The Neurological Consequences of Sleep Deprivation
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Because of on-call responsibilities, many medical residents are subjected to chronic partial sleep deprivation, a form of sleep restriction whereby individuals have chronic patterns of insufficient sleep. It is unclear whether deterioration in cognitive processing skills due to chronic partial sleep deprivation among medical residents would influence educational exposure or patient safety.Twenty-six medical residents were recruited to participate in the study. Participants wore an Actigraph over a period of 5 consecutive days and nights so their sleep pattern could be recorded. Thirteen participants worked on services that forced chronic partial sleep deprivation (<6 hours of sleep per 24h for 5 consecutive days and nights). The other thirteen residents worked on services that permitted regular and adequate sleep patterns. Following the 5-day sleep monitoring period, the participants completed the three following cognitive tasks: (a) the Wisconsin Card Sorting Test (WCST) to assess abstract reasoning and prefrontal cortex performance; (b) the Time Perception Task (TPT) to assess time estimation and time reproduction skills; and (c) the Iowa Gambling Task (IGT) to assess decision-making ability.The results of independent samples t-tests found no significant differences between the group who was chronically sleep deprived and the group who rested adequately (all ps > .05).THESE RESULTS MAY HAVE EMERGED FOR SEVERAL POSSIBLE REASONS: (a) chronic partial sleep deprivation may have a lesser impact on prefrontal cortex function than on other cognitive functions; (b) fairly modest chronic sleep restriction may be less harmful than acute and more significant sleep restriction; or (c) our research may have suffered from poor statistical power. Future research is recommended.
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To evaluate the effects of acute sleep deprivation and chronic sleep restriction on vigilance, performance, and self-perception of sleepiness.
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Electrical lighting and increasing capital intensiveness have helped undermine the importance that society previously placed on obtaining adequate sleep. Even modest amounts of daily sleep loss accumulate as “sleep debt.” Sleep debt manifests in a myriad of ways, the most common being an increasing tendency to fall asleep, increased risk of accidental injury, impaired mood, and reduced psychomotor performance. Sleep debt can have far reaching consequences, both to an individual in terms of increased cardiovascular risk and to society at large, because of sleepiness-related fatigue and errors. Sleep specialists need to further their understanding of the physiologic and behavioral consequences of total, partial, and selective sleep stage deprivation, because they affect many organ systems. Studies of selective sleep stage deprivation also provide insights into the function of sleep. Evaluating the effects of sleep deprivation must take into account the following factors: (1) the duration of prior sleep, (2) circadian time frame, (3) arousal influences, and (4) subject and test characteristics. Sleep deprivation has been extensively studied in the acute experimental setting. Under extreme conditions, sleep deprivation is associated with mortality in laboratory animals. In the natural human environment, the behavioral consequence of chronic sleep debt in shift work intolerance is well described. The link between electrophysiological sleep disturbance and pathogenesis of disease is less well understood in both acute and chronic states. Additional investigation into the relationship between sleep deprivation and disease mechanisms, such as impaired glucose tolerance, hormonal dysregulation, and cytokine imbalance, will enhance our comprehension of this link.
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Each sleep phase is characterized by specifi c chemical, cellular and anatomic events of vital importance for normal neural functioning.Diff erent forms of sleep deprivation may lead to a decline of cognitive functions in individuals.Studies in this fi eld make a distinction between total sleep deprivation, chronic sleep restriction, and the situation of sleep disruption.Investigations covering the acute eff ects of sleep deprivation on the brain show that the discovered behavioral defi cits in most cases regenerate after two nights of complete sleep.However, some studies done on mice emphasize the possible chronic eff ects of long-term sleep deprivation or chronic restriction on the occurrence of neurodegenerative diseases such as Alzheimer's disease and dementia.In order to better understand the acute and chronic eff ects of sleep loss, the mechanisms of neural adaptation in the situations of insuffi cient sleep need to be further investigated.Future integrative research on the impact of sleep deprivation on neural functioning measured through the macro level of cognitive functions and the micro molecular and cell level could contribute to more accurate conclusions about the basic cellular mechanisms responsible for the detected behavioral defi cits occurring due to sleep deprivation.
