Insomnia, also known as sleeplessness, is a sleep disorder in which people have trouble sleeping. They may have difficulty falling asleep, or staying asleep as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, ...
, and sleep deprivation has been shown to induce a manic state in about 30% of patients. Sleep deprivation may represent a final common pathway in the genesis of mania, and manic patients usually have a continuous reduced need for sleep.
Chronic sleep problems affect 50% to 80% of patients in a typical psychiatric practice, compared with 10% to 18% of adults in the general U.S. population. Sleep problems are particularly common in patients with anxiety, depression, bipolar disorder, and attention deficit hyperactivity disorder (ADHD).
The symptoms of sleep deprivation and those of
schizophrenia
Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
are paralleled, including those of positive and cognitive symptoms.
School
The
National Sleep Foundation
The National Sleep Foundation (NSF) is an American non-profit, charitable organization. Founded in 1990, it's stated goal is to provide expert information on health-related issues concerning sleep.
Research NSF Sleep Duration Recommendations
...
cites a 1996 paper showing that college/university-aged students got an average of less than 6 hours of sleep each night. A 2018 study highlights the need for a good night's sleep for students finding that college students who averaged eight hours of sleep for the five nights of finals week scored higher on their final exams than those who didn't.
In the study, 70.6% of students reported obtaining less than 8 hours of sleep, and up to 27% of students may be at risk for at least one sleep disorder. Sleep deprivation is common in first year college students as they adjust to the stress and social activities of college life.
Estevan, et al, studied the relationships between sleep and test performance. They found that students tend to sleep less than usual the night before an exam, and that exam performance was positively correlated with sleep duration.
A study performed by the Department of Psychology at the
National Chung Cheng University
National Chung Cheng University (CCU; ) is a national university in Minxiong Township, Chiayi County, Taiwan. CCU is a member of the Association to Advance Collegiate Schools of Business.
History
National Chung Cheng University was the first ...
in Taiwan concluded that freshmen received the least amount of sleep during the week.
Studies of later start times in schools have consistently reported benefits to adolescent sleep, health and learning using a wide variety of methodological approaches. In contrast, there are no studies showing that early start times have any positive impact on sleep, health or learning. Data from international studies demonstrate that "synchronised" start times for adolescents are far later than the start times in the overwhelming majority of educational institutions. In 1997,
University of Minnesota
The University of Minnesota, formally the University of Minnesota, Twin Cities, (UMN Twin Cities, the U of M, or Minnesota) is a public university, public Land-grant university, land-grant research university in the Minneapolis–Saint Paul, Tw ...
research compared students who started school at 7:15 am with those who started at 8:40 am. They found that students who started at 8:40 got higher grades and more sleep on weekday nights than those who started earlier.
One in four U.S. high school students admits to falling asleep in class at least once a week.
It is known that during human adolescence,
circadian rhythm
A circadian rhythm (), or circadian cycle, is a natural, internal process that regulates the sleep–wake cycle and repeats roughly every 24 hours. It can refer to any process that originates within an organism (i.e., Endogeny (biology), endogeno ...
s and therefore sleep patterns typically undergo marked changes.
Electroencephalogram
Electroencephalography (EEG) is a method to record an electrogram of the spontaneous electrical activity of the brain. The biosignals detected by EEG have been shown to represent the postsynaptic potentials of pyramidal neurons in the neocortex ...
(EEG) studies indicate a 50% reduction of deep (stage 4) sleep and a 75% reduction in the peak amplitude of delta waves during NREM sleep in adolescence. School schedules are often incompatible with a corresponding delay in sleep offset, leading to a less than optimal amount of sleep for the majority of adolescents.
Caffeine
Consumption of
caffeine
Caffeine is a central nervous system (CNS) stimulant of the methylxanthine class. It is mainly used recreationally as a cognitive enhancer, increasing alertness and attentional performance. Caffeine acts by blocking binding of adenosine t ...
in large quantities can have negative effects on one's sleep cycle.
While there are short-term performance benefits to caffeine consumption, overuse can lead to insomnia symptoms or worsen pre-existing insomnia. Consuming caffeine to stay awake at night may lead to sleeplessness, anxiety, frequent nighttime awakenings, and overall poorer sleep quality.
Hospital stay
A study performed nationwide in the Netherlands found that general ward patients staying at the hospital experienced shorter total sleep (83 min. less), more night-time awakenings, and earlier awakenings compared to sleeping at home. Over 70% experienced being woken up by external causes, such as hospital staff (35.8%). Sleep disturbing factors included noise of other patients, medical devices, pain, and toilet visits. Sleep deprivation is even more severe in ICU patients, where the naturally occurring nocturnal peak of melatonin secretion was found to be absent, possibly causing the disruption in the normal sleep-wake cycle. However, as the personal characteristics and the clinical picture of hospital patients are so diverse, the possible solutions to improve sleep and circadian rhythmicity should be tailored to the individual and within the possibilities of the hospital ward. Multiple interventions could be considered to aid patient characteristics, improve hospital routines, or the hospital environment.
Internet
A study published in the
Journal of Economic Behavior and Organisation found out that broadband internet connection was associated with sleep deprivation. The study concluded that the people with a broadband connection tend to sleep 25 minutes less than those without the broadband connection, hence they are less likely to get the scientifically recommended 7–9 hours of sleep. Another study conducted on 435 non-medical staff at
King Saud University
King Saud University (KSU, ar, جامعة الملك سعود) is a public university in Riyadh, Saudi Arabia. Established in 1957 by King Saud bin Abdulaziz to address the country's skilled worker shortage, it is the first university in the K ...
Medical City reported that 9 out of 10 of the respondents used their smartphones at bedtime, with social media being the most used service (80.5%). The study found participants who spent more than 60 minutes using their smartphones at bedtime were 7.4 times more likely to have poor sleep quality than participants who spent less than 15 minutes.
Effects and consequences
Brain
One study suggested, based on neuroimaging, that 35 hours of total sleep deprivation in healthy controls negatively affected the brain's ability to put an emotional event into the proper perspective and make a controlled, suitable response to the event.
The negative effects of sleep deprivation on alertness and cognitive performance suggest decreases in brain activity and function. These changes primarily occur in two regions: the
thalamus
The thalamus (from Greek θάλαμος, "chamber") is a large mass of gray matter located in the dorsal part of the diencephalon (a division of the forebrain). Nerve fibers project out of the thalamus to the cerebral cortex in all directions, ...
, a structure involved in alertness and attention; and the
prefrontal cortex
In mammalian brain anatomy, the prefrontal cortex (PFC) covers the front part of the frontal lobe of the cerebral cortex. The PFC contains the Brodmann areas BA8, BA9, BA10, BA11, BA12, BA13, BA14, BA24, BA25, BA32, BA44, BA45, BA46, ...
