Napping

Canadian 24-Hour Movement Guidelines for the Early Years (0–4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep

Mark S. Tremblay, Jean‐Philippe Chaput, Kristi B. Adamo +23 more · BMC Public Health · 2017 · 644 citations

This systematic review and guideline development process integrated evidence from four systematic reviews and compositional data analyses to produce the first integrated 24-hour movement behaviour guidelines for children aged 0–4 years, recommending specific daily combinations of physical activity, sedentary behaviour (including screen time), and sleep that are associated with better health outcomes across adiposity, motor development, cognitive development, and psychosocial health.

A collaborative approach to adopting/adapting guidelines - The Australian 24-Hour Movement Guidelines for the early years (Birth to 5 years): an integration of physical activity, sedentary behavior, and sleep

Anthony D. Okely, Davina Ghersi, Kylie D. Hesketh +24 more · BMC Public Health · 2017 · 443 citations

This paper describes how Australia adapted Canada's 24-hour movement guidelines for children aged 0–5 years using a structured, transparent process (GRADE-ADOLOPMENT), adopting nearly all Canadian recommendations with only minor wording changes, which saved time and money compared to developing guidelines from scratch.

A Randomized Controlled Trial of Cognitive-Behavior Therapy Plus Bright Light Therapy for Adolescent Delayed Sleep Phase Disorder

Michael Gradisar, Hayley Dohnt, Greg Gardner +8 more · SLEEP · 2011 · 239 citations

Combining cognitive-behavior therapy with morning bright light therapy effectively shifted sleep times earlier and improved sleep quality, sleepiness, and fatigue in adolescents with delayed sleep phase disorder, with benefits lasting at least six months, suggesting a promising multi-component approach for self-experimenters struggling with late sleep.

Cancer-Related Fatigue

Ann M. Berger, Amy Pickar Abernethy, Ashley Atkinson +17 more · Journal of the National Comprehensive Cancer Network · 2010 · 275 citations

This is not a single study but a clinical practice guideline from the National Comprehensive Cancer Network (NCCN) — a consensus document synthesising evidence from multiple randomised controlled trials and observational studies — concluding that cancer-related fatigue affects 70–100% of patients undergoing treatment, is best managed through a combination of screening (using a 0–10 scale), treating underlying causes (anaemia, pain, sleep disturbance, emotional distress), and implementing both exercise and psychosocial interventions, with exercise showing the strongest evidence for reducing fatigue severity by approximately 1–2 points on a 10-point scale.

The prevalence and association of stress with sleep quality among medical students

Abdullah I. Almojali, Sami Almalki, Ali Alothman +2 more · Journal of Epidemiology and Global Health · 2017 · 572 citations

Among 700 medical students in Saudi Arabia, 76% reported poor sleep quality and 53% reported high stress; students without stress were 72% less likely to have poor sleep, and those with a GPA below 4.25 had nearly 4 times the risk of poor sleep—suggesting that stress and academic pressure are tightly linked to sleep disruption in high-demand environments.

Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older: an integration of physical activity, sedentary behaviour, and sleep

Robert Ross, Jean‐Philippe Chaput, Lora Giangregorio +29 more · Applied Physiology Nutrition and Metabolism · 2020 · 892 citations

This paper synthesises existing evidence to produce the first integrated 24-hour movement guidelines for adults, recommending specific daily targets for physical activity, sedentary behaviour, and sleep — showing that reallocating just 30 minutes of sedentary time to moderate-to-vigorous physical activity is associated with a 4–8% lower risk of all-cause mortality, and that meeting all three movement behaviour targets is associated with better health outcomes than meeting any single target alone.

Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support

Inbal Nahum‐Shani, Shawna N. Smith, Bonnie Spring +4 more · Annals of Behavioral Medicine · 2016 · 2,114 citations

This is a conceptual framework paper—not an experiment—that defines the essential components and design principles for building mobile health interventions that adapt in real-time to a person's changing internal states and environment, providing the right support at the right moment, and it provides a structured way for anyone designing a self-experiment to think about when, why, and how to deliver an intervention.

Identifying Objective Physiological Markers and Modifiable Behaviors for Self-Reported Stress and Mental Health Status Using Wearable Sensors and Mobile Phones: Observational Study

Akane Sano, Sara Taylor, Andrew W. McHill +4 more · Journal of Medical Internet Research · 2018 · 342 citations

