Aircrew Fatigue in Trans‐Atlantic Morning and Evening Flights

The aim of the investigation was to compare sleepiness and sleep on westward morning and evening flights. Seven morning‐crew pilots and seven evening‐crew pilots participated. Data were collected before, during, and after outward‐bound (westward) and homeward‐bound (eastward) flights across six time zones. A sleep/wake diary (with repeated sleepiness and performance ratings) and wrist actigraphy were used for data collection. Maximum sleep was obtained after return and minimum sleep before the outward‐bound flights. Actigraphy measures and sleep efficiency over the course of the study showed no significant differences between the morning and evening crews. There was a trend for a significant effect of morning vs. evening flight for time with heavy eyelids, with the homeward‐bound flight showing more time with heavy eyelids. There were no significant differences between morning and evening crews with regard to napping during the flight. The duration of wakefulness was longer for the evening flight crew. There were significant interactions for Karolinska sleepiness scale (KSS) self‐ratings on both the outward‐bound and homeward‐bound flights, and KSS was elevated during a considerable portion of the evening flights. Rated performance showed a significant time effect, but there was no difference in self‐ratings between morning and evening crews. Evening flights involve higher levels of sleepiness than morning flights, presumably because of the close proximity in time to the circadian trough of alertness.     

Does the circadian clock drift when pilots fly multiple transpacific flights with 1- to 2-day layovers?

On trips with multiple transmeridian flights, pilots experience successive non-24 h day/night cycles with circadian and sleep disruption. One study across a 9-day sequence of transpacific flights (no in-flight sleep, 1-day layovers between flights) reported an average period in the core body temperature rhythm of 24.6 h (circadian drift). Consequently, pilots were sometimes flying through the circadian performance nadir and had to readapt to home base time at the end of the trip. The present study examined circadian drift in trip patterns with longer flights and in-flight sleep. Thirty-nine B747-400 pilots (19 captains, 20 first officers, mean age = 55.5 years) were monitored on 9- to 13-day trips with multiple return flights between East Coast USA and Japan (in 4-pilot crews) and between Japan and Hawaii (in 3-pilot crews), with 1-day layovers between each flight. Measures included total in-flight sleep (actigraphy, log books) and top of descent (TOD) measures of sleepiness (Karolinska Sleepiness Scale), fatigue (Samn–Perelli Crew Status Check) and psychomotor vigilance task (PVT) performance. Circadian rhythms of individual pilots were not monitored. To detect circadian drift, mixed-model analysis of variance examined whether for a given flight, total in-flight sleep and TOD measures varied according to when the flight occurred in the trip sequence. In addition, sleep propensity curves for pre-trip and post-trip days were examined (Chi-square periodogram analyses). Limited data suggest that total in-flight sleep of relief crew at landing may have decreased across successive East Coast USA–Japan (flights 1, 3, 5 or 7; median arrival 03:45 Eastern Daylight Time (EDT)). However, PVT response speed at TOD was faster on East Coast USA–Japan flights later in the trip. On these flights, circadian drift would result in flights later in the trip landing closer to the evening wake maintenance zone, when sleep is difficult and PVT response speeds are fastest. On Japan–East Coast USA flights (flights 2, 4, 6 or 8; median arrival time 14:52 EDT), PVT response speeds were slower on flight 8 than on flight 2. Circadian drift would move these arrivals progressively earlier in the SCN pacemaker cycle, where PVT response speeds are slower. Across the five post-trip days, 12 pilots (Group A) immediately resumed their pre-trip sleep pattern of a single nocturnal sleep episode; 9 pilots (Group B) had a daytime nap on most days that moved progressively earlier until it merged with nocturnal sleep and 17 pilots (Group C) had nocturnal sleep and intermittent naps. Chi-square periodogram analyses of the sleep propensity curves for each group across baseline and post-trip days suggest full adaptation to EDT from post-trip day 1 (dominant period = 24 h). However, in Groups B and C, the patterns of split sleep post-trip compared to pre-trip suggest that this may be misleading. We conclude that the trends in total in-flight sleep and significant changes in PVT performance speed at TOD provide preliminary evidence for circadian drift, as do persistent patterns of split sleep post-trip. However, new measures to track circadian rhythms in individual pilots are needed to confirm these findings.     

