Sleep

Sleep is a natural state of bodily rest observed throughout the animal kingdom. It is
common to all mammals and birds, and is also seen in many reptiles, amphibians and
fish. In humans, other mammals, and a substantial majority of other animals which have
been studied — such as fish, birds, ants, and fruit-flies — regular sleep is essential for
survival. However, its purposes are only partly clear and are the subject of intense
research.

Contents
[hide]

• 1 Physiology
o 1.1 Stages of sleep
o 1.2 Sleep timing
o 1.3 Optimal amount in humans
 1.3.1 Adults
 1.3.2 Hours by age
o 1.4 Sleep debt
• 2 Functions
o 2.1 Restoration
o 2.2 Anabolic/catabolic
o 2.3 Ontogenesis
o 2.4 Memory processing
o 2.5 Preservation
• 3 Dreaming
• 4 Effect of food and drink on sleep
o 4.1 Depressants
o 4.2 Stimulants
• 5 Causes of difficulty in sleeping
• 6 Anthropology of sleep
• 7 Sleep in non-humans
• 8 Longest period without sleep
• 9 See also
o 9.1 Common sleeping positions, practices, and rituals
o 9.2 Other
• 10 References
• 11 Further reading

• 12 External links
Physiology
In mammals and birds the measurement of eye movement during sleep is used to divide
sleep into the two broad types of Rapid Eye Movement (REM) and Non-Rapid Eye
Movement (NREM) sleep. Each type has a distinct set of associated physiological,
neurological and psychological features.

Sleep proceeds in cycles of REM and the four stages of NREM, the order normally being:

stages 1 -> 2 -> 3 -> 4 -> 3 -> 2 -> REM.

In humans this cycle is on average 90 to 110 minutes, with a greater amount of stages 3
and 4 early in the night and more REM later in the night. Each phase may have a distinct
physiological function. Drugs such as sleeping pills and alcoholic beverages can suppress
certain stages of sleep (see Sleep deprivation). This can result in a sleep that exhibits loss
of consciousness but does not fulfill its physiological functions.

Allan Rechtschaffen and Anthony Kales originally outlined the criteria for staging sleep
in 1968. The American Academy of Sleep Medicine (AASM) updated the staging rules in
2007.

Stages of sleep

Criteria for REM sleep include not only rapid eye movements but also a rapid low
voltage EEG. In mammals, at least, low muscle tone is also seen. Most memorable
dreaming occurs in this stage. NREM accounts for 75–80% of total sleep time in normal
human adults. In NREM sleep, there is relatively little dreaming. Non-REM encompasses
four stages; stages 1 and 2 are considered 'light sleep', and 3 and 4 'deep sleep' or slow-
wave sleep, SWS. They are differentiated solely using EEG, unlike REM sleep which is
characterized by rapid eye movements and relative absence of muscle tone. In non-REM
sleep there are often limb movements, and parasomnias such as sleepwalking may occur.
A cyclical alternating pattern may sometimes be observed during a stage.

NREM consists of four stages according to the 2007 AASM standards:

• During Stage N1 the brain transitions from alpha waves (having a frequency of 8
to 13 Hz, common to people who are awake) to theta waves (frequency of 4 to 7
Hz). This stage is sometimes referred to as somnolence, or "drowsy sleep".
Associated with the onset of sleep during N1 may be sudden twitches and hypnic
jerks also known as positive myoclonus. Some people may also experience
hypnagogic hallucinations during this stage, which can be more troublesome to
the subject. During N1 the subject loses some muscle tone and conscious
awareness of the external environment.
• Stage N2, is characterized by "sleep spindles" (12 to 16 Hz) and "K-complexes."
During this stage, muscular activity as measured by electromyography (EMG)
 lowers and conscious awareness of the external environment disappears. This
stage occupies 45 to 55% of total sleep.
• In Stage N3, the delta waves, also called delta rhythms (0.5 to 4 Hz) make up less
than 50% of the total wave-patterns. This is considered part of deep or slow-wave
sleep (SWS) and appears to function primarily as a transition into stage N4. This
is the stage in which night terrors, bedwetting, sleepwalking and sleep-talking
occur.
• In Stage N4, delta-waves make up more than 50% of the wave-patterns. Stages
N3 and N4 are the deepest forms of sleep; N4 is effectively a deeper version of
N3, in which the deep-sleep characteristics, such as delta-waves, are more
pronounced. As of new AASM guidelines, the determination between stage 3 and
stage 4 sleep is inconsequential and both may be considered delta sleep or slow
wave sleep. Therefore, in a recent ruling by the AASM, in order to make
precision the scoring guidelines, stage four had been disbanded, and left is the
stage of sleep N3 to describe the delta sleep attributed to it.

