Sleep deprivation: Difference between revisions - Wikipedia

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[[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~~sleeping 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

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'''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, emotional, and ~~emotional~~physical 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>

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== Sleep deprivation vs sleep restriction ==

Reviews differentiate between having no sleep over a short-term period, such as one night ('sleep deprivation'), and having less than required sleep over a longer period ('sleep restriction'). Sleep deprivation was seen as more impactful in the short term, but sleep restriction had similar effects over a longer period.<ref>{{Cite ~~web~~journal|title=Predicting and mitigating fatigue effects due to sleep deprivation: A review - PMC|date=2022 |pmc=9389006 |journal=Frontiers in Neuroscience |volume=16 |doi=10.3389/fnins.2022.930280 |doi-access=free |pmid=35992930 | vauthors = Kayser KC, Puig VA, Estepp JR }}</ref><ref>{{Cite web|url=https://sleepeducation.org/the-effects-of-sleep-deprivation-vs-sleep-restriction/|title=The effects of sleep deprivation vs. sleep restriction|first=Jonathan|last=Paprocki|date=17 July 2012|website=Sleep Education}}</ref><ref>{{~~Cite~~cite book |~~url~~doi=~~https://www~~10.~~sciencedirect.com/science/article~~1016/~~pii/B9780444537027000063~~B978-0-444-53702-7.00006-3 |title=Total sleep deprivation, chronic sleep restriction and sleep disruption |series=Progress in Brain Research |~~first1~~date=~~Amy~~2010 C.|~~last1~~volume=~~Reynolds~~185 |~~first2~~pages=~~Siobhan~~91–103 |~~last2=Banks|editor-first1~~pmid=~~Gerard~~21075235 A.|~~editor-last1~~isbn=~~Kerkhof|editor~~978-~~first2=Hans~~0-444-53702-7 P.| A.vauthors ~~van|editor-last2~~=~~Dongen|date=1~~ ~~January~~Reynolds AC, Banks S ~~2010|publisher=Elsevier|volume=185|pages=91–103|via=ScienceDirect~~}}</ref><ref>{{Cite journal|title=Impaired Vigilant Attention Partly Accounts for Inhibition Control Deficits After Total Sleep Deprivation and Partial Sleep Restriction|first1=Tianxin|last1=Mao|first2=David|last2=Dinges|first3=Yao|last3=Deng|first4=Ke|last4=Zhao|first5=Zijing|last5=Yang|first6=Hui|last6=Lei|first7=Zhuo|last7=Fang|first8=Fan Nils|last8=Yang|first9=Olga|last9=Galli|first10=Namni|last10=Goel|first11=Mathias|last11=Basner|first12=Hengyi|last12=Rao|date=16 September 2021|journal=Nature and Science of Sleep|volume=13|pages=1545–1560|doi=10.2147/NSS.S314769|doi-access=free |pmid=34557048 |pmc=8455079 }}</ref><ref>{{cite journal | url=https://jcsm.aasm.org/doi/10.5664/jcsm.26918 | doi=10.5664/jcsm.26918 | title=Behavioral and Physiological Consequences of Sleep Restriction | date=2007 | journal=Journal of Clinical Sleep Medicine | volume=03 | issue=5 | pages=519–528 | vauthors = Banks S, Dinges DF }}</ref> A 2022 study found that in most cases the changes induced by chronic or acute sleep loss waxed or waned across the waking day.<ref>{{Cite journal|title=Contrasting Effects of Sleep Restriction, Total Sleep Deprivation, and Sleep Timing on Positive and Negative Affect - PMC|date=2022 |pmc=9433122 |journal=Frontiers in Behavioral Neuroscience |volume=16 |doi=10.3389/fnbeh.2022.911994 |doi-access=free |pmid=36062257 | vauthors = Groeger JA, Lo JC, Santhi N, Lazar AS, Dijk DJ }}</ref>

==Causes==

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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 [[Psychological stress and sleep|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===

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===Self-imposed===

Sleep deprivation can sometimes be self-imposed due to a lack of desire to sleep or the habitual use of stimulant drugs. Revenge Bedtime Procrastination 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">{{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 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====

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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">{{cite journal |author-link=Siri Carpenter |vauthors=Carpenter S |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> 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>

