Sleep deprivation

==Causes==

===Insomnia===
{{Main|Insomnia}}
[[Insomnia]], one of the six types of [[dyssomnia]], affects 21–37% of the adult population.<ref name="UKInsomnia">{{cite journal | vauthors = Morphy H, Dunn KM, Lewis M, Boardman HF, Croft PR | title = Epidemiology of insomnia: a longitudinal study in a UK population | journal = Sleep | volume = 30 | issue = 3 | pages = 274–280 | date = March 2007 | pmid = 17425223 | url = http://www.journalsleep.org/ViewAbstract.aspx?pid=26762 | url-status = live | access-date = 13 December 2015 | archive-url = https://web.archive.org/web/20151222082309/http://www.journalsleep.org/ViewAbstract.aspx?pid=26762 | archive-date = 22 December 2015 }}</ref><ref name="JapanInsomnia">{{cite journal | vauthors = Kim K, Uchiyama M, Okawa M, Liu X, Ogihara R | title = An epidemiological study of insomnia among the Japanese general population | journal = Sleep | volume = 23 | issue = 1 | pages = 41–47 | date = February 2000 | pmid = 10678464 | doi = 10.1093/sleep/23.1.1a | doi-access = free }}</ref><ref>{{Cite journal | vauthors = Rajaee Rizi F, Asgarian FS |date=2022-08-24 |title=Reliability, validity, and psychometric properties of the Persian version of the Tayside children's sleep questionnaire|journal=Sleep and Biological Rhythms |volume=21 |issue=1 |pages=97–103 |language=en |doi=10.1007/s41105-022-00420-6 |pmid=38468908 |s2cid=245863909 |issn=1479-8425|pmc=10899986 }}</ref> 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 [[Comorbidity|comorbid]], insomnia.<ref name="WHO">{{cite web|title=Dyssomnias|url=https://www.who.int/selection_medicines/committees/expert/17/application/Section24_GAD.pdf|url-status=live|archive-url=https://web.archive.org/web/20090318104517/http://www.who.int/selection_medicines/committees/expert/17/application/Section24_GAD.pdf|archive-date=18 March 2009|access-date=25 January 2009|publisher=WHO|pages=7–11}}</ref><ref>{{cite journal | vauthors = Buysse DJ | title = Chronic insomnia | journal = The American Journal of Psychiatry | volume = 165 | issue = 6 | pages = 678–686 | date = June 2008 | pmid = 18519533 | pmc = 2859710 | doi = 10.1176/appi.ajp.2008.08010129 | quote = For this reason, the NIH conference [of 2005] commended the term "comorbid insomnia" as a preferable alternative to the term "secondary insomnia." }}</ref><ref>{{Cite journal| vauthors = Erman MK | title = Insomnia: Comorbidities and Consequences | journal = Primary Psychiatry | date = 2007 | volume = 14 | issue = 6 | pages = 31–35 |url=http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=1102|url-status=live |archive-url= https://web.archive.org/web/20110715113025/http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=1102 |archive-date=15 July 2011|quote=Two general categories of insomnia exist, primary insomnia and comorbid insomnia.}}</ref>

Primary insomnia is a [[sleep disorder]] not attributable to a medical, psychiatric, or environmental cause.<ref>{{cite web|author=World Health Organization|year=2007|title=Quantifying burden of disease from environmental noise|url=http://www.euro.who.int/__data/assets/pdf_file/0005/87638/Noise_EDB_2nd_mtg.pdf|url-status=live|archive-url=https://web.archive.org/web/20101123213411/http://www.euro.who.int/__data/assets/pdf_file/0005/87638/Noise_EDB_2nd_mtg.pdf|archive-date=23 November 2010|access-date=22 September 2010|page=20}}</ref> There are three main types of primary insomnia. These include psychophysiological, idiopathic insomnia, and [[sleep state misperception]] (paradoxical insomnia).<ref name="WHO" /> Psychophysiological insomnia is anxiety-induced. Idiopathic insomnia generally begins in childhood and lasts for 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.<ref>{{cite journal | vauthors = Lai C, Qiu H | title = Paradoxical Insomnia: Misperception of Sleep Can Be a Tormenting Experience | journal = American Family Physician | volume = 95 | issue = 12 | pages = 770 | date = June 2017 | pmid = 28671423 | url = https://www.aafp.org/afp/2017/0615/p770.html | access-date = 10 May 2020 }}</ref>

