Sleep deprivation Warning: You are not logged in. Your IP address will be publicly visible if you make any edits. If you log in or create an account, your edits will be attributed to your username, along with other benefits.Anti-spam check. Do not fill this in! {{Short description|Condition of not having enough sleep}} {{cs1 config|name-list-style=vanc|display-authors=6}} {{Use dmy dates|date=January 2021}} {{Distinguish|Insomnia}} [[File:2023 CDC recommendations for amount of sleep needed, by age.svg |thumb |The Centers for Disease Control and Prevention's (CDC) recommendations for the amount of sleep needed decrease with age.<ref name=CDC_sleep/> While sleep quantity is important, good sleep quality is also essential to avoid sleep disorders.<ref name=CDC_sleep>{{cite web |title=How Much Sleep Do I Need? |url=https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html |website=CDC.gov |date=14 September 2022 |publisher=Centers for Disease Control and Prevention (CDC) |archive-url=https://web.archive.org/web/20231102143914/https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html |archive-date=2 November 2023 |quote=Last Reviewed: September 14, 2022. Source: National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. |url-status=live }}</ref>]] {{Infobox medical condition (new) | name = Sleep deprivation | image = | caption = | field = [[Sleep medicine]] | symptoms = [[Fatigue]], [[Periorbital puffiness|eye bags]], poor memory, irritable mood, weight gain | complications = Car and work accidents, weight gain, [[cardiovascular disease]] | onset = | duration = | causes = [[Insomnia]], [[sleep apnea]], [[stimulant]]s (caffeine, amphetamine), voluntary imposition (school, work), [[mood disorder]]s | risks = | diagnosis = | differential = | prevention = | treatment = [[Cognitive behavioral therapy]], [[caffeine]] (to induce alertness), [[sleeping pill]]s | medication = | prognosis = | frequency = | deaths = }} '''Sleep deprivation''', also known as '''sleep insufficiency'''<ref name=":4">{{cite book | vauthors = Amin F, Sankari A | chapter= Sleep Insufficiency |date=2022 | chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK585109/ | title = StatPearls |access-date=2023-05-18 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=36256756 }}</ref> 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 (medicine)|chronic]] or [[Acute (medicine)|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.<ref name=":4" /> 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.<ref>{{cite web | vauthors = Suni E, Dimitriu A | date = 25 July 2023 | title = Sleep Deprivation: Understanding the Hidden Consequences | url = https://www.sleepfoundation.org/sleep-deprivation | work = SleepFoundation.org }}</ref> 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]]{{Citation needed|date=May 2023}}. 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.<ref>{{Cite journal | vauthors = Mai Z, Xu H, Ma N | title = Research progress on the impact of acute sleep deprivation on cognitive and emotional functions and its neural mechanisms. | journal = Chinese General Medicine | date = October 2021 | volume = 24 | issue = 29 | pages = 3653–3659 | doi=10.12114/j.issn.1007-9572.2021.01.016 | language = zh }}</ref> Sleep-deprived people are able to fall asleep rapidly when allowed, but those with insomnia have difficulty falling asleep overall.<ref>{{Cite book| title=International Classification of Sleep Disorders |location=Darien, IL |publisher=American Academy of Sleep Medicine |year=2014 |edition=3rd }}</ref> 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.<ref>{{cite web | vauthors = Olson E |title=How many hours of sleep are enough for good health? |url=https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/how-many-hours-of-sleep-are-enough/faq-20057898 |website=Mayo Clinic |publisher=Simon & Schuster |access-date=7 March 2022}}</ref> Sleep deprivation can also lead to high anxiety, irritability, erratic behavior, poor cognitive functioning and performance, and psychotic episodes.<ref>{{Cite web |title=How poor sleep affects your mental health |url=http://www.priorygroup.com/blog/how-poor-sleep-affects-your-mental-health |access-date=2022-04-17 | work = Priory |date=3 July 2018 |language=en}}</ref> A chronic sleep-restricted state adversely [[Effects of sleep deprivation on cognitive performance|affects the brain and cognitive function]].<ref name="Alhola">{{cite journal | vauthors = Alhola P, Polo-Kantola P | title = Sleep deprivation: Impact on cognitive performance | journal = Neuropsychiatric Disease and Treatment | volume = 3 | issue = 5 | pages = 553–567 | date = October 2007 | pmid = 19300585 | pmc = 2656292 | quote = Although both conditions [total and partial SD] induce several negative effects including impairments in cognitive performance, the underlying mechanisms seem to be somewhat different. }}</ref> 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 [[#Treating depression|treatment for depression]].<ref name="REM deprivation in healthy people">{{cite journal | vauthors = Nykamp K, Rosenthal L, Folkerts M, Roehrs T, Guido P, Roth T | title = The effects of REM sleep deprivation on the level of sleepiness/alertness | journal = Sleep | volume = 21 | issue = 6 | pages = 609–614 | date = September 1998 | pmid = 9779520 | doi = 10.1093/sleep/21.6.609 | doi-access = free }}</ref><ref name="Sleep and depression review">{{cite journal | vauthors = Riemann D, Berger M, Voderholzer U | title = Sleep and depression--results from psychobiological studies: an overview | journal = Biological Psychology | volume = 57 | issue = 1–3 | pages = 67–103 | date = July–August 2001 | pmid = 11454435 | doi = 10.1016/s0301-0511(01)00090-4 | s2cid = 31725861 }}</ref> Few studies have compared the effects of acute total sleep deprivation and chronic partial sleep restriction.<ref name="Alhola"/> 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 [[microsleep]]s cannot be avoided.<ref>{{cite book |title=Sleep deprivation |url= https://books.google.com/books?id=EaGWMXsR5XYC&pg=PA183 | vauthors = Kushida CA |publisher=Informa Health Care |year=2005 |pages=1–2 |isbn=978-0-8247-5949-0}}</ref> Long-term total sleep deprivation has caused death in lab animals.<ref>{{cite journal | vauthors = Rechtschaffen A, Bergmann BM | title = Sleep deprivation in the rat by the disk-over-water method | journal = Behavioural Brain Research | volume = 69 | issue = 1–2 | pages = 55–63 | year = 1995 | pmid = 7546318 | doi = 10.1016/0166-4328(95)00020-T | s2cid = 4042505 }}</ref> ==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 a.m. with those who started at 8:40 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> ==Effects and consequences== [[File:Effects of sleep deprivation.svg|thumb|300px|Main health effects of sleep deprivation]] ===The brain=== ==== Temporary ==== 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.<ref>{{cite journal | vauthors = Yoo SS, Gujar N, Hu P, Jolesz FA, Walker MP | title = The human emotional brain without sleep--a prefrontal amygdala disconnect | journal = Current Biology | volume = 17 | issue = 20 | pages = R877–R878 | date = October 2007 | pmid = 17956744 | doi = 10.1016/j.cub.2007.08.007 | s2cid = 9008816 | doi-access = free | bibcode = 2007CBio...17.R877Y }}</ref> According to the latest research, lack of sleep may cause more harm than previously thought and may lead to the permanent loss of brain cells.<ref>{{Cite web |date=2014-03-21 |title=最新研究：睡眠不足会永久损伤脑细胞 | trans-title = Latest research: Lack of sleep can permanently damage brain cells |url=https://www.bbc.com/zhongwen/simp/science/2014/03/140321_lost_sleep |access-date=2023-12-05 |website=BBC News 中文 (Chinese) |language=zh-hans}}</ref> 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 subserving alertness, attention, and higher-order cognitive processes.<ref name="performance" /> 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. [[Positron emission tomography|PET]] scans were used, and attention was paid to the circadian rhythm of cognitive performance.