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Positive affect helps people in coping with difficult situations. People with high positive affect have been shown to be happier, have more success in life and better relationships than people scoring low. Positive affect is reduced during chronic and acute sleep loss. The aims of the present study were 1) to establish the adverse effect of 5 days of sleep restriction on positive affect, 2) to test whether one night of recovery sleep reverses this effect, and 3) to test whether the combined effects of prior sleep restriction and acute sleep deprivation are cumulative. In an ongoing investigation, 27 healthy volunteers completed two baseline nights (8h TIB) and either five nights of sleep restriction (experimental group: 5h TIB, N=18, mean age 26 ± 3 years, 9 females) or regular sleep (control group: 8h TIB, N=9, mean age 25 ± 5 years, 3 females). Thereafter, all participants had 8h of recovery sleep and 38h of total sleep deprivation. Participants filled out the mood scale PANAS at 9 a.m. on all days. Differences in the positive affect subscale between experimental days and the second baseline day were calculated. Wilcoxon signed-rank tests with Bonferroni-adjusted alpha-level showed a decrease in positive affect after one night of sleep restriction (Δ5.06 ± 3.78; p<.001). Positive affect scores of the last day of chronic sleep restriction and of the day after recovery sleep did not differ (Δ1.33 ± 4.67; p=.18). Positive affect decreased from the last day of chronic sleep restriction to acute sleep deprivation (Δ4.11 ± 4.27; p=.001) for the experimental group. No significant difference was found between chronic sleep restriction (last day) in the experimental group and total sleep deprivation in the control group (Mann-Whitney-U-Test, z(26)=-1.24; p=.5). Chronic sleep loss for five days exhibited long-lasting effects on the reduction of positive affect which were not reset by one recovery night. Positive affect decreased further following acute sleep deprivation, indicating that people’s sleep curtailing lifestyles make them more vulnerable to additional acute sleep loss. Five days of chronically reduced sleep exhibited a comparable reduction in positive affect as a sleepless night.
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To compare the behavioral effects of sleep‐loss sleepiness (performance impairment due to sleep loss) and sleep inertia (period of impaired performance that follows awakening), mean response latencies and number of lapses from a visual simple reaction‐time task were analyzed. Three experimental conditions were designed to manipulate sleepiness and sleep‐inertia levels: uninterrupted sleep, partial sleep reduction, and total sleep deprivation. Each condition included two consecutive nights (the first always a night of uninterrupted sleep, and the second either a night of uninterrupted sleep, a night when sleep was reduced to 3 h, or a night of total sleep deprivation), as well as two days in which performance was assessed at 10 different time points (08:00, 08:30, 09:00, 09:30, 10:00, 11:00, 14:00, 17:00, 20:00, and 23:00 h). From 08:00 to 09:00 h, reaction times in the partial sleep‐reduction and total sleep‐deprivation conditions were at a similar level and were slower than those observed in the uninterrupted sleep condition. In the same time period, the frequency of lapses in the total sleep‐deprivation condition was higher than in the partial sleep‐reduction condition, while this latter condition never differed from the uninterrupted sleep condition. The results indicate that both sleep inertia and sleep‐loss sleepiness lead to an increase in response latencies, but only extreme sleepiness leads to an increase in lapse frequency. We conclude that while reaction times slow as a result of both sleep inertia and sleep‐loss sleepiness, lapses appear to be a specific feature of sleep‐loss sleepiness.
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This review discusses the need for sleep, effects of sleep deprivation on behaviour and performance in the military, and sleep management recommendations to optimise combat effectiveness. Most people, regardless of sex or race, prefer 7 to 8 hours of sleep each night. Sleeping during the day is less recuperative. Continuous sleep is more effective than multiple short naps-even when the total hours for naps is more. Ten to 20 minute naps are useful when continuous sleep is not possible. Sleep inertia is the 5 to 30 minute period of sluggishness after awakening and important military tasks should be avoided. Previously, continuous work episodes (CWEs) duration was restricted by limited night vision, unreliable equipment and reduced endurance of military personnel. With improved technology, CWEs are now restricted primarily by endurance which is affected by sleep deprivation. This was one of the experiences noted in recent conflicts (e.g. Desert Storm) by personnel in the air force, army and navy. Since there will be changes in operational requirements, several work-rest-sleep plans must be prepared. Sleeping the preferred 7 to 8 hours per 24 hours the week before an operation may help prepare for optimal performance. Personnel should be familiarised with conditions under which they may sleep. During combat, sleep management should ideally avoid situations where all personnel are exhausted at the same time. As sleep debt accumulates, a person's mood, motivation, attention, alertness, short-term memory, ability to complete routines, task performance (errors of omission more than errors of commission) and physical performance will become more negatively affected. Counter measures must then be taken (e.g. time for sleep or naps, changing routines or rotating jobs). Drugs like caffeine and amphetamine can help personnel stay awake. However, they may also keep them awake when they need to sleep- and on awakening, they could suffer from "hang-overs" and are less efficient. Sleep lost need not be replaced hour-for-hour. Therefore, after operations, personnel need continuous sleep for only 10 to 12 hours as longer sleep increases sleep inertia and delays getting back to normal schedules.
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