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Campanella C, Byun K, Senerat A, Li L, Zhang R, Aristizabal S, Porter P, Bauer B. The Efficacy of a Multimodal Bedroom-Based 'Smart' Alarm System on Mitigating the Effects of Sleep Inertia. Clocks Sleep 2024; 6:183-199. [PMID: 38534801 DOI: 10.3390/clockssleep6010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
Previous work has demonstrated the modest impact of environmental interventions that manipulate lighting, sound, or temperature on sleep inertia symptoms. The current study sought to expand on previous work and measure the impact of a multimodal intervention that collectively manipulated light, sound, and ambient temperature on sleep inertia. Participants slept in the lab for four nights and were awoken each morning by either a traditional alarm clock or the multimodal intervention. Feelings of sleep inertia were measured each morning through Psychomotor Vigilance Test (PVT) assessments and ratings of sleepiness and mood at five time-points. While there was little overall impact of the intervention, the participant's chronotype and the length of the lighting exposure on intervention mornings both influenced sleep inertia symptoms. Moderate evening types who received a shorter lighting exposure (≤15 min) demonstrated more lapses relative to the control condition, whereas intermediate types exhibited a better response speed and fewer lapses. Conversely, moderate evening types who experienced a longer light exposure (>15 min) during the intervention exhibited fewer false alarms over time. The results suggest that the length of the environmental intervention may play a role in mitigating feelings of sleep inertia, particularly for groups who might exhibit stronger feelings of sleep inertia, including evening types.
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Affiliation(s)
- Carolina Campanella
- Delos Living LLC, New York, NY 10014, USA
- Well Living Lab, Inc., Rochester, MN 55902, USA
| | - Kunjoon Byun
- Delos Living LLC, New York, NY 10014, USA
- Well Living Lab, Inc., Rochester, MN 55902, USA
| | - Araliya Senerat
- Well Living Lab, Inc., Rochester, MN 55902, USA
- International Society for Urban Health, New York, NY 10003, USA
| | - Linhao Li
- Delos Living LLC, New York, NY 10014, USA
- Well Living Lab, Inc., Rochester, MN 55902, USA
| | | | - Sara Aristizabal
- Delos Living LLC, New York, NY 10014, USA
- Well Living Lab, Inc., Rochester, MN 55902, USA
| | - Paige Porter
- Well Living Lab, Inc., Rochester, MN 55902, USA
- School of Environment and Sustainability, University of Michigan, Ann Arbor, MI 48109, USA
| | - Brent Bauer
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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2
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Beute F, Aries MB. The importance of residential dusk and dawn light exposure for sleep quality, health, and well-being. Sleep Med Rev 2023; 72:101865. [PMID: 37864914 DOI: 10.1016/j.smrv.2023.101865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/23/2023]
Abstract
Light exposure during twilight plays a critical role in the entrainment of the human circadian system. People are most often at home during dusk and dawn, and light exposure at home - either natural or from electric light - may therefore contribute substantially to sleep and well-being. However, very little research has focused on the effects of home lighting on sleep and well-being, and even less research has investigated the effects of light exposure during twilight. Therefore, a literature study was performed to collect studies on light exposure at home during dusk and dawn. Studies looking at light exposure during dusk and dawn have focused on either electric light intervention (i.e., dusk and dawn simulation) at home or in the laboratory or daylight exposure in the bedroom (i.e., the presence and type of curtains in the bedroom). Most research has focused on dawn simulation during the darker months of the year, often using sunrise alarms. In general, study results pointed to the importance of twilight light exposure at home for sleep and well-being. These results may depend on the characteristics of the user, such as age or chronotype.
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Affiliation(s)
| | - Myriam Bc Aries
- Jönköping University, School of Engineering, Jönköping, Sweden.
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3
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Ingram DG, Cranford TA, Al-Shawwa B. Sleep Technology. Sleep Med Clin 2023; 18:235-244. [PMID: 37120166 DOI: 10.1016/j.jsmc.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Pediatric sleep providers frequently encounter issues related to sleep technology in clinical settings. In this review article, we discuss technical issues related to standard polysomnography, research on putative complementary novel metrics derived from polysomnographic signals as well as research on home sleep apnea testing in children and consumer sleep devices. Although developments across several of these domains are exciting, it remains a rapidly evolving area. When evaluating innovative devices and home sleep testing approaches, clinicians should be mindful of accurately interpreting diagnostic agreement statistics to apply these technologies appropriately.