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=== 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~~cite press release ~~news~~|title=Broadband internet causes sleep deprivation, a new study finds~~|work=ScienceDaily~~ |url=https://www.sciencedaily.com/releases/2018/08/180802102340.htm |work=ScienceDaily |publisher=Bocconi University |~~access-~~date=102 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 ===

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[[File:Effects of sleep deprivation.svg|thumb|300px|Main health effects of sleep deprivation]]

===~~The brain~~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~~well since 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>

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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~~====

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 |date=November ~~title~~2013 |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 |pmid=23998288 |s2cid = 4682794 }}</ref>▼

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" />▼

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 |date=March ~~title~~2003 |title= The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation |url=http://www.aasmnet.org/Resources/FactSheets/DrowsyDriving.pdf |url-status=live |journal = Sleep | volume = 26 | issue = 2 | pages = 117–126 | ~~date = March 2003 | pmid = 12683469 |~~ doi = 10.1093/sleep/26.2.117 | ~~url~~ pmid= ~~http://www.aasmnet.org/Resources/FactSheets/DrowsyDriving.pdf~~12683469 | ~~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 |doi-access=free}}</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}}▼

▲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>

===== Driving ability =====

▲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}}

{{main|Sleep-deprived driving}}▼

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 |date=October ~~title~~2000 |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 |pmc=1739867 |pmid=10984335}}</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 |date=July ~~title~~1997 |title= Fatigue, alcohol and performance impairment | journal = Nature | volume = 388 | issue = 6639 | pages = 235 | ~~date~~ bibcode= ~~July 1997~~1997Natur.388..235D | ~~pmid = 9230429 |~~ doi = 10.1038/40775 |pmid=9230429 |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 [[American Academy of Sleep Medicine]] (AASM) reports that one in every five serious motor vehicle injuries are related to driver fatigue.▼

==== ~~Mood~~Working memory ====

▲~~Among the possible physical consequences of sleep deprivation, deficits~~Deficits in attention and [[working memory]] are ~~perhaps~~one of 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" />

==== 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>

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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~~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> ▼

▲{{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 ====

~~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~~Propensity =====

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.<ref>{{cite web | url=https://health.clevelandclinic.org/what-you-should-know-about-microsleep | title=What You Should Know About Microsleep }}</ref> 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 | hdl = 20.500.11850/391781 | hdl-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>

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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" />

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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) and Tayside children’s sleep questionnaire 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><ref>{{Cite journal |~~last~~last1=Rizi |~~first~~first1=Farid Rajaee |last2=Asgarian |first2=Fatemeh Sadat |date=January 2023~~-01~~ |title=Reliability, validity, and psychometric properties of the Persian version of the Tayside ~~children’s~~children's sleep questionnaire ~~|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10899986/~~ |journal=Sleep and Biological Rhythms |language=en |volume=21 |issue=1 |pages=9797–103 |doi=10.1007/s41105-022-00420-6 |pmid=38468908|pmc=10899986 }}</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>

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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>

Wearable devices such as ~~FitBits~~[[Fitbit]]s and [[Apple ~~Watches~~Watch]]es monitor various body signals, including heart rate, skin temperature, and movement, to provide information about sleep patterns. They operate continuously, collecting extensive data which can be used to offer insights on sleep improvement. These devices are user-friendly and have increased awareness about the significance of quality sleep for health.<ref>{{Cite journal |last1=Zambotti |first1=Massimiliano |last2=Cellini |first2=Nicola |last3=Goldstone |first3=Aimee |last4=Colrain |first4=Ian M |last5=Baker C |date=2020 |title=Wearable Sleep Technology in Clinical and Research Settings |journal=Medicine and Science in Sports and Exercise |volume=51 |issue=7 |pages=1538–1557 |doi=10.1249/MSS.0000000000001947 |pmid=30789439 |pmc=6579636 }}</ref>

==Uses==

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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~~www.latimes.com/~~2009~~archives/la-xpm-2009-apr/-17~~/nation/~~-na-interrogation17-story.html|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>

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=== 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~~even 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~~[[benzodiazepine]]s, 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~~journal | 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~~are not 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>

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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 (United States)|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 (United States)|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>