The sleep, subjective fatigue, and sustained attention of commercial airline pilots during an international pattern

International commercial airline pilots may experience heightened fatigue due to irregular sleep schedules, long duty days, night flying, and multiple time zone changes. Importantly, current commercial airline flight and duty time regulations are based on work/rest factors and not sleep/wake factors. Consequently, the primary aim of the current study was to investigate pilots' amount of sleep, subjective fatigue, and sustained attention before and after international flights. A secondary aim was to determine whether prior sleep and/or duty history predicted pilots' subjective fatigue and sustained attention during the international flights. Nineteen pilots (ten captains, nine first officers; mean age: 47.42+/-7.52 years) participated. Pilots wore wrist activity monitors and completed sleep and duty diaries during a return pattern from Australia to Europe via Asia. The pattern included four flights: Australia-Asia, Asia-Europe, Europe-Asia, and Asia-Australia. Before and after each flight, pilots completed a 5 min PalmPilot-based psychomotor vigilance task (PVT) and self-rated their level of fatigue using the Samn-Perelli Fatigue Checklist. Separate repeated-measures ANOVAs were used to determine the impact of stage of flight and flight sector on the pilots' sleep in the prior 24 h, self-rated fatigue, and PVT mean response speed. Linear mixed model regression analyses were conducted to examine the impact of sleep in the prior 24 h, prior wake, duty length, and flight sector on pilots' self-rated fatigue and sustained attention before and after the international flights. A significant main effect of stage of flight was found for sleep in the prior 24 h, self-rated fatigue, and mean response speed (all p < 0.05). In addition, a significant main effect of flight sector on self-rated fatigue was found (p < .01). The interaction between flight sector and stage of flight was significant for sleep in the prior 24 h and self-rated fatigue (both p < .05). Linear mixed model analyses indicated that sleep in the prior 24 h was a significant predictor of self-rated fatigue and mean response speed after the international flight sectors. Flight sector was also a significant predictor of self-rated fatigue. These findings highlight the importance of sleep and fatigue countermeasures during international patterns. Furthermore, in order to minimize the risk of fatigue, the sleep obtained by pilots should be taken into account in the development of flight and duty time regulations.     

Reataining Home-Base Sleep Hours to Prevent Jet Lag in Connection with a Westward Flight Across Nine Time Zones

The aim of this study was to test a possible countermeasure to jet lag: letting air crew retain their home-base sleep/wake pattern during layover. Instead of their usual adoption of local sleep hours, 19 flight attendants were scheduled to a westward layover (50h) flight (Copenhagen-Los Angeles, -9h) on two occasions. On one trip, crews adopted the local sleep pattern, and on the other trip, the crew retained home-base sleep hours. Subjects were monitored for 10 days before, during, and after the flight; they wore activity loggers and gave ratings through sleep/wake diaries and a questionnaire. Ratings of jet lag symptoms and sleepiness were greatly reduced during layover, but not at home, for the home-base condition. It was also found that jet lag feelings seemed to be related mainly to mean sleepiness ratings (multiple regression; 16%, beta = 0.46) and to the number of awakenings (6%, beta = 0.29) during sleep. It is concluded that retaining the home-base sleep pattern may reduce jet lag during layover.     

The Sleep,Subjective Fatigue,and Sustained Attention of Commercial Airline Pilots during an International Pattern

International commercial airline pilots may experience heightened fatigue due to irregular sleep schedules, long duty days, night flying, and multiple time zone changes. Importantly, current commercial airline flight and duty time regulations are based on work/rest factors and not sleep/wake factors. Consequently, the primary aim of the current study was to investigate pilots' amount of sleep, subjective fatigue, and sustained attention before and after international flights. A secondary aim was to determine whether prior sleep and/or duty history predicted pilots' subjective fatigue and sustained attention during the international flights. Nineteen pilots (ten captains, nine first officers; mean age: 47.42±7.52 years) participated. Pilots wore wrist activity monitors and completed sleep and duty diaries during a return pattern from Australia to Europe via Asia. The pattern included four flights: Australia‐Asia, Asia‐Europe, Europe‐Asia, and Asia‐Australia. Before and after each flight, pilots completed a 5 min PalmPilot‐based psychomotor vigilance task (PVT) and self‐rated their level of fatigue using the Samn‐Perelli Fatigue Checklist. Separate repeated‐measures ANOVAs were used to determine the impact of stage of flight and flight sector on the pilots' sleep in the prior 24 h, self‐rated fatigue, and PVT mean response speed. Linear mixed model regression analyses were conducted to examine the impact of sleep in the prior 24 h, prior wake, duty length, and flight sector on pilots' self‐rated fatigue and sustained attention before and after the international flights. A significant main effect of stage of flight was found for sleep in the prior 24 h, self‐rated fatigue, and mean response speed (all p<0.05). In addition, a significant main effect of flight sector on self‐rated fatigue was found (p<.01). The interaction between flight sector and stage of flight was significant for sleep in the prior 24 h and self‐rated fatigue (both p<.05). Linear mixed model analyses indicated that sleep in the prior 24 h was a significant predictor of self‐rated fatigue and mean response speed after the international flight sectors. Flight sector was also a significant predictor of self‐rated fatigue. These findings highlight the importance of sleep and fatigue countermeasures during international patterns. Furthermore, in order to minimize the risk of fatigue, the sleep obtained by pilots should be taken into account in the development of flight and duty time regulations.     

