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What's the worst that can happen from too much sleep deprivation? Can you die?


It is well known that sleep deprivation causes considerable discomfort in humans (and has even used as a form of torture), but nevertheless there have been people who went through protracted sleep deprivation, apparently with no long term consequence.

I've noticed that sleep deprivation seems to trigger an intense sense of "this is bad for me" - yet given the apparent lack of ill effects (beyond the obvious) I cannot say whether this is merely anxiety over discomfort, as opposed to a genuine perception of physiological damage.

What if you were to go without sleep for as long as possible, despite the discomfort? Is it possible to commit suicide in this way (and what would be the cause of death)? Would you fail because you eventually ignore whatever stimulus was preventing sleep, and sleep anyway? Would artificially counteracting the temporary debilitating physiological effects (such as loss of body temperature) allow you to survive sleep deprivation of arbitrary length?


The short answer is: Yes.

Fatal familial insomnia is a genetically passed down disease that at some random point in a carriers life will suddenly stop them from sleeping, ever, they die within 7 to 18 months

I know you did not ask about the disease, but it shows (even without illegal war tests) that it will kill you eventually, even in humans.

I believe in humans without the disease a complete lack of sleep may kill them within weeks, but who knows? maybe it was the drug.


Eventually your brain will start to break down and malfunction.

Chronic poor sleep puts us at increased risk for serious medical conditions, such as obesity, heart disease, and diabetes. During sleep, our bodies secrete hormones that help control appetite, metabolism, and glucose processing. Poor sleep can lead to an increase in the body's production of cortisol, also known as the stress hormone. In addition, skimping on sleep seems to throw other body hormones out of whack. Less insulin is released after you eat, and this along with the increased cortisol may lead to too much glucose in the bloodstream and thus an increased risk for type 2 diabetes.

At 24 Hours: Impaired Coordination, Memory, and Judgment At 36 Hours: Physical Health Starts to Be Negatively Impacted At 48 Hours: Microsleeps and Disorientation At 72 Hours: Major Cognitive Deficits and Hallucinations

After even longer, your brain deteriorates and eventually you will die.


The Spooky Effects of Sleep Deprivation

It's no surprise that a night without enough Zzzs can lead to a groggy morning. But bleary eyes and gaping yawns aren't the only things that can happen when your body needs more shut-eye.

Indeed, there are more nightmarish side effects to sleep deprivation.

If a person is deprived of sleep, it can lead to "tremendous emotional problems," said Dr. Steven Feinsilver, the director of the Center for Sleep Medicine at Icahn School of Medicine at Mount Sinai in New York City. "Sleep deprivation has been used as a form of torture," he said. [7 Strange Facts About Insomnia]

There isn't a clear definition of exactly how long a person must go without sleep, or how little sleep a person has to get to be considered sleep-deprived, and different people need different amounts of sleep, so there may be no universal definition of "sleep deprivation." Rather, a person is considered sleep-deprived if they get less sleep than they need to feel awake and alert, researchers say.

But still, research over the years has shown that people can be physically and psychologically damaged from not getting enough sleep, said David Dinges, a professor of psychology and the director of the Unit for Experimental Psychiatry at the University of Pennsylvania.

In fact, the damage is so apparent that it is unethical to coercively deprive someone of sleep, Dinges said. In the studies of sleep deprivation that Dinges and his colleagues conduct in their lab, healthy volunteers are placed in medically safe environments and constantly monitored.

But studying sleep deprivation is important, according to these researchers and others who study the condition. They say that learning what happens in people who are deprived of sleep can help researchers better understand the function of sleep and its importance for both physical and emotional health.

Emotions askew

The problems can start on a somewhat minor scale.

"Clearly, your brain doesn't work very well when you're sleep-deprived," Feinsilver said. Even a low level of sleep deprivation has an impact on cognitive and emotional function, he said.

Dinges explained that some of the first emotional impacts of sleep deprivation involve positive emotions. "When people get sleep-deprived, they don't show positive emotion in their faces," Dinges said. A sleep-deprived person may say they're happy, but they still have a neutral face, he said.

And they won't recognize other people as happy, either. A positive look on someone's face can appear neutral to a sleep-deprived person, and neutral look is often interpreted as a negative look, Dinges said. The sleep-deprived brain may not be as capable of detecting positive emotions as a more rested brain, he said.

And sleep-deprived people also don't tolerate disappointment very well, Dinges added.

Microsleeps

As little as a single night of sleep deprivation can result in a person having a phenomenon called "microsleeps," the next day, Feinsilver said.

A person begins to fall into mini-snooze sessions, which last up to 30 seconds. Some people's eyes remain open during microsleeps, but the disturbing thing about microsleeps is that during sleep, the person is essentially blind, even if their eyes are open, Feinsilver said. They're not processing information, he said.

Studies show that during microsleeps, the brain goes into a sleep state rapidly and uncontrollably, Dinges said. People can force themselves awake, but they will soon fall into another microsleep, he said.

Both Dinges and Feinsilver said that this condition can be incredibly dangerous, especially if you're behind the wheel.

People often say they feel loopy after a night of no sleep. But in more extreme cases, losing sleep may cause delirium.

True delirium occurs when a person becomes completely disoriented, Feinsilver said. "Sleep can play a role in that," he said. [5 Things You Must Know About Sleep]

Patients who have been hospitalized in intensive care units &mdash where lights and sounds may continue all day and night &mdash can develop a condition that doctors call "ICU delirium," he said. And while it's unclear if sleep deprivation is the cause of this delirium, doctors do think that loss of sleep is one reason people in the hospital for extended periods develop bizarre behavior, he said.

The worst thing you can do for sleep is put someone is a hospital, Feinsilver added. It's fairly common for for hospitalized patients to develop insomnia, he said.

Hallucinations

Seeing things that aren't there can be a side effect of chronic sleep deprivation, but whether sleep deprivations can induce true hallucinations may be up for debate.

Feinsilver said he personally experienced hallucinations due to sleep deprivation, in October of his first year out of medical school. A newly minted medical resident, Feinsilver said he had been chronically sleep-deprived for several months.

"I [knew] it was October, because I was in the ICU after a night on call," and there was pumpkin by the nurses' station, he said. "I had a very vivid feeling of the pumpkin talking to me," he said.

But Dinges was more skeptical about hallucinations.

"There's no question that misperceptions can occur," Dinges said. When people are very sleepy and performing a task, they may see something flicker in their peripheral vision, or they may think they see blinking lights, but not be sure, he said. All of these are indications that the brain isn't interpreting information clearly, he said.

Can you die of sleep deprivation?

In a famous series of animal experiments, researcher found that total sleep deprivation could kill lab rats.

In 2012, a Chinese man reportedly died after going 11 days without sleep. However, it's unlikely that lack of sleep alone caused his death (other factors likely played a role, such as drinking and smoking).

Of course, studying this phenomenon in humans is difficult &ndash even when you put aside the clear ethical dilemmas.

"Can you die of sleep deprivation? It's not easy," Feinsilver said. "Because you'll fall asleep," he added.

"I don't believe that people can keep themselves awake until they succumb to death," because the drive to sleep turns on, and then continues to turn on, he said. "You can't will yourself to stay awake that long," he said.

Still, there's no question that sleep deprivation has "serious adverse health effects," Dinges said.

"Everything we know about sleep loss is harmful," he said. But &mdash on a more positive note &mdash most of the effects of sleep deprivation dissipate after you sleep, he added.

Follow Sara G. Miller on Twitter @SaraGMiller. Follow Live Science @livescience, Facebook & Google+. Originally published on Live Science.


Death From Sleep Deprivation Is Incredibly Rare

Don't worry, you can go ahead and finish that cup of coffee. There are only a few documented cases of people dying from lack of sleep. In 2014, a Chinese man in the city of Suzhou tried to stay up to watch the FIFA World Cup in one, long marathon TV session. This meant he was awake for at least 11 days, and that was enough to kill him. When he was brought into the hospital (in one of the first recorded cases of that type), doctors concluded his death was, in fact, brought about through sleep deprivation.

Shockingly enough, this isn't the first time soccer has caused someone to stay awake until their death. During Euro 2012, another Chinese man stayed up to watch the whole thing in one sitting. After 11 days, Jiang Xiaoshan also succumbed to death from exhaustion, suggesting that, even if you love soccer, you probably shouldn't watch it nonstop for over a week.


Can You Die From Sleep-Deprivation?

The short answer? Yes, total sleep deprivation can almost certainly kill you. What's less clear is how it does it.

Before we get to the experimental and hypothetical ramifications of total sleep deprivation, let's pause briefly to address the much more pressing and pernicious issue of poor sleep hygiene, the long-term effects of which can also be deadly. THE MORE YOU KNOW, PEOPLE.

The Real Risk

The short-term consequences of poor or insufficient sleep have been well-documented, and include diminished cognitive and motor performance, impaired memory, blunted alertness, and an increased risk of injury – not to mention blighted sex lives . If you've ever pulled an all-nighter, you've experienced these effects firsthand. But even if you rarely go a night without sleep, there's a good chance you've suffered the ill-effects of sleep deprivation.

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The exact figures vary from study to study , but according to a 2011 poll conducted by the National Sleep Foundation , 43% of Americans between the ages of 13 and 64 "rarely or never get a good night's sleep on weeknights." Nearly two-thirds of Americans said their sleep needs were not being met during the week. Sixty percent reported experiencing a sleep problem on an almost nightly basis.

