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At least 19 records

The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation

OBJECTIVES: To inform the debate over whether human sleep can be chronically reduced without consequences, we conducted a dose-response chronic sleep restriction experiment in which waking neurobehavioral and sleep physiological functions were monitored and compared to those for total sleep deprivation. DESIGN: The chronic sleep restriction experiment involved randomization to one of three sleep doses (4 h, 6 h, or 8 h time in bed per night), which were maintained for 14 consecutive days. The total sleep deprivation experiment involved 3 nights without sleep (0 h time in bed). Each study also involved 3 baseline (pre-deprivation) days and 3 recovery days. SETTING: Both experiments were conducted under standardized laboratory conditions with continuous behavioral, physiological and medical monitoring. PARTICIPANTS: A total of n = 48 healthy adults (ages 21-38) participated in the experiments. INTERVENTIONS: Noctumal sleep periods were restricted to 8 h, 6 h or 4 h per day for 14 days, or to 0 h for 3 days. All other sleep was prohibited. RESULTS: Chronic restriction of sleep periods to 4 h or 6 h per night over 14 consecutive days resulted in significant cumulative, dose-dependent deficits in cognitive performance on all tasks. Subjective sleepiness ratings showed an acute response to sleep restriction but only small further increases on subsequent days, and did not significantly differentiate the 6 h and 4 h conditions. Polysomnographic variables and delta power in the non-REM sleep EEG-a putative marker of sleep homeostasis--displayed an acute response to sleep restriction with negligible further changes across the 14 restricted nights. Comparison of chronic sleep restriction to total sleep deprivation showed that the latter resulted in disproportionately large waking neurobehavioral and sleep delta power responses relative to how much sleep was lost. A statistical model revealed that, regardless of the mode of sleep deprivation, lapses in behavioral alertness were near-linearly related to the cumulative duration of wakefulness in excess of 15.84 h (s.e. 0.73 h). CONCLUSIONS: Since chronic restriction of sleep to 6 h or less per night produced cognitive performance deficits equivalent to up to 2 nights of total sleep deprivation, it appears that even relatively moderate sleep restriction can seriously impair waking neurobehavioral functions in healthy adults. Sleepiness ratings suggest that subjects were largely unaware of these increasing cognitive deficits, which may explain why the impact of chronic sleep restriction on waking cognitive functions is often assumed to be benign. Physiological sleep responses to chronic restriction did not mirror waking neurobehavioral responses, but cumulative wakefulness in excess of a 15.84 h predicted performance lapses across all four experimental conditions. This suggests that sleep debt is perhaps best understood as resulting in additional wakefulness that has a neurobiological "cost" which accumulates over time.

NASA Discipline Regulatory Physiology

Astronaut Sleep Duration Varies by Timing of Scheduled Sleep

INTRODUCTION: Studies find that humans average approximately six hours of sleep per night in space, which is less than they sleep on Earth. Such short sleep duration has been associated with reduced alertness and performance in space. It is unclear whether this sleep loss is related to modifiable factors, such as irregular scheduling, poor sleep environment, and excessive workload or due to features of spaceflight that alter physiology (e.g., microgravity). Recent missions have afforded crew better, more stable sleep and work schedules, and an improved sleep environment. Despite these improvements, schedules do still vary enough to cause decrements in sleep duration. METHODS: Crewmembers (n = 19) who volunteered for the NASA Standard Measures protocol between January 2019 and March 2022 were provided with actiwatches (Phillips, Respironics, Bend OR) that they wore for two bouts of data collection lasting two weeks each before flight (at approximately L-270 and L-180), either continuously (n = 9) or for two weeks every two months while in space (n = 10), and for seven days postflight, immediately upon return to Earth (R+0). A regularly scheduled (or “nominal”) sleep episode would take place between the hours of 9:30pm and 6:00am. We looked at sleep outcomes (sleep duration, wake after sleep onset [WASO], sleep efficiency) depending on the distance from nominal sleep offset to see whether scheduled sleep period affected sleep durations and other metrics of sleep quality. RESULTS: Crewmembers provided data from 402 nights preflight, 2,137 nights inflight, and 275 nights postflight. They averaged 7.33 hours of sleep per night (± 1.16, SD) in space. Though this was significantly less sleep than they achieved preflight (7.87 ± 1.10) or postflight (7.75 ± 1.43, p < .01), this duration of sleep meets the recommended amount for optimal human health and well-being. For every hour after the nominal sleep period a crewmember woke up, their total sleep increased by 25 minutes (up to 5 hours). CONCLUSIONS: We conclude that humans are capable of achieving sufficient sleep in space, especially when their schedules afford adequate sleep (namely, schedules that phase delay rather than advance). Future studies are needed to determine whether microgravity impacts sleep architecture and sleep quality. Going forward, it is imperative that crewmembers are provided with stable schedules, with moderate workload, and environments that are conducive to sleep.

