Arne Lowden

Effects of alternating 8- and 12-hour shifts on sleep, sleepiness, physical effort and performance

OBJECTIVES This study concerned the influence of 6 positions of the computer mouse on the work table on posture, muscular load, and perceived exertion during text editing. METHODS An optoelectronic 3-dimensional motion analysis system was used to register the postures of 10 men and 10 women using video display units. Muscular load was also registered (with electromyography), as was perceived exertion (with rating scales). RESULTS A neutral posture with a relaxed and supported arm showed the least perceived exertion, and the electromyographic results showed low activity in both trapezius muscles in this position. Short operators (all women) showed a numerically higher activity in the 4 examined muscles than the tall operators (all men, except 1). This finding could be related to lower muscle force among women and to anthropometric differences, which also influence biomechanic load moments. Narrow-shouldered operators (8 women and 1 man) and short operators worked with larger outward rotation and abduction of the shoulder in a position of the mouse lateral to the keyboard than the broad-shouldered (7 men and 2 women) and tall operators did. Arm support markedly reduced muscle load in the neck-shoulder region among the operators. CONCLUSIONS The operators using video display units in this study preferred to use the mouse on a table in a close to relaxed, neutral posture of the arm in combination with arm support. Short and narrow-shouldered operators worked in more strenuous postures of the arm when the mouse was located lateral to the keyboard.

Suppression of sleepiness and melatonin by bright light exposure during breaks in night work

Night work is non‐optimal for performance and recuperation because of a lack of circadian influence that fully promote a night orientation. Our study assessed, in an industrial setting, the effects of bright light exposure (BL) on sleepiness, sleep and melatonin, during night work and during the following readaptation to day work. In a crossover design, 18 workers at a truck production plant were exposed to either BL (2500 lx) during breaks or normal light during four consecutive weeks. Twenty minute breaks were initiated by 67% of the workers between 03:00 and 04:00 hours. Sleep/wake patterns were assessed through actigraphs and ratings were given in a sleep/wake diary. Saliva melatonin was measured at 2‐h intervals before, during and after night shift weeks. A significant interaction demonstrated a reduction of sleepiness in the BL condition particularly on the first two nights at 04:00 and 06:00 hours. Day sleep in the BL condition was significantly lengthened. Bright light administration significantly suppressed melatonin levels during night work and most strongly at 02:00 hours. Daytime melatonin during the readaptation after night work remained unaffected. The present findings demonstrate the feasibility and benefits of photic stimulation in industrial settings to increase adaptation to night work.

Sleep and sleepiness among working and non-working high school evening students.

The aim of this study was to evaluate patterns of sleepiness, comparing working and non‐working students. The study was conducted on high school students attending evening classes (19:00–22:30 h) at a public school in São Paulo, Brazil. The study group consisted of working (n=51) and non‐working (n=41) students, aged 14–21 yrs. The students answered a questionnaire about working and living conditions and reported health symptoms and diseases. For seven consecutive days, actigraphy measurements were recorded, and the students also filled in a sleep diary. Sleepiness ratings were given six times per day, including upon waking and at bedtime, using the Karolinska Sleepiness Scale. Statistical analyses included three‐way ANOVA and t‐test. The mean sleep duration during weekdays was shorter among workers (7.2 h) than non‐workers (8.8 h) (t=4.34; p<.01). The mean duration of night awakenings was longer among workers on Tuesdays and Wednesdays (28.2 min) and shorter on Mondays (24.2 min) (t=2.57; p=.03). Among workers, mean napping duration was longer on Mondays and Tuesdays (89.9 min) (t=2.27; p=.03) but shorter on Fridays and Sundays (31.4 min) (t=3.13; p=.03). Sleep efficiency was lower on Fridays among non‐workers. Working students were moderately sleepier than non‐workers during the week and also during class on specific days: Mondays (13:00–15:00 h), Wednesdays (19:00–22:00 h), and Fridays (22:00–00:59 h). The study found that daytime sleepiness of workers is moderately higher in the evening. This might be due to a work effect, reducing the available time for sleep and shortening the sleep duration. Sleepiness and shorter sleep duration can have a negative impact on the quality of life and school development of high school students.

