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Cassie J. Hilditch

Publications and source records attributed to Cassie J. Hilditch.

Light in Ecological Settings: Entrainment, Circadian Disruption, and Interventions

Light is the predominant signal for the human circadian clock to synchronize to the solar 24-h day through an active process called entrainment. Modern light profiles are characterized by exposure to both natural daylight and artificial lighting. A mismatch between these self-selected light profiles and the solar day-night alternation can disrupt the circadian system, resulting in acute and chronic effects for health and safety. In this chapter, we describe (i) how entrainment works in the real world, illustrating the major role of light for this process; (ii) ways in which the circadian system can be disrupted by (external) factors such as irregular sleep, shift work, daylight saving time, and longitudinal position in a time zone; and (iii) how field studies have used light interventions to reduce direct and indirect effects of circadian disruption in ecological settings.

light interventions↗

Rise and Shine: The Use of Polychromatic Short-Wavelength-Enriched Light to Mitigate Sleep Inertia at Night Following Awaking From Slow-Wave Sleep

Sleep inertia is the brief period of performance impairment and reduced alertness experienced after waking, especially from slow-wave sleep. We assessed the efficacy of polychromatic short-wavelength-enriched light to improve vigilant attention, alertness and mood immediately after waking from slow-wave sleep at night. Twelve participants (six female, 23.3 ± 4.2 years) maintained an actigraphy-confirmed sleep schedule of 8.5 hr for 5 nights, and 5 hr for 1 night prior to an overnight laboratory visit. In the laboratory, participants were awakened from slow-wave sleep, and immediately exposed to either dim, red ambient light (control) or polychromatic short-wavelength-enriched light (light) for 1 hr in a randomized crossover design. They completed a 5-min Psychomotor Vigilance Task, the Karolinska Sleepiness Scale, and Visual Analogue Scales of mood at 2, 17, 32 and 47 min after waking. Following this testing period, lights were turned off and participants returned to sleep. They were awakened from their subsequent slow-wave sleep period and received the opposite condition. Compared with the control condition, participants exposed to light had fewer Psychomotor Vigilance Task lapses (χ 2 [1] = 5.285, p = 0.022), reported feeling more alert (Karolinska Sleepiness Scale: F 1,77 = 4.955, p = 0.029; Visual Analogue Scale alert : F 1,77 = 8.226, p = 0.005), and reported improved mood (Visual Analogue Scale cheerful : F 1,77 = 8.615, p = 0.004). There was no significant difference in sleep-onset latency between conditions following the testing period (t 10 = 1.024, p = 0.330). Our results suggest that exposure to polychromatic short-wavelength-enriched light immediately after waking from slow-wave sleep at night may help improve vigilant attention, subjective alertness, and mood. Future studies should explore the potential mechanisms of this countermeasure and its efficacy in real-world environments.

alertness↗

Light Improves Alertness and Mood during the Sleep Inertial Period following Slow Wave Sleep

Introduction: Waking from sleep, especially slow wave sleep (SWS), is associated with reduced alertness known as sleep inertia. Light improves alertness during sleep deprivation and circadian misalignment. In this study, we assessed the efficacy of light to improve alertness and mood immediately after waking from SWS. Methods: Twelve participants kept a sleep schedule of 8.5 h for 5 nights and 5 h for one night prior to the overnight laboratory visit (confirmed by actigraphy). Participants went to bed at their scheduled habitual bedtime in the laboratory and were monitored by standard polysomnography. After at least 5 min of SWS, participants were awoken and exposed to either red ambient light (control) or blue-enriched bright light (light) for 1 h. During this time, participants completed a subjective scale of alertness (Karolinska Sleepiness Scale, KSS) and visual analogue scales (VAS) of mood at 2 min, 17 min, 32 min, and 47 min after waking. Following this sleep inertia measurement period, all lights were turned off and participants were allowed to return to sleep. They were then awoken again from their subsequent SWS period and exposed to the opposite condition (control or light). A linear mixed-effects model with fixed effects of condition, time, and condition*time and a random effect of participant was used to determine the impact of light across the testing period. An average of baseline responses (pre-sleep) was included as a covariate. Results: Compared to the control condition, participants exposed to bright blue-enriched light reported feeling more alert (KSS: F1,77=4.955, p=.029; VASalert: F1,77=8.226, p=.005), more cheerful (VAScheerful: F1,77=8.615, p=.004), less depressed (VASdepressed: F1,77=4.649, p=.034), and less lethargic (VASlethargic: F1,77=5.652, p=.020). Discussion: Exposure to blue-enriched bright light immediately after waking from SWS may help to improve subjective alertness and mood. Future analyses will explore whether these findings extend to effects on cognitive performance.

