Sleep

Self-help cognitive-behavioral therapy for insomnia: a meta-analysis of randomized controlled trials.

Ho FY, Chung KF, Yeung WF +4 more · Sleep Med Rev · 2015 · 243 citations

Effect of Sleep Extension on Objectively Assessed Energy Intake Among Adults With Overweight in Real-life Settings

Esra Tasali, Kristen Wroblewski, Eva Kahn +2 more · JAMA Internal Medicine · 2022 · 146 citations

Extending sleep by about 1.2 hours per night in adults who habitually slept less than 6.5 hours led to an average reduction of 270 calories per day in energy intake, with no change in energy expenditure, resulting in weight loss — suggesting that improving sleep duration alone can shift energy balance in a direction that supports weight management.

The prevalence and association of stress with sleep quality among medical students

Abdullah I. Almojali, Sami Almalki, Ali Alothman +2 more · Journal of Epidemiology and Global Health · 2017 · 572 citations

Among 700 medical students in Saudi Arabia, 76% reported poor sleep quality and 53% reported high stress; students without stress were 72% less likely to have poor sleep, and those with a GPA below 4.25 had nearly 4 times the risk of poor sleep—suggesting that stress and academic pressure are tightly linked to sleep disruption in high-demand environments.

Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline

Michael J. Sateia, Daniel J. Buysse, Andrew D. Krystal +2 more · Journal of Clinical Sleep Medicine · 2017 · 1,438 citations

The two‐process model of sleep regulation: a reappraisal

Alexander A. Borbély, Serge Daan, Anna Wirz‐Justice +1 more · Journal of Sleep Research · 2016 · 1,540 citations

In the last three decades the two-process model of sleep regulation has served as a major conceptual framework in sleep research. It has been applied widely in studies on fatigue and performance and to dissect individual differences in sleep regulation. The model posits that a homeostatic process (Process S) interacts with a process controlled by the circadian pacemaker (Process C), with time-courses derived from physiological and behavioural variables. The model simulates successfully the timing and intensity of sleep in diverse experimental protocols. Electrophysiological recordings from the suprachiasmatic nuclei (SCN) suggest that S and C interact continuously. Oscillators outside the SCN that are linked to energy metabolism are evident in SCN-lesioned arrhythmic animals subjected to restricted feeding or methamphetamine administration, as well as in human subjects during internal desynchronization. In intact animals these peripheral oscillators may dissociate from the central pacemaker rhythm. A sleep/fast and wake/feed phase segregate antagonistic anabolic and catabolic metabolic processes in peripheral tissues. A deficiency of Process S was proposed to account for both depressive sleep disturbances and the antidepressant effect of sleep deprivation. The model supported the development of novel non-pharmacological treatment paradigms in psychiatry, based on manipulating circadian phase, sleep and light exposure. In conclusion, the model remains conceptually useful for promoting the integration of sleep and circadian rhythm research. Sleep appears to have not only a short-term, use-dependent function; it also serves to enforce rest and fasting, thereby supporting the optimization of metabolic processes at the appropriate phase of the 24-h cycle.

Cumulative Sleepiness, Mood Disturbance, and Psychomotor Vigilance Performance Decrements During a Week of Sleep Restricted to 4–5 Hours per Night

David F. Dinges, Frances M. Pack, Katherine Williams +5 more · SLEEP · 1997 · 2,042 citations

To determine whether a cumulative sleep debt (in a range commonly experienced) would result in cumulative changes in measures of waking neurobehavioral alertness, 16 healthy young adults had their sleep restricted 33% below habitual sleep duration, to an average 4.98 hours per night [standard deviation (SD) = 0.57] for seven consecutive nights. Subjects slept in the laboratory, and sleep and waking were monitored by staff and actigraphy. Three times each day (1000, 1600, and 2200 hours) subjects were assessed for subjective sleepiness (SSS) and mood (POMS) and were evaluated on a brief performance battery that included psychomotor vigilance (PVT), probed memory (PRM), and serial-addition testing, Once each day they completed a series of visual analog scales (VAS) and reported sleepiness and somatic and cognitive/emotional problems. Sleep restriction resulted in statistically robust cumulative effects on waking functions. SSS ratings, subscale scores for fatigue, confusion, tension, and total mood disturbance from the POMS and VAS ratings of mental exhaustion and stress were evaluated across days of restricted sleep (p = 0.009 to p = 0.0001). PVT performance parameters, including the frequency and duration of lapses, were also significantly increased by restriction (p = 0.018 to p = 0.0001). Significant time-of-day effects were evident in SSS and PVT data, but time-of-day did not interact with the effects of sleep restriction across days. The temporal profiles of cumulative changes in neurobehavioral measures of alertness as a function of sleep restriction were generally consistent. Subjective changes tended to precede performance changes by 1 day, but overall changes in both classes of measure were greatest during the first 2 days (P1, P2) and last 2 days (P6, P7) of sleep restriction. Data from subsets of subjects also showed: 1) that significant decreases in the MSLT occurred during sleep restriction, 2) that the elevated sleepiness and performance deficits continued beyond day 7 of restriction, and 3) that recovery from these deficits appeared to require two full nights of sleep. The cumulative increase in performance lapses across days of sleep restriction correlated closely with MSLT results (r = -0.95) from an earlier comparable experiment by Carskadon and Dement (1). These findings suggest that cumulative nocturnal sleep debt had a dynamic and escalating analog in cumulative daytime sleepiness and that asymptotic or steady-state sleepiness was not achieved in response to sleep restriction.