Impact of layover length on sleep, subjective fatigue levels, and sustained attention of long-haul airline pilots

Long-haul airline pilots often experience elevated levels of fatigue due to extended work hours and circadian misalignment of sleep and wake periods. During long-haul trips, pilots are typically given 1-3 d off between flights (i.e., layover) to recover from, and prepare for, duty. Anecdotally, some pilots prefer long layovers because it maximizes the time available for recovery and preparation, but others prefer short layovers because it minimizes both the length of the trip, and the degree to which the body clock changes from "home time" to the layover time zone. The aim of this study was to examine the impact of layover length on the sleep, subjective fatigue levels, and capacity to sustain attention of long-haul pilots. Participants were 19 male pilots (10 Captains, 9 First Officers) working for an international airline. Data were collected during an 11- or 12-d international trip. The trips involved (i) 4 d at home prior to the trip; (ii) an eastward flight of 13.5 h across seven time zones; (iii) a layover of either 39 h (i.e., short, n = 9) or 62 h (i.e., long, n = 10); (iv) a return westward flight of 14.3 h across seven time zones; and (v) 4 d off at home after the trip. Sleep was recorded using a self-report sleep diary and wrist activity monitor; subjective fatigue level was measured using the Samn-Perelli Fatigue Checklist; and sustained attention was assessed using the psychomotor vigilance task for a personal digital assistant (PalmPVT). Mixed-model regression analyses were used to determine the effects of layover length (short, long) on the amount of sleep that pilots obtained during the trip, and on the pilots' subjective fatigue levels and capacity to sustain attention. There was no main effect of layover length on ground-based sleep or in-flight sleep, but pilots who had a short layover at the midpoint of their trip had higher subjective fatigue levels and poorer sustained attention than pilots who had a long layover. The results of this study indicate that a short layover during a long-haul trip does not substantially disrupt pilots' sleep, but it may result in elevated levels of fatigue during and after the trip. If short layovers are used, pilots should have a minimum of 4 d off to recover prior to their next long-haul trip.     

Effects of 6/6 and 4/8 Watch Systems on Sleepiness among Bridge Officers

During the last ten years, severe sleepiness or falling asleep by watch keeping officers has been a direct or a contributing factor in a number of maritime accidents. This study examined the relationship between two watch systems and its impact on fatigue and sleepiness in bridge officers. A questionnaire and a sleep/work diary were sent to a representative sample of the Finnish Maritime Officer Association. In all, 185 bridge officers answered the questionnaire on sleep, work hours, and safety, including the Skogby Excessive Daytime Sleepiness index (SEDS); 42% of the bridge officers worked two 4 h watches (4/8) per day, while 26% worked two 6 h watches per day (6/6). Ninety‐five of the participants completed a sleep diary for seven consecutive days while at sea. The timing of the watch duties and sleep was recorded, as was subjective sleepiness every 2 h using the Karolinska Sleepiness Scale (KSS). 17.6% of the participants had fallen asleep at least once while on duty during their career. Compared to the 4/8 watch system, the officers working the 6/6 watch system reported shorter sleep durations, more frequent nodding‐off on duty (7.3% vs. 1.5%), and excessive sleepiness (32% vs. 16% with SEDS>14). Based on a logistic regression analysis, high SEDS was significantly related with probable obstructive sleep apnea (OR 5.7), the 6/6 watch system (OR 4.0), and morningness‐eveningness while controlling simultaneously several individual and sleep‐related factors. Subjective sleepiness (KSS) was highest at 04:00 and 06:00 h. In a multivariate analysis, the KSS was significantly related to time of day, time after awaking, sleep length, and interactions of the watch systems with age, morningness‐eveningness, and Epworth sleepiness scale (ESS) score. Severe sleepiness at 04:00–06:00 h was especially problematic in the 6/6 watch system among evening types and among the bridge officers with high ESS. The results suggest the 6/6 watch system is related to a higher risk of severe sleepiness during the early morning hours compared to the 4/8 and the other watch systems assessed.     

