One night's CPAP withdrawal in otherwise compliant OSA patients: marked driving impairment but good awareness of increased sleepiness.

PURPOSE: Obstructive sleep apnoea (OSA) patients effectively treated by and compliant with continuous positive air pressure (CPAP) occasionally miss a night's treatment. The purpose of this study was to use a real car interactive driving simulator to assess the effects of such an occurrence on the next day's driving, including the extent to which these drivers are aware of increased sleepiness. METHODS: Eleven long-term compliant CPAP-treated 50-75-year-old male OSA participants completed a 2-h afternoon, simulated, realistic monotonous drive in an instrumented car, twice, following one night: (1) normal sleep with CPAP and (2) nil CPAP. Drifting out of road lane ('incidents'), subjective sleepiness every 200 s and continuous electroencephalogram (EEG) activities indicative of sleepiness and compensatory effort were monitored. RESULTS: Withdrawal of CPAP markedly increased sleep disturbance and led to significantly more incidents, a shorter 'safe' driving duration, increased alpha and theta EEG power and greater subjective sleepiness. However, increased EEG beta activity indicated that more compensatory effort was being applied. Importantly, under both conditions, there was a highly significant correlation between subjective and EEG measures of sleepiness, to the extent that participants were well aware of the effects of nil CPAP. CONCLUSIONS: Patients should be aware that compliance with treatment every night is crucial for safe driving.

I think I'm sleepy, therefore I am - Awareness of sleepiness while driving: A systematic review.

Driver drowsiness contributes to 10-20% of motor vehicle crashes. To reduce crash risk, ideally drivers would be aware of the drowsy state and cease driving. The extent to which drivers can accurately identify sleepiness remains under much debate. We systematically examined whether individuals are aware of sleepiness while driving, and whether this accurately reflects driving impairment, using meta-analyses and narrative review. Within this scope, there is high variability in measures of subjective sleepiness, driving performance and physiologically-derived drowsiness, and statistical analyses. Thirty-four simulated/naturalistic driving studies were reviewed. To summarise, drivers were aware of sleepiness, and this was associated to physiological drowsiness and driving impairment, such that high levels of sleepiness significantly predicted crash events and lane deviations. Subjective sleepiness was more strongly correlated (i) with physiological drowsiness compared to driving outcomes; (ii) under simulated driving conditions compared to naturalistic drives; and (iii) when examined using the Karolinska sleepiness scale (KSS) compared to other measures. Gaps remain in relation to how age, sex, and varying degrees of sleep loss may influence this association. This review provides evidence that drivers are aware of drowsiness while driving, and stopping driving when feeling 'sleepy' may significantly reduce crash risk.

PVT lapses differ according to eyes open, closed, or looking away.

STUDY OBJECTIVES: A lapse during the psychomotor vigilance task (PVT) is usually defined as a response longer than 500 ms; however, it is currently unknown what psychobiological phenomena occur during a lapse. An assessment of what a participant is doing during a lapse may depict varying levels of "disengagement" during these events and provide more insight into the measurement of both a lapse and sleepiness. DESIGN: Repeated measures. SETTING: Participants underwent extended 30-min PVT sessions twice, at 22:00 and 04:00, under: (i) typical non-distractive laboratory conditions, and (ii) an additional distractive condition. PARTICIPANTS: Twenty-four healthy young adults (mean age: 23.2 y +/- 2 y; range 21-25 y [12 m; 12 f]) without any sleep or medical problems and without any prior indication of daytime sleepiness. INTERVENTIONS: One night of sleep loss. Distraction comprised a TV located at 90 degrees in the visual periphery showing a popular TV program. For the non-distraction condition, the TV was turned off. MEASUREMENTS & RESULTS: Video data (bird's-eye and frontal view) were used to classify each lapse (> or = 500 ms) as occurring with eyes open (EO), eyes closed (EC), or due to a head turn (HT). EO lapses were more prevalent, with all lapses (EO, EC, and HT) increasing with sleepiness. There was a significant effect of distraction for HT lapses which was exacerbated when sleepy. For lapse duration there was little effect of sleepiness for EO lapses but a significant effect for EC and HT. The 95% confidence intervals for lapse duration and associated behavior showed those lapses greater than 2669 ms were 95% likely to be EC, whereas those 500-549 ms were 95% likely to be EO. Response times of 1217 ms had a 50:50 probability of being EO:EC. CONCLUSIONS: Discriminating the varying causes of lapses whether due to visual inattention (eyes open), microsleep (eyes closed), or distraction (head turn) may provide further insight into levels of disengagement from the PVT and further insight into developing sleepiness.

