Sleep deprivation

Not to be confused with Insomnia.

The Centers for Disease Control and Prevention's (CDC) recommendations for the amount of sleep needed decrease with age. While sleep quantity is important, good sleep quality is also essential to avoid sleeping disorders.

Sleep deprivation
Specialty	Sleep medicine
Symptoms	Fatigue, eye bags, poor memory, irritable mood, weight gain
Complications	Car and work accidents, weight gain, cardiovascular disease
Causes	Insomnia, sleep apnea, stimulants (caffeine, amphetamine), voluntary imposition (school, work), mood disorders
Treatment	Cognitive behavioral therapy, caffeine (to induce alertness), sleeping pills

Sleep deprivation, also known as sleep insufficiency ^[2] or sleeplessness, is the condition of not having adequate duration and/or quality of sleep to support decent alertness, performance, and health. It can be either chronic or acute and may vary widely in severity. All known animals sleep or exhibit some form of sleep behavior, and the importance of sleep is self-evident for humans, as nearly a third of a person's life is spent sleeping. ^[2] Sleep deprivation is common as it affects about 1/3 of the population. ^[3]

The National Sleep Foundation recommends that adults aim for 7-9 hours of sleep per night, while children and teenagers require even more. For instance, healthy individuals with normal sleep, the appropriate sleep duration for school-aged children is between 9 and 11 hours. ^{[4] [5]} 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. The amount of sleep needed can depend on sleep quality, age, pregnancy, and level of sleep deprivation. Sleep deprivation is linked to various adverse health outcomes, including cognitive impairments, mood disturbances, and increased risk for chronic conditions. A meta-analysis published in Sleep Medicine Reviews indicates that individuals who experience chronic sleep deprivation are at a higher risk for developing conditions such as obesity, diabetes, and cardiovascular diseases.^{[ citation needed ]}

Insufficient sleep has been linked to weight gain, high blood pressure, diabetes, depression, heart disease, and strokes. ^[6] Sleep deprivation can also lead to high anxiety, irritability, erratic behavior, poor cognitive functioning and performance, and psychotic episodes. ^[7] A chronic sleep-restricted state adversely affects the brain and cognitive function. ^[8] However, in a subset of cases, sleep deprivation can paradoxically lead to increased energy and alertness; although its long-term consequences have never been evaluated, sleep deprivation has even been used as a treatment for depression. ^{[9] [10]}

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 physical functions and brain mechanisms. ^[11] Few studies have compared the effects of acute total sleep deprivation and chronic partial sleep restriction. ^[8] A complete absence of sleep over a long period is not frequent in humans (unless they have fatal insomnia or specific issues caused by surgery); it appears that brief microsleeps cannot be avoided. ^[12] Long-term total sleep deprivation has caused death in lab animals. ^[13]

Terminology

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. ^{[14] [15] [16] [17] [18]} A 2022 study found that in most cases the changes induced by chronic or acute sleep loss waxed or waned across the waking day. ^[19]

Sleep debt

Sleep debt refers to a build up of lost optimum sleep. Sleep deprivation is known to be cumulative. ^[20] 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. ^{[21] [22] [23]} 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 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. ^[24] Short-term insomnia can be induced by stress or when the body experiences changes in environment and regimen. ^[25]

Insomnia

Insomnia is a sleep disorder where people have difficulty falling asleep, or staying asleep for as long as desired. ^{[26] [27] [28] [29]} Insomnia may be a factor in causing sleep deprivation.

Effects and consequences

Main health effects of sleep deprivation

Introduction and overview

Effects of sleep deprivation can include

• reduced ability to put an emotional event in perspective
• inattentiveness (including reduced driving ability)
• reduced working memory
• mood effects
• feeling older
• microsleeps. ^[30]

Negative effects

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. ^[31]

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. ^[32] 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. ^[33] 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. ^[34]

Lasting

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. ^[35] Studies in mice show neuronal death (in the hippocampus, locus coeruleus, and medial PFC) occurs after two days of REM sleep deprivation. However, mice do not model the effects in humans well since they sleep a third of the duration of REM sleep of humans and caspase-3, the main effector of apoptosis, kills three times the number of cells in humans than in mice. ^[36] 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. ^[37] For these reasons, both the time before cells degenerate and the extent of degeneration could be greatly underevaluated in humans.

Such 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 ^[38] than age, ^[39] occurring in areas like the precuneus. ^[40]

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 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 Na⁺/K⁺-ATPase pump, which itself activates the intrinsic pathway of apoptosis ^[41] 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 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. ^[42]

Cognitive and neurobehavioural effects

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. ^[43]

Attention

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. ^[44]

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. ^[45] 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.^{[ citation needed ]}

Driving ability

Main article: Sleep-deprived driving

According to a 2000 study, sleep deprivation can have some of the same hazardous effects as being drunk. ^[46] 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. ^[47]

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. 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. ^[48]

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. ^[49] 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. ^[50]

Impacts on reasoning and decision-making

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 ]} Naturally occurring sleep loss affects the choice of everyday tasks, such that low-effort tasks are mostly commonly selected.^{[ citation needed ]} 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. ^{[51] [52]}

Astronauts have reported 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. ^[53]

Working memory

Deficits in attention and working memory are one of the most important; ^[8] 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. ^[54] Working memory is tested by methods such as choice-reaction time tasks. ^[8]

Mood

Sleep deprivation can have a negative impact on mood. ^[55] 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. ^{[56] [57]}

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. ^{[58] [59]} About 75% of adult patients with depression can present with insomnia. ^[60] Sleep deprivation, whether total or not, can induce significant anxiety, and longer sleep deprivations tend to result in an increased level of anxiety. ^[61]

Sleep deprivation has also shown some positive effects on mood and can be used to treat depression. ^[10] 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. ^[62]

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. ^[56]

Subjective age

One study found that sleepiness increases the subjective sense one is old, with extreme sleepiness leading people to feel 10 years older. ^[63] Other studies have also shown a correlation between relatively old subjective age and poor sleep quality. ^{[64] [65]}

Fatigue

Sleep deprivation and disruption is associated with subsequent fatigue. ^{[66] [67]} Fatigue has different effects and characteristics from sleep deprivation.

Sleep

Propensity

Sleep propensity can be defined as the readiness to transition from wakefulness to sleep or the ability to stay asleep if already sleeping. ^[68] Sleep deprivation increases this propensity, which can be measured by polysomnography (PSG) as a reduction in sleep latency (the time needed to fall asleep). ^[69] 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. ^[69]

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. ^[69] 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. ^[69]

Impact on the sleep-wake cycle

Some research shows that sleep deprivation dysregulates the sleep-wake cycle. ^[69] 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. ^{[69] [70]}

To describe the temporal course of the sleep-wake cycle, a two-process model of sleep regulation can be mentioned. ^[69] This model proposes a homeostatic process (Process S) and a circadian process (Process C) that interact to define the time and intensity of sleep. ^[71] 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. ^{[69] [71]}

Microsleeps

Microsleeps are periods of brief sleep that most frequently occur when a person has a significant level of sleep deprivation. ^[72] Microsleeps usually last for a few seconds, usually no longer than 15 seconds, ^[73] and happen most frequently when a person is trying to stay awake when they are feeling sleepy. ^[74] The person usually falls into microsleep while doing a monotonous task like driving, reading a book, or staring at a computer. ^[75] Microsleeps are similar to 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. ^[76]

Cardiovascular morbidity

Decreased sleep duration is associated with many adverse cardiovascular consequences. ^{[77] [78] [79] [80]} 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. ^[81] 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. ^[82]

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. ^[83]

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. ^[84]

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 immunity. ^{[85] [86]}

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. ^[87]

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 ]} 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. ^[85]

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). ^{[85] [88] [89]}

Weight gain

Main article: 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. ^{[90] [91]} 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. ^[92]

In rats, prolonged, complete sleep deprivation increased both food intake and energy expenditure, with a net effect of weight loss and ultimately death. ^[93] 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. ^[91]

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. ^[94] 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. ^[95]

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. ^[96] 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). ^[97]

Other effects

Sleep deprivation may facilitate or intensify: ^[98]

• aching muscles ^[99]
• confusion, memory lapses or loss ^[100]
• depression ^[100]
• development of false memory
• hypnagogic and hypnopompic hallucinations during falling asleep and waking, which are entirely normal ^[101]
• hand tremor ^[102]
• headaches
• malaise
• stye
• periorbital puffiness, commonly known as "bags under eyes" or eye bags
• increased blood pressure ^[103]
• increased stress hormone levels ^[103]
• increased risk of type 2 diabetes ^[103]
• lowering of immunity, increased susceptibility to illness ^[104]
• increased risk of fibromyalgia ^[105]
• irritability ^[98]
• nystagmus (rapid involuntary rhythmic eye movement) ^[106]
• obesity ^[103]
• seizures ^[107]
• mania ^[108]
• Sleep inertia ^[109]
• tachycardia risk. One study 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). ^{[110] [111]}
• temper tantrums in children ^[98]
• violent behavior ^[112]
• yawning ^[98]

Sleep deprivation may cause symptoms similar to:

• attention-deficit hyperactivity disorder (ADHD) ^[98]
• psychosis ^{[101] [113] [114] [115]}

Positive effects

Increased energy and alertness in some cases

In a subset of cases, sleep deprivation can paradoxically lead to increased energy and alertness. ^{[9] [10]}

Other

See the Uses section below for possible beneficial benefits of sleep deprivation on treating depression and insomnia.