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4
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Yousefzadehfard Y, Wechsler B, DeLorenzo C. Human circadian rhythm studies: Practical guidelines for inclusion/exclusion criteria and protocol. Neurobiol Sleep Circadian Rhythms 2022; 13:100080. [PMID: 35989718 PMCID: PMC9382328 DOI: 10.1016/j.nbscr.2022.100080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022] Open
Abstract
As interest in circadian rhythms and their effects continues to grow, there is an increasing need to perform circadian studies in humans. Although the constant routine is the gold standard for these studies, there are advantages to performing more naturalistic studies. Here, a review of protocols for such studies is provided along with sample inclusion and exclusion criteria. Sleep routines, drug use, shift work, and menstrual cycle are addressed as screening considerations. Regarding protocol, best practices for measuring melatonin, including light settings, posture, exercise, and dietary habits are described. The inclusion/exclusion recommendations and protocol guidelines are intended to reduce confounding variables in studies that do not involve the constant routine. Given practical limitations, a range of recommendations is provided from stringent to lenient. The scientific rationale behind these recommendations is discussed. However, where the science is equivocal, recommendations are based on empirical decisions made in previous studies. While not all of the recommendations listed may be practical in all research settings and with limited potential participants, the goal is to allow investigators to make well informed decisions about their screening procedures and protocol techniques and to improve rigor and reproducibility, in line with the objectives of the National Institutes of Health.
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Affiliation(s)
- Yashar Yousefzadehfard
- Center for Understanding Biology Using Imaging Technology, Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.,Department of Psychiatry, Texas Tech University Health Science Center, Midland, TX, USA
| | - Bennett Wechsler
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christine DeLorenzo
- Center for Understanding Biology Using Imaging Technology, Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
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5
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Toward Sustainable Gentle Awakenings and Sleep Inertia Mitigation: A Low-Cost IoT-Based Adaptable Lighting and Temperature Control Approach. SUSTAINABILITY 2022. [DOI: 10.3390/su14137928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In this paper, our design aims to assist in sleep inertia reduction and avoid the startle response and irritation caused by alarm-made unpleasant wakeup stimuli. Thus, we propose an approach that employs a soft and alerting sunrise simulation, conditionally utilizes natural light, and appropriately lowers the bedroom temperature for awakening a sleeper tenderly and gradually to gain full alertness. This approach is inspired by known scientific implications confirming the effectiveness of lights and temperatures on wakefulness. In this regard, we present an economical do-it-yourself digital tech-assisted system for bedroom lighting and temperature control. The system design is based on the smartphone and Internet of Things (IoT) technology. We develop the hardware and software in the system for implementing three IoT-based control tasks. One is the tuning of artificial light brightness using the pulse width modulation technique. Another is the opening of the window curtain using stepper motor control and light detection. The other is the activation of the air-conditioning setting using an infrared remote control and temperature detection. We construct a testbed for conducting experiments. Experimental results demonstrate that the proposed system can execute task requirements satisfactorily. The proposed system is promising for achieving our goal. It embodies features of sustainability.
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6
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Ma Z, Tao Y, Chen H, Zhang Y, Pan Y, Meng D, Fan F. An Exploration of Self-Reported Sleep Inertia Symptoms Using Network Analysis. Nat Sci Sleep 2022; 14:661-674. [PMID: 35450224 PMCID: PMC9018210 DOI: 10.2147/nss.s347419] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/30/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Sleep inertia (SI) is the transitional state accompanied by compromised cognitive and physical performance and sleepiness. Network analysis offers a potential new framework to conceptualize a complex network of symptom-symptom interactions, and the network structure is analyzed to reveal the core characteristics. However, no previous study examined the network structure of SI symptoms. Thus, this study aimed to elucidate characteristics and compare sex differences of SI symptom networks in the general population. MATERIALS AND METHODS A total of 1491 participants from China were recruited from 30 May to 17 June, 2021. SI symptoms were assessed by using the Sleep Inertia Questionnaire (SIQ). The network structures were estimated and compared using network analytic methods in the R version 4.1.1. RESULTS Centrality properties analysis of the expected influence suggested that symptoms of "Feel sleepy", "Groggy, fuzzy or hazy mind", and "Dread starting your day" exerted greatest influences. The weighted adjacency matrix revealed that the "Dread starting your day" and "Anxious about the upcoming day" edge showed the strongest connection (edge weight value = 0.70). The network comparison test found no significant difference in network global strength (p=0.928), distribution of edge weights (p=0.194) and individual edge weights (all p values >0.05 after Holm-Bonferroni corrections) between males and females. CONCLUSION Symptoms of "Feel sleepy", "Groggy, fuzzy or hazy mind", and "Dread starting your day" were central in the SI symptom network. Intervention, such as the artificial dawn and change in body temperature, for symptoms of "Feel sleepy", "Groggy, fuzzy or hazy mind", and "Dread starting your day" might be crucial to hasten the dissipation of SI in the general population who may need to perform tasks upon waking.