Sleep and the athlete: narrative review and 2021 expert consensus recommendations

Neil P. Walsh, Shona L. Halson, Charli Sargent +16 more · British Journal of Sports Medicine · 2020 · 504 citations

Elite athletes commonly sleep less than 7 hours per night and have fragmented sleep, which impairs performance and increases illness risk; the expert panel recommends an individualised approach to sleep (not a one-size-fits-all 7–9 hour target) based on perceived needs, with targeted interventions for sport-specific and non-sport risk factors.

The Cumulative Cost of Additional Wakefulness: Dose-Response Effects on Neurobehavioral Functions and Sleep Physiology From Chronic Sleep Restriction and Total Sleep Deprivation

Hans P. A. Van Dongen, Greg Maislin, Janet Mullington +1 more · SLEEP · 2003 · 3,120 citations

OBJECTIVES: To inform the debate over whether human sleep can be chronically reduced without consequences, we conducted a dose-response chronic sleep restriction experiment in which waking neurobehavioral and sleep physiological functions were monitored and compared to those for total sleep deprivation. DESIGN: The chronic sleep restriction experiment involved randomization to one of three sleep doses (4 h, 6 h, or 8 h time in bed per night), which were maintained for 14 consecutive days. The total sleep deprivation experiment involved 3 nights without sleep (0 h time in bed). Each study also involved 3 baseline (pre-deprivation) days and 3 recovery days. SETTING: Both experiments were conducted under standardized laboratory conditions with continuous behavioral, physiological and medical monitoring. PARTICIPANTS: A total of n = 48 healthy adults (ages 21-38) participated in the experiments. INTERVENTIONS: Noctumal sleep periods were restricted to 8 h, 6 h or 4 h per day for 14 days, or to 0 h for 3 days. All other sleep was prohibited. RESULTS: Chronic restriction of sleep periods to 4 h or 6 h per night over 14 consecutive days resulted in significant cumulative, dose-dependent deficits in cognitive performance on all tasks. Subjective sleepiness ratings showed an acute response to sleep restriction but only small further increases on subsequent days, and did not significantly differentiate the 6 h and 4 h conditions. Polysomnographic variables and delta power in the non-REM sleep EEG-a putative marker of sleep homeostasis--displayed an acute response to sleep restriction with negligible further changes across the 14 restricted nights. Comparison of chronic sleep restriction to total sleep deprivation showed that the latter resulted in disproportionately large waking neurobehavioral and sleep delta power responses relative to how much sleep was lost. A statistical model revealed that, regardless of the mode of sleep deprivation, lapses in behavioral alertness were near-linearly related to the cumulative duration of wakefulness in excess of 15.84 h (s.e. 0.73 h). CONCLUSIONS: Since chronic restriction of sleep to 6 h or less per night produced cognitive performance deficits equivalent to up to 2 nights of total sleep deprivation, it appears that even relatively moderate sleep restriction can seriously impair waking neurobehavioral functions in healthy adults. Sleepiness ratings suggest that subjects were largely unaware of these increasing cognitive deficits, which may explain why the impact of chronic sleep restriction on waking cognitive functions is often assumed to be benign. Physiological sleep responses to chronic restriction did not mirror waking neurobehavioral responses, but cumulative wakefulness in excess of a 15.84 h predicted performance lapses across all four experimental conditions. This suggests that sleep debt is perhaps best understood as resulting in additional wakefulness that has a neurobiological "cost" which accumulates over time.

Sleep: A Health Imperative

Faith S. Luyster, Patrick J. Strollo, Phyllis C. Zee +1 more · SLEEP · 2012 · 852 citations

Chronic sleep deficiency, defined as a state of inadequate or mistimed sleep, is a growing and underappreciated determinant of health status. Sleep deprivation contributes to a number of molecular, immune, and neural changes that play a role in disease development, independent of primary sleep disorders. These changes in biological processes in response to chronic sleep deficiency may serve as etiological factors for the development and exacerbation of cardiovascular and metabolic diseases and, ultimately, a shortened lifespan. Sleep deprivation also results in significant impairments in cognitive and motor performance which increase the risk of motor vehicle crashes and work-related injuries and fatal accidents. The American Academy of Sleep Medicine and the Sleep Research Society have developed this statement to communicate to national health stakeholders the current knowledge which ties sufficient sleep and circadian alignment in adults to health.