Both REM sleep and NREM sleep stages 3 and 4 are homeostatically driven; that is, if a
person or animal is selectively deprived of one of these, it rebounds once uninhibited
sleep again is allowed. This suggests that both are essential to the functions of the sleep
process.

Sleep timing

Sleep timing is controlled by the circadian clock, by homeostasis and, in humans, by

willed behavior. The circadian clock, an inner time-keeping, temperature-fluctuating,
enzyme-controlling device, works in tandem with adenosine, a neurotransmitter which
inhibits many of the bodily processes that are associated with wakefulness. Adenosine is
created over the course of the day; high levels of adenosine lead to sleepiness. In diurnal
animals, sleepiness occurs as the circadian element causes the release of the hormone
melatonin and a gradual decrease in core body temperature. The timing is affected by
one's chronotype. It is the circadian rhythm which determines the ideal timing of a
correctly structured and restorative sleep episode.

Homeostatic sleep propensity, the need for sleep as a function of the amount of time
elapsed since the last adequate sleep episode, is also important and must be balanced
against the circadian element for satisfactory sleep. Along with corresponding messages
from the circadian clock, this tells the body it needs to sleep. Sleep offset, awakening, is
primarily determined by circadian rhythm. A normal person who regularly awakens at an
early hour will generally not be able to sleep much later than the person's normal waking
time, even if moderately sleep deprived.

Optimal amount in humans

Adults
The optimal amount of sleep is not a meaningful concept unless the timing of that sleep is
seen in relation to an individual's circadian rhythms. A person's major sleep episode is
relatively inefficient and inadequate when it occurs at the "wrong" time of day. The
timing is correct when the following two circadian markers occur after the middle of the
sleep episode but before awakening:

• maximum concentration of the hormone melatonin, and

• minimum core body temperature.

The National Sleep Foundation in the United States maintains that eight to nine hours of
sleep for adult humans is optimal and that sufficient sleep benefits alertness, memory and
problem solving, and overall health, as well as reducing the risk of accidents. A widely
publicized 2003 study performed at the University of Pennsylvania School of Medicine
demonstrated that cognitive performance declines with fewer than eight hours of sleep.

However, a University of California, San Diego psychiatry study of more than one
million adults found that people who live the longest self-report sleeping for six to seven
hours each night. Another study of sleep duration and mortality risk in women showed
similar results. Other studies show that "sleeping more than 7 to 8 hours per day has been
consistently associated with increased mortality", though this study suggests the cause is
probably other factors such as depression and socio-economic status which would
correlate statistically. It has been suggested that the correlation between lower sleep
hours and reduced morbidity only occurs with those who wake after less sleep naturally,
rather than those who use an alarm.

Causal links are currently speculative: the available data may only reflect comorbid
depression, socioeconomic status, or even alcohol use, for example. These studies cannot
be used to determine optimal sleep habits, only correlation — and empirically observed
correlation is a necessary but not sufficient condition for causality. A need for nine or ten
hours of sleep a day, or only five to six, may or may not have the same cause as the
shortened life span. In other words, long or short sleep duration itself has not been shown
to be a cause of early death.