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Affiliation(s)
- Zijuan Ma
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People's Republic of China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, People's Republic of China
| | - Yanqiang Tao
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, People's Republic of China
| | - Huilin Chen
- Department of Psychology, University of Bath, Bath, UK
| | - Yifan Zhang
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People's Republic of China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, People's Republic of China
| | - Ye Pan
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People's Republic of China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, People's Republic of China
| | - Dongjing Meng
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People's Republic of China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, People's Republic of China
| | - Fang Fan
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People's Republic of China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, People's Republic of China
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7
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Gabel V, Miglis M, Zeitzer JM. Effect of artificial dawn light on cardiovascular function, alertness, and balance in middle-aged and older adults. Sleep 2021; 43:5822621. [PMID: 32307533 DOI: 10.1093/sleep/zsaa082] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 03/10/2020] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES When arising in the morning, many older people experience dizziness and difficulty maintaining proper balance, as the cardiovascular system is not able to compensate to the postural shift (standing) and maintain sufficient blood flow to the brain. Such changes in cardiovascular function are observed in young individuals exposed to a dawn simulation light. In this study, we examined whether exposure to a dawn simulation light could impact cardiovascular function and consequent changes in balance in middle-aged and older adults. METHODS Twenty-three participants (67.3 ± 8.8 y), 12 of whom reported a history of dizziness in the morning, underwent two overnight stays in our laboratory. During both nights, they slept in complete darkness, except for the last 30 minutes of one of the nights during which a dawn simulation light was used. Continuous blood pressure (BP) and heart rate (HR) were monitored. Subjective and objective alertness, salivary cortisol, and mobile and standing balance were examined upon arising. RESULTS Dawn simulation light decreased (33%) the amount of sleep before morning awakening, lowered BP (6.24 mmHg), and increased HR (0.93 bpm). Despite these changes in physiology, there was no significant impact of dawn simulation on subjective or objective alertness, measures of standing or ambulatory balance, morning cortisol awakening response, or cardiovascular function after awakening. CONCLUSION While the dawn simulation did cause an increase in wake and a change in cardiovascular function prior to morning arousal in older adults, we could find no evidence of a functional change in either cardiovascular function or balance upon standing. CLINICAL TRIAL Registered on Clinicaltrials.gov, #NCT02632318, https://clinicaltrials.gov/ct2/show/NCT02632318.
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Affiliation(s)
- Virginie Gabel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Mitchell Miglis
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA.,Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA
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8
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Figueiro MG, Sahin L, Roohan C, Kalsher M, Plitnick B, Rea MS. Effects of red light on sleep inertia. Nat Sci Sleep 2019; 11:45-57. [PMID: 31118850 PMCID: PMC6506010 DOI: 10.2147/nss.s195563] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/08/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction: Sleep inertia, broadly defined as decrements in performance and lowering of alertness following waking, lasts for durations ranging between 1 min and 3 hrs. This study investigated whether, compared to a dim light condition (the control), exposure to long-wavelength (red) light delivered to closed eyelids during sleep (red light mask) and to eyes open upon waking (red light goggles) reduced sleep inertia. Methods: Thirty participants (18 females, 12 males; mean age=30.4 years [SD 13.7]) completed this crossover, within-subjects, counterbalanced design study. Self-reported measures of sleepiness and objective measures of auditory performance and cortisol levels were collected on 3 Friday nights over the course of 3 consecutive weeks. Results: Performance improved significantly during the 30-min data collection period in all experimental conditions. Subjective sleepiness also decreased significantly with time awake in all experimental conditions. As hypothesized, performance of some tasks was significantly better in the red light mask condition than in the dim light condition. Performance scores in the red light goggles condition improved significantly after a few minutes of wearing the light goggles. Discussion: The results show that saturated red light delivered through closed eyelids at levels that do not suppress melatonin can be used to mitigate sleep inertia upon waking.
