I had an argument with a friend in college who claimed that it was possible to remain awake with little to no detrimental affects for an arbitrarily long period of time. I am wondering, has anybody ever tried to measure the effects of extreme sleep deprivation? Can death result?
Fatal Familial Insomnia
It's extremely rare, but I saw a video in a Psychology class about a man who was observed (can't find the link I'm afraid) during the 6 months of the disease activating. Within that 6 months, they tried to drug him, which didn't make him sleep, and over due course his body degraded so rapidly that just before his death he looked like he had aged decades.
Wikipedia identifies 4 stages of the disease:
- The patient suffers increasing insomnia, resulting in panic attacks, paranoia, and phobias. This stage lasts for about four months.
- Hallucinations and panic attacks become noticeable, continuing for about five months.
- Complete inability to sleep is followed by rapid loss of weight. This lasts for about three months.
- Dementia, during which the patient becomes unresponsive or mute over the course of six months. This is the final progression of the disease, resulting in death.
Voluntary Lack of Sleep
Randy Gardner currently holds the record for voluntary lack of sleep:
He went 11 days, and if I recall correctly he was studied throughout by psychologists who wanted to measure the effects of it. There is a lot of dispute over the results about the after effects however.
The question stated, 'Death by lack of sleep — is it possible?' and, yes it can. Tiredness is also proven killer for drivers, as it is in other high risk jobs/environments.
Fruit flies were one of the key organisms to cracking the sleep cycle. They have a fond spot in my heart, because I started real lab work (as opposed to student lab work) in 1989 with D. Melanogaster.
Doubletime (fruit fly mutations have a history of colorful naming) flies tended to have abnormal circadian rhythms associated with the loss of normal DBT protein kinase activity. This interacts with the Period protein PER such that the balance between the two shift regularly in conjunction with circadian rhythms. The research was generally know back in 2006, (pg 56), and some of the work was done as early as 1998. The state of the art has probably progressed since then; but, the biochemistry of the circadian rhythm is known in fruit flies, and is known to have nearly identical analogues in humans.
An loss of DBT in conjunction with the light induced buildup of caspase DRONC can lead to higher concentrations of DRONC in the cytoplasam. DRONC promotes cellular death, and can cause reactions in the cell that are similar to those found in Alzheimers (TAU buildup). A likely regulator of DBT is known (one has been discovered called "spaghetti" or SPAG). SPAG has a role in the aggregation of HTT (Huntingtin) a protien associated with Huntington's disease.
Also a starvation of PER or TIM in fly larvae lead to 100% death for DBT-P (allele P of the DBT gene), where the proteins were destroyed by light exposure in larvae carrying these mutations.
So two major neural degenerative diseases located in close proximity biochemically, a promoter of cellular death is related to light exposure and sleep, and a misstep in the gene can induce light triggered death. I would say that it would be possible to die biochemically from lack of sleep. However, there are many failure modes that might create "lack of sleep" and it is highly unlikely all "lack of sleep" scenarios would be lethal.
DBT activity is related to far more than just sleep. It impacts 13 unique biological processes, including psycho-stimulant pathways. This may mean that lack of sleep may trigger other causes of death indirectly, even at a biochemical level.
As for whether the "stress" is a factor outside of the lack of sleep, in science, there are many who feel that "stress" is used as a blanket statement to cover non-specific scenarios; much in the same way that nobody really dies of "old age" but the number of contributing factors to death in the old are great enough that a comprehensive examination of "root cause" is often not possible or practical.