The Impact of Sleep Deprivation on Decision-Making in those with Chronic Insomnia: Implications for Physicians in High-Stakes Environments

Background: Work in healthcare routinely involves variable work schedules resulting in short/disrupted sleep. Objective: We conducted a laboratory-based experiment in healthy sleepers and those with chronic insomnia to understand the effect of sleep deprivation (SD) on decision-making using a reversal-learning task (GNGr) with unannounced reversal contingencies.Methods: 51 individuals were recruited for the study and data from 28 participants (55%) was available for analysis. 15 participants had chronic insomnia (7 underwent SD) and 13 were healthy sleepers (7 underwent SD). Data was collected between 2013 and 2016. Participants were in the laboratory for 5 days/4 nights. Following 2 baseline days, participants underwent 38h of SD or another nighttime sleep opportunity, followed by a recovery sleep opportunity for all participants. Unique versions of a GNGr task were administered in random, counterbalanced order at SD and 24h later. Results: There was a significant main effect of day, condition, phase, and their interaction (all p<0.01). Participants performed better when rested and pre-reversal. While both SD groups showed poorer performance post-reversal during SD, the SD insomnia group showed relatively intact performance pre-reversal. Conclusions: SD led to significant overall impairment on a reversal-learning task for both healthy sleepers and those with chronic insomnia. However, the nature of impairment differed between groups. Hyperarousal may have conferred a protective effect on those with insomnia, resulting in more preserved decision-making. These findings have important implications for healthcare providers in high-stakes environments where sleep disruption is common; it may leave them more susceptible to making life-threatening errors.