BACKGROUND: Wearable and mobile devices that capture multimodal data have the potential to identify risk factors for high stress and poor mental health and to provide information to improve health and well-being. OBJECTIVE: We developed new tools that provide objective physiological and behavioral measures using wearable sensors and mobile phones, together with methods that improve their data integrity. The aim of this study was to examine, using machine learning, how accurately these measures could identify conditions of self-reported high stress and poor mental health and which of the underlying modalities and measures were most accurate in identifying those conditions. METHODS: We designed and conducted the 1-month SNAPSHOT study that investigated how daily behaviors and social networks influence self-reported stress, mood, and other health or well-being-related factors. We collected over 145,000 hours of data from 201 college students (age: 18-25 years, male:female=1.8:1) at one university, all recruited within self-identified social groups. Each student filled out standardized pre- and postquestionnaires on stress and mental health; during the month, each student completed twice-daily electronic diaries (e-diaries), wore two wrist-based sensors that recorded continuous physical activity and autonomic physiology, and installed an app on their mobile phone that recorded phone usage and geolocation patterns. We developed tools to make data collection more efficient, including data-check systems for sensor and mobile phone data and an e-diary administrative module for study investigators to locate possible errors in the e-diaries and communicate with participants to correct their entries promptly, which reduced the time taken to clean e-diary data by 69%. We constructed features and applied machine learning to the multimodal data to identify factors associated with self-reported poststudy stress and mental health, including behaviors that can be possibly modified by the individual to improve these measures. RESULTS: We identified the physiological sensor, phone, mobility, and modifiable behavior features that were best predictors for stress and mental health classification. In general, wearable sensor features showed better classification performance than mobile phone or modifiable behavior features. Wearable sensor features, including skin conductance and temperature, reached 78.3% (148/189) accuracy for classifying students into high or low stress groups and 87% (41/47) accuracy for classifying high or low mental health groups. Modifiable behavior features, including number of naps, studying duration, calls, mobility patterns, and phone-screen-on time, reached 73.5% (139/189) accuracy for stress classification and 79% (37/47) accuracy for mental health classification. CONCLUSIONS: New semiautomated tools improved the efficiency of long-term ambulatory data collection from wearable and mobile devices. Applying machine learning to the resulting data revealed a set of both objective features and modifiable behavioral features that could classify self-reported high or low stress and mental health groups in a college student population better than previous studies and showed new insights into digital phenotyping.

The two‐process model of sleep regulation: a reappraisal

Alexander A. Borbély, Serge Daan, Anna Wirz‐Justice +1 more · Journal of Sleep Research · 2016 · 1,540 citations

In the last three decades the two-process model of sleep regulation has served as a major conceptual framework in sleep research. It has been applied widely in studies on fatigue and performance and to dissect individual differences in sleep regulation. The model posits that a homeostatic process (Process S) interacts with a process controlled by the circadian pacemaker (Process C), with time-courses derived from physiological and behavioural variables. The model simulates successfully the timing and intensity of sleep in diverse experimental protocols. Electrophysiological recordings from the suprachiasmatic nuclei (SCN) suggest that S and C interact continuously. Oscillators outside the SCN that are linked to energy metabolism are evident in SCN-lesioned arrhythmic animals subjected to restricted feeding or methamphetamine administration, as well as in human subjects during internal desynchronization. In intact animals these peripheral oscillators may dissociate from the central pacemaker rhythm. A sleep/fast and wake/feed phase segregate antagonistic anabolic and catabolic metabolic processes in peripheral tissues. A deficiency of Process S was proposed to account for both depressive sleep disturbances and the antidepressant effect of sleep deprivation. The model supported the development of novel non-pharmacological treatment paradigms in psychiatry, based on manipulating circadian phase, sleep and light exposure. In conclusion, the model remains conceptually useful for promoting the integration of sleep and circadian rhythm research. Sleep appears to have not only a short-term, use-dependent function; it also serves to enforce rest and fasting, thereby supporting the optimization of metabolic processes at the appropriate phase of the 24-h cycle.

Cumulative Sleepiness, Mood Disturbance, and Psychomotor Vigilance Performance Decrements During a Week of Sleep Restricted to 4–5 Hours per Night

David F. Dinges, Frances M. Pack, Katherine Williams +5 more · SLEEP · 1997 · 2,042 citations

