Although comparisons across tasks cannot be made due to the different times of administration, within-task comparisons suggest that, at the doses tested here, each stimulant may produce differential advantages depending on the cognitive demands of the task.

Summary Prolonged sleep loss impairs alertness, vigilance and some higher‐order cognitive and affective capacities. Some deficits can be temporarily reversed by stimulant medications including caffeine, dextroamphetamine, and modafinil. To date, only one study has directly compared the effectiveness of these three compounds and specified the doses at which all were equally effective in restoring alertness and vigilance following 64 h of wakefulness. The present study compared the effectiveness of these same three stimulants/doses following a less extreme period of sleep loss (i.e., 44 h). Fifty‐three healthy adults received a single dose of modafinil 400 mg (n = 11), dextroamphetamine 20 mg (n = 16), caffeine 600 mg (n = 12), or placebo (n = 14) after 44 h of continuous wakefulness. After 61 h of being awake, participants obtained 12 h of recovery sleep. Psychomotor vigilance was assessed bi‐hourly during waking and following recovery sleep. Relative to placebo, all three stimulants were equally effective in restoring psychomotor vigilance test speed and reducing lapses, although the duration of action was shortest for caffeine and longest for dextroamphetamine. At these doses, caffeine was associated with the highest percentage of subjectively reported side‐effects while modafinil did not differ significantly from placebo. Subsequent recovery sleep was adversely affected in the dextroamphetamine group, but none of the stimulants had deleterious effects on postrecovery performance. Decisions regarding stimulant selection should be made with consideration of how factors such as duration of action, potential side‐effects, and subsequent disruption of recovery sleep may interact with the demands of a particular operational environment.

Recent evidence suggests that sleep deprivation leads to suboptimal decision-making on the Iowa Gambling Task (IGT), a pattern that appears to be unaffected by moderate doses of caffeine. It is not known whether impaired decision-making could be reversed by higher doses of caffeine or by other stimulant countermeasures, such as dextroamphetamine or modafinil. Fifty-four diurnally active healthy subjects completed alternate versions of the IGT at rested baseline, at 23 and 46 h awake, and following a night of recovery sleep. After 44 h awake, participants received a double-blind dose of caffeine (600 mg), dextroamphetamine (20 mg), modafinil (400 mg), or placebo. At baseline, participants showed a normal pattern of advantageous performance, whereas both sleep-deprived sessions were associated with suboptimal decision-making on the IGT. Following stimulant administration on the second night of sleep deprivation, groups receiving caffeine, dextroamphetamine, or modafinil showed significant reduction in subjective sleepiness and improvement in psychomotor vigilance, but decision-making on the IGT remained impaired for all stimulants and did not differ from placebo. Decision-making returned to normal following recovery sleep. These findings are consistent with prior research showing that sleep deprivation leads to suboptimal decision-making on some types of tasks, particularly those that rely heavily on emotion processing regions of the brain, such as the ventromedial prefrontal cortex. Moreover, the deficits in decision-making were not reversed by commonly used stimulant countermeasures, despite restoration of psychomotor vigilance and alertness. These three stimulants may restore some, but not all, aspects of cognitive functioning during sleep deprivation.

Cognitive abilities such as vigilance, attention, memory, and executive functioning can be degraded significantly following extended periods of wakefulness. Although much evidence suggests that sleep-loss induced deficits in alertness and vigilance can be reversed or mitigated by stimulants such as caffeine, it is not clear how these compounds may affect other higher level cognitive processes such as emotional perception and judgment. Following 47 h of sleep deprivation, the study examined the effect of three stimulant medications (modafinil 400 mg, dextroamphetamine 20 mg, caffeine 600 mg) or placebo on the ability of 54 healthy participants to discriminate and label simple emotional expressions versus complex affect blends (created by morphing photographs of two different affective facial expressions). For simple affective faces, neither sleep loss nor stimulant medications made any difference on the accuracy of judgments. In contrast, for complex emotion blends, all three stimulant medications significantly improved the ability to discriminate subtle aspects of emotion correctly relative to placebo, but did not differ from one another. These findings suggest that all three stimulant medications are effective at restoring some aspects of subtle affective perception.

Findings are consistent with the hypothesis that greater prefrontal/executive functioning may be protective against the adverse effects of sleep deprivation and suggest that baseline executive function testing may prove useful for prediction of resilience during sleep loss.

The Evaluation of Risks scale was recently developed as a self-report inventory for assessing risk-taking propensity, but further validation is necessary because most studies have predominantly included male subjects. Because males commonly exhibit greater risk-taking propensity than females, evidence of such a sex difference on the scale would further support its construct validity. 29 men and 25 women equated for age (range: 18 to 36 years) completed the scale. Internal consistency of the scale was generally modest, particularly among women. Men scored significantly higher than women on four of nine indices of risk-taking propensity, including Danger Seeking, Energy, Invincibility, and Total Risk-Propensity. Factors measuring thrill seeking and danger seeking correlated positively with a concurrent measure of sensation seeking. Although the higher scores exhibited by men are consistent with prior research on other measures of risk-taking, further research on this scale with samples including women is warranted.

Stimulant medications, particularly dextroamphetamine, sustained risk-related attitudes and behavior during continuous wakefulness. The extent to which stimulants restore other aspects of judgment during sleep loss remains to be determined.

Odor identification ability is sensitive to prefrontal lobe dysfunction and preliminary evidence suggests that this capacity may decline with prolonged wakefulness. We hypothesized that declines in odor identification during a single night of sleep loss might, therefore, be predictive of prefrontal lobe executive function deficits following an additional night of sleep deprivation. Change scores between two administrations of the University of Pennsylvania Smell Identification Test (SIT) during 24 hr of sleep deprivation were used to predict performance on the Wisconsin Card Sorting Test (WCST) following 45 hr of wakefulness in 54 healthy adults. Declines in SIT performance predicted poorer performance on the WCST following an additional night of sleep loss. These findings suggest that individual differences in vulnerability to the effects of sleep loss on odor identification ability are predictive of deficits in executive functioning following additional wakefulness. Odor identification ability may provide an unobtrusive method for assessing vulnerability to sleep deprivation.