Why sleep matters -- the economic costs of insufficient sleep: A cross-country comparative analysis

Marco Hafner, Martin Štěpánek, Jirka Taylor +2 more · RAND Corporation eBooks · 2016 · 616 citations

The Centers for Disease Control and Prevention (CDC) in the United States has declared insufficient sleep a "public health problem." Indeed, according to a recent CDC study, more than a third of American adults are not getting enough sleep on a regular basis. However, insufficient sleep is not exclusively a US problem, and equally concerns other industrialised countries such as the United Kingdom, Japan, Germany, or Canada. According to some evidence, the proportion of people sleeping less than the recommended hours of sleep is rising and associated with lifestyle factors related to a modern 24/7 society, such as psychosocial stress, alcohol consumption, smoking, lack of physical activity and excessive electronic media use, among others. This is alarming as insufficient sleep has been found to be associated with a range of negative health and social outcomes, including success at school and in the labour market. Over the last few decades, for example, there has been growing evidence suggesting a strong association between short sleep duration and elevated mortality risks. Given the potential adverse effects of insufficient sleep on health, well-being and productivity, the consequences of sleep-deprivation have far-reaching economic consequences. Hence, in order to raise awareness of the scale of insufficient sleep as a public-health issue, comparative quantitative figures need to be provided for policy- and decision-makers, as well as recommendations and potential solutions that can help tackling the problem.

Irregular sleep/wake patterns are associated with poorer academic performance and delayed circadian and sleep/wake timing

Andrew J. K. Phillips, William M. Clerx, Conor S. O’Brien +6 more · Scientific Reports · 2017 · 602 citations

The association of irregular sleep schedules with circadian timing and academic performance has not been systematically examined. We studied 61 undergraduates for 30 days using sleep diaries, and quantified sleep regularity using a novel metric, the sleep regularity index (SRI). In the most and least regular quintiles, circadian phase and light exposure were assessed using salivary dim-light melatonin onset (DLMO) and wrist-worn photometry, respectively. DLMO occurred later (00:08 ± 1:54 vs. 21:32 ± 1:48; p < 0.003); the daily sleep propensity rhythm peaked later (06:33 ± 0:19 vs. 04:45 ± 0:11; p < 0.005); and light rhythms had lower amplitude (102 ± 19 lux vs. 179 ± 29 lux; p < 0.005) in Irregular compared to Regular sleepers. A mathematical model of the circadian pacemaker and its response to light was used to demonstrate that Irregular vs. Regular group differences in circadian timing were likely primarily due to their different patterns of light exposure. A positive correlation (r = 0.37; p < 0.004) between academic performance and SRI was observed. These findings show that irregular sleep and light exposure patterns in college students are associated with delayed circadian rhythms and lower academic performance. Moreover, the modeling results reveal that light-based interventions may be therapeutically effective in improving sleep regularity in this population.

Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

Nathaniel F. Watson, M. Safwan Badr, Gregory Belenky +18 more · Journal of Clinical Sleep Medicine · 2015 · 555 citations

The Impact of Shift Work on Sleep, Alertness and Performance in Healthcare Workers

Saranea Ganesan, Michelle Magee, J. Stone +6 more · Scientific Reports · 2019 · 406 citations

Abstract Shift work is associated with impaired alertness and performance due to sleep loss and circadian misalignment. This study examined sleep between shift types (day, evening, night), and alertness and performance during day and night shifts in 52 intensive care workers. Sleep and wake duration between shifts were evaluated using wrist actigraphs and diaries. Subjective sleepiness (Karolinska Sleepiness Scale, KSS) and Psychomotor Vigilance Test (PVT) performance were examined during day shift, and on the first and subsequent night shifts (3 rd , 4 th or 5 th ). Circadian phase was assessed using urinary 6-sulphatoxymelatonin rhythms. Sleep was most restricted between consecutive night shifts (5.74 ± 1.30 h), consecutive day shifts (5.83 ± 0.92 h) and between evening and day shifts (5.20 ± 0.90 h). KSS and PVT mean reaction times were higher at the end of the first and subsequent night shift compared to day shift, with KSS highest at the end of the first night. On nights, working during the circadian acrophase of the urinary melatonin rhythm led to poorer outcomes on the KSS and PVT. In rotating shift workers, early day shifts can be associated with similar sleep restriction to night shifts, particularly when scheduled immediately following an evening shift. Alertness and performance remain most impaired during night shifts given the lack of circadian adaptation to night work. Although healthcare workers perceive themselves to be less alert on the first night shift compared to subsequent night shifts, objective performance is equally impaired on subsequent nights.

Randomized Clinical Trial of Melatonin After Night-Shift Work: Efficacy and Neuropsychologic Effects

Seth W Wright, L.M. Lawrence, K D Wrenn +3 more · Annals of Emergency Medicine · 1998 · 65 citations

Effects of Partial and Acute Total Sleep Deprivation on Performance across Cognitive Domains, Individuals and Circadian Phase

June C. Lo, John A. Groeger, Nayantara Santhi +6 more · PLoS ONE · 2012 · 330 citations

