Circadian determinants of subjective alertness

Measuring the working experience of doctors in training

Using an online tool, we report the association between tasks and 'affect' (underlying experience of feeling, emotion or mood) among 565 doctors in training, how positive and negative emotional intensity are associated with time of day, the extent to which positive affect is associated with breaks, and consideration about leaving the profession. Respondents spent approximately 25% of their day on paperwork or clinical work that did not involve patients, resulting in more negative emotions. Positive emotions were expressed for breaks, staff meetings, research, learning and clinical tasks that involved patients. Those having considered leaving the profession report more negative feelings. Systematic workplace changes (regular breaks, reducing paperwork and improved IT systems) could contribute to positive workday experiences and reduce intention to quit. Educators and employers have important roles in recognising, advocating for and implementing improvements at work to enhance wellbeing with potential to improve retention of doctors in training.

Diurnal variations in hypnotic responsiveness: is there an optimal time to be hypnotized?

With a sample of nearly 700 undergraduate students, the authors found support for diurnal variations in hypnotic responsiveness. Administering the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A) in the morning or evening resulted in higher average scores than from afternoon sessions. The authors replicated this finding using a second independent sample. In the primary study, participants indicated the time of day that they are most alert. Matching self-reported preferred time of the day with HGSHS:A administration time did not improve hypnotic responsiveness. Considering this as well as past research, the authors argue that mid-morning may be the optimal time to be hypnotized and afternoon the least favorable.

Circadian rhythms, sleep deprivation, and human performance

Much of the current science on, and mathematical modeling of, dynamic changes in human performance within and between days is dominated by the two-process model of sleep-wake regulation, which posits a neurobiological drive for sleep that varies homeostatically (increasing as a saturating exponential during wakefulness and decreasing in a like manner during sleep), and a circadian process that neurobiologically modulates both the homeostatic drive for sleep and waking alertness and performance. Endogenous circadian rhythms in neurobehavioral functions, including physiological alertness and cognitive performance, have been demonstrated using special laboratory protocols that reveal the interaction of the biological clock with the sleep homeostatic drive. Individual differences in circadian rhythms and genetic and other components underlying such differences also influence waking neurobehavioral functions. Both acute total sleep deprivation and chronic sleep restriction increase homeostatic sleep drive and degrade waking neurobehavioral functions as reflected in sleepiness, attention, cognitive speed, and memory. Recent evidence indicating a high degree of stability in neurobehavioral responses to sleep loss suggests that these trait-like individual differences are phenotypic and likely involve genetic components, including circadian genes. Recent experiments have revealed both sleep homeostatic and circadian effects on brain metabolism and neural activation. Investigation of the neural and genetic mechanisms underlying the dynamically complex interaction between sleep homeostasis and circadian systems is beginning. A key goal of this work is to identify biomarkers that accurately predict human performance in situations in which the circadian and sleep homeostatic systems are perturbed.

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.

Using blue-green light at night and blue-blockers during the day to improves adaptation to night work: a pilot study

BACKGROUND

Bright light at night paired with darkness during the day seem to facilitate adaptation to night work. Considering the biological clock sensitive to short wavelengths, we investigated the possibility of adaptation in shift workers exposed to blue-green light at night, combined with using blue-blockers during the day.

METHODS

Four sawmill shift workers were evaluated during two weeks of night shifts (control and experimental) and one week of day shifts. Throughout the experimental week, ambient light (approximately 130 lx) was supplemented with blue-green light (200 lx) from 00:00 h to: 05:00 h on Monday and Tuesday, 06:00 h on Wednesday and 07:00 h on Thursday. Blue-blockers had to be worn outside from the end of the night shift until 16:00 h. For circadian assessment, salivary melatonin profiles were obtained between 00:00 h and 08:00 h, before and after 4 experimental night shifts. Sleep was continuously monitored with actigraphy and subjective vigilance was measured at the beginning, the middle and the end of each night and day shifts. The error percentage in wood board classification was used as an index of performance.

RESULTS

Through experimental week, melatonin profiles of 3 participants have shifted by at least 2 hours. Improvements were observed in sleep parameters and subjective vigilance from the third night (Wednesday) as performance increased on the fourth night (Thursday) from 5.14% to 1.36% of errors (p=0.04).

CONCLUSIONS

Strategic exposure to short wavelengths at night, and/or daytime use of blue-blocker glasses, seemed to improve sleep, vigilance and performance.