fatigue

Neuroimmunologic aspects of sleep and sleep loss

The complex and intimate interactions between the sleep and immune systems have been the focus of study for several years. Immune factors, particularly the interleukins, regulate sleep and in turn are altered by sleep and sleep deprivation. The sleep-wake cycle likewise regulates normal functioning of the immune system. Although a large number of studies have focused on the relationship between the immune system and sleep, relatively few studies have examined the effects of sleep deprivation on immune parameters. Studies of sleep deprivation's effects are important for several reasons. First, in the 21st century, various societal pressures require humans to work longer and sleep less. Sleep deprivation is becoming an occupational hazard in many industries. Second, to garner a greater understanding of the regulatory effects of sleep on the immune system, one must understand the consequences of sleep deprivation on the immune system. Significant detrimental effects on immune functioning can be seen after a few days of total sleep deprivation or even several days of partial sleep deprivation. Interestingly, not all of the changes in immune physiology that occur as a result of sleep deprivation appear to be negative. Numerous medical disorders involving the immune system are associated with changes in the sleep-wake physiology--either being caused by sleep dysfunction or being exacerbated by sleep disruption. These disorders include infectious diseases, fibromyalgia, cancers, and major depressive disorder. In this article, we will describe the relationships between sleep physiology and the immune system, in states of health and disease. Interspersed will be proposals for future research that may illuminate the clinical relevance of the relationships between sleeping, sleep loss and immune function in humans. Copyright 2001 by W.B. Saunders Company.

NASA Discipline Space Human Factors

Individual Differences in Response to Sleep Deprivation: Assessment of Fatigue Following Sleep Loss

Previous work has indicated that a small but significant number of participants in sleep deprivation studies or in simulated shift work experiments manifests an exaggerated performance decrement when they reach a critical point in the experiment, usually near the trough of the circadian cycle or the middle of the night. Those who show this exaggerated response do not appear to differ from other non-nal volunteers in any substantial way according to usual screening criteria or baseline values. The present study aims to examine factors that may provide the basis for this extreme response. We propose that a preexisting sleep deficit-as manifested by low values on the Multiple Sleep Latency Test (MSLT)-may account for extreme responders. Roth and colleagues (1993) have shown that among normal volunteers screened for a variety of studies, approximately 20 to 25 percent show low (< 6 minutes) MSLT scores on a consistent basis, whereas a like proportion shows consistently high MSLT scores (> 13 minutes). Additionally, studies by this group have indicated that subjects with low MSLT scores may suffer from chronic insufficient sleep (Roth et al., 1993), as further substantiated by the finding that they have consistently higher nocturnal sleep efficiency and that their MSLT scores rise to normal values when sleep is extended (Roehrs et al., 1996). We hypothesize that the short MSLT subjects have a significant long-term sleep deficit that leads to a marked intolerance for sleep deprivation or shift work. We further suggest that this sleep debt may signify an increased sleep need in these individuals that is not met either due to personal preference or to societal pressures (or both). If this speculation is accurate, then we predict that the tolerance for sleep deprivation in such individuals can be increased by "pretreatment" with sleep extension. Thus, the present study is designed to test the following two hypotheses: subjects with nominal sleep patterns who have low MSLT scores (e.g., Sleepy subjects) will show an exaggerated response (performance decrement) to sleep loss compared to subjects who have high MSLT scores (Alert subjects) on a nominal sleep schedule. when permitted to extend sleep-thus discharging their sleep debt-the Sleepy subjects will show a sleep-loss response resembling that of the Alert subjects.

