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Deep into Sleep

Lack of sleep impairs performance on a wide variety of tasks. A single all-nighter can triple reaction time and vastly increase lapses of attention. Not long ago, a psychiatrist in private practice telephoned associate professor of psychiatry Robert Stickgold, a cognitive neuroscientist specializing in sleep research. He asked whether Stickgold knew of any reason not to prescribe modafinil, a new wakefulness-promoting drug, to a Harvard undergraduate facing a lot of academic work in exam period. The question resonated on several levels. Used as an aid to prolonged study, modafinil is tantamount to a “performance-enhancing” drug—one of those controversial, and often illegal, boosters used by some athletes. In contrast to wakefulness-producing stimulants like amphetamines, modafinil (medically indicated for narcolepsy and tiredness secondary to multiple sclerosis and depression) does not seem to impair judgment or produce jitters. “There’s no buzz, no crash, and it’s not clear that the body tries to make up the lost sleep,” reports Stickgold. “That said, all sleeping medications more or less derange your normal sleep patterns. They do not produce normal sleep.” Even so, the U.S. military is sinking millions of dollars into research on modafinil, trying to see if they can keep soldiers awake and on duty—in Iraq, for example—for 80 out of 88 hours: two 40-hour shifts separated by eight hours of sleep. “No—no reason at all not to,” Stickgold told the psychiatrist. “Not unless you think sleep does something.” When people make the unlikely claim that they get by on four hours of sleep per night, Stickgold often asks if they worry about what they are losing. “You get a blank look,” he says. “They think that sleep is wasted time.” But sleep is not merely “down time” between episodes of being alive. Within an evolutionary framework, the simple fact that we spend about a third of our lives asleep suggests that sleep is more than a necessary evil. Much transpires while we are asleep, and the question is no longer whether sleep does something, but exactly what it does. Lack of sleep may be related to obesity, diabetes, immune-system dysfunction, and many illnesses, as well as to safety issues such as car accidents and medical errors, plus impaired job performance and productivity in many other activities. Although the modern era of sleep research started in the 1950s with the discovery of REM (Rapid Eye Movement) sleep, the field remained, well, somnolent until recently. Even 20 years ago, “The dominant paradigm in sleep research was that ‘Sleep cures sleepiness,’” says Stickgold. Since then, researchers have developed a far more complex picture of what happens while we snooze. The annual meetings in sleep medicine, which only this year became a recognized medical specialty, now draw 5,000 participants. Harvard has long been a leader in the area. The Medical School’s Division of Sleep Medicine, founded in 1997 and chaired by Baldino professor of s

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