Causes

People aged 18 to 64 need seven to nine hours of sleep per night. ^[116] Sleep deprivation occurs when this is not achieved. Causes of this can be as follows:

Environmental Factors

Environmental factors significantly influence sleep quality and can contribute to sleep deprivation in various ways. Noise pollution from traffic, construction, and loud neighbors can disrupt sleep by causing awakenings and preventing deeper sleep stages. ^[117] Similarly, light exposure, particularly from artificial sources like screens, interferes with the body’s natural circadian rhythms by suppressing melatonin production, making it challenging to fall asleep. ^[118] Air quality, odours and temperatures can all affect sleep quality and duration as well. ^[119]

To mitigate the effects of these environmental influences, individuals can consider strategies, such as using soundproofing measures, installing blackout curtains, adjusting room temperatures, ^[120] investing in comfortable bedding, and improving air quality with purifiers. By addressing these environmental factors, individuals can enhance their sleep hygiene and overall health.

Insomnia

Main article: Insomnia

Insomnia, one of the six types of dyssomnia, affects 21–37% of the adult population. ^{[121] [122] [123]} 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 comorbid, insomnia. ^{[124] [125] [126]}

Primary insomnia is a sleep disorder not attributable to a medical, psychiatric, or environmental cause. ^[127] There are three main types of primary insomnia. These include psychophysiological, idiopathic insomnia, and sleep state misperception (paradoxical insomnia). ^[124] 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. ^[128]

Secondary insomnia, or comorbid insomnia, occurs concurrently with other medical, neurological, psychological, and psychiatric conditions. Causation is not necessarily implied. ^[129] Causes can be from depression, anxiety, and personality disorders. ^[130]

Sleep apnea

Main article: 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. ^[131] It is a sleep related breathing disorder that can cause partial or complete obstruction of the upper airways during sleep. ^[132] One billion people worldwide are affected by obstructive sleep apnea. ^[132] 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. ^[133] 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. ^[134]

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. ^[135]

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. ^[136]

Caffeine

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.

Caffeine consumption, usually in the form of coffee, is one of the most widely used stimulants in the world. ^[137] While there are short-term performance benefits to caffeine consumption, overuse can lead to insomnia symptoms or worsen pre-existing insomnia. ^[138] Consuming caffeine to stay awake at night may lead to sleeplessness, anxiety, frequent nighttime awakenings, and overall poorer sleep quality. ^[139] The main metabolite of melatonin (6-sulfatoxymelatonin) gets reduced with consumption of caffeine in the day, which is one of the mechanisms by which sleep is interrupted. ^[137]

Studying

See also: Sleep deprivation in higher education

The 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. ^[140] 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. ^[141]

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. ^[142] 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. ^[143]

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. ^[144]

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. ^[145] 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. ^[145] 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. ^[146] One in four U.S. high school students admits to falling asleep in class at least once a week. ^[147]

It is known that during human adolescence, circadian rhythms and, therefore, sleep patterns typically undergo marked changes. 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. ^[148]

Mental illness

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). ^[131]

The specific causal relationships between sleep loss and effects on psychiatric disorders have been most extensively studied in patients with mood disorders. ^{[149] [ medical citation needed ]} Shifts into mania in bipolar patients are often preceded by periods of insomnia, ^[150] and sleep deprivation has been shown to induce a manic state in about 30% of patients. ^[151] Sleep deprivation may represent a final common pathway in the genesis of mania, ^[152] and manic patients usually have a continuous reduced need for sleep. ^[153]

The symptoms of sleep deprivation and those of schizophrenia are parallel, including those of positive and cognitive symptoms. ^[154]

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. ^[155] 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. ^[156] 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. ^[157]

Time online

A 2018 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. ^[158] 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. ^[159] 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 can disrupt the normal circadian rhythms of biologic functions, which is associated with the sleep/wake cycle. Both the sleep length and quality can be affected. A “shift-work sleep disorder” has been diagnosed in approximately 10% of shift workers aged between 18-65 years old according to the International Classification of Sleep Disorders, version 2 (ICSD-2). ^[160] 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. ^[161]

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. ^[162]

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. ^[162]

Sleep diaries

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. ^{[163] [164]}

Sleep questionnaires

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. ^{[165] [166]}

Sleep quality can be assessed using the Pittsburgh Sleep Quality Index (PSQI), a self-report questionnaire designed to measure sleep quality and disturbances over a one-month period.

Actigraphy

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. ^{[167] [168] [169] [170]}

Wearable devices

Wearable devices such as Fitbits and Apple Watches monitor various body signals, including heart rate, skin temperature, and movement, to provide information about sleep patterns. They operate continuously, collecting extensive data which can be used to offer insights on sleep improvement. These devices are user-friendly and have increased awareness about the significance of quality sleep for health. ^[171]

Prevention

Although there are numerous causes of sleep deprivation, there are some fundamental measures that promote quality sleep, as suggested by organizations such as the Centers for Disease Control and Prevention, the National Institute of Health, the National Institute of Aging, and the American Academy of Family Physicians.

Sleep hygiene

Historically, sleep hygiene, as first medically defined by Hauri in 1977, ^[172] 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 ^[173] and for people without. ^[172] The key is to implement healthier sleep habits, also known as sleep hygiene. ^[174]

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 and caffeine
• avoiding heavy meals in the evening
• winding down and avoiding electronic use or physical activities close to bedtime
• getting out of bed if unable to fall asleep. ^[175]

CBT

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). ^[173]

CBT-i contains five different components:

• cognitive therapy
• stimulus control
• sleep restriction
• sleep hygiene
• relaxation.

As this approach has minimal adverse effects and long-term benefits, it is often preferred to (chronic) drug therapy. ^[176]

Management

Measures to increase alertness

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. ^[177]

Other strategies recommended by the American Academy of Sleep Medicine include

• prophylactic sleep before deprivation,
• naps,
• other stimulants,

and combinations thereof.

However, the American Academy of Sleep Medicine has said that the only sure and safe way to combat sleep deprivation is to increase nightly sleep time. ^[178]

Uses

Treating depression

Further information: Sleep Deprivation Therapy

Studies show that sleep restriction has some potential for treating depression. ^[10] 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. ^[179] 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). ^[180] 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. ^[181]

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). ^{[182] [183]} Many tricyclic antidepressants suppress REM sleep, providing additional evidence for a link between mood and sleep. ^[184] Similarly, tranylcypromine has been shown to completely suppress REM sleep at adequate doses.

Sleep deprivation has been used as a treatment for depression. ^{[9] [10]}

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. ^[185] One of the components is a controlled regime of "sleep restriction" in order to restore the homeostatic drive to sleep and encourage normal "sleep efficiency". ^[186] Stimulus control therapy is intended to limit behaviors intended to condition the body to sleep while in bed. ^[185] The main goal of stimulus control and 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. ^{[186] [176]} 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. ^{[185] [173]} 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, eye fatigue, and even mania. ^[187]

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. ^[185]

Military uses

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. ^{[188] [189]}

Sleep deprivation has been used by the military in training programs to prepare personnel for combat experiences when proper sleep schedules 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 ]}

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 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. ^{[190] [191]}

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. ^{[188] [189]}

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. ^[192]

To facilitate abusive control

Sleep deprivation can be used to disorient abuse victims to help set them up for abusive control. ^{[193] [194]}

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. ^[195]

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:

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. ^[196]

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 and degrading treatment", in breach of the European Convention on Human Rights. ^[197]

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 (7+1⁄2 days) ^{[198] [199]} by shackling a diapered prisoner to the ceiling did not constitute torture, ^[200] nor did the combination of multiple interrogation methods (including sleep deprivation) constitute torture under United States law. ^{[201] [202]} These memoranda were repudiated and withdrawn during the first months of the Obama administration. ^[198]