Researchers from the University of Warwick and University College London have found
that lack of sleep can more than double the risk of death from cardiovascular disease, but
that too much sleep can also double the risk of death. Professor Francesco Cappuccio
said: “Short sleep has been shown to be a risk factor for weight gain, hypertension and
Type 2 diabetes sometimes leading to mortality but in contrast to the short sleep-
mortality association it appears that no potential mechanisms by which long sleep could
be associated with increased mortality have yet been investigated. Some candidate causes
for this include depression, low socioeconomic status and cancer-related fatigue. [...] In
terms of prevention, our findings indicate that consistently sleeping around 7 hours per
night is optimal for health and a sustained reduction may predispose to ill-health.”

Hours by age
Children need a greater amount of sleep per day than adults to develop and function
properly: up to 18 hours for newborn babies, with a declining rate as a child ages. A
newborn baby spends almost half of its sleep time in REM-sleep. By the age of five or so,
only a bit over two hours are spent in REM.

Age Average amount of sleep per day

Newborn up to 18 hours
1-12 months 14–18 hours
1-3 years 12-15 hours
3-5 years 11-13 hours
5-12 years 9-11 hours
Adolescents 9-10 hours
Adults, including elderly 7-8 (+) hours
Pregnant women 8 (+) hours

Sleep debt

Sleep debt is the effect of not getting quite enough rest and sleep; a large debt causes
mental, emotional and physical fatigue. Scientists do not agree on how much sleep debt it
is possible to accumulate, nor on whether the prevalence of sleep debt among adults has
changed appreciably in the industrialized world in recent decades. It is likely that children
are sleeping less than previously in Western societies.

Functions
The multiple theories proposed to explain the function of sleep reflect the as yet
incomplete understanding of the subject.

It is likely that sleep evolved to fulfill some primeval function, but has taken over
multiple functions over time as organisms have evolved. An analogy would be that to the
larynx, which performs multiple functions, such as controlling the passage of food and
air, phonation for communicating and social purposes, etc. These are all functions of the
larynx, but just one of them likely represents the original function. Some of the many
proposed functions of sleep are as follows:

Restoration

Wound healing has been shown to be affected by sleep. A study conducted by

Gumustekin et al. in 2004 shows sleep deprivation hindering the healing of burns on rats.

It has also been shown that sleep deprivation affects the immune system and metabolism.
In a study by Zager et al in 2007, rats were deprived of sleep for 24 hours. When
compared with a control group, the sleep-deprived rats' blood tests indicated a 20%
decrease in white blood cell count, a significant change in the immune system.
A study by Bonnet and Arand in 2003 indicates that sleep affects metabolism. Comparing
normal human sleepers and sleepers with sleep state misperception insomnia, where
patients complain of poor sleep but have normal sleep by electroencephalographic (EEG)
criteria, the researchers found significantly greater metabolism values for the normal
sleepers.

It has yet to be clearly proven that sleep duration affects somatic growth. One study by
Jenni et al in 2007 recorded growth, height and weight, as correlated to parent-reported
time-in-bed in 305 children over a period of nine years (age 1-10). It was found that "the
variation of sleep duration among children does not seem to have an effect on growth". It
has been shown that sleep, more specifically slow-wave sleep (SWS), does affect growth
hormone levels in adult men. During eight hours sleep, Van Cauter, Leproult, and Plat
found that the men with a high percentage of SWS (average 24%) also had high growth
hormone secretion, while subjects with a low percentage of SWS (average 9%) had low
growth hormone secretion.

There are multiple arguments supporting the restorative function of sleep. We feel rested
after sleeping, and it is natural to assume that this is a basic purpose of sleep. Overall
metabolic rate goes down during sleep and certain anabolic hormones such as growth
hormones as mentioned above are secreted preferentially during sleep. Sleep among
species is, in general, inversely related to the animal size and basal metabolic rate. Rats
with a very high basal metabolic rate sleep for up to 14 hours a day whereas elephants
and giraffes with lower BMRs sleep only 3-4 hours per day.

Energy conservation could as well have been accomplished by resting quiescent without
shutting off the organism from the environment, potentially a dangerous situation. A
sedentary non-sleeping animal is more likely to survive predators, while still preserving
energy. Sleep therefore does something else other than conserving energy. Most
interestingly, hibernating animals that wake up from hibernation go into rebound sleep
because of lack of sleep during the hibernation period. They are definitely well rested and
are conserving energy during hibernation, but need sleep for something else. Rats kept
awake indefinitely start dying after a few days.

