A Survey Exploring How Watch Officers Manage Effects of Sleep Restrictions during Maritime Navigation.

Merchant marine officers work shifted hours with a sometimes very tiring work/rest rhythm that can lead to sleep restrictions and increased sleepiness during navigation. The aim of this study is to assess the risk of sleep deprivation-related sleepiness during navigation and the factors contributing to this risk. A second objective is to evaluate the use and effectiveness of sleepiness countermeasures. An online quantitative survey of 43 questions was conducted on 183 French maritime officers. A total of 39.9% of the participants experienced at least occasionally severe sleepiness and 29% had fallen asleep during navigation. A total of 42.6% reported not being able to experience enough sleep on board. Sleep requirements were affected by time spent on board, area of activity, and watch system. Sleepiness was more common during monotonous than demanding sailing. Officers frequently use caffeine, as well as vigilance-enhancing activities that they consider effective, which are not yet validated, (i.e., social interactions). However, they are not inclined to seek replacements in case of severe sleepiness. Sleep deprivation is common among maritime officers and leads to the risk of severe sleepiness while operating the vessel, with few effective countermeasures available. Strategies used for sleep management and sleepiness prevention should focus more on sleep duration, safety culture, and improving countermeasures to sleepiness.

A systematic review of effects of daytime napping strategies on sports performance in physically active individuals with and without partial-sleep deprivation.

Background: Sleep is the body's natural recovery process, restoring routine metabolic and regulatory functions. Various sleep interventions have been developed to facilitate recovery, and athletic performance, and daytime napping are among them. However, due to inconsistencies in studies, it remains unclear whether daytime napping affects sports performance. This article aims to review the effects of daytime napping on various variables of sports performance in physically active individuals with and without partial-sleep deprivation. Methods: A systematic search in three clinical databases, namely Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Web of Science, was conducted. To be included in the current review, the study should be a randomized controlled trial that evaluated the influence of daytime napping on one or more components of sports performance in healthy adults, 18 years old or older. Results: In the accessible data available until December 2021, 1,094 records were found, of which 12 relevant randomized controlled trials were selected for qualitative synthesis. The majority of studies reported favourable effects of daytime napping on sports performance. However, only one study reported no significant impact, possibly due to a different methodological approach and a shorter nap duration. Conclusion: Napping strategies optimize sports performance in physically active, athletic populations, benefitting partially sleep-deprived and well-slept individuals, with longer nap durations (~90 min) having more significant advantages. Daytime naps can be considered as cost-efficient, self-administered methods promoting recovery of body functions.

Resting and Recharging: A Narrative Review of Strategies to Improve Sleep During Residency Training.

Background: Residency involves demanding training with long hours that may cause fatigue and sleep deprivation and adversely impact residents and patients under their care. Objective: To identify, using a narrative review, evidence-based interventions to reduce the physiologic effects of fatigue and sleep deprivation from overnight and night shift work. Methods: A PubMed literature search was conducted through August 30, 2021, using the terms "resident" and "sleep" in the title or abstract and further narrowed using a third search term. Observational studies, randomized controlled trials, systematic reviews, and meta-analyses of human subjects written and published in English were included. Studies that were not specific to residents or medical interns or did not investigate an intervention were excluded. Additional studies were identified by bibliography review. Due to the heterogeneity of study design and intervention, a narrative review approach was chosen with results categorized into non-pharmacological and pharmacological interventions. Results: Initially, 271 articles were identified, which were narrowed to 28 articles with the use of a third search term related to sleep. Bibliography review yielded 4 additional articles. Data on interventions are limited by the heterogeneity of medical specialty, sample size, length of follow-up, and reliance on self-report. Non-pharmacological interventions including strategic scheduling and sleep hygiene may improve sleep and well-being. The available evidence, including randomized controlled trials, to support pharmacological interventions is limited. Conclusions: Non-pharmacological approaches to mitigating fatigue and sleep deprivation have varying effectiveness to improve sleep for residents; however, data for pharmacological interventions is limited.