To determine whether a cumulative sleep debt (in a range commonly experienced) would result in cumulative changes in measures of waking neurobehavioral alertness, 16 healthy young adults had their sleep restricted 33% below habitual sleep duration, to an average 4.98 hours per night [standard deviation (SD) = 0.57] for seven consecutive nights. Subjects slept in the laboratory, and sleep and waking were monitored by staff and actigraphy. Three times each day (1000, 1600, and 2200 hours) subjects were assessed for subjective sleepiness (SSS) and mood (POMS) and were evaluated on a brief performance battery that included psychomotor vigilance (PVT), probed memory (PRM), and serial-addition testing, Once each day they completed a series of visual analog scales (VAS) and reported sleepiness and somatic and cognitive/emotional problems. Sleep restriction resulted in statistically robust cumulative effects on waking functions. SSS ratings, subscale scores for fatigue, confusion, tension, and total mood disturbance from the POMS and VAS ratings of mental exhaustion and stress were evaluated across days of restricted sleep (p = 0.009 to p = 0.0001). PVT performance parameters, including the frequency and duration of lapses, were also significantly increased by restriction (p = 0.018 to p = 0.0001). Significant time-of-day effects were evident in SSS and PVT data, but time-of-day did not interact with the effects of sleep restriction across days. The temporal profiles of cumulative changes in neurobehavioral measures of alertness as a function of sleep restriction were generally consistent. Subjective changes tended to precede performance changes by 1 day, but overall changes in both classes of measure were greatest during the first 2 days (P1, P2) and last 2 days (P6, P7) of sleep restriction. Data from subsets of subjects also showed: 1) that significant decreases in the MSLT occurred during sleep restriction, 2) that the elevated sleepiness and performance deficits continued beyond day 7 of restriction, and 3) that recovery from these deficits appeared to require two full nights of sleep. The cumulative increase in performance lapses across days of sleep restriction correlated closely with MSLT results (r = -0.95) from an earlier comparable experiment by Carskadon and Dement (1). These findings suggest that cumulative nocturnal sleep debt had a dynamic and escalating analog in cumulative daytime sleepiness and that asymptotic or steady-state sleepiness was not achieved in response to sleep restriction.

Brain training with non-action video games enhances aspects of cognition in older adults: a randomized controlled trial

Soledad Ballesteros, A. Fernandez Prieto, Julia Mayas +5 more · Frontiers in Aging Neuroscience · 2014 · 187 citations

Age-related cognitive and brain declines can result in functional deterioration in many cognitive domains, dependency, and dementia. A major goal of aging research is to investigate methods that help to maintain brain health, cognition, independent living and wellbeing in older adults. This randomized controlled study investigated the effects of 20 1-h non-action video game training sessions with games selected from a commercially available package (Lumosity) on a series of age-declined cognitive functions and subjective wellbeing. Two groups of healthy older adults participated in the study, the experimental group who received the training and the control group who attended three meetings with the research team along the study. Groups were similar at baseline on demographics, vocabulary, global cognition, and depression status. All participants were assessed individually before and after the intervention, or a similar period of time, using neuropsychological tests and laboratory tasks to investigate possible transfer effects. The results showed significant improvements in the trained group, and no variation in the control group, in processing speed (choice reaction time), attention (reduction of distraction and increase of alertness), immediate and delayed visual recognition memory, as well as a trend to improve in Affection and Assertivity, two dimensions of the Wellbeing Scale. Visuospatial working memory (WM) and executive control (shifting strategy) did not improve. Overall, the current results support the idea that training healthy older adults with non-action video games will enhance some cognitive abilities but not others.

Sleep and the athlete: narrative review and 2021 expert consensus recommendations

Neil P. Walsh, Shona L. Halson, Charli Sargent +16 more · British Journal of Sports Medicine · 2020 · 504 citations

Elite athletes commonly sleep less than 7 hours per night and have fragmented sleep, which impairs performance and increases illness risk; the expert panel recommends an individualised approach to sleep (not a one-size-fits-all 7–9 hour target) based on perceived needs, with targeted interventions for sport-specific and non-sport risk factors.

Advancing a Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors

Gregory A. Aarons, Michael S. Hurlburt, Sarah McCue Horwitz · Administration and Policy in Mental Health and Mental Health Services Research · 2010 · 3,231 citations

Implementation science is a quickly growing discipline. Lessons learned from business and medical settings are being applied but it is unclear how well they translate to settings with different historical origins and customs (e.g., public mental health, social service, alcohol/drug sectors). The purpose of this paper is to propose a multi-level, four phase model of the implementation process (i.e., Exploration, Adoption/Preparation, Implementation, Sustainment), derived from extant literature, and apply it to public sector services. We highlight features of the model likely to be particularly important in each phase, while considering the outer and inner contexts (i.e., levels) of public sector service systems.

Why sleep matters -- the economic costs of insufficient sleep: A cross-country comparative analysis

Marco Hafner, Martin Štěpánek, Jirka Taylor +2 more · RAND Corporation eBooks · 2016 · 616 citations

The Centers for Disease Control and Prevention (CDC) in the United States has declared insufficient sleep a "public health problem." Indeed, according to a recent CDC study, more than a third of American adults are not getting enough sleep on a regular basis. However, insufficient sleep is not exclusively a US problem, and equally concerns other industrialised countries such as the United Kingdom, Japan, Germany, or Canada. According to some evidence, the proportion of people sleeping less than the recommended hours of sleep is rising and associated with lifestyle factors related to a modern 24/7 society, such as psychosocial stress, alcohol consumption, smoking, lack of physical activity and excessive electronic media use, among others. This is alarming as insufficient sleep has been found to be associated with a range of negative health and social outcomes, including success at school and in the labour market. Over the last few decades, for example, there has been growing evidence suggesting a strong association between short sleep duration and elevated mortality risks. Given the potential adverse effects of insufficient sleep on health, well-being and productivity, the consequences of sleep-deprivation have far-reaching economic consequences. Hence, in order to raise awareness of the scale of insufficient sleep as a public-health issue, comparative quantitative figures need to be provided for policy- and decision-makers, as well as recommendations and potential solutions that can help tackling the problem.