Anabolic/catabolic

Non-REM sleep may be an anabolic state marked by physiological processes of growth

and rejuvenation of the organism's immune, nervous, muscular, and skeletal systems (but
see above). Wakefulness may perhaps be viewed as a cyclical, temporary, hyperactive
catabolic state during which the organism acquires nourishment and procreates.

Ontogenesis

According to the ontogenetic hypothesis of REM sleep, the activity occurring during
neonatal REM sleep (or active sleep) seems to be particularly important to the developing
organism (Marks et al., 1995). Studies investigating the effects of deprivation of active
sleep have shown that deprivation early in life can result in behavioral problems,
permanent sleep disruption, decreased brain mass (Mirmiran et al. 1983), and an
abnormal amount of neuronal cell death (Morrissey, Duntley & Anch, 2004).

REM sleep appears to be important for development of the brain. REM sleep occupies
majority of time of sleep of infants, which spend most of their time sleeping. Among
different species, the more immature the baby is born, the more time it spends in REM
sleep. Proponents also suggest that REM-induced muscle inhibition in the presence of
brain activation exists to allow for brain development by activating the synapses yet
without any motor consequences which may get the infant in trouble. Additionally, REM
deprivation results in developmental abnormalities later in life.

However, this does not explain why older adults still need REM sleep, and why the
fraction of time spent does not change significantly as one ages. Aquatic mammal infants
do not have REM sleep in infancy. REM sleep in those animals increases as they age.
Obviously, REM sleep is not needed for development in these animals.

Memory processing

Scientists have shown numerous ways in which sleep is related to memory. In a study
conducted by Turner, Drummond, Salamat, and Brown working memory was shown to
be affected by sleep deprivation. Working memory is important because it keeps
information active for further processing and supports higher-level cognitive functions
such as decision making, reasoning, and episodic memory. Turner et al. allowed 18
women and 22 men to sleep only 26 minutes per night over a 4-day period. Subjects were
given initial cognitive tests while well rested and then tested again twice a day during the
4 days of sleep deprivation. On the final test the average working memory span of the
sleep deprived group had dropped by 38% in comparison to the control group.

Memory also seems to be affected differently by certain stages of sleep such as REM and
slow-wave sleep (SWS). In one study cited in Born, Rasch, and Gais multiple groups of
human subjects were used: wake control groups and sleep test groups. Sleep and wake
groups were taught a task and then tested on it both on early and late nights, with the
order of nights balanced across participants. When the subjects' brains were scanned
during sleep, hypnograms revealed that SWS was the dominant sleep stage during the
early night representing around 23% on average for sleep stage activity. The early night
test group performed 16% better on the declarative memory test than the control group.
During late night sleep, REM became the most active sleep stage at about 24%, and the
late night test group performed 25% better on the procedural memory test than the control
group. This indicates that procedural memory benefits from late REM-rich sleep whereas
declarative memory benefits from early SWS-rich sleep.

Another study conducted by Datta indirectly supports these results. The subjects chosen
were 22 male rats. A box was constructed where a single rat could move freely from one
end to the other. The bottom of the box was made of a steel grate. A light would shine in
the box accompanied by a sound. After a 5 second delay an electrical shock would be
applied. Once the shock commenced the rat could move to the other end of the box,
ending the shock immediately. The rat could also use the 5-second delay to move to the
other end of the box and avoid the shock entirely. The length of the shock never exceeded
5 seconds. This was repeated 30 times for half the rats. The other half, the control group,
was placed in the same trial but the rats were shocked regardless of their reaction. After
each of the training sessions the rat would be placed in a recording cage for 6 hours of
polygraphic recordings. This process was repeated for 3 consecutive days. This study
found that during the post-trial sleep recording session rats spent 25.47% more time in
REM sleep after learning trials than after control trials. These trials support the results of
the Born et al. study, indicating an obvious correlation between REM sleep and
procedural knowledge.