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Affiliation(s)
- Mariana G Figueiro
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Levent Sahin
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Charles Roohan
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Michael Kalsher
- Department of Cognitive Sciences, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Barbara Plitnick
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Mark S Rea
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
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9
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Zerbini G, Kantermann T, Merrow M. Strategies to decrease social jetlag: Reducing evening blue light advances sleep and melatonin. Eur J Neurosci 2018; 51:2355-2366. [DOI: 10.1111/ejn.14293] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/29/2018] [Accepted: 11/23/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Giulia Zerbini
- Chronobiology UnitGroningen Institute for Evolutionary Life SciencesUniversity of Groningen Groningen The Netherlands
- Institute of Medical PsychologyLMU Munich Munich Germany
| | - Thomas Kantermann
- Chronobiology UnitGroningen Institute for Evolutionary Life SciencesUniversity of Groningen Groningen The Netherlands
- SynOpus Bochum Germany
- University of Applied Sciences for Economics and Management (FOM) Essen Germany
| | - Martha Merrow
- Chronobiology UnitGroningen Institute for Evolutionary Life SciencesUniversity of Groningen Groningen The Netherlands
- Institute of Medical PsychologyLMU Munich Munich Germany
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10
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Kaplan KA, Talavera DC, Harvey AG. Rise and shine: A treatment experiment testing a morning routine to decrease subjective sleep inertia in insomnia and bipolar disorder. Behav Res Ther 2018; 111:106-112. [PMID: 30399503 DOI: 10.1016/j.brat.2018.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 09/28/2018] [Accepted: 10/26/2018] [Indexed: 12/29/2022]
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11
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Dautovich ND, Schreiber DR, Imel JL, Tighe CA, Shoji KD, Cyrus J, Bryant N, Lisech A, O'Brien C, Dzierzewski JM. A systematic review of the amount and timing of light in association with objective and subjective sleep outcomes in community-dwelling adults. Sleep Health 2018; 5:31-48. [PMID: 30670164 DOI: 10.1016/j.sleh.2018.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 09/12/2018] [Accepted: 09/17/2018] [Indexed: 12/01/2022]
Abstract
Light is considered the dominant environmental cue, or zeitgeber, influencing the sleep-wake cycle. Despite recognizing the importance of light for our well-being, less is known about the specific conditions under which light is optimally associated with better sleep. Therefore, a systematic review was conducted to examine the association between the amount and timing of light exposure in relation to sleep outcomes in healthy, community-dwelling adults. A systematic search was conducted of four databases from database inception to June 2016. In total, 45 studies met the review eligibility criteria with generally high study quality excepting for the specification of eligibility criteria and the justification of sample size. The majority of studies involved experimental manipulation of light (n = 32) vs observational designs (n = 13). Broad trends emerged suggesting that (1) bright light (>1000 lux) has positive implications for objectively assessed sleep outcomes compared to dim (<100 lux) and moderate light (100-1000 lux) and (2) bright light (>1000 lux) has positive implications for subjectively assessed sleep outcomes compared to moderate light (100-1000 lux). Effects due to the amount of light are moderated by the timing of light exposure such that, for objectively assessed sleep outcomes, brighter morning and evening light exposure are consistent with a shift in the timing of the sleep period to earlier and later in the day, respectively. For subjectively assessed sleep outcomes, brighter light delivered in the morning was associated with self-reported sleep improvements and brighter evening light exposure was associated with worse self-reported sleep.
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Affiliation(s)
- Natalie D Dautovich
- Psychology Department, Virginia Commonwealth University, 800 W Franklin St, Room 203, PO Box 842018, Richmond, VA 23284-2018.