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. ^[203] 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." ^[204]

Changes in American sleep habits

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. ^[205] USA Today reported in 2007 that most adults in the USA get about an hour less than the average sleep time 40 years ago. ^[206]

Other researchers have questioned these claims. A 2004 editorial in the 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. ^[207]

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. ^{[208] [209]}

Longest periods without sleep

Randy Gardner holds the scientifically documented record for the longest period of time a human being has intentionally gone without sleep not using stimulants of any kind. Gardner stayed awake for 264 hours (11 days), breaking the previous record of 260 hours held by Tom Rounds of Honolulu. ^[210] 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. ^{[210] [211] [212]}

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. ^[211]

Claims of total sleep deprivation lasting years have been made several times, ^{[213] [214] [215]} but none are scientifically verified. ^[216] 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. ^{[217] [218]}

French sleep expert Michel Jouvet and his team reported the case of a patient who was quasi-sleep-deprived for four months, as confirmed by repeated polygraphic recordings showing less than 30 minutes (of stage-1 sleep) per night, a condition they named "agrypnia". The 27-year-old man had Morvan's fibrillary chorea, a rare disease that leads to involuntary movements, and in this particular case, extreme insomnia. The researchers found that treatment with 5-HTP restored almost normal sleep stages. However, some months after this recovery, the patient died during a relapse that was unresponsive to 5-HTP. The cause of death was pulmonary edema. Despite the extreme insomnia, psychological investigation showed no sign of cognitive deficits, except for some hallucinations. ^[219]

Fatal insomnia is a neurodegenerative disease that eventually results in a complete inability to go past stage 1 of NREM sleep. In addition to insomnia, patients may experience panic attacks, paranoia, phobias, hallucinations, rapid weight loss, and dementia. Death usually occurs between 7 and 36 months from onset.^{[ citation needed ]}

See also

• Effects of sleep deprivation on cognitive performance
• Narcolepsy
• Polyphasic sleep
• Sleep medicine
• Sleep onset latency
• Wake therapy
• Tony Wright, who claims to hold the world record for sleep deprivation
• Foreign Correspondent , a 1940 film depicting interrogation by sleep deprivation