, a region sub-serving alertness, attention, and higher-order cognitive processes.
This was the finding of an American study in 2000. Seventeen men in their 20s were tested. Sleep deprivation was progressive with measurements of glucose (absolute regional CMRglu), cognitive performance, alertness, mood, and subjective experiences collected after 0, 24, 48, and 72 hours of sleep deprivation. Additional measures of alertness, cognitive performance, and mood were collected at fixed intervals.
PET
A pet, or companion animal, is an animal kept primarily for a person's company or entertainment rather than as a working animal, livestock, or a laboratory animal. Popular pets are often considered to have attractive appearances, intelligence ...
scans were used and attention was paid to the circadian rhythm of cognitive performance.
Interestingly, the effects of sleep deprivation appear to be constant across "night owls" and "early birds", or different sleep chronotypes, as revealed by
fMRI
Functional magnetic resonance imaging or functional MRI (fMRI) measures brain activity by detecting changes associated with blood flow. This technique relies on the fact that cerebral blood flow and neuronal activation are coupled. When an area o ...
and
graph theory
In mathematics, graph theory is the study of ''graphs'', which are mathematical structures used to model pairwise relations between objects. A graph in this context is made up of '' vertices'' (also called ''nodes'' or ''points'') which are conne ...
.
A noted 2002 University of California animal study indicated that
non-rapid eye movement sleep
Non-rapid eye movement sleep (NREM), also known as quiescent sleep, is, collectively, sleep stages 1–3, previously known as stages 1–4. Rapid eye movement sleep (REM) is not included. There are distinct electroencephalographic and other cha ...
(NREM) is necessary for turning off
neurotransmitter
A neurotransmitter is a signaling molecule secreted by a neuron to affect another cell across a synapse. The cell receiving the signal, any main body part or target cell, may be another neuron, but could also be a gland or muscle cell.
Neuro ...
s and allowing their receptors to "rest" and regain sensitivity which allows monoamines (norepinephrine,
serotonin
Serotonin () or 5-hydroxytryptamine (5-HT) is a monoamine neurotransmitter. Its biological function is complex and multifaceted, modulating mood, cognition, reward, learning, memory, and numerous physiological processes such as vomiting and vas ...
and histamine) to be effective at naturally produced levels. This leads to improved regulation of mood and increased learning ability. The study also found that
rapid eye movement sleep
Rapid eye movement sleep (REM sleep or REMS) is a unique phase of sleep in mammals and birds, characterized by random rapid movement of the eyes, accompanied by low muscle tone throughout the body, and the propensity of the sleeper to dream ...
(REM) deprivation may alleviate
clinical depression
Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introdu ...
because it mimics
selective serotonin reuptake inhibitors
Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions.
SSRIs increase the extracell ...
(SSRIs). This is because the natural decrease in monoamines during REM is not allowed to occur, which causes the concentration of neurotransmitters in the brain, that are depleted in clinically depressed persons, to increase. Sleep outside of the REM phase may allow enzymes to repair brain cell damage caused by
free radicals
In chemistry, a radical, also known as a free radical, is an atom, molecule, or ion that has at least one unpaired valence electron.
With some exceptions, these unpaired electrons make radicals highly chemically reactive. Many radicals spont ...
. High metabolic activity while awake damages the enzymes themselves preventing efficient repair. This study observed the first evidence of brain damage in rats as a direct result of sleep deprivation.
Attention and working memory
Among the possible physical consequences of sleep deprivation, deficits in attention and working memory are perhaps the most important;
such lapses in mundane routines can lead to unfortunate results, from forgetting ingredients while cooking to missing a sentence while taking notes. Performing tasks that require attention appears to be correlated with number of hours of sleep received each night, declining as a function of hours of sleep deprivation. Working memory is tested by methods such as choice-reaction time tasks.
The attentional lapses also extend into more critical domains in which the consequences can be life-or-death; car crashes and industrial disasters can result from inattentiveness attributable to sleep deprivation. To empirically measure the magnitude of attention deficits, researchers typically employ the
psychomotor vigilance task
A psychomotor vigilance task (PVT) is a sustained-attention, reaction-timed task that measures the consistency with which subjects respond to a visual stimulus. Research indicates increased sleep debt or sleep deficit correlates with deteriorat ...
(PVT) which requires the subject to press a button in response to a light at random intervals. Failure to press the button in response to the stimulus (light) is recorded as an error, attributable to the microsleeps that occur as a product of sleep deprivation.
Crucially, individuals' subjective evaluations of their fatigue often do not predict actual performance on the PVT. While totally sleep-deprived individuals are usually aware of the degree of their impairment, lapses from chronic (lesser) sleep deprivation can build up over time so that they are equal in number and severity to the lapses occurring from total (acute) sleep deprivation. Chronically sleep-deprived people, however, continue to rate themselves considerably less impaired than totally sleep-deprived participants.
Since people usually evaluate their capability on tasks like driving subjectively, their evaluations may lead them to the false conclusion that they can perform tasks that require constant attention when their abilities are in fact impaired.
Mood
Sleep deprivation can have a negative impact on mood. Staying up all night or taking an unexpected night shift can make one feel irritable. Once one catches up on sleep, one's mood will often return to baseline or normal. Even partial sleep deprivation can have a significant impact on mood. In one study, subjects reported increased sleepiness, fatigue, confusion, tension, and total mood disturbance, which all recovered to their baseline after one to two full nights of sleep.
Depression and sleep are in a bidirectional relationship. Poor sleep can lead to development of depression and depression can cause
insomnia
Insomnia, also known as sleeplessness, is a sleep disorder in which people have trouble sleeping. They may have difficulty falling asleep, or staying asleep as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, ...
,
hypersomnia
Hypersomnia is a neurological disorder of excessive time spent sleeping or excessive sleepiness. It can have many possible causes (such as seasonal affective disorder) and can cause distress and problems with functioning. In the fifth edition ...
, or
obstructive sleep apnea. About 75% of adult patients with depression can present insomnia. Sleep deprivation, whether total or not, can induce significant anxiety and longer sleep deprivations tend to result in increased level of anxiety.
Sleep deprivation has also shown some positive effects on mood, and can be used to treat depression.
Chronotype can affect how sleep deprivation influences mood. Those with morningness (advanced sleep period or "lark") preference become more depressed after sleep deprivation while those with eveningness (delayed sleep period or "owl") preference show an improvement in mood.
Mood and mental states can affect sleep as well. Increased agitation and arousal from anxiety or stress can keep one more aroused, awake, and alert.