Secondary insomnia, or comorbid insomnia, occurs concurrently with other medical, neurological, psychological, and psychiatric conditions. Causation is not necessarily implied.<ref>Biological Rhythms, Sleep and Hypnosis by Simon Green</ref> Causes can be from depression, anxiety, and personality disorders.<ref>{{cite journal | vauthors = McCrae CS, Lichstein KL | title = Secondary insomnia: diagnostic challenges and intervention opportunities | journal = Sleep Medicine Reviews | volume = 5 | issue = 1 | pages = 47–61 | date = February 2001 | pmid = 12531044 | doi = 10.1053/smrv.2000.0146 }}</ref>

Sleep deprivation is known to be cumulative. This means that the fatigue and sleep one lost as a result of, for example, staying awake all night, would be carried over to the following day.<ref>{{Cite web |date=2010-01-20 |title=Sleep Debt: Can You Catch up on Sleep? |url=https://www.sleepfoundation.org/how-sleep-works/sleep-debt-and-catch-up-sleep |access-date=2022-06-27 |website=Sleep Foundation |language=en}}</ref> Not getting enough sleep for a couple of days cumulatively builds up a deficiency and causes symptoms of sleep deprivation to appear. A well-rested and healthy individual will generally spend less time in the [[Rapid eye movement sleep|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.<ref>{{Cite book| vauthors = Plaford GR |title=Sleep and learning : the magic that makes us healthy and smart|year=2009|isbn=978-1-60709-091-5|location=Lanham | publisher = Rowman & Littlefield Education |oclc=310224798}}</ref> Short-term insomnia can be induced by stress or when the body experiences changes in environment and regimen.<ref>{{Cite web |date=2022-03-24 |title=Insomnia - What Is Insomnia? {{!}} NHLBI, NIH |url=https://www.nhlbi.nih.gov/health/insomnia |access-date=2023-10-19 |website=www.nhlbi.nih.gov |language=en}}</ref>

===Sleep apnea===
{{Main|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, and difficulty concentrating.<ref name="mayoclinic.org">{{Cite web |title=Obstructive sleep apnea - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090 |access-date=2022-04-17 |website=Mayo Clinic |language=en}}</ref> 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 1 to 10 percent of Americans.<ref>{{Cite book| vauthors = Zammit GK |url=https://archive.org/details/goodnightshowtos00zamm|title=Good nights : how to stop sleep deprivation, overcome insomnia, and get the sleep you need|date=1997|publisher=Andrews and McMeel|others=Zanca, Jane A.|isbn=0-8362-2188-5|location=Kansas City|oclc=35849087|url-access=registration}}</ref> It has many serious health outcomes if left untreated. [[Positive airway pressure]] therapy using CPAP ([[continuous positive airway pressure]]), APAP, or BPAP devices is considered the first-line treatment option for sleep apnea.<ref name="pmid26336596">{{cite journal | vauthors = Spicuzza L, Caruso D, Di Maria G | title = Obstructive sleep apnoea syndrome and its management | journal = Therapeutic Advances in Chronic Disease | volume = 6 | issue = 5 | pages = 273–85 | date = September 2015 | pmid = 26336596 | pmc = 4549693 | doi = 10.1177/2040622315590318 }}</ref>

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.<ref>{{cite journal | vauthors = Muza RT | title = Central sleep apnoea-a clinical review | journal = Journal of Thoracic Disease | volume = 7 | issue = 5 | pages = 930–937 | date = May 2015 | pmid = 26101651 | pmc = 4454847 | doi = 10.3978/j.issn.2072-1439.2015.04.45 }}</ref>

===Self-imposed===
Sleep deprivation can sometimes be self-imposed due to a lack of desire to sleep or the habitual use of stimulant drugs.<ref name="auto1">{{Cite web |date=2021-02-23 |title=Revenge Bedtime Procrastination: Definition & Psychology |url=https://www.sleepfoundation.org/sleep-hygiene/revenge-bedtime-procrastination |access-date=2024-03-13 |website=Sleep Foundation |language=en-US}}</ref>