<ref name="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]].<ref>{{cite journal | vauthors = Farahani FV, Fafrowicz M, Karwowski W, Douglas PK, Domagalik A, Beldzik E, Oginska H, Marek T | title = Effects of Chronic Sleep Restriction on the Brain Functional Network, as Revealed by Graph Theory | journal = Frontiers in Neuroscience | volume = 13 | pages = 1087 | date = 11 October 2019 | pmid = 31680823 | pmc = 6807652 | doi = 10.3389/fnins.2019.01087 | publisher = Frontiers Media SA | doi-access = free }}</ref> ==== Lasting ==== [[File:Effect of REM sleep deprivation on the mitochondrial structure of neurons in rats.jpg|thumb|REM sleep deprivation causes swollen mitochondria in neurons (caused by [[cytochrome c]]); noradrenaline receptor blockers keep their inner cristae intact.]] Studies on rodents show that the response to neuronal injury due to acute sleep deprivation is adaptative before three hours of sleep loss per night and becomes maladaptative, and [[apoptosis]] occurs after.<ref>{{cite journal | vauthors = Wu J, Dou Y, Ladiges WC | title = Adverse Neurological Effects of Short-Term Sleep Deprivation in Aging Mice Are Prevented by SS31 Peptide | journal = Clocks & Sleep | volume = 2 | issue = 3 | pages = 325–333 | date = September 2020 | pmid = 33089207 | pmc = 7573804 | doi = 10.3390/clockssleep2030024 | doi-access = free }}</ref> Studies in mice show neuronal death (in the [[hippocampus]], [[locus coeruleus]], and medial [[Prefrontal cortex|PFC]]) occurs after two days of [[Rapid eye movement sleep|REM sleep]] deprivation. However, mice do not model well the effects in humans, because they sleep a third of the duration of REM sleep of humans and [[Caspase 3|caspase-3]], the main effector of apoptosis, kills three times the number of cells in humans than in mice.<ref>{{cite journal | vauthors = Kerr LE, McGregor AL, Amet LE, Asada T, Spratt C, Allsopp TE, Harmar AJ, Shen S, Carlson G, Logan N, Kelly JS, Sharkey J | title = Mice overexpressing human caspase 3 appear phenotypically normal but exhibit increased apoptosis and larger lesion volumes in response to transient focal cerebral ischaemia | journal = Cell Death and Differentiation | volume = 11 | issue = 10 | pages = 1102–1111 | date = October 2004 | pmid = 15153940 | doi = 10.1038/sj.cdd.4401449 | s2cid = 9525364 | doi-access = free }}</ref> Also not accounted for in nearly all of the studies is that acute REM sleep deprivation induces lasting (> 20 days) neuronal apoptosis in mice, and the apoptosis rate increases on the day following its end, so the amount of apoptosis is often undercounted in mice because experiments nearly always measure it the day the sleep deprivation ends.<ref>{{cite journal | vauthors = Soto-Rodriguez S, Lopez-Armas G, Luquin S, Ramos-Zuñiga R, Jauregui-Huerta F, Gonzalez-Perez O, Gonzalez-Castañeda RE | title = Rapid Eye Movement Sleep Deprivation Produces Long-Term Detrimental Effects in Spatial Memory and Modifies the Cellular Composition of the Subgranular Zone | journal = Frontiers in Cellular Neuroscience | volume = 10 | pages = 132 | year = 2016 | pmid = 27303266 | pmc = 4884737 | doi = 10.3389/fncel.2016.00132 | doi-access = free }}</ref> For these reasons, both the time before cells degenerate and the extent of degeneration could be greatly underevaluated in humans. Such [[Histology|histological]] studies cannot be performed on humans for ethical reasons, but long-term studies show that sleep quality is more associated with [[gray matter]] volume reduction<ref>{{Cite web | vauthors = Haelle T | date = 3 September 2014 |title=Poor Quality Sleep May Be Linked to Shrinking Brain |url=https://www.webmd.com/sleep-disorders/news/20140903/poor-quality-sleep-may-be-linked-to-shrinking-brain | archive-url = https://web.archive.org/web/20230309202947/https://www.webmd.com/web/20230309202947/https:/www.webmd.com/sleep-disorders/news/20140903/poor-quality-sleep-may-be-linked-to-shrinking-brain | archive-date = 9 March 2023 |access-date=9 March 2023|website=WebMD |language=en}}</ref> than age,<ref>{{cite journal | vauthors = Van Someren EJ, Oosterman JM, Van Harten B, Vogels RL, Gouw AA, Weinstein HC, Poggesi A, Scheltens P, Scherder EJ | title = Medial temporal lobe atrophy relates more strongly to sleep-wake rhythm fragmentation than to age or any other known risk | journal = Neurobiology of Learning and Memory | volume = 160 | pages = 132–138 | date = April 2019 | pmid = 29864525 | doi = 10.1016/j.nlm.2018.05.017 | series = Sleep and Hippocampal Function | s2cid = 46932040 | doi-access = free | hdl = 2066/202856 | hdl-access = free }}</ref> occurring in areas like the [[precuneus]].<ref>{{cite journal | vauthors = Grau-Rivera O, Operto G, Falcón C, Sánchez-Benavides G, Cacciaglia R, Brugulat-Serrat A, Gramunt N, Salvadó G, Suárez-Calvet M, Minguillon C, Iranzo Á, Gispert JD, Molinuevo JL | title = Association between insomnia and cognitive performance, gray matter volume, and white matter microstructure in cognitively unimpaired adults | journal = Alzheimer's Research & Therapy | volume = 12 | issue = 1 | pages = 4 | date = January 2020 | pmid = 31907066 | pmc = 6945611 | doi = 10.1186/s13195-019-0547-3 | collaboration = ALFA Study | doi-access = free }}</ref> [[File:Molecular pathway of REMSD-induced apoptosis in neurons.jpg|left|thumb|Molecular pathway of REM sleep deprivation-induced apoptosis in neurons]] Sleep is necessary to repair cellular damage caused by [[reactive oxygen species]] and DNA damage. During long-term sleep deprivation, cellular damage aggregates up to a tipping point that triggers cellular degeneration and apoptosis. REM sleep deprivation causes an increase in [[Norepinephrine|noradrenaline]] (which incidentally causes the person sleep deprived to be stressed) due to the neurons in the [[locus coeruleus]] producing it not ceasing to do so, which causes an increase in the activity of the [[Sodium–potassium pump|Na⁺/K⁺-ATPase pump]], which itself activates the [[Apoptosis#Intrinsic pathway|intrinsic pathway of apoptosis]]<ref>{{cite journal | vauthors = Somarajan BI, Khanday MA, Mallick BN | title = Rapid Eye Movement Sleep Deprivation Induces Neuronal Apoptosis by Noradrenaline Acting on Alpha1 Adrenoceptor and by Triggering Mitochondrial Intrinsic Pathway | journal = Frontiers in Neurology | volume = 7 | pages = 25 | date = 2016 | pmid = 27014180 | pmc = 4779900 | doi = 10.3389/fneur.2016.00025 | doi-access = free }}</ref> and prevents autophagy, which also induces the mitochondrial pathway of apoptosis. Sleep outside of the REM phase may allow enzymes to repair brain cell damage caused by [[radical (chemistry)|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.<ref name="Siegel">{{cite news | vauthors = Siegel JM |title=Why We Sleep |url=http://www.semel.ucla.edu/sleepresearch/sciam2003/sciamsleep.pdf |work=[[Scientific American]] |date=November 2003 |access-date=3 April 2008 |url-status=live |archive-url=https://web.archive.org/web/20081203071459/http://www.semel.ucla.edu/sleepresearch/sciam2003/sciamsleep.pdf |archive-date=3 December 2008 }}</ref> ===Attention and working memory=== Among the possible physical consequences of sleep deprivation, deficits in attention and [[working memory]] are perhaps the most important;<ref name="Alhola" /> 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 the number of hours of sleep received each night, declining as a function of hours of sleep deprivation.<ref>{{Cite book|title = An Introduction to Brain and Behavior| vauthors = Kolb B, Whishaw I |publisher = Worth Publishers|year = 2014|isbn = 978-1-4292-4228-8|location = New York, New York|pages = 468–469|edition = 4th}}</ref> Working memory is tested by methods such as choice-reaction time tasks.<ref name="Alhola" /> 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.<ref>{{cite journal | vauthors = Innes CR, Poudel GR, Jones RD | title = Efficient and regular patterns of nighttime sleep are related to increased vulnerability to microsleeps following a single night of sleep restriction | journal = Chronobiology International | volume = 30 | issue = 9 | pages = 1187–1196 | date = November 2013 | pmid = 23998288 | doi = 10.3109/07420528.2013.810222 | s2cid = 4682794 }}</ref> 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.