Driving ability
The dangers of sleep deprivation are apparent on the road; the
American Academy of Sleep Medicine (AASM) reports that one in every five serious motor vehicle injuries is related to driver fatigue, with 80,000 drivers falling asleep behind the wheel every day and 250,000 accidents every year related to sleep,
though the National Highway Traffic Safety Administration suggests the figure for
traffic accidents may be closer to 100,000.
The AASM recommends pulling off the road and taking a 15- or 20-minute nap to alleviate drowsiness.
According to a 2000 study published in the ''
British Medical Journal
''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...
'', researchers in Australia and New Zealand reported that sleep deprivation can have some of the same hazardous effects as being drunk.
People who drove after being awake for 17–19 hours performed worse than those with a blood alcohol level of 0.05 percent, which is the legal limit for drunk driving in most western European countries and Australia. Another study suggested that performance begins to degrade after 16 hours awake, and 21 hours awake was equivalent to a blood alcohol content of 0.08 percent, which is the
blood alcohol limit
Blood alcohol content (BAC), also called blood alcohol concentration or blood alcohol level, is a measurement of alcohol intoxication used for legal or medical purposes; it is expressed as mass of alcohol per volume or mass of blood. For exampl ...
for drunk driving in Canada, the U.S., and the U.K.
Fatigue of drivers of goods trucks and passenger vehicles have come to the attention of authorities in many countries, where specific laws have been introduced with the aim of reducing the risk of traffic accidents due to driver fatigue. Rules concerning minimum break lengths, maximum shift lengths and minimum time between shifts are common in the driving regulations used in different countries and regions, such as the
drivers' working hours
Drivers' working hours is the commonly used term for regulations that govern the activities of the drivers of commercial goods vehicles and passenger carrying vehicles. In the United States, they are known as hours of service.
Within the Europ ...
regulations in the European Union and
hours of service
Hours of Service (HOS) regulations are issued by the Federal Motor Carrier Safety Administration (FMCSA) and govern the working hours of anyone operating a commercial motor vehicle (CMV) in the United States. These regulations apply to truck dr ...
regulations in the United States.
The
Exxon Valdez Oil Spill was the second largest oil spill in the United States. This accident occurred when an Exxon oil tanker struck a reef at the Prince William Sound in Alaska. Approximately 10.8 million gallons of oil spilled into the sea. The accident caused great environmental damage including the death of hundreds of thousands of birds and sea creatures. Fatigue and sleep deprivation were the major contributors to the accident. The captain of the ship was asleep after a night of heavy drinking; he was severely fatigued and had been awake for 18 hours. The entire crew was suffering from fatigue and inadequate sleep.
Sleep transition
Sleep propensity (SP) can be defined as the readiness to transit from wakefulness to sleep, or the ability to stay asleep if already sleeping. Sleep deprivation increases this propensity, which can be measured by polysomnography (PSG), as a reduction in sleep latency (the time needed to fall asleep).
An indicator of sleep propensity can also be seen in the shortening of transition from light stages of non-REM sleep to deeper slow-waves oscillations can also be measured as indicator of sleep propensity.
On average, the latency in healthy adults decreases by a few minutes after a night without sleep, and the latency from sleep onset to slow-wave sleep is halved.
Sleep latency is generally measured with the multiple sleep latency test (MSLT). In contrast, the maintenance of wakefulness test (MWT) also uses sleep latency, but this time as a measure of the capacity of the participants to stay awake (when asked to) instead of falling asleep.
Sleep-wake cycle
People aged 18 to 64 need seven to nine hours of sleep per night. Research studying sleep deprivation shows its impact on mood, cognitive and motor functioning, due to dysregulation of the sleep-wake cycle and augmented sleep propensity.
Multiple studies that identified the role of the hypothalamus and multiple neural systems controlling circadian rhythms and homeostasis have been helpful in understanding sleep deprivation better.
To describe the temporal course of the sleep-wake cycle, the two-process model of sleep regulation can be mentioned.
This model proposes a homeostatic process (Process S) and a circadian process (Process C) that interact to define the time and intensity of sleep.
Process S represents the drive for sleep, increasing during wakefulness and decreasing during sleep, until a defined threshold level, while Process C is the oscillator responsible for these levels. When being sleep deprived, homeostatic pressure accumulates to the point that waking functions will be degraded even at the highest circadian drive for wakefulness.
Microsleeps
Microsleep
A microsleep is a sudden temporary episode of sleep or drowsiness which may last for a few seconds where an individual fails to respond to some arbitrary sensory input and becomes unconscious.International Classification of Sleep Disorders, , pa ...
s are periods of brief sleep that most frequently occur when a person has a significant level of sleep deprivation. Microsleeps usually last for a few seconds, usually no longer than 15 seconds, and happen most frequently when a person is trying to stay awake when they are feeling sleepy. The person usually falls into microsleep while doing a monotonous task like driving, reading a book, or staring at a
computer
A computer is a machine that can be programmed to Execution (computing), carry out sequences of arithmetic or logical operations (computation) automatically. Modern digital electronic computers can perform generic sets of operations known as C ...
. Microsleeps are similar to
blackouts and a person experiencing them is not consciously aware that they are occurring.
An even lighter type of sleep has been seen in rats that have been kept awake for long periods of time. In a process known as
local sleep, specific localized brain regions went into periods of short (~80 ms) but frequent (~40/min) NREM-like states. Despite the on and off periods where neurons shut off, the rats appeared to be awake, although they performed poorly at tests.
Cardiovascular morbidity
Decreased sleep duration is associated with many adverse cardiovascular consequences. The
American Heart Association
The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate cardiac care in an effort to reduce disability and death ...
has stated that sleep restriction is a risk factor for adverse cardiometabolic profiles and outcomes. The organization recommends healthy sleep habits for ideal cardiac health along with other well known factors like blood pressure, cholesterol, diet, glucose, weight, smoking, and physical activity. The
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
has noted that adults who sleep less than 7 hours per day are more likely to have chronic health conditions including heart attack, coronary heart disease, and stroke compared to those with adequate amount of sleep.
In a study that followed over 160,000 healthy, non-obese adults, the subjects who self-reported sleep duration less than 6 hours a day were at an increased risk for developing multiple cardiometabolic risk factors. They presented with increased central obesity, elevated fasting glucose, hypertension, low high-density lipoprotein, hypertriglyceridemia, and metabolic syndrome. The presence or lack of insomnia symptoms did not modify the effects of sleep duration in this study.
The United Kingdom Biobank studied nearly 500,000 adults who had no cardiovascular disease, and the subjects who slept less than 6 hours a day were associated with a 20 percent increase in the risk of developing myocardial infarction (MI) over 7 years of follow-up period. Interestingly, long sleep duration of more than 9 hours a night was also a risk factor.
