Gay Gaer Luce. Current Researcher Sleep and Dreams. HEW, PHS, NIMH Public Health Service Publication No. 1389

And touching this point, Phisitians may consider; whether sleep be so necessarie that our life must needs depend of it; for we finde that Perseus King of Maced on, prisoner at Rome, being kept from sleep was made to die; but Pliny aleageth that some have lived a long time without sleep at all.

Montaigne

One sort of treatment used for those accused of witchcraft was the "tortura insomniae." Of all things in brain disease, calm and regular sleep is most beneficial; yet, under this practice, these half-crazed creatures were prevented night after night and day after day, from sleeping or even resting. In this way temporary delusion became chronic insanity, mild cases became violent, torture and death ensued . . .

Andrew Dickson White

Chapter III. Sleep Deprivation

 

Man, often in laudable arrogance accompanied by blinding ignorance, has always attempted to exceed the limits of his own physical nature. The obvious need, hunger, thirst, respiration-have been accorded respect as essentials to survival. The very word "starvation" has its roots in the Old English word "sterve" (to die); and the connection between lack of food and death has been plain throughout the world's history. Sleep has been a different issue without the status of a drive, although sleep deprivation has long been used as torture. Before we can answer why we sleep, or how much sleep we need, modern civilization appears to be racing to eliminate sleep. This is a heady prospect, for, if successful, it would add about 20 productive years to the lifetime of the average man. Nevertheless the question remains: must we sleep? Is sleep an integral part of our organic rhythms, our metabolism ? One useful procedure for exploring body needs is to deprive -- take away sleep and see what happens. In the 1950's, following World War II, a large number of volunteers underwent periods of sleep starvation in laboratories where they were measured for physiological and chemical changes, their ability to perform tasks, and where their psychological changes were under continuous scrutiny. Anyone who seriously thinks of eliminating or drastically reducing his sleep should examine this literature.

    We have all been exposed to anecdotal "proofs" that certain people can manage well without sleep -- long vigils of sleepless performance by medical interns, the so-called charrette or 3-day drafting binge of the architect, a spate of remarkable incidents retold after World War II, famous "wakathons" endured by disc jockeys, and last year an 11-day stint of sleeplessness by a 17-year-old high school student in San Diego. Despite the lack of sleep the architects drafted winning plans, the interns treated the sick, the disc jockeys gave their usual performances, soldiers won battles B and after a night's sleep, we are told, they were fresh as ever. Studies performed at the Walter Reed Army Institute of Research, largely by Dr. Harold L. Williams and his associates, have told a discouraging story about a person's performance during prolonged wakefulness. Several of the famous wakathons were, at least in part, studied by scientists, and these too offer some disheartening information about the psychological effects of going without sleep for long periods, as well as raising questions about aftereffects. One disc jockey, with a record of some mental instability, went T days without sleep, endured persistent symptoms even after rest, and ended in a mental hospital, although a stable young high school student apparently recovered from a much longer stint with no noticeable aftereffects. The mental symptoms of prolonged sleeplessness seem to occur slowly, in a somewhat predictable fashion, mounting, ms the time goes on, sometimes into very dramatic proportions. At Walter Reed and elsewhere one of the most consistent observations was the progressive unevenness of mental functioning, lapses in attention, growing fatigue, weariness, and a tendency to withdraw from the outside world. People began to make fewer and fewer unnecessary movements, and showed some confusion between their own thoughts and external events. Certain bodily sensations began to develop. A tightness around the head gave the impression that a hat was being worn. Many complained that their eyes burned or itched and their vision was blurred, after 360 hours of sleeplessness people had difficulty with depth perception. Small objects seemed to dart out of place, and chairs changed apparent size. Commonly, lights seemed to wear a halo of fog. Even the floor seemed to undulate. By 90 hours, some people developed vivid hallucinations. One volunteer, for instance, called for help in washing the cobwebs from his face and hands. Brief dreams would intrude and become confused with reality, and people found their time sense distorted. These symptoms, along with changes of mood and deterioration in performance, were disturbing enough, and were recorded in detail in the definitive Walter Reed studies that did not extend the sleep starvation beyond 98 hours (Williams, Lubin, and Goodnow). If the sleep-loss is protracted beyond 100 or 200 hours, however, it appears that the symptoms intensify and begin to resemble psychosis. The fifth day has seemed to be a turning point in a number of cases observed (West et al., 1962).

