The best-studied case of prolonged sleep deprivation
A well-documented case of a long period without sleep (described by Gulevich G, Dement W and Johnson L in the paper “Psychiatric and EEG observations on a case of prolonged (264 hours) wakefulness“) is that of 17-year-old Randy Gardner from California, who in 1964 asked himself: how long can you go without sleep?
He lasted a full 264 hours, or about 11 days. To this day it is the official world record, at least among cases documented this well. Randy Gardner coped with such a long stretch without sleep surprisingly well, which led to the premature conclusion that lack of sleep is relatively harmless to human health. Today we know otherwise: in experiments, prolonged total sleep deprivation has even led to the death of laboratory animals.
According to some press reports, Gardner’s record has been broken several times. Gardner’s case, however, has the advantage over the others of having been documented extensively and in great detail.
In less well-documented cases it is hard to pin down exactly how long the person went without sleep, because someone attempting the record may slip into short episodes of so-called microsleep without even being aware of it.
What is more, records for voluntary sleep deprivation are no longer kept in the Guinness Book of Records, out of concern for the health of daredevils trying to break them.
Some sources say that Gardner’s record was broken a month later by Toimi Soini of Hamina in Finland, who stayed awake for 11½ days, or 276 hours, from 5 to 15 February 1964, and that the record listed in the Guinness Book of Records is 449 hours, set by Maureen Weston of Peterborough, Cambridgeshire, UK, in April 1977. Because of the new safety policy, recent editions of the Guinness Book of Records give no information at all about sleep deprivation records.
Symptoms of sleep loss
Chronic lack of sleep (in other words sleep deprivation) can cause fatigue, daytime sleepiness, clumsiness and increased appetite leading to weight gain. It has a harmful effect on the brain and on cognitive function. In some cases, however, lack of sleep can, paradoxically, lead to higher energy levels and a better mood. Although the long-term consequences of sleep deprivation have never been fully studied, there have been attempts to use it as a treatment for depression.
In extreme situations, when we are acting under stress, we often push the need for sleep to the back of the queue. That is a mistake, though, because lack of sleep can do more harm than good. Soldiers fighting at the front know this and follow the rule: “march when you are ordered to; when you are not marching, sleep”. So even in very extreme situations you should not neglect sleep. As a rule of thumb, an adult needs about 7 to 9 hours of sleep a day.
Physiological effects: the main health consequences of sleep deprivation.
Generally speaking, sleep deprivation can cause:
- aching muscles
- confusion, memory lapses or complete memory loss
- depression
- the formation of false memories
- hallucinations
- trembling limbs
- headaches
- malaise
- styes
- swelling around the eyes, commonly known as “bags under the eyes”
- raised blood pressure
- higher levels of stress hormones
- a higher risk of diabetes
- weaker immunity and greater susceptibility to illness
- a higher risk of fibromyalgia
- irritability
- nystagmus (rapid, involuntary, rhythmic eye movement)
- obesity
- temper tantrums in children
- violent behaviour
- yawning
- paranoia
- ADHD-like symptoms
- psychosis
Symptoms and effects of sleep deprivation over time
Night 1: 24 hours without sleep.
Most people can get through one night without sleep, although they may feel slightly uncomfortable. Going 24 hours without sleep does not significantly affect behaviour, but there may be trembling and increased muscle tension, leading to less precise movements.
Night 2: 48 hours without sleep.
The feeling of tiredness sets in and the need for sleep grows stronger, especially between 3 and 5 in the morning, when body temperature reaches its lowest point.
Night 3: 72 hours without sleep.
Tasks that need concentration and calculation can become difficult, especially if they are boring and repetitive. Volunteers taking part in the study become irritable and rude. In the late morning hours the subjects feel an overwhelming need to sleep. Staying awake is only possible with the help of observers who wake the volunteers when necessary.
Night 4: 96 hours without sleep.