The self-morningness/eveningness (Self-ME): An extremely concise and totally subjective assessment of diurnal preference

The assessment of diurnal preference, or the preferred timing of sleep and activity, is generally based on comprehensive questionnaires such as the Horne–Östberg (HÖ). The aim of the present study was to assess the reliability of a subject’s self-classification as extremely morning (Self-MM), more morning than evening (Self-M), more evening than morning (Self-E) or extremely evening (Self-EE) type, based on the last question of the HÖ (Self-ME). A convenience sample of 461 subjects [23.8?±?4.7 years; 322 females] completed a full sleep–wake assessment, including diurnal preference (HÖ), night sleep quality (Pittsburgh Sleep Quality Index, PSQI), daytime sleepiness (Karolinska Sleepiness Scale, KSS), and habitual sleep–wake timing (12?d sleep diaries; n?=?296). Significant differences in HÖ total score were observed between Self-ME classes, with each class being significantly different from neighboring classes (p?<?0.0001). Significant differences in sleep–wake timing (bed time, try to sleep and sleep onset, wake up, and get up time) were observed between Self-ME classes. Such differences were maintained when sleep–wake habits were analysed separately on work and free days, and also in a smaller group of 67 subjects who completed the Self-ME as a stand-alone rather than as part of the original questionnaire. Significant differences were observed in the time-course of subjective sleepiness by Self-ME class in both the large and the small group, with Self-MM and Self-M subjects being significantly more alert in the morning and sleepier in the evening hours compared with their Self-E and Self-EE counterparts. Finally, significant differences were observed in night sleep quality between Self-ME classes, with Self-EE/Self-E subjects sleeping worse than their Self-MM/Self-M counterparts, and averaging just over the abnormality PSQI threshold of 5. In conclusion, young, healthy adults can define their diurnal preference based on a single question (Self-ME) in a way that reflects their sleep–wake timing, their sleepiness levels over the daytime hours, and their night sleep quality. Validation of the Self-ME across the decades and in diseased populations seems worthy.     

Effects of 6/6 and 4/8 watch systems on sleepiness among bridge officers

During the last ten years, severe sleepiness or falling asleep by watch keeping officers has been a direct or a contributing factor in a number of maritime accidents. This study examined the relationship between two watch systems and its impact on fatigue and sleepiness in bridge officers. A questionnaire and a sleep/work diary were sent to a representative sample of the Finnish Maritime Officer Association. In all, 185 bridge officers answered the questionnaire on sleep, work hours, and safety, including the Skogby Excessive Daytime Sleepiness index (SEDS); 42% of the bridge officers worked two 4 h watches (4/8) per day, while 26% worked two 6 h watches per day (6/6). Ninety-five of the participants completed a sleep diary for seven consecutive days while at sea. The timing of the watch duties and sleep was recorded, as was subjective sleepiness every 2 h using the Karolinska Sleepiness Scale (KSS). 17.6% of the participants had fallen asleep at least once while on duty during their career. Compared to the 4/8 watch system, the officers working the 6/6 watch system reported shorter sleep durations, more frequent nodding-off on duty (7.3% vs. 1.5%), and excessive sleepiness (32% vs. 16% with SEDS>14). Based on a logistic regression analysis, high SEDS was significantly related with probable obstructive sleep apnea (OR 5.7), the 6/6 watch system (OR 4.0), and morningness-eveningness while controlling simultaneously several individual and sleep-related factors. Subjective sleepiness (KSS) was highest at 04:00 and 06:00 h. In a multivariate analysis, the KSS was significantly related to time of day, time after awaking, sleep length, and interactions of the watch systems with age, morningness-eveningness, and Epworth sleepiness scale (ESS) score. Severe sleepiness at 04:00-06:00 h was especially problematic in the 6/6 watch system among evening types and among the bridge officers with high ESS. The results suggest the 6/6 watch system is related to a higher risk of severe sleepiness during the early morning hours compared to the 4/8 and the other watch systems assessed.     