| | - Dana R Schreiber
- Psychology Department, Virginia Commonwealth University, 806 W Franklin St, PO Box 842018, Richmond, VA 23284-2018
| | - Janna L Imel
- Psychology Department, Virginia Commonwealth University, 806 W Franklin St, PO Box 842018, Richmond, VA 23284-2018
| | - Caitlan A Tighe
- Department of Psychology, University of Alabama, Box 870348, The University of Alabama, Tuscaloosa, AL 35487-0348
| | - Kristy D Shoji
- South Texas Veterans Healthcare System, 7400 Merton Minter, San Antonio, TX 78229
| | - John Cyrus
- Tompkins-McCaw Library, Virginia Commonwealth University, 509 N 12th St, Box 980582, Richmond, VA 23298-0582
| | - Nita Bryant
- James Branch Cabell Library, Virginia Commonwealth University, 901 Park Ave, Box 842033,Richmond, VA 23284-2033
| | - Andrew Lisech
- Psychology Department, Virginia Commonwealth University, 806 W Franklin St, PO Box 842018, Richmond, VA 23284-2018
| | - Chris O'Brien
- Psychology Department, Chatham University, Woodland Rd, Pittsburgh, PA 15232
| | - Joseph M Dzierzewski
- Psychology Department, Virginia Commonwealth University, 806 W Franklin St, PO Box 842018, Richmond, VA 23284-2018
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12
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Erren TC, Morfeld P, Lewis P. Computing circadian misalignment: Why not combine sleep timing and duration to assess accumulated sleep deficiency? Chronobiol Int 2017; 34:1321-1324. [PMID: 29064723 DOI: 10.1080/07420528.2017.1371729] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- T C Erren
- a Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research , University Hospital of Cologne , Cologne , Germany
| | - P Morfeld
- a Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research , University Hospital of Cologne , Cologne , Germany
| | - P Lewis
- a Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research , University Hospital of Cologne , Cologne , Germany
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13
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Chellappa SL, Lasauskaite R, Cajochen C. In a Heartbeat: Light and Cardiovascular Physiology. Front Neurol 2017; 8:541. [PMID: 29104560 PMCID: PMC5654948 DOI: 10.3389/fneur.2017.00541] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/27/2017] [Indexed: 12/22/2022] Open
Abstract
Light impinging on the retina fulfils a dual function: it serves for vision and it is required for proper entrainment of the endogenous circadian timing system to the 24-h day, thus influencing behaviors that promote health and optimal quality of life but are independent of image formation. The circadian pacemaker located in the suprachiasmatic nuclei modulates the cardiovascular system with an intrinsic ability to anticipate morning solar time and with a circadian nature of adverse cardiovascular events. Here, we infer that light exposure might affect cardiovascular function and provide evidence from existing research. Findings show a time-of-day dependent increase in relative sympathetic tone associated with bright light in the morning but not in the evening hours. Furthermore, dynamic light in the early morning hours can reduce the deleterious sleep-to-wake evoked transition on cardiac modulation. On the contrary, effects of numerous light parameters, such as illuminance level and wavelength of monochromatic light, on cardiac function are mixed. Therefore, in future research studies, light modalities, such as timing, duration, and its wavelength composition, should be taken in to account when testing the potential of light as a non-invasive countermeasure for adverse cardiovascular events.
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Affiliation(s)
- Sarah L Chellappa
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Ruta Lasauskaite
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
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14
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Trotti LM. Waking up is the hardest thing I do all day: Sleep inertia and sleep drunkenness. Sleep Med Rev 2017; 35:76-84. [PMID: 27692973 PMCID: PMC5337178 DOI: 10.1016/j.smrv.2016.08.005] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/28/2016] [Accepted: 08/23/2016] [Indexed: 11/24/2022]
Abstract
The transition from sleep to wake is marked by sleep inertia, a distinct state that is measurably different from wakefulness and manifests as performance impairments and sleepiness. Although the precise substrate of sleep inertia is unknown, electroencephalographic, evoked potential, and neuroimaging studies suggest the persistence of some features of sleep beyond the point of awakening. Forced desynchrony studies have demonstrated that sleep inertia impacts cognition differently than do homeostatic and circadian drives and that sleep inertia is most intense during awakenings from the biological night. Recovery sleep after sleep deprivation also amplifies sleep inertia, although the effects of deep sleep vary based on task and timing. In patients with hypersomnolence disorders, especially but not exclusively idiopathic hypersomnia, a more pronounced period of confusion and sleepiness upon awakening, known as "sleep drunkenness", is common and problematic. Optimal treatment of sleep drunkenness is unknown, although several medications have been used with benefit in small case series. Difficulty with awakening is also commonly endorsed by individuals with mood disorders, disproportionately to the general population. This may represent an important treatment target, but evidence-based treatment guidance is not yet available.
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Affiliation(s)
- Lynn M Trotti
- Emory Sleep Center and Department of Neurology, Emory University School of Medicine, 12 Executive Park Dr NE, Atlanta, GA 30329, USA.