Increased adverse perinatal outcome of hospital delivery at night

OBJECTIVE

To determine whether delivery in the evening or at night and some organisational features of maternity units are related to perinatal adverse outcome.

DESIGN

A 7-year national registry-based cohort study.

SETTING

All 99 Dutch hospitals.

POPULATION

From nontertiary hospitals (n = 88), 655 961 singleton deliveries from 32 gestational weeks onwards, and, from tertiary centres (n = 10), 108 445 singleton deliveries from 22 gestational weeks onwards.

METHODS

Multiple logistic regression analysis of national perinatal registration data over the period 2000-2006. In addition, multilevel analysis was applied to investigate whether the effects of time of delivery and other variables systematically vary across different hospitals.

MAIN OUTCOME MEASURES

Delivery-related perinatal mortality (intrapartum or early neonatal mortality) and combined delivery-related perinatal adverse outcome (any of the following: intrapartum or early neonatal mortality, 5-minute Apgar score below 7, or admission to neonatal intensive care).

RESULTS

After case mix adjustment, relative to daytime, increased perinatal mortality was found in nontertiary hospitals during the evening (OR, 1.32; 95% CI, 1.15-1.52) and at night (OR, 1.47; 95% CI, 1.28-1.69) and, in tertiary centres, at night only (OR, 1.20; 95% CI, 1.06-1.37). Similar significant effects were observed using the combined perinatal adverse outcome measure. Multilevel analysis was unsuccessful; extending the initial analysis with nominal hospital effects and hospital-delivery time interaction effects confirmed the significant effect of night in nontertiary hospitals, whereas other organisational effects (nontertiary, tertiary) were taken up by the hospital terms.

CONCLUSION

Hospital deliveries at night are associated with increased perinatal mortality and adverse perinatal outcome. The time of delivery and other organisational features representing experience (seniority of staff, volume) explain hospital-to-hospital variation.

Alcohol hangover effects on memory functioning and vigilance performance after an evening of binge drinking

The impairing effects on memory functioning after acute alcohol intoxication in healthy volunteers and after chronic use in alcoholics are well established. However, research determining the next-morning effects of a single episode of binge drinking on memory functioning is scarce. A total of 48 healthy volunteers participated in a single-blind study comprising an evening (baseline) session, followed by a treatment administration (ethanol 1.4 g/kg or placebo), and a morning session. Memory was tested with a word-learning test (including immediate and delayed recall, and recognition). Further, a 45-min Mackworth clock test for measuring vigilance was included (parameters: number of hits and false alarms) and subjective alertness was assessed, to infer whether word-learning test findings reflect sedation or specific memory impairments. Delayed recall in the morning session was significantly worse in the alcohol group when compared to the placebo group (F(1,42)=6.0, p<0.02). In contrast, immediate recall and recognition were unimpaired in the alcohol group. In the morning session, relative to the placebo group, subjective alertness was significantly reduced in the alcohol group before and after the tests (F(1,44)=8.7, p<0.005; F(1,44)=13.3, p&<0.001, respectively). However, in the Mackworth clock test, the alcohol group and placebo group did not differ significantly in the morning session. The specific findings of impaired delayed recall show that memory retrieval processes are significantly impaired during alcohol hangover. Vigilance performance was not significantly affected, indicating that this memory impairment does not reflect sedation.

Individual differences in subjective and objective alertness during sleep deprivation are stable and unrelated

This study examines the individual reproducibility of alterations of subjective, objective, and EEG measures of alertness during 27 h of continuous wakefulness and analyzes their interrelationships. Eight subjects were studied twice under similar constant-routine conditions. Scales and performance tasks were administered at hourly intervals to define temporal changes in subjective and objective alertness. The wake EEG was recorded every 2 h, 2 min with eyes open and 2 min with eyes closed. Plasma glucose and melatonin levels were measured to estimate brain glucose utilization and individual circadian phase, respectively. Decrements of subjective alertness and performance deficits were found to be highly reproducible for a given individual. Remarkably, there was no relationship between the impairments of subjective and objective alertness. With increased duration of wakefulness, EEG activity with eyes closed increased in the delta range and decreased in the alpha range, but the magnitudes of these changes were also unrelated. These findings indicate that sleep deprivation has highly reproducible, but independent, effects on brain mechanisms controlling subjective and objective alertness.