Repeated episodes of so-called microsleep occur: the subjects stop what they are doing and stare into space, and EEG recordings have shown that their brains produce delta waves, typical of a resting state, even while the person is awake. Microsleep episodes have a negative but short-lived effect on the tasks being performed. Subjects may also experience distorted perception, illusions, hallucinations, irritability and a feeling of pressure around the head.
Night 5: 120 hours without sleep.
The symptoms get worse and include impaired logical thinking and orientation, visual and tactile hallucinations, fatigue, irritability and delusions. Subjects may become deeply distrustful, to the point of suspecting that someone is trying to murder them. This is a typical syndrome at this stage. Intellectual abilities and problem-solving skills are significantly weakened.
Night 6: 144 hours without sleep.
Participants develop symptoms of depersonalisation and are no longer able to interpret reality. This condition is called sleep deprivation psychosis. This kind of psychosis very rarely persists after the study ends and usually clears up after a long enough period of catch-up sleep.
How lack of sleep affects the brain
Sleep deprivation can have a harmful effect on the brain and on cognitive function.
The negative effects of sleep deprivation on alertness and cognitive performance suggest a drop in brain activity and function. These changes occur mainly in two regions of the brain: the thalamus, a structure involved in maintaining focus and attention, and the prefrontal cortex, a region responsible for alertness, attention and higher-order cognitive processes.
The link between sleep deprivation and psychosis was documented in research from 2007. A study using MRI scans revealed that sleep deprivation leaves the brain unable to put an event into proper perspective and unable to respond to that event in a controlled and appropriate way.
A study carried out in 2002 showed that NREM sleep is needed to switch off neurotransmitters and allow their receptors to “rest” and recover full function. Non-REM sleep allows enzymes to repair damage to brain cells caused by free radicals. The high metabolic activity of the waking state damages the enzymes themselves, preventing them from carrying out repairs effectively. This study also recorded the first evidence of brain damage in rats as a direct result of sleep deprivation.
Animal studies also suggest that lack of sleep raises the level of stress hormones, which may reduce the production of new cells in adult brains.
The dangers of chronically not getting enough sleep
Among the possible physical consequences of sleep deprivation, the most important are the inability to stay focused and attentive, and memory problems. This causes uncontrolled lapses in everyday activities, which can lead to unfortunate results: from leaving out ingredients when cooking to skipping a sentence when taking notes. How well you perform tasks that need attention is directly linked to the number of hours you sleep each night: the less sleep, the worse it gets.
Lapses in concentration also affect more critical areas, where the consequences can be a matter of life and death: car crashes and industrial disasters often result from inattention put down to lack of sleep.
Most importantly, the subjects’ own assessments of how tired they are often fail to predict how well they actually perform. While people who are completely deprived of sleep are usually aware of how impaired they are, the lapses in mental performance caused by chronic sleep restriction (for example in people who sleep only 4 hours a night for a long time) can build up over time until they match, in number and severity, the lapses caused by total (acute) sleep deprivation.
Despite this, people who are short of sleep still rate themselves as much less impaired than those who have not slept for many hours or days in a row. Because people usually judge their ability to perform tasks subjectively, their judgement can lead them to the false conclusion that they can handle tasks requiring constant attention, when their abilities are in fact significantly impaired.
Air traffic controllers who had less than four hours of sleep a night made more than twice as many mistakes as those who slept more than seven hours a day.
Don’t neglect sleep, it doesn’t pay!
There is only one conclusion to draw from all this: never neglect your night’s rest. To function normally you need at least 7 hours of sleep a day.
Chronic lack of sleep causes lasting changes in the brain, which is frightening enough in itself.
On top of that, lack of sleep has a negative effect on every area of our lives. A person who has not slept enough makes wrong decisions and also makes mistakes, often without even realising it. This is especially dangerous in extreme situations, when a single wrong decision can shape your whole future, or even decide between life and death.
The scientific paper by Jolanta Orzeł-Gryglewska that I relied on when writing the text above.
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