Temporary Psychosis

    In January, 1959, the largely unaware public saw before its very eyes the kind of temporary psychosis that can be induced with sleep starvation. Under the supervision of doctors and scientists, Peter Tripp, a 32-year-old disc jockey, undertook to stay awake for 200 hours in a Times Square booth for the benefit of the March of Dimes. Throughout this marathon of over 8 days, Tripp was given medical and neurological examinations, tests of performance, psychological tests, and was closely attended by Drs. Harold L. Williams, Ardie Lubin, Louis Jolyon West, Harold Wolff, William C. Dement, and others. Although his experience was undoubtedly worsened by the tension of publicity and public conditions, some of the ordeals of Peter Tripp may indicate the kind of mental symptoms that can beleaguer the severely sleep starved.

    Almost from the first, the desire to sleep was so strong that Tripp was fighting to keep himself awake. After little more than 2 days and 2 nights he began to have visual illusions; for example, he reported finding cobwebs in his shoes. By about 100 hours the simple daily tests that required only minimal mental agility and attention were a torture for him. He was having trouble remembering things, and his visual illusions were perturbing: he saw the tweed suit of one of the scientists as a suit of furry worms. After 120 hours he went across the street to a room in the Hotel Astor, where he periodically washed and changed clothes. He opened a bureau drawer and dashed out into the hall for help. The drawer, as he had seen it, was ablaze. Perhaps in an effort to explain this and other visions to himself he decided that the doctors had set the illusory fire, deliberately, to test him and frighten him. About this time he developed a habit of staring at the wall clock in the Times Square booth. As he later explained, the face of the clock bore the face of an actor friend, and he had begun to wonder whether he were Peter Tripp, or the friend whose face he saw in the clock. The daily tests were almost unendurable for Tripp and those who were studying him. "He looked liked a blind animal trying to feel his way through a maze." A simple algebraic formula that he had earlier solved with ease now required such superhuman effort that Tripp broke down, frightened at his inability to solve the problem, fighting to perform. Scientists saw the spectacle of a suave New York radio entertainer trying vainly to find his way through the alphabet.    By 170 hours the agony had become almost unbearable to watch. At times Tripp was no longer sure he was himself, and frequently tried to gain proof of his identity. Although he behaved as if he were awake, his brain wave patterns resembled those of sleep. In his psychotic delusions he vas convinced that the doctors were in a conspiracy against him to send him to jail. On the last morning of his wakathon, Tripp was examined by Dr. Harold Wolf of Cornell. The late Dr. Wolff had a somewhat archaic manner of dress, and to Tripp he must have appeared funebrial. Tripp undressed, as requested, and lay down on the table for medical examination, but as he gazed up at the stimulants, he stayed awake for 264 hours. Drs. L. C. Johnson, W. C. Dement, and J. J. Ross were on hand for observation and medical examination. Here there was quite a contrast to Tripp=s wakathon.

    Randy Gardner did, indeed, show progressive sleepless hours, nightmare hallucination and changes with sleep loss. By the fourth day he became irritable, suffered lapses of memory and difficulty in concentrating. He saw fog around street lights, felt the band of pressure of an illusory hat, and imagined a street sign to be a person. By the ninth day he seemed to think in a fragmented manner and often did not finish sentences, sometimes experiencing transient reveries. His eyes bothered him, and he became unsmiling and expressionless. At one point, about the fourth day, he had imagined himself a great Negro football player. He did not, however, show extreme symptoms, and at the end of 11 days, he slept for over 14 hours, and rebounded into a healthy and cheerful mood. During the last few days of his vigil, however, he had shown definite neurological changes. His vision was blurred, and his right eye was making involuntary sidewise movements. Whether his eyes were open or closed, his alpha rhythm was markedly reduced, and he showed waves characteristic of sleep. The usual alpha wave enhancement to external stimuli was no longer present. Physiological measures indicated that during deprivation the basal autonomic pattern was one of activation, but also that there was less responsiveness to outside stimuli. For example, during deprivation there was marked vasoconstriction. Randy=s heart rate rose above normal. His skin temperature and electrical skin resistance were very low. As time went on these indices, which usually show changes in response to external events, became less and less responsive. When Randy finally went to sleep, however, all of these measures showed responses to external stimuli, save only the galvanic skin response. On the first night of sleep after his vigil, his EEG showed a different pattern than on successive nights. It contained a concentration of slow wave (stage 4) and stage 1 REM. Ten days after the vigil, Randy was clear of all symptoms except for slight difficulty with memory and involuntary eye movements (nystagmus) (Johnson, et al., 1965; Ross, 1964). These two very different individual reactions illustrate several important aspects of sleep loss that have been corroborated in other studies. Randy Gardner, by psychiatric measures, withstood his long vigil with greater ease and less effect than any of the people who had so far been recorded beyond 120 hours of sleep loss. His own home and the attendance of his own family physician provided surroundings that were less exacerbating than those of Peter Tripp or others, even on shorter vigils in the laboratory. He took no stimulants. But perhaps equally if not more important, were his youth and his general stability.