<ref name="SleepDepPVT">{{cite journal | vauthors = Van Dongen HP, Maislin G, Mullington JM, Dinges DF | title = The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation | journal = Sleep | volume = 26 | issue = 2 | pages = 117–126 | date = March 2003 | pmid = 12683469 | doi = 10.1093/sleep/26.2.117 | url = http://www.aasmnet.org/Resources/FactSheets/DrowsyDriving.pdf | url-status = live | doi-access = free | archive-url = https://web.archive.org/web/20110718152642/http://www.aasmnet.org/Resources/FactSheets/DrowsyDriving.pdf | archive-date = 18 July 2011 }}</ref> 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.{{cn|date=April 2023}} === Mood === Sleep deprivation can have a negative impact on mood.<ref>{{cite journal | vauthors = Kramer M, Roehrs T, Roth T | title = Mood change and the physiology of sleep | journal = Comprehensive Psychiatry | volume = 17 | issue = 1 | pages = 161–165 | date = January 1976 | pmid = 174865 | doi = 10.1016/0010-440x(76)90065-1 }}</ref> 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.<ref name=":0">{{Cite web|title=Sleep and Mood {{!}} Need Sleep|url=http://healthysleep.med.harvard.edu/need-sleep/whats-in-it-for-you/mood#1.|access-date=21 January 2021|website=healthysleep.med.harvard.edu|archive-date=21 March 2021|archive-url=https://web.archive.org/web/20210321052445/http://healthysleep.med.harvard.edu/need-sleep/whats-in-it-for-you/mood#1.|url-status=dead}}</ref><ref>{{cite journal | vauthors = Dinges DF, Pack F, Williams K, Gillen KA, Powell JW, Ott GE, Aptowicz C, Pack AI | title = Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4-5 hours per night | journal = Sleep | volume = 20 | issue = 4 | pages = 267–277 | date = April 1997 | pmid = 9231952 }}</ref> [[Depression (mood)|Depression]] and sleep are in a bidirectional relationship. Poor sleep can lead to the development of depression, and depression can cause [[insomnia]], [[hypersomnia]], or [[obstructive sleep apnea]].<ref>{{Cite web|title=Depression and Sleep|url=https://www.sleepfoundation.org/mental-health/depression-and-sleep|access-date=21 January 2021|website=Sleep Foundation |date=18 September 2020 |language=en}}</ref><ref>{{cite journal | vauthors = Franzen PL, Buysse DJ | title = Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications | journal = Dialogues in Clinical Neuroscience | volume = 10 | issue = 4 | pages = 473–481 | date = 2008 | pmid = 19170404 | pmc = 3108260 | doi = 10.31887/DCNS.2008.10.4/plfranzen }}</ref> About 75% of adult patients with depression can present with insomnia.<ref>{{cite journal | vauthors = Nutt D, Wilson S, Paterson L | title = Sleep disorders as core symptoms of depression | journal = Dialogues in Clinical Neuroscience | volume = 10 | issue = 3 | pages = 329–336 | date = 2008 | pmid = 18979946 | pmc = 3181883 | doi = 10.31887/DCNS.2008.10.3/dnutt }}</ref> Sleep deprivation, whether total or not, can induce significant anxiety, and longer sleep deprivations tend to result in an increased level of anxiety.<ref>{{cite journal | vauthors = Pires GN, Bezerra AG, Tufik S, Andersen ML | title = Effects of acute sleep deprivation on state anxiety levels: a systematic review and meta-analysis | journal = Sleep Medicine | volume = 24 | pages = 109–118 | date = August 2016 | pmid = 27810176 | doi = 10.1016/j.sleep.2016.07.019 }}</ref> Sleep deprivation has also shown some positive effects on mood and can be used to treat depression.<ref name="Sleep and depression review" /> 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.<ref>{{cite journal | vauthors = Selvi Y, Gulec M, Agargun MY, Besiroglu L | title = Mood changes after sleep deprivation in morningness-eveningness chronotypes in healthy individuals | journal = Journal of Sleep Research | volume = 16 | issue = 3 | pages = 241–244 | date = September 2007 | pmid = 17716271 | doi = 10.1111/j.1365-2869.2007.00596.x | url = http://dl.dropboxusercontent.com/u/85192141/2006-selvi.pdf | url-status = live | s2cid = 42338269 | doi-access = free | archive-url = https://web.archive.org/web/20141215025258/https://dl.dropboxusercontent.com/u/85192141/2006-selvi.pdf | archive-date = 15 December 2014 }}</ref> 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.<ref name=":0" /> ===Driving ability=== {{main|Sleep-deprived driving}} 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,<ref name="DrowsyDriving">{{cite web |title=Drowsy Driving Fact Sheet |url=http://www.aasmnet.org/Resources/FactSheets/DrowsyDriving.pdf |work=American Academy of Sleep Medicine |date=2 December 2009 |url-status=live |archive-url=https://web.archive.org/web/20110718152642/http://www.aasmnet.org/Resources/FactSheets/DrowsyDriving.pdf |archive-date=18 July 2011 }}</ref> though the National Highway Traffic Safety Administration suggests the figure for [[traffic accidents]] may be closer to 100,000.<ref name="SleepDepReport">{{cite journal| vauthors = Carpenter S |author-link=Siri Carpenter|year=2001|title=Sleep deprivation may be undermining teen health|url=http://www.apa.org/monitor/oct01/sleepteen.html|url-status=live|journal=Monitor on Psychology|volume=32|issue=9|page=42|archive-url=https://web.archive.org/web/20061006064800/http://www.apa.org/monitor/oct01/sleepteen.html|archive-date=6 October 2006}}</ref> The AASM recommends pulling off the road and taking a 15- or 20-minute nap to alleviate drowsiness.<ref name="DrowsyDriving" /> 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.<ref name="Drunkhazard">{{cite journal | vauthors = Williamson AM, Feyer AM | title = Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication | journal = Occupational and Environmental Medicine | volume = 57 | issue = 10 | pages = 649–655 | date = October 2000 | pmid = 10984335 | pmc = 1739867 | doi = 10.1136/oem.57.10.649 }}</ref> 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.<ref name="FatigueandAlcohol">{{cite journal | vauthors = Dawson D, Reid K | title = Fatigue, alcohol and performance impairment | journal = Nature | volume = 388 | issue = 6639 | pages = 235 | date = July 1997 | pmid = 9230429 | doi = 10.1038/40775 | s2cid = 4424846 | bibcode = 1997Natur.388..235D | doi-access = free }}</ref> The fatigue of drivers of goods trucks and passenger vehicles has 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 United States waters, after the 2010 Deepwater Horizon oil spill. This accident occurred when an Exxon oil tanker struck a reef at [[Prince William Sound]] in Alaska. Approximately 10.8 million gallons of oil spilled into the sea. The accident caused great environmental damage, including the deaths 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.<ref>{{ProQuest|2092623770}}</ref> ===Fatigue=== Sleep deprivation and disruption is associated with subsequent [[fatigue]]. <ref>{{cite book | chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK384963 | title=Commercial Motor Vehicle Driver Fatigue, Long-Term Health, and Highway Safety: Research Needs | chapter=Consequences of Fatigue from Insufficient Sleep | date=12 August 2016 | publisher=National Academies Press (US) }}</ref><ref>{{cite journal | doi=10.3389/fnins.2022.930280 | doi-access=free | title=Predicting and mitigating fatigue effects due to sleep deprivation: A review | date=2022 | last1=Kayser | first1=Kylie C. | last2=Puig | first2=Vannia A. | last3=Estepp | first3=Justin R. | journal=Frontiers in Neuroscience | volume=16 | pmid=35992930 | pmc=9389006 }}</ref> ===Sleep transition=== Sleep propensity (SP) can be defined as the readiness to transition from wakefulness to sleep or the ability to stay asleep if already sleeping.<ref>{{cite book | vauthors = Schulz H, Bes E, Jobert M | chapter = Modelling sleep propensity and sleep disturbances. | title = Sleep—Wake Disorders | date = 1998 | pages = 11–26 | location = Boston, MA | publisher = Springer US | doi = 10.1007/978-1-4899-0245-0_2 | isbn = 978-1-4899-0247-4 }}</ref> Sleep deprivation increases this propensity, which can be measured by polysomnography (PSG) as a reduction in sleep latency (the time needed to fall asleep).