BACKGROUND: Cognitive performance deteriorates during extended wakefulness and circadian phase misalignment, and some individuals are more affected than others. Whether performance is affected similarly across cognitive domains, or whether cognitive processes involving Executive Functions are more sensitive to sleep and circadian misalignment than Alertness and Sustained Attention, is a matter of debate. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a 2 × 12-day laboratory protocol to characterize the interaction of repeated partial and acute total sleep deprivation and circadian phase on performance across seven cognitive domains in 36 individuals (18 males; mean ± SD of age = 27.6 ± 4.0 years). The sample was stratified for the rs57875989 polymorphism in PER3, which confers cognitive susceptibility to total sleep deprivation. We observed a deterioration of performance during both repeated partial and acute total sleep deprivation. Furthermore, prior partial sleep deprivation led to poorer cognitive performance in a subsequent total sleep deprivation period, but its effect was modulated by circadian phase such that it was virtually absent in the evening wake maintenance zone, and most prominent during early morning hours. A significant effect of PER3 genotype was observed for Subjective Alertness during partial sleep deprivation and on n-back tasks with a high executive load when assessed in the morning hours during total sleep deprivation after partial sleep loss. Overall, however, Subjective Alertness and Sustained Attention were more affected by both partial and total sleep deprivation than other cognitive domains and tasks including n-back tasks of Working Memory, even when implemented with a high executive load. CONCLUSIONS/SIGNIFICANCE: Sleep loss has a primary effect on Sleepiness and Sustained Attention with much smaller effects on challenging Working Memory tasks. These findings have implications for understanding how sleep debt and circadian rhythmicity interact to determine waking performance across cognitive domains and individuals.

Effects of Experimental Sleep Restriction on Weight Gain, Caloric Intake, and Meal Timing in Healthy Adults

Andrea M. Spaeth, David F. Dinges, Namni Goel · SLEEP · 2013 · 444 citations

STUDY OBJECTIVES: Examine sleep restriction's effects on weight gain, daily caloric intake, and meal timing. DESIGN: Repeated-measures experiments assessing body weight at admittance and discharge in all subjects (N = 225) and caloric intake and meal timing across days following 2 baseline nights, 5 sleep restriction nights and 2 recovery nights or across days following control condition nights in a subset of subjects (n = 37). SETTING: Controlled laboratory environment. PARTICIPANTS: Two hundred twenty-five healthy adults aged 22-50 y (n = 198 sleep-restricted subjects; n = 31 with caloric intake data; n = 27 control subjects; n = 6 with caloric intake data). INTERVENTIONS: Approximately 8-to-1 randomization to an experimental condition (including five consecutive nights of 4 h time in bed [TIB]/night, 04:00-08:00) or to a control condition (all nights 10 h TIB/night, 22:00-08:00). MEASUREMENTS AND RESULTS: Sleep-restricted subjects gained more weight (0.97 ± 1.4 kg) than control subjects (0.11 ± 1.9 kg; d = 0.51, P = 0.007). Among sleep-restricted subjects, African Americans gained more weight than Caucasians (d = 0.37, P = 0.003) and males gained more weight than females (d = 0.38, P = 0.004). Sleep-restricted subjects consumed extra calories (130.0 ± 43.0% of daily caloric requirement) during days with a delayed bedtime (04:00) compared with control subjects who did not consume extra calories (100.6 ± 11.4%; d = 0.94, P = 0.003) during corresponding days. In sleep-restricted subjects, increased daily caloric intake was due to more meals and the consumption of 552.9 ± 265.8 additional calories between 22:00-03:59. The percentage of calories derived from fat was greater during late-night hours (22:00-03:59, 33.0 ± 0.08%) compared to daytime (08:00-14:59, 28.2 ± 0.05%) and evening hours (15:00-21:59, 29.4 ± 0.06%; Ps < 0.05). CONCLUSIONS: In the largest, most diverse healthy sample studied to date under controlled laboratory conditions, sleep restriction promoted weight gain. Chronically sleep-restricted adults with late bedtimes may be more susceptible to weight gain due to greater daily caloric intake and the consumption of calories during late-night hours. CITATION: 2013;36(7):981-990.

An evening light intervention reduces fatigue and errors during night shifts: A randomized controlled trial.

Cyr M, Artenie DZ, Al Bikaii A +3 more · Sleep Health · 2023 · 15 citations

The Effects of Sleep Deprivation on Pain Inhibition and Spontaneous Pain in Women

Michael T. Smith, Robert R. Edwards, Una D. McCann +1 more · SLEEP · 2007 · 530 citations

Impaired central pain modulation is implicated in the pathophysiology of chronic pain. In this controlled experiment, we evaluated whether partial sleep loss altered endogenous pain inhibition and reports of spontaneous pain. Thirty-two healthy females were studied polysomnographically for 7 nights. On Nights 1-2 (Baseline), subjects slept undisturbed for 8 hours. After Night 2, subjects were randomized to Control (N = 12), Forced Awakening (FA, N = 10), or Restricted Sleep Opportunity (RSO, N = 10) conditions. Controls continued to sleep undisturbed. FA underwent 8 forced awakenings (one per hour) on Nights 3-5. RSO subjects were yoked to FA on total sleep time (TST), receiving partial sleep deprivation by delayed bedtime. On Night 6, both FA & RSO underwent 36 hours total sleep deprivation (TSD), followed by 11-hour recovery sleep (Night 7). Subjects completed twice-daily psychophysical assessments of mechanical pain thresholds and pain inhibition (Diffuse Noxious Inhibitory Controls), via use of a conditioning stimulus (i.e., cold pressor) paradigm. FA and RSO demonstrated 50% reductions in total sleep time and increases in nonpainful somatic symptoms during partial sleep deprivation. While sleep deprivation had no effect on pain thresholds, during partial sleep deprivation the FA group demonstrated a significant loss of pain inhibition and an increase in spontaneous pain; neither of the other 2 groups showed changes in pain inhibition or spontaneous pain during partial sleep deprivation. These data suggest that sleep continuity disturbance, but not simple sleep restriction, impairs endogenous pain-inhibitory function and increases spontaneous pain, supporting a possible pathophysiologic role of sleep disturbance in chronic pain.