Carskadon, Mary A.

Individual Differences in Response to Sleep Deprivation: Assessment of Fatigue Following Sleep Loss

Previous work has indicated that a small but significant number of participants in sleep deprivation studies or in simulated shift work experiments manifests an exaggerated performance decrement when they reach a critical point in the experiment, usually near the trough of the circadian cycle or the middle of the night. Those who show this exaggerated response do not appear to differ from other non-nal volunteers in any substantial way according to usual screening criteria or baseline values. The present study aims to examine factors that may provide the basis for this extreme response. We propose that a preexisting sleep deficit-as manifested by low values on the Multiple Sleep Latency Test (MSLT)-may account for extreme responders. It has been shown that among normal volunteers screened for a variety of studies, approximately 20 to 25 percent show low (< 6 minutes) MSLT scores on a consistent basis, whereas a like proportion shows consistently high MSLT scores (> 13 minutes). Additionally, studies by this group have indicated that subjects with low MSLT scores may suffer from chronic insufficient sleep, as further substantiated by the finding that they have consistently higher nocturnal sleep efficiency and that their MSLT scores rise to normal values when sleep is extended. We hypothesize that the short MSLT subjects have a significant long-term sleep deficit that leads to a marked intolerance for sleep deprivation or shift work. We further suggest that this sleep debt may signify an increased sleep need in these individuals that is not met either due to personal preference or to societal pressures (or both). If this speculation is accurate, then we predict that the tolerance for sleep deprivation in such individuals can be increased by "pretreatment" with sleep extension. Thus, the present study is designed to test the following two hypotheses: (1) subjects with nominal sleep patterns who have low MSLT scores (e.g., Sleepy subjects) will show an exaggerated response (performance decrement) to sleep loss compared to subjects who have high MSLT scores (Alert subjects) on a nominal sleep schedule; (2) when permitted to extend sleep--thus discharging their sleep debt-the Sleepy subjects will show a sleep-loss response resembling that of the Alert subjects.

Carskadon, Mary A.

Individual Differences in Response to Sleep Deprivation: Assessment of Fatigue Following Sleep Loss

Previous work has indicated that a small but significant number of participants in sleep deprivation studies or in simulated shift work experiments manifests an exaggerated performance decrement when they reach a critical point in the experiment, usually near the trough of the circadian cycle or the middle of the night. Those who show this exaggerated response do not appear to differ from other normal volunteers in any substantial way according to usual screening criteria or baseline values. The present study aims to examine factors that may provide the basis for this extreme response. We propose that a preexisting sleep deficit-as manifested by low values on the Multiple Sleep Latency Test (MSLT)-may account for extreme responders. Roth and colleagues (1993) have shown that among normal volunteers screened for a variety of studies, approximately 20 to 25 percent show low (< or = 6 minutes) MSLT scores on a consistent basis, whereas a like proportion shows consistently high MSLT scores (> or = 13 minutes). Additionally, studies by this group have indicated that subjects with low MSLT scores may suffer from chronic insufficient sleep (Roth et al., 1993), as further substantiated by the finding that they have consistently higher nocturnal sleep efficiency and that their MSLT scores rise to normal values when sleep is extended (Roehrs et al., 1996). We hypothesize that the short MSLT subjects have a significant long-term sleep deficit that leads to a marked intolerance for sleep deprivation or shift work. We further suggest that this sleep debt may signify an increased sleep need in these individuals that is not met either due to personal preference or to societal pressures (or both). If this speculation is accurate, then we predict that the tolerance for sleep deprivation in such individuals can be increased by "pretreatment" with sleep extension. Thus, the present study is designed to test the following two hypotheses: subjects with nominal sleep patterns who have low MSLT scores (e.g., Sleepy subjects) will show an exaggerated response (performance decrement) to sleep loss compared to subjects who have high MSLT scores (Alert subjects) on a nominal sleep schedule. When permitted to extend sleep-thus discharging their sleep debt-the Sleepy subjects will show a sleep-loss response resembling that of the Alert subjects.