Immunosuppression
Among the myriad of health consequences that sleep deprivation can cause, disruption of the immune system is one of them. While it is not clearly understood, researchers believe that sleep is essential to providing sufficient energy for the immune system to work and allow inflammation to take place during sleep. Also, just as sleep can reinforce memory in a person's brain, it can help consolidate the memory of the immune system or
adaptive immunity
The adaptive immune system, also known as the acquired immune system, is a subsystem of the immune system that is composed of specialized, systemic cells and processes that eliminate pathogens or prevent their growth. The acquired immune system ...
.
An adequate amount of sleep improves effects of vaccines that utilize adaptive immunity. When vaccines expose the body to a weakened or deactivated antigen, the body initiates an immune response. The immune system learns to recognize that antigen and attacks it when exposed again in the future. Studies have found that people who don't sleep the night after getting a vaccine were less likely to develop a proper immune response to the vaccine and sometimes even required a second dose. People who are sleep deprived in general also do not provide their bodies with sufficient time for an adequate immunological memory to form, and thus, can fail to benefit from vaccination.
People who sleep less than 6 hours a night are more prone to infection and are more likely to catch a cold or flu. A lack of sleep can also prolong the recovery time in patients in intensive care unit (ICU).
Weight gain
A lack of sleep can cause an imbalance in several hormones that are critical in weight gain. Sleep deprivation increases the level of ghrelin (hunger hormone) and decreases the level of leptin (fullness hormone), resulting in an increased feeling of hunger and desire for high-calorie foods.
Sleep loss is also associated with decreased growth hormone and elevated cortisol levels, which are connected to obesity. People who do not get sufficient sleep can also feel sleepy and fatigued during the day and get less exercise. Obesity can cause poor sleep quality as well. Individuals who are overweight or obese can experience obstructive sleep apnea, gastroesophageal reflux disease (GERD), depression, asthma, and osteoarthritis which all can disrupt a good night's sleep.
In rats, prolonged, complete sleep deprivation increased both food intake and energy expenditure with a net effect of weight loss and ultimately death. This study hypothesizes that the moderate chronic
sleep debt
Sleep debt or sleep deficit is the cumulative effect of not getting enough sleep. A large sleep debt may lead to mental or physical fatigue, and can adversely affect one's mood, energy and ability to think clearly.
There are two kinds of sleep ...
associated with habitual short sleep is associated with increased appetite and energy expenditure with the equation tipped towards food intake rather than expenditure in societies where high-calorie food is freely available.
Type 2 diabetes
It has been suggested that people experiencing short-term sleep restrictions process glucose more slowly than individuals receiving a full 8 hours of sleep, increasing the likelihood of developing type 2
diabetes
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...
. Poor sleep quality is linked to high blood sugar levels in diabetic and prediabetic patients but the causal relationship is not clearly understood. Researchers suspect that sleep deprivation affects insulin, cortisol, and oxidative stress, which subsequently influence blood sugar levels. Sleep deprivation can increase the level of
ghrelin
Ghrelin (; or lenomorelin, INN) is a hormone produced by enteroendocrine cells of the gastrointestinal tract, especially the stomach, and is often called a "hunger hormone" because it increases the drive to eat. Blood levels of ghrelin are hi ...
and decrease the level of
leptin
Leptin (from Ancient Greek, Greek λεπτός ''leptos'', "thin" or "light" or "small") is a hormone predominantly made by adipose cells and enterocytes in the small intestine that helps to regulate Energy homeostasis, energy balance by inhib ...
. People who get insufficient amount of sleep are more likely to crave food in order to compensate for the lack of energy. This habit can raise blood sugar and put them at risk of
obesity
Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...
and diabetes.
In 2005, a study of over 1400 participants showed that participants who habitually slept few hours were more likely to have associations with
type 2 diabetes
Type 2 diabetes, formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urinatio ...
.
However, because this study was merely correlational, the direction of cause and effect between little sleep and diabetes is uncertain. The authors point to an earlier study which showed that experimental rather than habitual restriction of sleep resulted in
impaired glucose tolerance
Prediabetes is a component of the metabolic syndrome and is characterized by elevated blood sugar levels that fall below the threshold to diagnose diabetes mellitus. It usually does not cause symptoms but people with prediabetes often have obesit ...
(IGT).
Other effects
The National Sleep Foundation identifies several warning signs that a driver is dangerously fatigued. These include rolling down the window, turning up the radio, trouble keeping eyes open, head-nodding, drifting out of their lane, and daydreaming. At particular risk are lone drivers between midnight and 6:00 am.
Sleep deprivation can negatively impact overall performance, and has led to major fatal accidents. Due largely to the February 2009 crash of
Colgan Air Flight 3407
Colgan Air Flight 3407 (marketed as Continental Connection Flight 3407 under a codeshare agreement with Continental Airlines), was a scheduled passenger flight from Newark, New Jersey, to Buffalo, New York, which crashed on February 12, 2009. Th ...
, which killed 50 people and was partially attributed to pilot fatigue, the FAA reviewed its procedures to ensure that pilots are sufficiently rested. Air traffic controllers were under scrutiny when in 2010 there were 10 incidents of controllers falling asleep while on shift. The common practice of turn-around shifts caused sleep deprivation and was a contributing factor to all air traffic control incidents. The FAA reviewed its practices of shift changes and the findings saw that controllers were not well rested.
A 2004 study also found medical residents with less than four hours of sleep a night made more than twice as many errors as the 11% of surveyed residents who slept for more than seven hours a night.
Twenty-four hours of continuous sleep deprivation results in the choice of less difficult math tasks without decreases in subjective reports of effort applied to the task. Naturally caused sleep loss affects the choice of everyday tasks such that low effort tasks are mostly commonly selected.
Adolescents
Adolescence () is a transitional stage of Developmental biology, physical and psychological Human development (biology), development that generally occurs during the period from puberty to adulthood (typically corresponding to the age of majo ...
who experience less sleep show a decreased willingness to engage in sports activities that require effort through fine motor coordination and attention to detail.
Great sleep deprivation mimics psychosis: distorted perceptions can lead to inappropriate emotional and behavioral responses.
Astronauts have reported
performance errors and decreased cognitive ability during periods of extended working hours and wakefulness as well as due to sleep loss caused by circadian rhythm disruption and environmental factors.
One study has found that a single night of sleep deprivation may cause tachycardia, a condition in which the heartrate exceeds 100 beats per minute (in the following day).
Generally, sleep deprivation may facilitate or intensify:
* aching muscles
*
confusion
In medicine, confusion is the quality or state of being bewildered or unclear. The term "acute mental confusion" ,
memory
Memory is the faculty of the mind by which data or information is encoded, stored, and retrieved when needed. It is the retention of information over time for the purpose of influencing future action. If past events could not be remembered, ...
lapses or loss
[National Institute of Neurological Disorders and Stroke – Brain Basics: Understanding Sleep](_blank)
. ninds.nih.gov
*
depression
* development of
false memory
In psychology, a false memory is a phenomenon where someone recalls something that did not happen or recalls it differently from the way it actually happened. Suggestibility, activation of associated information, the incorporation of misinformat ...
