Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point of care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

For more information, click below.


Subscribers log in here


Definition and consequences of sleep deprivation

INTRODUCTION

Clinical wisdom and supporting research suggest that most people require approximately eight hours of sleep nightly [1]. However, there appears to be considerable variation around the mean, with many people claiming to need only four to six hours of sleep. The definition and consequences of sleep deprivation are reviewed here. Sleep deprivation is distinguished from insomnia separately (see "Overview of insomnia", section on 'Differential diagnosis').

DEFINITION OF SLEEP DEPRIVATION

Sleep deprivation exists when sleep is insufficient to support adequate alertness, performance, and health, either because of reduced total sleep time or fragmentation of sleep by brief arousals. Acute sleep deprivation refers to no sleep or a reduction in the usual total sleep time, usually lasting one or two days. In contrast, chronic sleep deprivation (also called sleep restriction) exists when the individual routinely sleeps less than required for optimal functioning.

EPIDEMIOLOGY

More than one-third of individuals report sleeping less than seven hours per night on weekdays or workday nights, according to the 2005 to 2008 National Health and Nutrition Examination Survey [2]. This was most common among individuals 20 to 59 years of age and among non-Hispanic blacks. Individuals who reported sleeping fewer than seven hours per night were more likely to report difficulty concentrating than individuals who reported sleeping seven to nine hours per night (29 versus 19 percent).

CAUSES OF SLEEP DEPRIVATION

Sleep deprivation may be a consequence of an insufficient amount of sleep and/or poor quality sleep.

Insufficient quantity of sleep — It is difficult to determine what constitutes a normal quantity of sleep for a given individual. One approach involves determining how long a patient would sleep if left to awaken spontaneously. An alternative approach involves determining how alert the patient feels after different durations of sleep. Alertness is normal if the patient wakes feeling refreshed and is capable of moving through the day feeling alert without effort, even when placed in boring or monotonous situations. This sense of easy alertness should be distinguished from alertness that exists when the individual feels pressure, since the latter may persist despite sleep deprivation.

              