alertness↗

Sleep & Sleep Inertia

Sleep inertia, or the grogginess felt upon awakening, is associated with significant cognitive performance decrements that dissipate as time awake increases. This presentation will cover the: 1) causes of sleep inertia including the interaction with homeostatic and circadian pressures and neural correlates; 2) consequences for cognitive performance from both laboratory studies and real world incidents; and 3) novel countermeasures currently being investigated to lessen the impact of sleep inertia.

sleep inertia↗

The Effects of Chronic Sleep Restriction on Calorie and Macronutrient Intake

Introduction: Chronic sleep restriction (CSR) has been associated with increased calorie intake and increased consumption of fats and carbohydrates, with inconsistent changes in protein. However, the majority of studies have either been observational field studies with no sleep intervention, or laboratory-based studies where food availability may not have reflected participants’ real-world choices. We hypothesized that calorie, fat, and carbohydrate intake would increase during a week of imposed CSR compared to a week of sleep satiation (SS) among individuals living in their home environment. Methods: Twelve healthy participants (6 females) kept a fixed sleep-wake schedule, with a constant waketime, at home for four weeks (actigraphy confirmed compliance). During weeks one and three, participants maintained 9 hours in bed. During weeks two and four, participants were randomly assigned to experimental weeks of 5 and 9 hours of time-in-bed in a crossover design. Participants documented their food consumption during both experimental weeks using a picture-based meal logging application (MealLogger). Intake of calories and macronutrients were classified by two blinded evaluators. Descriptive statistics were calculated in SAS (Cary, NC). Results: Participants averaged 4.43 ± 0.33 (SD) hours of sleep per night during CSR compared to 7.42 ± 0.42 hours during SS. Participants consumed a daily average of 1812 ± 672 kilocalories, 71 ± 31 grams of total fat, 217 ± 69 grams of carbohydrates, and 84 ± 40 grams of protein during CSR, compared to 1682 ± 514 kilocalories, 68 ± 23 grams of total fat, 198 ± 61 grams of carbohydrates, and 77 ± 32 grams of protein during SS. Conclusion: Preliminary descriptive findings suggest that, on average, participants consumed more calories, from an increase in consumption of each macronutrient group, during a week of sleep restriction compared to a week of sleep satiation. Further analysis is needed to determine whether these differences are statistically different and to identify when calories were consumed in each of the experimental conditions.

chronic sleep restriction↗

An At-Home Evaluation of a Light Intervention to Mitigate Sleep Inertia Symptoms

Introduction: Sleep inertia symptoms typically occur after waking from nocturnal sleep. Under laboratory settings, light exposure upon waking has been shown to improve alertness, mood, and vigilant attention. We investigated whether a field-deployable light-emitting device would help to improve alertness and working memory in a real-world setting. Methods: Thirty-five participants (18 female; 26.4 ± 6.0 y) completed an at-home, within-subject, randomized crossover study. Participants wore actiwatches during their normal sleep-wake schedule for five nights ahead of the adaptation and experimental nights. On the experimental night, participants performed baseline testing before their self-selected bedtime. Forty-five minutes after bedtime, participants received a phone call and were instructed to perform test bouts while wearing light-emitting glasses with the light either on (light condition) or off (control). A 3-minute descending subtraction task (DST) and the Karolinska Sleepiness Scale (KSS) were performed at +7, +17, +27, and +37 minutes after the call. Participants were then instructed to go back to sleep and were called 45 minutes after lights out to repeat the test bouts in the opposite condition. A series of mixed-effects models were performed with fixed effects of condition, test bout, and their interaction, and a random effect of participant. Condition order, sex, and baseline were included as covariates. Results: There was a significant effect of test bout for DST total responses (χ2 [3] = 17.42; p < .001) and total correct (χ2 [3] = 21.29; p < .001) with improved performance at +27 and +37 minutes compared to +7 minutes. Sex was a significant predictor for KSS (F1,30 = 10.26; p = .003), with females (8.20 ± 0.23) rating higher sleepiness than males (7.10 ± 0.25). There were no other significant effects for DST or KSS outcomes (p > .05). Conclusion: These results suggest that the intervention was not able to improve working memory or alertness under naturalistic at-home settings. Further analysis is needed to determine whether these results are applicable to other cognitive performance domains.

