The end of sleep: ‘Sleep debt’ versus biological adaptation of human sleep to waking needs

It is argued that the latter part of usual human sleep is phenotypically adaptable (without ‘sleep debt’) to habitual shortening or lengthening, according to environmental influences of light, safety, food availability and socio-economic factors, but without increasing daytime sleepiness. Pluripotent brain mechanisms linking sleep, hunger, foraging, locomotion and alertness, facilitate this time management, with REM acting as a ‘buffer’ between wakefulness and nonREM (‘true’) sleep. The adaptive sleep range is approximately 6–9 h, although, a timely short (<20 min) nap can equate to 1 h ‘extra’ nighttime sleep. Appraisal of recent epidemiological findings linking habitual sleep duration to mortality and morbidity points to nominal causal effects of sleep within this range. Statistical significance, here, may not equate to real clinical significance. Sleep durations outside 6–9 h are usually surrogates of common underlying causes, with sleep associations taking years to develop. Manipulation of sleep, alone, is unlikely to overcome these health effects, and there are effective, rapid, non-sleep, behavioural countermeasures. Sleep can be taken for pleasure, with minimal sleepiness; such ‘sleepability’ is ‘unmasked’ by sleep-conducive situations. Sleep is not the only anodyne to sleepiness, but so is wakefulness, inasmuch that some sleepiness disappears when wakefulness becomes more challenging and eventful. A more ecological approach to sleep and sleepiness is advocated.

Research highlights▶ Sleep is phenotypically adaptable (without ‘sleep debt’) to habitual shortening or lengthening. ▶ Acute, partial sleep restriction studies are insufficiently long for this adaptation. ▶ Common systems linking sleep, feeding, locomotion, and alertness, facilitate this time management. ▶ Epidemiological links between sleep and mortality/morbidity show 6–9 h sleep as ‘safe’. ▶ Sleep also acts as a time-filler, and a more ecological approach to sleep and sleepiness is advocated.