Another interesting observation of the Datta study is that the learning group spent 180%
more time in SWS than did the control group during the post-trial sleep-recording
session. This phenomenon is supported by a study performed by Kudrimoti, Barnes, and
McNaughton. This study shows that after spatial exploration activity, patterns of
hippocampal place cells are reactivated during SWS following the experiment. In a study
by Kudrimoti et al. seven rats were run through a linear track using rewards on either
end. The rats would then be placed in the track for 30 minutes to allow them to adjust
(PRE), then they ran the track with reward based training for 30 minutes (RUN), and then
they were allowed to rest for 30 minutes. During each of these three periods EEG data
were collected for information on the rats’ sleep stages. Kudrimoti et al. computed the
mean firing rates of hippocampal place cells during pre-behavior SWS (PRE) and three
10-minute intervals in post-behavior SWS (POST) by averaging across 22 track-running
sessions from seven rats. The results showed that 10 minutes after the trial RUN session
there was a 12% increase in the mean firing rate of hippocampal place cells from the PRE
level, however after 20 minutes the mean firing rate returned rapidly toward the PRE
level. The elevated firing of hippocampal place cells during SWS after spatial exploration
could explain why there were elevated levels of SWS sleep in Datta’s study as it also
dealt with a form of spatial exploration.

The different studies all suggest that there is a correlation between sleep and the many
complex functions of memory.

Further information: Sleep and learning, Sleep and creativity

Preservation

The "Preservation and Protection" theory holds that sleep serves an adaptive function. It
protects the person during that portion of the 24-hour day in which being awake, and
hence roaming around, would place the individual at greatest risk. Organisms do not
require 24 hours to feed themselves and meet other necessities. From this perspective of
adaptation, organisms are safer by staying out of harm's way where potentially they could
be prey to other, stronger organisms. They sleep at times that maximize their safety,
given their physical capacities and their habitats. (Allison & Cicchetti, 1976; Webb,
1982).
However, this theory fails to explain why the brain disengages from the external
environment during normal sleep. Another argument against the theory is that sleep is not
simply a passive consequence of removing the animal from the environment, but is a
"drive": animals alter their behaviors in order to obtain sleep. Therefore, circadian
regulation is more than sufficient to explain periods of activity and quiescence that are
adaptive to an organism, but the more peculiar specializations of sleep probably serve
different and unknown functions.

Moreover, the preservation theory does not explain why carnivores like lions, which are
on top of the food chain, sleep the most. By the preservation logic, these top carnivores
should not need any sleep at all. Preservation does not explain why aquatic mammals
sleep while moving. Lethargy during these vulnerable hours would do the same, and will
be more advantageous because the animal will be quiescent but still be able to respond to
environmental challenges like predators etc. Sleep rebound that occurs after a sleepless
night will be maladaptive, but still occurs for a reason. For example, a zebra falling
asleep the day after it spent the sleeping time running from a lion is more and not less
vulnerable to predation.

[edit] Dreaming
Main article: Dream

Dreaming is the perception of sensory images during sleep, in a sequence which the
sleeper/dreamer usually perceives more as an apparent participant than an observer.
Dreaming is stimulated by the pons and mostly occurs during the REM phase of sleep.

People have proposed many hypotheses about the functions of dreaming. Sigmund Freud
postulated that dreams are the symbolic expression of frustrated desires that had been
relegated to the subconscious, and he used dream interpretation in the form of
psychoanalysis to uncover these desires. Scientists have become skeptical about the
Freudian interpretation, and place more emphasis on dreaming as a requirement for
organization and consolidation of recent memory and experience. See Freud: The
Interpretation of Dreams

Rosalind Cartwright stated that

One Function of dreams may be to restore our sense of competence.... it is also probable
that in many times of stress, dreams have more work to do in resolving our problems and
are thus more salient and memorable.

– Rosalind Cartwright, The Sunday Observer

J. Allan Hobson's and Robert McCarley's activation synthesis theory proposes that
dreams are caused by the random firing of neurons in the cerebral cortex during the REM
period. According to the theory, the forebrain then creates a story in an attempt to
reconcile and make sense of the nonsensical sensory information presented to it; hence
the odd nature of many dreams.

