Sleep inertia

Morning sleep inertia in alertness and performance: effect of cognitive domain and white light conditions

The transition from sleep to wakefulness entails a temporary period of reduced alertness and impaired performance known as sleep inertia. The extent to which its severity varies with task and cognitive processes remains unclear. We examined sleep inertia in alertness, attention, working memory and cognitive throughput with the Karolinska Sleepiness Scale (KSS), the Psychomotor Vigilance Task (PVT), n-back and add tasks, respectively. The tasks were administered 2 hours before bedtime and at regular intervals for four hours, starting immediately after awakening in the morning, in eleven participants, in a four-way cross-over laboratory design. We also investigated whether exposure to Blue-Enhanced or Bright Blue-Enhanced white light would reduce sleep inertia. Alertness and all cognitive processes were impaired immediately upon awakening (p<0.01). However, alertness and sustained attention were more affected than cognitive throughput and working memory. Moreover, speed was more affected than accuracy of responses. The light conditions had no differential effect on performance except in the 3-back task (p<0.01), where response times (RT) at the end of four hours in the two Blue-Enhanced white light conditions were faster (200 ms) than at wake time. We conclude that the effect of sleep inertia varies with cognitive domain and that it’s spectral/intensity response to light is different from that of sleepiness. That is, just increasing blue-wavelength in light may not be sufficient to reduce sleep inertia. These findings have implications for critical professions like medicine, law-enforcement etc., in which, personnel routinely wake up from night-time sleep to respond to emergency situations.

Enhanced spontaneous oscillations in the supplementary motor area are associated with sleep-dependent offline learning of finger-tapping motor-sequence task

Sleep is beneficial for various types of learning and memory, including a finger-tapping motor-sequence task. However, methodological issues hinder clarification of the crucial cortical regions for sleep-dependent consolidation in motor-sequence learning. Here, to investigate the core cortical region for sleep-dependent consolidation of finger-tapping motor-sequence learning, while human subjects were asleep, we measured spontaneous cortical oscillations by magnetoencephalography together with polysomnography, and source-localized the origins of oscillations using individual anatomical brain information from MRI. First, we confirmed that performance of the task at a retest session after sleep significantly increased compared with performance at the training session before sleep. Second, spontaneous δ and fast-σ oscillations significantly increased in the supplementary motor area (SMA) during post-training compared with pretraining sleep, showing significant and high correlation with the performance increase. Third, the increased spontaneous oscillations in the SMA correlated with performance improvement were specific to slow-wave sleep. We also found that correlations of δ oscillation between the SMA and the prefrontal and between the SMA and the parietal regions tended to decrease after training. These results suggest that a core brain region for sleep-dependent consolidation of the finger-tapping motor-sequence learning resides in the SMA contralateral to the trained hand and is mediated by spontaneous δ and fast-σ oscillations, especially during slow-wave sleep. The consolidation may arise along with possible reorganization of a larger-scale cortical network that involves the SMA and cortical regions outside the motor regions, including prefrontal and parietal regions.

Altered overnight modulation of spontaneous waking EEG reflects altered sleep homeostasis in major depressive disorder: a high-density EEG investigation

BACKGROUND

Prior investigations have suggested sleep homeostasis is altered in major depressive disorder (MDD). Low frequency activity (LFA) in the electroencephalogram during waking has been correlated with sleep slow wave activity (SWA), suggesting that waking LFA reflects sleep homeostasis in healthy individuals. This study investigated whether the overnight change in waking LFA and its relationship with sleep SWA are altered in MDD.

METHODS

256-channel high-density electroencephalography (hdEEG) recordings during waking (pre- and post-sleep) and during sleep were collected in 14 unmedicated, unipolar MDD subjects (9 women) and age- and sex-matched healthy controls (HC).

RESULTS

Waking LFA (3.25-6.25 Hz) declined significantly overnight in the HC group, but not in the group of MDD subjects. Overnight decline of waking LFA correlated with sleep SWA in frontal brain regions in HC, but a comparable relationship was not found in MDD.

LIMITATIONS

This study is not able to definitely segregate overnight changes in the waking EEG that may occur due to homeostatic and/or circadian factors.

CONCLUSIONS

MDD involves altered overnight modulation of waking low frequency EEG activity that may reflect altered sleep homeostasis in the disorder. Future research is required to determine the functional significance and clinical implications of these findings.

Consolidation through the looking-glass: sleep-dependent proactive interference on visuomotor adaptation in children

Although a beneficial role of post-training sleep for declarative memory has been consistently evidenced in children, as in adults, available data suggest that procedural memory consolidation does not benefit from sleep in children. However, besides the absence of performance gains in children, sleep-dependent plasticity processes involved in procedural memory consolidation might be expressed through differential interference effects on the learning of novel but related procedural material. To test this hypothesis, 32 10-12-year-old children were trained on a motor rotation adaptation task. After either a sleep or a wake period, they were first retested on the same rotation applied at learning, thus assessing offline sleep-dependent changes in performance, then on the opposite (unlearned) rotation to assess sleep-dependent modulations in proactive interference coming from the consolidated visuomotor memory trace. Results show that children gradually improve performance over the learning session, showing effective adaptation to the imposed rotation. In line with previous findings, no sleep-dependent changes in performance were observed for the learned rotation. However, presentation of the opposite, unlearned deviation elicited significantly higher interference effects after post-training sleep than wakefulness in children. Considering that a definite feature of procedural motor memory and skill acquisition is the implementation of highly automatized motor behaviour, thus lacking flexibility, our results suggest a better integration and/or automation or motor adaptation skills after post-training sleep, eventually resulting in higher proactive interference effects on untrained material.