The role of chronobiology in sleep disorders medicine

This review is concerned with circadian (approximately 24 h) aspects of chronobiology, and how they relate to sleep disorders medicine. We begin with an introduction to the key concepts and paradigms of circadian rhythms research in general, including a description of homeostatic and circadian determinants of sleep timing. This is followed by a brief history of chronobiology in relation to sleep disorders medicine. Both animal and human circadian rhythm studies are considered. We trace historical changes in the relative emphasis placed on social contacts, light, and melatonin in human circadian rhythms research. Special attention is given to free-running, forced desynchrony, and ultra-short sleep/wake cycle findings of particular relevance to sleep disorders medicine. The latter part of the review comprises a description of the circadian rhythm sleep disorders, highlighting insights derived from basic circadian rhythms research, including recent advances in molecular genetics. We conclude that the role of chronobiology in sleep disorders medicine is profound and pervasive, and that the two disciplines will move ever closer as a natural function of important new insights into sleep and sleep disorders provided by basic circadian rhythms research.

Is dawn simulation effective in ameliorating the difficulty awakening in seasonal affective disorder associated with hypersomnia?

BACKGROUND

Patients with winter depression, (seasonal affective disorder, SAD) frequently complain of difficulty awakening in the morning. Dawn simulation has been found effective in treating SAD, but its effect on difficulty awakening has not been assessed.

METHODS

Fifty medication-free patients with SAD associated with hypersomnia were randomized to receive either 1 week of dawn simulation (250 lux) or a dim (0.2-2 lux) placebo signal. The patients assessed their level of drowsiness upon awakening during the baseline week and during the treatment week using the Stanford sleepiness scale (SSS). A psychiatrist rated difficulty awakening after the baseline week and after the treatment week.

RESULTS

Dawn simulation lowered both the difficulty awakening score (P<0.05) and the SSS score (P<0.05) compared to the placebo dawn signal.

LIMITATIONS

Replication is necessary. No biological markers of circadian phase were measured.

CONCLUSIONS

Compared to a placebo condition, dawn simulation appears effective in decreasing both prospectively assessed morning drowsiness and retrospectively assessed difficulty awakening. The symptom of difficulty awakening is consistent with the phase delay hypothesis of SAD. Assessment of difficulty awakening could prove useful in the evaluation of SAD.

Residual effects of daytime administration of melatonin on performance relevant to flight

There is a general consensus that melatonin possesses time-dependent hypnotic effects, but there is no information yet whether it has residual effects on neurobehavioral performance, especially after daytime administration. In the present study we investigated the possible residual effects of 3 mg melatonin on performance relevant to flight and on subjective feelings of sleepiness, arousal, activation and affect after a daytime nap, as a function of nap length. Fifteen reserve pilots of the Israeli Air Force participated in the study. The experiment consisted of four sessions during which either melatonin or placebo was administered at 16:00 h. In two conditions, subjects were allowed to sleep for 2 h (17:00-19:00 h) whereas in the other two only a 0.5-h nap was allowed. After the naps they started performing a flight simulator task every 2 h. Sleep efficiency significantly increased and sleep latency significantly decreased in both melatonin conditions compared to placebo. Flight performance was only mildly affected in the 0.5-h nap condition. Subjective assessment of sleepiness significantly differed between the two treatment conditions, only in the 0.5-h nap condition. Subjects felt sleepier 2-4 h after melatonin administration. To conclude, our data suggest that administration of melatonin before a brief daytime nap (about 0.5 h) may be associated with mild residual effects on psychomotor performance and may significantly affect subjective feeling of sleepiness for 2-4 h.

Circadian motor asymmetries in humans

Previous research studies indicate that motor activity during sleep is lateralized to the non-dominant hand. We put forward the hypothesis that the relative superiority of the non-dominant hand movements during night could arise from a different circadian phase relationship between the two hemispheres, independently of the sleep condition. The present study evaluated whether actigraphic data are consistent with such hypothesis. A total of 58 right-handed university students wore actigraphs (AMI 32K) on both left and right wrist for 3 consecutive days. Mesor and acrophase were computed using cosinor analysis. Moreover, factorial analysis of variances were carried out on side (left versus right) and time of day. The results indicated that the left hand circadian rhythm had a significant phase delay in comparison to the right hand one. The mean activity of the left hand was significantly higher than that of the right hand from 20:00 until 04:00 h. The results are suggestive of a different circadian activation between the two hemispheres and are discussed in relation to models of circadian regulation of sleep/wake cycle.