light↗

Short-haul fatigue: A focus group study

Researchers from NASA Ames Research Center, together with research scientists from CAMI, are preparing to conduct a study to evaluate fatigue during short-haul operations. In order to develop the scope of our study, we conducted a series of focus groups across multiple US airlines. Participants were recruited through emails distributed by airline safety teams and union representatives. We conducted 14 focus groups in early 2022 for a total of 90 participants across four airlines. Participants were asked to identify short-haul pairings and operations that they felt: a) elevated fatigue, b) were not fatiguing, and c) were important to study. Data were collected anonymously and coded using content analysis techniques to identify main themes. This analysis is ongoing.

short-haul↗

Investigating the Effects of Exposure to Blue-Enriched Light or Peppermint Odor on Alertness, Mood, and Performance Upon Awakening from Deep Sleep at Night

Introduction: Sleep inertia refers the transient neurobehavioral impairments experienced immediately after waking from sleep. This period of reduced alertness and performance poses a significant safety risk to on-call workers who may be required to perform a safety-critical task immediately after waking (e.g., emergency services, health care, and military). In these operations, the need for a rapid return to full alertness is critical to mission safety and success. Several factors may exacerbate sleep inertia, resulting in greater impairment upon waking, including: waking from deep sleep, (i.e., slow wave sleep, SWS), waking at night, and waking following prior sleep loss. Awakenings under these conditions are common for on-call and extended shift workers who may need to perform safety-critical tasks soon after waking from unprotected sleep opportunities. Therefore, there is a need for evidence-based reactive countermeasures (i.e., used upon waking) to the cognitive consequences sleep inertia. Specifically, countermeasures that can rapidly restore alertness and performance immediately following sleep. A recent review of the literature on reactive countermeasures highlighted several research gaps and promising candidates for further investigation. The review also emphasized the need for countermeasures that are operationally viable and readily deployed in occupational settings. This study aims to address the identified gaps and limitations by assessing the efficacy of exposure to two known acute alerting stimuli - blue-enriched light and peppermint odor - to improve cognitive performance, alertness, and mood immediately after waking from SWS at night. Materials and Methods: Twelve participants completed a two-week within-subject, randomized, cross-over intervention study including two in-laboratory overnight visits. During each experimental week, the subjects experienced one intervention (light or peppermint) and a control condition upon awakening from SWS at night. The presentation order of the two conditions (intervention or control) at wake-up and the order of intervention (light or peppermint) by week was randomized by sex. Prior to each in-laboratory visit, participants maintained a sleep schedule of 8.5 h for 5 nights and 5 h for one night. Compliance with this sleep schedule was confirmed by actigraphy. In the laboratory, participants went to bed at their habitual bedtime and were monitored by standard polysomnography. After at least five minutes of continuous SWS, participants were awoken and exposed, in a randomized order, to either the control or intervention condition. During the hour after awakening from SWS (at 2, 17, 32, and 47 minutes after waking), participants completed a battery of tasks including a 5-minute psychomotor vigilance task (PVT), a subjective scale of alertness (Karolinska Sleepiness Scale, KSS), and visual analogue scales (VAS) of mood. Following this sleep inertia measurement period, all lights were turned off and participants were allowed to return to sleep. They were then awoken again from their subsequent SWS period and exposed to the alternative condition (control or intervention). Following this second awakening, participants were allowed to sleep until their habitual wake time and were then released from the laboratory. Participants then followed the at-home sleep schedule and returned to the laboratory for the second intervention (light or peppermint) following the procedures described above. The light intervention involved exposure to a blue-enriched light canvas illuminated for 1 hour at a distance of ~56 cm from the participant (~200 lux and ~60 melanopic lux at angle of gaze). For the peppermint intervention, peppermint oil was pipetted onto a mask, and participants inhaled the odor with the mask covering the nose and mouth for 1 minute. The control condition for both weeks involved a dim, red ambient light (<1 lux). An odorless mask, without any oil pipetted onto the mask, was also worn in the peppermint control condition. Results: Compared to the control condition, participants exposed to blue-enriched light had fewer PVT lapses (χ2 = 5.285, p = .022), reported feeling more alert (KSS: F1,77 = 4.955, p = .029; VASalert: F1,77 = 8.226, p = .005), and had improved mood (VAScheerful: F1,77 = 8.615, p = .004; VASdepressed: F1,77 = 4.649, p = .034; VASlethargic: F1,77 = 5.652, p = .020). Exposure to peppermint oil did not improve any outcome measures on any of the tasks compared to control condition (p > .05). Conclusions: We found that participants had fewer lapses of attention upon awakening when exposed to blue-enriched light compared to dim, red light. In addition, participants reported feeling more alert, more cheerful, less depressed, and less lethargic in the blue-enriched light condition. Brief exposure to a peppermint odor, however, did not appear to improve performance, alertness, or mood under the experimental conditions. Our null results in the peppermint condition may have been due to methodological limitations such as the duration and method of administration. Given the need to mitigate the potential impact of sleep inertia on safety-critical tasks in on-call operations, our findings suggest that blue-enriched light exposure upon awakening may help to improve performance and alertness during the sleep inertia period following awakening from deep, nocturnal sleep. We are currently exploring the potential mechanisms for the effect of light on cognitive performance upon awakening as well as investigating its application in real-world settings to explore the translational efficacy of this countermeasure to occupational environments. Continued exploration into light and other reactive countermeasures, and potentially their combination, is needed in order to provide evidence-based guidance on effective sleep inertia countermeasures to improve the alertness and performance of those required to perform safety-critical tasks soon after waking.