Revenge Bedtime Procrastination, which is a need to stay up late after a busy day to feel like the day is longer. Leading to sleep deprivation from staying up and wanting to make the day "seem/feel" longer. <ref name="auto1"/>

====Caffeine====
[[File:Health effects of caffeine.png|thumb|300x300px|This diagram shows how caffeine affects the different areas of the body, both positively and negatively.]]
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.<ref>{{cite journal | vauthors = Chaudhary NS, Grandner MA, Jackson NJ, Chakravorty S | title = Caffeine consumption, insomnia, and sleep duration: Results from a nationally representative sample | journal = Nutrition | volume = 32 | issue = 11–12 | pages = 1193–1199 | date = 2016-11-01 | pmid = 27377580 | pmc = 6230475 | doi = 10.1016/j.nut.2016.04.005 }}</ref> Consuming caffeine to stay awake at night may lead to sleeplessness, anxiety, frequent nighttime awakenings, and overall poorer sleep quality.<ref>{{Cite web |date=2009-04-17 |title=Caffeine's Connection to Sleep Problems |url=https://www.sleepfoundation.org/nutrition/caffeine-and-sleep |access-date=2022-04-17 |website=Sleep Foundation |language=en}}</ref>

===Mental illness===
The specific causal relationships between sleep loss and effects on psychiatric disorders have been most extensively studied in patients with mood disorders.<ref>{{cite journal | vauthors = Benca RM | title = Sleep in psychiatric disorders | journal = Neurologic Clinics | volume = 14 | issue = 4 | pages = 739–764 | date = November 1996 | pmid = 8923493 | doi = 10.1016/s0733-8619(05)70283-8 }}</ref>{{medical citation needed|date=March 2021}} Shifts into [[mania]] in bipolar patients are often preceded by periods of [[insomnia]],<ref>{{cite journal | vauthors = McKenna BS, Eyler LT | title = Overlapping prefrontal systems involved in cognitive and emotional processing in euthymic bipolar disorder and following sleep deprivation: a review of functional neuroimaging studies | journal = Clinical Psychology Review | volume = 32 | issue = 7 | pages = 650–663 | date = November 2012 | pmid = 22926687 | pmc = 3922056 | doi = 10.1016/j.cpr.2012.07.003 }}</ref> and sleep deprivation has been shown to induce a manic state in about 30% of patients.<ref>{{cite journal | vauthors = Young JW, Dulcis D | title = Investigating the mechanism(s) underlying switching between states in bipolar disorder | journal = European Journal of Pharmacology | volume = 759 | pages = 151–162 | date = July 2015 | pmid = 25814263 | pmc = 4437855 | doi = 10.1016/j.ejphar.2015.03.019 }}</ref> Sleep deprivation may represent a final common pathway in the genesis of mania,<ref>{{cite journal | vauthors = Wehr TA, Sack DA, Rosenthal NE | title = Sleep reduction as a final common pathway in the genesis of mania | journal = The American Journal of Psychiatry | volume = 144 | issue = 2 | pages = 201–204 | date = February 1987 | pmid = 3812788 | doi = 10.1176/ajp.144.2.201 }}</ref> and manic patients usually have a continuous reduced need for sleep.<ref>{{cite book|author=American Psychiatry Association|title=Diagnostic and Statistical Manual of Mental Disorders|date=2013|publisher=American Psychiatric Publishing |location=Arlington |isbn=978-0-89042-555-8 |pages=123–154 |edition=5th}}</ref>

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).<ref name="mayoclinic.org"/>

The symptoms of sleep deprivation and those of [[schizophrenia]] are parallel, including those of positive and cognitive symptoms.<ref name="Pocivavsek">{{cite journal | vauthors = Pocivavsek A, Rowland LM | title = Basic Neuroscience Illuminates Causal Relationship Between Sleep and Memory: Translating to Schizophrenia | journal = Schizophrenia Bulletin | volume = 44 | issue = 1 | pages = 7–14 | date = January 2018 | pmid = 29136236 | pmc = 5768044 | doi = 10.1093/schbul/sbx151 }}</ref>