RETAINING 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 (50 h) flight (Copenhagen-Los Angeles, -9 h) 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.

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)

Eastward long distance flights, sleep and wake patterns in air crews in connection with a two-day layover

The present study describes the spontaneous sleep/wake pattern in connection with an eastward (Stockholm to Tokyo,+8 h) transmeridian flight and short (51 h) layovers. To describe all sleep episodes and the recovery process across 4 days, and to relate adjustment to individual differences, 49 Scandinavian Airlines System (SAS) air crew were monitored for 9 days with activity monitors and sleep/wake diary before‐during‐after flight. The outbound flight involved a period of wakefulness extended to 21 h, frequently (87% of air crew) terminated by a long nap in Tokyo which was calm but difficult to wake up from. Then followed two night oriented sleep periods of normal length but of reduced efficiency, containing many and long awakenings. Napping was common during the extended periods of wakefulness, particularly during flights. During the recovery days, ease of rising from sleep in the mornings was difficult throughout, and feelings of not being refreshed returned to baseline levels on the third recovery sleep. Elevated daytime sleepiness (24% of the day) was observed on the first recovery day. No individual differences related to gender, age or position (cabin/pilot) was found in sleep strategy. Poor adjusters, subjects with a perceived lowered capacity on recovery days, showed more premature awakenings abroad and less refreshing sleep during the last 12 months, suggesting a decreased ability to cope with air crew scheduling. Comparisons with a westbound flight showed the eastbound flight layover sleep to be more problematic and containing more napping.

Recovery after shift work: Relation to coronary risk factors in women.

Shift work increases the risk for developing cardiovascular disease. There is, however, little knowledge of what aspects of shift scheduling that are detrimental and what characteristics promote good health. The aim of the present study was to evaluate whether coronary risk factors deteriorate after a hard work period and whether recovery, in the form of a week off, was sufficient to improve them. A total of 19 women worked an extremely rapidly rotating and clockwise shift schedule at a paper and pulp factory. They underwent two health examinations, one at the end of the work period and one after the week off. In addition, the women were divided into a tolerant and a vulnerable group, depending on their satisfaction with their work hours. Most risk factors did not change, but total cholesterol and low‐density lipoprotein (LDL)‐cholesterol were lower after the working period than after the week‐off. In addition, vulnerable women had higher levels of total cholesterol and a higher ratio of total cholesterol/high‐density lipoprotein (HDL) than tolerant ones. In conclusion, the finding that a week‐off worsens cholesterol levels was against our hypothesis and suggests further studies on how activities/responsibilities outside the workplace affect shift‐working women. It was also shown that susceptible shift workers had worse lipid profiles.

Performance and sleepiness during a 24 h wake in constant conditions are affected by diet.

This study investigated the effects of high-carbohydrate (HC) and high-fat (HF) diet on cognitive performance, and subjective and objective sleepiness. Seven male participants were kept awake for 24 h in a metabolic ward. Meals were given every 4h and cognitive performance and sleepiness ratings were assessed hourly. The Karolinska Drowsiness Test (KDT, EEG derived) was performed twice after meal. Performance in simple reaction time showed a significant interaction of diet and the post-prandial period, a slower reaction time was observed for the HC-diet 3.5 h after meal intake. Diet did not affect EEG measures but a general post-prandial increase of objective sleepiness was observed 3.5h after meal servings. The HC-diet was significantly associated with an increase of subjective sleepiness. The study demonstrated that the HC-diet caused larger oscillation in performance and increased sleepiness as compared to HF-diet throughout day and night.