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15
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Münch M, Nowozin C, Regente J, Bes F, De Zeeuw J, Hädel S, Wahnschaffe A, Kunz D. Blue-Enriched Morning Light as a Countermeasure to Light at the Wrong Time: Effects on Cognition, Sleepiness, Sleep, and Circadian Phase. Neuropsychobiology 2017. [PMID: 28637029 DOI: 10.1159/000477093] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Light during the day and darkness at night are crucial factors for proper entrainment of the human circadian system to the solar 24-h day. However, modern life and work styles have led to much more time spent indoors, often with lower daytime and higher evening/nighttime light intensity from electrical lighting than outdoors. Whether this has long-term consequences for human health is being currently investigated. We tested if bright blue-enriched morning light over several days could counteract the detrimental effects of inadequate daytime and evening lighting. In a seminaturalistic, within-between subject study design, 18 young participants were exposed to different lighting conditions on 3 evenings (blue-enriched, bright orange, or dim light), after exposure to 2 lighting conditions (mixed blue-enriched light and control light, for 3 days each) in the mornings. Subjective sleepiness, reaction times, salivary melatonin concentrations, and nighttime sleep were assessed. Exposure to the blue-enriched morning lighting showed acute wake-promoting effects and faster reaction times than with control lighting. Some of these effects persisted until the evening, and performance improved over several days. The magnitude of circadian phase shifts induced by combinations of 3 different evening and 2 morning lighting conditions were significantly smaller with the blue-enriched morning light. During the night, participants had longer total sleep times after orange light exposure than after blue light exposure in the evening. Our results indicate that bright blue-enriched morning light stabilizes circadian phase, and it could be an effective counterstrategy for poor lighting during the day and also light exposure at the wrong time, such as in the late evening.
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Affiliation(s)
- Mirjam Münch
- Sleep Research and Clinical Chronobiology, Institute of Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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HILDITCH CJ, DORRIAN J, BANKS S. Time to wake up: reactive countermeasures to sleep inertia. INDUSTRIAL HEALTH 2016; 54:528-541. [PMID: 27193071 PMCID: PMC5136610 DOI: 10.2486/indhealth.2015-0236] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 05/11/2016] [Indexed: 06/05/2023]
Abstract
Sleep inertia is the period of impaired performance and grogginess experienced after waking. This period of impairment is of concern to workers who are on-call, or nap during work hours, and need to perform safety-critical tasks soon after waking. While several studies have investigated the best sleep timing and length to minimise sleep inertia effects, few have focused on countermeasures -especially those that can be implemented after waking (i.e. reactive countermeasures). This structured review summarises current literature on reactive countermeasures to sleep inertia such as caffeine, light, and temperature and discusses evidence for the effectiveness and operational viability of each approach. Current literature does not provide a convincing evidence-base for a reactive countermeasure. Caffeine is perhaps the best option, although it is most effective when administered prior to sleep and is therefore not strictly reactive. Investigations into light and temperature have found promising results for improving subjective alertness; further research is needed to determine whether these countermeasures can also attenuate performance impairment. Future research in this area would benefit from study design features highlighted in this review. In the meantime, it is recommended that proactive sleep inertia countermeasures are used, and that safety-critical tasks are avoided immediately after waking.
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Affiliation(s)
| | - Jillian DORRIAN
- Centre for Sleep Research, University of South Australia, Australia
| | - Siobhan BANKS
- Centre for Sleep Research, University of South Australia, Australia
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17
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Meesters Y, Gordijn MC. Seasonal affective disorder, winter type: current insights and treatment options. Psychol Res Behav Manag 2016; 9:317-327. [PMID: 27942239 PMCID: PMC5138072 DOI: 10.2147/prbm.s114906] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Seasonal affective disorder (SAD), winter type, is a seasonal pattern of recurrent major depressive episodes most commonly occurring in autumn or winter and remitting in spring/summer. The syndrome has been well-known for more than three decades, with light treatment being the treatment of first choice. In this paper, an overview is presented of the present insights in SAD. Description of the syndrome, etiology, and treatment options are mentioned. Apart from light treatment, medication and psychotherapy are other treatment options. The predictable, repetitive nature of the syndrome makes it possible to discuss preventive treatment options. Furthermore, critical views on the concept of SAD as a distinct diagnosis are discussed.