===School===
{{See also|Sleep deprivation in higher education}}

The [[United States|U.S.]] [[National Sleep Foundation]] cites a 1996 paper showing that college/university-aged students get an average of less than 6 hours of sleep each night.<ref>{{Cite web|title=National Sleep Foundation Key Messages/Talking Points|url=https://sleepfoundation.org/sites/default/files/Drowsy%20Driving-Key%20Messages%20and%20Talking%20Points.pdf|url-status=live|archive-url=https://web.archive.org/web/20160418142432/https://sleepfoundation.org/sites/default/files/Drowsy%20Driving-Key%20Messages%20and%20Talking%20Points.pdf|archive-date=18 April 2016|access-date=18 April 2016}}</ref> 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 did not.<ref>{{Cite web| vauthors = Schroeder J |date=7 December 2018|title=Students Who Sleep 8 Hours Score Higher On Final Exams|url=https://www.tun.com/blog/students-who-sleep-8-hours-score-higher-on-final-exams/|access-date=10 December 2018|website=The University Network}}</ref>

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.<ref>{{cite journal | vauthors = Hershner SD, Chervin RD | title = Causes and consequences of sleepiness among college students | journal = Nature and Science of Sleep | volume = 6 | pages = 73–84 | date = 23 June 2014 | pmid = 25018659 | pmc = 4075951 | doi = 10.2147/NSS.S62907 | doi-access = free }}</ref> 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.<ref>{{cite journal | vauthors = Estevan I, Sardi R, Tejera AC, Silva A, Tassino B | title = Should I study or should I go (to sleep)? The influence of test schedule on the sleep behavior of undergraduates and its association with performance | journal = PLOS ONE | volume = 16 | issue = 3 | pages = e0247104 | date = March 10, 2021 | pmid = 33690625 | pmc = 7946303 | doi = 10.1371/journal.pone.0247104 | doi-access = free | bibcode = 2021PLoSO..1647104E }}</ref>

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.<ref name="Sleep patterns in college students; Gender and grade differences">{{cite journal | vauthors = Tsai LL, Li SP | title = Sleep patterns in college students: gender and grade differences | journal = Journal of Psychosomatic Research | volume = 56 | issue = 2 | pages = 231–237 | date = February 2004 | pmid = 15016583 | doi = 10.1016/S0022-3999(03)00507-5 | url = http://www.websciences.org/cftemplate/NAPS/archives/indiv.cfm?ID=20041266 | url-status = live | archive-url = https://web.archive.org/web/20081220062545/http://www.websciences.org/cftemplate/NAPS/archives/indiv.cfm?ID=20041266 | archive-date = 20 December 2008 }}</ref>

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.<ref name = "Kelly_2014">{{cite journal| vauthors = Kelley P, Lockley SW, Foster RG, Kelley J |date=1 August 2014|title=Synchronizing education to adolescent biology: 'let teens sleep, start school later'|journal=Learning, Media and Technology|volume=40|issue=2|page=220|doi=10.1080/17439884.2014.942666|doi-access=free}}</ref> Data from international studies demonstrate that "synchronized" start times for adolescents are far later than the start times in the overwhelming majority of educational institutions.<ref name = "Kelly_2014" /> In 1997, [[University of Minnesota]] researchers compared students who started school at 7:15&nbsp;a.m. with those who started at 8:40&nbsp;a.m. They found that students who started at 8:40 got higher grades and more sleep on weekday nights than those who started earlier.<ref name="SleepDepReport" /> One in four U.S. high school students admits to falling asleep in class at least once a week.<ref name="SleepDepAbcNews">{{cite news| vauthors = Schmid RE |date=28 March 2006|title=Sleep-deprived teens dozing off at school|work=ABC News|agency=Associated Press|url=https://abcnews.go.com/US/wireStory?id=1775003|url-status=dead|archive-url=https://web.archive.org/web/20061208094359/https://abcnews.go.com/US/wireStory?id=1775003|archive-date=8 December 2006}}</ref>