*
hypnagogic
Hypnagogia is the experience of the transitional state from wakefulness to sleep: the ''hypnagogic'' state of consciousness, during the onset of sleep. Its opposite state is described as the transitional state from sleep into wakefulness. Menta ...
and
hypnopompic
Hypnopompia (also known as hypnopompic state) is the state of consciousness leading out of sleep, a term coined by the psychical researcher Frederic Myers. Its mirror is the hypnagogic state at sleep onset; though often conflated, the two stat ...
hallucination
A hallucination is a perception in the absence of an external stimulus that has the qualities of a real perception. Hallucinations are vivid, substantial, and are perceived to be located in external objective space. Hallucination is a combinatio ...
s during falling asleep and waking, which are entirely normal
* hand
tremor
*
headaches
Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches.
Headaches can occur as a result of m ...
*
malaise
*
stye
A stye, also known as a hordeolum, is a bacterial infection of an oil gland in the eyelid. This results in a red tender bump at the edge of the eyelid. The outside or the inside of the eyelid can be affected.
The cause of a stye is usually a b ...
*
periorbital puffiness
Periorbital puffiness, also known as puffy eyes, or swelling around the eyes, is the appearance of swelling in the tissues around the eyes, called the orbits. It is almost exclusively caused by fluid buildup around the eyes, or periorbital edema ...
, commonly known as "bags under eyes" or
eye bags
Periorbital puffiness, also known as puffy eyes, or swelling around the eyes, is the appearance of swelling in the tissues around the eyes, called the orbits. It is almost exclusively caused by fluid buildup around the eyes, or periorbital edema ...
* increased
blood pressure
Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...
* increased
stress hormone
Stress hormones are secreted by endocrine glands to modify one's internal environment during times of stress. By performing various functions such as mobilizing energy sources, increasing heart rate, and downregulating metabolic processes which a ...
levels
* increased risk of Type 2
diabetes
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...
* lowering of
immunity
Immunity may refer to:
Medicine
* Immunity (medical), resistance of an organism to infection or disease
* ''Immunity'' (journal), a scientific journal published by Cell Press
Biology
* Immune system
Engineering
* Radiofrequence immunity desc ...
, increased susceptibility to illness
* increased risk of
fibromyalgia
Fibromyalgia (FM) is a medical condition defined by the presence of chronic widespread pain, fatigue, waking unrefreshed, cognitive symptoms, lower abdominal pain or cramps, and depression. Other symptoms include insomnia and a general hyp ...
*
irritability
Irritability (also called as crankiness) is the excitatory ability that living organisms have to respond to changes in their environment. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessi ...
*
nystagmus
Nystagmus is a condition of involuntary (or voluntary, in some cases) eye movement. Infants can be born with it but more commonly acquire it in infancy or later in life. In many cases it may result in reduced or limited vision. Due to the invol ...
(rapid involuntary rhythmic eye movement)
*
obesity
Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...
*
seizures
An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or neural oscillation, synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much o ...
*
temper tantrums in children
* violent behavior
*
yawn
A yawn is a reflex lasting 4-7 seconds, and is characterized by a long inspiratory phase with gradual mouth gaping, followed by a brief climax (or acme) with muscle stretching, and a rapid expiratory phase with muscle relaxation. For fish an ...
ing
*
mania
Mania, also known as manic syndrome, is a mental and behavioral disorder defined as a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together wit ...
*
Sleep inertia
Sleep inertia is a physiological state of impaired cognitive and sensory-motor performance that is present immediately after awakening. It persists during the transition of sleep to wakefulness, where an individual will experience feelings of drows ...
* symptoms similar to:
**
attention-deficit hyperactivity disorder
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inappr ...
(ADHD)
**
psychosis
Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior ...
Assessment
Patients with sleep deprivation may present with complaints of symptoms and signs of insufficient sleep such as fatigue, sleepiness, drowsy driving, and cognitive difficulties. Sleep insufficiency can easily go unrecognized and undiagnosed unless patients are specifically asked about it by their clinicians.
Several questions are critical in evaluating sleep duration and quality, as well as the cause of sleep deprivation. Sleep patterns (typical bed time or rise time on weekdays and weekends), shift work, and frequency of naps can reveal the direct cause of poor sleep, and quality of sleep should be discussed to rule out any diseases such as obstructive sleep apnea and restless leg syndrome.
Sleep diaries are useful in providing detailed information about sleep patterns. They are inexpensive, readily available, and easy to use. The diaries can be as simple as a 24-hour log to note the time of being asleep or can be detailed to include other relevant information. Sleep questionnaires such as the Sleep Timing Questionnaire (STQ) can be used instead of sleep diaries if there is any concern for patient adherence.
Actigraphy is a useful, objective wrist-worn tool if the validity of self-reported sleep diaries or questionnaires is questionable. Actigraphy works by recording movements and using computerized algorithms to estimate total sleep time, sleep onset latency, the amount of wake after sleep onset, and sleep efficiency. Some devices have light sensors to detect light exposure.
Management
Although there are numerous causes of sleep deprivation, there are some fundamental measures that promote quality sleep as suggested by organizations such as
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
, the
National Institute of Health
The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...
, the
National Institute of Aging
The National Institute on Aging (NIA) is a division of the U.S. National Institutes of Health (NIH), located in Bethesda, Maryland. The NIA itself is headquartered in Baltimore, Maryland.
The NIA leads a broad scientific effort to understand the ...
, and the
American Academy of Family Physicians. The key is to implement healthier sleep habits, also known as
sleep hygiene
Sleep hygiene is a behavioral and environmental practice developed in the late 1970s as a method to help people with mild to moderate insomnia. Clinicians assess the sleep hygiene of people with insomnia and other conditions, such as depression, ...
. Sleep hygiene recommendations include setting a fixed sleep schedule, taking naps with caution, maintaining a sleep environment that promotes sleep (cool temperature, limited exposure to light and noise, comfortable mattress and pillows), exercising daily, avoiding alcohol, cigarettes, caffeine, and heavy meals in the evening, winding down and avoiding electronic use or physical activities close to bedtime, and getting out of bed if unable to fall asleep.
For long term involuntary sleep deprivation, cognitive behavioral therapy for Insomnia (CBT-i) is commonly recommended as a first-line treatment, after exclusion of physical diagnosis (f.e. sleep apnea). CBT-i contains five different components: cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation. These components together have shown to be effective in adults, with clinical meaningful effect sizes. As this approach has minimal adverse effects, and long-term benefits, it is often preferred to (chronic) drug therapy.