Self-reported 'sleep deficit' is unrelated to daytime sleepiness.

Seemingly, many healthy adults have accrued a sleep debt, as determined by findings based on the multiple sleep latency test (MSLT). However, our recent, extensive survey found self-reported sleep deficit was not linked to daytime sleepiness determined by the Epworth sleepiness scale (ESS). Here, we report on the link between self-reported sleep deficit and gold standard measures of sleepiness: MSLT, Psychomotor vigilance test (PVT) and Karolinska Sleepiness Scale (KSS). Habitual sleep time in forty-three participants, from using a week long sleep diary and actiwatch data, compared with self-ratings of how much sleep they needed, provided estimates of apparent sleep deficit or otherwise. They were split into categories: 'sleep deficit' (Av. -47 min), 'sleep plus' (Av. 47 min) or 'neutral' (Av. 0+/-15 min), depicting perceived shortfall (or excess) sleep. Although the deficit group desired to sleep longer than the other groups, they actually obtained similar habitual nightly sleep as the neutral group, but less than the sleep plus group. 'Survival curves' based on those falling asleep during the MSLT showed no difference between the groups. Neither was there any difference between the groups for the PVT, KSS, or ESS. Here, factors other than sleepiness seem to influence self-perceived sleep deficits.

Do we really want more sleep? A population-based study evaluating the strength of desire for more sleep.

OBJECTIVE: The sleep literature increasingly points to an apparent chronic sleep debt in the general population. We investigated this by examining perceived shortfalls in daily sleep, using more indirect questioning methods. METHODS: To determine perceived sleep deficits, 10,810 adults completed a simple questionnaire, which avoided leading questions and provided information on sleep length, daytime sleepiness, desired sleep length, a choice of attractive daytime activities in a "free hour", and "stressful lifestyle". From this we assessed whether deficits were reflected by increased daytime sleepiness or opting for more sleep when given attractive waking alternatives. Respondents were divided according to age and sex. RESULTS: Half of men and women seemed to desire more sleep, but this apparent sleep deficit was not correlated with daytime sleepiness, for any age or sex group. Irrespective of deficit, few people opted for sleep when given waking alternatives. "Stressful lifestyle" was independently related to this sleep deficit. CONCLUSION: Desiring more sleep may also be synonymous with a need for more "time out", as sleep deficit was unrelated to daytime sleepiness but rather related to "stressful lifestyle." Extra sleep may not be the only anodyne for sleep deficit.

Placebo response to caffeine improves reaction time performance in sleepy people.

Caffeine is the most widely used stimulant to counteract sleepiness. However, little is known about any placebo effect of caffeine in sleepy people and the effect of suggestibility. Over a 95 min test period, and in a counterbalanced design, 16 young healthy adults underwent 3 x 30 min sessions at the psychomotor vigilance test (PVT), during an early afternoon 'dip' enhanced by a prior night's sleep restriction (5 h). On both occasions they were given a cup of a decaffeinated coffee; once when the participant was verbally primed to suggest the coffee was caffeinated (Placebo) and on the other under neutral priming (Control). There were significantly fewer lapses and shorter reaction times following Placebo, for the initial two 30 min sessions, indicating that suggestion about consuming caffeine was effective in improving performance in moderately sleepy people.

Mobile phone 'talk-mode' signal delays EEG-determined sleep onset.

Mobile phones signals are pulse-modulated microwaves, and EEG studies suggest that the extremely low-frequency (ELF) pulse modulation has sleep effects. However, 'talk', 'listen' and 'standby' modes differ in the ELF (2, 8, and 217Hz) spectral components and specific absorption rates, but no sleep study has differentiated these modes. We used a GSM900 mobile phone controlled by a base-station simulator and a test SIM card to simulate these three specific modes, transmitted at 12.5% (23dBm) of maximum power. At weekly intervals, 10 healthy young adults, sleep restricted to 6h, were randomly and single-blind exposed to one of: talk, listen, standby and sham (nil signal) modes, for 30 min, at 13:30 h, whilst lying in a sound-proof, lit bedroom, with a thermally insulated silent phone beside the right ear. Bipolar EEGs were recorded continuously, and subjective ratings of sleepiness obtained every 3 min (before, during and after exposure). After exposure the phone and base-station were switched off, the bedroom darkened, and a 90 min sleep opportunity followed. We report on sleep onset using: (i) visually scored latency to onset of stage 2 sleep, (ii) EEG power spectral analysis. There was no condition effect for subjective sleepiness. Post-exposure, sleep latency after talk mode was markedly and significantly delayed beyond listen and sham modes. This condition effect over time was also quite evident in 1-4Hz EEG frontal power, which is a frequency range particularly sensitive to sleep onset. It is possible that 2, 8, 217Hz modulation may differentially affect sleep onset.