Delays of 5-15 min between awakening and the start of saliva sampling matter in assessment of the cortisol awakening response

Linking psychosocial measures to the cortisol awakening response (CAR) demands accurate saliva sampling times. Monitoring adherence to the saliva sampling protocol requires electronic monitoring of both awakening and sampling times since self-reported times are inaccurate. Delays greater than 15 min between awakening and commencement of saliva sampling reduce CAR magnitude. Less delay has been judged tolerable but remains unexplored for different magnitude measures, and for timing of the CAR peak. Study 1: Fifty healthy females (21 ± 4 years) were instructed to collect saliva on four days at 0, 15, 30 and 45 min post-awakening (samples 1-4). Both self-reported awakening and sampling times were electronically monitored using actigraphy and track caps. Self-reported awakening was later than actigraph estimated awakening (median difference of 4 min). Estimates of CAR magnitude were significantly greater on non-adherent days (delay of 5-15 min) compared to adherent days (delay<5 min). On non-adherent compared to adherent days cortisol on average peaked earlier, at sample 3 rather than at sample 4. Study 2: Accurately timed cortisol values were obtained in an intensive investigation of 10 participants who collected saliva on 2 days every 5 min for 30 min post-awakening. Cortisol did not significantly increase until 10 min post-awakening, suggesting a time lag may be typical between awakening and observation of a cortisol increase. We conclude that moderate delays between awakening and collection of saliva samples previously considered tolerable result in erroneous estimation of CAR magnitude and timing of the peak. These results are attributed to an approximate 10 min time lag between awakening and the start of the cortisol rise. The absence of this latent period in calculations leads to overestimation of the CAR magnitude on moderately non-adherent sampling days. These findings, if more universally generalizable, will further theoretical understanding of the physiology of the CAR, but are methodologically challenging for researchers since self-reported awakening times are not accurate enough to override the concerns raised. However accurate electronic measurement of adherence to protocol would enable sampling delays to be taken into account in computing CAR estimates.

Biological and psychological rhythms: an integrative approach to rhythm disturbances in autistic disorder

Biological rhythms are crucial phenomena that are perfect examples of the adaptation of organisms to their environment. A considerable amount of work has described different types of biological rhythms (from circadian to ultradian), individual differences in their patterns and the complexity of their regulation. In particular, the regulation and maturation of the sleep-wake cycle have been thoroughly studied. Its desynchronization, both endogenous and exogenous, is now well understood, as are its consequences for cognitive impairments and health problems. From a completely different perspective, psychoanalysts have shown a growing interest in the rhythms of psychic life. This interest extends beyond the original focus of psychoanalysis on dreams and the sleep-wake cycle, incorporating central theoretical and practical psychoanalytic issues related to the core functioning of the psychic life: the rhythmic structures of drive dynamics, intersubjective developmental processes and psychic containment functions. Psychopathological and biological approaches to the study of infantile autism reveal the importance of specific biological and psychological rhythmic disturbances in this disorder. Considering data and hypotheses from both perspectives, this paper proposes an integrative approach to the study of these rhythmic disturbances and offers an etiopathogenic hypothesis based on this integrative approach.

The effects of a self-selected nap opportunity on the psychophysiological, performance and subjective measures during a simulated industrial night shift regimen

This study compared the effects of a 1 h self-selected recovery period to those of a standard night shift arrangement (with a total break time of 1-h) over a simulated three-day night shift schedule in a laboratory setting. Results showed that the inclusion of the flexible nap scheme resulted in higher performance output, improvements in physiological strain responses and reduced sleepiness during each night shift and generally over the three-night cycle. Certain variables also revealed the impact of napping compared with the standard rest break condition on the circadian rhythm. The sleep diary records show that the inclusion of the current intervention did not significantly reduce daytime recovery sleep. The results suggest that the potential benefits of flexible napping may outweigh the logistical effort it requires in a workplace environment.

PRACTITIONER SUMMARY

Consensus on appropriate napping strategies for shift work remains a challenge. This simulated night shift laboratory study sought to determine the effects of a 1-h self-selected nap opportunity relative to a normal shift set-up. The nap improved performance and decreased sleepiness, without affecting daytime sleep.

Psychomotor performance of truck drivers before and after day shifts

OBJECTIVE

The aim of the present study is to evaluate the psychomotor performance of professional drivers in a field setting and in relation to certain variables, including age, behavioral factors, urinary levels of 6-sulfatoxymelatonin (aMT6s) normalized to urinary creatinine excretion, and the characteristics of the work shifts.

METHODS

The study was carried out on 16 professional male truck drivers aged 34-53 years. The drivers were submitted to the Vienna Reaction Test (RT) and Vienna Determination Test (DT) and provided urine specimens before and after 39 work shifts. They were also asked to record the road and traffic conditions (motorways, suburban and urban roads, traffic jams, visibility), duration, and mileage for each driving shift.

RESULTS

Using the 50th percentile as a cut point to arbitrarily categorize the performance measurements (Vienna RT reaction time and motor time, Vienna DT reaction time and number of correct reactions) into low and high performance levels, a direct relation emerged between the risk of low performance levels, as assessed by RT reaction time and motor time, and morning urinary levels of aMT6s categorized by tertiles. Before the driving shifts, the odds ratios of low performance levels (adjusted for start time and age) were 8.39 (95% confidence interval [CI]: 1.23-57.10) in the highest tertile compared to the lower tertile of aMT6s for RT reaction time and 4.15 (95% CI: 1.26-13.65) for RT motor time, respectively. After driving shifts, negative age-related effects on motor performance were detected. Multiple linear regression analyses, performed using early morning urinary aMT6s levels, age, and driving shift characteristics (start time, duration of driving shift) as predictors of performance measurements, showed aMT6s levels to be the primary independent predictor of RT reaction time before driving shifts and age as the primary predictor of RT motor time after driving shifts. No correlation was found between the risk of low performance levels as assessed by Vienna DT (reaction time and number of correct reactions) and aMT6s levels.