Irregular sleep/wake patterns are associated with poorer academic performance and delayed circadian and sleep/wake timing

Andrew J. K. Phillips, William M. Clerx, Conor S. O’Brien +6 more · Scientific Reports · 2017 · 602 citations

The association of irregular sleep schedules with circadian timing and academic performance has not been systematically examined. We studied 61 undergraduates for 30 days using sleep diaries, and quantified sleep regularity using a novel metric, the sleep regularity index (SRI). In the most and least regular quintiles, circadian phase and light exposure were assessed using salivary dim-light melatonin onset (DLMO) and wrist-worn photometry, respectively. DLMO occurred later (00:08 ± 1:54 vs. 21:32 ± 1:48; p < 0.003); the daily sleep propensity rhythm peaked later (06:33 ± 0:19 vs. 04:45 ± 0:11; p < 0.005); and light rhythms had lower amplitude (102 ± 19 lux vs. 179 ± 29 lux; p < 0.005) in Irregular compared to Regular sleepers. A mathematical model of the circadian pacemaker and its response to light was used to demonstrate that Irregular vs. Regular group differences in circadian timing were likely primarily due to their different patterns of light exposure. A positive correlation (r = 0.37; p < 0.004) between academic performance and SRI was observed. These findings show that irregular sleep and light exposure patterns in college students are associated with delayed circadian rhythms and lower academic performance. Moreover, the modeling results reveal that light-based interventions may be therapeutically effective in improving sleep regularity in this population.

Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

Nathaniel F. Watson, M. Safwan Badr, Gregory Belenky +18 more · Journal of Clinical Sleep Medicine · 2015 · 555 citations

The Impact of Shift Work on Sleep, Alertness and Performance in Healthcare Workers

Saranea Ganesan, Michelle Magee, J. Stone +6 more · Scientific Reports · 2019 · 406 citations

Abstract Shift work is associated with impaired alertness and performance due to sleep loss and circadian misalignment. This study examined sleep between shift types (day, evening, night), and alertness and performance during day and night shifts in 52 intensive care workers. Sleep and wake duration between shifts were evaluated using wrist actigraphs and diaries. Subjective sleepiness (Karolinska Sleepiness Scale, KSS) and Psychomotor Vigilance Test (PVT) performance were examined during day shift, and on the first and subsequent night shifts (3 rd , 4 th or 5 th ). Circadian phase was assessed using urinary 6-sulphatoxymelatonin rhythms. Sleep was most restricted between consecutive night shifts (5.74 ± 1.30 h), consecutive day shifts (5.83 ± 0.92 h) and between evening and day shifts (5.20 ± 0.90 h). KSS and PVT mean reaction times were higher at the end of the first and subsequent night shift compared to day shift, with KSS highest at the end of the first night. On nights, working during the circadian acrophase of the urinary melatonin rhythm led to poorer outcomes on the KSS and PVT. In rotating shift workers, early day shifts can be associated with similar sleep restriction to night shifts, particularly when scheduled immediately following an evening shift. Alertness and performance remain most impaired during night shifts given the lack of circadian adaptation to night work. Although healthcare workers perceive themselves to be less alert on the first night shift compared to subsequent night shifts, objective performance is equally impaired on subsequent nights.

Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015

R. Robert Auger, Helen J. Burgess, Jonathan S. Emens +3 more · Journal of Clinical Sleep Medicine · 2015 · 426 citations

State of the science and recommendations for using wearable technology in sleep and circadian research

Massimiliano de Zambotti, Cathy Goldstein, Jesse D. Cook +4 more · SLEEP · 2023 · 193 citations

Wearable sleep-tracking technology is of growing use in the sleep and circadian fields, including for applications across other disciplines, inclusive of a variety of disease states. Patients increasingly present sleep data derived from their wearable devices to their providers and the ever-increasing availability of commercial devices and new-generation research/clinical tools has led to the wide adoption of wearables in research, which has become even more relevant given the discontinuation of the Philips Respironics Actiwatch. Standards for evaluating the performance of wearable sleep-tracking devices have been introduced and the available evidence suggests that consumer-grade devices exceed the performance of traditional actigraphy in assessing sleep as defined by polysomnogram. However, clear limitations exist, for example, the misclassification of wakefulness during the sleep period, problems with sleep tracking outside of the main sleep bout or nighttime period, artifacts, and unclear translation of performance to individuals with certain characteristics or comorbidities. This is of particular relevance when person-specific factors (like skin color or obesity) negatively impact sensor performance with the potential downstream impact of augmenting already existing healthcare disparities. However, wearable sleep-tracking technology holds great promise for our field, given features distinct from traditional actigraphy such as measurement of autonomic parameters, estimation of circadian features, and the potential to integrate other self-reported, objective, and passively recorded health indicators. Scientists face numerous decision points and barriers when incorporating traditional actigraphy, consumer-grade multi-sensor devices, or contemporary research/clinical-grade sleep trackers into their research. Considerations include wearable device capabilities and performance, target population and goals of the study, wearable device outputs and availability of raw and aggregate data, and data extraction, processing, and analysis. Given the difficulties in the implementation and utilization of wearable sleep-tracking technology in real-world research and clinical settings, the following State of the Science review requested by the Sleep Research Society aims to address the following questions. What data can wearable sleep-tracking devices provide? How accurate are these data? What should be taken into account when incorporating wearable sleep-tracking devices into research? These outstanding questions and surrounding considerations motivated this work, outlining practical recommendations for using wearable technology in sleep and circadian research.

