title: Feedback Blunting: Total Sleep Deprivation Impairs Decision Making that Requires Updating Based on Feedback.
abstract: OBJECTIVE
  To better understand the sometimes catastrophic effects of sleep loss on naturalistic decision making, we investigated effects of sleep deprivation on decision making in a reversal learning paradigm requiring acquisition and updating of information based on outcome feedback.
  
  
  METHODS
  Subjects were randomized to a sleep deprivation or control condition, with performance testing at baseline, after 2 nights of total sleep deprivation (or rested control), and following 2 nights of recovery sleep. Subjects performed a decision task involving initial learning of go and no go response sets followed by unannounced reversal of contingencies, requiring use of outcome feedback for decisions. A working memory scanning task and psychomotor vigilance test were also administered.
  
  
  METHODS
  Six consecutive days and nights in a controlled laboratory environment with continuous behavioral monitoring.
  
  
  METHODS
  Twenty-six subjects (22-40 y of age; 10 women).
  
  
  METHODS
  Thirteen subjects were randomized to a 62-h total sleep deprivation condition; the others were controls.
  
  
  RESULTS
  Unlike controls, sleep deprived subjects had difficulty with initial learning of go and no go stimuli sets and had profound impairment adapting to reversal. Skin conductance responses to outcome feedback were diminished, indicating blunted affective reactions to feedback accompanying sleep deprivation. Working memory scanning performance was not significantly affected by sleep deprivation. And although sleep deprived subjects showed expected attentional lapses, these could not account for impairments in reversal learning decision making.
  
  
  CONCLUSIONS
  Sleep deprivation is particularly problematic for decision making involving uncertainty and unexpected change. Blunted reactions to feedback while sleep deprived underlie failures to adapt to uncertainty and changing contingencies. Thus, an error may register, but with diminished effect because of reduced affective valence of the feedback or because the feedback is not cognitively bound with the choice. This has important implications for understanding and managing sleep loss-induced cognitive impairment in emergency response, disaster management, military operations, and other dynamic real-world settings with uncertain outcomes and imperfect information.
authors.affiliation: Department of Psychology, Washington State University, Pullman, WA.
authors.forename: Paul
authors.initials: P
authors.lastname: Whitney
authors.affiliation: Department of Psychology, Washington State University, Pullman, WA.
authors.forename: John M
authors.initials: JM
authors.lastname: Hinson
authors.affiliation: Melbourne School of Psychological Sciences, The University of Melbourne, VIC, Australia.
authors.forename: Melinda L
authors.initials: ML
authors.lastname: Jackson
authors.affiliation: Sleep and Performance Research Center and College of Medical Sciences, Washington State University, Spokane, WA.
authors.forename: Hans P A
authors.initials: HP
authors.lastname: Van Dongen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001288:Attention / Q000502:physiology; D002755:Choice Behavior; D003072:Cognition Disorders / Q000503:physiopathology / Q000523:psychology*; D003657:Decision Making; D030141:Feedback, Psychological; D005260:Female; D006801:Humans; D008297:Male; D008570:Memory, Short-Term; D012193:Reversal Learning; D012890:Sleep / Q000502:physiology; D012892:Sleep Deprivation / Q000503:physiopathology / Q000523:psychology*; D013997:Time Factors; D035501:Uncertainty; D055815:Young Adult
keywords: affective valence; attentional lapses; feedback blunting; hot cognition; naturalistic decision making; reversal learning; salience; skin conductance response; total sleep deprivation; working memory