Variation in sleepiness during early morning shifts: a mixed model approach to an experimental field study of train drivers

The present study aimed to experimentally evaluate the effect of early morning shifts on sleep and sleepiness of train drivers during normal working conditions. A total of 17 experienced train drivers were studied during a 4.5 h drive in two directions with a 2.5 h break in between on three different shifts: an early shift that started at 05:49 h (train left at 06:18 h) and ended at 17:41h, a day shift (07:49-19:41 h), and an evening shift (09:49-21:41 h). Retrospective (since the last stop) ratings of mean sleepiness and peak sleepiness (Karolinska Sleepiness Scale--KSS: 1 = very alert, 9= very sleepy, fighting sleep, difficulty staying awake) were assessed at each stop during the drive. The results showed that sleep length was reduced (p <0.001) by 1 h and 2h, respectively, by the early shift compared to the day and evening shifts. The prevalence of severe sleepiness (KSS > or = 7) was high, especially during the early shift when 14 (82%) subjects reported at least one event during the drive. Application of the Generalized Linear Mixed Models (GLMM) to the sleepiness data showed that there was an increased risk for severe sleepiness during the early shift (OR = 4.9) that increased further with the length of the drive between stops (OR = 1.9, 15 min), suggesting an interaction between early morning shift and monotony. The findings have practical implications in risk assessment. Long drives without stops and other monotonous situations should have a higher risk rating for severe sleepiness in shifts with an early start before 06:00 h, compared to shifts that begin 2 h later.     

Circadian adaptation of airline pilots during extended duration operations between the USA and Asia

This study tracked circadian adaptation among airline pilots before, during, and after trips where they flew from Seattle (SEA) or Los Angeles (LAX) to Asia (7--9 time zones westward), spent 7--12?d in Asia, and then flew back to the USA. In Asia, pilots' exposures to local time cues and sleep opportunities were constrained by duty (short-haul flights crossing ≤1 time zone/24?h). Fourteen captains and 16 first officers participated (median age?=?56 versus 48 yrs, p.U)?<?0.001). Their sleep was monitored (actigraphy, duty/sleep diaries) from 3?d pre-trip to 5?d post-trip. For every flight, Karolinska Sleepiness and Samn-Perelli Fatigue scales and 5-min psychomotor vigilance task (PVT) tests were completed pre-flight and at top of descent (TOD). Participants had ≥3 d free of duty prior to outbound flight(s). From 72--24?h prior to departure (baseline sleep), mean total sleep/24?h (TST)?=?7.00?h (SD?=?1.18?h) and mean sleep efficiency?=?87% (SD?=?4.9%). Most pilots (23/30) flew direct to and from Asia, but 7 LAX-based pilots flew via a 1-d layover in Honolulu (HNL). On flights with ≥2 pilots, mean total in-flight sleep varied from 0.40 to 2.09?h outbound and from 0.74 to 1.88?h inbound. Duty patterns in Asia were variable, with ≤2 flights/d (mean flight duration?=?3.53?h, SD?=?0.53?h). TST on days 17 in Asia did not differ from baseline (p.F)?=?0.2031). However, mean sleep efficiency was significantly lower than baseline on days 5--7 (p.F)?=?0.0041). More pilots were on duty between 20:00 and 24:00?h on days 57 (mean?=?21%) than on days 24 (mean?=?14%). Sleep propensity distribution phase markers and chi-square periodogram analyses suggest that adaptation to local time was complete by day 4 in Asia. On pre-flight PVT tests in Asia, the slowest 10% of responses improved for flights departing 14:00--19:59?h (p.F)?=?0.0484). At TOD, the slowest 10% of responses improved across days for flights arriving 14:00--19:59?h (p.F)?=?0.0349) and 20:00--01:59?h (p.F)?=?0.0379). Sleepiness and fatigue ratings pre-flight and at TOD did not change across days in Asia. TST on post-trip day 1 was longer than baseline (estimated mean extension?=?1.68?h; adjusted p(t)?<?0.0001). On all post-trip days, sleep efficiency was comparable to baseline. Sleep propensity distribution phase markers and chi-square periodogram analyses suggest complete readaptation in 12?d. Two opposing influences appeared to affect sleep and PVT performance across days in Asia: progressive circadian adaptation to local time and increasing duty during local night, which displaced sleep from the optimal physiological time. Cumulative sleep restriction across the return flight may explain the large rebound in TST on day 1 post-trip. Thereafter TST, sleep efficiency, and sleep timing suggest that readaptation was complete. Rapid post-trip readaptation may be facilitated by pilots having unconstrained nocturnal sleep opportunities, coupled with stronger patterns of family and social cues than in Asia.     