Carskadon, Mary A.

Jet Lag, Sleep Timing, and Sleep Inertia

This chapter explores the causes, consequences, and countermeasures of jet lag, mistimed sleep, and sleep inertia. Jet lag can occur when rapidly crossing multiple time zones (e.g., trans-meridian travel for long-haul pilots). The desynchrony between the body’s biological clock, or circadian rhythm, and the new day-night cycle can lead to indigestion, sleep disturbances, fatigue, and cognitive impairments. Mistimed sleep can also occur within a time zone. In the case of night shiftwork, sleep is displaced to the daytime which leads to poor sleep and increased fatigue at night due to the combination of pressures from the two-process model of sleep regulation: sleep loss (homeostatic pressure); and being awake when the body is promoting sleep (circadian pressure). There is also a third process of sleep regulation called sleep inertia, which refers to the brief period of fatigue and impaired cognitive performance experienced after waking. Sleep inertia can be a fatigue risk for transportation workers who work on-call (e.g., emergency services) or who nap on shift (e.g., long-haul truck drivers) and are required to perform a safety-critical task soon after waking. For each of these fatigue risks, strategic exposure to bright light can be used to help realign sleep timing and to promote alertness.

sleep inertia

Crew factors in flight operations. 8: Factors influencing sleep timing and subjective sleep quality in commercial long-haul flight crews

How flight crews organize their sleep during layovers on long-haul trips is documented. Additionally, environmental and physiological constraints on sleep are examined. In the trips studied, duty periods averaging 10.3 hr alternated with layovers averaging 24.8 hr, which typically included two subject-defined sleep episodes. The circadian system had a greater influence on the timing and duration of first-sleeps than second-sleeps. There was also a preference for sleeping during the local night. The time of falling asleep for second-sleeps was related primarily to the amount of sleep already obtained in the layover, and their duration depended on the amount of time remaining in the layover. For both first- and second-sleeps, sleep durations were longer when subjects fell asleep earlier with respect to the minimum of the circadian temperature cycle. Naps reported during layovers and on the flight deck may be a useful strategy for reducing cumulative sleep loss. The circadian system was not able to synchronize with the rapid series of time-zone shifts. The sleep/wake cycle was forced to adopt a period different from that of the circadian system. Flight and duty time regulations are a means of ensuring that reasonable minimum rest periods are provided. This study clearly documents that there are physiologically and environmentally determined preferred sleep times within a layover. The actual time available for sleep is thus less than the scheduled rest period.

Gander, Philippa H.

Measuring sleep habits without using a diary: the sleep timing questionnaire

STUDY OBJECTIVES: To develop a single-administration instrument yielding equivalent measures of sleep to those obtained from a formal (2-week) sleep diary. DESIGN & SETTING: A single-administration Sleep riming Questionnaire (STQ) is described (and reproduced in the Appendix). Test-retest reliability was examined in 40 subjects who were given the STQ on two occasions separated by less than 1 year. Convergent validity was measured both by comparing STO-derived measures with objective measures derived from wrist actigraphy (n=23) and by comparing STQ-derived measures with other subjective measures derived from a detailed 2-week sleep diary in two nonoverlapping samples (n=101, 93). Correlations of STQ measures with age and momingness-eveningness (chronotype) were also examined. SUBJECTS: The analyses used sample sizes of 40, 23, 101, and 93 (both genders, overall age range 20y-89y). Most subjects were healthy volunteers; some Study 4 subjects were patients (enrolled in research protocols). RESULTS: Test-retest reliability for the STQ was demonstrated for estimates of bedtime (r = 0.705, p < 0.001) and waketime (r = 0.826, p < 0.001). Convergent validity using wrist actigraphy was demonstrated by correlations of 0.592 (p < 0.005) for bedtime, and of 0.769 (p < 0.001) for waketime. Diary studies indicated STQ bedtime and waketime data to be highly correlated (at about 0.8) with those obtained from a formal 2-week sleep diary. The STQ also provided data on estimated sleep latency and wake after sleep onset (WASO), which correlated reliably (at about 0.7) with average nightly ratings of these variables from a 2-week sleep diary. Mean estimated values of sleep latency and WASO from the two instruments were within 1 minute of each other. ST-derived bedtimes and waketimes correlated with both age and chronotype in the expected direction (older subjects earlier, morning types earlier). CONCLUSION: The STQ may be a reliable valid measure of sleep timing that could provide a time-efficient alternative to traditional sleep diaries.