The side-effects associated with prolonged periods of inadequate shuteye have been shown to be cumulative, and exact a harmful toll. In one of the most extensive human sleep deprivation studies ever conducted , test subjects restricted to six hours of sleep per night for 14 consecutive days performed just as poorly on cognitive and motor tasks as test subjects who had forgone sleep entirely for two nights in a row. In the long term, poor sleep hygiene has been shown to negatively impact "the heart, lungs and kidneys appetite, metabolism and weight control immune function and disease resistance sensitivity to pain reaction time mood and brain function." It is a risk factor for depression and substance abuse, and has been linked to an increased risk of obesity, diabetes, heart disease and certain forms of cancer .

Most of us need seven-to-eight hours of solid sleep per night to function properly , and many of us simply aren't getting it . Falling short of sleep requirements night after night is almost certainly compromising the health of hundreds of millions of people. Though its impacts are often gradual to the point of invisibility, experts suspect that lack of sleep is , in a very real way , killing us .

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Enough With The Lecture – What If I Just Stopped Sleeping? What Then?

Yes, you say, bored with our disquisition on the perils of poor sleep hygiene, but what about total sleep deprivation? What if I were to just stop sleeping completely? Would it kill me?

Well, yes. Almost certainly. As far as we know, however, no human has ever died due to intentional or forced sleep-deprivation. (Animals, however, have – more on that below.)

Unsurprisingly, the consequences of prolonged periods of absolute sleep deprivation are less thoroughly documented than those of merely insufficient slumber. What we do know has been cobbled together from a handful of studies, world-record attempts, and harrowing accounts like this one from psychotherapist John Schlapobersky , a consultant to the Medical Foundation for Victims of Torture who was himself tormented with sleep deprivation:

I was kept without sleep for a week in all. I can remember the details of the experience, although it took place 35 years ago. After two nights without sleep, the hallucinations start, and after three nights, people are having dreams while fairly awake, which is a form of psychosis.

By the week's end, people lose their orientation in place and time — the people you're speaking to become people from your past a window might become a view of the sea seen in your younger days. To deprive someone of sleep is to tamper with their equilibrium and their sanity.

Accounts from victims like Schlapobersky align with those of more formal test subjects. In her 2011 essay "Up All Night," Elizabeth Kolbert recounts one of the earliest studies of Nathaniel Kleitman, a 20th Century physiologist widely recognized as the father of modern sleep research. His chosen discipline could barely be called a field at the time, but Kleitman was, by the 1930s, wholly dedicated to the systematic investigation of sleep and wakefulness . As disrupting a system is often the best way to figure out how that system works, Kleitmen's initial experiments centered largely on sleep deprivation:

In one of Kleitman's first experiments, he kept half a dozen young men awake for days at a stretch, then ran them through a battery of physical and psychological tests. Frequently, he used himself as a subject. As a participant in the sleep-deprivation experiment, Kleitman stayed awake longer than anyone else—a hundred and fifteen hours straight. At one point, exhausted and apparently hallucinating, he declared, apropos of nothing in particular, "It is because they are against the system." (Asked what he meant, he said heɽ been under the impression that he was "having a heated argument with the observer on the subject of labor unions.")

Fatal Familial Insomnia

115 hours is a long time, but humans have been known to tolerate significantly longer periods of wakefulness. Depending on who you ask , the world record for intentional sleep deprivation is somewhere between 11 and 19 days. The people who endure these long bouts of sleeplessness reportedly recover within a few days. No human death has been attributed to forced or intentional wakefulness. at least, not that we know of. Outcomes have, however, been fatal in rare instances when humans have been literally unable to sleep . Such is the case with fatal familial insomnia (FFI).

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FFI is an exceedingly rare prion disease of the brain. Its progression is marked by a complete inability to sleep, dementia, and eventually death, with the typical survival span for FFI patients being between 7 and 36 months . Its most simplified cause is damage to the thalamus, which receives input from many sensory systems, often via the spinal cord, and relays these signals to the rest of the brain.

The disease progresses like this: insomnia, hallucinations and temperature fluctuations (sweating) complete loss of sleep rapid weight loss dementia and irresponsiveness, followed by sudden death.

These symptoms, and others observed in studies of sleep loss, suggest prolonged periods of wakefulness may hasten death's arrival by "the disruption of critical functions," including ones related to hypometabolism. The hypometabolic body becomes unable to appropriately manage its energy intake and expenditure. It is accompanied by dysautonomia, in which the autonomic nervous system (fight or flight) goes into overdrive, further wasting energy.

These symptoms resemble those observed in animal investigations that have looked at the detrimental effects of prolonged wakefulness. Among these investigations is a series of experiments , led by University of Chicago researcher Allan Rechtschaffen, that showed definitively that sleep deprivation could prove fatal in rats.

Killing Rats With Total (And Partial) Sleep Deprivation

Results from a series of Rechtschaffen's experiments, published in 1989, showed that "all rats subjected to unrelenting total sleep deprivation died, usually after 2–3 weeks."

However, rats who were allowed no sleep at all were not the only ones to perish in the course of the experiments. The study's methods are worth recounting in detail – though, fair warning, animal lovers may wish to skip the next few paragraphs.

The researchers developed a simple mechanism to deprive rats of sleep. A 46-cm disk, divided along its diameter, was suspended over a shallow tray of water 2–3 centimeters deep. On one side of the disk the researchers would place a control rat, on the opposite side an experimental rat (the one to be deprived of sleep). The status of the rats – whether they were asleep or awake – was monitored via EEG, which measured brain activity, and EMG, which measured muscle movement. Whenever the experimental rat's brain and muscle activity indicated it was dozing off, the disk, stationary moments before, would spring to life, spinning in place a rate of 3.3 rpm. That might seem slow, but it was fast enough to bring both rats to attention and force them to move to avoid falling into the water below. In sleep-research circles, the technique is known as the "disk-over-water method." Its construction is roughly reproduced here, on the cover of Clete Anthony Kushida's Sleep Deprivation: Basic Science, Physiology, and Behavior.

The researchers tested three degrees of sleep deprivation, namely total sleep deprivation (TSD) paradoxical sleep deprivation (PSD, in which the disk turned only when the sleep deprived animal drifted into REM sleep) and high EEG amplitude non-REM (HS2D) sleep deprivation. Though none of their protocols was able to eliminate its target form of sleep completely, no sleep-deprived animal could survive any of the three forms of sleep deprivation for long. TSD animals lasted 2–3 weeks PSD animals persisted for about 5 week HS2D animals endured for just shy of seven weeks.

The results suggested that different parts of sleep help preserve the body's necessary functions in different ways, but all are probably required, in general. As for how sleep deprivation contributed to the rats' demise, the researchers do not present a definitive cause of death. Possible explanations include severe drops in body temperature, catabolism (the breakdown of bodily molecules prior to death), and bacterial infection. While all three of these symptoms correlated with death via sleep-deprivation, none was shown to be necessary keeping sleep-deprived rats warm, for instance, could not save them, and artificially cooling the bodies of control rats did not kill them. The results are perplexing, and contribute to sleep's status as one of biology's most baffling mysteries .

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The effects of prolonged sleep deprivation were various and troubling. The sleep-deprived rats ate more food, but lost weight. They lost the ability to maintain a healthy body temperature. Their skin deteriorated. Many sleep-deprived rats contracted bacterial diseases, though their immune systems varied when it came to type and severity of degradation. The researchers reported no obvious brain damage. If sleep-deprived rats were granted reprieve before it was too late, they could avoid death, albeit with some problems with REM sleep during their recovery.

In short, losing sleep overall killed the rats quickly losing certain types of sleep killed the rats a little less quickly, but still resulted in death and the various changes in physiology that were observed could not be proven to be the actual cause of death. It stands to reason that you or I would suffer the same fate, were we, heaven forbid, subjected to some scaled-up version of the disk-over-water device.


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Comments

I just wanna say thank you for your article because this article was very useful and helped me to learn.

Through out day our mind is continuously working even then we are not working it is the only m/c which human can not build it works continuously hence in 24 hours it needs min 6 hours of rest if it don’t get that much amount of rest then obviously it’s functions stop working slowly slowly.


Acute total sleep deprivation

Attention and working memory

The two most widely studied cognitive domains in SD research are attention and working memory, which in fact are interrelated. Working memory can be divided into four subsystems: phonological loop, visuospatial sketchpad, episodic buffer and central executive ( Baddeley and Hitch 1974 Baddeley 2000 ). The phonological loop is assumed to temporarily store verbal and acoustic information (echo memory) the sketchpad, to hold visuospatial information (iconic memory), and the episodic buffer to integrate information from several different sources. The central executive controls them all. Executive processes of working memory play a role in certain attentional functions, such as sustained attention ( Baddeley et al 1999 ), which is referred to here as vigilance. Both attention and working memory are linked to the functioning of frontal lobes (for a review, see Naghavi and Nyberg 2005 ). Since the frontal brain areas are vulnerable to SD ( Harrison et al 2000 Thomas et al 2000 ), it can be hypothesized that both attention and working memory are impaired during prolonged wakefulness.

The decrease in attention and working memory due to SD is well established. Vigilance is especially impaired, but a decline is also observed in several other attentional tasks ( Table 1 ). These include measures of auditory and visuo-spatial attention, serial addition and subtraction tasks, and different reaction time tasks ( Table 1 ). The most frequently used task is the psychomotor vigilance test (PVT, lasts usually 10 min) ( Dinges and Powell 1985 ), which is sensitive to sleep loss effects and provides information about both reaction speed and lapses. In working memory, the tests have varied from n-back style tasks with different demand levels to choice-reaction time tasks with a working memory component ( Table 1 ). However, some studies have also failed to find any effect. After one night of SD, no difference was observed between deprived and non-deprived subjects in simple reaction time, vigilance, or selective attention tasks in one study ( Forest and Godbout 2000 ). Performance on the Wisconsin Card Sorting Test, a measure of frontal lobe function, also remained even ( Binks et al 1999 Forest and Godbout 2000 ). These results may be partly biased because of small sample sizes, inadequate control of the subjects’ sleep history or the use of stimulants before the study.