    A person=s reaction to prolonged wakefulness would appear to be congruent with his personality patterns and what might loosely be called stability. From interviews and psychiatric tests of 74 army volunteers in Walter Reed studies, researchers found they could predict reasonably well which individual would find the experience most difficult and would report hallucinatory events (Morris and Singer, 1961). Some years ago, at McGill University, six chronic schizophrenic patients were kept awake for 100 hours. As sleep loss continued these patients began to show acute symptoms that had not been seen for several years among them, auditory hallucinations (Koranyi and Lehman, 1960). The extent of a person=s suffering under protracted sleep loss would seem to depend upon what we term mental health, and the six publicly recorded wakathons that have been undergone in recent years seem to highlight the point that symptoms occur sooner, and with greater intensity, in unstable individuals. There is also some evidence, however, that age may be an important factor.

    Randy Gardner, who set the record for a sleepless vigil, was the youngest person to attempt this stint. Further evidence that young creatures may withstand sleep loss for longer periods than older ones has come from the laboratory of Wilse B. Webb at the University of Florida. The finding was serendipitous because it arose from a rat study that was not designed to explore this point. Originally, the experimenters had designed a continuously rotating mesh wheel, two-thirds submerged in water, in order to keep rats alert without causing muscular exhaustion so that they would fall asleep instantly when placed in a recording cage. Rats avoid cold water, and the wheel moved slowly enough so that they would not fal in if they kept awake and moved very slightly. Because the original wheel was small, it could not carry a fully gown animal, and so the first experimental animals were very young, about 63 days old.

    The experimenters expected the creatures to last atop the wheel for several days, but were surprised to see them maintain position day after day. Some lasted 27 days before the fall. This feat of wakefulness raised some interesting questions. How had the young rats managed to stay awake, continuously moving for 27 days? The experimenters speculated from other data that these flexible young animals had not yet formed rigid sleep patterns and were able to sneak short naps of a few seconds. The only way to corroborate this hunch was to obtain continuous EEG readings while they were astride the water wheel, and see if characteristic brain waves of sleep appeared in the record. It was technically impossible to obtain EEGs from rats 63 days old, for there was then no way of implanting electrodes into the small and delicate brain. The repeated experiment had to be conducted with older rats, whose brains could be implanted with tiny electrodes. The older rats were about 200 days old.

   When these adults were placed upon the water wheel, however, they had no staying power. They fell off in 3 to 4 days. The experimenters immediately began testing rats of intermediate ages on the wheel. The animal=s age was directly correlated with the number of days he would last upon the wheel (Webb, 1962). In order to gain some insight into this differential staying power, the experimenters developed techniques for implanting young animals. They have recently found that the young animals manage to spend a surprising amount of their time asleep. By running to one edge of the turning wheel they can then ride with it, catching a nap of 10-15 seconds before they must quickly move to avoid falling. By this maneuver, the experimenters have estimated the animals may spend a third of their time on the wheel asleep. They are evidently very tired by the time they leave the wheel; nevertheless, the young rats manage to spend long periods atop the wheel in this fashion, whereas the older rats cannot. It does seem, at present, that age bears some relation to the ability to withstand sleep loss, and this capacity may be associated with the ability to snatch brief naps, although the reasons may be multiple and related to metabolism, especially in rodents, and muscular vitality as well as habits of the nervous system.

 

    H. L. Williams et. al.  Impaired performance with acute sleep loss.  Psych. Managr., 73, #14.

    L. J. West et. al. (1962).  The psychosis of sleep deprivation.   Ann. NY Acad. Sci, 96, 66-70.

    J. Ross (1964).  Neurol. finding after prolonged sleep deprivation.  APSS, Palo Alto.

    L. Johnson et. al. (1965).  EEG and autonomic activation during and after prolonged sleep deprivation  Psycho Med.

    G. Morriss & M. Singer (1961).  Sleep deprivation.  Arch. Gen. Psychiat., 5, 453.

    W. Webb (1962).  Sleep deprivation:  Aged exhaustion time in rats.  Science, 136, 1122.