Background: Previous reports have suggested that acupressure is effective in reducing pain and improving sleep quality; however, its effects on alertness have not been characterized. Objectives: The aim of this study was to determine whether two different acupressure treatments have opposing effects on alertness in a full-day classroom setting. Design: This was a cross-over (two-treatments; three periods), single-blinded, randomized trial. Setting: The University of Michigan School of Public Health was the setting. Subjects: Students attending a course in clinical research design and statistical analysis at the University of Michigan participated in the study. Interventions and outcome measures: Blinded subjects were randomized to two acupressure treatment sequences: stimulation–relaxation–relaxation or relaxation–stimulation–stimulation. Acupressure treatments were self administered over 3 consecutive days. Pre- and post-treatment alertness scores were assessed each day using the Stanford Sleepiness Scale (SSS). Changes in the SSS score (afternoon – morning) were analyzed using a mixed regression model of fixed and random effects. Important factors that were expected to affect alertness, such as caffeine and previous night's sleep, were also assessed. Results: Baseline characteristics and protocol compliance were similar between the two sequences. Stimulation acupressure treatment yielded a 0.56-point greater difference in score on the SSS, corresponding to less fatigue, compared to the relaxation acupressure treatment (p = 0.019). Day of study (p = 0.004) and hours of overnight sleep (p = 0.042) also significantly affected the change in SSS scores. Incorporating participants' beliefs as to which treatment they received did not significantly alter the observed treatment effect. Conclusions: Acupressure at stimulation and relaxation points has differential effects on alertness in a classroom setting. Further research is necessary to confirm these findings and to determine whether stimulation and relaxation acupressure are equally effective in influencing alertness
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