Table 1

Cognitive tests in which deterioration of performance has been reported during acute total sleep deprivation

Cognitive testEffectAuthors
Attention
 Simple reaction timeChoo et al 2005, Karakorpi et al 2006
𠀼hoice reaction time tasksWilkinson et al 1990, Smulders et al 1997, Wright and Badia 1999, Frey et al 2004, Karakorpi et al 2006, Kendall et al 2006
 Serial reaction time testNilsson et al 2005
 Vienna Test System (computerized): Vigilance, simple reaction time Cognitrone (visual analytical ability, attention and working memory Vigilance)Lee et al 2003
Wu et al 1991, Corsi-Cabrera et al 2003, Karakorpi et al 2006, Sagaspe et al 2006, Taillard et al 2006
𠀿lanker task (computerized: attention, vigilance?)Tsai et al 2005
𠀽ichotic listening (vigilance)Johnsen et al 2002
 Psychomotor vigilance task (PVT)Dinges et al 1994, Wright and Badia 1999, Doran et al 2001, Van Dongen et al 2003, Frey et al 2004, Graw et al 2004, Van Dongen et al 2004, Adam et al 2006, Blatter et al 2006
 Serial addition and/or subtraction taskDrummond et al 1999, Thomas et al 2000, Van Dongen et al 2003 and 2004, Kendall et al 2006
 Two column additionWright and Badia 1999, Frey et al 2004
 Visuo-spatial attention (saccadic eye movements)Bocca and Denise 2006
𠀿inding Embedded Figures TestBlagrove et al 1995
𠀺uditory attention taskBlagrove et al 1995, Linde et al 1999
𠀽ual taskWright and Badia 1999, Frey et al 2004
𠀽ual taskDrummond et al 2001, Alhola et al 2005
 Paced Auditory Serial Addition Test (PASAT)Binks et al 1999
Working memory
 N-backSmith et al 2002, Choo et al 2005
 LTR, PLUSChee and Choo 2004, Chee et al 2006
 PLUS-L (verbal working memory)Chee et al 2006
�layed-match-to-sample taskHabeck et al 2004
𠀼hoise-reaction time task (with working memory component)Jennings et al 2003
𠀻rown-PetersonForest and Godbout 2000
 Sternberg verbal working memory taskMu et al 2005
 Working memory taskWimmer et al 1992
𠀽igit recallFrey et al 2004
𠀽igit spanLinde and Bergström 1992 (2 studies), Quigley et al 2000
 Word recall (working memory)Quigley et al 2000
 Verbal working memory, visuo-spatial working memory testNilsson et al 2005
 Spatial working memory taskHeuer et al 2005
𠀺ttentional power (effortful information processing)Linde and Bergström 1992 (2 studies)
Long-term memory
 Word memory testDrummond et al 2000
 Temporal memory for faces (recency)Harrison and Horne 2000
 Probed forced memory recall and digit recallWright and Badia 1999
 Memory searchMcCarthy and Waters 1997
 Paired word learning (implicit memory)Forest and Godbout 2000
𠀾pisodic memory (Claeson-Dahl test)Nilsson et al 2005
 Implicit memory test, prose recall, Mill Hill vocabulary test (chrystallized semantic memory), procedural memory, face memoryQuigley et al 2000
�nton visual retention testAlhola et al 2005
Visuomotor performance
𠀼ritical trackingVan Dongen et al 2004
 Letter cancellation task (visual search)Casagrande et al 1997, De Gennaro et al 2001
 Trail-making taskWimmer et al 1992
 Maze tracing taskBlatter et al 2005
𠀽igit symbolVan Dongen et al 2003, 2004
𠀽igit symbol, Bourdon-Wiersma, other psychomotor testsQuigley et al 2000, Alhola et al 2005
 Procedural motor task↓ ↔Forest and Godbout 2000
Decision making
𠀼ritical reasoning, MasterplannerHarrison and Horne 1999
�ision-making taskLinde et al 1999, Kilgore et al 2006
Verbal functions
 Logical reasoningMcCarthy and Waters 1997
 Logical reasoning test (Baddeley)Blagrove et al 1995, Monk and Carrier 1997
 Logical reasoning test (Baddeley)Linde and Bergström 1992 (2 studies), Quigley et al 2000 , Drummond et al 2004
 Word detection task, repeated acquisition of responce sequence taskVan Dongen et al 2004
 Vowel/consonant discrimination task, letter recognition taskWimmer et al 1992
 Sentence processing, categories test, spot the word, word recognitionQuigley et al 2000
 Word fluency, Booklet form of the Category testBinks et al 1999
Response inhibition
 Response inhibition (the Haylings sentence completion task), verb generation to nounsHarrison and Horne 1998
 Go-NoGo (response inhibition)Drummond et al 2006
 Stroop (color-word, emotional, specific)Sagaspe et al 2006
 Spatial Stroop (suppression of prepotent responses)Heuer et al 2005
 StroopBinks et al 1999
Other measures
𠀽ichotic temporal order judgmentBabkoff et al 2005
 Negative priming (effect vanished during SD)Harrison and Espelid 2004
 Task-shiftingHeuer et al 2004 (2 studies)
 Simon taskHeuer et al 2005
 Raven’s progressive matricesLinde and Bergström 1992
𠀿igural form of the Torrance Tests of Creative ThinkingWimmer et al 1992
 Modified Six Elements test (story-telling, simple arithmetic calculations and object naming)Nilsson et al 2005
 Switching TaskFrey et al 2004
 Implicit sequence learning in the serial reaction taskHeuer et al 1998, Heuer and Klein 2003
𠀾xplicit sequence learning task (serial reaction tasks)Heuer et al 1998
 Luria-Nebraska Neuropsychological Battery, Calculation and digit span from WAIS↓ ↔Kim et al 2001
 Number-series inductionsLinde and Bergström 1992
 Novel oddball task (auditory)↓ ↔Gosselin et al 2005
 Random generation tasks↓ ↔Heuer et al 2005 (3 studies)
𠀼omplex navigation taskStrangman et al 2005
 Wisconsin Card Sorting Test (computerized), WAIS-R short formBinks et al 1999

Abbreviations: SD, sleep deprivation WAIS, Wechsler Adult Intelligence Scale WAIS-R, Wechsler Adult Intelligence Scale-Revised.

Outcomes are inconsistent in various dual tasks used for measuring divided attention. Sleep deprivation of 24 h impaired performance in one study ( Wright and Badia 1999 ), whereas in two others, performance was maintained after 25� h of SD ( Drummond et al 2001 Alhola et al 2005 ). The divergent findings in these studies may be explained by the uneven loads between different subtests as well as by uncontrolled practice effect. Although dividing attention between different tasks puts high demands on cognitive capacity, subjects often attempt to reduce the load by automating some easier procedures of a dual or multitask. In the study by Wright and Badia (1999) , the test was not described in the study by Alhola et al (2005) , subjects had to count backwards and carry out a visual search task simultaneously, and in the study by Drummond et al (2001) subjects had to memorize words and complete a serial subtraction task sequentially. In addition, differences in essential study elements, like the age and gender of participants, as well as the duration of SD, further complicate comparison of the results.

In the tasks measuring attention or working memory, two aspects of performance are important: speed and accuracy. In practice, people can switch their emphasis between the two with attentional focusing ( Rinkenauer et al 2004 ). Oftentimes, concentrating on improving one aspect leads to the deterioration of the other. This is called the speed/accuracy trade-off phenomenon. Some SD studies have found impairment only in performance speed, whereas accuracy has remained intact ( De Gennaro et al 2001 Chee and Choo 2004 ). In others, the results are the opposite ( Kim et al 2001 Gosselin et al 2005 ). De Gennaro et al (2001) proposed that in self-paced tasks, there is likely to be a stronger negative impact on speed, while accuracy remains intact. In experimenter-paced tasks, the effect would be the opposite. However, many studies show detrimental effect on both speed and accuracy (eg, Smith et al 2002 Jennings et al 2003 Chee and Choo 2004 Habeck et al 2004 Choo et al 2005 ). The speed/accuracy trade-off phenomenon is moderately affected by gender, age, and individual differences in response style ( Blatter et al 2006 Karakorpi et al 2006 ), which could be a reason for inconsistencies in the SD results. It has been argued that low signal rates increase fatigue during performance in SD studies and that subjects may even fall asleep during the test ( Dorrian et al 2005 ). Therefore, tasks with different signal loads may produce different results in terms of performance speed and accuracy.

Long-term memory

Long-term memory can be divided between declarative and non-declarative (procedural) memory. Declarative memory is explicit and limited, whereas non-declarative memory is implicit and has a practically unlimited capacity. Declarative memory includes semantic memory, which consists of knowledge about the world, and episodic memory, which holds autobiographical information. The contents of declarative memory can be stored in visual or verbal forms and they can be voluntarily recalled. Non-declarative or procedural memory includes the information needed in everyday functioning and behavior, eg, motor and perceptual skills, conditioned functions and priming. In previous studies, long-term memory has been measured with a variety of tasks, and the results are somewhat inconsistent.