It is known that during human adolescence, [[circadian rhythm]]s and, therefore, sleep patterns typically undergo marked changes. [[Electroencephalography|Electroencephalogram]] (EEG) studies indicate a 50% reduction in 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.<ref>{{cite journal | vauthors = Giedd JN | title = Linking adolescent sleep, brain maturation, and behavior | journal = The Journal of Adolescent Health | volume = 45 | issue = 4 | pages = 319–320 | date = October 2009 | pmid = 19766933 | pmc = 3018343 | doi = 10.1016/j.jadohealth.2009.07.007 }}</ref>

=== 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 the noise of other patients, medical devices, pain, and toilet visits.<ref>{{cite journal | vauthors = Wesselius HM, van den Ende ES, Alsma J, Ter Maaten JC, Schuit SC, Stassen PM, de Vries OJ, Kaasjager KH, Haak HR, van Doormaal FF, Hoogerwerf JJ, Terwee CB, van de Ven PM, Bosch FH, van Someren EJ, Nanayakkara PW | title = Quality and Quantity of Sleep and Factors Associated With Sleep Disturbance in Hospitalized Patients | journal = JAMA Internal Medicine | volume = 178 | issue = 9 | pages = 1201–1208 | date = September 2018 | pmid = 30014139 | pmc = 6142965 | doi = 10.1001/jamainternmed.2018.2669 }}</ref>  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.<ref>{{cite journal | vauthors = Shilo L, Dagan Y, Smorjik Y, Weinberg U, Dolev S, Komptel B, Balaum H, Shenkman L | title = Patients in the intensive care unit suffer from severe lack of sleep associated with loss of normal melatonin secretion pattern | journal = The American Journal of the Medical Sciences | volume = 317 | issue = 5 | pages = 278–281 | date = May 1999 | pmid = 10334113 | doi = 10.1016/s0002-9629(15)40528-2 }}</ref> 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 improve the hospital environment.<ref>{{cite journal | vauthors = Tan X, van Egmond L, Partinen M, Lange T, Benedict C | title = A narrative review of interventions for improving sleep and reducing circadian disruption in medical inpatients | journal = Sleep Medicine | volume = 59 | pages = 42–50 | date = July 2019 | pmid = 30415906 | doi = 10.1016/j.sleep.2018.08.007 | doi-access = free }}</ref>

=== The Internet ===
A study published in the [[Journal of Economic Behavior and Organization]] found that broadband internet connection was associated with sleep deprivation. The study concluded that people with a broadband connection tend to sleep 25 minutes less than those without a broadband connection; hence, they are less likely to get the scientifically recommended 7–9 hours of sleep.<ref>{{Cite news|title=Broadband internet causes sleep deprivation, a new study finds|work=ScienceDaily|url=https://www.sciencedaily.com/releases/2018/08/180802102340.htm|access-date=10 August 2018}}</ref> 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.<ref>{{cite journal | vauthors = Alshobaili FA, AlYousefi NA | title = The effect of smartphone usage at bedtime on sleep quality among Saudi non- medical staff at King Saud University Medical City | journal = Journal of Family Medicine and Primary Care | volume = 8 | issue = 6 | pages = 1953–1957 | date = June 2019 | pmid = 31334161 | pmc = 6618184 | doi = 10.4103/jfmpc.jfmpc_269_19 | doi-access = free }}</ref> Overall, internet usage an hour before bedtime has been found to disrupt sleeping patterns.

=== Shift work ===
Many businesses are operational 24/7, such as airlines, hospitals, etc., where workers perform their duties in different shifts. [[Shift work]] patterns cause sleep deprivation and lead to poor concentration, detrimental health effects, and fatigue. Shift work remains an unspoken challenge within industries, often disregarded by both employers and employees alike, leading to an increase in occupational injuries. A worker experiencing fatigue poses a potential danger, not only to themselves, but also to others around them. Both employers and employees must acknowledge the risks associated with sleep deprivation and on-the-job fatigue to effectively mitigate the chances of occupational injuries.<ref>{{Cite web | vauthors = Malik A |date=1 May 2020 |title=Correlation Between Shiftwork, Sleep & Fatigue and Increased Occupational Injuries in a Manufacturing Plant in Pakistan |url=https://aiha-assets.sfo2.digitaloceanspaces.com/AIHA/aihce/2020/Documents/1740.pdf}}</ref>