Topic: Sleep Deprivation

Sleep deprivation, also known as sleep insufficiency or sleeplessness, is the condition of not
having adequate duration and/or quality of sleep to support decent alertness, performance, and
health. It can be either chronic or acute 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. Although both chronic sleep deficiency and
insomnia share decreased quantity and/or quality of sleep as well as impaired function, their
difference lies on 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 or specific issues caused by
surgery); it appears that brief microsleeps cannot be avoided. Long-term total sleep deprivation
has caused death in lab animals.

Causes
Insomnia

Insomnia, one of the six types of dyssomnia, affects 21–37% of the adult population. Many of its
symptoms are easily recognizable, including excessive daytime sleepiness; 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, insomnia.Primary insomnia
is a sleep disorder 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 (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 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, 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 therapy
using a CPAP (Continuous positive airway pressure), 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) in some cases may be an appropriate choice of
treatment.

Central sleep apnea 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 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, 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
are paralleled, including those of positive and cognitive symptoms.

School

The National Sleep Foundation 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.

A study performed by the Department of Psychology at the National Chung Cheng University 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 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 rhythms and therefore sleep patterns typically undergo marked changes.
Electroencephalogram (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 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 the
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
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, a structure involved in
alertness and attention; and the prefrontal cortex, 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 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 and graph theory.A noted 2002 University of
California animal study indicated that non-rapid eye movement sleep (NREM) is necessary for
turning off neurotransmitters and allowing their receptors to "rest" and regain sensitivity which
allows monoamines (norepinephrine, serotonin 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 (REM) deprivation may alleviate clinical
depression because it mimics selective serotonin reuptake inhibitors (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. 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.Animal studies suggest that sleep deprivation
increases levels of stress hormones, which may reduce new cell production in adult
brains.Other animal studies suggest that prolonged sleep deprivation leads to the death of a
large percentage of neurons in the locus coeruleus, a brainstem nucleus that is the main source
of the neurotransmitter noradrenaline in the brain and is critically involved in many cognitive
functions such as sustained attention (vigilance), learning and memory. Due to the inability of
the central nervous system to regenerate lost neurons, sleeplessness-induced degeneration of
the locus coeruleus might lead to long-lasting, perhaps even permanent impairments in
associated functions.

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 (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, hypersomnia, or obstructive
sleep apnea. About 75% of adult patients with depression can present with 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, 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 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 regulations in the European Union and hours of
service 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

Microsleeps 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. 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 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
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.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 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. 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 and decrease
the level of leptin. 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 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. 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
(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, 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 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, memory lapses or loss

depression

development of false memory

hypnagogic and hypnopompic hallucinations during falling asleep and waking, which are entirely
normal

hand tremor

headaches

malaise

stye

periorbital puffiness, commonly known as "bags under eyes" or eye bags

increased blood pressure

increased stress hormone levels

increased risk of Type 2 diabetes

lowering of immunity, increased susceptibility to illness

increased risk of fibromyalgia

irritability

nystagmus (rapid involuntary rhythmic eye movement)

obesity

seizures

temper tantrums in children

violent behavior

yawning

mania

Sleep inertia

symptoms similar to:

attention-deficit hyperactivity disorder (ADHD)

psychosis

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 National Institute of Health, the National Institute of Aging,
and the American Academy of Family Physicians. The key is to implement healthier sleep
habits, also known as sleep hygiene. 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 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 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.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, the Prime Minister of Israel from 1977 to 1983,
described his experience of sleep deprivation as a prisoner of the NKVD in the Soviet Union as
follows:
In the head of the interrogated prisoner, a haze begins to form. His spirit is wearied to death, his
legs are unsteady, and he has one sole desire: to sleep... Anyone who has experienced this
desire knows that not even hunger and thirst are comparable with it.

Sleep deprivation was one of the five techniques used by the British government in the 1970s.
The European Court of Human Rights ruled that the five techniques "did not occasion suffering
of the particular intensity and cruelty implied by the word torture ... [but] amounted to a practice
of inhuman and degrading treatment", in breach of the European Convention on Human
Rights.The United States Justice Department released four memos in August 2002 describing
interrogation techniques used by the Central Intelligence Agency. They first described 10
techniques used in the interrogation of Abu Zubaydah, described as a terrorist logistics
specialist, including sleep deprivation. Memos signed by Steven G. Bradbury in May 2005
claimed that forced sleep deprivation for up to 180 hours (7+1⁄2 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 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, 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 (BDNF). A
comprehensive evaluation of the human metabolome in sleep deprivation in 2014 found that 27
metabolites are increased after 24 waking hours and suggested serotonin, 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 and phase
advance (going to bed substantially earlier than one's normal time). Many tricyclic
antidepressants suppress REM sleep, providing an additional evidence for a link between mood
and sleep. Similarly, tranylcypromine 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.
Some common sleep disorders have been shown to respond to cognitive behavioral therapy for
insomnia. 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 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 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 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 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 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' 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 stimulants of any kind. Gardner
stayed awake for 264 hours (11 days), breaking the previous record of 260 hours held by Tom
Rounds of Honolulu. Lieutenant Commander 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, Cambridgeshire 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 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 where brain tissue 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 in St.
Petersburg in May 2008. Two days after surgery he slept through the night.French sleep expert
Michel Jouvet and his team reported the case of a patient who was quasi-sleep-deprived for
four months, as confirmed by repeated polygraphic 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. 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
hallucinations.Fatal insomnia 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. Death usually
occurs between 7 and 36 months from onset.

See also

References