| Sumario: | Study Objectives The aim of this laboratory-based study was to understand the effect of total sleep deprivation (TSD) on decision-making using a reversal learning task with unannounced contingency reversals in those with chronic insomnia compared to healthy sleepers. Methods Twenty-eight individuals completed the study, 15 with chronic insomnia (7 underwent TSD) and 13 healthy sleepers (7 underwent TSD). Participants were in the laboratory for 5 days/4 nights. Following baseline sleep, participants underwent 38 h of TSD or another nighttime sleep opportunity, followed by a recovery sleep opportunity for all participants. Mixed-effects ANOVAs with fixed effects of condition (healthy TSD, insomnia TSD, healthy control, or insomnia control), session (baseline or TSD/control), phase (pre or post-reversal), block (1-4), and their interactions were run to assess performance. Results There were significant effects of day, condition, phase, and their interaction (all p <.01). Participants performed better when rested and pre-reversal (i.e. before the rule change). While both TSD groups showed poorer performance post-reversal (i.e. after the rule change) during TSD, the TSD insomnia group showed relatively intact performance pre-reversal. Conclusions TSD led to significant overall impairment on a reversal learning decision task for healthy sleepers and those with insomnia. However, the nature of impairment differed between groups. Hyperarousal may have conferred a protective effect on those with insomnia, resulting in preserved decision-making pre-reversal. These findings have important implications for our understanding of the nature of cognitive impairment associated with chronic insomnia. Statement of Significance This study demonstrates that while total sleep deprivation impairs decision making in both individuals with insomnia and healthy controls, it also provides preliminary evidence that people with insomnia show some level of protection prior to task reversal. This finding supports the idea that chronic hyperarousal in insomnia may confer paradoxical short-term cognitive resilience under sleep loss. Understanding this protective effect is important because it challenges assumptions that insomnia may uniformly degrade cognition, and it raises critical questions about the physiological mechanisms involved. Future research is needed to clarify whether this resilience comes at a long-term cost to brain and body health, and how it may inform interventions for sleep disorders and cognitive function in vulnerable populations.
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