sleep inertia↗

Focus Group Study of US Pilots on Fatigue in Short-Haul Flight Operations

Introduction: There are few studies investigating the impact of fatigue in short-haul flight operations conducted under United States (US) Federal Aviation Regulations (FAR) Part 117 flight and duty limitations and rest requirements. In order to understand the fatigue factors unique to short-haul operations, we conducted a series of focus groups across four major commercial passenger airlines in the US. The outcomes of this study were intended to inform the scope of a larger study of fatigue in short-haul operations. Methods: Ninety short-haul pilots were recruited through emails distributed by airline safety teams and labor representatives. Fourteen focus groups were conducted via an online conferencing platform in which participants were asked to identify, specific to short-haul: a) schedules and operations that lead to elevated fatigue; b) schedules and operations that are not fatiguing, and c) important fatigue factors to study. Data were collected anonymously and coded using conventional qualitative content analysis, with axial coding and summative analysis used to identify main themes and over-arching categories. Results: Participants had an average of 12,348 (6,483) lifetime flying hours with 71 (14.5) hours of monthly flying. Forty-six percent of participants were captains. The six fatigue factor categories identified were: circadian disruption (e.g., circadian switches, redeyes), high workload (e.g., hassle factors, number of flights per duty), inadequate rest opportunity (e.g., minimum rest layovers, quality of rest facilities), schedule changes (e.g., unpredictability), regulation and policy issues (e.g., scheduling up to FAR 117 limits), and long sits (e.g., long wait times between flights). Discussion: A field study informed by these results and designed to investigate the prevalence and impact of these factors in US short-haul operations is currently underway.

aviation↗

Light as a Reactive Countermeasure to Sleep Inertia: Translating Laboratory Findings to the Field