Validation Studies

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

Frontal predominance of a relative increase in sleep delta and theta EEG activity after sleep loss in humans

The effect of sleep deprivation (40 h) on topographic and temporal aspects of electroencephalographic (EEG) activity during sleep was investigated by all night spectral analysis in six young volunteers. The sleep-deprivation-induced increase of EEG power density in the delta and theta frequencies (1-7 Hz) during nonREM sleep, assessed along the antero-posterior axis (midline: Fz, Cz, Pz, Oz), was significantly larger in the more frontal derivations (Fz, Cz) than in the more parietal derivations (Pz, Oz). This frequency-specific frontal predominance was already present in the first 30 min of recovery sleep, and dissipated in the course of the 8-h sleep episode. The data demonstrate that the enhancement of slow wave EEG activity during sleep following extended wakefulness is most pronounced in frontal cortical areas.

NASA Discipline Space Human Factors

Better Performance on the Psychomotor Vigilance Task Is Associated with Longer Sleep Duration and Lower Self-Reported Sleep Need in the Real World

The psychomotor vigilance task (PVT) is sensitive measure of performance impairment arising from sleep loss and circadian misalignment. Some individuals are able to maintain stable, good performance during laboratory-imposed sleep restriction. It is unclear whether such individuals need less sleep or whether they are more resilient to the effects of sleep loss. We aimed to characterize the relationship between sleep duration and perceived sleep need with PVT performance under real-world conditions.

sleep

Sleep-wake cycle effects on sleep stages, and plasma cortisol and growth secretions

Studies were made of the effects of various stimuli on sleep stages and of secretion of a number of different hormones during sleep in human subjects. Among the stimuli were vestibular stimulation, the action of L-Dopa, and a three-hour sleep-wake cycle. Hormones observed included plasma cortisol, growth hormone, dehydroisoandrosterone, and luteinizing hormone. Relationships between sleep onset, the presence of Cushing's syndrome or sleep disorders, and ultradian rhythmicity, and hormone secretion were investigated. Sleep patterns and hormone secretion in normal subjects were also studied.

Source record

Effect of sleep-wake reversal and sleep deprivation on the circadian rhythm of oxygen toxicity seizure susceptibility.

Albino Sprague-Dawley rats were exposed in a previously O2 flushed, CO2 free chamber. The exposure began with attainment of 60 psi (gauge) and the end point was the first generalized oxygen toxicity seizure. Animals were exposed to reversal diurnal conditions since weanlings until their sleep-wake cycles had completely reversed, and then divided into four groups of 20 based on the time of day exposed. The time of exposure to oxygen at high pressure prior to seizure was now significantly longer in the group exposed from 1900 to 2000 hr and a reversal of the circadian rhythm of oxygen toxicity seizure susceptibility was noted. Animals maintained on normal diurnal conditions were deprived of sleep on the day of exposure for the 12 hours prior to exposure at 1900 hr, while controls were allowed to sleep. There was no significant differences in the time prior to seizure between the deprived animals and the controls with an n = 40. Thus the inherent threshold in susceptibility to high-pressure oxygen seizures seems not to be a function of sleep itself, but of some biochemical/physiologic event which manifests a circadian rhythm.

Dexter, J. D.

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

Sleep mechanisms: Sleep deprivation and detection of changing levels of consciousness

An attempt was made to obtain information relevant to assessing the need to sleep and make up for lost sleep. Physiological and behavioral parameters were used as measuring parameters. Sleep deprivation in a restricted environment, derivation of data relevant to determining sleepiness from EEG, and the development of the Sanford Sleepiness Scale were discussed.

Dement, W. C.