<ref name="Durmer2005">{{cite journal | vauthors = Durmer JS, Dinges DF | title = Neurocognitive consequences of sleep deprivation | journal = Seminars in Neurology | volume = 25 | issue = 1 | pages = 117–129 | date = March 2005 | pmid = 15798944 | pmc = 3564638 | doi = 10.1055/s-2005-867080 }}</ref> An indicator of sleep propensity can also be seen in the shortening of the transition from light stages of non-REM sleep to deeper slow-wave oscillations.<ref name="Durmer2005" /> 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.<ref name="Durmer2005" /> 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.<ref name="Durmer2005" /> ===Sleep-wake cycle=== People aged 18 to 64 need seven to nine hours of sleep per night.<ref>{{Cite web |date=2022-03-25 |title=Here's What Happens When You Don't Get Enough Sleep (And How Much You Really Need a Night) |url=https://health.clevelandclinic.org/happens-body-dont-get-enough-sleep/ |access-date=2022-04-17 |website=Cleveland Clinic |language=en-US}}</ref> 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.<ref name="Durmer2005" /> 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.<ref name="Durmer2005" /><ref>{{cite journal | vauthors = Saper CB, Chou TC, Scammell TE | title = The sleep switch: hypothalamic control of sleep and wakefulness | journal = Trends in Neurosciences | volume = 24 | issue = 12 | pages = 726–731 | date = December 2001 | pmid = 11718878 | doi = 10.1016/S0166-2236(00)02002-6 | s2cid = 206027570 }}</ref> To describe the temporal course of the sleep-wake cycle, the two-process model of sleep regulation can be mentioned.<ref name="Durmer2005" /> This model proposes a homeostatic process (Process S) and a circadian process (Process C) that interact to define the time and intensity of sleep.<ref name="Borbély2016">{{cite journal | vauthors = Borbély AA, Daan S, Wirz-Justice A, Deboer T | title = The two-process model of sleep regulation: a reappraisal | journal = Journal of Sleep Research | volume = 25 | issue = 2 | pages = 131–143 | date = April 2016 | pmid = 26762182 | doi = 10.1111/jsr.12371 | doi-access = free }}</ref> 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.<ref name="Durmer2005" /><ref name="Borbély2016" /> ===Microsleeps=== [[Microsleep]]s 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,<ref>{{cite journal | vauthors = Skorucak J, Hertig-Godeschalk A, Schreier DR, Malafeev A, Mathis J, Achermann P | title = Automatic detection of microsleep episodes with feature-based machine learning | journal = Sleep | volume = 43 | issue = 1 | pages = zsz225 | date = January 2020 | pmid = 31559424 | doi = 10.1093/sleep/zsz225 | doi-access = free }}</ref> and happen most frequently when a person is trying to stay awake when they are feeling sleepy.<ref>{{Cite web|url = http://healthysleep.med.harvard.edu/need-sleep/glossary/k-m|title = Glossary K-M|date = 2012|website = Get Sleep|publisher = Harvard Medical School|url-status = live|archive-url = https://web.archive.org/web/20150402122751/http://healthysleep.med.harvard.edu/need-sleep/glossary/k-m|archive-date = 2 April 2015|df = dmy-all}}</ref> The person usually falls into microsleep while doing a monotonous task like driving, reading a book, or staring at a [[computer]].<ref>{{Cite web|title = Microsleep {{!}} Microsleeps|url = http://www.sleepdex.org/microsleep.htm|website = www.sleepdex.org|access-date = 14 February 2016|url-status = live|archive-url = https://web.archive.org/web/20160303102646/http://www.sleepdex.org/microsleep.htm|archive-date = 3 March 2016|df = dmy-all}}</ref> Microsleeps are similar to [[syncope (medicine)|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.<ref>{{cite journal | vauthors = Vyazovskiy VV, Olcese U, Hanlon EC, Nir Y, Cirelli C, Tononi G | title = Local sleep in awake rats | journal = Nature | volume = 472 | issue = 7344 | pages = 443–447 | date = April 2011 | pmid = 21525926 | pmc = 3085007 | doi = 10.1038/nature10009 | bibcode = 2011Natur.472..443V }}</ref> === Cardiovascular morbidity === Decreased sleep duration is associated with many adverse cardiovascular consequences.<ref>{{Cite web|date=13 February 2019|title=CDC - Sleep and Chronic Disease - Sleep and Sleep Disorders|url=https://www.cdc.gov/sleep/about_sleep/chronic_disease.html|access-date=21 January 2021|website=www.cdc.gov|language=en-us}}</ref><ref>{{cite journal | vauthors = Knutson KL, Van Cauter E, Rathouz PJ, Yan LL, Hulley SB, Liu K, Lauderdale DS | title = Association between sleep and blood pressure in midlife: the CARDIA sleep study | journal = Archives of Internal Medicine | volume = 169 | issue = 11 | pages = 1055–1061 | date = June 2009 | pmid = 19506175 | pmc = 2944774 | doi = 10.1001/archinternmed.2009.119 }}</ref><ref>{{cite journal | vauthors = King CR, Knutson KL, Rathouz PJ, Sidney S, Liu K, Lauderdale DS | title = Short sleep duration and incident coronary artery calcification | journal = JAMA | volume = 300 | issue = 24 | pages = 2859–2866 | date = December 2008 | pmid = 19109114 | pmc = 2661105 | doi = 10.1001/jama.2008.867 }}</ref><ref>{{cite journal | vauthors = Sabanayagam C, Shankar A | title = Sleep duration and cardiovascular disease: results from the National Health Interview Survey | journal = Sleep | volume = 33 | issue = 8 | pages = 1037–1042 | date = August 2010 | pmid = 20815184 | pmc = 2910533 | doi = 10.1093/sleep/33.8.1037 }}</ref> 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.<ref>{{cite journal | vauthors = St-Onge MP, Grandner MA, Brown D, Conroy MB, Jean-Louis G, Coons M, Bhatt DL | title = Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association | journal = Circulation | volume = 134 | issue = 18 | pages = e367–e386 | date = November 2016 | pmid = 27647451 | pmc = 5567876 | doi = 10.1161/CIR.0000000000000444 }}</ref> The [[Centers for Disease Control and Prevention]] has noted that adults who sleep less than seven hours per day are more likely to have chronic health conditions, including heart attack, coronary heart disease, and stroke, compared to those with an adequate amount of sleep.<ref>{{Cite web|date=5 March 2019|title=CDC - Data and Statistics - Sleep and Sleep Disorders|url=https://www.cdc.gov/sleep/data_statistics.html|access-date=21 January 2021|website=www.cdc.gov|language=en-us}}</ref> In a study that followed over 160,000 healthy, non-obese adults, the subjects who self-reported sleep duration less than six hours a day were at 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.<ref>{{cite journal | vauthors = Deng HB, Tam T, Zee BC, Chung RY, Su X, Jin L, Chan TC, Chang LY, Yeoh EK, Lao XQ | title = Short Sleep Duration Increases Metabolic Impact in Healthy Adults: A Population-Based Cohort Study | journal = Sleep | volume = 40 | issue = 10 | date = October 2017 | pmid = 28977563 | doi = 10.1093/sleep/zsx130 | doi-access = free }}</ref> The United Kingdom Biobank studied nearly 500,000 adults who had no cardiovascular disease, and the subjects who slept less than six hours a day were associated with a 20 percent increase in the risk of developing myocardial infarction (MI) over a seven-year follow-up period. Interestingly, a long sleep duration of more than nine hours a night was also a risk factor.<ref>{{cite journal | vauthors = Daghlas I, Dashti HS, Lane J, Aragam KG, Rutter MK, Saxena R, Vetter C | title = Sleep Duration and Myocardial Infarction | journal = Journal of the American College of Cardiology | volume = 74 | issue = 10 | pages = 1304–1314 | date = September 2019 | pmid = 31488267 | pmc = 6785011 | doi = 10.1016/j.jacc.2019.07.022 }}</ref> === 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 allowing 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 immune system|adaptive immunity]].<ref name=":1">{{Cite web|title=Sleep & Immunity: Can a Lack of Sleep Make You Sick?