Sleep inertia describes the brief period of impaired alertness, mood, and cognitive performance experienced after waking. Under laboratory settings, light exposure upon waking during a habitual sleep period has been shown to improve sleep inertia symptoms. We investigated whether a field-deployable light-emitting device would help to mitigate sleep inertia in a real-world setting. Thirty-six participants (18 female; 26.6 years ± 6.1) completed an at-home, within-subject, randomized crossover study. Participants followed their habitual sleep-wake schedule for five nights before an adaptation and experimental night. Forty-five minutes after bedtime on the experimental night, participants received a phone call and were instructed to wear light-emitting glasses with the light either on (light condition) or off (control). A 5-minute psychomotor vigilance task (PVT), the Karolinska Sleepiness Scale (KSS), visual analog scales of mood (VASmood), and a 3-minute descending subtraction task (DST) were performed starting at +2, +12, +22, and +32 minutes after the call. Participants then went back to sleep and were called 45 minutes after lights out for the opposite condition. A series of mixed-effects models were performed with fixed effects of test bout, condition, test bout × condition, and a random effect of participant. Covariates included pre-sleep baseline scores, randomization order, sex, and sleep history. Participants rated themselves as more alert and energetic in the light condition compared to the control condition (VASalert-sleepy p = .01; VASlethargic-energetic p = .001). There was no effect of condition for DST outcomes, but there was a significant improvement in DST total responses in the light condition in a subset of participants waking from N3 (p = .03). There was a significant effect of condition for PVT outcomes, with faster responses (p < .001) and fewer lapses (p < .001) in the control condition. Our results under naturalistic at-home settings suggest that, similar to the in-laboratory study findings, the light intervention improved subjective alertness and mood, while working memory improved after waking from N3. Future studies of light interventions should include measures of visual acuity and comfort to assess the full feasibility and efficacy of interventions in real-world environments.

sleep inertia↗

Is "Sleepy Supervision" the New "Drowsy Driving"?

Human error has been implicated as a causal factor in a large proportion of road accidents. Automated driving systems purport to mitigate this risk, but self-driving systems that allow a driver to entirely disengage from the driving task also require the driver to monitor the environment and take control when necessary. Given that sleep loss impairs monitoring performance and there is a high prevalence of sleep deficiency in modern society, we hypothesized that supervising a self-driving vehicle would unmask latent sleepiness compared to manually controlled driving among individuals following their typical sleep schedules. We found that participants felt sleepier, had more involuntary transitions to sleep, had slower reaction times and more attentional failures, and showed substantial modifications in brain synchronization during and following an autonomous drive compared to a manually controlled drive. Our findings suggest that the introduction of partial self-driving capabilities in vehicles has the potential to paradoxically increase accident risk.

sleepiness↗

The View From the Flight Deck: Pilot Perspectives on Fatigue in Short-Haul Operations

INTRODUCTION: There are few studies investigating the impact of fatigue in short-haul flight operations conducted under United States (US) Federal Aviation Regulations (FAR) Part 117 flight and duty limitations and rest requirements. In order to understand the fatigue factors unique to short-haul operations, we conducted a series of focus groups across four major commercial passenger airlines in the US. The outcomes of this study were intended to inform the scope of a larger study of fatigue in short-haul operations. METHODS: Ninety short-haul pilots were recruited through emails distributed by airline safety teams and labor representatives. Fourteen focus groups were conducted via an online conferencing platform in which participants were asked to identify, specific to short-haul: a) schedules and operations that lead to elevated fatigue; b) schedules and operations that are not fatiguing, and c) important fatigue factors to study. Data were collected anonymously and coded using conventional qualitative content analysis, with axial coding and summative analysis used to identify main themes and over-arching categories. RESULTS: Participants had an average of 12,348 (6,483) lifetime flying hours with 71 (14.5) hours of monthly flying. Forty-six percent of participants were captains. The six fatigue factor categories identified were: circadian disruption (e.g., circadian switches, redeyes), high workload (e.g., hassle factors, number of flights per duty), inadequate rest opportunity (e.g., minimum rest layovers, quality of rest facilities), schedule changes (e.g., unpredictability), regulation and policy issues (e.g., scheduling up to FAR 117 limits), and long sits (e.g., long wait times between flights). DISCUSSION: A field study informed by these results and designed to investigate the prevalence and impact of these factors in US short-haul operations is currently underway.

aviation↗

Can Pre-Flight Subjective Sleepiness Predict the Use of Controlled Rest on the Flight Deck?