References

1. "How Much Sleep Do I Need?". CDC.gov. Centers for Disease Control and Prevention (CDC). 14 September 2022. Archived from the original on 2 November 2023. Last Reviewed: September 14, 2022. Source: National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health.
2. Amin F, Sankari A (2022). "Sleep Insufficiency". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID   36256756 . Retrieved 18 May 2023.
3. Grandner MA (2019). "Epidemiology of insufficient sleep and poor sleep quality". Sleep and Health. pp. 11–20. doi:10.1016/B978-0-12-815373-4.00002-2. ISBN   978-0-12-815373-4.
4. Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, et al. (March 2015). "National Sleep Foundation's sleep time duration recommendations: methodology and results summary". Sleep Health. 1 (1): 40–43. doi:10.1016/j.sleh.2014.12.010.
5. Suni E, Dimitriu A (25 July 2023). "Sleep Deprivation: Understanding the Hidden Consequences". SleepFoundation.org.
6. Olson E. "How many hours of sleep are enough for good health?". Mayo Clinic. Simon & Schuster. Retrieved 7 March 2022.
7. "How poor sleep affects your mental health". Priory. 3 July 2018. Retrieved 17 April 2022.
8. Alhola P, Polo-Kantola P (October 2007). "Sleep deprivation: Impact on cognitive performance". Neuropsychiatric Disease and Treatment. 3 (5): 553–567. PMC   2656292 . PMID   19300585. Although both conditions [total and partial SD] induce several negative effects including impairments in cognitive performance, the underlying mechanisms seem to be somewhat different.
9. Nykamp K, Rosenthal L, Folkerts M, Roehrs T, Guido P, Roth T (September 1998). "The effects of REM sleep deprivation on the level of sleepiness/alertness". Sleep. 21 (6): 609–614. doi: 10.1093/sleep/21.6.609 . PMID   9779520.
10. Riemann D, Berger M, Voderholzer U (July–August 2001). "Sleep and depression--results from psychobiological studies: an overview". Biological Psychology. 57 (1–3): 67–103. doi:10.1016/s0301-0511(01)00090-4. PMID   11454435.
11. Mai Z, Xu H, Ma N (October 2021). "Research progress on the impact of acute sleep deprivation on cognitive and emotional functions and its neural mechanisms". Chinese General Medicine (in Chinese). 24 (29): 3653–3659. doi:10.12114/j.issn.1007-9572.2021.01.016.
12. Kushida CA (2005). Sleep deprivation. Informa Health Care. pp. 1–2. ISBN   978-0-8247-5949-0.
13. Rechtschaffen A, Bergmann BM (1995). "Sleep deprivation in the rat by the disk-over-water method". Behavioural Brain Research. 69 (1–2): 55–63. doi:10.1016/0166-4328(95)00020-T. PMID   7546318.
14. Kayser KC, Puig VA, Estepp JR (2022). "Predicting and mitigating fatigue effects due to sleep deprivation: A review - PMC". Frontiers in Neuroscience. 16. doi: 10.3389/fnins.2022.930280 . PMC   9389006 . PMID   35992930.
15. Paprocki J (17 July 2012). "The effects of sleep deprivation vs. sleep restriction". Sleep Education.
16. Reynolds AC, Banks S (2010). Total sleep deprivation, chronic sleep restriction and sleep disruption. Progress in Brain Research. Vol. 185. pp. 91–103. doi:10.1016/B978-0-444-53702-7.00006-3. ISBN   978-0-444-53702-7. PMID   21075235.
17. Mao T, Dinges D, Deng Y, Zhao K, Yang Z, Lei H, et al. (16 September 2021). "Impaired Vigilant Attention Partly Accounts for Inhibition Control Deficits After Total Sleep Deprivation and Partial Sleep Restriction". Nature and Science of Sleep. 13: 1545–1560. doi: 10.2147/NSS.S314769 . PMC   8455079 . PMID   34557048.
18. Banks S, Dinges DF (15 August 2007). "Behavioral and Physiological Consequences of Sleep Restriction". Journal of Clinical Sleep Medicine. 03 (5): 519–528. doi:10.5664/jcsm.26918.
19. Groeger JA, Lo JC, Santhi N, Lazar AS, Dijk DJ (2022). "Contrasting Effects of Sleep Restriction, Total Sleep Deprivation, and Sleep Timing on Positive and Negative Affect - PMC". Frontiers in Behavioral Neuroscience. 16. doi: 10.3389/fnbeh.2022.911994 . PMC   9433122 . PMID   36062257.
20. "Sleep Deprivation and Deficiency - How Much Sleep Is Enough". National Heart, Lung, and Blood Institute. 24 March 2022.
21. "Sleep Debt: Can You Catch up on Sleep?". Sleep Foundation. 20 January 2010. Retrieved 27 June 2022.
22. Colten HR, Altevogt BM, Research Io (2006). "Extent and Health Consequences of Chronic Sleep Loss and Sleep Disorders". Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. National Academies Press (US).
23. "Sleep Debt: The Hidden Cost of Insufficient Rest". Sleep Foundation. 20 January 2010.
24. Plaford GR (2009). Sleep and learning : the magic that makes us healthy and smart. Lanham: Rowman & Littlefield Education. ISBN   978-1-60709-091-5. OCLC   310224798.
25. "Insomnia - What Is Insomnia?". National Heart, Lung, and Blood Institute. 24 March 2022.
26. "What Is Insomnia?". Health Topics. NHLBI. 24 March 2022. Archived from the original on 28 July 2016. Retrieved 26 November 2023.
27. "Insomnia: Causes, symptoms, and treatments". www.medicalnewstoday.com. 16 July 2020. Retrieved 25 July 2024.
28. Roth T (August 2007). "Insomnia: definition, prevalence, etiology, and consequences". Journal of Clinical Sleep Medicine (Supplement). 3 (5 Suppl): S7–10. doi: 10.5664/jcsm.26929 . PMC   1978319 . PMID   17824495.
29. Punnoose AR, Golub RM, Burke AE (June 2012). "Insomnia". JAMA (JAMA patient page). 307 (24): 2653. doi: 10.1001/jama.2012.6219 . PMID   22735439.
30. See sections below for refs
31. Yoo SS, Gujar N, Hu P, Jolesz FA, Walker MP (October 2007). "The human emotional brain without sleep--a prefrontal amygdala disconnect". Current Biology. 17 (20): R877–R878. Bibcode:2007CBio...17.R877Y. doi: 10.1016/j.cub.2007.08.007 . PMID   17956744.
32. "最新研究：睡眠不足会永久损伤脑细胞" [Latest research: Lack of sleep can permanently damage brain cells]. BBC News 中文 (Chinese) (in Simplified Chinese). 21 March 2014. Retrieved 5 December 2023.
33. Thomas M, Sing H, Belenky G, Holcomb H, Mayberg H, Dannals R, et al. (December 2000). "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 of Sleep Research. 9 (4): 335–352. doi:10.1046/j.1365-2869.2000.00225.x. PMID   11123521.
34. Farahani FV, Fafrowicz M, Karwowski W, Douglas PK, Domagalik A, Beldzik E, et al. (11 October 2019). "Effects of Chronic Sleep Restriction on the Brain Functional Network, as Revealed by Graph Theory". Frontiers in Neuroscience. 13. Frontiers Media SA: 1087. doi: 10.3389/fnins.2019.01087 . PMC   6807652 . PMID   31680823.
35. Wu J, Dou Y, Ladiges WC (September 2020). "Adverse Neurological Effects of Short-Term Sleep Deprivation in Aging Mice Are Prevented by SS31 Peptide". Clocks & Sleep. 2 (3): 325–333. doi: 10.3390/clockssleep2030024 . PMC   7573804 . PMID   33089207.
36. Kerr LE, McGregor AL, Amet LE, Asada T, Spratt C, Allsopp TE, et al. (October 2004). "Mice overexpressing human caspase 3 appear phenotypically normal but exhibit increased apoptosis and larger lesion volumes in response to transient focal cerebral ischaemia". Cell Death and Differentiation. 11 (10): 1102–1111. doi: 10.1038/sj.cdd.4401449 . PMID   15153940.
37. Soto-Rodriguez S, Lopez-Armas G, Luquin S, Ramos-Zuñiga R, Jauregui-Huerta F, Gonzalez-Perez O, et al. (2016). "Rapid Eye Movement Sleep Deprivation Produces Long-Term Detrimental Effects in Spatial Memory and Modifies the Cellular Composition of the Subgranular Zone". Frontiers in Cellular Neuroscience. 10: 132. doi: 10.3389/fncel.2016.00132 . PMC   4884737 . PMID   27303266.
38. Haelle T (3 September 2014). "Poor Quality Sleep May Be Linked to Shrinking Brain". WebMD. Archived from the original on 9 March 2023. Retrieved 9 March 2023.
39. Van Someren EJ, Oosterman JM, Van Harten B, Vogels RL, Gouw AA, Weinstein HC, et al. (April 2019). "Medial temporal lobe atrophy relates more strongly to sleep-wake rhythm fragmentation than to age or any other known risk". Neurobiology of Learning and Memory. Sleep and Hippocampal Function. 160: 132–138. doi: 10.1016/j.nlm.2018.05.017 . hdl: 2066/202856 . PMID   29864525.
40. Grau-Rivera O, Operto G, Falcón C, Sánchez-Benavides G, Cacciaglia R, Brugulat-Serrat A, et al. (ALFA Study) (January 2020). "Association between insomnia and cognitive performance, gray matter volume, and white matter microstructure in cognitively unimpaired adults". Alzheimer's Research & Therapy. 12 (1): 4. doi: 10.1186/s13195-019-0547-3 . PMC   6945611 . PMID   31907066.
41. Somarajan BI, Khanday MA, Mallick BN (2016). "Rapid Eye Movement Sleep Deprivation Induces Neuronal Apoptosis by Noradrenaline Acting on Alpha1 Adrenoceptor and by Triggering Mitochondrial Intrinsic Pathway". Frontiers in Neurology. 7: 25. doi: 10.3389/fneur.2016.00025 . PMC   4779900 . PMID   27014180.