Subscribers log in here

To continue reading this article you must have access through your hospital or your group practice, log in to your personal subscription, or purchase a personal subscription. For more information, click below.
Literature review current through: Apr 2013. | This topic last updated: Oct 1, 2012.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2013 UpToDate, Inc.
References
Top
  1. Bonnet MH, Arand DL. We are chronically sleep deprived. Sleep 1995; 18:908.
  2. Centers for Disease Control and Prevention (CDC). Effect of short sleep duration on daily activities--United States, 2005-2008. MMWR Morb Mortal Wkly Rep 2011; 60:239.
  3. Van Dongen HP, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep 2003; 26:117.
  4. Carskadon MA, Dement WC. Cumulative effects of sleep restriction on daytime sleepiness. Psychophysiology 1981; 18:107.
  5. Horne J. The end of sleep: 'sleep debt' versus biological adaptation of human sleep to waking needs. Biol Psychol 2011; 87:1.
  6. Martin SE, Engleman HM, Deary IJ, Douglas NJ. The effect of sleep fragmentation on daytime function. Am J Respir Crit Care Med 1996; 153:1328.
  7. Martin SE, Wraith PK, Deary IJ, Douglas NJ. The effect of nonvisible sleep fragmentation on daytime function. Am J Respir Crit Care Med 1997; 155:1596.
  8. Bonnet MH. Effect of sleep disruption on sleep, performance, and mood. Sleep 1985; 8:11.
  9. Johnson, LC. Sleep deprivation and performance. In: Biological Rhythms, Sleep and Performance, Webb, WB (Eds), John Wiley and Sons, New York 1982. p.111.
  10. Dinges DF, Kribbs NB. Performing while sleeping: effects of experimentally induced sleepiness. In: Sleep, sleepiness, and performance, Monk TH. (Ed), Wiley & Sons, Chichester, UK 1991. p.97-128.
  11. Van Dongen HP, Baynard MD, Maislin G, Dinges DF. Systematic interindividual differences in neurobehavioral impairment from sleep loss: evidence of trait-like differential vulnerability. Sleep 2004; 27:423.
  12. King AC, Belenky G, Van Dongen HP. Performance impairment consequent to sleep loss: determinants of resistance and susceptibility. Curr Opin Pulm Med 2009; 15:559.
  13. Lim J, Dinges DF. A meta-analysis of the impact of short-term sleep deprivation on cognitive variables. Psychol Bull 2010; 136:375.
  14. Tucker AM, Whitney P, Belenky G, et al. Effects of sleep deprivation on dissociated components of executive functioning. Sleep 2010; 33:47.
  15. Killgore WD, Killgore DB, Day LM, et al. The effects of 53 hours of sleep deprivation on moral judgment. Sleep 2007; 30:345.
  16. Kim HC, Young T, Matthews CG, et al. Sleep-disordered breathing and neuropsychological deficits. A population-based study. Am J Respir Crit Care Med 1997; 156:1813.
  17. Mitler, MM, Dinges, DF, Dement, WC. medicine, public policy, and public Health. In: Principles and Practice of Sleep Medicine, 2nd, Kryger, MH, Roth, T, Dement, WC (Eds), WB Saunders, Philadelphia 1994. p.453.
  18. Summala H, Mikkola T. Fatal accidents among car and truck drivers: effects of fatigue, age, and alcohol consumption. Hum Factors 1994; 36:315.
  19. Pack AI, Maislin G, Staley B, et al. Impaired performance in commercial drivers: role of sleep apnea and short sleep duration. Am J Respir Crit Care Med 2006; 174:446.
  20. Mitler MM, Carskadon MA, Czeisler CA, et al. Catastrophes, sleep, and public policy: consensus report. Sleep 1988; 11:100.
  21. Leger D. The cost of sleep-related accidents: a report for the National Commission on Sleep Disorders Research. Sleep 1994; 17:84.
  22. Kripke DF, Simons RN, Garfinkel L, Hammond EC. Short and long sleep and sleeping pills. Is increased mortality associated? Arch Gen Psychiatry 1979; 36:103.
  23. Vgontzas AN, Liao D, Pejovic S, et al. Insomnia with short sleep duration and mortality: the Penn State cohort. Sleep 2010; 33:1159.
  24. Moore-Ede, MC, Sulzman, FM, Fuller, CA. The Clocks That Time Us, Harvard University Press, Cambridge, MA 1982.
  25. White DP, Douglas NJ, Pickett CK, et al. Sleep deprivation and the control of ventilation. Am Rev Respir Dis 1983; 128:984.
  26. Schiffman PL, Trontell MC, Mazar MF, Edelman NH. Sleep deprivation decreases ventilatory response to CO2 but not load compensation. Chest 1983; 84:695.
  27. Bowes, G, Woolf, GM, Sullivan, CE, Phillipson, EA. Effect of sleep fragmentation on ventilatory and arousal response of sleeping dogs to respiratory stimuli. Am Rev Respir Dis 1980; 125:286.
  28. Spengler CM, Shea SA. Sleep deprivation per se does not decrease the hypercapnic ventilatory response in humans. Am J Respir Crit Care Med 2000; 161:1124.
  29. Chen HI, Tang YR. Sleep loss impairs inspiratory muscle endurance. Am Rev Respir Dis 1989; 140:907.
  30. Phillips BA, Cooper KR, Burke TV. The effect of sleep loss on breathing in chronic obstructive pulmonary disease. Chest 1987; 91:29.
  31. Knutson KL, Van Cauter E, Rathouz PJ, et al. Association between sleep and blood pressure in midlife: the CARDIA sleep study. Arch Intern Med 2009; 169:1055.
  32. King CR, Knutson KL, Rathouz PJ, et al. Short sleep duration and incident coronary artery calcification. JAMA 2008; 300:2859.
  33. Sabanayagam C, Shankar A. Sleep duration and cardiovascular disease: results from the National Health Interview Survey. Sleep 2010; 33:1037.
  34. Rechtschaffen A, Bergmann BM, Everson CA, et al. Sleep deprivation in the rat: X. Integration and discussion of the findings. Sleep 1989; 12:68.
  35. Everson CA. Sustained sleep deprivation impairs host defense. Am J Physiol 1993; 265:R1148.
  36. Brown R, Pang G, Husband AJ, King MG. Suppression of immunity to influenza virus infection in the respiratory tract following sleep disturbance. Reg Immunol 1989; 2:321.
  37. Vgontzas AN, Zoumakis E, Bixler EO, et al. Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. J Clin Endocrinol Metab 2004; 89:2119.
  38. Shearer WT, Reuben JM, Mullington JM, et al. Soluble TNF-alpha receptor 1 and IL-6 plasma levels in humans subjected to the sleep deprivation model of spaceflight. J Allergy Clin Immunol 2001; 107:165.
  39. Redwine L, Hauger RL, Gillin JC, Irwin M. Effects of sleep and sleep deprivation on interleukin-6, growth hormone, cortisol, and melatonin levels in humans. J Clin Endocrinol Metab 2000; 85:3597.
  40. National Sleep Foundation. Sleep in America Poll, National Sleep Foundation, Washington, DC, 2002.
  41. Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med 2004; 141:846.