|url=https://www.sleepfoundation.org/physical-health/how-sleep-affects-immunity|access-date=21 January 2021|website=Sleep Foundation|date=26 October 2018 |language=en}}</ref><ref>{{cite journal | vauthors = Irwin MR | title = Sleep and inflammation: partners in sickness and in health | journal = Nature Reviews. Immunology | volume = 19 | issue = 11 | pages = 702–715 | date = November 2019 | pmid = 31289370 | doi = 10.1038/s41577-019-0190-z | s2cid = 195847558 }}</ref> Sleep quality is directly related to immunity levels. The team, led by Professor Cohen of Carnegie Mellon University in the United States, found that even a slight disturbance of sleep may affect the body's response to the cold virus. Those with better sleep quality had significantly higher blood T and B lymphocytes than those with poor sleep quality.These two lymphocytes are the main body of immune function in the human body.<ref>{{Cite web |title=睡眠好坏直接影响免疫力--健康·生活--人民网 |url=http://health.people.com.cn/n1/2020/0331/c14739-31655366.html |access-date=2023-12-05 |website=health.people.com.cn}}</ref> An adequate amount of sleep improves the 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 are less likely to develop a proper immune response to the vaccine and sometimes even require a second dose. {{Citation needed|date=June 2023}} 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.<ref name=":1" /> People who sleep less than six hours a night are more susceptible to infection and are more likely to catch a cold or flu. A lack of sleep can also prolong the recovery time of patients in the intensive care unit (ICU).<ref name=":1" /><ref>{{cite journal | vauthors = Prather AA, Janicki-Deverts D, Hall MH, Cohen S | title = Behaviorally Assessed Sleep and Susceptibility to the Common Cold | journal = Sleep | volume = 38 | issue = 9 | pages = 1353–1359 | date = September 2015 | pmid = 26118561 | pmc = 4531403 | doi = 10.5665/sleep.4968 }}</ref><ref>{{cite journal | vauthors = Pisani MA, Friese RS, Gehlbach BK, Schwab RJ, Weinhouse GL, Jones SF | title = Sleep in the intensive care unit | journal = American Journal of Respiratory and Critical Care Medicine | volume = 191 | issue = 7 | pages = 731–738 | date = April 2015 | pmid = 25594808 | pmc = 5447310 | doi = 10.1164/rccm.201411-2099CI }}</ref> ===Weight gain === {{main|Sleep and weight}} A lack of sleep can cause an imbalance in several hormones that are critical for 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 a desire for high-calorie foods.<ref name="VanCauter">{{cite journal | vauthors = Van Cauter E, Spiegel K | title = Sleep as a mediator of the relationship between socioeconomic status and health: a hypothesis | journal = Annals of the New York Academy of Sciences | volume = 896 | issue = 1 | pages = 254–261 | year = 1999 | pmid = 10681902 | doi = 10.1111/j.1749-6632.1999.tb08120.x | bibcode = 1999NYASA.896..254V | s2cid = 36513336 }}</ref><ref name="RatExperiments"/> 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, all of which can disrupt a good night's sleep.<ref>{{Cite web|title=The Link Between Obesity and Sleep Deprivation|url=https://www.sleepfoundation.org/physical-health/obesity-and-sleep|access-date=21 January 2021|website=Sleep Foundation|date=4 December 2020 |language=en}}</ref> In rats, prolonged, complete sleep deprivation increased both food intake and energy expenditure, with a net effect of weight loss and ultimately death.<ref>{{cite journal | vauthors = Everson CA, Bergmann BM, Rechtschaffen A | title = Sleep deprivation in the rat: III. Total sleep deprivation | journal = Sleep | volume = 12 | issue = 1 | pages = 13–21 | date = February 1989 | pmid = 2928622 | doi = 10.1093/sleep/12.1.13 | doi-access = free }}</ref> 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.<ref name="RatExperiments">{{cite journal | vauthors = Taheri S, Lin L, Austin D, Young T, Mignot E | title = Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index | journal = PLOS Medicine | volume = 1 | issue = 3 | pages = e62 | date = December 2004 | pmid = 15602591 | pmc = 535701 | doi = 10.1371/journal.pmed.0010062 | doi-access = free }}</ref> ===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]].<ref>{{Cite web|date=2007|title=Sleep and Disease Risk|url=http://healthysleep.med.harvard.edu/healthy/matters/consequences/sleep-and-disease-risk|url-status=live|archive-url=https://web.archive.org/web/20160325003506/http://healthysleep.med.harvard.edu/healthy/matters/consequences/sleep-and-disease-risk|archive-date=25 March 2016|website=Healthy Sleep|publisher=Harvard Medical School}}</ref> 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 amounts 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.<ref>{{Cite web|title=Diabetes and Sleep: Sleep Disturbances & Coping|url=https://www.sleepfoundation.org/physical-health/lack-of-sleep-and-diabetes|access-date=21 January 2021|website=Sleep Foundation|date=20 November 2020|language=en}}</ref> In 2005, a study of over 1400 participants showed that participants who habitually slept fewer hours were more likely to have associations with [[type 2 diabetes]].<ref name="DGottlieb">{{cite journal | vauthors = Gottlieb DJ, Punjabi NM, Newman AB, Resnick HE, Redline S, Baldwin CM, Nieto FJ | title = Association of sleep time with diabetes mellitus and impaired glucose tolerance | journal = Archives of Internal Medicine | volume = 165 | issue = 8 | pages = 863–867 | date = April 2005 | pmid = 15851636 | doi = 10.1001/archinte.165.8.863 | doi-access = free }}</ref> 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 that showed that experimental rather than habitual restriction of sleep resulted in [[impaired glucose tolerance]] (IGT).<ref>{{cite journal | vauthors = Spiegel K, Leproult R, Van Cauter E | title = Impact of sleep debt on metabolic and endocrine function | journal = Lancet | volume = 354 | issue = 9188 | pages = 1435–1439 | date = October 1999 | pmid = 10543671 | doi = 10.1016/S0140-6736(99)01376-8 | s2cid = 3854642 }}</ref> ===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, having trouble keeping eyes open, head-nodding, drifting out of their lane, and daydreaming. At particular risk are lone drivers between midnight and 6:00 a.m.<ref name="SleepFoundationDrowsyDriving">{{cite web|date=2 December 2009|title=Drowsy Driving:Key Messages and Talking Points|url=http://www.sleepfoundation.org/sites/default/files/Drowsy%20Driving-Key%20Messages%20and%20Talking%20Points.pdf|url-status=live|archive-url=https://web.archive.org/web/20131126062848/http://www.sleepfoundation.org/sites/default/files/Drowsy%20Driving-Key%20Messages%20and%20Talking%20Points.pdf|archive-date=26 November 2013|work=National Sleep Foundation}}</ref> 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 for shift changes, and the findings showed that controllers were not well rested.<ref name="PlaneCrash">{{cite web|date=10 September 2010|title=Fact Sheet – Pilot Fatigue|url=http://www.faa.gov/news/fact_sheets/news_story.cfm?newsId=11857|url-status=live|archive-url=https://web.archive.org/web/20161005194346/http://www.faa.gov/news/fact_sheets/news_story.cfm?newsId=11857|archive-date=5 October 2016|work=Federal Aviation Administration}}</ref> 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.<ref name="MedicalErrors">{{cite journal | vauthors = Baldwin DC, Daugherty SR | title = Sleep deprivation and fatigue in residency training: results of a national survey of first- and second-year residents | journal = Sleep | volume = 27 | issue = 2 | pages = 217–223 | date = March 2004 | pmid = 15124713 | doi = 10.1093/sleep/27.2.217 | doi-access = free }}</ref> Twenty-four hours of continuous sleep deprivation results in the choice of less difficult math tasks without a decrease in subjective reports of effort applied to the task.{{Citation needed|date=June 2023}} Naturally occurring sleep loss affects the choice of everyday tasks, such that low-effort tasks are mostly commonly selected.{{Citation needed|date=June 2023}} [[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.