Noise reduction in the ICU: a best practice implementation project.

INTRODUCTION: Sleep deprivation is a relevant problem among patients hospitalized in ICUs. Further, noise is the most critical disruptive factor according to patients. OBJECTIVE: To implement scientific evidence-based best practices for noise control in an adult ICU. METHODS: This was an evidence-based implementation project of best practices in noise control, conducted in a high-complexity hospital's adult ICU. The intervention consisted of three steps: baseline audit and identification of barriers, implementation of best practices, and a follow-up audit. RESULTS: No compliance with best practices was detected in the baseline audit. After the implementation phase, the unit reached compliance levels of 78-88% for most of these criteria only one criterion related to noise level did not match the expected compliance. CONCLUSION: Adherence to best practices regarding noise control was satisfactory, achieving more than 70% compliance in the six audit criteria. Only the noise level did not reach the threshold recommended by the WHO - a difficulty reported in other studies. RELEVANCE TO CLINICAL PRACTICE: Best practices related to noise control are essential for managing sleep deprivation in ICUs and include changes in the behaviour of involved professionals.

A comparative study of the effect of a gentle ketogenic diet containing medium-chain or long-chain triglycerides on chronic sleep deprivation-induced cognitive deficiency.

The ketogenic diet (KD) is well known for its neuroprotective effect, but little is known about its prophylactic efficacy against chronic sleep deprivation (SD) induced cognitive deficiency. An emerging study indicated that ferroptosis plays an important role in neurologic diseases but has been rarely reported in chronic SD. Here, we investigated the prophylactic effects of a medium-chain triglyceride-enriched KD (MKD) and a long-chain triglyceride-enriched KD (LKD) on cognitive deficiency and revealed the underlying mechanism focused on ferroptosis in chronic SD model mice. The results showed that the MKD exhibited stronger effects than the LKD on improving cognitive deficiency via suppressing ferroptosis and improving synaptic plasticity. Further mechanism results indicated that MKD produced higher Sirt3 protein levels than LKD, which probably contributed to the synergistic effect of beta hydroxybutyric acid and decanoic acid. Our finds provide novel evidence for the KD as a safe and feasible dietary intervention to prevent chronic SD-induced cognitive deficiency, and suggest a better choice of medium-chain fatty acid-enriched KD.

Performance Nutrition for Physician Trainees Working Overnight Shifts: A Randomized Controlled Trial.

PURPOSE: To compare acute effects of 2 dietary interventions with usual dietary habits on physician trainees' alertness during overnight shifts. METHOD: This registered, controlled, block randomized crossover trial (NCT03698123) was conducted between October 2018 and May 2019 at Stanford Medicine. Physician trainees working at least 3 overnight shifts during a 1-week period were recruited. During the first night, participants followed their usual dietary habits. During the intervention nights (low carbohydrate-to-protein ratio and high carbohydrate-to-protein ratio interventions), participants received healthy dinners, snacks, water, and, upon request, caffeinated beverages, at the beginning of their shifts and were instructed to eat meals before 10 pm. The sequence of interventions on the second and third nights were block randomized across study weeks. Outcome measures (a priori) were overnight changes in validated measures of specific neurobehavioral dimensions: psychomotor vigilance, sensory-motor speed, working memory, and risk decision making, as well as self-reported sleepiness and work exhaustion. RESULTS: Sixty-one physician trainees participated in this study. Compared with usual dietary habits, overnight changes in psychomotor vigilance scores (scale 0-1,000) improved by 51.02 points (95% CI: 12.08, 89.96) and sleepiness (scale 1-7) improved by 0.69 points (95% CI: 0.33, 1.05) under the low carbohydrate-to-protein ratio intervention. Compared with usual dietary habits, overnight changes in sleepiness (scale 1-7) improved by 0.61 points (95% CI: 0.25, 0.96) under the high carbohydrate-to-protein ratio intervention. Neither intervention had beneficial effects relative to usual dietary habits with respect to sensory-motor speed, working memory, risk decision making, or work exhaustion. There were no differences in outcomes between low carbohydrate-to-protein ratio and high carbohydrate-to-protein ratio interventions. CONCLUSIONS: Dietary interventions may mitigate negative effects of physician trainee sleep deprivation during overnight shifts. Future studies are warranted to further examine the effectiveness of nutritional strategies on physician alertness during overnight shifts.