42. Siegel JM (November 2003). "Why We Sleep" (PDF). Scientific American . Archived (PDF) from the original on 3 December 2008. Retrieved 3 April 2008.
43. Goel N, Rao H, Durmer JS, Dinges DF (2009). "Neurocognitive Consequences of Sleep Deprivation - PMC". Seminars in Neurology. 29 (4): 320–339. doi:10.1055/s-0029-1237117. PMC   3564638 . PMID   19742409.
44. Innes CR, Poudel GR, Jones RD (November 2013). "Efficient and regular patterns of nighttime sleep are related to increased vulnerability to microsleeps following a single night of sleep restriction". Chronobiology International. 30 (9): 1187–1196. doi:10.3109/07420528.2013.810222. PMID   23998288.
45. Van Dongen HP, Maislin G, Mullington JM, Dinges DF (March 2003). "The Cumulative Cost of Additional Wakefulness: Dose-Response Effects on Neurobehavioral Functions and Sleep Physiology From Chronic Sleep Restriction and Total Sleep Deprivation". Sleep. 26 (2): 117–126. doi:10.1093/sleep/26.2.117. PMID   12683469.
46. Williamson AM, Feyer AM (October 2000). "Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication". Occupational and Environmental Medicine. 57 (10): 649–655. doi:10.1136/oem.57.10.649. PMC   1739867 . PMID   10984335.
47. Dawson D, Reid K (July 1997). "Fatigue, alcohol and performance impairment". Nature. 388 (6639): 235. Bibcode:1997Natur.388..235D. doi: 10.1038/40775 . PMID   9230429.
48. "Drowsy Driving:Key Messages and Talking Points" (PDF). National Sleep Foundation. 2 December 2009. Archived (PDF) from the original on 26 November 2013.
49. "Fact Sheet – Pilot Fatigue". Federal Aviation Administration. 10 September 2010. Archived from the original on 5 October 2016.
50. Baldwin DC, Daugherty SR (March 2004). "Sleep deprivation and fatigue in residency training: results of a national survey of first- and second-year residents". Sleep. 27 (2): 217–223. doi: 10.1093/sleep/27.2.217 . PMID   15124713.
51. Engle-Friedman M, Riela S, Golan R, Ventuneac AM, Davis CM, Jefferson AD, et al. (June 2003). "The effect of sleep loss on next day effort". Journal of Sleep Research. 12 (2): 113–124. doi:10.1046/j.1365-2869.2003.00351.x. PMID   12753348.
52. Engle-Friedman M, Palencar V, Riela S (June 2010). "Sleep and effort in adolescent athletes". Journal of Child Health Care. 14 (2): 131–141. doi:10.1177/1367493510362129. PMID   20435615.
53. Whitmire AM, Leveton LB, Barger L, Brainard G, Dinges DF, Klerman E, et al. "Risk of Performance Errors due to Sleep Loss, Circadian Desynchronization, Fatigue, and Work Overload" (PDF). Human Health and Performance Risks of Space Exploration Missions: Evidence reviewed by the NASA Human Research Program. Archived (PDF) from the original on 15 February 2012. Retrieved 25 June 2012.
54. Kolb B, Whishaw I (2014). An Introduction to Brain and Behavior (4th ed.). New York, New York: Worth Publishers. pp. 468–469. ISBN   978-1-4292-4228-8.
55. Kramer M, Roehrs T, Roth T (January 1976). "Mood change and the physiology of sleep". Comprehensive Psychiatry. 17 (1): 161–165. doi:10.1016/0010-440x(76)90065-1. PMID   174865.
56. "Sleep and Mood | Need Sleep". healthysleep.med.harvard.edu. Archived from the original on 21 March 2021. Retrieved 21 January 2021.
57. Dinges DF, Pack F, Williams K, Gillen KA, Powell JW, Ott GE, et al. (April 1997). "Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4-5 hours per night". Sleep. 20 (4): 267–277. PMID   9231952.
58. "Depression and Sleep". Sleep Foundation. 18 September 2020. Retrieved 21 January 2021.
59. Franzen PL, Buysse DJ (2008). "Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications". Dialogues in Clinical Neuroscience. 10 (4): 473–481. doi:10.31887/DCNS.2008.10.4/plfranzen. PMC   3108260 . PMID   19170404.
60. Nutt D, Wilson S, Paterson L (2008). "Sleep disorders as core symptoms of depression". Dialogues in Clinical Neuroscience. 10 (3): 329–336. doi:10.31887/DCNS.2008.10.3/dnutt. PMC   3181883 . PMID   18979946.
61. Pires GN, Bezerra AG, Tufik S, Andersen ML (August 2016). "Effects of acute sleep deprivation on state anxiety levels: a systematic review and meta-analysis". Sleep Medicine. 24: 109–118. doi:10.1016/j.sleep.2016.07.019. PMID   27810176.
62. Selvi Y, Gulec M, Agargun MY, Besiroglu L (September 2007). "Mood changes after sleep deprivation in morningness–eveningness chronotypes in healthy individuals". Journal of Sleep Research. 16 (3): 241–244. doi:10.1111/j.1365-2869.2007.00596.x. PMID   17716271.
63. Balter LJ, Axelsson J (27 March 2024). "Sleep and subjective age: protect your sleep if you want to feel young". Proceedings of the Royal Society B: Biological Sciences. 291 (2019). The Royal Society. doi: 10.1098/rspb.2024.0171 . PMC   10965331 . PMID   38531399.
64. Stephan Y, Sutin AR, Bayard S, Terracciano A (2 September 2017). "Subjective age and sleep in middle-aged and older adults". Psychology & Health. 32 (9): 1140–1151. doi:10.1080/08870446.2017.1324971. PMID   28480746.
65. Yoon JE, Oh D, Hwang I, Park JA, Im HJ, Thomas RJ, et al. (3 September 2023). "Association between older subjective age and poor sleep quality: a population-based study". Behavioral Sleep Medicine. 21 (5): 585–600. doi:10.1080/15402002.2022.2144860. PMID   36377789.
66. "Consequences of Fatigue from Insufficient Sleep". Commercial Motor Vehicle Driver Fatigue, Long-Term Health, and Highway Safety: Research Needs. National Academies Press (US). 12 August 2016.
67. Kayser KC, Puig VA, Estepp JR (2022). "Predicting and mitigating fatigue effects due to sleep deprivation: A review". Frontiers in Neuroscience. 16. doi: 10.3389/fnins.2022.930280 . PMC   9389006 . PMID   35992930.
68. Schulz H, Bes E, Jobert M (1998). "Modelling sleep propensity and sleep disturbances.". Sleep—Wake Disorders. Boston, MA: Springer US. pp. 11–26. doi:10.1007/978-1-4899-0245-0_2. ISBN   978-1-4899-0247-4.
69. Durmer JS, Dinges DF (March 2005). "Neurocognitive consequences of sleep deprivation". Seminars in Neurology. 25 (1): 117–129. doi:10.1055/s-2005-867080. PMC   3564638 . PMID   15798944.
70. Saper CB, Chou TC, Scammell TE (December 2001). "The sleep switch: hypothalamic control of sleep and wakefulness". Trends in Neurosciences. 24 (12): 726–731. doi:10.1016/S0166-2236(00)02002-6. PMID   11718878.
71. Borbély AA, Daan S, Wirz-Justice A, Deboer T (April 2016). "The two-process model of sleep regulation: a reappraisal". Journal of Sleep Research. 25 (2): 131–143. doi: 10.1111/jsr.12371 . PMID   26762182.
72. "What You Should Know About Microsleep".
73. Skorucak J, Hertig-Godeschalk A, Schreier DR, Malafeev A, Mathis J, Achermann P (January 2020). "Automatic detection of microsleep episodes with feature-based machine learning". Sleep. 43 (1): zsz225. doi: 10.1093/sleep/zsz225 . hdl: 20.500.11850/391781 . PMID   31559424.
74. "Glossary K-M". Get Sleep. Harvard Medical School. 2012. Archived from the original on 2 April 2015.
75. "Microsleep | Microsleeps". www.sleepdex.org. Archived from the original on 3 March 2016. Retrieved 14 February 2016.
76. Vyazovskiy VV, Olcese U, Hanlon EC, Nir Y, Cirelli C, Tononi G (April 2011). "Local sleep in awake rats". Nature. 472 (7344): 443–447. Bibcode:2011Natur.472..443V. doi:10.1038/nature10009. PMC   3085007 . PMID   21525926.
77. "CDC - Sleep and Chronic Disease - Sleep and Sleep Disorders". www.cdc.gov. 13 February 2019. Retrieved 21 January 2021.
78. Knutson KL, Van Cauter E, Rathouz PJ, Yan LL, Hulley SB, Liu K, et al. (June 2009). "Association between sleep and blood pressure in midlife: the CARDIA sleep study". Archives of Internal Medicine. 169 (11): 1055–1061. doi:10.1001/archinternmed.2009.119. PMC   2944774 . PMID   19506175.
79. King CR, Knutson KL, Rathouz PJ, Sidney S, Liu K, Lauderdale DS (December 2008). "Short sleep duration and incident coronary artery calcification". JAMA. 300 (24): 2859–2866. doi:10.1001/jama.2008.867. PMC   2661105 . PMID   19109114.
80. Sabanayagam C, Shankar A (August 2010). "Sleep duration and cardiovascular disease: results from the National Health Interview Survey". Sleep. 33 (8): 1037–1042. doi:10.1093/sleep/33.8.1037. PMC   2910533 . PMID   20815184.
81. St-Onge MP, Grandner MA, Brown D, Conroy MB, Jean-Louis G, Coons M, et al. (November 2016). "Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association". Circulation. 134 (18): e367–e386. doi:10.1161/CIR.0000000000000444. PMC   5567876 . PMID   27647451.