Effect of food and drink on sleep

Depressants

• Tryptophan

The amino acid tryptophan is a building block of the protein found in foods. It contributes
to sleepiness. Carbohydrates make tryptophan more available to the brain, which is why
carbohydrate-heavy meals containing tryptophan tend to cause drowsiness. Tryptophan is
a precursor to the neurotransmitter serotonin, which is a precursor to the neurohormone
melatonin (see below).

• Melatonin

Melatonin is a naturally occurring hormone that regulates sleepiness. It is made in the

brain where tryptophan is converted into serotonin and then into melatonin, which is
released at night by the pineal gland to induce and maintain sleep. Melatonin
supplementation may be used as a sleep aid, both as a hypnotic and as a chronobiotic (see
phase response curve, PRC).

• 5-hydroxy-tryptophan (5-HTP)

5-HTP, the precursor to serotonin (5-HT) can cause drowsiness when ingested.

• The "Post-Lunch Dip"

Many people have a temporary drop in alertness in early afternoon, commonly known as
the post-lunch dip. While a large meal, rich in carbohydrates, can make a person feel
sleepy, the post-lunch dip is mostly an effect of the biological clock. People naturally feel
most sleepy (have the greatest "drive for sleep") at two times of the day about 12 hours
apart, for example at 2:00 AM and 2:00 PM. At those two times, the body clock "kicks
in". At about 2 p.m. (14:00), it overrides the homeostatic build-up of sleep debt, allowing
several more hours of wakefulness. At about 2 a.m. (02:00), with the daily sleep debt
paid off, it "kicks in" again to ensure a few more hours of sleep.

• Alcohol

Alcoholic beverages aid relaxation and commonly are used as a sleep aid. Alcohol tends,
however, to disrupt sleep throughout the night and can prevent the deeper stages of sleep
from occurring.

• Barbiturates
Barbiturates when taken cause drowsiness and have actions similar to ethanol (alcohol).

Stimulants

• Caffeine

Caffeine is a stimulant that works by slowing the action of the hormones in the brain that
cause sleepiness. Effective dosage is individual, in part dependent on prior usage. It can
cause a rapid reduction in alertness as it wears off.

• Energy Drinks

The stimulating effects of energy drinks comes from natural stimulants such as caffeine,
sugars, and essential amino acids, and eventually will create a rapid reduction in alertness
similar to that of caffeine.

• Amphetamines

Amphetamines (amphetamine, dextroamphetamine, methamphetamine, etc) are often

used to treat narcolepsy and ADHD disorders, the most common effects are decreased
appetite, stimulation and insomnia, and increased alertness.

• Cocaine and Crack Cocaine

Similar in action to the amphetamines.

• MDMA

Commonly known as ecstacy, users are kept awake similar to amphetamines with intense
euphoria, includes other similar drugs like MDA, MMDA, or bk-MDMA.

• Methylphenidate

Commonly known as Ritalin, similar in action to amphetamines and cocaine.

[edit] Causes of difficulty in sleeping

There are a great many possible reasons for sleeping poorly. Following sleep hygienic
principles may solve problems of physical or emotional discomfort. When pain, illness,
drugs or stress are the culprit, the cause must be treated. Sleep disorders, including the
sleep apneas, narcolepsy, primary insomnia, periodic limb movement disorder (PLMD),
restless leg syndrome (RLS) and the circadian rhythm sleep disorders, are treatable.

Elderly people may to some degree lose the ability to consolidate sleep. They need the
same amount per day as they've always needed, but may need to take some of their sleep
as daytime naps.
Anthropology of sleep
Recent research suggests that sleep patterns vary significantly across human cultures. The
most striking differences are between societies that have plentiful artificial light and ones
that do not. Cultures without artificial light have more broken-up sleep patterns. This is
called polyphasic sleep or segmented sleep and has led to expressions such as "first
sleep," "watch," and "second sleep" which appear in literature from all over the world.