Sleepiness enhances distraction during a monotonous task.

STUDY OBJECTIVES: Although sleepiness appears to heighten distraction from the task at hand, especially if the latter is dull and monotonous, this aspect of sleep loss has not been assessed in any systematic way. Distractions are a potential cause of performance lapses (as are micro-sleeps). Here, we investigate the effects of sleepiness on a monotonous task, with and without distraction. DESIGN: Repeated Measures 2 x 2 counterbalanced design, comprising Sleepiness (night sleep restricted to 5 hours x normal sleep) and Distraction (distraction x no distraction). SETTING: Participants underwent 30-minute sessions on the Psychomotor Vigilance Test (2:00 PM - 3:10 PM), with or without an attractive distraction to be ignored, under normal and sleep-restricted conditions. PARTICIPANTS: Sixteen healthy young adults (mean age 21.10 years; 21-25 years [8 men; 8 women]) without any sleep or medical problems and without any indication of daytime sleepiness. INTERVENTIONS: Normal sleep versus sleep restricted to 5 hours and distraction versus no distraction. Distraction comprised a television in the visual periphery, showing an attractive video that had to be ignored. MEASUREMENTS AND RESULTS: Psychomotor Vigilance Test performance was monitored, as were the participants' head turns toward the television via videocameras. There was a significant increase in both head turns and lapses during sleep restriction plus distraction. Moreover, sleepiness also increased head turns even during no distraction. Distracting effects of sleepiness were clearly evident during the initial 10 minutes of testing. CONCLUSIONS: Distractibility is an important aspect of sleepiness, which has relevance to safety in the real world, eg, sleepy driving.

Human REM sleep: influence on feeding behaviour, with clinical implications.

Rapid eye movement (REM) sleep shares many underlying mechanisms with wakefulness, to a much greater extent than does non-REM, especially those relating to feeding behaviours, appetite, curiosity, exploratory (locomotor) activities, as well as aspects of emotions, particularly 'fear extinction'. REM is most evident in infancy, thereafter declining in what seems to be a dispensable manner that largely reciprocates increasing wakefulness. However, human adults retain more REM than do other mammals, where for us it is most abundant during our usual final REM period (fREMP) of the night, nearing wakefulness. The case is made that our REM is unusual, and that (i) fREMP retains this 'dispensability', acting as a proxy for wakefulness, able to be forfeited (without REM rebound) and substituted by physical activity (locomotion) when pressures of wakefulness increase; (ii) REM's atonia (inhibited motor output) may be a proxy for this locomotion; (iii) our nocturnal sleep typically develops into a physiological fast, especially during fREMP, which is also an appetite suppressant; (iv) REM may have 'anti-obesity' properties, and that the loss of fREMP may well enhance appetite and contribute to weight gain ('overeating') in habitually short sleepers; (v) as we also select foods for their hedonic (emotional) values, REM may be integral to developing food preferences and dislikes; and (vii) REM seems to have wider influences in regulating energy balance in terms of exercise 'substitution' and energy (body heat) retention. Avenues for further research are proposed, linking REM with feeding behaviours, including eating disorders, and effects of REM-suppressant medications.

Electroencephalographic activities during wakefulness and sleep in the frontal cortex of healthy older people: links with "thinking".

STUDY OBJECTIVE: Separate studies have shown for the frontal cortex that: i) sleep electroencephalogram (EEG) activity less than 1 Hz may be linked to waking recovery, and ii) waking frontal theta activity may reflect "cortical workload." We explored the potential linkage between (i) and (ii) in relation to specific waking theta frequencies and 0.5-Hz to 1.0-Hz activity in sleep. DESIGN: A correlational study SETTING: Laboratory-based waking EEGs under different (eyes-closed) contrived "thinking" conditions (mostly localized to the left frontal area), and night sleep EEGs at home. PARTICIPANTS: Twelve right-handed, healthy, good-sleeping, older adults (mean age, 67.3 years) MEASUREMENT & RESULTS: EEGs comprised 4 bipolar derivations (Fp1-F3; Fp2-F4; O1-P3; O2-P4). Power in the 7-8-Hz bin was the only waking frequency significantly (positively) correlated with power in the 0.5- to 1.0-Hz bin during the first NREM period and only for the left frontal EEG. Interestingly, 7- to 8-Hz power immediately after lights out at bedtime, and before the appearance of EEG sleepiness, showed an even higher positive correlation with 0.5- to 1.0-Hz power during sleep. This wake-sleep EEG link was confirmed in another sample of 8 similar participants. Waking frontal 7- to 8-Hz EEG may not be typical theta, but "kappa" activity, believed to be associated with thinking CONCLUSIONS: Within limits of the EEG, and for the left frontal area, waking thinking may be reflected by putative cortical reorganization during the first NREM period.