CONCLUSIONS

The wide interindividual variability of urinary aMT6s excretion observed before driving shifts and the direct association between aMT6s levels in the early morning and performance measurements suggest that the circadian typology of drivers should be taken into account when scheduling the work shifts of professional drivers.

Local experience-dependent changes in the wake EEG after prolonged wakefulness

STUDY OBJECTIVES

Prolonged wakefulness leads to a progressive increase in sleep pressure, reflected in a global increase in slow wave activity (SWA, 0.5-4.5 Hz) in the sleep electroencephalogram (EEG). A global increase in wake theta activity (5-9 Hz) also occurs. Recently, it was shown that prolonged wakefulness in rodents leads to signs of "local sleep" in an otherwise awake brain, accompanied by a slow/theta wave (2-6 Hz) in the local EEG that occurs at different times in different cortical areas. Compelling evidence in animals and humans also indicates that sleep is locally regulated by the amount of experience-dependent plasticity. Here, we asked whether the extended practice of tasks that involve specific brain circuits results in increased occurrence of local intermittent theta waves in the human EEG, above and beyond the global EEG changes previously described.

DESIGN

Participants recorded with high-density EEG completed 2 experiments during which they stayed awake ≥ 24 h practicing a language task (audiobook listening [AB]) or a visuomotor task (driving simulator [DS]).

SETTING

Sleep laboratory.

PATIENTS OR PARTICIPANTS

16 healthy participants (7 females).

INTERVENTIONS

Two extended wake periods.

MEASUREMENTS AND RESULTS

Both conditions resulted in global increases in resting wake EEG theta power at the end of 24 h of wake, accompanied by increased sleepiness. Moreover, wake theta power as well as the occurrence and amplitude of theta waves showed regional, task-dependent changes, increasing more over left frontal derivations in AB, and over posterior parietal regions in DS. These local changes in wake theta power correlated with similar local changes in sleep low frequencies including SWA.

CONCLUSIONS

Extended experience-dependent plasticity of specific circuits results in a local increase of the wake theta EEG power in those regions, followed by more intense sleep, as reflected by SWA, over the same areas.

Fifteen-hour day shifts have little effect on the performance of taskwork by anaesthesia trainees during uncomplicated clinical simulation

Shiftwork and work-hour limits for junior doctors are now well established in hospital work patterns. In order to ensure that trainees have adequate exposure to daytime elective surgical procedures, there is a tendency to have long shifts that include an after-hours component. However, long shifts can cause performance decrement due to time-on-task fatigue. In addition, shifts that encroach upon sleep time result in sleep loss. Using a high-fidelity patient simulation environment, we undertook a randomised, controlled trial to examine fatigue effects. A within-subjects comparison was used to evaluate the effect of 15-hour day shifts on the performance of 12 anaesthesia registrars. Preoperative assessment, machine check and taskwork using 42 task categories were evaluated. In both conditions, there was failure to meet current guidelines for preoperative evaluation or machine check, and when fatigued there was a 'trend' (P=0.06) to a reduction in the number of items in the machine check. With increase in time awake, there was an increase in time taken for explanation to the patient, an increase in mean duration of explanation to the patient, more time looking at the intravenous line or fluids when multi-tasking but less time adjusting the intravenous fluid. These effects are minor during routine uncomplicated induction of anaesthesia, but further investigation is needed to examine fatigue effects during non-routine circumstances.

Gender differences in nighttime sleep and daytime napping as predictors of mortality in older adults: the Rancho Bernardo study

OBJECTIVE

Many studies suggest optimal sleep duration for survival is 7-8h/night. We report the gender-specific independent association of all-cause mortality with nighttime sleep and daytime nap duration in older adults who were followed for up to 19years.

METHODS

Between 1984 and 1987, 2001 community-dwelling, mostly retired, adults (1112 women), age 60-96years, answered questions about health, mood, medications, life-style, daytime napping, and nighttime sleep duration. Vital status was confirmed for 96% through July 2001.

RESULTS

At baseline, men reported significantly longer nighttime sleep and daytime napping than women. In both men and women, nighttime sleep <6h was associated with depressed mood and sleep-related medication, and ⩾9h was associated with more alcohol consumption. Napping ⩾30min was associated with prevalent depressed mood, coronary heart disease, and cancer. Of the group, 61% died over the next 19years, at an average age of 85.6years. Mortality risk was lowest among those sleeping 7-7.9h/night in both men and women. Multiple-adjusted analyses showed that increased mortality was associated with nighttime sleep ⩾9h in women (HR 1.51: 95% CI=1.05-2.18), and with daytime napping ⩾30min in men (HR 1.28: 95% CI, 1.00-1.64).

CONCLUSIONS

Mechanisms for these differences are unknown.

Sleep architecture of consolidated and split sleep due to the dawn (Fajr) prayer among Muslims and its impact on daytime sleepiness

BACKGROUND:

Muslims are required to wake up early to pray (Fajr) at dawn (approximately one and one-half hours before sunrise). Some Muslims wake up to pray Fajr and then sleep until it is time to work (split sleep), whereas others sleep continuously (consolidated sleep) until work time and pray Fajr upon awakening.