Effects of Partial and Acute Total Sleep Deprivation on Performance across Cognitive Domains, Individuals and Circadian Phase

June C. Lo, John A. Groeger, Nayantara Santhi +6 more · PLoS ONE · 2012 · 330 citations

BACKGROUND: Cognitive performance deteriorates during extended wakefulness and circadian phase misalignment, and some individuals are more affected than others. Whether performance is affected similarly across cognitive domains, or whether cognitive processes involving Executive Functions are more sensitive to sleep and circadian misalignment than Alertness and Sustained Attention, is a matter of debate. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a 2 × 12-day laboratory protocol to characterize the interaction of repeated partial and acute total sleep deprivation and circadian phase on performance across seven cognitive domains in 36 individuals (18 males; mean ± SD of age = 27.6 ± 4.0 years). The sample was stratified for the rs57875989 polymorphism in PER3, which confers cognitive susceptibility to total sleep deprivation. We observed a deterioration of performance during both repeated partial and acute total sleep deprivation. Furthermore, prior partial sleep deprivation led to poorer cognitive performance in a subsequent total sleep deprivation period, but its effect was modulated by circadian phase such that it was virtually absent in the evening wake maintenance zone, and most prominent during early morning hours. A significant effect of PER3 genotype was observed for Subjective Alertness during partial sleep deprivation and on n-back tasks with a high executive load when assessed in the morning hours during total sleep deprivation after partial sleep loss. Overall, however, Subjective Alertness and Sustained Attention were more affected by both partial and total sleep deprivation than other cognitive domains and tasks including n-back tasks of Working Memory, even when implemented with a high executive load. CONCLUSIONS/SIGNIFICANCE: Sleep loss has a primary effect on Sleepiness and Sustained Attention with much smaller effects on challenging Working Memory tasks. These findings have implications for understanding how sleep debt and circadian rhythmicity interact to determine waking performance across cognitive domains and individuals.

A Tale of Two Cities: Software Developers Working from Home during the COVID-19 Pandemic

Denae Ford, Margaret‐Anne Storey, Thomas Zimmermann +6 more · ACM Transactions on Software Engineering and Methodology · 2021 · 203 citations

The COVID-19 pandemic has shaken the world to its core and has provoked an overnight exodus of developers who normally worked in an office setting to working from home. The magnitude of this shift and the factors that have accompanied this new unplanned work setting go beyond what the software engineering community has previously understood to be remote work. To find out how developers and their productivity were affected, we distributed two surveys (with a combined total of 3,634 responses that answered all required questions) weeks apart to understand the presence and prevalence of the benefits, challenges, and opportunities to improve this special circumstance of remote work. From our thematic qualitative analysis and statistical quantitative analysis, we find that there is a dichotomy of developer experiences influenced by many different factors (that for some are a benefit, while for others a challenge). For example, a benefit for some was being close to family members but for others having family members share their working space and interrupting their focus, was a challenge. Our surveys led to powerful narratives from respondents and revealed the scale at which these experiences exist to provide insights as to how the future of (pandemic) remote work can evolve.

An evening light intervention reduces fatigue and errors during night shifts: A randomized controlled trial.

Cyr M, Artenie DZ, Al Bikaii A +3 more · Sleep Health · 2023 · 15 citations

The Effects of Sleep Deprivation on Pain Inhibition and Spontaneous Pain in Women

Michael T. Smith, Robert R. Edwards, Una D. McCann +1 more · SLEEP · 2007 · 530 citations

