Performing Sleep/Wake Cycles: An Arts-Science Dialogue through Embodied Technologies

This paper describes an arts-science collaborative project titled Standing Waves, which creatively entwines data drawn from the rhythms of the body in sleep/wake cycles with sensor-based technology for synaesthetic performance. The project partners situate their practice and research in the fields of choreography/dance, sleep science and media art and design. Our work explores how the non-literalness of scientific phenomena can be embodied in interactive performance and made meaningful for audiences. The aim of this collaboration is to create a unique performance ecology, by bringing together elements of the collaborators’ respective disciplines and expertise and experimenting within the areas of intersection. The Standing Waves performance system involves wearable electronic sensor technology to allow a dancer to interact with a malleable sound environment. Sensing the body, its gestures, and its environment through the measurement of light and acceleration, the ‘sensor suit’ allows the dancer to intuitively control sound. In turn, the sonic feedback influences the emerging choreographic score, inducing constraints and generative cyclic patterns for movement. This feedback loop between movement and sonic state creates waves of sensation heightening the experience of the space as a perceptible field of embodied technology. The performance exists at the threshold between the figurative and the factual as it takes data and information from the lab practice of a sleep scientist and reinterprets this within the condition of a performance environment, effectively making visible the dynamic processes of subtle physiological phenomena

Insomnia - treatment pathways, costs and quality of life

<p>Abstract</p> <p>Background</p> <p>Insomnia is perhaps the most common sleep disorder in the general population, and is characterised by a range of complaints around difficulties in initiating and maintaining sleep, together with impaired waking function. There is little quantitative information on treatment pathways, costs and outcomes. The aims of this New Zealand study were to determine from which healthcare practitioners patients with insomnia sought treatment, treatment pathways followed, the net costs of treatment and the quality of life improvements obtained.</p> <p>Methods</p> <p>The study was retrospective and prevalence based, and was both cost effectiveness (CEA) and a cost utility (CUA) analysis. Micro costing techniques were used and a societal analytic perspective was adopted. A deterministic decision tree model was used to estimate base case values, and a stochastic version, with Monte Carlo simulation, was used to perform sensitivity analysis. A probability and cost were attached to each event which enabled the costs for the treatment pathways and average treatment cost to be calculated. The inputs to the model were prevalence, event probabilities, resource utilisations, and unit costs. Direct costs and QALYs gained were evaluated.</p> <p>Results</p> <p>The total net benefit of treating a person with insomnia was $482 (the total base case cost of$145 less health costs avoided of $628). When these results were applied to the total at-risk population in New Zealand additional treatment costs incurred were$6.6 million, costs avoided $28.4 million and net benefits were$21.8 million. The incremental net benefit when insomnia was "successfully" treated was $3,072 per QALY gained.</p> <p>Conclusions</p> <p>The study has brought to light a number of problems relating to the treatment of insomnia in New Zealand. There is both inadequate access to publicly funded treatment and insufficient publicly available information from which a consumer is able to make an informed decision on the treatment and provider options. This study suggests that successful treatment of insomnia leads to direct cost savings and improved quality of life.</p

Understanding and Counteracting Fatigue in Flight Crews

The materials included in the collection of documents describe the research of the NASA Ames Fatigue Countermeasures Group (FCG), which examines the extent to which fatigue, sleep loss, and circadian disruption affect flight-crew performance. The group was formed in 1980 in response to a Congressional request to examine a possible safety problem of uncertain magnitude due to transmeridian flying and a potential problem due to fatigue in association with various factors found in air-transport operations and was originally called the Fatigue/Jet Lag Program. The goals of the FCG are: (1) the development and evaluation of strategies for mitigating the effects of sleepiness and circadian disruption on pilot performance levels; (2) the identification and evaluation of objective approaches for the prediction of alertness changes in flight crews; and (3) the transfer and application of research results to the operational field via classes, workshops, and safety briefings. Some of the countermeasure approaches that have been identified to be scientifically valid and operationally relevant are brief naps (less than 40 min) in the cockpit seat and 7-min activity breaks, which include postural changes and ambulation. Although a video-based alertness monitor based on slow eyelid closure shows promise in other operational environments, research by the FCG has demonstrated that in its current form at the time of this reporting, it is not feasible to implement it in the cockpit. Efforts also focus on documenting the impact of untreated fatigue on various types of flight operations. For example, the FCG recently completed a major investigation into the effects of ultra-long-range flights (20 continuous hours in duration) on the alertness and performance of pilots in order to establish a baseline set of parameters against which the effectiveness of new ultra-long-range fatigue remedies can be judged