AIM:

To objectively assess sleep architecture and daytime sleepiness in consolidated and split sleep due to the Fajr prayer.

SETTING AND DESIGN:

A cross-sectional, single-center observational study in eight healthy male subjects with a mean age of 32.0 ± 2.4 years.

METHODS:

The participants spent three nights in the Sleep Disorders Center (SDC) at King Khalid University Hospital, where they participated in the study, which included (1) a medical checkup and an adaptation night, (2) a consolidated sleep night, and (3) a split-sleep night. Polysomnography (PSG) was conducted in the SDC following the standard protocol. Participants went to bed at 11:30 PM and woke up at 7:00 AM in the consolidated sleep protocol. In the split-sleep protocol, participants went to bed at 11:30 PM, woke up at 3:30 AM for 45 minutes, went back to bed at 4:15 AM, and finally woke up at 7:45 AM. PSG was followed by a multiple sleep latency test to assess the daytime sleepiness of the participants.

RESULTS:

There were no differences in sleep efficiency, the distribution of sleep stages, or daytime sleepiness between the two protocols.

CONCLUSION:

No differences were detected in sleep architecture or daytime sleepiness in the consolidated and split-sleep schedules when the total sleep duration was maintained.

Differential effects of sodium oxybate and baclofen on EEG, sleep, neurobehavioral performance, and memory

STUDY OBJECTIVES

Sodium oxybate (SO) is a GABAβ agonist used to treat the sleep disorder narcolepsy. SO was shown to increase slow wave sleep (SWS) and EEG delta power (0.75-4.5 Hz), both indexes of NREM sleep (NREMS) intensity and depth, suggesting that SO enhances recuperative function of NREM. We investigated whether SO induces physiological deep sleep.

DESIGN

SO was administered before an afternoon nap or before the subsequent experimental night in 13 healthy volunteers. The effects of SO were compared to baclofen (BAC), another GABAβ receptor agonist, to assess the role of GABAβ receptors in the SO response.

MEASUREMENTS AND RESULTS

As expected, a nap significantly decreased sleep need and intensity the subsequent night. Both drugs reversed this nap effect on the subsequent night by decreasing sleep latency and increasing total sleep time, SWS during the first NREMS episode, and EEG delta and theta (0.75-7.25 Hz) power during NREMS. The SO-induced increase in EEG delta and theta power was, however, not specific to NREMS and was also observed during REM sleep (REMS) and wakefulness. Moreover, the high levels of delta power during a nap following SO administration did not affect delta power the following night. SO and BAC taken before the nap did not improve subsequent psychomotor performance and subjective alertness, or memory consolidation. Finally, SO and BAC strongly promoted the appearance of sleep onset REM periods.

CONCLUSIONS

The SO-induced EEG slow waves seem not to be functionally similar to physiological slow waves. Our findings also suggest a role for GABAβ receptors in REMS generation.

[The effects of self-awakening on daytime sleepiness]

This study investigated the effects of self-awakening on daytime sleepiness. Eleven undergraduate and graduate students without the habit of self-awakening participated. They were instructed to follow their usual sleep-wake schedule at home during the experimental weeks and were required to awaken at their usual time by themselves every morning for one week without the aid of an alarm (self-awakening condition) or in response to a telephone call from the experimenter every morning for another one week (forced-awakening condition). On the last day of each week, daytime tests were conducted in the laboratory. The participants would arrive at the laboratory 2 h after awakening, and 1 h later, they performed the auditory simple reaction time task, the digit-symbol substitution task, the letter cancellation test, and the multiple sleep latency test, and assessment of sleepiness, fatigue, comfort, and work motivation every 2 h. In the week when the participants underwent the self-awakening condition, self-awakening had a higher success rate (82%) than failure rate (18%) on the seventh day. In comparison with forced-awakening, self-awakening resulted in an improvement in subjective fatigue; however, sleepiness did not deteriorate.

Overnight changes in waking auditory evoked potential amplitude reflect altered sleep homeostasis in major depression

OBJECTIVE

Sleep homeostasis is altered in major depressive disorder (MDD). Pre- to postsleep decline in waking auditory evoked potential (AEP) amplitude has been correlated with sleep slow wave activity (SWA), suggesting that overnight changes in waking AEP amplitude are homeostatically regulated in healthy individuals. This study investigated whether the overnight change in waking AEP amplitude and its relation to SWA is altered in MDD.

METHOD

Using 256-channel high-density electroencephalography, all-night sleep polysomnography and single-tone waking AEPs pre- and postsleep were collected in 15 healthy controls (HC) and 15 non-medicated individuals with MDD.

RESULTS

N1 and P2 amplitudes of the waking AEP declined after sleep in the HC group, but not in MDD. The reduction in N1 amplitude also correlated with fronto-central SWA in the HC group, but a comparable relationship was not found in MDD, despite equivalent SWA between groups. No pre- to postsleep differences were found for N1 or P2 latencies in either group. These findings were not confounded by varying levels of alertness or differences in sleep variables between groups.

CONCLUSION

MDD involves altered sleep homeostasis as measured by the overnight change in waking AEP amplitude. Future research is required to determine the clinical implications of these findings.

The effects of a nighttime nap on the error-monitoring functions during extended wakefulness

STUDY OBJECTIVES

To examine the effects of a 1-hr nighttime nap, and the associated sleep inertia, on the error-monitoring functions during extended wakefulness using the 2 event-related potential components thought to reflect error detection and emotional or motivational evaluation of the error, i.e., the error-related negativity/error-negativity (ERN/Ne) and error-positivity (Pe), respectively.

