Sleep deprivation

==Uses==

===To facilitate abusive control===
Sleep deprivation can be used to disorient [[abuse]] victims to help set them up for [[abusive power and control|abusive control]].<ref>{{Cite web |title=Sleep Deprivation Used as Abuse Tactic |url=https://www.domesticshelters.org/articles/identifying-abuse/sleep-deprivation-as-abuse |access-date=2023-01-31 |website=DomesticShelters.org |language=en-US}}</ref><ref>{{Cite web |url=https://federation.edu.au/staff/working-at-feduni/feduni-against-violence/family-and-domestic-violence?a=282376 |title=Family and Domestic Violence - Healthy Work Healthy Living Tip Sheet |access-date=21 January 2019 |archive-date=19 May 2019 |archive-url=https://web.archive.org/web/20190519200619/https://federation.edu.au/staff/working-at-feduni/feduni-against-violence/family-and-domestic-violence?a=282376 |url-status=dead }}</ref>

===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]].<ref>{{cite news|date=2 October 2009|title=Binyam Mohamed torture appeal lost by UK government...|work=BBC News|url=http://news.bbc.co.uk/2/hi/uk_news/8507852.stm|url-status=live|archive-url=https://web.archive.org/web/20100211025746/http://news.bbc.co.uk/2/hi/uk_news/8507852.stm|archive-date=11 February 2010}}</ref>

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:
{{Blockquote|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.<ref>{{cite book | vauthors = Begin M |title=White nights: the story of a prisoner in Russia |publisher=Harper & Row |location=San Francisco |year=1979 |isbn=978-0-06-010289-0 |url-access=registration |url=https://archive.org/details/whitenightsstory00begi }}</ref>}}

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 or degrading treatment|inhuman and degrading treatment]]", in breach of the [[European Convention on Human Rights]].<ref name="Ireland v. UK-102">{{Cite web |title=HUDOC - European Court of Human Rights |url=https://hudoc.echr.coe.int/eng |access-date=2023-01-31 |website=hudoc.echr.coe.int}}</ref>

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 ({{frac|7|1|2}} days)<ref name="latimes2009-04-17">{{cite news| vauthors = Miller G, Meyer J |date=17 April 2009|title=Obama assures intelligence officials they won't be prosecuted over interrogations|newspaper=[[Los Angeles Times]]|url=https://articles.latimes.com/2009/apr/17/nation/na-interrogation17|access-date=10 July 2016}}</ref><ref name="memo10May2005-1">{{cite web| vauthors = Bradbury SG |date=10 May 2005|title=Memorandum for John Rizzo |url= http://media.luxmedia.com/aclu/olc_05102005_bradbury46pg.pdf |url-status=dead|archive-url=https://web.archive.org/web/20111106150408/http://media.luxmedia.com/aclu/olc_05102005_bradbury46pg.pdf|archive-date=6 November 2011|access-date=24 October 2011|publisher=ACLU|page=14}}</ref> by shackling a diapered prisoner to the ceiling did not constitute torture,<ref name="time">{{cite news| vauthors = Scherer M |date=21 April 2009|title=Scientists Claim CIA Misused Work on Sleep Deprivation|newspaper=[[Time (magazine)|Time]]|url=http://content.time.com/time/nation/article/0,8599,1892897,00.html|access-date=2 February 2017}}</ref> nor did the combination of multiple interrogation methods (including sleep deprivation) constitute torture under United States law.<ref name="Explaining and Authorizing Specific Interrogation Techniques">{{cite news|date=17 April 2009|title=Explaining and Authorizing Specific Interrogation Techniques|work=The New York Times|url=https://www.nytimes.com/interactive/2009/04/17/us/politics/20090417-interrogation-techniques.html|url-status=live|archive-url=https://web.archive.org/web/20171019152619/http://www.nytimes.com/interactive/2009/04/17/us/politics/20090417-interrogation-techniques.html|archive-date=19 October 2017}}</ref><ref name="OPR">{{cite report|url=https://www.aclu.org/files/pdfs/natsec/opr20100219/20090729_OPR_Final_Report_with_20100719_declassifications.pdf|title=Investigation into the Office of Legal Counsel's Memoranda Concerning Issues Relating to the Central Intelligence Agency's Use of "Enhanced Interrogation Techniques" on Suspected Terrorists|author=Department of Justice Office of Professional Responsibility|date=29 July 2009|publisher=[[United States Department of Justice]]|pages=133–138|author-link=Office of Professional Responsibility|access-date=29 May 2017}}</ref> These memoranda were repudiated and withdrawn during the first months of the Obama administration.<ref name="latimes2009-04-17" />