Impaired central pain modulation is implicated in the pathophysiology of chronic pain. In this controlled experiment, we evaluated whether partial sleep loss altered endogenous pain inhibition and reports of spontaneous pain. Thirty-two healthy females were studied polysomnographically for 7 nights. On Nights 1-2 (Baseline), subjects slept undisturbed for 8 hours. After Night 2, subjects were randomized to Control (N = 12), Forced Awakening (FA, N = 10), or Restricted Sleep Opportunity (RSO, N = 10) conditions. Controls continued to sleep undisturbed. FA underwent 8 forced awakenings (one per hour) on Nights 3-5. RSO subjects were yoked to FA on total sleep time (TST), receiving partial sleep deprivation by delayed bedtime. On Night 6, both FA & RSO underwent 36 hours total sleep deprivation (TSD), followed by 11-hour recovery sleep (Night 7). Subjects completed twice-daily psychophysical assessments of mechanical pain thresholds and pain inhibition (Diffuse Noxious Inhibitory Controls), via use of a conditioning stimulus (i.e., cold pressor) paradigm. FA and RSO demonstrated 50% reductions in total sleep time and increases in nonpainful somatic symptoms during partial sleep deprivation. While sleep deprivation had no effect on pain thresholds, during partial sleep deprivation the FA group demonstrated a significant loss of pain inhibition and an increase in spontaneous pain; neither of the other 2 groups showed changes in pain inhibition or spontaneous pain during partial sleep deprivation. These data suggest that sleep continuity disturbance, but not simple sleep restriction, impairs endogenous pain-inhibitory function and increases spontaneous pain, supporting a possible pathophysiologic role of sleep disturbance in chronic pain.

Contemplative Education: A Systematic, Evidence-Based Review of the effect of Meditation Interventions in Schools

Lea Waters, Adam Barsky, Amanda Ridd +1 more · Educational Psychology Review · 2014 · 250 citations

Schools need reliable evidence about the outcomes of meditation programs before they consider if and how such programmes can influence learning agendas, curriculum and timetables. This paper reviewed evidence from 15 peer-reviewed studies of school meditation programmes with respect to three student outcomes: well-being, social competence and academic achievement. In total, there were 76 results where effect sizes could be calculated. The overall number of participants in the effect size analyses was 1,797. Of the 76 effect sizes calculated, 61 % were statistically significant. Sixty-seven per cent of the results had small effects on student outcomes, 24 % of the results had medium effect strength and 9 % showed a large effect of meditation upon student outcomes. Transcendental meditation programmes had a higher percentage of significant effects than mindfulness-based and other types of meditation programmes, but this may be to do with the settings and programme delivery rather than the technique itself. Programme elements such as duration, frequency of practice and type of instructor influenced student outcomes. A conceptual model is put forward based on two propositions: proposition 1—meditation positively influences student success by increasing cognitive functioning; proposition 2—meditation positively influences student success by increasing emotional regulation. Suggestions are made to stimulate future research and to assist in the development of more efficacious applications for meditation in schools.

Coping During the COVID-19 Pandemic: A Qualitative Study of Older Adults Across the United States

Jessica Finlay, Jasdeep S. Kler, Brendan O’Shea +3 more · Frontiers in Public Health · 2021 · 157 citations

Objective: Older adults may struggle with stresses and daily life challenges associated with the Coronavirus Disease 2019 (COVID-19) pandemic. Yet they may also utilize emotional and behavioral coping strategies. This qualitative paper aims to identify ways of coping with worries and stress during the pandemic from the perspectives of older adults in the United States. Methods: The COVID-19 Coping Study recruited 6,938 adults aged ≥55 through online multi-frame sampling from April 2-May 31, 2020 across all 50 US states, the District of Columbia, and Puerto Rico. The online questionnaire focused on the effects of COVID-19 on daily life, mental health, and well-being. This included an open-ended question regarding participants' coping strategies. We used qualitative content analysis to identify and code diverse coping strategies. Our general inductive approach enabled findings to emerge from the most frequent and dominant themes in the raw data. Results: A total of 5,180 adults [74% of the total sample; mean age 67.3 (SD 7.9); 63.8% female] responded to the question about using strategies to cope with living through the COVID-19 pandemic. Frequently-reported strategies included exercising and going outdoors, modifying routines, following public health guidelines, adjusting attitudes, and staying socially connected. Some coping strategies were health-limiting (e.g., overeating), while most strategies encouraged self-improvement, positive adjustment, and wellness. Conclusions: This study provides novel qualitative evidence on coping strategies of older adults early in the COVID-19 pandemic. Findings can inform community and clinical interventions to support older adults that harness positive coping strategies such as exercise, modified routines, and social strategies to improve physical and mental health, foster social support, and encourage meaningful daily activities during times of stress and trauma.

Guidelines for Assessment and Instruction in Statistics Education (GAISE) College Report 2016

Robert H. F. Carver, Michelle Everson, John Gabrosek +8 more · Scholarly Commons (Embry–Riddle Aeronautical University) · 2016 · 328 citations

In 2005 the American Statistical Association (ASA) endorsed the Guidelines for Assessment and Instruction in Statistics Education (GAISE) College Report. This report has had a profound impact on the teaching of introductory statistics in two- and four-year institutions, and the six recommendations put forward in the report have stood the test of time. Much has happened within the statistics education community and beyond in the intervening 10 years, making it critical to re-evaluate and update this important report. For readers who are unfamiliar with the original GAISE College Report or who are new to the statistics education community, the full version of the 2005 report can be found at http://www.amstat.org/education/gaise/GaiseCollege_full.pdf and a brief history of statistics education can be found in Appendix A of this new report. The revised GAISE College Report takes into account the many changes in the world of statistics education and statistical practice since 2005 and suggests a direction for the future of introductory statistics courses. Our work has been informed by outreach to the statistics education community and by reference to the statistics education literature.