DESIGN

Participants awakened at 07:00 the morning of the experimental day, and performed a stimulus-response compatibility (arrow-orientation) task at 21:00, 02:00, and 03:00.

SETTING

A cognitive task with EEG data recording was performed in a laboratory setting.

PARTICIPANTS

Twenty young adults (mean age 21.3 ± 1.0 yr, 14 males) participated.

INTERVENTIONS

Half of the participants took a 1-hr nap, and the others had a 1-hr awake-rest period from 01:00-02:00.

MEASUREMENTS AND RESULTS

Behavioral performance and amplitude of the Pe declined after midnight (i.e., 02:00 and 03:00) compared with the 21:00 task period in both groups. During the task period starting at 03:00, the participants in the awake-rest condition reported less alertness and showed fewer correct responses than those who napped. However, there were no effects of a nap on the amplitude of the ERN/Ne or Pe.

CONCLUSIONS

Our results suggest that a 1-hr nap can alleviate the decline in subjective alertness and response accuracy during nighttime; however, error-monitoring functions, especially emotional or motivational evaluation of the error, might remain impaired by extended wakefulness even after the nap. This phenomenon could imply that night-shift workers experiencing extended wakefulness should not overestimate the positive effects of a nighttime 1-hr nap during extended wakefulness.

The influence of circadian time and sleep dose on subjective fatigue ratings

Subjective ratings of fatigue are increasingly being used as part of a suite of tools to assess fatigue-related risk on the road and in the workplace. There is some debate however, as to whether individuals can accurately gauge their own fatigue states, particularly under conditions of sleep restriction. It is also unclear which references are used by individuals to assess fatigue - for example prior sleep, time of day, workload, or previous ratings. The current study used a sophisticated laboratory protocol to examine the independent contributions of sleep, circadian phase and sleep debt to fatigue ratings. Importantly, participants had no knowledge of time of day, how much sleep they were getting, or how long they were awake. Twenty-eight healthy, young males participated in one of two conditions of a 28 h forced desynchrony protocol - severe sleep restriction (4.7h sleep and 23.3h wake) or moderate sleep restriction (7h sleep and 21 h wake). Fatigue ratings were provided prior to and following each sleep period using the Samn-Perelli fatigue scale. Repeated measures ANOVAs were used to analyse the effects of circadian phase, sleep dose and study day. Results demonstrated an effect of circadian phase on both pre-sleep and post-sleep fatigue ratings. The significant effect of study day is interpreted as an effect of circadian time, as opposed to accumulating sleep debt. An effect of sleep dose was only seen in post-sleep fatigue ratings. The findings suggest that post-sleep fatigue ratings may be sensitive to prior sleep and may be useful as an indicator of fatigue-related risk, particularly when triangulated with information about recent total sleep time.

Network physiology reveals relations between network topology and physiological function

The human organism is an integrated network where complex physiological systems, each with its own regulatory mechanisms, continuously interact, and where failure of one system can trigger a breakdown of the entire network. Identifying and quantifying dynamical networks of diverse systems with different types of interactions is a challenge. Here we develop a framework to probe interactions among diverse systems, and we identify a physiological network. We find that each physiological state is characterized by a specific network structure, demonstrating a robust interplay between network topology and function. Across physiological states, the network undergoes topological transitions associated with fast reorganization of physiological interactions on time scales of a few minutes, indicating high network flexibility in response to perturbations. The proposed system-wide integrative approach may facilitate the development of a new field, Network Physiology.

Longitudinal study of self-awakening and sleep/wake habits in adolescents

Self-awakening is the ability to awaken without external assistance at a predetermined time. Cross-sectional studies reported that people who self-awaken have sleep/wake habits different from those of people who use external means to wake from sleep. However, no longitudinal study has examined self-awakening. The present study investigated self- awakening, both habitual and inconsistent, compared to awakening by external means in relation to sleep/wake schedules for five consecutive years in 362 students (starting at mean age 15.1 ± 0.3 years). Students who self-awakened consistently for five consecutive years (5% of all students) went to bed earlier than those who inconsistently self-awakened (mixed group, 40%) or consistently used forced awakening by external means (56%). Awakening during sleep was more frequent and sleep was lighter in the consistently self-awakened group than in the mixed and consistently forced-awakened groups. However, daytime dozing was less frequent and comfort immediately after awakening was greater for the consistently self-awakened group than for the mixed and consistently forced-awakened groups. These results indicate that the three groups have different sleep/wake habits. Previous studies of self-awakening using cross-sectional survey data may have confounded both consistent and inconsistent self-awakening habits. A longitudinal study is necessary to clarify the relationship between the self-awakening habit and sleep/wake patterns.

Effects of acute and chronic sleep deprivation on daytime alertness and cognitive performance of healthy snorers and non-snorers

BACKGROUND

Respiratory events during sleep usually lead to micro arousals resulting in consecutive daytime sleepiness even in healthy snorers. The present study investigated the evolution of subjective and objective daytime sleepiness and reaction time in healthy snorers submitted to acute and chronic sleep deprivation.

METHODS

Objective sleepiness was measured by the MSLT, subjective sleepiness by the Karolinska Sleepiness Scale (KSS), and reaction time (RT) by the Psychomotor Vigilance Test. Mean sleep latencies, KSS scores and performance were analyzed through repeated measures ANOVAs with one between-factor (snorers and non-snorers) and two within-factors (sleep deprivation [baseline, acute, and chronic sleep deprivation] and time-of-day).