The question of the 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.<ref name="SleepTorture2">{{cite news| vauthors = Hassan T |date=3 October 2006|title=Sleep deprivation remains red-hot question|work=PM|publisher=abc.net.au|url=http://www.abc.net.au/pm/content/2006/s1754821.htm|url-status=live|archive-url=https://web.archive.org/web/20071011211903/http://abc.net.au/pm/content/2006/s1754821.htm|archive-date=11 October 2007}}</ref> Nicole Bieske, a spokeswoman for Amnesty International Australia, has stated the opinion of her organization as follows: "At the very least, sleep deprivation is cruel, inhumane and degrading. If used for prolonged periods of time it is torture."<ref name="SleepTorture">{{cite news|date=3 October 2006|title=Sleep deprivation is torture: Amnesty|work=The Sydney Morning Herald|agency=AAP|url=https://www.smh.com.au/news/National/Sleep-deprivation-is-torture-Amnesty/2006/10/03/1159641317450.html|url-status=live|archive-url=https://web.archive.org/web/20071027141433/http://www.smh.com.au/news/National/Sleep-deprivation-is-torture-Amnesty/2006/10/03/1159641317450.html|archive-date=27 October 2007}}</ref>

===Treating depression===
{{Further|Sleep Deprivation Therapy}}
Studies show that sleep restriction has some potential for treating [[Major depressive disorder|depression]].<ref name="Sleep and depression review"/> 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.<ref>{{Cite book| vauthors = Carlson N |title=Physiology of Behavior|publisher=Pearson|year=2013|isbn=978-0-205-23939-9|edition=11th|location=Boston|pages=578–579}}</ref> 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 [[brain-derived neurotrophic factor]] (BDNF).<ref>{{cite journal | vauthors = Gorgulu Y, Caliyurt O | title = Rapid antidepressant effects of sleep deprivation therapy correlates with serum BDNF changes in major depression | journal = Brain Research Bulletin | volume = 80 | issue = 3 | pages = 158–162 | date = September 2009 | pmid = 19576267 | doi = 10.1016/j.brainresbull.2009.06.016 | s2cid = 7672556 }}</ref>  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.<ref>{{cite journal | vauthors = Davies SK, Ang JE, Revell VL, Holmes B, Mann A, Robertson FP, Cui N, Middleton B, Ackermann K, Kayser M, Thumser AE, Raynaud FI, Skene DJ | title = Effect of sleep deprivation on the human metabolome | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 111 | issue = 29 | pages = 10761–10766 | date = July 2014 | pmid = 25002497 | pmc = 4115565 | doi = 10.1073/pnas.1402663111 | bibcode = 2014PNAS..11110761D | doi-access = free }}</ref>

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).<ref name="Ncbi">{{cite journal | vauthors = Wirz-Justice A, Van den Hoofdakker RH | title = Sleep deprivation in depression: what do we know, where do we go? | journal = Biological Psychiatry | volume = 46 | issue = 4 | pages = 445–453 | date = August 1999 | pmid = 10459393 | doi = 10.1016/S0006-3223(99)00125-0 | s2cid = 15428567 }}</ref><ref>{{cite journal | vauthors = Wirz-Justice A, Benedetti F, Berger M, Lam RW, Martiny K, Terman M, Wu JC | title = Chronotherapeutics (light and wake therapy) in affective disorders | journal = Psychological Medicine | volume = 35 | issue = 7 | pages = 939–944 | date = July 2005 | pmid = 16045060 | doi = 10.1017/S003329170500437X | doi-access = free }}</ref> Many [[tricyclic antidepressants]] suppress REM sleep, providing additional evidence for a link between [[mood (psychology)|mood]] and sleep.<ref name="SleepDepEmedicinehealth">{{cite web | url = http://www.emedicinehealth.com/articles/42677-5.asp | title = Disorders That Disrupt Sleep (Parasomnias) | archive-url = https://web.archive.org/web/20051222202250/http://www.emedicinehealth.com/articles/42677-5.asp| archive-date=22 December 2005 | work = eMedicineHealth }}</ref> 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.<ref name=":3">{{Citation | vauthors = Perlis M, Gehrman P |title=Psychophysiological Insomnia |date=2013 |encyclopedia=Encyclopedia of Sleep |pages=203–204 |publisher=Elsevier |doi=10.1016/b978-0-12-378610-4.00177-7 |isbn=978-0-12-378611-1 }}</ref> One of the components is a controlled regime of "sleep restriction" in order to restore the [[Homeostasis|homeostatic]] drive to sleep and encourage normal "sleep efficiency".<ref name="auto2">{{cite journal | vauthors = Miller CB, Espie CA, Epstein DR, Friedman L, Morin CM, Pigeon WR, Spielman AJ, Kyle SD | title = The evidence base of sleep restriction therapy for treating insomnia disorder | journal = Sleep Medicine Reviews | volume = 18 | issue = 5 | pages = 415–424 | date = October 2014 | pmid = 24629826 | doi = 10.1016/j.smrv.2014.01.006 }}</ref> Stimulus control therapy is intended to limit behaviors intended to condition the body to sleep while in bed.<ref name=":3"/> The main goal of stimulus control and [[Cognitive behavioral therapy for insomnia#Sleep restriction therapy|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.<ref name="auto2"/><ref name="Trauer 191" /> 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.<ref name=":3"/><ref name="AASM-behavioral-therapies-2021" /> Light stimulation affects the supraoptic nucleus of the hypothalamus, controlling circadian rhythm and inhibiting the secretion of melatonin from the pineal gland. Light therapy can improve sleep quality, improve sleep efficiency, and extend sleep duration by helping to establish and consolidate regular sleep-wake cycles. Light therapy is a natural, simple, low-cost treatment that does not lead to residual effects or tolerance. Adverse reactions include headaches and eye fatigue and can also induce mania.<ref>{{Cite journal |date=2017-06-27 |title=中国失眠症诊断和治疗指南 | trans-title = Guidelines for Diagnosis and Treatment of Insomnia in China |language=zh  | url=https://rs.yiigle.com/CN112137201724/993548.htm |journal=National Medical Journal of China |volume=97 |issue=24 |pages=1844–1856 |doi=10.3760/cma.j.issn.0376-2491.2017.24.002 |issn=0376-2491}}</ref>