Light as a chronobiologic countermeasure for long-duration space operations

Long-duration space missions require adaptation to work-rest schedules which are substantially shifted with respect to earth. Astronauts are expected to work in two-shift operations and the environmental synchronizers (zeitgebers) in a spacecraft differ significantly from those on earth. A study on circadian rhythms, sleep, and performance was conducted by exposing four subjects to 6 deg head-down tilt bedrest (to simulate the effects of the weightless condition) and imposing a 12-h shift (6 h delay per day for two days). Bright light was tested in a cross-over design as a countermeasure for achieving faster resynchronization and regaining stable conditions for sleep and circadian rhythmicity. Data collection included objective sleep recording, temperature, heart rate, and excretion of hormones and electrolytes as well as performance and responses to questionnaires. Even without a shift in the sleep-wake cycle, the sleep quantity, circadian amplitudes and 24 h means decreased in many functions under bedrest conditions. During the shift days, sleepiness and fatigue increased, and alertness decreased. However, sleep quantity was regained, and resynchronization was completed within seven days after the shift for almost all functions, irrespective of whether light was administered during day-time or night-time hours. The time of day of light exposure surprisingly appeared not to have a discriminatory effect on the resynchronization speed under shift and bedrest conditions. The results indicate that simulated weightlessness alters circadian rhythms and sleep, and that schedule changes induce additional physiological disruption with decreased subjective alertness and increased fatigue. Because of their operational implications, these phenomena deserve additional investigation

Crew factors in flight operations 6: Psychophysiological responses to helicopter operations

Thirty-two helicopter pilots were studied before, during, and after 4-5 day trips providing support services from Aberdeen, Scotland, to rigs in the North Sea oil fields. Early on-duty times obliged subjects to wake up 1.5 hours earlier on trip days than on pretrip days. Consequently, they slept nearly an hour less per night on trips. They reported more fatigue on post-trip days than on pretrip days, suggesting a cumulative effect of duty-related activities and sleep loss. Fatigue and negative affect were higher, and activation lower, by the end of trip days than by the end of pretrip days. The earlier a subject went on duty, the lower his activation by the end of the day. Caffeine consumption increased 42 percent on trip days. The incidence of headache doubled, of back pain increased twelve fold, and of burning eyes quadrupled. In the aircraft studied, thermal discomfort and high vibration levels were common. The longer pilots remained on duty, the more negative their mood became

Crew Factors in Flight Operations 7: Psychophysiological Responses to Overnight Cargo Operations

To document the psychophysiological effects of flying overnight cargo operations, 41 B-727 crew members (average age 38 yr) were monitored before, during, and after one of two typical 8-day trip patterns. During daytime layovers, the average sleep episode was 3 hr (41%) shorter than nighttime sleeps and was rated as lighter, less restorative, and poorer overall. Sleep was frequently split into several episodes and totaled 1.2 hr less per 24 hr than on pretrip days. Each trip pattern included a night off, which was an effective countermeasure against the accumulating sleep debt. The organization of sleep during daytime layovers reflected the interaction of duty timing with circadian physiology. The circadian temperature rhythm did not adapt completely to the inverted wake-rest schedule on duty days, being delayed by about 3 hr. Highest subjective fatigue and lowest activation occurred around the time of the temperature minimum. On duty days, reports of headaches increased by 400%, of congested nose by 200%, and of burning eyes by 900%. Crew members also reported eating more snacks. Compared with daytime short-haul air-transport operations, the overnight cargo trips included fewer duty and flight hours, and had longer layovers. Overnight cargo crews also averaged 5.4 yr younger than their daytime short-haul counterparts. On trips, both groups lost a comparable amount of sleep per 24 hr, but the overnight cargo crews had shorter individual sleep episodes and more broken sleep. These data clearly demonstrate that overnight cargo operations, like other night work, involve physiological disruption not found in comparable daytime operations