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Affiliation(s)
- Ybe Meesters
- University Center for Psychiatry, University Medical Center Groningen
| | - Marijke Cm Gordijn
- Department of Chronobiology, GeLifes, University of Groningen, Groningen, the Netherlands; Chrono@Work B.V., Groningen, the Netherlands
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19
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van Maanen A, Meijer AM, van der Heijden KB, Oort FJ. The effects of light therapy on sleep problems: A systematic review and meta-analysis. Sleep Med Rev 2015; 29:52-62. [PMID: 26606319 DOI: 10.1016/j.smrv.2015.08.009] [Citation(s) in RCA: 207] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 08/27/2015] [Accepted: 08/30/2015] [Indexed: 12/16/2022]
Abstract
Although bright light therapy seems a promising treatment for sleep problems, research shows inconclusive results. This meta-analysis is the first to systematically review the effect of light therapy on sleep problems in general and on specific types of sleep problems in particular (circadian rhythm sleep disorders, insomnia, sleep problems related to Alzheimer's disease and dementia). Fifty-three studies with a total of 1154 participants were included. Overall effects and effects on separate circadian and sleep outcomes were examined. We calculated Hedges' g effect sizes and we investigated the effects of twelve moderators (design-related, treatment-related, participant-related). Light therapy was found effective in the treatment of sleep problems in general (g = 0.39), and for circadian rhythm sleep disorders (g = 0.41), insomnia (g = 0.47), and sleep problems related to Alzheimer's disease/dementia (g = 0.30) specifically. For circadian rhythm sleep disorders, effects were smaller for randomised controlled trials. For insomnia, we found larger effects for studies using a higher light intensity, and for sleep problems related to Alzheimer's disease/dementia larger effects were found for studies with more female participants. There was indication of publication bias. To conclude, light therapy is effective for sleep problems in general, particularly for circadian outcomes and insomnia symptoms. However, most effect sizes are small to medium.
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Affiliation(s)
- Annette van Maanen
- Research Institute of Child Development and Education, University of Amsterdam, The Netherlands.
| | - Anne Marie Meijer
- Research Institute of Child Development and Education, University of Amsterdam, The Netherlands
| | | | - Frans J Oort
- Research Institute of Child Development and Education, University of Amsterdam, The Netherlands
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20
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Emens JS, Burgess HJ. Effect of Light and Melatonin and Other Melatonin Receptor Agonists on Human Circadian Physiology. Sleep Med Clin 2015; 10:435-53. [PMID: 26568121 DOI: 10.1016/j.jsmc.2015.08.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Circadian (body clock) timing has a profound influence on mental health, physical health, and health behaviors. This review focuses on how light, melatonin, and other melatonin receptor agonist drugs can be used to shift circadian timing in patients with misaligned circadian rhythms. A brief overview of the human circadian system is provided, followed by a discussion of patient characteristics and safety considerations that can influence the treatment of choice. The important features of light treatment, light avoidance, exogenous melatonin, and other melatonin receptor agonists are reviewed, along with some of the practical aspects of light and melatonin treatment.
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Affiliation(s)
- Jonathan S Emens
- Department of Hospital and Specialty Medicine, Portland VA Medical Center, 3710 SW US Veterans Hospital Road, P3-PULM, Portland, OR 97239, USA; Departments of Psychiatry and Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Helen J Burgess
- Biological Rhythms Research Laboratory, Department of Behavioral Sciences, Rush University Medical Center, 1645 West Jackson Boulevard, Suite 425, Chicago, IL 60612, USA.
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21
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Tonetti L, Fabbri M, Erbacci A, Filardi M, Martoni M, Natale V. Effects of dawn simulation on attentional performance in adolescents. Eur J Appl Physiol 2014; 115:579-87. [DOI: 10.1007/s00421-014-3033-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 10/15/2014] [Indexed: 01/25/2023]
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Thompson A, Jones H, Gregson W, Atkinson G. Effects of dawn simulation on markers of sleep inertia and post-waking performance in humans. Eur J Appl Physiol 2014; 114:1049-56. [PMID: 24509892 DOI: 10.1007/s00421-014-2831-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/21/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the effects of a simulated dawn during the last 30 min of sleep on the subsequent dissipation of sleep inertia and changes in simulated work and physical performance. METHODS Eight participants, who reported difficulty with morning waking, were administered in a random order to a control (C) and a dawn simulation (DS) trial (starting 30 min prior to waking). Subjective ratings of sleep quality and alertness were obtained alongside measures of cognitive performance (addition and reaction time tasks measured at 5, 30 and 75 min after waking at habitual workday times). Physical performance was also measured 35 min after waking using a self-paced cycling protocol. RESULTS After waking in DS, perceived sleep quality was 1.16 ± 0.89 (p = 0.01) points higher compared with C. Ratings of alertness were significantly higher in DS than C throughout the testing period (p = 0.04). Cognitive performance improved in both trials as time awake increased (p < 0.0005). On average, participants completed a greater number of additions in DS compared with C (69.5 ± 15.3 vs 66.9 ± 16.7, p = 0.03). Reaction times were also faster in DS compared with C (0.81 ± 0.07 s vs 0.86 ± 0.06 s, p < 0.0005). The self-paced time-trial was completed 21.4 s (4.7 %) quicker in DS (p = 0.07). CONCLUSION These data provide the first evidence that light exposure during the last 30 min of habitual sleep can increase subjective alertness and improve both cognitive and physical performance after waking.