There are several strategies that help increase alertness and counteract the effects of sleep deprivation.
Caffeine
Caffeine is a central nervous system (CNS) stimulant of the methylxanthine class. It is mainly used recreationally as a cognitive enhancer, increasing alertness and attentional performance. Caffeine acts by blocking binding of adenosine t ...
is often used over short periods to boost wakefulness when acute sleep deprivation is experienced; however, caffeine is less effective if taken routinely. Other strategies recommended by the American Academy of Sleep Medicine include prophylactic sleep before deprivation, naps, other stimulants, and combinations thereof. However, the only sure and safe way to combat sleep deprivation is to increase nightly sleep time.
Uses
To facilitate abusive control
Sleep deprivation can be used to disorientate
abuse
Abuse is the improper usage or treatment of a thing, often to unfairly or improperly gain benefit. Abuse can come in many forms, such as: physical or verbal maltreatment, injury, assault, violation, rape, unjust practices, crimes, or other t ...
victims to help set them up for
abusive control.
Interrogation
Sleep deprivation can be used as a means of interrogation, which has resulted in court trials over whether or not the technique is a form of
torture
Torture is the deliberate infliction of severe pain or suffering on a person for reasons such as punishment, extracting a confession, interrogation for information, or intimidating third parties. Some definitions are restricted to acts c ...
.
Under one interrogation technique, a subject might be kept awake for several days and when finally allowed to fall asleep, suddenly awakened and questioned.
Menachem Begin
Menachem Begin ( ''Menaḥem Begin'' (); pl, Menachem Begin (Polish documents, 1931–1937); ''Menakhem Volfovich Begin''; 16 August 1913 – 9 March 1992) was an Israeli politician, founder of Likud and the sixth Prime Minister of Israel. B ...
, the Prime Minister of
Israel
Israel (; he, יִשְׂרָאֵל, ; ar, إِسْرَائِيل, ), officially the State of Israel ( he, מְדִינַת יִשְׂרָאֵל, label=none, translit=Medīnat Yīsrāʾēl; ), is a country in Western Asia. It is situated ...
from 1977 to 1983, described his experience of sleep deprivation as a prisoner of the
NKVD
The People's Commissariat for Internal Affairs (russian: Наро́дный комиссариа́т вну́тренних дел, Naródnyy komissariát vnútrennikh del, ), abbreviated NKVD ( ), was the interior ministry of the Soviet Union.
...
in the Soviet Union as follows:
Sleep deprivation was one of the
five techniques
The five techniques (also known as Deep-Interrogation) are illegal interrogation methods which were originally developed by the British military in other operational theatres and then applied to detainees during the Troubles in Northern Ireland. ...
used by the British government in the 1970s. The
European Court of Human Rights
The European Court of Human Rights (ECHR or ECtHR), also known as the Strasbourg Court, is an international court of the Council of Europe which interprets the European Convention on Human Rights. The court hears applications alleging that a ...
ruled that the five techniques "did not occasion suffering of the particular intensity and cruelty implied by the word torture ...
utamounted to a practice of
inhuman and degrading treatment
Cruel, inhuman or degrading treatment (CIDT) is treatment of persons which is contrary to human rights or dignity, but is not classified as torture. It is forbidden by the Universal Declaration of Human Rights, Article 3 of the European Convention ...
", in breach of the
European Convention on Human Rights
The European Convention on Human Rights (ECHR; formally the Convention for the Protection of Human Rights and Fundamental Freedoms) is an international convention to protect human rights and political freedoms in Europe. Drafted in 1950 by t ...
.
[Ireland v. the United Kingdom](_blank)
paragraph 102
The
United States Justice Department
The United States Department of Justice (DOJ), also known as the Justice Department, is a United States federal executive departments, federal executive department of the United States government tasked with the enforcement of federal law and a ...
released four memos in August 2002 describing interrogation techniques used by the
Central Intelligence Agency
The Central Intelligence Agency (CIA ), known informally as the Agency and historically as the Company, is a civilian foreign intelligence service of the federal government of the United States, officially tasked with gathering, processing, ...
. They first described 10 techniques used in the interrogation of
Abu Zubaydah
Abu Zubaydah ( ; , ''Abū Zubaydah''; born March 12, 1971, as Zayn al-Abidin Muhammad Husayn) is a Saudi Arabian currently held by the U.S. in the Guantanamo Bay detention camp in Cuba. He is held under the authority of Authorization for Use ...
, described as a terrorist logistics specialist, including sleep deprivation. Memos signed by
Steven G. Bradbury
Steven Gill Bradbury (born September 12, 1958) is an American attorney and government official who served as the General Counsel of the United States Department of Transportation. He previously served as Acting Assistant Attorney General (AAG) f ...
in May 2005 claimed that forced sleep deprivation for up to 180 hours ( days)
by shackling a diapered prisoner to the ceiling did not constitute torture,
nor did the combination of multiple interrogation methods (including sleep deprivation) constitute torture under United States law.
These memoranda were repudiated and withdrawn during the first months of the Obama administration.
The question of extreme use of sleep deprivation as torture has advocates on both sides of the issue. In 2006, Australian Federal Attorney-General
Philip Ruddock
Philip Maxwell Ruddock (born 12 March 1943 in Canberra) is an Australian politician and the current mayor of Hornsby Shire.
Ruddock is a member of the Liberal Party of Australia and currently the state president of the party's New South W ...
argued that sleep deprivation does not constitute torture.
Nicole Bieske, a spokeswoman for Amnesty International Australia, has stated the opinion of her organization thus: "At the very least, sleep deprivation is cruel, inhumane and degrading. If used for prolonged periods of time it is torture."
Treating depression
Studies show that sleep restriction has some potential in treating
depression.
Those with depression tend to have earlier occurrences of REM sleep with an increased number of rapid eye movements; therefore, monitoring patients' EEG and awakening them during occurrences of REM sleep appear to have a
therapeutic effect
Therapeutic effect refers to the response(s) after a treatment of any kind, the results of which are judged to be useful or favorable. This is true whether the result was expected, unexpected, or even an unintended consequence. An adverse effect ( ...
, alleviating depressive symptoms. This kind of treatment is known as
wake therapy. Although as many as 60% of patients show an immediate recovery when sleep-deprived, most patients relapse the following night. The effect has been shown to be linked to an increase in the
brain-derived neurotrophic factor
Brain-derived neurotrophic factor (BDNF), or abrineurin, is a protein found in the and the periphery. that, in humans, is encoded by the ''BDNF'' gene. BDNF is a member of the neurotrophin family of growth factors, which are related to the cano ...