Sleepiness combined with low alcohol intake in women drivers: greater impairment but better perception than men?

OBJECTIVES: We have previously shown that low blood alcohol concentrations (BAC) (at approximately half the legal driving limit in both the United Kingdom and in most states in the United States) exacerbate moderate sleepiness (sleep during the night restricted to 5 hours) and markedly impair driving ability in young men. There are distinct physiologic sex differences in the absorption, metabolism, and central nervous system effects of alcohol; therefore, we replicated this earlier study, this time using women and using similar BAC to provide a comparison. DESIGN: 2 x 2 repeated-measures counterbalanced. SETTING: 2-hour drive from 2:00 pm in an instrumented car on a simulated highway. INTERVENTIONS: Alcohol versus control and normal sleep versus sleep restricted to 5 hours. MEASUREMENTS AND RESULTS: Driving impairment (lane drifting), subjective sleepiness, and electroencephalographic measures of sleepiness. Sleep restriction significantly worsened driving performance and subjective sleepiness as it had in men. Surprisingly, unlike men, women showed no apparent adverse effects of alcohol alone on these indexes; they seemingly compensated for the effects of alcohol. However, alcohol's effects were profound when alcohol was combined with sleep restriction; nevertheless, women, unlike men, were aware of this enhanced sleepiness. After alcohol ingestion, the electroencephalogram showed increased beta activity, an effect not seen in men, indicating a differential pharmacokinetic effect of alcohol on the central nervous system, compensatory effort, or both. Debriefing questionnaires indicated that women were aware of the varying risks of driving under these different conditions. CONCLUSIONS: Legally "safe" BAC markedly worsen sleepiness-impaired driving in women. However, they seem to be aware of their impaired driving and are able to judge the degree of risk entailed. Such an attitude may contribute to the lower incidence of sleep- or alcohol-related crashes in women compared with men.

Presleep relaxed 7-8 Hz EEG from left frontal region: marker of localised neuropsychological performance?

Others have shown that frontally dominant EEG activity of around 7-8 Hz is linked to ongoing cognitive performance. Interestingly, we have found that this EEG activity is particularly evident during the relatively artefact-free period following "lights out" at bedtime when people report "thinking" when lying relaxed in their own beds prior to the appearance of EEG-determined sleepiness. Here, we explore the extent to which this localised activity is indicative of 'trait' performance on left frontal neuropsychological tasks, as well as with less localised, more general tasks. Twelve right-handed young adults (mean age: 21.3 years) and 12 right-handed older adults (mean age: 67.2 years) underwent (i) morning, laboratory-based, waking EEGs comprising (eyes closed) contrived thinking tasks, and (ii) a home-based wake EEG at bedtime. EEGs divided the cortex into the four comparable quadrants: Fp1-F3; Fp2-F4; O1-P3; and O2-P4. From a wide frequency band of 3-10 Hz analysed in 1-Hz bins, only 7-8 Hz was associated with the neuropsychological performance (nonverbal planning, verbal fluency) for both younger and older participants. This was most evident during relaxed waking after 'lights out,' and from the left frontal EEG. Such associations were not apparent for the other EEG channels or for the nonspecific tasks. Laboratory-based daytime, frontal EEG recordings are problematic because of eye movement artefact and when participants are not fully relaxed. In contrast, the nighttime data are almost artefact-free and from fully relaxed participants. This particular EEG is useful for assessing cortically localised behaviour and indicates that a more traditional approach of using large bandwidths (e.g., the whole of "alpha" or "theta" ranges) may mask subfrequencies of functional importance.

Driving drowsy also worsens driver distraction.