Sleep-in to stay well: addressing school start times for the health and wellbeing of teens in Aotearoa.

The under-acknowledged malleability of secondary school start times may be a lever towards addressing poor sleep, particularly the sleep deprivation that many adolescents living in Aotearoa New Zealand experience on a daily basis. Scrutinising morning school start times has not been prioritised in terms of a logical, modifiable way to counteract sleep deprivation in adolescents in Aotearoa. Importantly, later start times align with adolescents' natural sleep-wake biology that shifts at puberty to favour later bedtimes, meaning they naturally need to wake later in the morning. In this viewpoint we argue that a later school start time (no earlier than 9:45 am) every day for senior secondary school students is an attractive, non-stigmatising approach to address adolescent sleep. Increased sleep also has the potential to favourably impact multiple areas of adolescents' health and wellbeing, as well as school success. In fact, we argue that later school start times are a public health imperative to address the sleep and mental health issues faced by youth in Aotearoa today.

Efficacy and safety of electroacupuncture treatment in the prevention of negative moods in healthy young men after 30 h of total sleep deprivation: study protocol for a single-center, single-blind, parallel-arm, randomized clinical trial.

BACKGROUND: Sleep deprivation (SD) among young adults is a major public health concern. In humans, it has adverse effects on mood and results in serious health problems. Faced with SD, persons may take precautionary measures to try and reduce their risk. The aim of this study is to evaluate the efficacy and safety of electroacupuncture (EA) for the prevention of negative moods after SD. In addition, we will do a comparison of the effects of EA on mood after SD at different time points. METHODS: This randomized controlled trial (RCT) will be performed at the First Affiliated Hospital of Changchun University of Chinese Medicine in China. The Standards for Reporting Interventions in Clinical Trials of Acupuncture 2010 will be strictly adhered to. Forty-two healthy male volunteers will be distributed into acupoints electroacupuncture (AE) group, non-acupoints electroacupuncture (NAE) control group, or blank control group. This trial will comprise 1-week baseline (baseline sleep), 1-week preventative treatment, 30-h total sleep deprivation (TSD), and 24-h after waking follow-up period. Participants in the AE group and the NAE control group during the preventative treatment period will be administered with EA treatment once daily for 1 week. Participants in the blank control group will not be administered with any treatment. The primary outcome will be the Profile of Mood States (POMS) Scale. Secondary outcome measures will include changes in the Noldus FaceReader (a tool for automatic analysis of facial expressions) and Positive and Negative Affect Schedule (PANAS) Scale. Total sleep deprivation will be 30 h. During the 30-h TSD period, participants will be subjected to 11 sessions of assessment. Adverse events will be recorded. DISCUSSION: This study is designed to evaluate the efficacy and safety of EA for the prevention of negative moods after SD. The results of this trial will allow us to compare the effects of EA on mood after SD at different time points. Moreover, the findings from this trial will be published in peer-reviewed journals. TRIAL REGISTRATION: Chinese Clinical Trial Registry Chi2000039713 . Registered on 06 November 2020.

The SmartSleep Experiment: Evaluation of changes in night-time smartphone behavior following a mass media citizen science campaign.