In verbal episodic memory, SD of 35 h impaired free recall, but not recognition ( Drummond et al 2000 ). The opposite results were obtained with one night of SD ( Forest and Godbout 2000 ). The groups in both studies were quite small (in Drummond’s study, N = 13 in Forest and Godbout’s study, experimental group = 9, control group = 9), which offers a possible explanation for the variation in results. In addition, Drummond et al (2000) used a within-subject design, whereas Forest and Godbout (2000) had a between-subject design. In visual memory, recognition was similar in the experimental and control groups when the measurement was taken once after 36 h SD ( Harrison and Horne 2000 ), whereas the practice effect in visual recall was postponed by SD in a study with three measurements (baseline, 25 h SD, recovery Alhola et al 2005 ). Performance was impaired in probed forced memory recall ( Wright and Badia 1999 ), and memory search ( McCarthy and Waters 1997 ), but no effect was found in episodic memory ( Nilsson et al 2005 ), implicit memory, prose recall, crystallized semantic memory, procedural memory, or face memory ( Quigley et al 2000 ). In the studies failing to find an effect, however, the subjects spent only the SD night under controlled conditions ( Quigley et al 2000 Nilsson et al 2005 ).

Free recall and recognition are both episodic memory functions which seem to be affected differently by SD. Temporal memory for faces (recall) deteriorated during 36 h of SD, although in the same study, face recognition remained intact ( Harrison and Horne 2000 ). In verbal memory, the same pattern was observed ( Drummond et al 2000 ). One explanation may be different neural bases, which supports the prefrontal vulnerability hypothesis. Episodic memory is strongly associated with the functioning of the medial temporal lobes ( Scoville and Milner 2000 ), but during free recall in a rested state, even stronger brain activation is found in the prefrontal cortex ( Hwang and Golby 2006 ). It is unclear whether this prefrontal activation reflects episodic memory function, the organization of information in working memory, or the executive control of attention and memory. Recognition, instead, presumably relies on the thalamus in addition to medial temporal lobes ( Hwang and Golby 2006 ). Since SD especially disturbs the functioning of frontal brain areas ( Drummond et al 1999 Thomas et al 2000 ), it is not surprising that free recall is more affected than recognition.

Although the prefrontal cortex vulnerability hypothesis has received wide support in the field of SD research, other brain areas are also involved. For instance, the exact role of the thalamus remains unknown. Some studies measuring attention or working memory have noted an increase in thalamic activation during SD (eg, Portas et al 1998 Chee and Choo 2004 Habeck et al 2004 Choo et al 2005 ). This may reflect an increase in phasic arousal or an attempt to compensate attentional performance during a demanding condition of low arousal caused by SD ( Coull et al 2004 ). In other cognitive tasks such as verbal memory ( Drummond and Brown 2001 ) or logical reasoning ( Drummond et al 2004 ), no increase in thalamic activation was found despite the fact that behavioral deterioration occurred. This implies that thalamic activation during SD is mainly related to some attentional function or compensation, providing further support for the hypothesis that “prefrontal dependent” recall is more affected by SD than “thalamus dependent” recognition. However, it is possible that the brain activation patterns during SD reflect something more than merely different cognitive domains. Harrison and Horne (2000) stated that their results may also reflect the difficulty of the task assigned to subjects.

Other cognitive functions

Sleep deprivation impairs visuomotor performance, which is measured with tasks of digit symbol substitution, letter cancellation, trail-making or maze tracing ( Table 1 ). It is believed that visual tasks would be especially vulnerable to sleep loss because iconic memory has short duration and limited capacity ( Raidy and Scharff 2005 ). Another suggestion is that SD impedes engagement of spatial attention, which can be observed as impairments in saccadic eye movements ( Bocca and Denise 2006 ). Decreased oculomotor functioning is associated with impaired visual performance ( De Gennaro et al 2001 ) and sleepiness (eg, De Gennaro et al 2001 Zils et al 2005 ). However, further research is needed to confirm this explanation, since not all studies have found oculomotor impairment with cognitive performance decrements ( Quigley et al 2000 ).

Reasoning ability during SD has for the most part been measured with Baddeley’s logical reasoning task or its modified versions. Again the results are inconsistent (deteriorated performance was reported by Blagrove et al 1995 McCarthy and Waters 1997 Monk and Carrier 1997 , and Harrison and Horne 1999 no effects were noted by Linde and Bergstrom 1992 Quigley et al 2000 , or Drummond et al 2004 ). The studies reporting no effect have mainly used SD of ca. 24 h ( Linde and Bergström 1992 Quigley et al 2000 ), whereas in the studies showing an adverse effect, the SD period has been longer (36 h). Thus reasoning ability seems to be maintained during short-term SD. However, choosing divergent study designs may result in different outcomes. Monk and Carrier (1997) repeated the cognitive test every 2 h and found deterioration after as little as 16 h of SD. In the studies with zero-results, cognitive tests were carried out in the morning ( Linde and Bergström 1992 Quigley et al 2000 ) or the practice effect was not adequately controlled ( Drummond et al 2004 ). In the studies with longer SD, the tests have been conducted either in the late afternoon ( McCarthy and Waters 1997 Harrison and Horne 1999 ) or have been repeated several times ( Blagrove et al 1995 Monk and Carrier 1997 ). Therefore, the different results may reflect the effect of circadian rhythm on alertness and cognitive performance. In the morning or before noon, the circadian process reaches its peak, inducing greater alertness, whereas the timing of the circadian nadir coincides with the late afternoon testing (see Achermann 2004 ).

In addition to the cognitive domains already introduced, total SD affects several other cognitive processes as well. It increases rigid thinking, perseveration errors, and difficulties in utilizing new information in complex tasks requiring innovative decision-making ( Harrison and Horne 1999 ). Deterioration in decision-making also appears as more variable performance and applied strategies ( Linde et al 1999 ), as well as more risky behavior ( Killgore et al 2006 ). Several other tasks have been used in the sleep deprivation studies ( Table 1 ). For example, motor function, rhythm, receptive and expressive speech, and memory measured with the Luria-Nebraska Neuropsychological Battery deteriorated after one night of SD, whereas tactile function, reading, writing, arithmetic and intellectual processes remain intact ( Kim et al 2001 ).

The adverse effects of total SD shown in experimental designs have also been confirmed in real-life settings, mainly among health care workers, professional drivers and military personnel ( Samkoff and Jacques 1991 Otmani et al 2005 Philibert 2005 Russo et al 2005 ). Performance of residents in routine practice and repetitive tasks requiring vigilance becomes more error-prone when wakefulness is prolonged (for a review, see Samkoff and Jacques 1991 ). However, in new situations or emergencies, the residents seem to be able to mobilize additional energy sources to compensate for the effects of tiredness. More recent meta-analysis shows that SD of less than 30 h causes a significant decrease in both the clinical and overall performance of both residents and non-physicians ( Philibert 2005 ).

Motivation

What role does motivation play in cognitive performance? Can high motivation reverse the adverse effect of SD? Does poor motivation further deteriorate performance? According to a commonly held opinion, high motivation compensates for a decrease in performance, but only a few attempts have been made to confirm this theory. Estimating the compensatory effect of motivation in performance during SD is generally difficult, because persons participating in research protocols, especially in SD studies, usually have high initial motivation. The concept of motivation is closely linked to the 𠇊ttentional effort” that is considered a cognitive incentive (for a review, see Sarter et al 2006 ). According to Sarter et al (2006) , “increases in attentional effort do not represent primarily a function of task demands but of subjects’ motivation to perform.” Furthermore, attentional effort is a function of explicit and implicit motivational forces and may be increased especially when the subjects are motivated or when they detect signals of performance decrements ( Sarter et al 2006 ).

Harrison and Horne (1998 , 1999) suggest that the deterioration of cognitive performance during SD could be due to boredom and lack of motivation caused by repeated tasks, especially if the tests are simple and monotonous. They used short, novel, and interesting tasks to abolish this motivational gap, yet still noted that SD impaired performance. In contrast, other researchers suggest that sleep-deprived subjects could maintain performance in short tasks by being able to temporarily increase their attentional effort. When a task is longer, performance deteriorates as a function of time. A meta-analysis by Pilcher and Huffcutt (1996) provides support for that: total SD of less than 45 h deteriorated performance more severely in complex tasks with a long duration than in simple and short tasks. Based on this, it is probably necessary to make a distinction between mere attentional effort and more general motivation. Although attentional effort reflects motivational aspects in performance, motivation in a broader sense can be considered a long-term process such as achieving a previously set goal, eg, completing a study protocol. If one has already invested a great deal of time and effort in the participation, motivation to follow through may be increased.

Different aspects of motivation were investigated in a study with 72 h SD, where the subjects evaluated both motivation to perform the tasks and motivation to carry out leisure activities ( Mikulincer et al 1989 ). Cognitive tasks were repeated every two hours. Performance motivation decreased only during the second night of SD, whereas leisure motivation decreased from the second day until the end of the study on the third day. The authors concluded that the subjects were more motivated to complete experimental testing than to enjoy leisure activities because by performing the tasks, they could advance the completion of the study. The researchers suggested that the increased motivation towards the tasks on the third day reflected the 𠇎nd spurt effect” caused by the anticipation of sleep.

Providing the subjects with feedback on their performance or rewarding them for effort or good performance is shown to help maintain performance both in normal, non-deprived conditions ( Tomporowski and Tinsley 1996 ) and during SD ( Horne and Pettitt 1985 Steyvers 1987 Steyvers and Gaillard 1993 ). In a large study with 61 subjects (experimental group = 29), with SD of 34� h, and with a comprehensive test battery, the subjects were continuously encouraged and provided with 2𠄳 minute breaks between the tests ( Binks et al 1999 ). Furthermore, they were told they would receive a monetary award for completing all tests with “honest effort”. As result, no deteriorating effect on cognitive performance was found. Unfortunately, a non-motivated control group was not included and thus the effect of motivation remained uncertain. In general, since this issue has not been addressed sufficiently, it is difficult to specify the role of motivation in performance. It seems that motivation affects performance, but it also appears that SD can lead to a loss of motivation.