Some cultures have fragmented sleep patterns in which people sleep at all times of the
day, and for shorter periods at night. For example, many Mediterranean and Latin
American cultures have a siesta, in which people sleep for a period in the afternoon. In
many nomadic or hunter-gatherer societies people sleep off and on throughout the day or
night depending on what is happening.

Sleep in non-humans

Sleeping Japanese Macaques.

Main article: Sleep (non-human)

Horses and other herbivorous ungulates can sleep while standing, but must necessarily lie
down for REM sleep (which causes muscular atony) for short periods - giraffes, for
example, only need to lie down for REM sleep for a few minutes at a time. Bats sleep
while hanging upside down. Some aquatic mammals and some birds can sleep with one
half of the brain, while the other half is awake, so called unihemispheric slow-wave
sleep. Birds and mammals have cycles of non-REM and REM sleep as described above
for humans, though birds’ cycles are much shorter and they do not lose muscle tone (go
limp) to the same extent that most mammals do.

Many animals sleep, but neurological sleep states are difficult to define in lower order
animals. In these animals, sleep is defined using behavioral characteristics such as
minimal movement, postures typical for the species and reduced responsiveness to
external stimulation. It is quickly reversible, as opposed to hibernation or coma, and sleep
deprivation is followed by longer and/or deeper sleep.

Many species of mammals sleep for a large proportion of each 24-hour period when they
are very young. However, killer whales and some dolphins do not sleep during the first
month of life.

Longest period without sleep

Depending on how sleep is defined, there are several people who can claim the record for
having gone the longest without sleep:
1. Thai Ngoc, born 1942, claimed in 2006 to have been awake for 33 years or 11,700
nights, according to Vietnamese news organization Thanh Nien. It was said that
Ngoc acquired the ability to go without sleep after a bout of fever in 1973, but
other reports indicate he stopped sleeping in 1976 with no known trigger. At the
time of the Thanh Nien report, Ngoc suffered from no apparent ill effect (other
than a minor decline in liver function), was mentally sound and could carry
100 kg of pig feed down a 4 km road, but another report indicates that he was
healthy before the sleepless episode but that now he was not feeling well because
of the lack of sleep.
2. In January 2005, the RIA Novosti published an article about Fyodor Nesterchuk
from the Ukrainian town of Kamen-Kashirsky who claimed to have not slept in
more than 20 years. Local doctor Fyodor Koshel, chief of the Lutsk city health
department, claimed to have examined him extensively and failed to make him
sleep. Koshel also said however that Nesterchuck did not suffer any of the
normally deleterious effects of sleep deprivation. People who claim not to sleep
are usually shown to sleep when studied in sleep laboratories with EEG.
Nesterchuck reports experiencing drowsiness at night, commenting that he
attempts to sleep "in vain" when he notices his eyelids drooping. Many people
experience microsleep episodes during sleep deprivation, in which they sleep for
periods of seconds to fractions of a second and frequently don't remember these
episodes. Because microsleep is frequently not remembered, microsleep or a
related phenomenon may be responsible for lack of sleep and/or lack of memory
of sleep in individuals like Nesterchuk and Thai Ngoc.
3. Randy Gardner holds the Guinness World Record for intentionally having gone
the longest without sleep. In 1965, Gardner, then 18, stayed awake for 264 hours
(about 11 days) for a high school science project. He experienced significant
deficits in concentration, motivation, perception and other higher mental
processes during his sleep deprivation. However, he recovered normal cognitive
functions after a few nights' sleep.
4. On May 25, 2007 the BBC reported that Tony Wright beat the Guinness World
Record by staying awake for 11 days and nights. The Guinness Book of Records
has, however, withdrawn its backing of a sleep deprivation class because of the
associated health risks.
5. A 3-year-old boy named Rhett Lamb of St. Petersburg Florida has a rare condition
and has only slept for one to two hours per day in the past three years. He has a
rare abnormality called an Arnold-Chiari malformation where brain tissue
protrudes into the spinal canal. The skull puts pressure on the protruding part of
the brain. It is not yet known if the brain malformation is directly related to his
sleep deprivation.