Sleep deprivation

Chakrit Sukying, M.D.

Department of Psychiatry
Ramathibodi Hospital
Mahidol University
Bangkok Thailand

Mortality all TSD rats died or showed signs of impending death—

usually in about two to three weeks

The deaths (after about four to six weeks) of PSD rats

were also confirmed

increased food intake

decreased weight
increased energy expenditure

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 Sleep deprivation
wake periods that extend beyond the typical 16 to 18 hours
Total sleep deprivation

Partial sleep deprivation / Sleep restriction

not getting enough sleep per 24 hours for one or multiple
nights

Sleep duration and physical health

Forest plots of the risk of developing or dying of coronary heart disease associated with
short duration of sleep
Cappuccio FP, Cooper D, D’Elia L, et al. Sleep duration predicts cardiovascular outcomes: a systematic review
and meta-analysis of prospective studies.
Eur Heart J 2011;32:1484–92.

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Forest plots of the risk of developing or dying of stroke associated with short duration of sleep

Cappuccio FP, Cooper D, D’Elia L, et al. Sleep duration predicts cardiovascular outcomes: a systematic review
and meta-analysis of prospective studies.
Eur Heart J 2011;32:1484–92.

EFFECTS OF SLEEP DEPRIVATION

Endocrine physiology

Neurobehavioral function

Total sleep deprivation

Partial sleep deprivation

Recovery

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8 hrs of nocturnal sleep 28 hrs of sleep deprivation 8 hrs of daytime sleep

PSD recovery

8 hrs of nocturnal sleep 28 hrs of sleep deprivation 8 hrs of daytime sleep

PSD recovery

Hunger, Satiety, Food Intake

and
sleep restriction

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 To determine whether partial sleep curtailment, an increasingly prevalent behavior,
alters appetite regulation

Randomized, 2-period, 2-condition crossover clinical study

2 days of sleep restriction and

2 days of sleep extension
under controlled conditions of caloric intake and physical activity

Sleep restriction was associated with

reductions in
leptin (decrease, 18%; P 0.04)

elevations in
ghrelin (increase, 28%; P < 0.04)

hunger (increase, 24%; P < 0.01)

appetite (increase, 23%; P< 0.01)

Effect of sleep duration on daytime leptin levels, ghrelin levels, hunger, and appetite
Karine Spiegel, Ann Intern Med. 2004;141:846-850.

assess the effects of extended bedtimes on sleep duration and food desire
under real life conditions
Ten overweight young adults
habitual sleep duration of less than 6.5 hours
studied in the home environment

Habitual bedtimes for 1-week (baseline)

followed by bedtimes extended to 8.5 hours for 2 weeks

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Additional sleep was associated with a 14% decrease in overall appetite (p=0.030)

62%decrease in desire for sweet and salty foods (p=0.017)

sleep curtailment may be a nontraditional lifestyle factor contributing to

the epidemics of obesity and type 2 diabetes

EFFECTS OF SLEEP DEPRIVATION

Endocrine physiology

Neurobehavioral function

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 Biomathematical Model Predictions to Experimental Data of Fatigue and Performance

Sleep, Activity, Fatigue, and Task Effectiveness (SAFTE) model

three-process models
Circadian Oscillator
circadian activation Performance
propensity to sleep Performance

Sleep-Wake Homeostatic Regulation

number of hours of recent sleep obtained (prior day)
number of hours of wakefulness (time since awakening)
current overall sleep debt
homeostatic depletion Performance

Sleep Inertia temporary degradation in performance that is seen immediately after awakening
depends primarily on depth of sleep at the time of awakening

sleep reservoir capacity

units are added units are subtracted

Fatigue model predictions for group-average (n = 12) cognitive performance during 54 hours of total
sleep deprivation (beginning at 7 AM) compared with actual observationsfor several cognitive measures
(different symbols) and mean cognitive performance (squares) expressed relative to baseline. Model
predictions were made with the SAFTE model (solid line) with a reservoir depletion rate of 1.1% per
hour
Angus R, Heslegrave R. Effects of sleep loss on sustained cognitive performance during a command and control simulation.
Behav Res Meth Instr Comp 1985;17:55–67.

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Fatigue model predictions for group-average psychomotor vigilance test (PVT) performance (averaged within each
day) across 3 baseline days (B1–B3) with 8 hours time for sleep; 7 experimental days (E1–E7) with daily sleep
restricted to 3 hours (●, n = 13), 5 hours (♦, n = 13), 7 hours (▲, n = 14), or 9 hours (■, n = 16); and 3
recovery days (R1–R3) with 8 hours time for sleep. Model predictions were made with the SAFTE model (solid
line)

Belenky G, Wesensten NJ, Thorne DR, et al. Patterns of performance degradation and restoration during sleep restriction and subsequent
recovery: a sleep dose-response study. J Sleep Res 2003;12:1–12.

Psychomotor Vigilance Task (PVT)

a sustained-attention reaction time task

with a random inter-stimulus interval of 2–10 s.