Effect of Melatonin on Sleep, Behavior, and Cognition in ADHD and Chronic Sleep-Onset Insomnia

Kristiaan B. van der Heijden, Marcel G. Smits, Eus J.W. Van Someren +2 more · Journal of the American Academy of Child & Adolescent Psychiatry · 2007 · 374 citations

Associations of frequent sleep insufficiency with health-related quality of life and health behaviors

Tara W. Strine, Daniel P. Chapman · Sleep Medicine · 2004 · 529 citations

Sleep Quality among Medical Students of a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Nabin Sundas, Saransh Ghimire, Suzit Bhusal +3 more · Journal of Nepal Medical Association · 2020 · 49 citations

Nearly half (44.23%) of medical students at one Nepalese hospital reported poor sleep quality, with an average sleep duration of only 6.7 hours per night — below the recommended 7–9 hours for young adults — suggesting that academic stress and lifestyle factors may be systematically disrupting sleep in this population.

Add-on prolonged-release melatonin for cognitive function and sleep in mild&amp;nbsp;to moderate Alzheimer&amp;rsquo;s disease: a 6-month, randomized, placebo-controlled, multicenter trial

Moshe Laudon, Alan Wade, Mildred V. Farmer +5 more · Clinical Interventions in Aging · 2014 · 169 citations

PURPOSE: A link between poor sleep quality and Alzheimer's disease (AD) has recently been suggested. Since endogenous melatonin levels are already reduced at preclinical AD stages, it is important to ask whether replenishing the missing hormone would be beneficial in AD and whether any such effects would be related to the presence of sleep disorder in patients. PATIENTS AND METHODS: The effects of add-on prolonged-release melatonin (PRM) (2 mg) to standard therapy on cognitive functioning and sleep were investigated in 80 patients (men [50.7%], women [49.3%], average age 75.3 years [range, 52-85 years]) diagnosed with mild to moderate AD, with and without insomnia comorbidity, and receiving standard therapy (acetylcholinesterase inhibitors with or without memantine). In this randomized, double-blind, parallel-group study, patients were treated for 2 weeks with placebo and then randomized (1:1) to receive 2 mg of PRM or placebo nightly for 24 weeks, followed by 2 weeks placebo. The AD Assessment Scale-Cognition (ADAS-Cog), Instrumental Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), sleep, as assessed by the Pittsburgh Sleep Quality Index (PSQI) and a daily sleep diary, and safety parameters were measured. RESULTS: Patients treated with PRM (24 weeks) had significantly better cognitive performance than those treated with placebo, as measured by the IADL (P=0.004) and MMSE (P=0.044). Mean ADAS-Cog did not differ between the groups. Sleep efficiency, as measured by the PSQI, component 4, was also better with PRM (P=0.017). In the comorbid insomnia (PSQI ≥6) subgroup, PRM treatment resulted in significant and clinically meaningful effects versus the placebo, in mean IADL (P=0.032), MMSE score (+1.5 versus -3 points) (P=0.0177), and sleep efficiency (P=0.04). Median ADAS-Cog values (-3.5 versus +3 points) (P=0.045) were significantly better with PRM. Differences were more significant at longer treatment duration. PRM was well tolerated, with an adverse event profile similar to that of placebo. CONCLUSION: Add-on PRM has positive effects on cognitive functioning and sleep maintenance in AD patients compared with placebo, particularly in those with insomnia comorbidity. The results suggest a possible causal link between poor sleep and cognitive decline.

Sleep inertia

Patrícia Tassi, Alain Muzet · Sleep Medicine Reviews · 2000 · 445 citations

Neurobehavioral Dynamics Following Chronic Sleep Restriction: Dose-Response Effects of One Night for Recovery

Siobhan Banks, Hans P. A. Van Dongen, Greg Maislin +1 more · SLEEP · 2010 · 288 citations