Decreased human circadian pacemaker influence after 100 days in space: a case study

OBJECTIVE

The objectives of this study were (1) to assess the circadian rhythms and sleep of a healthy, 42-year-old male astronaut experiencing microgravity (weightlessness) for nearly 5 months while living aboard Space Station Mir as it orbited Earth and (2) to determine the effects of prolonged space flight on the endogenous circadian pacemaker, as indicated by oral temperature and subjective alertness rhythms, and their ramifications for sleep, alertness, and performance.

METHODS

For three 12- to 14-day blocks of time (spread throughout the mission), oral temperatures were taken and subjective alertness was self-rated five times per day. Sleep diaries and performance tests were also completed daily during each block.

RESULTS

Examination of the subject's circadian alertness and oral temperature rhythms suggested that the endogenous circadian pacemaker seemed to function quite well up to 90 days in space. Thereafter (on days 110-122), the influence of the endogenous circadian pacemaker on oral temperature and subjective alertness circadian rhythms was considerably weakened, with consequent disruptions in sleep.

CONCLUSIONS

Space missions lasting more than 3 months might result in diminished circadian pacemaker influence in astronauts, leading to eventual sleep problems.

Circadian rhythms of performance: new trends

This brief review is concerned with how human performance efficiency changes as a function of time of day. It presents an overview of some of the research paradigms and conceptual models that have been used to investigate circadian performance rhythms. The influence of homeostatic and circadian processes on performance regulation is discussed. The review also briefly presents recent mathematical models of alertness that have been used to predict cognitive performance. Related topics such as interindividual differences and the postlunch dip are presented.

Circadian rhythms in healthy aging--effects downstream from the pacemaker

Using both previously published findings and entirely new data, we present evidence in support of the argument that the circadian dysfunction of advancing age in the healthy human is primarily one of failing to transduce the circadian signal from the circadian timing system (CTS) to rhythms "downstream" from the pacemaker rather than one of failing to generate the circadian signal itself. Two downstream rhythms are considered: subjective alertness and objective performance. For subjective alertness, we show that in both normal nychthemeral (24 h routine, sleeping at night) and unmasking (36 h of constant wakeful bed rest) conditions, advancing age, especially in men, leads to flattening of subjective alertness rhythms, even when circadian temperature rhythms are relatively robust. For objective performance, an unmasking experiment involving manual dexterity, visual search, and visual vigilance tasks was used to demonstrate that the relationship between temperature and performance is strong in the young, but not in older subjects (and especially not in older men).

Season of birth modulates morningness-eveningness preference in humans

The aim of present work is to test if circadian typology could be modulated by environmental light-dark cycle acting at the time of birth. A sample of 1584 university students was administered the Morningness-Eveningness Questionnaire. Subjects were subdivided in four season groups, according to the birth date. We found more morning types among the students born in autumn and winter than in spring and summer, while we found an opposite pattern for evening types. The exposition to a decreasing photoperiod at birth seems to favour a phase advance of the biological clock (morning typology), while an increasing photoperiod seems to favour a phase delay (evening typology) of the human circadian system. Nevertheless we found no differences if female subjects separately were considered, as though the circadian typology of human females was not modulated by seasonal photoperiod at birth.

Melatonin effects on sleep, mood, and cognition in elderly with mild cognitive impairment

The effects of immediate-release melatonin on circadian rest-activity profiles, cognition, and mood were investigated in ten elderly individuals with self-reported sleep-wake disturbances. Melatonin (6 mg), administered 2 hr before habitual bedtime, enhanced the rest-activity rhythm and improved sleep quality as observed in a reduction in sleep onset latency and in the number of transitions from sleep to wakefulness. However, total sleep time was not significantly increased nor was wake within sleep significantly reduced. The ability to remember previously learned items improved along with a significant reduction in depressed moods. No side effects or contraindications were reported by any of our participants during the 10 day trials. These data suggest that melatonin can safely improve some aspects of sleep, memory, and mood in the elderly in short-term use.