The effect of consecutive transmeridian flights on alertness,sleep–wake cycles and sleepiness: A case study

ABSTRACT

Travel across time zones disrupts circadian rhythms causing increased daytime sleepiness, impaired alertness and sleep disturbance. However, the effect of repeated consecutive transmeridian travel on sleep–wake cycles and circadian dynamics is unknown. The aim of this study was to investigate changes in alertness, sleep–wake schedule and sleepiness and predict circadian and sleep dynamics of an individual undergoing demanding transmeridian travel. A 47-year-old healthy male flew 16 international flights over 12 consecutive days. He maintained a sleep–wake schedule based on Sydney, Australia time (GMT + 10?h). The participant completed a sleep diary and wore an Actiwatch before, during and after the flights. Subjective alertness, fatigue and sleepiness were rated 4 hourly (08:00–00:00), if awake during the flights. A validated physiologically based mathematical model of arousal dynamics was used to further explore the dynamics and compare sleep time predictions with observational data and to estimate circadian phase changes. The participant completed 191?h and 159 736?km of flying and traversed a total of 144 time-zones. Total sleep time during the flights decreased (357.5?min actigraphy; 292.4?min diary) compared to baseline (430.8?min actigraphy; 472.1?min diary), predominately due to restricted sleep opportunities. The daily range of alertness, sleepiness and fatigue increased compared to baseline, with heightened fatigue towards the end of the flight schedule. The arousal dynamics model predicted sleep/wake states during and post travel with 88% and 95% agreement with sleep diary data. The circadian phase predicted a delay of only 34?min over the 16 transmeridian flights. Despite repeated changes in transmeridian travel direction and flight duration, the participant was able to maintain a stable sleep schedule aligned with the Sydney night. Modelling revealed only minor circadian misalignment during the flying period. This was likely due to the transitory time spent in the overseas airports that did not allow for resynchronisation to the new time zone. The robustness of the arousal model in the real-world was demonstrated for the first time using unique transmeridian travel.     

Melatonin Treatment Effects on Adolescent Students' Sleep Timing and Sleepiness in a Placebo-Controlled Crossover Study

During the last few decades, the incidence of sleep-onset insomnia, due to delay of circadian phase, has increased substantially among adolescents all over the world. We wanted to investigate whether a small dose of melatonin given daily, administered in the afternoon, could advance the sleep timing in teenagers. Twenty-one students, aged 14–19 yrs, with sleep-onset difficulties during school weeks were recruited. The study was a randomized, double blind, placebo (PL)-controlled crossover trial, lasting 5 wks. During the first 6 d in wks 2 and 4, the students received either PL or melatonin (1 mg) capsules between 16:30 and 18:00 h. During the first 6 d of wk 5, all students received melatonin. Wks 1 and 3 were capsule-free. In the last evening of each week and the following morning, the students produced saliva samples at home for later melatonin analysis. The samples were produced the same time each week, as late as possible in the evening and as early as possible in the morning. Both the student and one parent received automatic mobile text messages 15 min before saliva sampling times and capsule intake at agreed times. Diaries with registration of presumed sleep, subjective sleepiness during the day (Karolinska Sleepiness Scale, KSS) and times for capsule intake and saliva samplings were completed each day. Primary analysis over 5 wks gave significant results for melatonin, sleep and KSS. Post hoc analysis showed that reported sleep-onset times were advanced after melatonin school weeks compared with PL school weeks (p < .005) and that sleep length was longer (p < .05). After the last melatonin school week, the students fell asleep 68 min earlier and slept 62 min longer each night compared with the baseline week. Morning melatonin values in saliva diminished compared with PL (p < .001) and evening values increased (p < .001), indicating a possible sleep phase advance. Compared with PL school weeks, the students reported less wake up (p < .05), less school daytime sleepiness (p < .05) and increased evening sleepiness (p < .005) during melatonin weeks. We conclude that a small dose of melatonin given daily, administered in the afternoon, could advance the sleep timing and make the students more alert during school days even if they continued their often irregular sleep habits during weekends. (Author correspondence: arne.lowden@stress.su.se)     

Impact of Layover Length on Sleep,Subjective Fatigue Levels,and Sustained Attention of Long-Haul Airline Pilots