The increasing 24-hour smartphone use is of public health concern. This study aims to evaluate whether a massive public focus on sleep and smartphone use generated through a large-scale citizen science project, the SmartSleep Experiment, influence participants' night-time smartphone behavior. A total of 8,894 Danish adults aged 16 and above participated in the SmartSleep Experiment, a web-based survey on smartphones and sleep behavior. The survey was carried out for one week in 2018, combined with an extensive national mass media campaign focusing on smartphone behaviors and sleep. A follow-up survey aimed at evaluating whether survey-participants had changed their night-time smartphone behavior was carried out two weeks after the campaign. A total of 15% of the participants who used their smartphone during sleep hours at baseline had changed their night-time smartphone behavior, and 83% of those indicated that they used their smartphone less at follow-up. The participants who had changed their smartphone behavior had primarily taken active precautions to avoid night-time smartphone use, e.g., activating silent mode (36%) or reduced their smartphone use before (50%) and during sleep hours (52%). The reduction in sleep problems (54%), recognition of poor smartphone behavior (48%), and the increased focus on night-time smartphone use (42%) were motivational factors for these behavior changes. Using citizen science and mass media appeared to be associated with changes in night-time smartphone behavior. Public health projects may benefit from combining citizen science with other interventional approaches.

Flight Crew Alertness and Sleep Relative to Timing of In-Flight Rest Periods in Long-Haul Flights.

BACKGROUND: In-flight breaks are used during augmented long-haul flight operations, allowing pilots a sleep opportunity. The U.S. Federal Aviation Administration duty and rest regulations restrict the pilot flying the landing to using the third rest break. It is unclear how effective these restrictions are on pilots ability to obtain sleep. We hypothesized there would be no difference in self-reported sleep, alertness, and fatigue between pilots taking the second vs. third rest breaks.METHODS: Pilots flying augmented operations in two U.S.-based commercial airlines were eligible for the study. Volunteers completed a survey at top-of-descent (TOD), including self-reported in-flight sleep duration, and Samn-Perelli fatigue and Karolinska Sleepiness Scale ratings. We compared the second to third rest break using noninferiority analysis. The influence of time of day (home-base time; HBT) was evaluated in 4-h blocks using repeated measures ANOVA.RESULTS: From 787 flights 500 pilots provided complete data. The second rest break was noninferior to the third break for self-reported sleep duration (1.5 0.7 h vs. 1.4 0.7 h), fatigue (2.0 1.0 vs. 2.9 1.3), and sleepiness (2.6 1.4 vs. 3.8 1.8) at TOD for landing pilots. Measures of sleep duration, fatigue, and sleepiness were influenced by HBT circadian time of day.DISCUSSION: We conclude that self-reported in-flight sleep, fatigue, and sleepiness from landing pilots taking the second in-flight rest break are equivalent to or better than pilots taking the third break. Our findings support providing pilots with choice in taking the second or third in-flight rest break during augmented operations.Gregory KB, Soriano-Smith RN, Lamp ACM, Hilditch CJ, Rempe MJ, Flynn-Evans EE, Belenky GL. Flight crew alertness and sleep relative to timing of in-flight rest periods in long-haul flights. Aerosp Med Hum Perform. 2021; 92(2):8391.

Assessing sleep-wake survival dynamics in relation to sleep quality in a placebo-controlled pharmacological intervention study with people with insomnia and healthy controls.

RATIONALE: The mechanisms underlying impaired sleep quality in insomnia are not fully known, but an important role for sleep fragmentation has been proposed. OBJECTIVES: The aim of this study is to explore potential mechanisms of sleep fragmentation influencing alterations of perceived sleep quality. METHODS: We analyzed polysomnography (PSG) recordings from a double-blind crossover study with zopiclone 7.5 mg and placebo, in elderly participants with insomnia complaints and age-matched healthy controls. We compared survival dynamics of sleep and wake across group and treatment. Subsequently, we used a previously proposed model to estimate the amount of sleep onset latency (SOL) misperception from PSG-defined sleep fragmentation. Self-reported and model-estimated amount of SOL misperception were compared across group and treatment, as well as model prediction errors. RESULTS: In the zopiclone night, the average segment length of NREM sleep was increased (group F = 1.16, p = 0.32; treatment F = 8.89, p < 0.01; group x treatment F = 0.44, p = 0.65), while the segment length of wake was decreased (group F = 1.48, p = 0.23; treatment F = 11.49, p < 0.01; group x treatment F = 0.36, p = 0.70). The self-reported and model-estimated amount of SOL misperception were lower during the zopiclone night (self-reported group F = 6.08, p < 0.01, treatment F = 10.8, p < 0.01, group x treatment F = 2.49, p = 0.09; model-estimated F = 1.70, p = 0.19, treatment F = 16.1, p < 0.001, group x treatment F = 0.60, p = 0.55). The prediction error was not altered (group F = 1.62, p = 0.20; treatment F = 0.20, p = 0.65; group x treatment F = 1.01, p = 0.37). CONCLUSIONS: Impaired subjective sleep quality is associated with decreased NREM stability, together with increased stability of wake. Furthermore, we conclude that zopiclone-induced changes in SOL misperception can be largely attributed to predictable changes of sleep architecture.