The Effects of 884 MHz GSM Wireless Communication Signals on Self-reported Symptom and Sleep (EEG)- An Experimental Provocation Study

In the current study we assessed possible efiects of prolonged (3 hours) exposure to 884MHz GSM wireless communication signals on self-reported symptoms, cognitive function, and electroencephalographically (EEG) recorded sleep. The study group consisted of 36 women and 35 men. Twenty-two women and sixteen men reported symptoms they speciflcally related to mobile phone use (SG). The rest of the participants reported no mobile phone-related symptoms (NG). Potential participants volunteering for the study were evaluated by physicians, including some biochemical assessments, to rule out medical conditions that could interfere with study variables of interest. Once selected, participants spent three difierent sessions in the laboratory. The ha- bituation session was followed by two subsequent sessions. In these subsequent sessions, subjects were either exposed to sham exposure (sham) or 884MHz GSM wireless communication signals for 3 hours (an average of 1.4W/kg including periods of DTX and Non-DTX. Exposure directed to the left hemisphere). Data was collected before, during and following the exposure/sham ses- sions. Data collected included self-reported symptoms, including headache, cognitive function, mood, and electroencephalographic recordings. During actual exposure, as compared to sham exposure, sleep initiated one hour after exposure was afiected. There was a prolonged latency to reach the flrst cycle of deep sleep (stage 3). The amount of stage 4 sleep was also decreased in exposed subjects. NG subjects reported more headaches during exposures vs. sham exposure. Neither group (SG and NG) was able to detect the true exposure status more frequently than by chance alone. The study indicates that during laboratory exposure to 884MHz wireless signals, components of sleep, believed to be important for recovery from daily wear and tear, are adversely afiected. Moreover, participants that otherwise have no self-reported symptoms related to mobile phone use, appear to have more headaches during actual radiofrequency exposure as compared to sham exposure. However, subjects were not able to detect the true exposure status more often than would have been expected by statistical chance alone. Additional self-reported flndings, biochemical, performance and electrophysiological data are currently being analyzed. Possible health implications from the flndings will also be further explored.

Assessment of a new dynamic light regimen in a nuclear power control room without windows on quickly rotating shiftworkers--effects on health, wakefulness, and circadian alignment: a pilot study.

The aim of the study was to test whether a new dynamic light regime would improve alertness, sleep, and adaptation to rotating shiftwork. The illumination level in a control room without windows at a nuclear power station was ∼200 lux (straight-forward horizontal gaze) using a weak yellow light of 200 lux, 3000 K (Philips Master TLD 36 W 830). New lighting equipment was installed in one area of the control room above the positions of the reactor operators. The new lights were shielded from the control group by a distance of >6 m, and the other operators worked at desks turned away from the new light. The new lights were designed to give three different light exposures: (i) white/blue strong light of 745 lux, 6000 K; (ii) weak yellow light of 650 lux, 4000 K; and (iii) yellow moderate light of 700 lux, 4000 K. In a crossover design, the normal and new light exposures were given during a sequence of three night shifts, two free days, two morning shifts, and one afternoon shift (NNN + MMA), with 7 wks between sessions. The operators consisted of two groups; seven reactor operators from seven work teams were at one time exposed to the new equipment and 16 other operators were used as controls. The study was conducted during winter with reduced opportunities of daylight exposure during work, after night work, or before morning work. Operators wore actigraphs, filled in a sleep/wake diary, including ratings of sleepiness on the Karolinska Sleepiness Scale (KSS) every 2 h, and provided saliva samples for analysis of melatonin at work (every 2nd h during one night shift and first 3 h during one morning shift). Results from the wake/sleep diary showed the new light treatment increased alertness during the 2nd night shift (interaction group × light × time, p < .01). Time of waking was delayed in the light condition after the 3rd night shift (group × light, p < .05), but the amount of wake time during the sleep span increased after the 2nd night shift (p < .05), also showing a tendency to affect sleep efficiency (p < .10). Effects on circadian phase were difficult to establish given the small sample size and infrequent sampling of saliva melatonin. Nonetheless, it seems that appropriate dynamic light in rooms without windows during the dark Nordic season may promote alertness, sleep, and better adaptation to quickly rotating shiftwork. (Author correspondence: arne.lowden@stress.su.se)