Long-haul airline pilots often experience elevated levels of fatigue due to extended work hours and circadian misalignment of sleep and wake periods. During long-haul trips, pilots are typically given 1–3 d off between flights (i.e., layover) to recover from, and prepare for, duty. Anecdotally, some pilots prefer long layovers because it maximizes the time available for recovery and preparation, but others prefer short layovers because it minimizes both the length of the trip, and the degree to which the body clock changes from “home time” to the layover time zone. The aim of this study was to examine the impact of layover length on the sleep, subjective fatigue levels, and capacity to sustain attention of long-haul pilots. Participants were 19 male pilots (10 Captains, 9 First Officers) working for an international airline. Data were collected during an 11- or 12-d international trip. The trips involved (i) 4 d at home prior to the trip; (ii) an eastward flight of 13.5?h across seven time zones; (iii) a layover of either 39?h (i.e., short, n?=?9) or 62?h (i.e., long, n?=?10); (iv) a return westward flight of 14.3?h across seven time zones; and (v) 4 d off at home after the trip. Sleep was recorded using a self-report sleep diary and wrist activity monitor; subjective fatigue level was measured using the Samn-Perelli Fatigue Checklist; and sustained attention was assessed using the psychomotor vigilance task for a personal digital assistant (PalmPVT). Mixed-model regression analyses were used to determine the effects of layover length (short, long) on the amount of sleep that pilots obtained during the trip, and on the pilots' subjective fatigue levels and capacity to sustain attention. There was no main effect of layover length on ground-based sleep or in-flight sleep, but pilots who had a short layover at the midpoint of their trip had higher subjective fatigue levels and poorer sustained attention than pilots who had a long layover. The results of this study indicate that a short layover during a long-haul trip does not substantially disrupt pilots' sleep, but it may result in elevated levels of fatigue during and after the trip. If short layovers are used, pilots should have a minimum of 4 d off to recover prior to their next long-haul trip. (Author correspondence: greg.roach@cqu.edu.au)     

News and Views

We surveyed the sleep‐wake patterns and lifestyle habits in a sample of Japanese first to third year junior high school children (n=638, age 12 to 15 yrs), of whom 29.3% were evening type, 64.1% intermediate type, and 6.6% morning type in preference. The morningness‐eveningness (M‐E) score was lower (more evening typed), 16.1 vs. 15.4 in first compared to third year students. There were significant gender differences, with girls showing a greater evening preference. Evening preference was associated with longer sleep latency, shortened sleep duration during schooldays and weekends, bad morning feeling, and episodes of daytime sleepiness. In contrast, morning preference was associated with higher sleep drive and better sleep‐wake parameters and lifestyle habits. Our results suggest the morning preference should be promoted among junior high school children to increase the likelihood of more regular sleep‐wake patterns and lifestyle habits.     

Examining courses of sleep quality and sleepiness in full 2 weeks on/2 weeks off offshore day shift rotations

ABSTRACT

To better understand sleep quality and sleepiness problems offshore, we examined courses of sleep quality and sleepiness in full 2-weeks on/2-weeks off offshore day shift rotations by comparing pre-offshore (1 week), offshore (2 weeks) and post-offshore (1 week) work periods. A longitudinal observational study was conducted among N=42 offshore workers. Sleep quality was measured subjectively with two daily questions and objectively with actigraphy, measuring: time in bed (TIB), total sleep time (TST), sleep latency (SL) and sleep efficiency percentage (SE%). Sleepiness was measured twice a day (morning and evening) with the Karolinska Sleepiness Scale. Changes in sleep and sleepiness parameters during the pre/post and offshore work periods were investigated using (generalized) linear mixed models. In the pre-offshore work period, courses of SE% significantly decreased (p=.038). During offshore work periods, the courses of evening sleepiness scores significantly increased (p<.001) and significantly decreased during post-offshore work periods (p=.004). During offshore work periods, TIB (p<.001) and TST (p<.001) were significantly shorter, SE% was significantly higher (p=.002), perceived sleep quality was significantly lower (p<.001) and level of rest after wake was significantly worse (p<.001) than during the pre- and post-offshore work periods. Morning sleepiness was significantly higher during offshore work periods (p=.015) and evening sleepiness was significantly higher in the post-offshore work period (p=.005) compared to the other periods. No significant changes in SL were observed. Courses of sleep quality and sleepiness parameters significantly changed during full 2-weeks on/2-weeks off offshore day shift rotation periods. These changes should be considered in offshore fatigue risk management programmes.     

Effects of Context on Sleepiness Self‐Ratings during Repeated Partial Sleep Deprivation

Ratings of subjective sleepiness are often used in laboratory and field studies of sleep loss and shifted sleep hours. Some studies suggest that such ratings might fail to reflect sleepiness as shown in physiology or performance. One reason for this may be the influence of the context of the rating. Social interaction or physical activity may mask latent sleepiness. The present study attempted to approach this question. Nine subjects participated in a partial sleep‐deprivation experiment (five days of 4 h of time in bed [TIB]), preceded by two baseline days (8 h TIB) and followed by three recovery days (8 h TIB). Sleepiness was self‐rated on the Karolinska Sleepiness Scale (KSS; scores of 1–9) after a period of relaxation, after a reaction‐time test, and after 30 min of free activities. The results showed a strong increase in subjective sleepiness during sleep restriction and a significant difference between conditions. Free activity reduced the self‐rated subjective sleepiness by 1.1 KSS units compared to the level of sleepiness self‐rated at the end of the reaction‐time test. Thus, the results of this study indicate that the context of a sleepiness rating affects the outcome of the rating.     

