Related Literature

Possible effects of sleep deprivation and fatigue on the performance and well-
being of residents have receivedlittle scientific examination until recently. This article is a review of the s
tudies on this topic published since 1970. All those studies that dealt with residents' moods and attitude
s demonstrated deleterious effects of sleepdeprivation and fatigue. The implications of this finding for p
atient care deserve exploration. Residents' acuity onperformance tests requiring prolonged vigilance ten
ded to deteriorate with acute sleep loss, while theirperformances on most brief psychomotor tests meas
uring manual dexterity, reaction times, and short-
term recallwere not adversely affected. The data presently available suggest that sleep-
deprived or fatigued house officerscan compensate for sleep loss in crises or other novel situations. How
ever, sleep-
deprived residents may be moreprone to errors on routine, repetitive tasks and tasks that require sustai
ned vigilance, which form a substantialportion of residents' workload. The authors concur with the reco
mmendation of the Executive Council of theAssociation of American Medical Colleges that the total wor
king hours for residents should not exceed 80 hoursper week averaged over four weeks.

https://journals.lww.com/academicmedicine/Abstract/1991/11000/A_review_of_studies_concerning_e
ffects_of_sleep.13.aspx

Epidemiological studies show a positive association between adequate sleep and good health. Further,
disrupted sleep may increase the risk for CNS diseases, such as stroke and Alzheimer’s disease. However,
there has been limited progress in determining how sleep is linked to brain health or how sleep
disruption may increase susceptibility to brain insult and disease. Animal studies can aid in
understanding these links. In reviewing the animal literature related to the effects of sleep disruption on
the brain, we found most of the work was directed toward investigating and characterizing the role of
various brain areas or structures in initiating and regulating sleep. In contrast, limited effort has been
directed towards understanding how sleep disruption alters the brain’s health or susceptibility to insult.
We also note many current studies have determined the changes in the brain following compromised
sleep by examining, for example, the brain transcriptome or to a more limited extent the proteome.
However, these studies have utilized almost exclusively total sleep deprivation (e.g., 24 out of 24 hours)
paradigms or single short periods of limited acute sleep deprivation (e.g., 3 out of 24 hours). While such
strategies are beneficial in understanding how sleep is controlled, they may not have much translational
value for determining links between sleep and brain health or for determining how sleep disruption may
increase brain susceptibility to insult. Surprisingly, few studies have determined how the duration and
recurrence of sleep deprivation influence the effects seen after sleep deprivation. Our aim in this review
was to identify relevant rodent studies from 1980 through 2012 and analyze those that use varying
durations of sleep deprivation or restriction in their effort to evaluate the effects of sleep deprivation on
the brain transcriptome and to a more limited extent the proteome. We examined how differences in
the duration of sleep deprivation affect gene and protein expression to better understand the full
consequences of repeated sleep disruption on the brain. Future research needs to consider and
emphasize how the type and extent of the sleep deprivation exposure impacts the conclusions reached
concerning the influence of sleep disruption on the brain.

We identified relevant studies between 1980 and 2012 by searching the electronic databases of
PubMed, Medline (Ovid), Embase (Ovid), and Web of Science using the terms “sleep” AND “disrupt”,
“deprivation”, “restrict”, “fragment”, “loss”, “disturb”, “disorder”, “dysfunction”, “brain”, “cortex”,
striatum”, hypothalamus”, “hippocampus”, “gene”, “protein”, “genomics”, “proteomics”, “polymerase
chain reaction”, “pcr”, “microarray”, “molecular”, “rodent” “rat”, “rats”, “mouse”, “mice”. All searches
were limited to rodent studies in English and the reference lists of retrieved articles were searched for
additional pertinent studies.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4409616/

Cognitive behaviour therapy for insomnia is well-regarded as an effective treatment for insomnia in
adults. Previous studies also suggest that CBT-i can be successfully applied to adolescents experiencing
insomnia and other sleep problems, which most commonly involve delayed sleep timing. The
recommended treatment involves a combined program of morning bright light therapy, stimulus control
therapy, and education about sleep hygiene. Improving sleep pattern regularity by getting up earlier on
weekends (i.e., at a time closer to the weekday wake-up time) can play a particularly important role in
increasing total sleep time during the week and decreasing daytime sleepiness. Recent research
suggests that the school classroom may be a promising arena for the dissemination of sleep
interventions for adolescents. However, many of the earlier studies in this area have been plagued by
problems such as inappropriate outcome measures, small sample size, lack of control group, and lack of
follow-up data. Reporting has also been poor, with a number of studies presented only in abstract form.
Results have been mixed: some studies showed improved knowledge about sleep, despite having no
data about actual changes in sleep habits or behaviours; another study measured sleep habits but found
no change from pre- to post-treatment. Finally, some studies found changes in sleep habits from pre- to
post-treatment, although these results must be interpreted with caution due to the previously
mentioned problems of small sample size, lack of control group, and lack of follow-up data. A series of
two studies conducted by researchers at Flinders University in Adelaide, Australia, attempted to
overcome the limitations of previous research by conducting randomised controlled trials evaluating
school-based intervention programs aimed at improving the sleep of adolescents. Full details of these
studies can be found in earlier publications; however, an outline of the main findings are presented
here, along with recommendations for others planning school-based interventions for adolescent sleep
problems.