Fatigue in surgical residents an analysis of duty-hours and the effect of hypothetical naps on predicted performance.

PURPOSE: Sleep loss and fatigue, common in resident physicians, are related to increased medical errors and decreased physician wellbeing. Biomathematical modeling of fatigue can illuminate the relationship between surgical resident fatigue and work scheduling. METHODS: General surgery resident schedules were analyzed using the Sleep, Activity, Fatigue and Task Effectiveness model to predict resident performance during work hours. Hypothetical naps were built into the model to assess their effect on predicted performance and fatigue risk. RESULTS: 12 months of duty-hours logged by 89 residents, ranging from post-graduate year (PGY) 1-5, were analyzed. Residents had moderate levels of fatigue risk over 12 month schedules, with at least an 8-h sleep debt during 24.36% of shifts. Performance scores decreased as shift lengths increased. The addition of hypothetical naps increased predicted performance and reduced shift time with fatigue risk. CONCLUSIONS: Biomathematical modeling of resident schedules and predicts a concerning level of fatigue and decreased effectiveness. Naps may improve performance without decreasing scheduled hours.

Sleep leadership in the army: A group randomized trial.

OBJECTIVES: Examine impact of training military leaders in sleep health on leaders and unit members. DESIGN: Following a baseline survey, two-person platoon leadership teams were randomly assigned by company to a training or waitlist control condition. After training, leadership teams completed a post-training survey. Six weeks later, leaders and unit members completed a final survey. SETTING: Classroom-style areas on a US military base. PARTICIPANTS: US soldiers (76 leaders and 448 unit members) from 39 platoons across 14 companies in a brigade combat team. INTERVENTION: One-hour training in sleep leadership. MEASUREMENTS: Leaders were surveyed about sleep knowledge, sleep attitudes, sleep training, sleep quantity, sleep quality and sleep problems. Unit members were surveyed about sleep leadership behaviors, sleep hours, sleep quality and sleep problems. RESULTS: Leaders rated the training highly and most knowledge and some attitudes about sleep improved from the baseline to post-training survey. Fewer leaders in the training condition reported sleep problems at follow-up than those in the waitlist control condition; there were no differences in sleep hours or sleep quality. More unit members with leaders in the training condition reported that their leaders engaged in sleep leadership behaviors at least sometimes and reported sleeping at least 7 hours/24 hours period than did unit members in the waitlist control condition; sleep quality and sleep problems did not differ by condition. CONCLUSIONS: Results suggest a simple training intervention targeting leaders may be able to shift sleep health and the cultural perspective on sleep across an organization.

Improving Quiet at Night on a Telemetry Unit: Introducing a Holistic Sleep Menu Intervention.

In a patient's recovery process, restful sleep is crucial. Although the essential role of sleep in healing has long been recognized, excessive noise in hospital environments remains a persistent and pervasive problem. For hospitalized patients, environmental noise can result in sleep deprivation and adverse health outcomes; not surprisingly, hospital noise ranks as a major patient complaint. At a small suburban community hospital, patients responding to a quiet-at-night question in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey gave the hospital's telemetry unit the lowest possible score: 1 out of 5 points. In response, the unit's quality improvement team, coordinated by a clinical nurse leader, introduced a holistic "sleep menu" intervention. The multicomponent intervention subsequently improved patients' care experience and staff engagement. The percentage of patients who self-reported five or more hours of uninterrupted sleep rose from 31% at baseline to 80% during the intervention. This improvement was sustained over the three-month intervention period and led to a quiet-at-night HCAHPS score of 4. The sleep menu initiative resulted in substantial benefits that optimized both patient and organizational outcomes.

