Sleep

Sleep. Most people sleep for about 1/3rd of their life, but rarely do people even think about what is going on when we sleep. For most people sleep is just a required part of living--but few people realize that sleep is essential to life.

When I was at the greatest college on earth I had a friend that purposely went without sleep for as long as he could. After about three days, when he could no longer consciously force himself to stay awake (despite any additional caffeine) his body forced him to drift off to sleep--on the floor where he was sitting.

When I was talking to him a few days later he reported that he began to experience hallucinations after staying awake for ~60 hours straight. After about 70 hours without sleep his body overrode his willpower and forced him to enter the sleep cycle. Without this he would have eventually died.

Of all the things that I've learned this year, probably the most interesting is that those who are physically unable to sleep will eventually die, usually within 9 days of the last time they slept. Although, for people who are able to voluntarily stay awake it has been shown that people can go upwards of 11 days without sleep, as described below.

One of the most common causes of death by insomnia is called Familial Fatal Insomnia. An exceedingly rare condition, FFI is an autosomally dominant condition that has been identified in only 28 families worldwide (according to wikipedia). It was first reported in the 1970s in Italy when two women from the same family died from an insomnia-causing disease, but the actual mutation is thought to have occured in an Italian doctor living in the 17th century.

The cause FFI is somewhat similar to diseases such as variant Crutzfeld-Jacob disease or Kuru inasmuch as it is a disease that results in a buildup of misfolded proteins in the brain (prions). In FFI, a mutation in the genetic code causes the improper translation of genetic material to proteins which causes the protein to improperly fold and aggregate with other misfolded proteins. In FFI, these proteins collect in the sleep regulating region of the thalamus, causing insomnia.

Once the first symptoms appear (usually when the patient is in their 50s), patients have around 7-36 months to live. There is a definitive course of progression for those with FFI.

First patients experience panic attacks, then hallucinations, then weight loss and insomnia, and subsequently dementia and death. At the end of its course, FFI causes patients to forever be stuck in a semi-sleep state which appears much like sleepwalking to observers. Any attempt at drug therapy such as sleeping pills only resulted in a faster spiral into dementia and death.

Equally interesting is the study of forced total sleep deprivation and its affects. In 1964, a 17 year old named Randy Gardner stayed awake for a record-12 days. What follows is the account from wikipedia.

"It is often claimed that Gardner's experiment demonstrated that extreme sleep deprivation has little effect, other than the mood changes associated with tiredness (mood swings, short temper, loss of concentration).[5] This is primarily due to a report by researcher William Dement, who stated that on the tenth day of the experiment, Gardner had been, among other things, able to beat Dement at pinball.

However, Lt. Cmdr. John J. Ross who monitored his health reported serious cognitive and behavioral changes. These included moodiness, problems with concentration and short term memory, paranoia, and hallucinations. On the fourth day he had a delusion that he was Paul Lowe winning the Rose Bowl, and that a street sign was a person. On the eleventh day, when he was asked to subtract seven repeatedly, starting with 100, he stopped at 65. When asked why he had stopped, he replied that he had forgotten what he was doing.[6]

On his final day without sleep, Gardner presided over a press conference where he spoke without slurring or stumbling his words and in general appeared to be in excellent health. "I wanted to prove that bad things didn't happen if you went without sleep," said Gardner. "I thought, 'I can break that (Peter Tripp's 1959) record and I don't think it would be a negative experience."