What the direct comparison found
The clearest evidence comes from a 2024 study that randomly assigned 28 healthy men aged 18 to 40 to either one night of total sleep deprivation (24 hours awake) or four nights of restricted sleep (4 hours in bed per night) [2]. Each participant also completed a normal sleep condition for comparison. After a glucose tolerance test, the researchers calculated a Matsuda Index, a measure of how well the body responds to insulin. After four nights of restricted sleep, the Matsuda Index decreased, indicating lower insulin sensitivity [2]. After one night of total sleep deprivation, insulin levels and the insulin area under the curve increased, but the Matsuda Index did not show the same clear decrease [2].
When the two sleep-debt conditions were compared directly, the restricted-sleep group had higher baseline insulin and higher HOMA-IR, a marker of insulin resistance, than the deprivation group [2]. The study concluded that four consecutive nights of restricted sleep were more detrimental to energy metabolism than a single 24-hour period of sleep deprivation [2]. This is a small, short-term study in healthy young men, so the size of the difference should be treated as an estimate rather than a fixed number.
Why one night may look different from several
One night of total sleep deprivation is an acute stress. In the 2024 study, free fatty acids were higher after sleep deprivation [2], and a 2010 review notes that total sleep deprivation for 24 hours has been shown to decrease insulin sensitivity in healthy subjects [3]. That review also discusses effects of chronic partial sleep restriction, but it does not compare the two durations directly [3].
Several nights of restricted sleep may accumulate a different kind of metabolic strain. In the 2024 study, four nights of 4-hour sleep led to higher insulin values and higher insulin resistance than the single night of deprivation [2]. A 2016 study of short-term moderate sleep restriction in young healthy adults also reported that several insulin sensitivity indices suggested decreased insulin sensitivity after restricted sleep [1]. That study did not include a one-night total deprivation condition, so it cannot say how the two compare [1].
How large is the drop?
The evidence does not provide a single percentage drop that applies to everyone. The 2024 study reports statistical significance and direction—lower Matsuda Index after restriction, higher insulin after deprivation—but not a simple effect size that translates into a percent change for a general reader [2]. The 2016 study reports that insulin sensitivity check index and other indices suggested decreased sensitivity after restricted sleep, again without a universal number in the abstract [1].
What can be said is that the direction is consistent: both conditions move insulin sensitivity in the wrong direction, and the four-night restriction condition appeared worse in the one study that compared them head-to-head [2]. The magnitude in any individual will depend on factors such as baseline insulin sensitivity, sex, age, and the exact sleep schedule, which this small study was not designed to quantify [2].
What this means for a real person
If you are choosing between one all-nighter and several short nights, the limited evidence suggests that several short nights may be the more metabolically costly pattern [2]. But the comparison comes from a single small study of healthy young men, so it should not be read as a precise ranking for everyone [2]. A 24-hour wake period still has measurable effects on insulin and free fatty acids [2], and older work has reported reduced insulin sensitivity after total sleep deprivation [3].
The practical takeaway is that sleep debt is not harmless in either form, and the longer it accumulates, the more the body's ability to respond to insulin appears to suffer [2]. The exact size of the drop after one night versus several nights remains uncertain because few studies measure both conditions in the same people with the same sensitive tests.
Sources used in this answer
Short-term moderate sleep restriction decreases insulin sensitivity in young healthy adults
Short-term moderate sleep restriction in young healthy adults was associated with decreased insulin sensitivity according to several insulin sensitivity indices, but the study did not include a one-night total sleep deprivation condition.
Sleep Debt and Insulin Resistance: What's Worse, Sleep Deprivation or Sleep Restriction?
In healthy men, four nights of 4-hour sleep restriction led to lower insulin sensitivity and higher insulin resistance markers, while one night of 24-hour total sleep deprivation raised insulin and free fatty acids after a glucose test; the restriction condition appeared more detrimental overall.
The impact of sleep disturbances on adipocyte function and lipid metabolism
A review notes that 24 hours of total sleep deprivation has been shown to decrease insulin sensitivity in healthy subjects and discusses effects of chronic partial sleep restriction, without directly comparing the two durations.