Pilot sleepiness in flight continues to be an issue in aviation due to irregular and extended working hours. In some regions of the world, pilots are allowed to use an in-flight countermeasure called controlled rest, which involves taking a short nap on the flight deck. The use of this countermeasure in practice is understudied. We aimed to investigate whether subjective sleepiness ratings taken pre-flight are predictive of controlled rest use.

aviation↗

Light as a Reactive Countermeasure to Sleep Inertia: Translating Laboratory Findings to the Field

Sleep inertia describes the brief period of impaired alertness, mood, and cognitive performance experienced after waking. Under laboratory settings, light exposure upon waking during a habitual sleep period has been shown to improve sleep inertia symptoms. We investigated whether a field-deployable light-emitting device would help to mitigate sleep inertia in a real-world setting.\ Thirty-six participants (18 female; 26.6 years ± 6.1) completed an at-home, within-subject, randomized crossover study. Participants followed their habitual sleep-wake schedule for five nights before an adaptation and experimental night. Forty-five minutes after bedtime on the experimental night, participants received a phone call and were instructed to wear light-emitting glasses with the light either on (light condition) or off (control). A 5-minute psychomotor vigilance task (PVT), the Karolinska Sleepiness Scale (KSS), visual analog scales of mood (VASmood), and a 3-minute descending subtraction task (DST) were performed starting at +2, +12, +22, and +32 minutes after the call. Participants then went back to sleep and were called 45 minutes after lights out for the opposite condition. A series of mixed-effects models were performed with fixed effects of test bout, condition, test bout × condition, and a random effect of participant. Covariates included pre-sleep baseline scores, randomization order, sex, and sleep history. Participants rated themselves as more alert and energetic in the light condition compared to the control condition (VASalert-sleepy p = .01; VASlethargic-energetic p = .001). There was no effect of condition for DST outcomes, but there was a significant improvement in DST total responses in the light condition in a subset of participants waking from N3 (p = .03). There was a significant effect of condition for PVT outcomes, with faster responses (p < .001) and fewer lapses (p < .001) in the control condition. Our results under naturalistic at-home settings suggest that, similar to the in-laboratory study findings, the light intervention improved subjective alertness and mood, while working memory improved after waking from N3. Future studies of light interventions should include measures of visual acuity and comfort to assess the full feasibility and efficacy of interventions in real-world environments.

sleep inertia↗

Space Transport and Fatigue

Space travel presents numerous challenges to fatigue management. Fatigue in space results from many of the same challenges that shiftworkers face on Earth, including inadequate sleep, circadian misalignment, and elevated workload. However, spaceflight also presents unique challenges including circadian misalignment due to non-24- hour light-dark cycles, erratic work schedules due to operational constraints, a microgravity sleep environment, constraints to habitat design, and an isolated and confined living environment. These challenges can be mitigated with fatigue management strategies and countermeasures specifically targeted for space travel. Those strategies can include light interventions, advanced scheduling tools, improved habitat design, and pharmacological countermeasures. What is needed is a future-facing approach to most effectively manage the challenges that may arise as advancements in space travel continue to develop at a rapid pace.

sleep deprivation and performance↗

The Impact of Controlled Rest on Self-Reported Sleepiness at Top-of-Descent

INTRODUCTION: Long and irregular working hours can lead to fatigue in aviation operations. In some regions, a short nap taken on the flight deck (known as controlled rest) can be used as a countermeasure to unexpected in-flight sleepiness. We aimed to investigate the impact of taking controlled rest on self-reported sleepiness at top-of-descent. METHODS: Data from 120 long-haul (> 6 h flight duration), unaugmented flights were analyzed (n = 31 pilots). Pilots wore actigraphs and completed sleep logs before and during trips. At pre-flight and top-of-descent, pilots completed a Karolinska Sleepiness Scale (KSS). A mixed-effects model was used to assess the impact of controlled rest on KSS at top-of-descent. Sleep duration in the 48 hours prior to departure, timing of the flight (day vs. night), and pre-flight KSS scores were included as covariates. RESULTS: Due to missing data, complete data from 83 flights (n = 29 participants) were available in the analyses of the KSS. There were no differences by controlled rest status for KSS scores at top-of-descent (estimated marginal means ± SEM with controlled rest: 5.10 ± 0.22, without controlled rest: 5.37 ± 0.29; p = .45, η2p = 0.01). DISCUSSION: Our results suggest that there is no difference in self-reported sleepiness at top-of-descent on flights in which controlled rest was taken compared to flights without controlled rest. Further research is necessary to determine the impact of controlled rest on objective measures of performance at top-of-descent.

aviation↗