82. "CDC - Data and Statistics - Sleep and Sleep Disorders". www.cdc.gov. 5 March 2019. Retrieved 21 January 2021.
83. Deng HB, Tam T, Zee BC, Chung RY, Su X, Jin L, et al. (October 2017). "Short Sleep Duration Increases Metabolic Impact in Healthy Adults: A Population-Based Cohort Study". Sleep. 40 (10). doi: 10.1093/sleep/zsx130 . PMID   28977563.
84. Daghlas I, Dashti HS, Lane J, Aragam KG, Rutter MK, Saxena R, et al. (September 2019). "Sleep Duration and Myocardial Infarction". Journal of the American College of Cardiology. 74 (10): 1304–1314. doi:10.1016/j.jacc.2019.07.022. PMC   6785011 . PMID   31488267.
85. "Sleep & Immunity: Can a Lack of Sleep Make You Sick?". Sleep Foundation. 26 October 2018. Retrieved 21 January 2021.
86. Irwin MR (November 2019). "Sleep and inflammation: partners in sickness and in health". Nature Reviews. Immunology. 19 (11): 702–715. doi:10.1038/s41577-019-0190-z. PMID   31289370.
87. "睡眠好坏直接影响免疫力--健康·生活--人民网". health.people.com.cn. Retrieved 5 December 2023.
88. Prather AA, Janicki-Deverts D, Hall MH, Cohen S (September 2015). "Behaviorally Assessed Sleep and Susceptibility to the Common Cold". Sleep. 38 (9): 1353–1359. doi:10.5665/sleep.4968. PMC   4531403 . PMID   26118561.
89. Pisani MA, Friese RS, Gehlbach BK, Schwab RJ, Weinhouse GL, Jones SF (April 2015). "Sleep in the intensive care unit". American Journal of Respiratory and Critical Care Medicine. 191 (7): 731–738. doi:10.1164/rccm.201411-2099CI. PMC   5447310 . PMID   25594808.
90. Van Cauter E, Spiegel K (1999). "Sleep as a mediator of the relationship between socioeconomic status and health: a hypothesis". Annals of the New York Academy of Sciences. 896 (1): 254–261. Bibcode:1999NYASA.896..254V. doi:10.1111/j.1749-6632.1999.tb08120.x. PMID   10681902.
91. Taheri S, Lin L, Austin D, Young T, Mignot E (December 2004). "Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index". PLOS Medicine. 1 (3): e62. doi: 10.1371/journal.pmed.0010062 . PMC   535701 . PMID   15602591.
92. "The Link Between Obesity and Sleep Deprivation". Sleep Foundation. 4 December 2020. Retrieved 21 January 2021.
93. Everson CA, Bergmann BM, Rechtschaffen A (February 1989). "Sleep deprivation in the rat: III. Total sleep deprivation". Sleep. 12 (1): 13–21. doi: 10.1093/sleep/12.1.13 . PMID   2928622.
94. "Sleep and Disease Risk". Healthy Sleep. Harvard Medical School. 2007. Archived from the original on 25 March 2016.
95. "Diabetes and Sleep: Sleep Disturbances & Coping". Sleep Foundation. 20 November 2020. Retrieved 21 January 2021.
96. Gottlieb DJ, Punjabi NM, Newman AB, Resnick HE, Redline S, Baldwin CM, et al. (April 2005). "Association of sleep time with diabetes mellitus and impaired glucose tolerance". Archives of Internal Medicine. 165 (8): 863–867. doi: 10.1001/archinte.165.8.863 . PMID   15851636.
97. Spiegel K, Leproult R, Van Cauter E (October 1999). "Impact of sleep debt on metabolic and endocrine function". Lancet. 354 (9188): 1435–1439. doi:10.1016/S0140-6736(99)01376-8. PMID   10543671.
98. "Sleep deprivation". betterhealth.vic.gov.au. Archived from the original on 20 August 2009.
99. Morin CM (2003). Insomnia. New York: Kluwer Academic/Plenum Publ. p.  28 death. ISBN   978-0-306-47750-8.
100. "Brain Basics: Understanding Sleep". National Institute of Neurological Disorders and Stroke. Archived from the original on 11 October 2007.
101. Ohayon MM, Priest RG, Caulet M, Guilleminault C (October 1996). "Hypnagogic and hypnopompic hallucinations: pathological phenomena?". The British Journal of Psychiatry. 169 (4): 459–467. doi:10.1192/bjp.169.4.459. PMID   8894197.
102. Smith AP (1992). Handbook of Human Performance. London: Acad. Press. p. 240. ISBN   978-0-12-650352-4.
103. "Harvard Heart Letter examines the costs of not getting enough sleep – Harvard Health Publications". Health.harvard.edu. 31 May 2012. Archived from the original on 9 May 2011. Retrieved 13 August 2012.
104. Olson E (9 June 2015). "Lack of sleep: Can it make you sick?". Mayo Clinic . Retrieved 26 August 2018.
105. "The Role of Magnesium in Fibromyalgia". Web.mit.edu. Archived from the original on 29 July 2012. Retrieved 13 August 2012.
106. Citek K, Ball B, Rutledge DA (November 2003). "Nystagmus testing in intoxicated individuals". Optometry. 74 (11): 695–710. PMID   14653658.
107. Engel J, Pedley TA, Aicardi J (2008). Epilepsy: A Comprehensive Textbook - Google Books. Lippincott Williams & Wilkins. ISBN   978-0-7817-5777-5 . Retrieved 30 January 2015.
108. Wehr TA (October 1991). "Sleep-Loss as a Possible Mediator of Diverse Causes of Mania". British Journal of Psychiatry. 159 (4): 576–578. doi:10.1192/bjp.159.4.576. PMID   1751874.
109. "Sleep deprivation - Better Health Channel". 20 August 2009. Archived from the original on 20 August 2009. Retrieved 24 October 2019.
110. "Tachycardia - Symptoms and causes". Mayo Clinic. Retrieved 27 June 2022.
111. Rangaraj VR, Knutson KL (February 2016). "Association between sleep deficiency and cardiometabolic disease: implications for health disparities". Sleep Medicine. 18: 19–35. doi:10.1016/j.sleep.2015.02.535. PMC   4758899 . PMID   26431758.
112. Vaughn MG, Salas-Wright CP, White NA, Kremer KP (2015). "Poor sleep and reactive aggression: Results from a national sample of African American adults". Journal of Psychiatric Research. 66–67: 54–59. doi:10.1016/j.jpsychires.2015.04.015. PMID   25940021.
113. "Neural Link Between Sleep Loss And Psychiatric Disorders". ts-si.org. 24 October 2007. Archived from the original on 28 February 2009.
114. Chan-Ob T, Boonyanaruthee V (September 1999). "Meditation in association with psychosis". Journal of the Medical Association of Thailand = Chotmaihet Thangphaet. 82 (9): 925–930. PMID   10561951.
115. Devillières P, Opitz M, Clervoy P, Stephany J (May–June 1996). "[Delusion and sleep deprivation]". L'Encephale. 22 (3): 229–231. PMID   8767052.
116. "Here's What Happens When You Don't Get Enough Sleep (And How Much You Really Need a Night)". Cleveland Clinic. 25 March 2022. Retrieved 17 April 2022.
117. Zaharna M, Guilleminault C (2010). "Sleep, noise and health: Review". Noise and Health. 12 (47): 64. doi: 10.4103/1463-1741.63205 .
118. Touitou Y, Reinberg A, Touitou D (March 2017). "Association between light at night, melatonin secretion, sleep deprivation, and the internal clock: Health impacts and mechanisms of circadian disruption". Life Sciences. 173: 94–106. doi:10.1016/j.lfs.2017.02.008.
119. Kushida CA, ed. (2004). "Environmental Influences on Sleep and Sleep Deprivation". Sleep Deprivation. pp. 148–183. doi:10.1201/b14428-11. ISBN   978-0-429-22511-6.
120. Schmidt-Kessen W, Kendel K (September 1973). "Einfluß der Raumtemperatur auf den Nachtschlaf" [The influence of room temperature on night-sleep in man]. Research in Experimental Medicine (in German). 160 (3): 220–233. doi:10.1007/bf01856786. PMID   4350670.
121. Morphy H, Dunn KM, Lewis M, Boardman HF, Croft PR (March 2007). "Epidemiology of insomnia: a longitudinal study in a UK population". Sleep. 30 (3): 274–280. PMID   17425223.
122. Kim K, Uchiyama M, Okawa M, Liu X, Ogihara R (February 2000). "An epidemiological study of insomnia among the Japanese general population". Sleep. 23 (1): 41–47. doi: 10.1093/sleep/23.1.1a . PMID   10678464.
123. Rajaee Rizi F, Asgarian FS (January 2023). "Reliability, validity, and psychometric properties of the Persian version of the Tayside children's sleep questionnaire". Sleep and Biological Rhythms. 21 (1): 97–103. doi:10.1007/s41105-022-00420-6. PMC   10899986 . PMID   38468908.
124. "Dyssomnias" (PDF). WHO. pp. 7–11. Archived (PDF) from the original on 18 March 2009. Retrieved 25 January 2009.
125. Buysse DJ (June 2008). "Chronic insomnia". The American Journal of Psychiatry. 165 (6): 678–686. doi:10.1176/appi.ajp.2008.08010129. PMC   2859710 . PMID   18519533. For this reason, the NIH conference [of 2005] commended the term "comorbid insomnia" as a preferable alternative to the term "secondary insomnia."
126. Erman MK (2007). "Insomnia: Comorbidities and Consequences". Primary Psychiatry. 14 (6): 31–35. Archived from the original on 15 July 2011. Two general categories of insomnia exist, primary insomnia and comorbid insomnia.
127. World Health Organization (2007). "Quantifying burden of disease from environmental noise" (PDF). p. 20. Archived (PDF) from the original on 23 November 2010. Retrieved 22 September 2010.
128. Lai C, Qiu H (June 2017). "Paradoxical Insomnia: Misperception of Sleep Can Be a Tormenting Experience". American Family Physician. 95 (12): 770. PMID   28671423 . Retrieved 10 May 2020.