Sleep and circadian rhythms in four orbiting astronauts

This experiment measured the sleep and circadian rhythms of four male astronauts aboard a space shuttle (STS-78) orbiting the Earth for 17 days. The space mission was specially scheduled to minimize disruptions in circadian rhythms and sleep so that the effects of space flight and microgravity per se could be studied. Data were collected in 72-h measurement blocks: one block 7 days before launch, one early within the mission (3 days after launch), one late in the mission (12 days after launch), and one 18 days after landing. Within each measurement block, all sleep was recorded both polysomnographically and by sleep diary. Core body temperature was sampled every 6 mins. Actillumes were worn continuously. All urine samples were collected separately. Performance was assessed by a computerized test battery (3/day) and by end-of-shift questionnaires (1/day); mood and alertness were measured by visual analogue scales (5/day). Circadian rhythms in orbit appeared to be very similar in phase and amplitude to those on the ground, and were appropriately aligned for the required work/rest schedule. There was no change from early flight to late flight. This was also reflected in mood, alertness, and performance scores, which were satisfactory at both in-flight time points. However, in-flight sleep showed a decreased amount of sleep obtained (mean = 6.1 h), and all four astronauts showed a decrease in delta sleep. No further degradation in sleep was seen when early flight was compared to late flight, and no other sleep parameters showed reliable trends.

A parallelism between human body temperature and performance independent of the endogenous circadian pacemaker

A battery of performance tests involving manual dexterity, serial search, and verbal reasoning was given about seven times per day to 2 healthy young male subjects (22 and 25 years of age) involved in separate forced desynchrony studies, each involving several months of temporal isolation. In these studies, the period lengths (denoted T) of the imposed day lengths (sleep/wake and light/dark cycles) were 25.8 and 26.0 h for the 2 subjects. For each subject, the endogenous circadian pacemaker (ECP) failed to entrain to a period of T and instead free ran at a period length denoted tau (24.2 and 24.5 h). By educing performance rhythms (and rectal temperature rhythms) separately at tau and at T (after three complete beating cycles for the first subject and two complete beating cycles for the second subject), the hypothesis could be tested as to whether performance and temperature were parallel, both when educed at tau (indicating ECP influence) and when educed at T (indicating sleep/wake cycle influences). The hypothesis was consistently confirmed at tau and mostly confirmed at T. For most variables, when educed at T, both performance speed and body temperature showed an inverted V-shaped function, with a peak about 9 to 12 h after waking.

The shape of the endogenous circadian rhythm of rectal temperature in humans

Fourteen healthy subjects have been studied in an isolation unit while living on a 30h "day" (20h awake, 10h asleep) for 14 (solar) days but while aware of real time. Waking activities were sedentary and included reading, watching television, and so forth. Throughout, regular recordings of rectal temperature were made, and in a subgroup of 6 subjects, activity was measured by a wrist accelerometer. Temperature data have been subjected to cosinor analysis after "purification," a method that enables the endogenous (clock-drive) and exogenous (activity-driven) components of the circadian rhythm to be assessed. Moreover, the protocol enables effects due to the circadian rhythm and time-since-waking to be separated. Results showed that the masking effects on body temperature exerted by the exogenous factors appeared to be less than average in the hours before and just after the peak of the endogenous temperature rhythm. This has the effect of producing a temperature plateau rather than a peak during the daytime. The implications of this for mental performance and sleep initiation are discussed.

Subjective alertness rhythms in elderly people

The aim of this study was to evaluate age-related changes in the circadian rhythm of subjective alertness and to explore the circadian mechanisms underlying such changes. Using a visual analogue scale (VAS) instrument, 25 older men and women (71 y and older; 15 female, 10 male) rated their subjective alertness about 7 times per day during 5 baseline days of temporal isolation during which habitual bedtimes and waketimes were enforced. Comparisons were made with 13 middle-aged men (37-52 y) experiencing the same protocol. Advancing age (particularly in the men) resulted in less rhythmic alertness patterns, as indicated by lower amplitudes and less reliability of fitted 24-h sinusoids. This appeared in spite of the absence of any reliable age-related diminution in circadian temperature rhythm amplitude, thus suggesting the effect was not due to SCN weakness per se, but to weakened transduction of SCN output. In a further experiment, involving 36 h of constant wakeful bedrest, differences in the amplitude of the alertness rhythm were observed between 9 older men (79 y+), 7 older women (79 y+), and 17 young controls (9 males, 8 females, 19-28 y) suggesting that with advancing age (particularly in men) there is less rhythmic input into subjective alertness from the endogenous circadian pacemaker. These results may explain some of the nocturnal insomnia and daytime hypersomnia that afflict many elderly people.