Self-evaluation of cognitive performance

It has been suggested that the self-evaluation of cognitive performance is impaired by SD. During 36 h SD, the subjects became more confident that their answers were correct as the wakefulness continued ( Harrison and Horne 2000 ). Confidence was even stronger when the answer was actually wrong. In another study, performance was similar between sleep-deprived and control groups in several attentional assessments, but the deprived subjects evaluated their performance as moderately impaired ( Binks et al 1999 ). The controls considered that their performance was high.

The ability to evaluate one’s own cognitive performance depends on age and on the study design. Young people seem to underestimate the effect of SD, whereas older people seem to overestimate it. In a simple reaction time task, both young (aged 20� years) and aging (aged 52� years) subjects considered that their performance had deteriorated after 24 h SD, although performance was actually impaired only in young subjects ( Philip et al 2004 ). When it comes to the study design and methodology, the way in which the self-evaluation is done may affect the outcome. The answers possibly reflect presuppositions of the subjects or their desire to please the researcher. The repetition of tasks is also essential. Evaluation ability is poor in studies with one measurement only ( Binks et al 1999 Harrison and Horne 2000 Philip et al 2004 ), whereas in repeated measures, the subjects are shown to be able to assess their performance quite reliably during 60� h SD and recovery ( Baranski et al 1994 Baranski and Pigeau 1997 ). Thus, self-evaluation is likely to be more accurate when subjects can compare their performance with baseline.


Sleep Deficit: The Performance Killer

Companies today glorify the executive who logs 100-hour workweeks, the road warrior who lives out of a suitcase in multiple time zones, and the negotiator who takes a red-eye to make an 8 AM meeting. But to Dr. Charles A. Czeisler, the Baldino Professor of Sleep Medicine at Harvard Medical School, this kind of corporate behavior is the antithesis of high performance. In fact, he says, it endangers employees and puts their companies at risk.

In this interview, Czeisler describes four neurobiological functions that affect sleep duration and quality as well as individual performance. When these functions fall out of alignment because of sleep deprivation, people operate at a far lower level of performance than they would if they were well rested. Czeisler goes on to observe that corporations have all kinds of policies designed to protect employees—rules against smoking, sexual harassment, and so on—but they push people to the brink of self-destruction by expecting them to work too hard, too long, and with too little sleep. The negative effects on cognitive performance, Czeisler says, can be similar to those that occur after drinking too much alcohol: “We now know that 24 hours without sleep or a week of sleeping four or five hours a night induces an impairment equivalent to a blood alcohol level of .1%. We would never say, ‘This person is a great worker! He’s drunk all the time!’ yet we continue to celebrate people who sacrifice sleep for work.”

Czeisler recommends that companies institute corporate sleep policies that discourage scheduled work beyond 16 consecutive hours as well as working or driving immediately after late-night or overnight flights. A sidebar to this article summarizes the latest developments in sleep research.

At 12:30 am on June 10, 2002, Israel Lane Joubert and his family of seven set out for a long drive home following a family reunion in Beaumont, Texas. Joubert, who had hoped to reach home in faraway Fort Worth in time to get to work by 8 am , fell asleep at the wheel, plowing the family’s Chevy Suburban into the rear of a parked 18-wheeler. He survived, but his wife and five of his six children were killed.

The Joubert tragedy underscores a problem of epidemic proportions among workers who get too little sleep. In the past five years, driver fatigue has accounted for more than 1.35 million automobile accidents in the United States alone, according to the National Highway Traffic Safety Administration. The general effect of sleep deprivation on cognitive performance is well-known: Stay awake longer than 18 consecutive hours, and your reaction speed, short-term and long-term memory, ability to focus, decision-making capacity, math processing, cognitive speed, and spatial orientation all start to suffer. Cut sleep back to five or six hours a night for several days in a row, and the accumulated sleep deficit magnifies these negative effects. (Sleep deprivation is implicated in all kinds of physical maladies, too, from high blood pressure to obesity.)

Nevertheless, frenzied corporate cultures still confuse sleeplessness with vitality and high performance. An ambitious manager logs 80-hour work weeks, surviving on five or six hours of sleep a night and eight cups of coffee (the world’s second-most widely sold commodity, after oil) a day. A Wall Street trader goes to bed at 11 or midnight and wakes to his BlackBerry buzz at 2:30 am to track opening activity on the DAX. A road warrior lives out of a suitcase while traveling to Tokyo, St. Louis, Miami, and Zurich, conducting business in a cloud of caffeinated jet lag. A negotiator takes a red-eye flight, hops into a rental car, and zooms through an unfamiliar city to make a delicate M&A meeting at 8 in the morning.

People like this put themselves, their teams, their companies, and the general public in serious jeopardy, says Dr. Charles A. Czeisler, the Baldino Professor of Sleep Medicine at Harvard Medical School. 1 To him, encouraging a culture of sleepless machismo is worse than nonsensical it is downright dangerous, and the antithesis of intelligent management. He notes that while corporations have all kinds of policies designed to prevent employee endangerment—rules against workplace smoking, drinking, drugs, sexual harassment, and so on—they sometimes push employees to the brink of self-destruction. Being “on” pretty much around the clock induces a level of impairment every bit as risky as intoxication.

As one of the world’s leading authorities on human sleep cycles and the biology of sleep and wakefulness, Dr. Czeisler understands the physiological bases of the sleep imperative better than almost anyone. His message to corporate leaders is simple: If you want to raise performance—both your own and your organization’s—you need to pay attention to this fundamental biological issue. In this edited interview with senior editor Bronwyn Fryer, Czeisler observes that top executives now have a critical responsibility to take sleeplessness seriously.

What does the most recent research tell us about the physiology of sleep and cognitive performance?

Four major sleep-related factors affect our cognitive performance. The kinds of work and travel schedules required of business executives today pose a severe challenge to their ability to function well, given each of these factors.

The first has to do with the homeostatic drive for sleep at night, determined largely by the number of consecutive hours that we’ve been awake. Throughout the waking day, human beings build up a stronger and stronger drive for sleep. Most of us think we’re in control of sleep—that we choose when to go to sleep and when to wake up. The fact is that when we are drowsy, the brain can seize control involuntarily. When the homeostatic pressure to sleep becomes high enough, a couple thousand neurons in the brain’s “sleep switch” ignite, as discovered by Dr. Clif Saper at Harvard Medical School. Once that happens, sleep seizes the brain like a pilot grabbing the controls. If you’re behind the wheel of a car at the time, it takes just three or four seconds to be off the road.

The second major factor that determines our ability to sustain attention and maintain peak cognitive performance has to do with the total amount of sleep you manage to get over several days. If you get at least eight hours of sleep a night, your level of alertness should remain stable throughout the day, but if you have a sleep disorder or get less than that for several days, you start building a sleep deficit that makes it more difficult for the brain to function. Executives I’ve observed tend to burn the candle at both ends, with 7 am breakfast meetings and dinners that run late, for days and days. Most people can’t get to sleep without some wind-down time, even if they are very tired, so these executives may not doze off until 2 in the morning. If they average four hours of sleep a night for four or five days, they develop the same level of cognitive impairment as if they’d been awake for 24 hours—equivalent to legal drunkenness. Within ten days, the level of impairment is the same as you’d have going 48 hours without sleep. This greatly lengthens reaction time, impedes judgment, and interferes with problem solving. In such a state of sleep deprivation, a single beer can have the same impact on our ability to sustain performance as a whole six-pack can have on someone who’s well rested.

The third factor has to do with circadian phase—the time of day in the human body that says “it’s midnight” or “it’s dawn.” A neurological timing device called the “circadian pacemaker” works alongside but, paradoxically, in opposition to the homeostatic drive for sleep. This circadian pacemaker sends out its strongest drive for sleep just before we habitually wake up, and its strongest drive for waking one to three hours before we usually go to bed, just when the homeostatic drive for sleep is peaking. We don’t know why it’s set up this way, but we can speculate that it has to do with the fact that, unlike other animals, we don’t take frequent catnaps throughout the day. The circadian pacemaker may help us to focus on that big project by enabling us to stay awake throughout the day in one long interval and by allowing us to consolidate sleep into one long interval at night.

In the midafternoon, when we’ve already built up substantial homeostatic sleep drive, the circadian system has not yet come to the rescue. That’s typically the time when people are tempted to take a nap or head for the closest Starbucks or soda machine. The caffeine in the coffee temporarily blocks receptors in the brain that regulate sleep drive. Thereafter, the circadian pacemaker sends out a stronger and stronger drive for waking as the day progresses. Provided you’re keeping a regular schedule, the rise in the sleep-facilitating hormone melatonin will then quiet the circadian pacemaker one to two hours before your habitual bedtime, enabling the homeostatic sleep drive to take over and allow you to get to sleep. As the homeostatic drive dissipates midway through the sleep episode, the circadian drive for sleep increases toward morning, maintaining our ability to obtain a full night of sleep. After our usual wake time, the levels of melatonin begin to decline. Normally, the two mutually opposing processes work well together, sustaining alertness throughout the day and promoting a solid night of sleep.

