0253 Total Sleep Deprivation Impairs Decision Making More in Healthy Sleepers Than in Individuals with Chronic Insomnia

Work in healthcare routinely involves night and rotating shifts, early morning starts, and variable call schedules, resulting in short and/or disrupted sleep. We conducted a laboratory-based experiment in both normal sleepers and those with chronic insomnia to better understand implications of total sleep deprivation (TSD) on decision making using a reversal learning task (i.e., go/no go; GNG) with unannounced reversal contingences. 28 individuals completed the sleep study, 15 with sleep-onset insomnia (ages 22-40, 11 females), of whom 7 underwent TSD, and 13 normal sleeper controls (ages 22-40, females), of whom 7 underwent TSD. The insomnia group met International Classification of Sleep Disorders (3rd edition; ICSD-3) criteria for chronic insomnia with no other clinically relevant condition contributing to their sleep disturbance. Subjects were in the laboratory for 5 days/4 nights. The first 2 days and nights were baseline days, each with a 10h opportunity for sleep (22:00—08:00). This was followed by 38h of TSD or another nighttime sleep opportunity for the control group. The last day was a recovery day, with a 10h sleep opportunity for all participants. Unique versions of a GNG task were administered in random, counterbalanced order at baseline and 24h later during TSD (or 2h awake in the control group). There was a significant main effect of day (F1,69= 10.37, P=0.002), condition (F3,69 = 5.94, P = 0.001), phase (F1,69 = 10.03, P = 0.002), and day by condition by phase interaction (F10,69 = 4.73, P < 0.001). In general, participants performed better before TSD and pre-reversal. While both TSD groups showed poorer performance post-reversal during TSD, only the TSD insomnia group showed relatively intact performance pre-reversal. TSD led to significant impairment on a reversal learning task for both normal sleepers and those with chronic sleep-onset insomnia. This has important implications for healthcare workers who are routinely exposed to disrupted sleep which may leave them more susceptible to making potentially life-threatening errors. Hyperarousal, the widely accepted underlying mechanism perpetuating insomnia, may provide those chronically exposed to sleep loss some level of protection on decision making tasks compared to normal healthy sleepers during TSD. ONR grant N00014-13-C-0063