129. Biological Rhythms, Sleep and Hypnosis by Simon Green
130. McCrae CS, Lichstein KL (February 2001). "Secondary insomnia: diagnostic challenges and intervention opportunities". Sleep Medicine Reviews. 5 (1): 47–61. doi:10.1053/smrv.2000.0146. PMID   12531044.
131. "Obstructive sleep apnea - Symptoms and causes". Mayo Clinic. Retrieved 17 April 2022.
132. Shaik L, Cheema MS, Subramanian S, Kashyap R, Surani SR (24 November 2022). "Sleep and Safety among Healthcare Workers: The Effect of Obstructive Sleep Apnea and Sleep Deprivation on Safety". Medicina. 58 (12): 1723. doi: 10.3390/medicina58121723 . PMC   9788062 . PMID   36556925.
133. Zammit GK (1997). Good nights : how to stop sleep deprivation, overcome insomnia, and get the sleep you need . Zanca, Jane A. Kansas City: Andrews and McMeel. ISBN   0-8362-2188-5. OCLC   35849087.
134. Spicuzza L, Caruso D, Di Maria G (September 2015). "Obstructive sleep apnoea syndrome and its management". Therapeutic Advances in Chronic Disease. 6 (5): 273–85. doi:10.1177/2040622315590318. PMC   4549693 . PMID   26336596.
135. Muza RT (May 2015). "Central sleep apnoea-a clinical review". Journal of Thoracic Disease. 7 (5): 930–937. doi:10.3978/j.issn.2072-1439.2015.04.45. PMC   4454847 . PMID   26101651.
136. "Revenge Bedtime Procrastination: Definition & Psychology". Sleep Foundation. 23 February 2021. Retrieved 13 March 2024.
137. O'Callaghan F, Muurlink O, Reid N (December 2018). "Effects of caffeine on sleep quality and daytime functioning". Risk Management and Healthcare Policy. 11: 263–271. doi: 10.2147/rmhp.s156404 . PMC   6292246 . PMID   30573997.
138. Chaudhary NS, Grandner MA, Jackson NJ, Chakravorty S (1 November 2016). "Caffeine consumption, insomnia, and sleep duration: Results from a nationally representative sample". Nutrition. 32 (11–12): 1193–1199. doi:10.1016/j.nut.2016.04.005. PMC   6230475 . PMID   27377580.
139. "Caffeine's Connection to Sleep Problems". Sleep Foundation. 17 April 2009. Retrieved 17 April 2022.
140. "National Sleep Foundation Key Messages/Talking Points" (PDF). Archived (PDF) from the original on 18 April 2016. Retrieved 18 April 2016.
141. Schroeder J (7 December 2018). "Students Who Sleep 8 Hours Score Higher On Final Exams". The University Network. Retrieved 10 December 2018.
142. Hershner SD, Chervin RD (23 June 2014). "Causes and consequences of sleepiness among college students". Nature and Science of Sleep. 6: 73–84. doi: 10.2147/NSS.S62907 . PMC   4075951 . PMID   25018659.
143. Estevan I, Sardi R, Tejera AC, Silva A, Tassino B (10 March 2021). "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". PLOS ONE. 16 (3): e0247104. Bibcode:2021PLoSO..1647104E. doi: 10.1371/journal.pone.0247104 . PMC   7946303 . PMID   33690625.
144. Tsai LL, Li SP (February 2004). "Sleep patterns in college students". Journal of Psychosomatic Research. 56 (2): 231–237. doi:10.1016/S0022-3999(03)00507-5. PMID   15016583.
145. Kelley P, Lockley SW, Foster RG, Kelley J (1 August 2014). "Synchronizing education to adolescent biology: 'let teens sleep, start school later'". Learning, Media and Technology. 40 (2): 220. doi: 10.1080/17439884.2014.942666 .
146. Carpenter S (2001). "Sleep deprivation may be undermining teen health". Monitor on Psychology. 32 (9): 42. Archived from the original on 6 October 2006.
147. Schmid RE (28 March 2006). "Sleep-deprived teens dozing off at school". ABC News. Associated Press. Archived from the original on 8 December 2006.
148. Giedd JN (October 2009). "Linking adolescent sleep, brain maturation, and behavior". The Journal of Adolescent Health. 45 (4): 319–320. doi:10.1016/j.jadohealth.2009.07.007. PMC   3018343 . PMID   19766933.
149. Benca RM (November 1996). "Sleep in psychiatric disorders". Neurologic Clinics. 14 (4): 739–764. doi:10.1016/s0733-8619(05)70283-8. PMID   8923493.
150. McKenna BS, Eyler LT (November 2012). "Overlapping prefrontal systems involved in cognitive and emotional processing in euthymic bipolar disorder and following sleep deprivation: a review of functional neuroimaging studies". Clinical Psychology Review. 32 (7): 650–663. doi:10.1016/j.cpr.2012.07.003. PMC   3922056 . PMID   22926687.
151. Young JW, Dulcis D (July 2015). "Investigating the mechanism(s) underlying switching between states in bipolar disorder". European Journal of Pharmacology. 759: 151–162. doi:10.1016/j.ejphar.2015.03.019. PMC   4437855 . PMID   25814263.
152. Wehr TA, Sack DA, Rosenthal NE (February 1987). "Sleep reduction as a final common pathway in the genesis of mania". The American Journal of Psychiatry. 144 (2): 201–204. doi:10.1176/ajp.144.2.201. PMID   3812788.
153. American Psychiatry Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. pp. 123–154. ISBN   978-0-89042-555-8.
154. Pocivavsek A, Rowland LM (January 2018). "Basic Neuroscience Illuminates Causal Relationship Between Sleep and Memory: Translating to Schizophrenia". Schizophrenia Bulletin. 44 (1): 7–14. doi:10.1093/schbul/sbx151. PMC   5768044 . PMID   29136236.
155. Wesselius HM, van den Ende ES, Alsma J, Ter Maaten JC, Schuit SC, Stassen PM, et al. (September 2018). "Quality and Quantity of Sleep and Factors Associated With Sleep Disturbance in Hospitalized Patients". JAMA Internal Medicine. 178 (9): 1201–1208. doi:10.1001/jamainternmed.2018.2669. PMC   6142965 . PMID   30014139.
156. Shilo L, Dagan Y, Smorjik Y, Weinberg U, Dolev S, Komptel B, et al. (May 1999). "Patients in the intensive care unit suffer from severe lack of sleep associated with loss of normal melatonin secretion pattern". The American Journal of the Medical Sciences. 317 (5): 278–281. doi:10.1016/s0002-9629(15)40528-2. PMID   10334113.
157. Tan X, van Egmond L, Partinen M, Lange T, Benedict C (July 2019). "A narrative review of interventions for improving sleep and reducing circadian disruption in medical inpatients". Sleep Medicine. 59: 42–50. doi: 10.1016/j.sleep.2018.08.007 . PMID   30415906.
158. "Broadband internet causes sleep deprivation, a new study finds". ScienceDaily (Press release). Bocconi University. 2 August 2018.
159. Alshobaili FA, AlYousefi NA (June 2019). "The effect of smartphone usage at bedtime on sleep quality among Saudi non- medical staff at King Saud University Medical City". Journal of Family Medicine and Primary Care. 8 (6): 1953–1957. doi: 10.4103/jfmpc.jfmpc_269_19 . PMC   6618184 . PMID   31334161.
160. Costa G (2015). "Sleep deprivation due to shift work". Occupational Neurology. Handbook of Clinical Neurology. Vol. 131. pp. 437–446. doi:10.1016/B978-0-444-62627-1.00023-8. ISBN   978-0-444-62627-1. PMID   26563802.
161. Malik A (1 May 2020). "Correlation Between Shiftwork, Sleep & Fatigue and Increased Occupational Injuries in a Manufacturing Plant in Pakistan" (PDF).
162. Maski K (7 September 2023). Scammell TE, Eichler AF (eds.). "Insufficient sleep: Evaluation and management". UpToDate. Retrieved 28 January 2021.
163. Carney CE, Buysse DJ, Ancoli-Israel S, Edinger JD, Krystal AD, Lichstein KL, et al. (February 2012). "The consensus sleep diary: standardizing prospective sleep self-monitoring". Sleep. 35 (2): 287–302. doi:10.5665/sleep.1642. PMC   3250369 . PMID   22294820.
164. "Sleep Deprivation: Causes, Symptoms, & Treatment". Sleep Foundation. 3 November 2020. Retrieved 21 January 2021.
165. Monk TH, Buysse DJ, Kennedy KS, Pods JM, DeGrazia JM, Miewald JM (March 2003). "Measuring sleep habits without using a diary: the sleep timing questionnaire". Sleep. 26 (2): 208–212. doi: 10.1093/sleep/26.2.208 . PMID   12683481.
166. Rizi FR, Asgarian FS (January 2023). "Reliability, validity, and psychometric properties of the Persian version of the Tayside children's sleep questionnaire". Sleep and Biological Rhythms. 21 (1): 97–103. doi:10.1007/s41105-022-00420-6. PMC   10899986 . PMID   38468908.
167. "Actigraphy". stanfordhealthcare.org. Retrieved 21 January 2021.
168. Morgenthaler T, Alessi C, Friedman L, Owens J, Kapur V, Boehlecke B, et al. (April 2007). "Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007". Sleep. 30 (4): 519–529. doi: 10.1093/sleep/30.4.519 . PMID   17520797.
169. Smith MT, McCrae CS, Cheung J, Martin JL, Harrod CG, Heald JL, et al. (July 2018). "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 of Clinical Sleep Medicine. 14 (7): 1231–1237. doi:10.5664/jcsm.7230. PMC   6040807 . PMID   29991437.