The fourth factor affecting performance has to do with what’s called “sleep inertia,” the grogginess most people experience when they first wake up. Just like a car engine, the brain needs time to “warm up” when you awaken. The part of your brain responsible for memory consolidation doesn’t function well for five to 20 minutes after you wake up and doesn’t reach its peak efficiency for a couple of hours. But if you sleep on the airplane and the flight attendant wakes you up suddenly upon landing, you may find yourself at the customs station before you realize you’ve left your laptop and your passport behind. There is a transitional period between the time you wake up and the time your brain becomes fully functional. This is why you never want to make an important decision as soon as you are suddenly awakened—ask any nurse who’s had to awaken a physician at night about a patient.

Most top executives are over 40. Isn’t it true that sleeping also becomes more difficult with age?

Yes, that’s true. When we’re past the age of 40, sleep is much more fragmented than when we’re younger. We are more easily awakened by disturbances such as noise from the external environment and from our own increasing aches and pains. Another thing that increases with age is the risk of sleep disorders such as restless legs syndrome, insomnia, and sleep apnea—the cessation of breathing during sleep, which can occur when the airway collapses many times per hour and shuts off the flow of oxygen to the heart and brain, leading to many brief awakenings.

Many people gain weight as they age, too. Interestingly, chronic sleep restriction increases levels of appetite and stress hormones it also reduces one’s ability to metabolize glucose and increases the production of the hormone ghrelin, which makes people crave carbohydrates and sugars, so they get heavier, which in turn raises the risk of sleep apnea, creating a vicious cycle. Some researchers speculate that the epidemic of obesity in the U.S. and elsewhere may be related to chronic sleep loss. Moreover, sleep-disordered breathing increases the risk of high blood pressure and heart disease due to the strain of starving the heart of oxygen many times per hour throughout the night.

As we age, the circadian window during which we maintain consolidated sleep also narrows. That’s why airline travel across time zones can be so brutal as we get older. Attempting to sleep at an adverse circadian phase—that is, during our biological daytime—becomes much more difficult. Thus, if you take a 7 pm flight from New York to London, you typically land about midnight in your home time zone, when the homeostatic drive for sleep is very strong, but the local time is 5 am . Exposure to daylight—the principal circadian synchronizer—at this time shifts you toward Hawaiian time rather than toward London time. In this circumstance, the worst possible thing you can do is rent a car and drive to a meeting where you have to impress people with your mental acuity at the equivalent of 3 or 4 in the morning. You might not even make the meeting, because you very easily could wrap your car around a tree. Fourteen or 15 hours later, if you’re trying to go to bed at 11 pm in the local time zone, you’ll have a more difficult time maintaining a consolidated night’s sleep.

So sleep deprivation, in your opinion, is a far more serious issue than most executives think it is.

Yes, indeed. Putting yourself or others at risk while driving or working at an impaired level is bad enough expecting your employees to do the same is just irresponsible. It amazes me that contemporary work and social culture glorifies sleeplessness in the way we once glorified people who could hold their liquor. We now know that 24 hours without sleep or a week of sleeping four or five hours a night induces an impairment equivalent to a blood alcohol level of .1%. We would never say, “This person is a great worker! He’s drunk all the time!” yet we continue to celebrate people who sacrifice sleep. The analogy to drunkenness is real because, like a drunk, a person who is sleep deprived has no idea how functionally impaired he or she truly is. Moreover, their efficiency at work will suffer substantially, contributing to the phenomenon of “presenteeism,” which, as HBR has noted, exacts a large economic toll on business. [See Paul Hemp’s article “Presenteeism: At Work—But Out of It,” HBR October 2004.]

Putting yourself or others at risk while driving or working at an impaired level is bad enough expecting your employees to do the same is just irresponsible.

Sleep deprivation is not just an individual health hazard it’s a public one. Consider the risk of occupational injury and driver fatigue. In a study our research team conducted of hospital interns who had been scheduled to work for at least 24 consecutive hours, we found that their odds of stabbing themselves with a needle or scalpel increased 61%, their risk of crashing a motor vehicle increased 168%, and their risk of a near miss increased 460%. In the U.S., drowsy drivers are responsible for a fifth of all motor vehicle accidents and some 8,000 deaths annually. It is estimated that 80,000 drivers fall asleep at the wheel every day, 10% of them run off the road, and every two minutes, one of them crashes. Countless innocent people are hurt. There’s now a vehicular homicide law in New Jersey (and some pending in other states) that includes driving without sleep for more than 24 hours in its definition of recklessness. There’s a man in Florida who’s serving a 15-year prison term for vehicular homicide—he’d been awake for 30-some hours when he crashed his company’s truck into a group of cars waiting for a light to change, killing three people. I would not want to be the CEO of the company bearing responsibility for those preventable deaths.

Sleep deprivation among employees poses other kinds of risks to companies as well. With too little sleep, people do things that no CEO in his or her right mind would allow. All over the world, people are running heavy and dangerous machinery or guarding secure sites and buildings while they’re exhausted. Otherwise intelligent, well-mannered managers do all kinds of things they’d never do if they were rested—they may get angry at employees, make unsound decisions that affect the future of their companies, and give muddled presentations before their colleagues, customers, the press, or shareholders.

What should companies be doing to address the sleep problem?

People in executive positions should set behavioral expectations and develop corporate sleep policies, just as they already have concerning behaviors like smoking or sexual harassment. It’s important to have a policy limiting scheduled work—ideally to no more than 12 hours a day, and exceptionally to no more than 16 consecutive hours. At least 11 consecutive hours of rest should be provided every 24 hours. Furthermore, employees should not be scheduled to work more than 60 hours a week and not be permitted to work more than 80 hours a week. When working at night or on extended shifts, employees should not be scheduled to work more than four or five consecutive days, and certainly no more than six consecutive days. People need at least one day off a week, and ideally two in a row, in order to avoid building up a sleep deficit.

Now, managers will often rationalize overscheduling employees. I hear them say that if their employees aren’t working, they will be out partying and not sleeping anyway. That may be true for some irresponsible individuals, but it doesn’t justify scheduling employees to work a hundred hours a week so that they can’t possibly get an adequate amount of sleep. Of course, some circumstances may arise in which you need someone to remain at work for more than 16 consecutive hours. The night security guard, for example, can’t just walk off the job if his replacement isn’t there, so you will need to have a provision for exceptional circumstances, such as offering transportation home for a sleep-deprived worker.

Companies also need executive policies. For example, I would advise executives to avoid taking red-eye flights, which severely disrupt sleep. If someone must travel overnight internationally, the policy should allow the executive to take at least a day to adapt to the sleep deprivation associated with the flight and the new time zone before driving or conducting business. Such a policy requires some good schedule planning, but the time spent making the adjustments will be worth it, for the traveler will be more functional before going into that important meeting. And the sleep policy should not permit anyone, under any circumstances, to take an overnight flight and then drive to a business meeting somewhere—period. He or she should at least be provided a taxi, car service, or shuttle.

A company’s sleep policy should not permit anyone, under any circumstances, to take an overnight flight and then drive to a business meeting somewhere—period.

Companies can do other things to promote healthy sleep practices among employees. Educational programs about sleep, health, and safety should be mandatory. Employees should learn to set aside an adequate amount of time for sleep each night and to keep their bedrooms dark and quiet and free of all electronic devices—televisions, BlackBerries, and so on. They should learn about the ways alcohol and caffeine interfere with sleep. When someone is sleep deprived, drinking alcohol only makes things worse, further eroding performance and increasing the propensity to fall asleep while also interfering with the ability to stay asleep. Additionally, companies should provide annual screening for sleep disorders in order to identify those who might be at risk. For example, this past year our team launched a Web-based screening survey that any law enforcement officer in the U.S. can take to help identify whether he or she is suffering from sleep apnea, restless legs syndrome, narcolepsy, or other sleep disorders. Those whose answers place them at high risk are referred for evaluation and treatment by a specialist accredited by the American Academy of Sleep Medicine. [Accredited sleep centers may be found at www.sleepcenters.org.]

Finally, I would recommend that supervisors undergo training in sleep and fatigue management and that they promote good sleep behavior. People should learn to treat sleep as a serious matter. Both the company and the employees bear a shared responsibility to ensure that everyone comes to work well rested.

This corporate sleep policy of yours sounds a little draconian, if not impossible, given people’s crazy schedules.

I don’t think it’s draconian at all. Business travelers expect that their pilots won’t drink before flying an airplane, and all of us expect that no driver on the highway will have a blood alcohol level above the legal limit. Many executives already realize that the immediate effect of sleep loss on individuals and on overall corporate performance is just as important. A good sleep policy is smart business strategy. People think they’re saving time and being more productive by not sleeping, but in fact they are cutting their productivity drastically. Someone who has adequate sleep doesn’t nod off in an important meeting with a customer. She can pay attention to her task for longer periods of time and bring her whole intelligence and creativity to bear on the project at hand.

What do you think about the use of drugs that help people fall asleep or that shut off the urge to sleep?

These agents should be used only after a thorough evaluation of the causes of insomnia or excessive daytime sleepiness. Patients too often think there’s a silver bullet for a problem like insomnia, and doctors too easily prescribe pills as part of a knee-jerk reaction to patient requests during the final minutes of an office visit. The causes of insomnia are subtle and need to be carefully investigated. These can be from too much caffeine, an irregular schedule, anxiety or depression, physical problems such as arthritis, use of other medications, and so on—and only a careful evaluation by a doctor experienced in sleep medicine can uncover the causes. I once saw a professor who complained of difficulty sleeping at night, and only after taking a careful history did we find that he was drinking 20 cups of coffee a day. He didn’t even realize he was drinking that much and didn’t think about the fact that so much caffeine, which has a six- to nine-hour half-life, would interfere with his ability to sleep. Prescribing a sleeping pill for his insomnia without identifying the underlying cause would have been a mistake.