<ref>{{cite journal | vauthors = Engle-Friedman M, Riela S, Golan R, Ventuneac AM, Davis CM, Jefferson AD, Major D | title = The effect of sleep loss on next day effort | journal = Journal of Sleep Research | volume = 12 | issue = 2 | pages = 113–124 | date = June 2003 | pmid = 12753348 | doi = 10.1046/j.1365-2869.2003.00351.x | s2cid = 13519528 }}</ref><ref>{{cite journal | vauthors = Engle-Friedman M, Palencar V, Riela S | title = Sleep and effort in adolescent athletes | journal = Journal of Child Health Care | volume = 14 | issue = 2 | pages = 131–141 | date = June 2010 | pmid = 20435615 | doi = 10.1177/1367493510362129 | s2cid = 7680316 }}</ref> Great sleep deprivation mimics psychosis: distorted perceptions can lead to inappropriate emotional and behavioral responses.<ref name="Coren">{{cite journal| vauthors = Coren S |date=1 March 1998|title=Sleep Deprivation, Psychosis and Mental Efficiency|url=http://www.psychiatrictimes.com/display/article/10168/54471|url-status=live|journal=Psychiatric Times|volume=15|issue=3|archive-url=https://web.archive.org/web/20090904142025/http://www.psychiatrictimes.com/display/article/10168/54471|archive-date=4 September 2009|access-date=25 November 2009}}</ref> Astronauts have reported [[Performance Errors due to Fatigue and Sleep Loss During Spaceflight|performance errors and decreased cognitive ability]] during periods of extended working hours and wakefulness, as well as sleep loss caused by circadian rhythm disruption and environmental factors.<ref>{{cite web| vauthors = Whitmire AM, Leveton LB, Barger L, Brainard G, Dinges DF, Klerman E, Shea C |title=Risk of Performance Errors due to Sleep Loss, Circadian Desynchronization, Fatigue, and Work Overload|url=http://humanresearchroadmap.nasa.gov/evidence/reports/Sleep.pdf|url-status=live|archive-url=https://web.archive.org/web/20120215234226/http://humanresearchroadmap.nasa.gov/evidence/reports/Sleep.pdf|archive-date=15 February 2012|access-date=25 June 2012|work=Human Health and Performance Risks of Space Exploration Missions: Evidence reviewed by the NASA Human Research Program}}</ref> 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).<ref>{{Cite web |title=Tachycardia - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/tachycardia/symptoms-causes/syc-20355127 |access-date=2022-06-27 |website=Mayo Clinic |language=en}}</ref><ref name="sleeptachy">{{cite journal | vauthors = Rangaraj VR, Knutson KL | title = Association between sleep deficiency and cardiometabolic disease: implications for health disparities | journal = Sleep Medicine | volume = 18 | pages = 19–35 | date = February 2016 | pmid = 26431758 | pmc = 4758899 | doi = 10.1016/j.sleep.2015.02.535 }}</ref> Generally, sleep deprivation may facilitate or intensify:<ref name="SleepDep">{{cite web|title=Sleep deprivation|url=http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Sleep_deprivation?OpenDocument|url-status=dead|archive-url=https://web.archive.org/web/20090820003333/http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Sleep_deprivation?OpenDocument|archive-date=20 August 2009|work=betterhealth.vic.gov.au}}</ref> * aching muscles<ref>{{cite book| vauthors = Morin CM |url=https://archive.org/details/springer_10.1007-b105845|title=Insomnia|publisher=Kluwer Academic/Plenum Publ.|year=2003|isbn=978-0-306-47750-8|location=New York|page=[https://archive.org/details/springer_10.1007-b105845/page/n39 28] death}}</ref> *[[confusion]], [[memory]] lapses or loss<ref name="BrainBasics">{{cite web | url = http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm | work = National Institute of Neurological Disorders and Stroke | title = Brain Basics: Understanding Sleep | archive-url = https://web.archive.org/web/20071011011207/http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm| archive-date=11 October 2007}}</ref> * [[depression (mood)|depression]]<ref name="BrainBasics" /> * development of [[false memory]] * [[hypnagogic]] and [[hypnopompic]] [[hallucination]]s during falling asleep and waking, which are entirely normal<ref name="Ohayon_et_al_1996">{{cite journal | vauthors = Ohayon MM, Priest RG, Caulet M, Guilleminault C | title = Hypnagogic and hypnopompic hallucinations: pathological phenomena? | journal = The British Journal of Psychiatry | volume = 169 | issue = 4 | pages = 459–467 | date = October 1996 | pmid = 8894197 | doi = 10.1192/bjp.169.4.459 | s2cid = 3086394 }}</ref> * hand [[tremor]]<ref>{{cite book| vauthors = Smith AP |title=Handbook of Human Performance|publisher=Acad. Press|year=1992|isbn=978-0-12-650352-4|location=London|page=240}}</ref> * [[headaches]] * [[malaise]] * [[stye]] * [[periorbital puffiness]], commonly known as "bags under eyes" or [[eye bags]] * increased [[blood pressure]]<ref name="health.harvard.edu">{{cite web|date=31 May 2012|title=Harvard Heart Letter examines the costs of not getting enough sleep – Harvard Health Publications|url=http://www.health.harvard.edu/press_releases/sleep_deprivation_problem.htm|url-status=live|archive-url=https://web.archive.org/web/20110509104601/http://www.health.harvard.edu/press_releases/sleep_deprivation_problem.htm|archive-date=9 May 2011|access-date=13 August 2012|publisher=Health.harvard.edu}}</ref> * increased [[stress hormone]] levels<ref name="health.harvard.edu" /> * increased risk of type 2 [[diabetes]]<ref name="health.harvard.edu" /> * lowering of [[immunity (medical)|immunity]], increased susceptibility to illness<ref>{{cite web| vauthors = Olson E |date=9 June 2015|title=Lack of sleep: Can it make you sick?|url=https://www.mayoclinic.org/diseases-conditions/insomnia/expert-answers/lack-of-sleep/faq-20057757|access-date=26 August 2018|publisher=[[Mayo Clinic]]}}</ref> * increased risk of [[fibromyalgia]]<ref>{{cite web|title=The Role of Magnesium in Fibromyalgia|url=http://web.mit.edu/london/www/magnesium.html|url-status=live|archive-url=https://web.archive.org/web/20120729085013/http://web.mit.edu/london/www/magnesium.html|archive-date=29 July 2012|access-date=13 August 2012|publisher=Web.mit.edu}}</ref> * [[irritability]]<ref name="SleepDep" /> * [[nystagmus]] (rapid involuntary rhythmic eye movement)<ref>{{cite journal | vauthors = Citek K, Ball B, Rutledge DA | title = Nystagmus testing in intoxicated individuals | journal = Optometry | volume = 74 | issue = 11 | pages = 695–710 | date = November 2003 | pmid = 14653658 | url = http://www.decp.org/pdfs/nystagmus.pdf | url-status = dead | archive-url = https://web.archive.org/web/20110716064218/http://www.decp.org/pdfs/nystagmus.pdf | archive-date = 16 July 2011 }}</ref> * [[obesity]]<ref name="health.harvard.edu" /> * [[epileptic seizure|seizures]]<ref>{{cite book| vauthors = Engel J, Pedley TA, Aicardi J |url= https://books.google.com/books?id=TwlXrOBkAS8C&q=sleep+deprivation+seizure&pg=PA77|title=Epilepsy: A Comprehensive Textbook - Google Books|year=2008|publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-5777-5|access-date=30 January 2015}}</ref> * [[temper tantrums]] in children<ref name="SleepDep" /> * violent behavior<ref>{{cite journal | vauthors = Vaughn MG, Salas-Wright CP, White NA, Kremer KP | title = Poor sleep and reactive aggression: Results from a national sample of African American adults | journal = Journal of Psychiatric Research | volume = 66-67 | pages = 54–59 | year = 2015 | pmid = 25940021 | doi = 10.1016/j.jpsychires.2015.04.015 }}</ref> * [[yawn]]ing<ref name="SleepDep" /> * [[mania]]<ref>{{cite journal | vauthors = Wehr TA | title = Sleep-loss as a possible mediator of diverse causes of mania | journal = The British Journal of Psychiatry | volume = 159 | issue = 4 | pages = 576–578 | date = October 1991 | pmid = 1751874 | doi = 10.1192/bjp.159.4.576 | publisher = Bjp.rcpsych.org | s2cid = 22945599 }}</ref> *[[Sleep inertia]]<ref>{{Cite web|date=20 August 2009|title=Sleep deprivation - Better Health Channel.