(BDNF). A comprehensive evaluation of the human
metabolome
The metabolome refers to the complete set of small-molecule chemicals found within a biological sample. The biological sample can be a cell, a cellular organelle, an organ, a tissue, a tissue extract, a biofluid or an entire organism. The smal ...
in sleep deprivation in 2014 found that 27 metabolites are increased after 24 waking hours and suggested
serotonin
Serotonin () or 5-hydroxytryptamine (5-HT) is a monoamine neurotransmitter. Its biological function is complex and multifaceted, modulating mood, cognition, reward, learning, memory, and numerous physiological processes such as vomiting and vas ...
, tryptophan, and taurine may contribute to the antidepressive effect.
The incidence of relapse can be decreased by combining sleep deprivation with medication or a combination of
light therapy
Light therapy, also called phototherapy or bright light therapy is intentional daily exposure to direct sunlight or similar-intensity artificial light in order to treat medical disorders, especially seasonal affective disorder (SAD) and circad ...
and phase advance (going to bed substantially earlier than one's normal time).
Many
tricyclic antidepressants
Tricyclic antidepressants (TCAs) are a class of medications that are used primarily as antidepressants, which is important for the management of depression. They are second-line drugs next to SSRIs. TCAs were discovered in the early 1950s and wer ...
suppress REM sleep, providing an additional evidence for a link between
mood and sleep.
[Disorders That Disrupt Sleep (Parasomnias)](_blank)
. eMedicineHealth Similarly,
tranylcypromine
Tranylcypromine, sold under the brand name Parnate among others,Drugs.co Page accessed April 17, 2016 is a monoamine oxidase inhibitor (MAOI). More specifically, tranylcypromine acts as nonselective and irreversible inhibitor of the enzyme mono ...
has been shown to completely suppress REM sleep at adequate doses.
Treating insomnia
Sleep deprivation can be implemented for a short period of time in the treatment of
insomnia
Insomnia, also known as sleeplessness, is a sleep disorder in which people have trouble sleeping. They may have difficulty falling asleep, or staying asleep as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, ...
. Some common sleep disorders have been shown to respond to
cognitive behavioral therapy for insomnia
Cognitive behavioral therapy for insomnia (CBT-I) is a technique for treating insomnia without (or alongside) medications. Insomnia is a common problem involving trouble falling asleep, staying asleep, or getting quality sleep. CBT-I aims to impro ...
. Cognitive behavioral therapy for insomnia is a multicomponent process that is composed of stimulus control therapy, sleep restriction therapy (SRT), and sleep hygiene therapy.
One of the components is a controlled regime of "sleep restriction" in order to restore the
homeostatic
In biology, homeostasis (British also homoeostasis) (/hɒmɪə(ʊ)ˈsteɪsɪs/) is the state of steady internal, physical, and chemical conditions maintained by living systems. This is the condition of optimal functioning for the organism and ...
drive to sleep and encourage normal "sleep efficiency". Stimulus control therapy is intended to limit behaviors intended to condition the body to sleep while in bed.
The main goal of stimulus control and
sleep restriction therapy is to create an association between bed and sleep. Although sleep restriction therapy shows efficacy when applied as an element of cognitive-behavioral therapy, its efficacy is yet to be proven when used alone.
Sleep Hygiene therapy is intended to help patients develop and maintain good sleeping habits. Sleep hygiene therapy is not helpful however, when used as a monotherapy without the pairing of Stimulus control therapy and Sleep restriction therapy.
In addition to the cognitive behavioral treatment of insomnia there are also generally four approaches to treating insomnia medically. These are through the use of barbiturates, benzodiazepines, and benzodiazepine receptor agonists. Barbiturates are not considered to be a primary source of treatment due to the fact that they have a low therapeutic index, while melatonin agonists are shown to have a higher therapeutic index.
Military training
Sleep deprivation has been used by the
military
A military, also known collectively as armed forces, is a heavily armed, highly organized force primarily intended for warfare. It is typically authorized and maintained by a sovereign state, with its members identifiable by their distinct ...
in training programs to prepare personnel combat experiences when proper sleep schedules aren't realistic.
Sleep deprivation is used to create a different time schedule pattern that is beyond a typical 24 hour day.
Sleep deprivation is pivotal in training games such as "Keep in Memory" exercises where personnel practice memorizing everything they can while under intense stress physically and mentally and being able to describe in as much detail as they can remember of what they remember seeing days later.
Sleep deprivation is used in training to create soldiers who are used to only going off of a few hours or minutes of sleep randomly when available.
Changes in American sleep habits
''
National Geographic Magazine
''National Geographic'' (formerly the ''National Geographic Magazine'', sometimes branded as NAT GEO) is a popular American monthly magazine published by National Geographic Partners. Known for its photojournalism, it is one of the most widely ...
'' has reported that the demands of work, social activities, and the availability of 24-hour home entertainment and Internet access have caused people to sleep less now than in premodern times. ''
USA Today
''USA Today'' (stylized in all uppercase) is an American daily middle-market newspaper and news broadcasting company. Founded by Al Neuharth on September 15, 1982, the newspaper operates from Gannett's corporate headquarters in Tysons, Virgini ...
'' reported in 2007 that most adults in the USA get about an hour less than the average sleep time 40 years ago.
Other researchers have questioned these claims. A 2004 editorial in the journal ''
Sleep
Sleep is a sedentary state of mind and body. It is characterized by altered consciousness, relatively inhibited sensory activity, reduced muscle activity and reduced interactions with surroundings. It is distinguished from wakefulness by a de ...
'' stated that according to the available data, the average number of hours of sleep in a 24-hour period has not changed significantly in recent decades among adults. Furthermore, the editorial suggests that there is a range of normal sleep time required by healthy adults, and many indicators used to suggest chronic sleepiness among the population as a whole do not stand up to scientific scrutiny.
A comparison of data collected from the
Bureau of Labor Statistics
The Bureau of Labor Statistics (BLS) is a unit of the United States Department of Labor. It is the principal fact-finding agency for the U.S. government in the broad field of labor economics and statistics and serves as a principal agency of t ...
' American Time Use Survey from 1965 to 1985 and 1998–2001 has been used to show that the median amount of sleep, napping, and resting done by the average adult American has changed by less than 0.7%, from a median of 482 minutes per day from 1965 through 1985, to 479 minutes per day from 1998 through 2001.
Longest periods without sleep
Randy Gardner holds the scientifically documented record for the longest period of time a human being has intentionally gone without sleep not using
stimulant
Stimulants (also often referred to as psychostimulants or colloquially as uppers) is an overarching term that covers many drugs including those that increase activity of the central nervous system and the body, drugs that are pleasurable and inv ...
s of any kind. Gardner stayed awake for 264 hours (11 days), breaking the previous record of 260 hours held by
Tom Rounds
Tom Rounds (June 6, 1936 – June 1, 2014) was an American radio broadcasting executive, founder and chief executive officer of Radio Express in Burbank, California.