Development of circadian rhythmicity of temperature in full-term normal infants

Twelve full-term infants (7 girls and 5 boys) with normal neurological, behavioral and somatic development were followed at regular intervals during the first 5 months of life to appreciate the development of circadian rectal temperature rhythmicity. Activity and temperature (oral at birth, rectal thereafter) were monitored for a minimum of 60 hours on seven separate occasions: at birth, 3 weeks, 6 weeks, 8 weeks, 10 weeks, 16 weeks and 20 weeks of age. Activity was measured using an actigraph worn on the infant's wrist, and rectal temperature was measured using a rectal probe attached to a portable microprocessor (Vitalog TM). Data points were collected every 2 minutes. No fewer than ten infants were monitored at each session, and no infant missed more than one session. Missing recordings were due to equipment malfunctions, probe expulsions and minor health problems. Six infants out of 12 were successfully monitored at each of the first four sessions, from birth to 8 weeks of age inclusively, and two subjects were successfully monitored at all seven sessions. Periodic regression analysis was performed by least squares curve fit with secondary analysis of variance. Analysis of covariance was performed on repeated measures. There was no evidence of rectal temperature circadian rhythmicity at 3 weeks. Two infants demonstrated a circadian rhythmicity at 6 weeks, and all infants had a circadian rhythmicity at 10 weeks post-natal age. At the time of the first observance of circadian rhythmicity of rectal temperature, the mean delta in temperature from peak to trough was 0.6 +/- 0.3 degrees C. This delta was greater at the 16th week, with a mean value of 1.2 +/- 0.3 degrees C. The trough was seen during the first part of the long nocturnal inactivity period. Circadian rhythmicity of rectal temperature was always observed in the studied subjects before the establishment of a consolidated, long daytime wake period.

Sleepiness of civil airline pilots during two consecutive night flights of extended duration

Sleepiness of civil airline pilots was studied in a two-crew cockpit during two consecutive night flights of about 10 h duration each. Sleepiness was assessed by EEG recordings and subjective ratings during hourly recurrent short experimental phases. On the second night flight, the alertness component that is related to the preceding sleep showed a modification due to reduced quality and quantity of sleep between flights. The daytime sleep during layover was not sufficient to maintain the same alertness level as observed during the initial flight. This result is in coincidence with investigations in shift workers starting a period of night shifts. It is concluded that improvements such as the introduction of a nap schedule should be considered to alleviate spontaneous sleepiness in the cockpit.

Regularity of daily life in relation to personality, age, gender, sleep quality and circadian rhythms

A diary-like instrument to measure lifestyle regularity (the 'Social Rhythm Metric'-SRM) was given to 96 subjects (48 women, 48 men), 39 of whom repeated the study after at least one year, with additional objective measures of rest/activity. Lifestyle regularity as measured by the SRM related to age, morningness, subjective sleep quality and time-of-day variations in alertness, but not to gender, extroversion or neuroticism. Statistically significant test-retest correlations of about 0.4 emerged for SRM scores over the 12-30 month delay. Diary-based estimates of bedtime and waketime appeared fairly reliable. In a further study of healthy young men, 4 high SRM scorers ('regular') had a deeper nocturnal body temperature trough than 5 low SRM scorers ('irregular'), suggesting a better functioning circadian system in the 'regular' group.

Strategies for the preflight circadian shifting of Space Shuttle crews

In June, 1990, a workshop was put together at NASA/Johnson Space Center to address difficulties the astronauts were having in adjusting their wake and sleep schedule, both immediately before and during Space Shuttle missions. The workshop members, prominent investigators in human circadian research, developed a number of strategies by which astronauts could tackle the problem of circadian adaptation within the demanding timetable of a Space Shuttle mission. The strategies included both abrupt and gradual methods, and some approaches used artificial "very bright lights" to reset the physiologic circadian pacemaker. The strategies have since been operationally implemented on Space Shuttle flights, with good success. This is a report of the problems addressed by the workshop and its recommendations.

The relationship of chronobiology to sleep schedules and performance demands

This review is concerned with how chronobiological results concerning the human circadian timekeeping system ( biological clock'), its response to changes in schedule, and its influence on performance ability can be used to improve shift worker wellbeing, safety and productivity.