Validation of Horne and Ostberg morningness-eveningness questionnaire in a middle-aged population of French workers

As suggested by the authors, the Horne and Ostberg morning/evening questionnaire (MEQ) has never been adapted to evaluate a nonstudent population. The purpose of this study was to validate this MEQ in a sample of middle-aged workers by modifying only the cutoffs. It was administered in 566 non-shift-workers aged 51.2 to 3.2 years who presented no sleep disorders. According to the Home and Ostberg classification, the sample consisted of 62.1% morning type, 36.6% neither type, and 2.2% evening type. Multiple correspondence analysis, which determines the principal components, was performed on all MEQ items. Then an ascending hierarchical classification was applied to determine 3 clusters from these principal components. On the basis of these 3 clusters, new cutoffs were determined: evening types were considered as scoring under 53 and morning types above 64, thus giving 28.1% morning type, 51.7% neither type, and 20.2% evening type. As an external validation, eveningness was associated with later bedtime and waking-up time (more pronounced at the weekend), greater need for sleep, larger daily sleep debt, greater morning sleepiness, and ease of returning to sleep in the early morning. A positive correlation between age and morningness was again found. This study confirms that "owls" are not rare in a middle-aged sample. We conclude that this adapted MEQ could be useful when investigating age-related changes in sleep.     

Comparative Study to Determine the Optimal Melatonin Dosage form for the Alleviation of Jet Lag

To compare the impact of various dosage forms of melatonin and placebo on jet lag symptoms, 320 volunteers who had flights over 6 to 8 time zones were recruited for a double-blind, randomized, placebo-controlled study. The volunteers received either melatonin 0.5-mg fast-release (FR) formulation, melatonin 5-mg FR formulation, melatonin 2-mg controlled-release (CR) formulation, or placebo. The study medication was taken once daily at bedtime during 4 days after an eastward flight. The volunteers completed the Profile of Mood States (POMS), sleep log, and symptoms questionnaires once daily and the Karolinska Sleepiness Scale (KSS) three times daily prior to departure and during the 4 days of medication intake postflight. A total of 234 (73.1%) participants were compliant and completed the study. The FR melatonin formulations were more effective than the slow-release formulation. The 5-mg FR formulation significantly improved the self-rated sleep quality (p <. 05), shortened sleep latency (p <. 05), and reduced fatigue and daytime sleepiness (p <. 05) after intercontinental flight. The lower physiological dose of 0.5 mg was almost as effective as the pharmacological dose of 5.0 mg. Only the hypnotic properties of melatonin, sleep quality and sleep latency, were significantly greater with the 5.0-mg dose. (Chronobiology International, 15(6), 655-666, 1998)     

Exposure to screens of digital media devices,sleep, and concentration abilities in a sample of Israel adults

A major consequence of the invasion of digital media devices with screens equipped with light-emitting diode (LED) into bedrooms exposes the users to ongoing short wavelength (SWL) lighting during the evening and at night when under natural conditions, long wavelength are dominant. Results of several studies reveal a negative physiological, behavioral, and functional outcome of the exposure to SWL artificial light at night (ALAN) from digital media screens. The aims of our study are to assess the relationships between digital media usage, sleep patterns, subjective sleepiness, and attention abilities in adult Israeli citizens compared with Israeli adolescents. We recruited 280 adult participants using convenience sample method, 49% males and 51% females with an age range of 18–82. The participants filled out self-reporting novel and original questionnaires as follows: demographic, general health evaluation, sleep habits, and difficulties by the Pittsburgh Sleep Quality Index (PSQI) and the Karolinska Sleepiness Scale (KSS), prevalence, and usage patterns of digital media devices. Smartphones are the most used digital media device in the evening and after bedtime (the time one gets to sleep in bed). Israeli adults used smartphones for 30 min and TV for about 15 min after bedtime. We noted that excessive exposure to these devices at nighttime was associated with longer sleep latency (r = 0.192, p < 0.01) and decreased sleep hours (r = − 0.143, p < 0.05). Moreover, we found a negative correlation between attention abilities in the morning and the usage time of digital media at nighttime (r = − 0.155, p < 0.01). Exposure to digital screens at evening and nighttime was positively correlated with subjective sleepiness on the KSS (r = 0.135, p < 0.05, and r = 0.261, p < 0.01). To the best of our knowledge, this study is the first to explore the association between digital media screens usage, sleep, and concentration abilities in the Israeli adult.