Sleep deprivation
Sleep deprivation, also known as sleep insufficiency[2] 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. All known animals sleep or exhibit some form of sleep behavior, and the importance of sleep is self-evident for humans, as nearly a third of a person's life is spent sleeping.[2]
Not to be confused with Insomnia.Sleep deprivation
Car and work accidents, weight gain, cardiovascular disease
Insomnia, sleep apnea, stimulants (caffeine, amphetamine), voluntary imposition (school, work), mood disorders
Cognitive behavioral therapy, caffeine (to induce alertness), sleeping pills
The average adult needs to sleep for 7 to 8 hours every 24 hours, and sleep deprivation can occur if they do not get enough sleep.[3] Acute sleep deprivation is when a person sleeps less than usual or does not sleep at all for a short period of time, normally lasting one to two days, but tends to follow the sleepless pattern for longer with no outside factors in play. Chronic sleep deprivation is when a person routinely sleeps less than an optimal amount for optimal 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 in the ability to fall asleep. To date, most sleep deprivation studies have focused on acute sleep deprivation, suggesting that acute sleep deprivation can cause significant damage to cognitive and emotional functions and brain mechanisms.[4]
Sleep-deprived people are able to fall asleep rapidly when allowed, but those with insomnia have difficulty falling asleep overall.[5]
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.[6] Sleep deprivation can also lead to high anxiety, irritability, erratic behavior, poor cognitive functioning and performance, and psychotic episodes.[7]
A chronic sleep-restricted state adversely affects the brain and cognitive function.[8] However, in a subset of cases, sleep deprivation can paradoxically lead to increased energy and alertness; although its long-term consequences have never been evaluated, sleep deprivation has even been used as a treatment for depression.[9][10]
Few studies have compared the effects of acute total sleep deprivation and chronic partial sleep restriction.[8] 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.[11] Long-term total sleep deprivation has caused death in lab animals.[12]
Sleep deprivation vs sleep restriction[edit]
Reviews differentiate between having no sleep over a short-term period, such as one night ('sleep deprivation'), and having less than required sleep over a longer period ('sleep restriction'). Sleep deprivation was seen as more impactful in the short term, but sleep restriction had similar effects over a longer period.[13][14][15][16][17] A 2022 study found that in most cases the changes induced by chronic or acute sleep loss waxed or waned across the waking day.[18]
Assessment[edit]
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.[146]
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.[146]
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.[147][148] Sleep questionnaires such as the Sleep Timing Questionnaire (STQ) and Tayside children’s sleep questionnaire can be used instead of sleep diaries if there is any concern for patient adherence.[149][150]
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.[151][152][153][154]
Management[edit]
Although there are numerous causes of sleep deprivation, there are some fundamental measures that promote quality sleep, as suggested by organizations such as the Centers for Disease Control and Prevention, the National Institute of Health, the National Institute of Aging, and the American Academy of Family Physicians. Historically, sleep hygiene, as first medically defined by Hauri in 1977,[155] was the standard for promoting healthy sleep habits, but evidence that has emerged since the 2010s suggests they are ineffective, both for people with insomnia[156] and for people without.[155] The key is to implement healthier sleep habits, also known as sleep hygiene.[157] 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 mattresses 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.[158]
For long-term involuntary sleep deprivation, cognitive behavioral therapy for insomnia (CBT-i) is recommended as a first-line treatment after the exclusion of a physical diagnosis (e.g., sleep apnea).[156] CBT-i contains five different components: cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation. As this approach has minimal adverse effects and long-term benefits, it is often preferred to (chronic) drug therapy.[159]
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.[160] 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.[161]
Wearable devices such as FitBits and Apple Watches monitor various body signals, including heart rate, skin temperature, and movement, to provide information about sleep patterns. They operate continuously, collecting extensive data which can be used to offer insights on sleep improvement. These devices are user-friendly and have increased awareness about the significance of quality sleep for health.[162]
Uses[edit]
To facilitate abusive control[edit]
Sleep deprivation can be used to disorient abuse victims to help set them up for abusive control.[163][164]
Interrogation[edit]
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.[165]
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:
Longest periods without sleep[edit]
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.[125] 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.[125][194][195]
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.[194]
Claims of total sleep deprivation lasting years have been made several times,[196][197][198] but none are scientifically verified.[199] 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.[200][201]
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 that 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.[202]
Fatal insomnia is a neurodegenerative disease that eventually results 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.