|url=http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Sleep_deprivation?OpenDocument|archive-url=https://web.archive.org/web/20090820003333/http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Sleep_deprivation?OpenDocument|archive-date=20 August 2009|access-date=24 October 2019}}</ref> Sleep deprivation may cause symptoms similar to: * [[attention-deficit hyperactivity disorder]] (ADHD)<ref name="SleepDep" /> * [[psychosis]]<ref name="Ohayon_et_al_1996" /><ref>{{cite web | url = http://ts-si.org/content/view/2634/992/ | title = Neural Link Between Sleep Loss And Psychiatric Disorders | archive-url = https://web.archive.org/web/20090228192413/http://ts-si.org/content/view/2634/992/| archive-date=28 February 2009 | work = ts-si.org | date = 24 October 2007 }}</ref><ref name="sleep_dep">{{cite journal | vauthors = Chan-Ob T, Boonyanaruthee V | title = Meditation in association with psychosis | journal = Journal of the Medical Association of Thailand = Chotmaihet Thangphaet | volume = 82 | issue = 9 | pages = 925–930 | date = September 1999 | pmid = 10561951 }}</ref><ref name="sleep_dep3">{{cite journal | vauthors = Devillières P, Opitz M, Clervoy P, Stephany J | title = [Delusion and sleep deprivation] | journal = L'Encephale | volume = 22 | issue = 3 | pages = 229–231 | date = May–June 1996 | pmid = 8767052 }}</ref> A 2009 review found that sleep loss had a wide range of cognitive and neurobehavioral effects including unstable attention, slowing of response times, decline of memory performance, reduced learning of cognitive tasks, deterioration of performance in tasks requiring divergent thinking, perseveration with ineffective solutions, performance deterioration as task duration increases; and growing neglect of activities judged to be nonessential.<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564638/|title=Neurocognitive Consequences of Sleep Deprivation - PMC}}</ref> == 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.<ref name=":2">{{Cite web | vauthors = Maski K | date = 7 September 2023 | veditors = Scammell TE, Eichler AF | title = Insufficient sleep: Evaluation and management |work = UpToDate |url= https://www.uptodate.com/contents/insufficient-sleep-evaluation-and-management|access-date=2021-01-28 }}</ref> 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]].<ref name=":2" /> 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.<ref>{{cite journal | vauthors = Carney CE, Buysse DJ, Ancoli-Israel S, Edinger JD, Krystal AD, Lichstein KL, Morin CM | title = The consensus sleep diary: standardizing prospective sleep self-monitoring | journal = Sleep | volume = 35 | issue = 2 | pages = 287–302 | date = February 2012 | pmid = 22294820 | pmc = 3250369 | doi = 10.5665/sleep.1642 }}</ref><ref>{{Cite web|title=Sleep Deprivation: Causes, Symptoms, & Treatment|url=https://www.sleepfoundation.org/sleep-deprivation|access-date=21 January 2021|website=Sleep Foundation|date=3 November 2020|language=en}}</ref> Sleep questionnaires such as the Sleep Timing Questionnaire (STQ) can be used instead of sleep diaries if there is any concern for patient adherence.<ref>{{cite journal | vauthors = Monk TH, Buysse DJ, Kennedy KS, Pods JM, DeGrazia JM, Miewald JM | title = Measuring sleep habits without using a diary: the sleep timing questionnaire | journal = Sleep | volume = 26 | issue = 2 | pages = 208–212 | date = March 2003 | pmid = 12683481 | doi = 10.1093/sleep/26.2.208 | doi-access = free }}</ref> [[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.<ref>{{Cite web|title=Actigraphy|url=https://stanfordhealthcare.org/medical-tests/s/sleep-disorder-tests/procedures/actigraphy.html|access-date=21 January 2021|website=stanfordhealthcare.org|language=en}}</ref><ref>{{cite journal | vauthors = Morgenthaler T, Alessi C, Friedman L, Owens J, Kapur V, Boehlecke B, Brown T, Chesson A, Coleman J, Lee-Chiong T, Pancer J, Swick TJ | title = Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007 | journal = Sleep | volume = 30 | issue = 4 | pages = 519–529 | date = April 2007 | pmid = 17520797 | doi = 10.1093/sleep/30.4.519 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Smith MT, McCrae CS, Cheung J, Martin JL, Harrod CG, Heald JL, Carden KA | title = Use of Actigraphy for the Evaluation of Sleep Disorders and Circadian Rhythm Sleep-Wake Disorders: An American Academy of Sleep Medicine Clinical Practice Guideline | journal = Journal of Clinical Sleep Medicine | volume = 14 | issue = 7 | pages = 1231–1237 | date = July 2018 | pmid = 29991437 | pmc = 6040807 | doi = 10.5664/jcsm.7230 }}</ref><ref>{{cite journal | vauthors = Smith MT, McCrae CS, Cheung J, Martin JL, Harrod CG, Heald JL, Carden KA | title = Use of Actigraphy for the Evaluation of Sleep Disorders and Circadian Rhythm Sleep-Wake Disorders: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment | journal = Journal of Clinical Sleep Medicine | volume = 14 | issue = 7 | pages = 1209–1230 | date = July 2018 | pmid = 29991438 | pmc = 6040804 | doi = 10.5664/jcsm.7228 }}</ref> ==Management== 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 Institutes of Health|National Institute of Health]], the [[National Institute on Aging|National Institute of Aging]], and the [[American Academy of Family Physicians]]. Historically, sleep hygiene, as first medically defined by Hauri in 1977,<ref name="auto">{{cite journal | vauthors = Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH | title = The role of sleep hygiene in promoting public health: A review of empirical evidence | journal = Sleep Medicine Reviews | volume = 22 | pages = 23–36 | date = August 2015 | pmid = 25454674 | pmc = 4400203 | doi = 10.1016/j.smrv.2014.10.001 }}</ref> 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<ref name="AASM-behavioral-therapies-2021">{{cite journal | vauthors = Edinger JD, Arnedt JT, Bertisch SM, Carney CE, Harrington JJ, Lichstein KL, Sateia MJ, Troxel WM, Zhou ES, Kazmi U, Heald JL, Martin JL | title = Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline | journal = Journal of Clinical Sleep Medicine | volume = 17 | issue = 2 | pages = 255–262 | date = February 2021 | pmid = 33164742 | pmc = 7853203 | doi = 10.5664/jcsm.8986 }}</ref> and for people without.<ref name="auto"/> The key is to implement healthier sleep habits, also known as [[sleep hygiene]].<ref>{{Cite web|title=How to Sleep Better|url=https://www.sleepfoundation.org/sleep-hygiene/healthy-sleep-tips|access-date=14 January 2021|website=Sleep Foundation|date=17 April 2009|language=en}}</ref> 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.<ref>{{Cite web|url=https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html|title=CDC - Sleep Hygiene Tips - Sleep and Sleep Disorders|date=13 February 2019|website=www.cdc.gov|language=en-us|access-date=21 April 2020}}</ref> 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).<ref name="AASM-behavioral-therapies-2021" /> 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.<ref name="Trauer 191">{{cite journal | vauthors = Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D | title = Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis | journal = Annals of Internal Medicine | volume = 163 | issue = 3 | pages = 191–204 | date = August 2015 | pmid = 26054060 | doi = 10.7326/M14-2841 | s2cid = 21617330 }}</ref> 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.<ref>{{Cite web|url = http://www.aasmnet.org/resources/factsheets/sleepdeprivation.pdf|title = Sleep Deprivation|date = 2008|access-date = 25 March 2015|website = American Academy of Sleep Medicine|url-status = live|archive-url = https://web.archive.org/web/20150226011724/http://www.aasmnet.org/Resources/FactSheets/SleepDeprivation.pdf|archive-date = 26 February 2015|df = dmy-all}}</ref> 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.<ref name="SleepFactSheet">{{cite web |work=American Academy of Sleep Medicine |title=Sleep Deprivation Fact Sheet |url=http://www.aasmnet.org/Resources/FactSheets/SleepDeprivation.pdf |date=2 December 2009 |url-status=live |archive-url=https://web.archive.org/web/20150226011724/http://www.aasmnet.org/Resources/FactSheets/SleepDeprivation.pdf |archive-date=26 February 2015 }}</ref> ==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> == Changes in American sleep habits == {{globalize|section|date=December 2010}} ''[[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.