Sleep deprivation has become one for the most pervasive health problems facing the United States. It is estimated that people on average now sleep one and a half hours less than people did a century ago. In a 2002 “Sleep in America” poll of 1,000 adults, nearly a third said that they need at least eight hours to avoid feeling sleepy the next day. However, the respondents responded that they average 6.9 hours of sleep on weeknights and 7.5 on weekend nights. Many Americans do not get the sleep they need because their schedules do not allow adequate time for it and they do not know the negative effects lack of sleep can have on their health and functioning. Others are unable to get a good night’s rest due to sleep disorders, chronic pain, medications, hot flashes, stress or health conditions such as heart disease, depression, arthritis or heart disease.

Some experts are even beginning to wonder if widespread sleep deprivation is having an effect on America’s brainpower and creativity. They are advocating that sleep deprivation be recognized with the same seriousness that is associated with the impact of alcohol on society.

How does a lack of sleep affect the body?

One well-known study undertaken more than a decade ago showed that a rat prevented from sleeping will die in about three weeks, having lost the ability to maintain body heat and develop a fever to stave off infection. In humans, fatal familial insomnia, a degenerative brain disease, leads to death after several months, though scientists have not determined whether the cause of death is the sleep loss or other aspects of brain damage. While this disease is extremely rare, lack of sleep can have dramatic effects on quality of life.

A person who loses one night’s sleep will generally be irritable and clumsy during the next day and will either become tired easily or speed up because of adrenalin. After missing two night’s sleep, a person will have problems concentrating and will begin to make mistakes on normal tasks. Three missed nights and a person will start to hallucinate and lose grasp of reality. Someone who gets just a few hours of sleep each night occurs a large “sleep debt” and can begin to experience many of the same problems over time. A 1997 study found that people whose sleep was restricted to four to five hours per night for one week needed two full nights of sleep to recover performance, alertness and normal mood.

A recent U.S. Army study concluded sleep deprivation reduces emotional intelligence and constructive thinking skills.

Other short-term consequences include:

• Decreased daytime alertness. Loss of just one and half hours sleep can result in a 32% reduction in daytime alertness.
• Impaired memory and cognitive ability, the ability to think and process information.
• More than double the risk of sustaining an occupational injury.
• Impaired immune system.

Long-term consequences can include the following:

• High blood pressure
• Heart attack
• Heart failure
• Stroke
• Psychiatric problems such as depression and other mood disorders
• Mental impairment
• Increased mortality risk
• Relationship problems with a bed partner
• Obesity - (The link between obesity and sleep is an interesting one as lack of sleep can cause weight gain by increasing hunger and affecting metabolism, and extra weight can cause sleep disorders such as apnea which cause sleep deprivation.)

Sleep Debt Can Be Dangerous

The National Highway Traffic Safety Administration estimates conservatively that, during an average year, “drowsy driving” causes 100,000 automobile wrecks, 71,000 injuries and 1,550 fatalities. The U.S. Department of Transportation reports that 20% of all drivers have dozed off at least once behind the wheel. Drowsy driving accidents are often more serious than other wrecks because they often occur on high speed highways (because the driver is maintaining the same speed for a long period of time), there is no attempt to avoid the crash since the driver’s eyes are closed and the driver is usually alone with no one to alert him or her. Adding to these alarming statistics is the fact that long-haul truck drivers tend to sleep only two to four hours per night.

In addition to truck drivers, other adults who are especially vulnerable to sleep deprivation are shift workers. An alarming increase in the frequency of accidents is seen during the graveyard shift. Notable incidents that have been due in part to sleep deprivation have included the Exxon Valdez oil spill and Three Mile Island. Shift workers are also in the top three populations at the highest risk for drowsy driving automobile accidents.

Does it make you crazy?

No, sleep deprivation does not make people mentally ill in any meaningful sense. Insomnia is a very common symptom of many mental illnesses, so confusion occasionally arises about cause and effect. But sleep researchers do not feel that sleep deprivation causes psychosis or schizophrenia or depression or similar problems.

"Visual misperceptions" happen to sleepy people, but these are not the same as hallucinations or waking dreams. Auditory hallucinations are not experienced by sleep deprived people.

Sleep deprivation and euphoria

Sleep deprivation gives a lot of people a buzz. Especially in the first night of staying up, many people experience euphoria. Indeed, sleep deprivation can even be a short-term way to address depression. The effects of depression decline. Total sleep deprivation for a whole night improves symptoms in 40-60% of patients. (In their manic phases people with bipolar disorder do not sleep much and do not need much sleep.) Unfortunately, sleep restriction is not a viable treatment for depression on an outpatient basis. Supervision is required.

Imaging research has shown that one night of sleep deprivation leads to an increase in brain dopamine levels. Dopamine is sometimes called the "pleasure neurotransmitter" because of its role in so much human behavior.

Sleep deprivation in children

Sleep deprivation is particularly a problem for children. In studies of elementary aged children, nearly 40% had some type of sleep problem, 15% exhibited bedtime resistance and 10% had daytime sleepiness. Nearly half of teens reported at least occasional difficulty in falling or staying asleep and almost 13% experiencing chronic and severe insomnia. This lack of sleep greatly affects mood, behavior, and academic performance. In pediatric research, poor sleepers reported being significantly more depressed and were even more likely to have a negative self-image. They were also more likely to exhibit type A behavior patterns and inferior coping behaviors and have more behavioral problems at home and in school. One study showed that students that students with C’s, D’s and F’s went to bed an average of 40 minutes later and got 20 minutes less sleep than A students. Insufficient sleep has also been associated with Attention Deficit Hyperactivity Disorder (ADHD), lower social skills and learning difficulties.

Are you and your family sleep-deprived?

Sleep clinics measure sleep debt through use of a sleep latency test, which measures how easily someone can fall asleep. When this test is performed several times in a day it is called a multiple sleep latency test. However, there are ways to tell if you are sleep-deprived without going to a sleep clinic. Experts say that needing an alarm clock in order to wake up is a sign that you are sleep deprived. Another is falling asleep within five minutes of your head hitting the pillow unlike well-rested people who tend to nod off after 10 to 15 minutes. Napping easily is a third sign.

With children, it is important to remember that they will rarely complain of sleep problems. Also, parents are often unaware of how long it takes their children to fall asleep and how often they awake during the night. Therefore, it is important to talk with their children about how well they sleep and monitor them for signs of sleep deprivation.

Sleep deprivation as a form of torture or as an interrogation technique

Law enforcement professionals employ forced sleep deprivation to get prisoners to talk – the idea being that tired people have lower resistance to truth telling. It's hard to lie when you're sleepy. More nefarious techniques such as attempts to “brain wash” prisoners also employ sleep deprivation.