There are non-pharmacological treatments for insomnia that seem very promising, by the way. Cognitive behavioral therapy, or CBT, helps people recognize and change thoughts and behaviors that might be keeping them awake at night. A researcher named Dr. Gregg Jacobs at Harvard Medical School has reported that CBT works better over both the short and the long term than sleeping pills do.

What’s New in Sleep?

Sleep science is advancing on a number of frontiers that, over time, may cause us to rethink everything from our personal habits to public policy. Here’s a short sampling of these new developments.

Sleep is power.

Your mother was right—to perform at your best, you need sleep. Discoveries about sleep cycles have given researchers new insight into the specific roles sleep plays in overall health and performance. For example, there is growing evidence that sleep aids in immune function, memory consolidation, learning, and organ function. “Some researchers now think sleep may be the missing link when it comes to overall health, safety, and productivity,” says Darrel Drobnich, the senior director of government and transportation affairs for the National Sleep Foundation. One new field of study is looking at a specific correlation between sleep and productivity, and the benefits of what sleep researchers call a “power nap”—a 20-minute period of sleep in the afternoon that heads off problems associated with cumulative sleep deficit.

Move over, Ambien.

Ambien, the sleep aid from drugmaker Sanofi-Aventis, is now de rigueur for the sleepless, ringing up $1.4 billion annually in U.S. sales alone. While Ambien has fewer side effects than most over-the-counter sleep aids, it’s still a blunt instrument, neurophysiologically speaking. “All of the current products on the market, including Ambien, take a sledgehammer to specific receptors in the brain,” says Dr. Robert McCarley, the head of psychiatry at Boston VA Medical Center and a professor of psychiatry at Harvard Medical School. “They have several negative side effects, ranging from disassociated states of consciousness to potential addiction. They also tend to lose their effectiveness over time.” Researchers hope a new family of sleep-inducing drugs will function closer to the body’s natural sleep mechanisms and so avoid problems associated with sedatives like Ambien. One such new drug—Rozerem, from Japanese drug giant Takeda—targets melatonin receptors in the brain. As researchers learn more about the body’s internal sleep mechanisms, McCarley believes, sleep aids will inevitably improve.

On the other side of the equation, the pharmaceutical company Cephalon is now marketing modafinil, a drug that helps people function well on very little sleep without suffering the ill effects of common stimulants. Sold under the commercial trade name Provigil in the U.S., modafinil was originally prescribed to treat narcolepsy it’s now used to promote wakefulness among those who can’t afford to go to sleep (such as field soldiers in war zones). Studies have shown that subjects taking modafinil are able to stay alert with only eight hours of sleep during an 88-hour period. While modafinil sounds like a dream drug, no one yet knows what effects may result from more than occasional use.

Car drowse alarms.

By the end of the decade, automakers will offer cars outfitted with devices designed to keep drowsy drivers from falling asleep at the wheel. Some may use cameras to scan drivers’ eyes for droopiness, or to sense when people are loosening their grip on the steering wheel, and then sound an alarm. In 2005, Ford and Volvo announced that they were working on a system called Driver Alert, consisting of a camera that measures the distance between the vehicle and the markings on the surface of the road. If the driver starts to swerve, an alarm goes off and a text warning appears on the dashboard. Another approach under consideration by the U.S. National Highway Traffic Safety Administration is the development of “intelligent” highways equipped with specialized sensors that continuously track vehicle trajectory and speed.

Tomorrow’s workforce needs sleep now.

Businesses need an educated workforce ironically, school is interfering. The current high school schedule in the U.S., which typically begins around 7:20 am , threatens the neurological development and health of adolescents, whose homeostatic drive operates differently from adults’. Most teens experience a delayed sleep phase, in which melatonin is released around 11 pm —an hour later than in most adults. Students who finally go to sleep by midnight and wake at 6 experience a chronic sleep deficit, which disrupts their ability to learn and puts them and you at risk on the roads. In the U.S., researchers and sleep advocates are now working closely with school districts, communities, and educators to change school start times so that students can get more sleep.

Sometimes executives simply have to function without much sleep. What are some strategies they can use to get by until they can go to bed?

Though there is no known substitute for sleep, there are a few strategies you can use to help sustain performance temporarily until you can get a good night’s sleep. Obviously, executives can drink caffeine, which is the most widely used wake-promoting therapeutic in the world. Naps can be very effective at restoring performance, and if they are brief—less than a half hour—they will induce less grogginess upon awakening. Being in a novel or engaging circumstance will also help you stay alert. Exercise, standing in an upright position, and exposure to bright light are all very helpful. Human beings are amazingly sensitive to light. In fact, the color of light may also be important. Exposure to shorter wavelength blue light is particularly effective in suppressing melatonin production, thereby allowing us to stay awake during our biological night. Photon for photon, looking up at the blue sky, for example, is more effective in both resetting our biological clock and enhancing our alertness than looking down at the green grass.

While all these things can help an executive function in an emergency, I must reiterate that he or she should still not drive when sleep deprived, even if a cup of coffee or a walk on a sunny day seems to help for a little while.

Like everyone else, I try to, but I don’t always achieve it.

1. Dr. Czeisler is the incumbent of an endowed professorship donated to Harvard by Cephalon and consults for a number of companies, including Actelion, Cephalon, Coca-Cola, Hypnion, Pfizer, Respironics, Sanofi-Aventis, Takeda, and Vanda.


Shower danger When Sleep Deprivation

Bathing is a daily activity that is done to prevent the body from harm will be dirt on the body. Bathing should be done 2 times a day up or when your body is dirty. Bathing is healthy because it can eliminate germs or bacteria that cause disease. But do you know, if you are the type of shower that dangerous?

Dangerous shower is a shower that is done after you stay up all night. The impact of lack of sleep that you continue to shower turned out very bad for your health. Bath when your own lack of sleep can cause a variety of health problems such as exposed to the wind sits deadly and symptoms of lung wet.

Why was dangerous to do so when you are sleep deprived?
Keep in mind, the human body is made such that not only used to work alone but also need to rest. Especially at night, the body should be rested after a long day before you use it for a whole day. But in some people, a night's rest, done less than the maximum. The habit of staying up itself can be done for many reasons such as insomnia or perhaps because of work to be done.

Although it does not do anything for staying up late, but the organ in the body keep doing the activity. When it should be, night is the time for the body to rest. Because of their activity in the body, the body will experience warming. Can you imagine yourself not? what happens if the body temperature is still hot doused by cold water?

When bathing the body temperature before the heat will certainly experience sudden temperature spike. The human body itself is not designed abrupt temperature changes like that. The parable light in this case is when you fill a cup with hot water. Furthermore, the glass suddenly emptied and replaced it using ice cold water. As a result the glass will crack and shatter.

  • Avoid taking a bath after you stayed up late or sleep deprivation
  • Get to know your own body temperature. If the body feels hot it would be better if you rest first. Then continued with a shower.

The emergence of panda eyes
Panda eye often seen in those who love staying up. Panda eyes itself is one of the physical characteristics of those who like to stay up next pouched eyes, the face is not bright, the eyes look glassy, ​​pale and so forth. Additionally, stay up too make wrinkles appear more quickly, especially in the area around the eyes. In this case, obviously if staying up it can make your natural beauty is reduced.

Decreased immune system
Power of the body decreases the side effects that you will encounter if familiarize themselves with staying up. For those of you who are too often stay up, the body will become sick more easily when compared to they sleeping enough. There are several types of ailments that can strike at any time you like flu, malaise, chills and others. Various examples of the mild disease, it will be easier to attack you at a time when low immune system results in diseases caused by lack of sleep.

Other possible health disorders attacking, is a type of severe diseases like stroke symptoms, lungs and health problems in the kidney. In addition, there are also obese hypertensive higher risk of outbreak on your body if often stay up. When sleeping, the cells in the body will work by removing toxins from the body. If you reduce the time of rest, the body working system will not run well.

loss of concentration
Other lack of sleep hazard impacts are thought to be made focusing difficult. When you sleep with intensity less than 6 hours, then wake up lackluster tendency will be greater. Unlike when you are getting enough sleep, your body becomes more fresh so that when you working become more comfortable. Not only lackluster, but the habit of staying up also makes the body easily tired, lackluster and worse, forgetful. Sleep with enough intensity was able to help your long-term memory for the better.

irregular eating patterns
Diet becomes regular due to often stay up an adverse side effect of habit related. When your body is sleep deprived, then you will tend to sleep longer so during the day, you just woke up. This habit makes you skip breakfast. In fact, breakfast is very important for a healthy body as well as your daily energy supplier.

easy to feel sleepy
The habit of staying up late at night, making it easy to feel drowsy the next day. This occurs because the body does not receive enough rations for him to rest. Drowsiness would be very dangerous if you're in a state of driving. Up to now has been a lot of accidents are caused by driver drowsiness.
Staying up late is a bad habit that must be changed . Get used to sleep at least 8 hours in a day . Sleep has so many health benefits . with enough sleep , the body will tend to be more fit, not easily tired and a good concentration and focus . A good time to sleep is at night . Make your schedule as best as possible and to make sure if your daily sleep requirement is fulfilled.
Keep in mind , the body needs to relax the conditions for removing toxins inside the body . If you stayed up late, then the process will be chaotic and the impact will be bad for your health .


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Your emotions are all over the place

You might feel like your emotions are out of control when you're sleep deprived. "You become over-reactive to emotional stimuli," Baron says. So things that normally haven't gotten you worked up in the past&mdasha tear-jerking movie or big work deadline&mdashmay provoke anxiety, sadness, or anger. (It could also go the opposite way: "People can get slap-happy and giddy as well," Baron says.)