OBJECTIVE: Establish the dose-response relationship between increasing sleep durations in a single night and recovery of neurobehavioral functions following chronic sleep restriction. DESIGN: Intent-to-treat design in which subjects were randomized to 1 of 6 recovery sleep doses (0, 2, 4, 6, 8, or 10 h TIB) for 1 night following 5 nights of sleep restriction to 4 h TIB. SETTING: Twelve consecutive days in a controlled laboratory environment. PARTICIPANTS: N = 159 healthy adults (aged 22-45 y), median = 29 y). INTERVENTIONS: Following a week of home monitoring with actigraphy and 2 baseline nights of 10 h TIB, subjects were randomized to either sleep restriction to 4 h TIB per night for 5 nights followed by randomization to 1 of 6 nocturnal acute recovery sleep conditions (N = 142), or to a control condition involving 10 h TIB on all nights (N = 17). MEASUREMENTS AND RESULTS: Primary neurobehavioral outcomes included lapses on the Psychomotor Vigilance Test (PVT), subjective sleepiness from the Karolinska Sleepiness Scale (KSS), and physiological sleepiness from a modified Maintenance of Wakefulness Test (MWT). Secondary outcomes included psychomotor and cognitive speed as measured by PVT fastest RTs and number correct on the Digit Symbol Substitution Task (DSST), respectively, and subjective fatigue from the Profile of Mood States (POMS). The dynamics of neurobehavioral outcomes following acute recovery sleep were statistically modeled across the 0 h-10 h recovery sleep doses. While TST, stage 2, REM sleep and NREM slow wave energy (SWE) increased linearly across recovery sleep doses, best-fitting neurobehavioral recovery functions were exponential across recovery sleep doses for PVT and KSS outcomes, and linear for the MWT. Analyses based on return to baseline and on estimated intersection with control condition means revealed recovery was incomplete at the 10 h TIB (8.96 h TST) for PVT performance, KSS sleepiness, and POMS fatigue. Both TST and SWE were elevated above baseline at the maximum recovery dose of 10 h TIB. CONCLUSIONS: Neurobehavioral deficits induced by 5 nights of sleep restricted to 4 h improved monotonically as acute recovery sleep dose increased, but some deficits remained after 10 h TIB for recovery. Complete recovery from such sleep restriction may require a longer sleep period during 1 night, and/or multiple nights of recovery sleep. It appears that acute recovery from chronic sleep restriction occurs as a result of elevated sleep pressure evident in both increased SWE and TST.

Cognitive-behavioral therapy for sleep disturbance decreases inflammatory cytokines and oxidative stress in hemodialysis patients

Hung‐Yuan Chen, I-Chih Cheng, Yi‐Ju Pan +7 more · Kidney International · 2011 · 135 citations

Lack of sleep as a contributor to obesity in adolescents: impacts on eating and activity behaviors

Jean‐Philippe Chaput, Caroline Dutil · International Journal of Behavioral Nutrition and Physical Activity · 2016 · 241 citations

BACKGROUND: Sleep is an important contributor to physical and mental health; however, chronic sleep deprivation has become common in adolescents, especially on weekdays. Adolescents aged 14-17 years are recommended to sleep between 8 and 10 h per night to maximize overall health and well-being. Although sleep needs may vary between individuals, sleep duration recommendations are important for surveillance and help inform policies, interventions, and the population of healthy sleep behaviors. Long sleepers are very rare among teenagers and sleeping too much is not a problem per se; only insufficient sleep is associated with adverse health outcomes in the pediatric population. Causes of insufficient sleep are numerous and chronic sleep deprivation poses a serious threat to the academic success, health and safety of adolescents. This article focuses on the link between insufficient sleep and obesity in adolescents. DISCUSSION: This "call to action" article argues that sleep should be taken more seriously by the public health community and by our society in general, i.e., given as much attention and resources as nutrition and physical activity. Not only that having a good night's sleep is as important as eating a healthy diet and being regularly physically active for overall health, but sleeping habits also impact eating and screen time behaviors and, therefore, can influence body weight control. Short sleep duration, poor sleep quality, and late bedtimes are all associated with excess food intake, poor diet quality, and obesity in adolescents. Sleep, sedentary behavior, physical activity and diet all interact and influence each other to ultimately impact health. A holistic approach to health (i.e., the whole day matters) targeting all of these behaviors synergistically is needed to optimize the impact of our interventions. Sleep is not a waste of time and sleep hygiene is an important factor to consider in the prevention and treatment of obesity.

The Scoring of Arousal in Sleep: Reliability, Validity, and Alternatives

Michael H. Bonnet, Karl Doghramji, Timothy Roehrs +5 more · Journal of Clinical Sleep Medicine · 2007 · 196 citations

The Impact of Moderate Sleep Loss on Neurophysiologic Signals during Working-Memory Task Performance

Michael E. Smith, Linda K. McEvoy, Alan Gevins · SLEEP · 2002 · 212 citations

STUDY OBJECTIVES: This study examined how sleep loss affects neurophysiologic signals related to attention and working memory. DESIGN: Subjective sleepiness, resting-state electroencephalogram, and behavior and electroencephalogram during performance of working-memory tasks were recorded in a within-subject, repeated-measures design. SETTING: Data collection occurred in a computerized laboratory setting. PARTICIPANTS: Sixteen healthy adults (mean age, 26 years; 8 female) INTERVENTIONS: Data from alert daytime baseline tests were compared with data from tests during a late-night, extended-wakefulness session that spanned up to 21 hours of sleep deprivation. MEASUREMENTS AND RESULTS: Alertness measured both subjectively and electrophysiologically decreased monotonically with increasing sleep deprivation. A lack of alertness-related changes in electroencephalographic measures of the overall mental effort exerted during task execution indicated that participants attempted to maintain high levels of performance throughout the late-night tests. Despite such continued effort, responses became slower, more variable, and more error prone within 1 hour after participants' normal time of sleep onset. This behavior failure was accompanied by significant degradation of event-related brain potentials related to the transient focusing of attention. CONCLUSIONS: Moderate sleep loss compromises the function of neural circuits critical to subsecond attention allocation during working-memory tasks, even when an effort is made to maintain wakefulness and performance. Multivariate analyses indicate that combinations of working-memory-related behavior and neurophysiologic measures can be sensitive enough to permit reliable detection of such effects of sleep loss in individuals. Similar methods might prove useful for assessment of functional alertness in patients with sleep disorders.