OBJECTIVES: Laboratory-based studies show that drowsiness increases the propensity to become distracted. As this phenomenon has not been investigated in drowsy drivers, we underwent a pilot study under realistic monotonous driving conditions to see if distraction was more apparent when drowsy; if so, how does it affect driving performance? METHODS: A repeated measures counterbalanced design whereby participants drove for two hours in a fully interactive car simulator during the bi circadian afternoon drive, after a night of either normal (baseline) or restricted sleep to five hours (sleep restriction). Videos of drivers' faces were analysed blind for short (<3 s) and long (>3 s) distractions, in which drivers took their eyes off the road ahead. These results were compared with the likelihood of simultaneous lane-drifting incidents, when at least two wheels left the driving lane. RESULTS: More distractions occurred after restricted sleep (p<0.005) for both short and long distractions (p<0.05). There was an overall significant (p<0.02) positive correlation between distractions and driving incidents for both conditions but with significantly more distraction-related incidents after sleep restriction (p<0.03). CONCLUSIONS: Following restricted sleep, drivers had an increased propensity to become distracted, which was associated with an increased likelihood of poor driving performance as evidenced by the car leaving the driving lane.

Driver sleepiness-comparisons between young and older men during a monotonous afternoon simulated drive.

Young men figure prominently in sleep-related road crashes. Non-driving studies show them to be particularly vulnerable to sleep loss, compared with older men. We assessed the effect of a normal night's sleep vs. prior sleep restricted to 5h, in a counterbalanced design, on prolonged (2 h) afternoon simulated driving in 20 younger (av. 23 y) and 19 older (av. 67 y) healthy men. Driving was monitored for sleepiness related lane deviations, EEGs were recorded continuously and subjective ratings of sleepiness taken every 200 s. Following normal sleep there were no differences between groups for any measure. After sleep restriction younger drivers showed significantly more sleepiness-related deviations and greater 4-11 Hz EEG power, indicative of sleepiness. There was a near significant increase in subjective sleepiness. Correlations between the EEG and subjective measures were highly significant for both groups, indicating good self-insight into increasing sleepiness. We confirm the greater vulnerability of younger drivers to sleep loss under prolonged afternoon driving.

Moderate sleep restriction in treated older male OSA participants: greater impairment during monotonous driving compared with controls.

OBJECTIVES: To examine the effects on monotonous driving of normal sleep versus one night of sleep restriction in continuous positive airway pressure (CPAP) treated obstructive sleep apnoea (OSA) patients compared with age matched healthy controls. METHODS: Nineteen CPAP treated compliant male OSA patients (OSA-treated patients (OPs)), aged 50-75 years, and 20 healthy age-matched controls underwent both a normal night's sleep and sleep restriction to 5h (OPs remained on CPAP) in a counterbalanced design. All participants completed a 2h afternoon monotonous drive in a realistic car simulator. Driving was monitored for sleepiness-related minor and major lane deviations, with 'safe' driving time being total time driven prior to first major lane deviation. EEGs were recorded continuously, and subjective sleepiness ratings were taken at regular intervals throughout the drive. RESULTS: After a normal night's sleep, OPs and controls did not differ in terms of driving performance or in their ability to assess the levels of their own sleepiness, with both groups driving 'safely' for approximately 90 min. However, after sleep restriction, OPs had a significantly shorter (65 min) safe driving time and had to apply more compensatory effort to maintain their alertness compared with controls. They also underestimated the enhanced sleepiness. Nevertheless, apart from this caveat, there were generally close associations between subjective sleepiness, likelihood of a major lane deviation and EEG changes indicative of sleepiness. CONCLUSIONS: With a normal night's sleep, effectively treated older men with OSA drive as safely as healthy men of the same age. However, after restricted sleep, driving impairment is worse than that of controls. This suggests that, although successful CPAP treatment can alleviate potential detrimental effects of OSA on monotonous driving following normal sleep, these patients remain more vulnerable to sleep restriction.

Evaluating the two-component inspection model in a simplified luggage search task.

Visual inspection of X-ray images of luggage is a time-pressured task that typically shows large initial training effects, but there exists a paucity of models capable of evaluating performance and speed concurrently. In the present study, visual inspection ability during learning was modeled using Drury's two-component inspection model (TCM; Drury, 1975) in a laboratory experiment involving 12 younger (mean age=20.8 years) and 12 older (mean age=60.0 years) naive participants undertaking a simplified luggage search task. Model fits and assumptions were found to be reliable and accurately reflected improvement with training for decision time, although neither search nor decision components of the model individually showed a significant effect of age. The decision component of the model showed larger improvement with training than did the search component, and stopping-time policy accurately reflected the improvements found between ages and within training levels. The TCM is a useful supplement to detection theory when speed of performance is a factor.

