We were particularly interested in the phenomenological description of perceptual distortions and hallucinations, and the changes that occur with progressive sleep loss. This paper presents an examination of psychopathological experiences reported by healthy individuals who participated in sleep-deprivation studies ranging in duration from 24 h up to 11 days. Given that chronic sleep difficulties affect approximately 10–30% of the population, and that for some people, sleeplessness is an occupational hazard ( 5, 6), it is important to better understand the psychopathological effects of sleep deprivation, and what happens with increasing time awake. Long periods without sleep are associated with cognitive difficulties, and can produce psychological symptoms ranging from mood changes to psychotic experiences such as hallucinations ( 3, 4). This is concerning, given evidence of the negative impact of sleep loss on health and wellbeing ( 2). Studies are reporting that we, as a society, are sleeping less and less ( 1). These experiences are likely to resolve after a period of sleep, although more information is required to identify factors which can contribute to the prevention of persistent symptoms. A period of normal sleep served to resolve psychotic symptoms in many-although not all-cases.Ĭonclusions: Psychotic symptoms develop with increasing time awake, from simple visual/somatosensory misperceptions to hallucinations and delusions, ending in a condition resembling acute psychosis. By the third day without sleep, hallucinations in all three sensory modalities were reported. Perceptual distortions, anxiety, irritability, depersonalization, and temporal disorientation started within 24–48 h of sleep loss, followed by complex hallucinations and disordered thinking after 48–90 h, and delusions after 72 h, after which time the clinical picture resembled that of acute psychosis or toxic delirium. Symptoms rapidly developed after one night without sleep, progressing in an almost fixed time-dependent way. The visual modality was the most consistently affected (in 90% of the studies), followed by the somatosensory (52%) and auditory (33%) modalities. All studies except one reported perceptual changes, including visual distortions (i.e., metamorphopsias), illusions, somatosensory changes and, in some cases, frank hallucinations. Duration of sleep loss ranged between 24 h and 11 nights (total 760 participants average 72–92 h without sleep). Of these, 21 were eligible for inclusion. Results: A total of 476 articles were identified. Methods: A systematic-review approach was used to identify experimental and observational studies of sleep deprivation in healthy people which describe the effects of prolonged sleep loss on psychopathological symptoms, without any date restriction. Since sleep deprivation exceeding 48 h is considered unethical today, an examination of historical studies with extreme sleep-loss duration is needed to obtain information about what happens during prolonged sleep loss. Many questions, however, remain unanswered regarding the types of symptoms which are most reliably elicited, the time of symptom onset, and whether symptoms worsen over time toward psychotic decompensation. Background: Going without sleep for long periods of time can produce a range of experiences, including perceptual distortions and hallucinations.
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