Interventions to improve inpatients' sleep quality in intensive care units and acute wards: a literature review.

BACKGROUND: Sleep is essential for the physical and psychological restoration of inpatients, and lack of sleep results in sleep deprivation and poor sleep quality, with potentially harmful consequences. AIM: To summarise sleep-promoting interventions in the Intensive care unit (ICU) and acute ward setting. METHOD AND RESULTS: Six databases were searched to obtain studies for review and eight studies were selected, appraised, analysed and produced two themes: sleep-disturbing factors and sleep-promoting strategies. Sleep-disturbing factors included environmental factors (such as light and noise), illness-related factors (such as pain, anxiety and discomfort), clinical care and diagnostics. Sleep-promoting strategies included using pharmacological aids (medication) and non-pharmacological aids (reducing noise and disturbances, eye masks, earplugs and educational and behavioural changes). CONCLUSION: The literature review showed that both ICU and acute ward settings affect patients' sleep and both use similar strategies to improve this. Nevertheless, noise and sleep disturbances remain the most critical sleep-inhibiting factors in both settings. The review recommended future research should focus on behavioural changes among health professionals to reduce noise and improve patients' sleep.

Sleep Disorders in Adolescents.

Chronic sleep deprivation is a common, treatable condition among adolescents. Growing literature supports a myriad consequences that impact overall health, behavior, mood, and academic performance in this vulnerable age group during a time when there are rapid changes in physical development and emotional regulation. This article reviews the epidemiology and health effects of sleep deprivation in adolescents as well as common disorders leading to sleep loss and evidence to support treatment. Although a variety of important sleep disorders may disrupt quality of sleep in adolescents, such as obstructive sleep apnea, restless leg syndrome, and narcolepsy, this article will focus on common disorders that affect the quantity of sleep, such as poor sleep hygiene, circadian rhythm disorders, and insomnia.

Sleep education for healthcare providers: Addressing deficient sleep in Australia and New Zealand.

Deficient sleep has been recognized as a current health crisis in Australia and New Zealand, contributing to the increased prevalence and severity of chronic diseases and mental health issues. However, all healthcare disciplines currently receive limited training in addressing deficient sleep, which is contributing to the current health crisis. This narrative review considers the following: (1) the prevalence and burden of deficient sleep in Australia and New Zealand; (2) the limited sleep education in healthcare training programs; (3) healthcare providers' lack of knowledge and evidence-based clinical practice in sleep disorders; (4) sleep-focused education initiatives for healthcare providers; (5) an action agenda for improved sleep education for healthcare providers. Both domestic and international sleep initiatives are considered, as is the role of general practitioners (primary care physicians), pediatricians, psychologists, pharmacists, and nurses. Three key themes emerge and guide action: (1) relevant training for students from all healthcare disciplines; (2) continuing professional development for practicing healthcare providers; and (3) translation of evidence-driven best practice into clinical practice. To achieve this sleep education agenda, the sleep community must form and strengthen partnerships across professional associations, public health agencies, and education providers. By improving education and clinical practice in sleep, we will equip healthcare providers with the knowledge and skills needed to address deficient sleep in Australia and New Zealand.

Top 10 evidence-based countermeasures for night shift workers.

Emergency edicine providers are responsible for ensuring the emergency department is staffed 24 hours a day. As such, providers must efficiently transition between day, swing and night shift on an almost weekly basis. There is no formal education in medical school or residency on how to approach the transition to and from night shift, remain alert and productive and maximise sleep during the day. There are a multitude of blogs and online sources discussing night shift, but few, if any, provide an evidence-based approach. This article will provide the top 10 evidence-based recommendations to increase sleep, maximise performance, decrease fatigue on shift and improve quality of life outside the workplace.