<ref>{{Cite web |title=National Geographic |url=https://www.nationalgeographic.com/ |access-date=2023-01-31 |website=National Geographic |language=en}}</ref> ''[[USA Today]]'' reported in 2007 that most adults in the USA get about an hour less than the average sleep time 40 years ago.<ref>{{cite news | url=https://www.usatoday.com/news/health/2007-11-25-sleep-deficit_N.htm | work=USA Today | vauthors = Fackelmann K | title=Study: Sleep deficit may be impossible to make up | date=25 November 2007 | url-status=live | archive-url=https://web.archive.org/web/20120628121051/http://www.usatoday.com/news/health/2007-11-25-sleep-deficit_N.htm | archive-date=28 June 2012 | df=dmy-all }}</ref> Other researchers have questioned these claims. A 2004 editorial in the journal ''[[Sleep (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.<ref>{{cite journal | vauthors = Horne J | title = Is there a sleep debt? | journal = Sleep | volume = 27 | issue = 6 | pages = 1047–1049 | date = September 2004 | pmid = 15532195 }}</ref> 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.<ref>{{cite web|url=http://www.popcenter.umd.edu/sdaweb/glaser/Doc/GLAS.htm|title=National Time Use Studies (1965–1985)|work=umd.edu|url-status=live|archive-url=https://web.archive.org/web/20060907204651/http://www.popcenter.umd.edu/sdaweb/glaser/Doc/GLAS.htm|archive-date=7 September 2006}}</ref><ref>{{cite web|url=http://www.popcenter.umd.edu/sdaweb/diary9801/Doc/Diar.htm|title=National Time Use Studies (1998 - 2001)|work=umd.edu|url-status=live|archive-url=https://web.archive.org/web/20060907204005/http://www.popcenter.umd.edu/sdaweb/diary9801/Doc/Diar.htm|archive-date=7 September 2006}}</ref> ==Longest periods without sleep== [[Randy Gardner (record holder)|Randy Gardner]] holds the scientifically documented record for the longest period of time a human being has intentionally gone without sleep not using [[stimulant]]s of any kind. Gardner stayed awake for 264 hours (11 days), breaking the previous record of 260 hours held by [[Tom Rounds]] of [[Honolulu]].<ref name="Coren"/> [[Lieutenant commander|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.<ref name="Coren"/><ref name=Eleven>{{cite book |chapter=Eleven days awake |title=Elephants on Acid: And Other Bizarre Experiments | vauthors = Boese A |isbn=978-0-15-603135-6 |publisher=Harvest Books |pages=90–93 |chapter-url=https://books.google.com/books?id=Wc-UlRRWQ1EC&pg=PA90 |date=5 November 2007 |url-status=live |archive-url=https://web.archive.org/web/20140919124145/http://books.google.com/books?id=Wc-UlRRWQ1EC&lpg=PA90 |archive-date=19 September 2014 }}</ref><ref>{{cite journal | vauthors = Ross JJ | title = Neurological Findings After Prolonged Sleep Deprivation | journal = Archives of Neurology | volume = 12 | issue = 4 | pages = 399–403 | date = April 1965 | pmid = 14264871 | doi = 10.1001/archneur.1965.00460280069006 }}</ref> 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.<ref name=Eleven /> Claims of total sleep deprivation lasting years have been made several times,<ref name="thanh">{{cite news |url=http://www.thanhniennews.com/features/?catid=10&newsid=12673 |title=Vietnam man handles three decades without sleep | vauthors = Thao VP |work=Thanh Nien Daily |publisher=Vietnam National Youth Federation |access-date=26 May 2008 |archive-url = https://web.archive.org/web/20080513061843/http://www.thanhniennews.com/features/?catid=10&newsid=12673 |archive-date = 13 May 2008}}</ref><ref>{{Cite web|url=http://www.pravdareport.com/news/society/sex/15-01-2005/60995-0/|title=Ukrainian man has been lacking sleep for 20 years|access-date=5 October 2016|url-status=live|archive-url=https://web.archive.org/web/20161005214445/http://www.pravdareport.com/news/society/sex/15-01-2005/60995-0/|archive-date=5 October 2016|date=15 January 2005}}</ref><ref>{{cite news |url=https://abcnews.go.com/Health/story?id=7191766&page=4 | vauthors = Childs D |title=11 Baffling Medical Conditions |at=The Boy Who Couldn't Sleep |date=30 March 2009 |work=[[ABC News]] }}</ref> but none are scientifically verified.<ref>{{cite news |title=Matters of dispute – Sleepless in Ukraine |newspaper=[[The Guardian]] |date=10 February 2005 |url=https://www.theguardian.com/theguardian/2005/feb/10/features11.g2 |access-date=11 May 2010 |url-status=live |archive-url=https://web.archive.org/web/20140304011755/http://www.theguardian.com/theguardian/2005/feb/10/features11.g2 |archive-date=4 March 2014 }}</ref> 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.<ref>{{cite news|url=http://www.foxnews.com/story/2008/05/16/boy-3-sleeps-for-first-time-after-experimental-surgery.html|title=Boy, 3, Sleeps for First Time After Experimental Surgery|date=16 May 2008|publisher=FoxNews.com|url-status=live|archive-url=https://web.archive.org/web/20161005204927/http://www.foxnews.com/story/2008/05/16/boy-3-sleeps-for-first-time-after-experimental-surgery.html|archive-date=5 October 2016}}</ref><ref>{{cite news |url=https://abcnews.go.com/GMA/OnCall/story?id=6711810&page=1 |title=Mystery of Sleepless Boy Solved: Boy Who Couldn't Sleep Undergoes Risky, Life-Changing Operation |work=[[ABC News]]| vauthors = Canning A |date=23 January 2009}}</ref> 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 [[polygraph]]ic recordings showing less than 30 minutes (of [[NREM sleep|stage-1 sleep]]) per night, a condition they named "agrypnia". The 27-year-old man had [[Morvan's syndrome|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 [[hallucination]]s.<ref>{{cite journal | vauthors = Fischer-Perroudon C, Mouret J, Jouvet M | title = [Case of agrypnia (4 months without sleep) in Morvan's disease. Favorable action of 5-hydroxytryptophan] | journal = Electroencephalography and Clinical Neurophysiology | volume = 36 | issue = 1 | pages = 1–18 | date = January 1974 | pmid = 4128428 | doi = 10.1016/0013-4694(74)90132-1 | url = http://sommeil.univ-lyon1.fr/articles/jouvet/ecn_74/print.php | url-status = live | archive-url = https://web.archive.org/web/20110130132421/http://sommeil.univ-lyon1.fr/articles/jouvet/ecn_74/print.php | archive-date = 30 January 2011 }}</ref> [[Fatal insomnia]] is a neurodegenerative disease that eventually results in a complete inability to go past [[Sleep#NREM 1|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 == {{col div|colwidth=36em}} * [[Effects of sleep deprivation on cognitive performance]] * [[Narcolepsy]] * [[Polyphasic sleep]] * [[Sleep medicine]] * [[Sleep onset latency]] * [[Wake therapy]] * [[Tony Wright (sleep deprivation)|Tony Wright]], who claims to hold the world record for sleep deprivation * ''[[Foreign Correspondent (film)|Foreign Correspondent]]'', a 1940 film depicting interrogation by sleep deprivation {{colend}} == References == {{Reflist|refs= <ref name="performance">{{cite journal | vauthors = Thomas M, Sing H, Belenky G, Holcomb H, Mayberg H, Dannals R, Wagner H, Thorne D, Popp K, Rowland L, Welsh A, Balwinski S, Redmond D | title = Neural basis of alertness and cognitive performance impairments during sleepiness. I. Effects of 24 h of sleep deprivation on waking human regional brain activity | journal = Journal of Sleep Research | volume = 9 | issue = 4 | pages = 335–352 | date = December 2000 | pmid = 11123521 | doi = 10.1046/j.1365-2869.2000.00225.x | s2cid = 35893889 }}</ref> }} {{SleepSeries2}} {{Authority control}} {{DEFAULTSORT:Sleep Deprivation}} [[Category:Sleep medicine]] [[Category:Sleeplessness and sleep deprivation| ]] [[Category:Nursing diagnoses]] [[Category:Psychological torture techniques]] [[Category:Physical torture techniques]] [[Category:Disorders causing seizures]] Summary: Please note that all contributions to Christianpedia may be edited, altered, or removed by other contributors. If you do not want your writing to be edited mercilessly, then do not submit it here. You are also promising us that you wrote this yourself, or copied it from a public domain or similar free resource (see Christianpedia:Copyrights for details). Do not submit copyrighted work without permission! 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