
Some call me Tim |

I don't know of any rules that actually apply a penalty for lack of sleep (if you don't "rest" you do not regain spells or healing naturally). So, I interpret "rest" as sleeping for those creatures that do sleep.
I usually impose the rules for forced march if you don't sleep for eight hours/day. I'm also fairly liberal with that figure. Occasionally only getting seven hours because of a watch schedule shouldn't have our heroes behaving like a bunch of narcoleptics.
I allow them to stay up for 24 hours but when the start any strenuous activity (walking, exploring, fighting) they need to make a Constitution check (DC 10, +2 per extra hour).

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I usually force party to make several constitution checks after around 8 hours of day if they wish to continue traveling or anything similar. After 16 hours however things start to look grim.
God knows that I have hold it out up to 24h being awake barely functioning from insomnia. PC's are hero's, but nobody can tell me their body function like a peach without magical influence. After 24h they get Con check; if they fail, they fall asleep.
Rules be damned as Ciaran Barnes said.

Selgard |

Sadly, its just houserules.
That being said- consider motivation.
Are the PC's sitting around for 3 days "at watch" waiting for something to happen?
le yawn fest.
Are the PC's racing to stop the end of the world, and taking a nap might mean they miss it? (sub end of the world with anything they find important. Princess missing, gotta get the antidote for the king's illness, whatever)
The more motivated, the longer they can go. (and of course- the worse the crash at the end.)
I've *never* tried to save the world- or even save a princess from a dragon.. but if I'm sufficiently self motivated I can stay up without issue from 8am to around 8pm the following day. And thats just "I'm too busy to sleep right now"- not anything earth shattering important. (and I'm also a good deal older than the average suggested age for the adventurers, too).
TL:DR Let the heroes be heroic- if heroic is what's going on.
-S

Lord Fyre RPG Superstar 2009 Top 32 |

As Ryric stated, we now have a clear ruling about this. No sleep for 24 h = Fatigued
(and thus, no sleep for 48 h = Exhausted).
That conflicts with the "Definitive Source." ;P

Lord Fyre RPG Superstar 2009 Top 32 |

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From what I know, insomnia might cause slight craziness depending how long it lasts. After 72h human body can die if insomnia continues but if I remember right, this never happens because people usually drop into slight coma as they slowly reach the 72h period.
When I say coma, I really mean coma. I didn't feel like goggling this so I am just saying what I remember slightly.

Claxon |

This article argues differently. I don't think everyone could stay awake for 11 days, but it seems clear that no matter how long you stay awake, a few days of good sleep and you'll be fine again. The worst things you have to worry about are falling asleep during an important action and the impairment to your cognitive processes.

Quatar |

Well by strict RAW, considering the latest FAQ that has been quoted already, after 24h you become fatigued. After 48 hours that means you become exhausted.
After 72h... you're still exhausted because there's nothing worse than that, and you'd stay that way forever till you get some sleep.
However Exhausted is pretty serious condition, so you'd probably not want to be that for too long.
Also obviously, if you're actually marching for more than 8 hours you make force marched checks as well. And the DC will get crazy soon.

Ciaran Barnes |

Last night I read about some guys online who had been awake for decades. The presumed record holder died at 94 and had no memory of ever sleeping. Mutants!
I myself have been awake for 36 hours a few times, and I always felt like hell. One time I went 48 hours when I was travelling across europe and had no place to crash. I even tried to and failed in the middle of a train station in Hamburg. The last 8 my body felt like it was vibrating so rapidly that it was humming.