RESULTS

The findings reveal that sleep deprivation does not enhance snoring but that, during baseline, objective daytime sleepiness is higher in snorers than in non-snorers (shorter sleep latencies) with no difference in subjective assessments. The effects of acute and chronic sleep deprivation on sleep are similar in both groups, but, after acute sleep deprivation, RT and attentional lapses (RT >500 ms) are higher in snorers. Chronic sleep deprivation produces similar results in both groups.

CONCLUSION

These results suggest that respiratory efforts may be involved in the increased vulnerability to sleep deprivation of healthy snorers when compared to non-snorers.

Short-term effects of morning versus evening dose of hydroxyzine 50 mg on cognition in healthy volunteers

It is well known that the sedative properties of antihistamines can differ considerably between individual drugs. Several factors have been suggested to determine the presence, absence, and/or magnitude of sedation by antihistamines. Research has suggested that the sedative effects caused by central H1 blockade partly depend on the availability of histamine competing for the same receptor and that this competition is affected by a mechanism related to sleep. Consequently, the present study was designed to compare the effects of evening and morning doses of the first-generation antihistamine hydroxyzine on cognition. It was expected that the sedative effect of hydroxyzine would be apparent in the evening after an evening dose but would be smaller in the morning after a morning dose owing to the greater release of histamine shortly after awakening. Eighteen participants (9 females) participated in a placebo-controlled, randomized, double-blind 3-way crossover design. Performance was assessed using several psychomotor tests: that is, divided attention task, critical tracking task, stop signal task, the attention network test, and the experimental attention switch task. Results demonstrated that evening doses of hydroxyzine impaired performance on the divided attention and the attention network test. Impairment after morning doses was generally larger in magnitude and affected performance measures in all tasks. It is concluded that hydroxyzine-induced impairment at tmax is more prominent after morning doses compared with evening doses and that the present study could not present direct evidence to substantiate the hypothesis that histamine availability inversely affects the magnitude of antihistamine impairment.

Hypnotizability, sleepiness, and subjective experience

The relationships between hypnotizability, sleepiness, and the subjective experience of hypnotic suggestions were investigated in 90 participants. Scores from the Harvard Group Scale of Hypnotic Susceptibility Form A (HGSHS:A), the Karolinska Sleepiness Scale (KSS), the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and our self-developed Questionnaire on Subjective Hypnotic Experiences (QSHE) were analyzed. Findings show that hypnotizability correlates with both habitual daytime sleepiness and instantaneous sleepiness after the hypnotic procedure. Results also indicate that subjective self-evaluation of responses to hypnotic suggestions may be a useful tool in some cases when comparing with other subjectively rated scales, such as those concerning sleepiness.

A postsleep decline in auditory evoked potential amplitude reflects sleep homeostasis

OBJECTIVE

It has been hypothesized that slow wave activity, a well established measure of sleep homeostasis that increases after waking and decreases after sleep, may reflect changes in cortical synaptic strength. If so, the amplitude of sensory evoked responses should also vary as a function of time awake and asleep in a way that reflects sleep homeostasis.

METHODS

Using 256-channel, high-density electroencephalography (EEG) in 12 subjects, auditory evoked potentials (AEP) and spontaneous waking data were collected during wakefulness before and after sleep.

RESULTS

The amplitudes of the N1 and P2 waves of the AEP were reduced after a night of sleep. In addition, the decline in N1 amplitude correlated with low-frequency EEG power during non-rapid eye movement sleep and spontaneous wakefulness, both homeostatically regulated measures of sleep need.

CONCLUSIONS

The decline in AEP amplitude after a night of sleep may reflect a homeostatic reduction in synaptic strength.

SIGNIFICANCE

These findings provide further evidence for a connection between synaptic plasticity and sleep homeostasis.

Enhancing pilot performance with a SymBodic system

Increased fatigue of pilots during long flights can place both humans and machine at high risk. In this paper, we describe our research on a SymBodic (SYMbiotic BODies) system designed to minimize pilot fatigue in a simulated 48 hour mission. The system detected the pilot's sleep breaks and used this information to plan future sleep breaks. When fatigue could not be prevented, the SymBodic system assisted the pilot by providing relevant flight information through a vibro-tactile vest. Experiments showed that it was difficult for the pilot to adapt to the suggested sleep schedule within the duration of the experiment, and fatigue was not avoided. However, during periods of severe sleep deprivation, the SymBodic system significantly improved piloting performance.

Influence of zolpidem and sleep inertia on balance and cognition during nighttime awakening: a randomized placebo-controlled trial

OBJECTIVES

To determine whether sleep inertia (grogginess upon awakening from sleep) with or without zolpidem impairs walking stability and cognition during awakenings from sleep.

DESIGN

Three within-subject conditions hypnotic medication (zolpidem), placebo (sleep inertia), and wakefulness control randomized using balanced Latin square design.

SETTING

Sleep laboratory.

PARTICIPANTS

Twelve older and 13 younger healthy adults.

INTERVENTION

Five milligrams of zolpidem or placebo 10 minutes before scheduled sleep (double-blind: zolpidem or sleep inertia); placebo before sitting in bed awake for 2 hours after their habitual bedtime (single-blind: wakefulness control).

MEASUREMENTS

Tandem walk on a beam and cognition, measured using computerized performance tasks, approximately 120 minutes after treatment.