Biography
Early years
After first entering the broadcasting profession at the c ...
of
Honolulu
Honolulu (; ) is the capital and largest city of the U.S. state of Hawaii, which is in the Pacific Ocean. It is an unincorporated county seat of the consolidated City and County of Honolulu, situated along the southeast coast of the island ...
.
Lieutenant Commander
Lieutenant commander (also hyphenated lieutenant-commander and abbreviated Lt Cdr, LtCdr. or LCDR) is a commissioned officer rank in many navies. The rank is superior to a lieutenant and subordinate to a commander. The corresponding rank i ...
John J. Ross of the U.S. Navy Medical Neuropsychiatric Research Unit later published an account of this event, which became well known among sleep-deprivation researchers.
The ''Guinness World Record'' stands at 449 hours (18 days, 17 hours), held by Maureen Weston, of
Peterborough
Peterborough () is a cathedral city in Cambridgeshire, east of England. It is the largest part of the City of Peterborough unitary authority district (which covers a larger area than Peterborough itself). It was part of Northamptonshire until ...
,
Cambridgeshire
Cambridgeshire (abbreviated Cambs.) is a Counties of England, county in the East of England, bordering Lincolnshire to the north, Norfolk to the north-east, Suffolk to the east, Essex and Hertfordshire to the south, and Bedfordshire and North ...
in April 1977, in a rocking-chair marathon.
Claims of total sleep deprivation lasting years have been made several times,
but none are scientifically verified. Claims of partial sleep deprivation are better documented. For example, Rhett Lamb of
St. Petersburg, Florida
St. Petersburg is a city in Pinellas County, Florida, United States. As of the 2020 census, the population was 258,308, making it the fifth-most populous city in Florida and the second-largest city in the Tampa Bay Area, after Tampa. It is the ...
was initially reported to not sleep at all, but actually had a rare condition permitting him to sleep only one to two hours per day in the first three years of his life. He had a rare abnormality called an
Arnold–Chiari malformation
Chiari malformation (CM) is a structural defect in the cerebellum, characterized by a downward displacement of one or both cerebellar tonsils through the foramen magnum (the opening at the base of the skull). CMs can cause headaches, difficu ...
where
brain tissue
The human brain is the central organ of the human nervous system, and with the spinal cord makes up the central nervous system. The brain consists of the cerebrum, the brainstem and the cerebellum. It controls most of the activities of th ...
protrudes into the spinal canal and the skull puts pressure on the protruding part of the brain. The boy was operated on at
All Children's Hospital
Johns Hopkins All Children's Hospital, formerly All Children's Hospital, is a pediatric acute care children's hospital located in St. Petersburg, Florida. The hospital has 259 beds and is affiliated with the USF Morsani College of Medicine and ...
in St. Petersburg in May 2008. Two days after surgery he slept through the night.
French sleep expert
Michel Jouvet
Michel Valentin Marcel Jouvet (16 November 1925 – 3 October 2017) was a French neuroscientist and medical researcher.
His works, and those of his team, have brought about the discovery of paradoxical sleep (a term he coined) and to its indi ...
and his team reported the case of a patient who was quasi-sleep-deprived for four months, as confirmed by repeated
polygraph
A polygraph, often incorrectly referred to as a lie detector test, is a device or procedure that measures and records several physiological indicators such as blood pressure, pulse, respiration, and skin conductivity while a person is asked an ...
ic recordings showing less than 30 minutes (of
stage-1 sleep) per night, a condition they named "agrypnia". The 27-year-old man had
Morvan's fibrillary chorea, a rare disease that leads to involuntary movements, and in this particular case, extreme
insomnia
Insomnia, also known as sleeplessness, is a sleep disorder in which people have trouble sleeping. They may have difficulty falling asleep, or staying asleep as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, ...
. The researchers found that treatment with
5-HTP restored almost normal sleep stages. However some months after this recovery the patient died during a relapse which was unresponsive to 5-HTP. The cause of death was pulmonary edema. Despite the extreme insomnia, psychological investigation showed no sign of cognitive deficits, except for some
hallucination
A hallucination is a perception in the absence of an external stimulus that has the qualities of a real perception. Hallucinations are vivid, substantial, and are perceived to be located in external objective space. Hallucination is a combinatio ...
s.
Fatal insomnia
Fatal insomnia is an extremely rare genetic (and even more rarely, sporadic) disorder that results in trouble sleeping as its hallmark symptom. The problems with sleeping typically start out gradually and worsen over time. Eventually, the patien ...
is a neurodegenerative disease eventually resulting in a complete inability to go past
stage 1 of NREM sleep. In addition to insomnia, patients may experience panic attacks, paranoia, phobias, hallucinations, rapid weight loss, and
dementia
Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
. Death usually occurs between 7 and 36 months from onset.
See also
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Insomnia
Insomnia, also known as sleeplessness, is a sleep disorder in which people have trouble sleeping. They may have difficulty falling asleep, or staying asleep as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, ...
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Effects of sleep deprivation on cognitive performance
It has been estimated that over 20% of adults suffer from some form of sleep deprivation. Insomnia and sleep deprivation are common symptoms of depression, and can be an indication of other mental disorders.Diagnostic and statistical manual of me ...
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Narcolepsy
Narcolepsy is a long-term neurological disorder that involves a decreased ability to regulate sleep–wake cycles. Symptoms often include periods of excessive daytime sleepiness and brief involuntary sleep episodes. About 70% of those affec ...
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Polyphasic sleep
Biphasic sleep (or ''diphasic'', ''bifurcated'', or bimodal sleep) is the practice of sleeping during two periods over the course of 24 hours, while polyphasic sleep refers to sleeping multiple times—usually more than two. Each of these is in ...
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Sleep medicine
Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and sleep disorder, disorders. From the middle of the 20th century, research has provided increasing knowledge and answered many ...
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Sleep onset latency
In sleep science, sleep onset latency (SOL) is the length of time that it takes to accomplish the transition from full wakefulness to sleep, normally to the lightest of the non-REM sleep stages.
Sleep latency studies
Pioneering Stanford Universi ...
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Wake therapy
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Tony Wright, who claims to hold the world record for sleep deprivation
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Foreign Correspondent
A correspondent or on-the-scene reporter is usually a journalist or commentator for a magazine, or an agent who contributes reports to a newspaper, or radio or television news, or another type of company, from a remote, often distant, locati ...
'', a 1940 film depicting interrogation by sleep deprivation
References
{{DEFAULTSORT:Sleep Deprivation
Sleep medicine
Nursing diagnoses
Psychological torture techniques
Physical torture techniques
Disorders causing seizures