Lapses reaction times greater than 500ms

counted per 10 min test bout as a measure of performance impairment
indicative of reduced behavioral alertness

EFFECTS OF SLEEP DEPRIVATION

Acute Total Sleep Deprivation

Partial sleep Deprivation/ Sleep restriction

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To inform the debate over whether human sleep can be chronically reduced without consequences

a dose-response chronic sleep restriction experiment

A total of n = 48 healthy adults (ages 21–38)
Randomization (4 h, 6 h, or 8 h time in bed per night) maintained for 14 consecutive days

waking neurobehavioral and sleep physiological functions were monitored

compared to those for total sleep deprivation

Psychomotor Vigilance Task (PVT)

0h 4h

6h
-24 h

8h

Neurobehavioral responses to varying doses of daily sleep

No cognitive deficits occurred following 8 hours time in bed

2 weeks of restriction to 6 hours , deficits were equivalent to 1 night of total sleep deprivation

2 weeks of sleep restriction to 4 hours , deficits were equivalent to 2 nights of total sleep deprivation

Van Dongen et al. SLEEP, Vol. 26, No. 2, 2003

0h 4h 0h

6h
4h
6h
8h 8h

Subjects cannot reliably introspect with regard to their actual sleepiness levels

as long as they are receiving at least approximately 4 h of sleep nightly

they do not experience a sense of sleepiness anywhere near the levels found for total sleep deprivation

Van Dongen et al. SLEEP, Vol. 26, No. 2, 2003

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“core sleep” hypothesis
“core” sleep occupies the first part of the night and serves to “repair the effects of waking wear and
tear on the cerebrum

4h

72 h

“sleep debt” hypothesis

8h
6h
4h

4h
6h

8h

4h
6h

8h

Van Dongen et al. SLEEP, Vol. 26, No. 2, 2003

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 6h 4h

8h
15.84 h

critical wake period beyond which lapsing would be expected to increase

15.84 ± 0.73 h (mean ± s.e.)
the average value for human sleep need to prevent cumulative neurobehavioral deficits
8.16 h
Van Dongen et al. SLEEP, Vol. 26, No. 2, 2003

performance impairment after 17 hours awake

was equivalent to that produced by

a blood alcohol concentration of 0.05%

To compare the relative effects on performance of sleep deprivation (over 28 hr.) and alcohol

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after 17–19 hours of wakefulness subjects’ performance on many tests had
dropped to that found at the legal limits for safe

RECOVERY FROM SLEEP LOSS

Recovery following Acute Total Sleep Deprivation

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 SLEEP 2007;30(3):353-360

Rate of recovery of daytime performance and sleepiness following

moderate and severe sleep deprivation
when recovery opportunity was either augmented or restricted

Speed Lapses

moderate SD response speed, lapses

returned to baseline after one 9-h sleep opportunity

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 9
6

6
9

Speed Lapses

moderate SD response speed, lapses

returned to baseline after one 9-h sleep opportunity
When the recovery opportunity was restricted to six hours
neither PVT performance nor sleepiness recovered
but stabilised at below-baseline levels

Speed Lapses

severe SD PVT performance remained significantly below baseline

for the entire recovery period

We may have underestimated the impact of sleep loss and/or the

restorative value of subsequent sleep

not restricting recovery sleep opportunities to less than 6 hours

the more severe the sleep loss, the longer the recovery sleep
opportunity required

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 Recovery following Sleep Restriction

normal volunteers spent either 3 , 5, 7, or 9 h daily time in bed for7 days (restriction ⁄ augmentation)
followed by 3 days with 8 h daily TIB (recovery)

more than 2 or 3 nights of extended sleep may be needed to return

neurobehavioral functions to
baseline levels

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 duration of the recovery period (longer than 3 days)

length of the recovery sleep opportunity

prophylactic manner

length of the recovery sleep opportunity

dose-response relationship between increasing sleep durations in a single night

and recovery of neurobehavioral functions following chronic sleep restriction

1 of 6 recovery sleep doses (0, 2, 4, 6, 8, or 10 h TIB) for 1 night

following 5 nights of sleep restriction to 4 h TIB

baseline night (B2, 10 h TIB) values

control group means
on day 8 (10 h TIB)

some deficits remained after 10 h TIB for recovery

Complete recovery from such sleep restriction may

require a longer sleep period during 1 night

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 duration of the recovery period (longer than 3 days)
prophylactic manner

systematically determine the effects of prior sleep history on rates of performance

during chronic (7 nights) sleep restriction and during the subsequent recovery period

Extend 10 h time in bed for one week

a week of sleep restricted to 3 hours of time in bed each night

extend the recovery period to five 8-hour sleep opportunities

3 h TIB
Habitual group

Extended group

sleep restriction and recovery vary as a function of prior sleep

sleep extension can be used as a prophylactic or countermeasure to lessen

the performance effects of sleep deprivation

Recovery following Sleep Restriction

complete recovery from a period of sleep restriction may necessitate a

sleep opportunity of more than 10 hours

or more than 3 days if sleep is restricted to 8 hours a night

different aspects of performance and neurobehavioral function recover at

different rates

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 SUMMARY

Sleep deprivation causes a multitude of changes to cognitive and behavioral

functioning
increases the risk for chronic diseases ; type 2 diabetes,
obesity, and cardiovascular disease

negative effects of sleep deprivation can be recovered by extending sleep

recovery appears to be dependent on

the type of sleep loss (acute versus chronic)

the recovery sleep duration
the number of days allowed for recovery
prior sleep duration

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