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Affiliation(s)
- Andrew Thompson
- Clinical Epidemiology Group, Department of Epidemiology and Public Health, University College London, London, UK,
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23
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Santhi N, Groeger JA, Archer SN, Gimenez M, Schlangen LJM, Dijk DJ. Morning sleep inertia in alertness and performance: effect of cognitive domain and white light conditions. PLoS One 2013; 8:e79688. [PMID: 24260280 PMCID: PMC3832615 DOI: 10.1371/journal.pone.0079688] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 09/24/2013] [Indexed: 01/15/2023] Open
Abstract
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.
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Affiliation(s)
- Nayantara Santhi
- Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
- * E-mail:
| | - John A. Groeger
- Department of Psychology, University of Hull, Hull, United Kingdom
| | - Simon N. Archer
- Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | | | | | - Derk-Jan Dijk
- Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
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Gabel V, Maire M, Reichert CF, Chellappa SL, Schmidt C, Hommes V, Viola AU, Cajochen C. Effects of artificial dawn and morning blue light on daytime cognitive performance, well-being, cortisol and melatonin levels. Chronobiol Int 2013; 30:988-97. [PMID: 23841684 DOI: 10.3109/07420528.2013.793196] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Light exposure elicits numerous effects on human physiology and behavior, such as better cognitive performance and mood. Here we investigated the role of morning light exposure as a countermeasure for impaired cognitive performance and mood under sleep restriction (SR). Seventeen participants took part of a 48h laboratory protocol, during which three different light settings (separated by 2 wks) were administered each morning after two 6-h sleep restriction nights: a blue monochromatic LED (light-emitting diode) light condition (BL; 100 lux at 470 nm for 20 min) starting 2 h after scheduled wake-up time, a dawn-simulating light (DsL) starting 30 min before and ending 20 min after scheduled wake-up time (polychromatic light gradually increasing from 0 to 250 lux), and a dim light (DL) condition for 2 h beginning upon scheduled wake time (<8 lux). Cognitive tasks were performed every 2 h during scheduled wakefulness, and questionnaires were administered hourly to assess subjective sleepiness, mood, and well-being. Salivary melatonin and cortisol were collected throughout scheduled wakefulness in regular intervals, and the effects on melatonin were measured after only one light pulse. Following the first SR, analysis of the time course of cognitive performance during scheduled wakefulness indicated a decrease following DL, whereas it remained stable following BL and significantly improved after DsL. Cognitive performance levels during the second day after SR were not significantly affected by the different light conditions. However, after both SR nights, mood and well-being were significantly enhanced after exposure to morning DsL compared with DL and BL. Melatonin onset occurred earlier after morning BL exposure, than after morning DsL and DL, whereas salivary cortisol levels were higher at wake-up time after DsL compared with BL and DL. Our data indicate that exposure to an artificial morning dawn simulation light improves subjective well-being, mood, and cognitive performance, as compared with DL and BL, with minimal impact on circadian phase. Thus, DsL may provide an effective strategy for enhancing cognitive performance, well-being, and mood under mild sleep restriction.
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Affiliation(s)
- Virginie Gabel
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
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Portaluppi F. The Medical Subject Headings® thesaurus remains inaccurate and incomplete for electronic indexing and retrieval of chronobiologic references. BIOL RHYTHM RES 2011. [DOI: 10.1080/09291016.2011.613619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Fromm E, Horlebein C, Meergans A, Niesner M, Randler C. Evaluation of a dawn simulator in children and adolescents. BIOL RHYTHM RES 2011. [DOI: 10.1080/09291016.2010.525851] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chellappa SL, Gordijn MC, Cajochen C. Can light make us bright? Effects of light on cognition and sleep. PROGRESS IN BRAIN RESEARCH 2011; 190:119-33. [DOI: 10.1016/b978-0-444-53817-8.00007-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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