Shift work: health, performance and safety problems, traditional countermeasures, and innovative management strategies to reduce circadian misalignment

Charmane I. Eastman, Smith · Nature and Science of Sleep · 2012 · 168 citations

There are three mechanisms that may contribute to the health, performance, and safety problems associated with night-shift work: (1) circadian misalignment between the internal circadian clock and activities such as work, sleep, and eating, (2) chronic, partial sleep deprivation, and (3) melatonin suppression by light at night. The typical countermeasures, such as caffeine, naps, and melatonin (for its sleep-promoting effect), along with education about sleep and circadian rhythms, are the components of most fatigue risk-management plans. We contend that these, while better than nothing, are not enough because they do not address the underlying cause of the problems, which is circadian misalignment. We explain how to reset (phase-shift) the circadian clock to partially align with the night-work, day-sleep schedule, and thus reduce circadian misalignment while preserving sleep and functioning on days off. This involves controlling light and dark using outdoor light exposure, sunglasses, sleep in the dark, and a little bright light during night work. We present a diagram of a sleep-and-light schedule to reduce circadian misalignment in permanent night work, or a rotation between evenings and nights, and give practical advice on how to implement this type of plan.

Learning from Difference: The New Architecture of Experimentalist Governance in the EU

Charles F. Sabel, Jonathan Zeitlin · European Law Journal · 2008 · 758 citations

Abstract: This article argues that current widespread characterisations of EU governance as multi‐level and networked overlook the emergent architecture of the EU's public rule making. In this architecture, framework goals (such as full employment, social inclusion, ‘good water status’, a unified energy grid) and measures for gauging their achievement are established by joint action of the Member States and EU institutions. Lower‐level units (such as national ministries or regulatory authorities and the actors with whom they collaborate) are given the freedom to advance these ends as they see fit. But in return for this autonomy, they must report regularly on their performance and participate in a peer review in which their results are compared with those pursuing other means to the same general ends. Finally, the framework goals, performance measures, and decision‐making procedures themselves are periodically revised by the actors, including new participants whose views come to be seen as indispensable to full and fair deliberation. Although this architecture cannot be read off from either Treaty provisions or textbook accounts of the formal competences of EU institutions, the article traces its emergence and diffusion across a wide range of policy domains, including telecommunications, energy, drug authorisation, occupational health and safety, employment promotion, social inclusion, pensions, health care, environmental protection, food safety, maritime safety, financial services, competition policy, state aid, anti‐discrimination policy and fundamental rights.

Impact of lifestyle and technology developments on sleep

Tamar Shochat · Nature and Science of Sleep · 2012 · 135 citations

Although the physiological and psychological mechanisms involved in the development of sleep disorders remain similar throughout history, factors that potentiate these mechanisms are closely related to the "zeitgeist", ie, the sociocultural, technological and lifestyle trends which characterize an era. Technological advancements have afforded modern society with 24-hour work operations, transmeridian travel and exposure to a myriad of electronic devices such as televisions, computers and cellular phones. Growing evidence suggests that these advancements take their toll on human functioning and health via their damaging effects on sleep quality, quantity and timing. Additional behavioral lifestyle factors associated with poor sleep include weight gain, insufficient physical exercise and consumption of substances such as caffeine, alcohol and nicotine. Some of these factors have been implicated as self-help aids used to combat daytime sleepiness and impaired daytime functioning. This review aims to highlight current lifestyle trends that have been shown in scientific investigations to be associated with sleep patterns, sleep duration and sleep quality. Current understanding of the underlying mechanisms of these associations will be presented, as well as some of the reported consequences. Available therapies used to treat some lifestyle related sleep disorders will be discussed. Perspectives will be provided for further investigation of lifestyle factors that are associated with poor sleep, including developing theoretical frameworks, identifying underlying mechanisms, and establishing appropriate therapies and public health interventions aimed to improve sleep behaviors in order to enhance functioning and health in modern society.