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.<ref name=":3"/>

=== Military training ===
Sleep deprivation has become hardwired into the military culture. It is prevalent in the entire force and especially severe for servicemembers deployed in high-conflict environments.<ref name=":5">{{Cite web | vauthors = Irving D |date=2017-03-01 |title=The Costs of Poor Sleep Are Staggering |url=https://www.rand.org/pubs/articles/2017/the-costs-of-poor-sleep-are-staggering.html |website=RAND}}</ref><ref name=":6">{{Cite book | vauthors = Troxel W, Shih R, Pedersen E, Geyer L, Fisher M, Griffin BA, Haas A, Kurz J, Steinberg P |date=2015 |title=Improving Sleep Health for U.S. Servicemembers: Policies, Programs, Barriers to Implementation, and Recommendations  |doi=10.7249/rb9824 |isbn=978-0-8330-8851-2}}</ref>

Sleep deprivation has been used by the [[military]] in training programs to prepare personnel for combat experiences when proper sleep schedules aren't realistic. Sleep deprivation is used to create a different 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.{{Citation needed|date=December 2023}}

DARPA initiated sleep research to create a highly resilient soldier capable of sustaining extremely prolonged wakefulness, inspired by the white-crowned sparrow's week-long sleeplessness during migration, at a time when it was not understood that [[Unihemispheric slow-wave sleep|migration birds actually slept with half of their brain]]. This pursuit aimed both to produce a "super soldier" able "to go for a minimum of seven days without sleep, and in the longer term perhaps at least double that time frame, while preserving high levels of mental and physical performance", and to enhance productivity in sleep-deprived personnel. Military experiments on sleep have been conducted on combatants and prisoners, such as those in Guantánamo, where controlled lighting is combined with torture techniques to manipulate sensory experiences. Crary highlights how constant illumination and the removal of day-night distinctions create what he defines as a "time of indifference," utilizing light management as a form of psychological control.<ref>{{Cite journal | vauthors = Eriksson M, Juárez G |date=2017 |title=The Biopolitics of Melanopic Illuminance |url=http://www.scapegoatjournal.org/docs/10/14.pdf |journal=Scapegoat |issue=10 |archive-url=https://web.archive.org/web/20210905132205/http://www.scapegoatjournal.org/docs/10/14.pdf |archive-date=2021-09-05}}</ref><ref>{{Cite book | vauthors = Crary J |title=24/7: late capitalism and the ends of sleep |date=2014 |publisher=Verso |isbn=978-1-78168-310-1 |edition= |location=London}}</ref>

However, studies have since evaluated the impact of the sleep deprivation imprint on the military culture. Personnel surveys reveal common challenges such as inadequate sleep, fatigue, and impaired daytime functioning, impacting operational effectiveness and post-deployment reintegration. These sleep issues elevate the risk of severe mental health disorders, including PTSD and depression. Early intervention is crucial. Though promising, implementing cognitive-behavioral and imagery-rehearsal therapies for insomnia remains a challenge. Several high-profile military accidents caused in part or fully by sleep deprivation of personnel have been documented. The military has prioritized sleep education, with recent Army guidelines equating sleep importance to nutrition and exercise. The Navy, particularly influenced by retired Captain John Cordle, has actively experimented with watch schedules to align shipboard life with sailors' circadian needs, leading to improved sleep patterns, especially in submarines, supported by ongoing research efforts at the Naval Postgraduate School. Watch schedules with longer and more reliable resting intervals are nowadays the norm on U.S. submarines and a recommended option for surface ships.<ref name=":5" /><ref name=":6" />

In addition to sleep deprivation, circadian misalignment, as commonly experienced by submarine crews, causes several long-term health issues and a decrease in cognitive performance.<ref>{{cite journal | vauthors = Guo JH, Ma XH, Ma H, Zhang Y, Tian ZQ, Wang X, Shao YC | title = Circadian misalignment on submarines and other non-24-h environments - from research to application | journal = Military Medical Research | volume = 7 | issue = 1 | pages = 39 | date = August 2020 | pmid = 32814592 | pmc = 7437048 | doi = 10.1186/s40779-020-00268-2 | doi-access = free }}</ref>