Crew factors in flight operations. 8: Factors influencing sleep timing and subjective sleep quality in commercial long-haul flight crews

How flight crews organize their sleep during layovers on long-haul trips is documented. Additionally, environmental and physiological constraints on sleep are examined. In the trips studied, duty periods averaging 10.3 hr alternated with layovers averaging 24.8 hr, which typically included two subject-defined sleep episodes. The circadian system had a greater influence on the timing and duration of first-sleeps than second-sleeps. There was also a preference for sleeping during the local night. The time of falling asleep for second-sleeps was related primarily to the amount of sleep already obtained in the layover, and their duration depended on the amount of time remaining in the layover. For both first- and second-sleeps, sleep durations were longer when subjects fell asleep earlier with respect to the minimum of the circadian temperature cycle. Naps reported during layovers and on the flight deck may be a useful strategy for reducing cumulative sleep loss. The circadian system was not able to synchronize with the rapid series of time-zone shifts. The sleep/wake cycle was forced to adopt a period different from that of the circadian system. Flight and duty time regulations are a means of ensuring that reasonable minimum rest periods are provided. This study clearly documents that there are physiologically and environmentally determined preferred sleep times within a layover. The actual time available for sleep is thus less than the scheduled rest period

Daytime fatigue as a predictor for subsequent retirement among older New Zealand workers

Objectives: There is limited information on the role of fatigue on retirement, either independently or in association with poor sleep. The aim of this study was to examine the prospective association between daytime fatigue, measured as feeling tired or feeling worn out, independently and in relation to dissatisfaction with sleep, and subsequent retirement among 960 older workers in New Zealand. Methods: Data from 2 consecutive surveys (2008 and 2010) of the New Zealand Health, Work, and Retirement Longitudinal Study were used. Poisson regression was used to investigate whether feeling tired and feeling worn out in 2008, along with dissatisfaction with sleep, were associated with self-reported retirement either due to health reasons or other reasons by 2010. Results: The risk for retirement due to health reasons during a 2-year follow-up was 1.80-fold (95% confidence interval [CI] 1.16-2.45) among those who felt tired and 1.99-fold (95% CI 1.34-2.64) among those who felt worn out when compared to those not tired or not feeling worn out after adjusting for several sociodemographic, work characteristics and self-rated health. The risk for retirement due to health reasons was even higher when participant experienced both tiredness and feeling worn out. Dissatisfaction with sleep did not predict retirement due to health or other reasons. Conclusions: Our results highlight that workers at risk of subsequent retirement due to health reasons may be identified with rather simple questions on tiredness and feeling worn out even among generally healthy older workers. </p

Crew factors in flight operations 2: Psychophysiological responses to short-haul air transport operations

Seventy-four pilots were monitored before, during, and after 3- or 4-day commercial short-haul trip patterns. The trips studied averaged 10.6 hr of duty per day with 4.5 hr of flight time and 5.5 flight segments. The mean rest period lasted 12.5 hr and occurred progressively earlier across successive days. On trip nights, subjects took longer to fall asleep, slept less, woke earlier, and reported lighter, poorer sleep with more awakenings than on pretrip nights. During layovers, subjective fatigue and negative affect were higher, and positive affect and activation lower, than during pretrip, in-flight, or posttrip. Pilots consumed more caffeine, alcohol, and snacks on trip days than either pretrip or posttrip. Increases in heart rate over mid-cruise were observed during descent and landing, and were greater for the pilot flying. Heart-rate increases were greater during takeoff and descent under instrument meteorological conditions (IMC) than under visual meteorological conditions (VMC). The following would be expected to reduce fatigue in short-haul operations: regulating duty hours, as well as flight hours; scheduling rest periods to begin at the same time of day, or progressively later, across the days of a trip; and educating pilots about alternatives to alcohol as a means of relaxing before sleep