Additionally, a 2008 study in the journal Sleep Medicine shows that lack of proper sleep not only makes you more emotional, it makes you less emotionally intelligent and lessens your constructive thinking skills. This means you&rsquore less able to express, control or even be aware of your emotions.


Sleep Deprivation: The Dark Side of Parenting

Sleep deprivation is an inevitable part of having a baby, and surely that’s been true throughout the history of our species. But we also live in a culture that seems to take some amount of pride in getting by on little sleep. We think of sleep as time wasted, as lost productivity. We forget – or ignore – the biological necessity of sleep.

Becoming a parent only further stretches our already-too-thin sleep allotments. Newborn babies wake frequently to feed or for comfort during the night. We try to “sleep when the baby sleeps” and piece it together to come up with a reasonable amount, but it often doesn’t feel sufficient. And now more than ever, new parents are really isolated as they make this transition they don’t have much in the way of backup resources to help with the 24/7 job of caring for a baby.

This month, the theme of our Carnival of Evidence-Based Parenting is Transition to Parenthood. (See the bottom of this post for links to other Carnival posts and here for summaries of them all.) Sleep deprivation is a universal part of that transition. What does the sleep deprivation of early parenthood really look like? How does it affect us? And what can we do to mitigate it?

Just How Bad Is It?

For many moms, sleep debt actually begins in pregnancy, when sleep needs may increase but discomfort and frequent trips to the bathroom interfere with a full night’s sleep. But by far, the biggest change happens in the immediate postpartum period. One study found that in the first week of the baby’s life (compared with late pregnancy), moms got 1.5 hours less sleep, fragmented into three times more sleep episodes per day. The early postpartum period is also characterized by lots of day-to-day variability in sleep. Sleeping with a new baby means unpredictability, with little to no control over whether tonight will be a good night or a bad one.

Mothers usually get the majority of our sympathy when it comes to postpartum sleep deprivation, but the research shows that fathers’ sleep takes a hit, too. A study of 72 San Francisco couples welcoming their first baby compared sleep in the last month of pregnancy to sleep in the first month postpartum (around 20 days of life). Across this time span, mothers lost an average of 41 minutes of nighttime sleep, while dads lost just 18 minutes. Moms, however, gained 30 minutes per day in daytime napping dads didn’t get a nap bump at all. In fact, in this study, dads actually slept less than moms – both in late pregnancy and in the postpartum period. Moms still had it harder they were waking more during the night and had more sleep fragmentation than dads (and it’s quite possible that moms need more sleep, what with recovery from childbirth and the demands of breastfeeding). But regardless, in this and other studies, moms and dads both reported a similar level of fatigue during the day.

There’s some good news to come out of this research, however. It seems that experienced moms are better at handling sleep in the postpartum period. Despite juggling more responsibility at home, studies show that moms who had given birth at least once before tended to get more sleep at all stages of pregnancy and in the postpartum period. Their sleep was also more efficient, meaning that of the time they spend in bed, they spend most of it sleeping rather than tossing and turning – or laying awake listening to the grunts and sighs of new baby sleep. Somehow, experienced moms seem to prioritize sleep more, or they’re just so tired that they crash hard at every opportunity.

How does sleep deprivation affect new parents?

We know a lot about the effects of sleep deprivation but actually very little about the specific type of crap sleep experienced by new parents. Most sleep deprivation studies have been conducted in residential labs, where participants (often young, probably resilient, undergrads) are generally paid to live for a few nights or maybe weeks so that their sleep habits can be controlled and monitored. In a review paper entitled “Sleep Disruption and Decline in Marital Satisfaction Across the Transition to Parenthood,” Gonzaga professor Anna Marie Medina and colleagues make an important point: Lab study participants know that they’ll be subjected to sleep deprivation for a finite amount of time, and they know they can even drop out if it becomes too much for them.

“Understanding that one can end a study, and being certain of the temporal parameters of potential sleep deprivation, imbues the experience of sleep loss with a level of controllability that new parents seldom have. That is, (most) new parents realize they cannot opt out of the sleep disruption experience, and they have no certainty about when they may have an opportunity for sufficient sleep. The stress literature has suggested that such uncontrollability could amplify the mood and physiological consequences of sleep deprivation.”

In other words, most of what we know about the effects of lost sleep may be even worse in new parents. On that happy note, there are a few major areas of concern…

Sleep deprivation impacts mood.

Medical residents are notorious for being sleep-deprived, and their situations may be similar to new parents in that their sleep is chronically restricted and fragmented. Studies on medical residents show that sleep loss is associated with more intense negative emotions and hostility. One study found that interns who became chronically sleep-deprived over the course of their first year of training had seven times the odds of becoming moderately depressed, compared to those managing to get enough sleep. Reading these studies, all I could feel was sympathy for my friends who juggled residency and new parenthood at the same time.

Specific to new moms, many studies show that moms whose babies have sleep problems are at greater risk for postpartum depression. In studies that have given parents advice in managing their baby’s sleep, resulting in improved sleep for the baby, maternal mood improves as well.

Sleep deprivation impacts cognitive function.

Sleep deprivation decreases a range of cognitive abilities, and I’m not just talking about SAT scores. For example, reaction time and alertness are essential for safe driving. Working memory is the ability to juggle multiple tasks, and well, that’s what parents do. Cognitive flexibility is what allows you to see a situation from more than one point of view (a skill vital to both parenting a toddler and maintaining a healthy marriage) or to quickly switch tasks, maybe from trying to fire off a work email to the more urgent demands of a toddler who has to go potty NOW. Verbal fluency is the ability to find the right word at the right time – to communicate effectively. We use all of these skills throughout our daily lives. They allow us to work towards goals (even mundane ones like getting out the door or getting dinner on the table), solve problems, and regulate emotions. And guess what? All of these cognitive skills are impaired by sleep deprivation.

To put this into perspective, one study found that two weeks of six hours of sleep per night caused declines in many cognitive measures – similar to those found after a full 24-48 hours of sleep deprivation. Perhaps more concerning is that the six-hour sleepers had no idea how impaired they were they rated their sleepiness as only mild, but their test performance showed otherwise. Another study found that cognitive performance of people who had been awake for 18-19 hours was comparable to those with blood alcohol content (BAC) of 0.10 (the legal limit for driving in most U.S. states is 0.08). It is estimated that 15-33% of fatal car crashes are related to driver fatigue.

What can you do to improve your sleep situation?

I know that you know that sleep deprivation sucks, and I don’t mean for this post to be a downer. Is there anything we can we do to make things better? I can’t claim to have answers, but I’ll offer some suggestions:

Cut yourself some slack. This parenting job is hard enough as it is. Doing it on little sleep everyday? It’s a hurculean task, and yet we do it. Sometimes we need to just focus on the basics and have popcorn for dinner.

Prioritize sleep. It’s so critical to our health and happiness. The dishes in the sink? They aren’t nearly as important.

Give yourself a bedtime. We know our kids don’t function well if they’re short on sleep. We don’t either – we’re just a little better at hiding it.

Get help. This is particularly critical for parents of newborns. It may require creative delegation of tasks to friends and family so that you can squeeze in a longer nap or an earlier bedtime. They’re happy to help, and you need it. We were never meant to parent alone.

Help your baby develop healthy sleep patterns. Check out my tips for newborn sleep here. And if your older baby is struggling with sleep (and by extension, you are too), know that it is not selfish to make changes that help everyone get the rest they need (more on that here).

Avoid screen time before bed. It gets in the way of melatonin release, confusing the biological clock trying to keep time in our brains and prepare us for sleep. Yes, your Facebook feed may be your lifeline to the world, but it could also be keeping you up at night.

Be aware of your sleep debt. I think that after a while, we forget how much sleep we’re missing. Six hours a night and chronic daytime yawns become our new normal. But knowing that we’re behind on sleep, combined with the knowledge of the profound effects of sleep debt on mood and cognition, can give us valuable perspective. Maybe, for example, your partner is being just a little bit of an ass instead of the complete asshole that you perceive. Maybe catching up on sleep will help the day’s problems seem a little more manageable.

And now, a confession: All of these tips I just gave you? I’m not very good at them. I hate leaving dishes in the sink, and I’m not good at asking for help. I stay up too late – usually in front of my computer. I don’t get enough sleep, and it isn’t even my daughter’s fault. She sleeps for 11 hours at night. Why can’t I manage to sleep for 8 of those? What am I staying up for? It’s that treasured ME time. These days, most of it is actually spent working, but that doesn’t make it easier for me to give any of it up. This research, though, has convinced me that sleep deprivation is probably putting a damper on my productivity, and maybe my parenting patience.

So, I’m taking a pledge: For the rest of the month of May, in honor of Mothers’ Day, I’m giving myself at least 7 hours of sleep each night. I’m making it a priority. I’m informing my husband that no, I will not watch one more episode of Breaking Bad with him, unless it is before 10 PM. And I’m turning off my computer and phone by that time, too. It’s a personal experiment and a gift to myself. Happy Mother’s Day, Me!

Do you get enough sleep? If so, how do you do it? If not, what’s standing in your way?

Check out the other posts in this second edition of the Carnival of Evidence-Based Parenting:

You can also “like” the Carnival of Evidence-Based Parenting on Facebook. Check out our Facebook page, and connect with all of us there! And finally, we’ll be hosting a Twitter party (I’m @scienceofmom) Friday 1-2 PM EST to discuss new parenthood and our posts (#parentscience). Please join us!


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