Spatial transcriptomics reveals unique gene expression changes in different brain regions after sleep deprivation

Yann Vanrobaeys, Zeru Peterson, Emily N. Walsh +5 more · Nature Communications · 2023 · 56 citations

Sleep deprivation has far-reaching consequences on the brain and behavior, impacting memory, attention, and metabolism. Previous research has focused on gene expression changes in individual brain regions, such as the hippocampus or cortex. Therefore, it is unclear how uniformly or heterogeneously sleep loss affects the brain. Here, we use spatial transcriptomics to define the impact of a brief period of sleep deprivation across the brain in male mice. We find that sleep deprivation induced pronounced differences in gene expression across the brain, with the greatest changes in the hippocampus, neocortex, hypothalamus, and thalamus. Both the differentially expressed genes and the direction of regulation differed markedly across regions. Importantly, we developed bioinformatic tools to register tissue sections and gene expression data into a common anatomical space, allowing a brain-wide comparison of gene expression patterns between samples. Our results suggest that distinct molecular mechanisms acting in discrete brain regions underlie the biological effects of sleep deprivation.

Why We Sleep

Matthew P. Walker, Matthew Walker · Simon & Schuster Audio and Blackstone Audio · 2017 · ★ 4.5 (20)

Why We Sleep: The New Science of Sleep and Dreams

Matthew Walker · Allan Lane · 2018

Chronic sleep restriction (less than 7 hours per night) impairs cognitive performance by 20–40%, increases risk of Alzheimer's disease by up to 33% per decade of poor sleep, and elevates all-cause mortality by 12–15% — but these effects are reversible with consistent 7–9 hour sleep schedules.

The circadian code

Satchin Panda · Rodale Books · 2018 · ★ 4.0 (1)

Melatonin for Sleep Quality and Occupational Cognitive Performance in Shift Workers with Low Sleep Quality: A Randomized, Double‐Blind, Placebo‐Controlled Clinical Trial

Sajad Khanjani, Ahmad Shamabadi, Shahin Akhondzadeh +1 more · Journal of Clinical Pharmacy and Therapeutics · 2024 · 4 citations

Taking 5 mg of melatonin before sleep for 4 weeks improved subjective sleep quality within a week and occupational cognitive performance within a month for shift workers experiencing sleep problems, suggesting it's a promising intervention for self-experimenters in similar situations.

Posttraining Sleep Enhances Automaticity in Perceptual Discrimination

Mercedes Atienza, José L. Cantero, Robert Stickgold · Journal of Cognitive Neuroscience · 2004 · 152 citations

Perceptual learning can develop over extended periods, with slow, at times sleep-dependent, improvement seen several days after training. As a result, performance can become more automatic, that is, less dependent on voluntary attention. This study investigates whether the brain correlates of this enhancement of automaticity are sleep-dependent. Event-related potentials produced in response to complex auditory stimuli were recorded while subjects' attention was focused elsewhere. We report here that following training on an auditory discrimination task, performance continued to improve, without significant further training, for 72 hr. At the same time, several event-related potential components became evident 48-72 hr after training. Posttraining sleep deprivation prevented neither the continued performance improvement nor the slow development of cortical dynamics related to an enhanced familiarity with the task. However, those brain responses associated with the automatic shift of attention to unexpected stimuli failed to develop. Thus, in this auditory learning paradigm, posttraining sleep appears to reduce the voluntary attentional effort required for successful perceptual discrimination by facilitating the intrusion of a potentially meaningful stimulus into one's focus of attention for further evaluation.

The prevalence of sleep disturbance and its possible associated factors among iranian medical students: A cross-sectional study with a national meta-analysis.

Shafiee A, Fili J, Ghafari S +3 more · Sleep Med X · 2024 · 9 citations

Associations between shift type, sleep, mood, and diet in a group of shift working nurses

Georgina Heath, Jillian Dorrian, Alison M. Coates · Scandinavian Journal of Work Environment & Health · 2019 · 70 citations

Objectives Unhealthy dietary profiles contribute to the elevated risk of chronic diseases for shift workers. There has been limited investigation into factors associated both with shift work and diet, such as sleep and mood, that may further influence food intake among shift workers. The aim of this study was to explore the relationship between shift work, sleep, mood, and diet. Methods Shift working nurses [N=52; 46 female; age: mean 39.8 (SD 12.4) years] participated in a 14-day, repeated measures, within- and between-subjects design study. Analyses included data from 40 nurses over 181 shifts. Food diaries were completed for a minimum of three days per shift type (morning, afternoon, night). Foodworks nutrition software was used to determine energy intake in kilojoules and macronutrient intake (as a percentage of total energy intake). Mood (happiness, anxiety, depressive mood, stress, and tiredness) was measured using visual analog scales. Sleep was estimated using actigraphy. Demographic and work-related variables (covariates) were measured using a modified version of the Standard Shiftwork Index. A path analysis was conducted using generalized structural equation modelling with a random effect of participant ID. Predictors were selected using purposive selection of covariates (an alternative to stepwise modelling) and final models included important predictors only. Results Compared to night and morning shifts, results showed that working an afternoon shift was associated with a lower energy intake (β= -1659.4, P<0.01) and lower levels of stress (β= -5.6, P<0.01). Higher levels of stress were associated with a higher energy intake (β=35.3, P<0.01) and a higher percentage of fat (ß=0.1, P=0.05) and saturated fat (β=0.1, P<0.01). Compared to the other shift types, morning shift was associated with lower carbohydrates (β= -4.3, P<0.01) and night shift was associated with lower protein (β= -2.7, P=0.03). Lower sleep efficiency was associated with a higher carbohydrate intake (β= -0.4, P<0.01) and a lower protein intake (β=0.25, P<0.01) Conclusions Results suggest that compared to nights and mornings, afternoon shifts were associated with reduced energy consumption. Negative mood (stress, depression, and anxiety) mediated the association between shift type and energy intake. Negative mood was also associated with higher fat intake. Dietary interventions for shift workers should consider the role of mood as well as shift type.