RESULTS

No participants stepped off the beam on 10 practice trials. Seven of 12 older adults stepped off the beam after taking zolpidem, compared with none after sleep inertia and three after wakefulness control. Fewer young adults stepped off the beam: three after taking zolpidem, one after sleep inertia, and none after wakefulness control. Number needed to harm analyses showed one tandem walk failure for every 1.7 (95% confidence interval (CI)=1.4-2.0) older and 5.5 (95% CI=5.2-5.8) younger adults treated with zolpidem. Cognition was significantly more impaired after zolpidem exposure than with wakefulness control in older and younger participants (working memory: older, -4.3 calculations, 95% CI=-7.0 to -1.7; younger, -12.4 calculations, 95% CI=-18.2 to -6.7; Stroop: older, 76-ms increase (95% CI=13.5-138.4 ms); younger, 126-ms increase, 95% CI=34.7-217.5 ms), whereas sleep inertia significantly impaired cognition in younger but not older participants.

CONCLUSION

Zolpidem produced clinically significant balance and cognitive impairments upon awakening from sleep. Because impaired tandem walk predicts falls and hip fractures and because impaired cognition has important safety implications, use of nonbenzodiazepine hypnotic medications may have greater consequences for health and safety than previously recognized.

A conserved behavioral state barrier impedes transitions between anesthetic-induced unconsciousness and wakefulness: evidence for neural inertia

One major unanswered question in neuroscience is how the brain transitions between conscious and unconscious states. General anesthetics offer a controllable means to study these transitions. Induction of anesthesia is commonly attributed to drug-induced global modulation of neuronal function, while emergence from anesthesia has been thought to occur passively, paralleling elimination of the anesthetic from its sites in the central nervous system (CNS). If this were true, then CNS anesthetic concentrations on induction and emergence would be indistinguishable. By generating anesthetic dose-response data in both insects and mammals, we demonstrate that the forward and reverse paths through which anesthetic-induced unconsciousness arises and dissipates are not identical. Instead they exhibit hysteresis that is not fully explained by pharmacokinetics as previously thought. Single gene mutations that affect sleep-wake states are shown to collapse or widen anesthetic hysteresis without obvious confounding effects on volatile anesthetic uptake, distribution, or metabolism. We propose a fundamental and biologically conserved concept of neural inertia, a tendency of the CNS to resist behavioral state transitions between conscious and unconscious states. We demonstrate that such a barrier separates wakeful and anesthetized states for multiple anesthetics in both flies and mice, and argue that it contributes to the hysteresis observed when the brain transitions between conscious and unconscious states.

Meditation acutely improves psychomotor vigilance, and may decrease sleep need

Background

A number of benefits from meditation have been claimed by those who practice various traditions, but few have been well tested in scientifically controlled studies. Among these claims are improved performance and decreased sleep need. Therefore, in these studies we assess whether meditation leads to an immediate performance improvement on a well validated psychomotor vigilance task (PVT), and second, whether longer bouts of meditation may alter sleep need.

Methods

The primary study assessed PVT reaction times before and after 40 minute periods of mediation, nap, or a control activity using a within subject cross-over design.

This study utilized novice meditators who were current university students (n = 10). Novice meditators completed 40 minutes of meditation, nap, or control activities on six different days (two separate days for each condition), plus one night of total sleep deprivation on a different night, followed by 40 minutes of meditation.

A second study examined sleep times in long term experienced meditators (n = 7) vs. non-meditators (n = 23). Experienced meditators and controls were age and sex matched and living in the Delhi region of India at the time of the study. Both groups continued their normal activities while monitoring their sleep and meditation times.

Results

Novice meditators were tested on the PVT before each activity, 10 minutes after each activity and one hour later. All ten novice meditators improved their PVT reaction times immediately following periods of meditation, and all but one got worse immediately following naps. Sleep deprivation produced a slower baseline reaction time (RT) on the PVT that still improved significantly following a period of meditation. In experiments with long-term experienced meditators, sleep duration was measured using both sleep journals and actigraphy. Sleep duration in these subjects was lower than control non-meditators and general population norms, with no apparent decrements in PVT scores.

Conclusions

These results suggest that meditation provides at least a short-term performance improvement even in novice meditators. In long term meditators, multiple hours spent in meditation are associated with a significant decrease in total sleep time when compared with age and sex matched controls who did not meditate. Whether meditation can actually replace a portion of sleep or pay-off sleep debt is under further investigation.

Effects of artificial dawn on sleep inertia, skin temperature, and the awakening cortisol response

The effect of artificial dawn during the last 30 min of sleep on subsequent dissipation of sleep inertia was investigated, including possible involvement of cortisol and thermoregulatory processes. Sixteen healthy subjects who reported difficulty with waking up participated in random order in a control and an artificial dawn night. Sleep inertia severity was measured by subjective ratings of sleepiness and activation, and by performance on an addition and a reaction time task measured at 1, 15, 30, 45, 60, and 90 min after waking up at habitual wake up time at workdays. At all intervals, saliva samples were collected for cortisol analysis. Sleep electroencephalogram was recorded during the 30 min prior to waking up; core body temperature and skin temperatures were recorded continuously until 90 min after waking up. Subjective sleepiness was significantly decreased and subjective activation increased after waking up in the artificial dawn condition as compared with control, in which lights were turned on at waking up. These effects can be explained by effects of artificial dawn on skin temperature and amount of wakefulness during the 30 min prior to the alarm. Artificial dawn accelerated the decline in skin temperature and in the distal-to-proximal skin temperature gradient after getting up. No significant effects of artificial dawn on performance, core body temperature, and cortisol were found. These results suggest that the physiology underlying the positive effects of artificial dawn on the dissipation of sleep inertia involves light sleep and an accelerated skin temperature decline after awakening.