170. Smith MT, McCrae CS, Cheung J, Martin JL, Harrod CG, Heald JL, et al. (July 2018). "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 of Clinical Sleep Medicine. 14 (7): 1209–1230. doi:10.5664/jcsm.7228. PMC   6040804 . PMID   29991438.
171. Zambotti M, Cellini N, Goldstone A, Colrain IM, Baker C (2020). "Wearable Sleep Technology in Clinical and Research Settings". Medicine and Science in Sports and Exercise. 51 (7): 1538–1557. doi:10.1249/MSS.0000000000001947. PMC   6579636 . PMID   30789439.
172. Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH (August 2015). "The role of sleep hygiene in promoting public health: A review of empirical evidence". Sleep Medicine Reviews. 22: 23–36. doi:10.1016/j.smrv.2014.10.001. PMC   4400203 . PMID   25454674.
173. Edinger JD, Arnedt JT, Bertisch SM, Carney CE, Harrington JJ, Lichstein KL, et al. (February 2021). "Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline". Journal of Clinical Sleep Medicine. 17 (2): 255–262. doi:10.5664/jcsm.8986. PMC   7853203 . PMID   33164742.
174. "How to Sleep Better". Sleep Foundation. 17 April 2009. Retrieved 14 January 2021.
175. "CDC - Sleep Hygiene Tips - Sleep and Sleep Disorders". www.cdc.gov. 13 February 2019. Retrieved 21 April 2020.
176. Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D (August 2015). "Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis". Annals of Internal Medicine. 163 (3): 191–204. doi:10.7326/M14-2841. PMID   26054060.
177. "Sleep Deprivation" (PDF). American Academy of Sleep Medicine. 2008. Archived (PDF) from the original on 26 February 2015. Retrieved 25 March 2015.
178. "Sleep Deprivation Fact Sheet" (PDF). American Academy of Sleep Medicine. 2 December 2009. Archived (PDF) from the original on 26 February 2015.
179. Carlson N (2013). Physiology of Behavior (11th ed.). Boston: Pearson. pp. 578–579. ISBN   978-0-205-23939-9.
180. Gorgulu Y, Caliyurt O (September 2009). "Rapid antidepressant effects of sleep deprivation therapy correlates with serum BDNF changes in major depression". Brain Research Bulletin. 80 (3): 158–162. doi:10.1016/j.brainresbull.2009.06.016. PMID   19576267.
181. Davies SK, Ang JE, Revell VL, Holmes B, Mann A, Robertson FP, et al. (July 2014). "Effect of sleep deprivation on the human metabolome". Proceedings of the National Academy of Sciences of the United States of America. 111 (29): 10761–10766. Bibcode:2014PNAS..11110761D. doi: 10.1073/pnas.1402663111 . PMC   4115565 . PMID   25002497.
182. Wirz-Justice A, Van den Hoofdakker RH (August 1999). "Sleep deprivation in depression: what do we know, where do we go?". Biological Psychiatry. 46 (4): 445–453. doi:10.1016/S0006-3223(99)00125-0. PMID   10459393.
183. Wirz-Justice A, Benedetti F, Berger M, Lam RW, Martiny K, Terman M, et al. (July 2005). "Chronotherapeutics (light and wake therapy) in affective disorders". Psychological Medicine. 35 (7): 939–944. doi: 10.1017/S003329170500437X (inactive 1 November 2024). PMID   16045060.
184. "Disorders That Disrupt Sleep (Parasomnias)". eMedicineHealth. Archived from the original on 22 December 2005.
185. Perlis M, Gehrman P (2013), "Psychophysiological Insomnia", Encyclopedia of Sleep, Elsevier, pp. 203–204, doi:10.1016/b978-0-12-378610-4.00177-7, ISBN   978-0-12-378611-1
186. Miller CB, Espie CA, Epstein DR, Friedman L, Morin CM, Pigeon WR, et al. (October 2014). "The evidence base of sleep restriction therapy for treating insomnia disorder". Sleep Medicine Reviews. 18 (5): 415–424. doi:10.1016/j.smrv.2014.01.006. PMID   24629826.
187. "中国失眠症诊断和治疗指南" [Guidelines for Diagnosis and Treatment of Insomnia in China]. National Medical Journal of China (in Chinese). 97 (24): 1844–1856. 27 June 2017. doi:10.3760/cma.j.issn.0376-2491.2017.24.002.
188. Irving D (1 March 2017). "The Costs of Poor Sleep Are Staggering". RAND.
189. Troxel W, Shih R, Pedersen E, Geyer L, Fisher M, Griffin BA, et al. (2015). Improving Sleep Health for U.S. Servicemembers: Policies, Programs, Barriers to Implementation, and Recommendations. doi:10.7249/rb9824. ISBN   978-0-8330-8851-2.
190. Eriksson M, Juárez G (2017). "The Biopolitics of Melanopic Illuminance" (PDF). Scapegoat (10). Archived from the original (PDF) on 5 September 2021.
191. Crary J (2014). 24/7: late capitalism and the ends of sleep. London: Verso. ISBN   978-1-78168-310-1.
192. Guo JH, Ma XH, Ma H, Zhang Y, Tian ZQ, Wang X, et al. (August 2020). "Circadian misalignment on submarines and other non-24-h environments - from research to application". Military Medical Research. 7 (1): 39. doi: 10.1186/s40779-020-00268-2 . PMC   7437048 . PMID   32814592.
193. "Sleep Deprivation Used as Abuse Tactic". DomesticShelters.org. Retrieved 31 January 2023.
194. "Family and Domestic Violence - Healthy Work Healthy Living Tip Sheet". Archived from the original on 19 May 2019. Retrieved 21 January 2019.
195. "Binyam Mohamed torture appeal lost by UK government..." BBC News. 2 October 2009. Archived from the original on 11 February 2010.
196. Begin M (1979). White nights: the story of a prisoner in Russia . San Francisco: Harper & Row. ISBN   978-0-06-010289-0.
197. "HUDOC - European Court of Human Rights". hudoc.echr.coe.int. Retrieved 31 January 2023.
198. Miller G, Meyer J (17 April 2009). "Obama assures intelligence officials they won't be prosecuted over interrogations". Los Angeles Times . Retrieved 10 July 2016.
199. Bradbury SG (10 May 2005). "Memorandum for John Rizzo" (PDF). ACLU. p. 14. Archived from the original (PDF) on 6 November 2011. Retrieved 24 October 2011.
200. Scherer M (21 April 2009). "Scientists Claim CIA Misused Work on Sleep Deprivation". Time . Retrieved 2 February 2017.
201. "Explaining and Authorizing Specific Interrogation Techniques". The New York Times. 17 April 2009. Archived from the original on 19 October 2017.
202. Department of Justice Office of Professional Responsibility (29 July 2009). 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 (PDF) (Report). United States Department of Justice. pp. 133–138. Retrieved 29 May 2017.
203. Hassan T (3 October 2006). "Sleep deprivation remains red-hot question". PM. abc.net.au. Archived from the original on 11 October 2007.
204. "Sleep deprivation is torture: Amnesty". The Sydney Morning Herald. AAP. 3 October 2006. Archived from the original on 27 October 2007.
205. "National Geographic". National Geographic. Retrieved 31 January 2023.
206. Fackelmann K (25 November 2007). "Study: Sleep deficit may be impossible to make up". USA Today. Archived from the original on 28 June 2012.
207. Horne J (September 2004). "Is there a sleep debt?". Sleep. 27 (6): 1047–1049. PMID   15532195.
208. "National Time Use Studies (1965–1985)". umd.edu. Archived from the original on 7 September 2006.
209. "National Time Use Studies (1998 - 2001)". umd.edu. Archived from the original on 7 September 2006.
210. Coren S (1 March 1998). "Sleep Deprivation, Psychosis and Mental Efficiency". Psychiatric Times. 15 (3). Archived from the original on 4 September 2009. Retrieved 25 November 2009.
211. Boese A (5 November 2007). "Eleven days awake". Elephants on Acid: And Other Bizarre Experiments. Harvest Books. pp. 90–93. ISBN   978-0-15-603135-6. Archived from the original on 19 September 2014.
212. Ross JJ (April 1965). "Neurological Findings After Prolonged Sleep Deprivation". Archives of Neurology. 12 (4): 399–403. doi:10.1001/archneur.1965.00460280069006. PMID   14264871.
213. Thao VP. "Vietnam man handles three decades without sleep". Thanh Nien Daily. Vietnam National Youth Federation. Archived from the original on 13 May 2008. Retrieved 26 May 2008.
214. "Ukrainian man has been lacking sleep for 20 years". 15 January 2005. Archived from the original on 5 October 2016. Retrieved 5 October 2016.
215. Childs D (30 March 2009). "11 Baffling Medical Conditions". ABC News . The Boy Who Couldn't Sleep.
216. "Matters of dispute – Sleepless in Ukraine". The Guardian . 10 February 2005. Archived from the original on 4 March 2014. Retrieved 11 May 2010.
217. "Boy, 3, Sleeps for First Time After Experimental Surgery". FoxNews.com. 16 May 2008. Archived from the original on 5 October 2016.
218. Canning A (23 January 2009). "Mystery of Sleepless Boy Solved: Boy Who Couldn't Sleep Undergoes Risky, Life-Changing Operation". ABC News .
219. Fischer-Perroudon C, Mouret J, Jouvet M (January 1974). "One case of agrypnia (4 months without sleep) in a morvan disease. Favourable action of 5-hydroxytryptophane". Electroencephalography and Clinical Neurophysiology. 36 (1): 1–18. doi:10.1016/0013-4694(74)90132-1. PMID   4128428.