Early evening low alcohol intake also worsens sleepiness-related driving impairment.

Following night-time sleep restriction, afternoon driving performance during the bi-circadian surge in afternoon sleepiness is markedly worsened by blood alcohol concentrations (BACs) well under most national driving limits. This study assessed how driving with this same sleep restriction and BACs (av 40 mg and 28 mg alcohol/100 ml blood at the beginning and end of drive, respectively) respond during the evening circadian rise in alertness. In a 2 x 2 (alcohol versus control drink [double blind] x normal night sleep versus sleep restricted), repeated-measures design, eight healthy young men drove for 2 h from 18:00 h, in a real-car simulator, on a monotonous, simulated highway. Driving impairment (lane drifting), subjective sleepiness and EEG measures of sleepiness were recorded. While sleep restriction alone produced significant impairments to evening driving and subjective sleepiness, alcohol alone did not. However, alcohol combined with sleep restriction significantly worsened all indices, although, this was less than that found for afternoon driving with identical interventions. Whereas low BACs may not affect driving in normally alert drivers in the early evening, the addition of moderate sleep restriction still produces a dangerous combination. Probably, there is no 'safe' level of alcohol intake for otherwise sleepy drivers, at any time of the day.

Awareness of sleepiness when driving.

The extent to which sleepy drivers are aware of sleepiness has implications for the prevention of sleep-related crashes, especially for drivers younger than 30 years old who are most at risk. Using a real car interactive simulator, we report on EEG, subjective sleepiness, and lane drifting (sleepiness-related driving impairment) from 38 sleep-restricted, healthy young adults undergoing nontreatment control conditions from three (unpublished) investigations using the same experimental protocols for assessing various drinks intended to alleviate sleepiness. Participants drove 2 h during midafternoon under monotonous conditions. For all studies, subjective sleepiness and EEG activity indicative of sleepiness were highly correlated, with both changing concomitantly, along with lane drifting. Drivers had knowledge of their physiological sleepiness. There were indications that sugar content of these drinks may additionally affect sleepiness.

Prefrontal cortex: links between low frequency delta EEG in sleep and neuropsychological performance in healthy, older people.

Low frequency (< 1 Hz) delta EEG in sleep is of increasing interest as it indicates cortical reorganization, especially in the prefrontal cortex (PFC). Other research shows that delta power in sleep is positively linked to waking cerebral metabolic rate. Such findings suggest that < 1 Hz activity may reflect waking performance at neuropsychological tests specific to the PFC. We investigated this unexplored area. Sleep EEGs (Fp1-F3, Fp2-F4, O1-P3, O2-P4) were recorded in 24 healthy 61-75-year-olds. We found significant associations between 0.5-1.0 Hz power from the left frontal EEG channel, in the first non-REM period, and performance at tasks more specific to the left PFC (e.g., nonverbal planning and verbal fluency). This association was absent from the posterior channels. Neither age nor response times were confounding factors. This potential sleep EEG marker for PFC neuropsychological function in healthy, older people also points to further uses of the sleep EEG in understanding the role of sleep.

Nonlinear analysis of EEG during NREM sleep reveals changes in functional connectivity due to natural aging.

The spatial organization of nonlinear interactions between different brain regions during the first NREM sleep stage is investigated. This is achieved via consideration of four bipolar electrode derivations, Fp1F3, Fp2F4, O1P3, O2P4, which are used to compare anterior and posterior interhemispheric interactions and left and right intrahemispheric interactions. Nonlinear interdependence is detected via application of a previously written algorithm, along with appropriately generated surrogate data sets. It is now well understood that the output of neural systems does not scale linearly with inputs received and, thus, the study of nonlinear interactions in EEG is crucial. This approach also offers significant advantages over standard linear techniques, in that the strength, direction, and topography of the interdependencies can all be calculated and considered. Previous research has linked delta activity during the first NREM sleep stage to performance on frontally activating tasks during waking hours. We demonstrate that nonlinear mechanisms are the driving force behind this delta activity. Furthermore, evidence is presented to suggest that the aging brain calls upon the right parietal region to assist the pre-frontal cortex. This is highlighted by statistically significant differences in the rates of interdependencies between the left pre-frontal cortex and the right parietal region when comparing younger subjects (<23 years) with older subjects (>60 years). This assistance has been observed in brain-imaging studies of sleep-deprived young adults, suggesting that similar mechanisms may play a role in the event of healthy aging. Additionally, the contribution to the delta rhythm via nonlinear mechanisms is observed to be greater in older subjects.