/x/EH/eh303nc.pdf

Sleep deprivation is common amongst university students whom live in a culture that promotes reduced
sleep, due to the burden of academic work and social pursuits. The reasons for poor sleep hygiene
include alcohol and caffeine intake, stimulants, and technology, which prevent students achieving
sufficient sleep time and quality [1]. A cross-sectional survey found that 71% of students did not achieve
the recommended 8 h of sleep, with 60% classified as poor sleepers [2]. An average of 5.7 h sleep has
been reported for students studying architecture, and sleepless nights due to academic work
throughout the night—defined by the Oxford English Dictionary as an all-nighter—occurred, on average,
2.7 days a month [3].

While many studies have investigated the effects of acute sleep deprivation, few focus on university
students, despite the prevalence and impact of sleep deprivation in this population [4, 5]. Such studies
often have a narrow focus on disease states, limiting their ability to provide a holistic assessment of
physical, emotional and cognitive wellbeing [4–6]. The importance of physical and cognitive function is
especially appreciable in the student population, 52% of whom play sport at least once a week.
Moreover, students rate sleep problems second only to stress in relation to negative impact on
academic performance [7]. The effect of acute sleep deprivation on physical performance has been well
documented with negligible effects on intense periods of exercise, whilst endurance task performance
suffers due to decreased motivation [8, 9].

The effect of sleep deprivation on cognitive performance has also been documented previously with a
correlation between sleep quality and grade point average in first year university students [10].
Moreover, sleep deprivation has been shown to have a detrimental effect on certain aspects of working
memory, such as filtering efficiency, whilst Stroop test scores show degradation; however, this has been
evidenced to be due to deficits in reaction time rather than processing skills [5, 11–17]. Taken together,
these data suggest that sleep deprivation may have a limited effect on cognitive ability in university
students.

This study aimed to determine whether a night of sleep deprivation, equivalent to an “all-nighter”,
would have a negative impact on the motor and cognitive performance of students, specifically focusing
on reaction time, executive function, working memory, and cardiopulmonary function.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5489575/

These days, sleep is often seen as an expendable resource. With so much work to do and limited time to
accomplish tasks, going to sleep later and waking up earlier seems so natural. For some people, lack of
sleep was used to prove toughness and stamina. It was common for physician trainees to boast (in some
cases complain) about getting little sleep. However, studies showing suboptimal patient care when
residents are sleep-deprived have resulted in shorter working hours and mandatory time off after a
number of hours at work.

Some of the most vulnerable to sleep deprivation are adolescents. With the economy faltering, parents
and families are under enormous pressure, and children are bearing more stress than they should. This
time period is also awkward for adolescents, because they are branching out and trying to discover
themselves. In addition, they compete academically to gain admission to prized universities and to win
scholarships. This competition, at times, can be stifling. To achieve their goals, many adolescents are
cutting back on sleep, sometimes significantly. The National Sleep Foundation’s Sleep in America poll
found that more than three-fourths of teens between the ages of 13-18 go to bed at 11:00 pm or later
on school nights. It is not uncommon for high school students to be found at coffee cafes drinking large
cups of coffee or lattes into the night as they finish their projects or study for an AP (advanced
placement) class. Energy drinks, and even caffeine tablets to keep awake are being consumed and are
causing irregular sleep patterns.

The loss of sleep in adolescents is causing more than just increased daytime sleepiness and
irregular sleep patterns. A study examining the influence of sleep patterns in adolescents (ages 11-14)
revealed symptoms of depression and a decrease in self-esteem with chronic loss of sleep. Those with
insomnia were more likely to develop major depression, abuse drugs, and have nicotine dependence.
Sleep deprived adolescents also experience more anger, sadness, and fear. Most alarming, however, has
been the suicidal behavior exhibited in this group.

It is well known that sleep deprivation can affect brain activity. Insomnia and serotonin, in particular,
may be linked to depression and suicidal behavior. Serotonin is a neurotransmitter important in the
regulation of the sleep-wake cycle and has been found in decreased concentrations in the brainstem of
suicide victims. Loss of sleep or the disturbance of sleep can cause fluctuations in serotonin.

Although there have not been many large studies examining loss of sleep and its effects on adolescent
behavior, the effects of sleep deprivation in general have been well documented. Some of these effects
include reduced short-term memory and learning ability, negative mood, inconsistent performance,
poor productivity and loss of some forms of behavioral control. It is important for youth to have the
proper amount of sleep. Doctors recommend at east 8 to 9 hours of sleep for teenagers.

References

S. Okie (2007). An Elusive Balance — Residents’ Work Hours and the Continuity of Care New England
Journal of Medicine, 356 (26), 2665-2667 DOI: 10.1056/NEJMp078085

National Sleep Foundation. Sleepiness in Teens. Not Just a Side Effect of Growing Up.

J. John Mann (2003). Neurobiology of suicidal behavior Nature Reviews Neuroscience, 4 (10), 819-828
DOI: 10.1038/nrn1220

https://www.brainblogger.com/2008/10/01/sleep-deprivation-behavior-and-the-young/