Effects of music-based interventions on sleep quality in older adults: a systematic review and meta-analysis.

He Y, Liu Y, He J +1 more · Front Psychiatry · 2026 · 0 citations

Global prevalence of poor sleep quality in cancer patients: A systematic review and meta-analysis.

Chen MY, Zheng WY, Liu YF +9 more · Gen Hosp Psychiatry · 2024 · 34 citations

Sleep quality in eating disorders: A systematic review and meta-analysis.

Degasperi G, Meneo D, Curati S +3 more · Sleep Med Rev · 2024 · 35 citations

This meta-analysis found that individuals with eating disorders (EDs) generally experience poorer subjective and physiological sleep quality compared to healthy individuals, with Anorexia Nervosa patients showing particularly impaired physiological sleep, suggesting that addressing sleep could be a valuable part of managing EDs and vice versa in self-experiments.

The prevalence of poor sleep quality in the general population in China: a meta-analysis of epidemiological studies.

Chen P, Lam MI, Si TL +7 more · Eur Arch Psychiatry Clin Neurosci · 2024 · 44 citations

Poor sleep quality in schizophrenia patients: A systematic review and meta-analyses of epidemiological and case-control studies.

Chen MY, Wang YY, Si TL +7 more · Schizophr Res · 2024 · 9 citations

Stimulus control for insomnia: A systematic review and meta-analysis.

Jansson-Fröjmark M, Nordenstam L, Alfonsson S +3 more · J Sleep Res · 2024 · 23 citations

This meta-analysis found that Stimulus Control (SC) significantly improves sleep onset latency and total sleep time for adults with insomnia compared to doing nothing, with effects similar to other active treatments, making it a valuable strategy for self-experimenters.

Impact of white noise on sleep quality across age groups and in critically ill/non-critically ill patients: A systematic review and meta-analysis of randomized controlled trials.

Ding Y, Sun X, Yin J +5 more · Sleep Med · 2025 · 1 citations

Comparative effectiveness of non-pharmacological interventions on sleep in individuals with chronic musculoskeletal pain: A systematic review with network meta-analysis.

Chang JR, Cheung YK, Sharma S +12 more · Sleep Med Rev · 2024 · 12 citations

Treatments for enhancing sleep quality in fibromyalgia: a systematic review and meta-analysis.

Pathak A, Kelleher EM, Brennan I +6 more · Rheumatology (Oxford) · 2025 · 6 citations

Cognitive Behavioral Therapy for Insomnia (CBT-I) is the most promising treatment for improving sleep quality in fibromyalgia, showing a moderate benefit, while some medications like pregabalin offer moderate improvements but come with risks, making CBT-I a strong candidate for self-experimentation.

Efficacy of non-pharmacological interventions on sleep quality in patients with cancer-related insomnia: a network meta-analysis.

Luo Y, He H, Cao C +3 more · Front Neurol · 2024 · 3 citations

This network meta-analysis likely synthesized evidence from multiple studies to identify and rank the most effective non-pharmacological interventions for improving sleep quality in cancer patients experiencing insomnia, offering guidance on which approaches might be most beneficial for self-experimentation.

The efficacy of cognitive behavioral therapy for sleep disorders following acquired brain injury: a systematic review and meta-analysis.

Zhu H, Wen Q, Zhang F +3 more · Sleep Med · 2026 · 0 citations

Pharmacotherapy for sleep disturbances in post-traumatic stress disorder (PTSD): A network meta-analysis.

Lappas AS, Glarou E, Polyzopoulou ZA +4 more · Sleep Med · 2024 · 15 citations

The Herbal Medicine Suanzaoren (Ziziphi Spinosae Semen) for Sleep Quality Improvements: A Systematic Review and Meta-analysis.

Yang M, Wang H, Zhang YL +8 more · Integr Cancer Ther · 2023 · 30 citations

A systematic review and meta-analysis found that Suanzaoren (Ziziphi Spinosae Semen), a traditional Chinese herbal medicine, can improve sleep quality, offering a potential natural intervention for individuals experiencing sleep disturbances, particularly within the context of cancer care.

Which Nonpharmacological Sleep Interventions Are Most Effective After Cardiac Surgery?: A Network Meta-analysis.

Lee S, Park CG, Chen P +1 more · J Cardiovasc Nurs · 2025 · 0 citations