The effects of binge drinking on college students' next-day academic test-taking performance and mood state

AIM

To assess the effects of binge drinking on students' next-day academic test-taking performance.

DESIGN

A placebo-controlled cross-over design with randomly assigned order of conditions. Participants were randomized to either alcoholic beverage [mean = 0.12 g% breath alcohol concentration (BrAC)] or placebo on the first night and then received the other beverage a week later. The next day, participants were assessed on test-taking, neurocognitive performance and mood state.

PARTICIPANTS

A total of 196 college students (>or=21 years) recruited from greater Boston.

SETTING

The trial was conducted at the General Clinical Research Center at the Boston Medical Center.

MEASUREMENTS

The Graduate Record Examinations(c) (GREs) and a quiz on a lecture presented the previous day measured test-taking performance; the Neurobehavioral Evaluation System (NES3) and the Psychomotor Vigilance Test (PVT) measured neurocognitive performance; and the Profile of Mood States (POMS) measured mood.

FINDINGS

Test-taking performance was not affected on the morning after alcohol administration, but mood state and attention/reaction-time were affected.

CONCLUSION

Drinking to a level of 0.12 g% BrAC does not affect next-day test-taking performance, but does affect some neurocognitive measures and mood state.

Performance monitoring during sleep inertia after a 1-h daytime nap

Performance monitoring is an essential function involved in the correction of errors. Deterioration of this function may result in serious accidents. This function is reflected in two event-related potential (ERP) components that occur after erroneous responses, specifically the error-related negativity/error negativity (ERN/Ne) and error positivity (Pe). The ERN/Ne is thought to be associated with error detection, while the Pe is thought to reflect motivational significance or recognition of errors. Using these ERP components, some studies have shown that sleepiness resulting from extended wakefulness may cause a decline in error-monitoring function. However, the effects of sleep inertia have not yet been explored. In this study, we examined the effects of sleep inertia immediately after a 1-h daytime nap on error-monitoring function as expressed through the ERN/Ne and Pe. Nine healthy young adults participated in two different experimental conditions (nap and rest). Participants performed the arrow-orientation task before and immediately after a 1-h nap or rest period. Immediately after the nap, participants reported an increased effort to perform the task and tended to estimate their performance as better, despite no objective difference in actual performance between the two conditions. ERN/Ne amplitude showed no difference between the conditions; however, the amplitude of the Pe was reduced following the nap. These results suggest that individuals can detect their own error responses, but the motivational significance ascribed to these errors might be diminished during the sleep inertia experienced after a 1-h nap. This decline might lead to overestimation of their performance.

The Effect of Prior Endurance Training on Nap Sleep Patterns

Purpose:

The use of daytime napping as a recovery tool following exercise is virtually unexplored. The objective of this study was to assess the quality of daytime nap sleep following endurance training in an athletic population, and to appraise the optimal circadian timing of the nap and the time interval between training and the nap.

Methods:

Six physically trained male subjects (22.5 ± 2.4 y) performed four separate standardized 90-min endurance training sessions followed by a 90-min daytime nap either 1 or 2 h after training (time interval), commencing at either 10:30 or 11:30 (circadian timing). During the nap, sleep was monitored using polysomnography. Subjective measurements of sleep quality, alertness and preparedness to train following a nap were recorded using a visual analog scale.

Results:

The duration of slow wave sleep (SWS) was significantly greater during the 11:30 naps (13.7 ± 9.0 min) compared with the 10:30 naps (6.9 ± 8.8 min) (P = .049). There was no significant difference in SWS duration between a 1-h (10.6 ± 10.2 min) or 2-h (10.0 ± 9.0 min) time interval between training and the nap (P = .82). No other sleep variables differed significantly according to circadian timing or time interval.

Conclusion:

Recovery naps commenced later in the morning contain more SWS than earlier naps. The data imply that daytime naps have a potential role as a valuable recovery tool following endurance exercise, given the suggested energy restorative functions of SWS.

Intoxication with bourbon versus vodka: effects on hangover, sleep, and next-day neurocognitive performance in young adults

BACKGROUND

This study assessed the effects of heavy drinking with high or low congener beverages on next-day neurocognitive performance, and the extent to which these effects were mediated by alcohol-related sleep disturbance or alcoholic beverage congeners, and correlated with the intensity of hangover.

METHODS

Healthy heavy drinkers age 21 to 33 (n = 95) participated in 2 drinking nights after an acclimatization night. They drank to a mean of 0.11 g% breath alcohol concentration on vodka or bourbon one night with matched placebo the other night, randomized for type and order. Polysomnography recordings were made overnight; self-report and neurocognitive measures were assessed the next morning.

RESULTS

After alcohol, people had more hangover and more decrements in tests requiring both sustained attention and speed. Hangover correlated with poorer performance on these measures. Alcohol decreased sleep efficiency and rapid eye movement sleep, and increased wake time and next-day sleepiness. Alcohol effects on sleep correlated with hangover but did not mediate the effects on performance. No effect of beverage congeners was found except on hangover severity, with people feeling worse after bourbon. Virtually no sex differences appeared.

CONCLUSIONS

As drinking to this level affects complex cognitive abilities, safety could be affected, with implications for driving and for safety-sensitive occupations. Congener content affects only how people feel the next day so does not increase risk. The sleep disrupting effects of alcohol did not account for the impaired performance so other mechanisms of effect need to be sought. As hangover symptoms correlate with impaired performance, these might be contributing to the impairment.