Effect of a Simulated Heat Wave on Physiological Strain and Labour Productivity

Leonidas G. Ioannou, Konstantinos Mantzios, Lydia Tsoutsoubi +6 more · International Journal of Environmental Research and Public Health · 2021 · 47 citations

BACKGROUND: The aim of the study was to investigate the effect of a simulated heat-wave on the labour productivity and physiological strain experienced by workers. METHODS: Seven males were confined for ten days in controlled ambient conditions. A familiarisation day was followed by three (pre, during, and post-heat-wave) 3-day periods. During each day volunteers participated in a simulated work-shift incorporating two physical activity sessions each followed by a session of assembly line task. Conditions were hot (work: 35.4 °C; rest: 26.3 °C) during, and temperate (work: 25.4 °C; rest: 22.3 °C) pre and post the simulated heat-wave. Physiological, biological, behavioural, and subjective data were collected throughout the study. RESULTS: The simulated heat-wave undermined human capacity for work by increasing the number of mistakes committed, time spent on unplanned breaks, and the physiological strain experienced by the participants. Early adaptations were able to mitigate the observed implications on the second and third days of the heat-wave, as well as impacting positively on the post-heat-wave period. CONCLUSIONS: Here, we show for first time that a controlled simulated heat-wave increases workers' physiological strain and reduces labour productivity on the first day, but it promotes adaptations mitigating the observed implications during the subsequent days.

Effects of cold-water immersion on health and wellbeing: A systematic review and meta-analysis.

Cain T, Brinsley J, Bennett H +3 more · PLoS One · 2025 · 25 citations

**[Unable to provide due to missing full text/abstract.]** A systematic review and meta-analysis synthesizes findings from multiple studies to provide a comprehensive overview of an intervention's effects. Without the specific findings, a concise summary of what was found and why it matters for self-experimentation cannot be generated.

Nutritional influences on cognitive function: mechanisms of susceptibility

E. Leigh Gibson, Michael W. Green · Nutrition Research Reviews · 2002 · 156 citations

The impact of nutritional variation, within populations not overtly malnourished, on cognitive function and arousal is considered. The emphasis is on susceptibility to acute effects of meals and glucose loads, and chronic effects of dieting, on mental performance, and effects of cholesterol and vitamin levels on cognitive impairment. New developments in understanding dietary influences on neurohormonal systems, and their implications for cognition and affect, allow reinterpretation of both earlier and recent findings. Evidence for a detrimental effect of omitting a meal on cognitive performance remains equivocal: from the outset, idiosyncrasy has prevailed. Yet, for young and nutritionally vulnerable children, breakfast is more likely to benefit than hinder performance. For nutrient composition, despite inconsistencies, some cautious predictions can be made. Acutely, carbohydrate-rich-protein-poor meals can be sedating and anxiolytic; by comparison, protein-rich meals may be arousing, improving reaction time but also increasing unfocused vigilance. Fat-rich meals can lead to a decline in alertness, especially where they differ from habitual fat intake. These acute effects may vary with time of day and nutritional status. Chronically, protein-rich diets have been associated with decreased positive and increased negative affect relative to carbohydrate-rich diets. Probable mechanisms include diet-induced changes in monoamine, especially serotoninergic neurotransmitter activity, and functioning of the hypothalamic pituitary adrenal axis. Effects are interpreted in the context of individual traits and susceptibility to challenging, even stressful, tests of performance. Preoccupation with dieting may impair cognition by interfering with working memory capacity, independently of nutritional status. The change in cognitive performance after administration of glucose, and other foods, may depend on the level of sympathetic activation, glucocorticoid secretion, and pancreatic beta-cell function, rather than simple fuelling of neural activity. Thus, outcomes can be predicted by vulnerability in coping with stressful challenges, interacting with nutritional history and neuroendocrine status. Functioning of such systems may be susceptible to dietary influences on neural membrane fluidity, and vitamin-dependent cerebrovascular health, with cognitive vulnerability increasing with age.

Personalized medicine in human space flight: using Omics based analyses to develop individualized countermeasures that enhance astronaut safety and performance

Michael A. Schmidt, Thomas J. Goodwin · Metabolomics · 2013 · 95 citations

Space flight is one of the most extreme conditions encountered by humans. Advances in Omics methodologies (genomics, transcriptomics, proteomics, and metabolomics) have revealed that unique differences exist between individuals. These differences can be amplified in extreme conditions, such as space flight. A better understanding of individual differences may allow us to develop personalized countermeasure packages that optimize the safety and performance of each astronaut. In this review, we explore the role of "Omics" in advancing our ability to: (1) more thoroughly describe the biological response of humans in space; (2) describe molecular attributes of individual astronauts that alter the risk profile prior to entering the space environment; (3) deploy Omics techniques in the development of personalized countermeasures; and (4) develop a comprehensive Omics-based assessment and countermeasure platform that will guide human space flight in the future. In this review, we advance the concept of personalized medicine in human space flight, with the goal of enhancing astronaut safety and performance. Because the field is vast, we explore selected examples where biochemical individuality might significantly impact countermeasure development. These include gene and small molecule variants associated with: (1) metabolism of therapeutic drugs used in space; (2) one carbon metabolism and DNA stability; (3) iron metabolism, oxidative stress and damage, and DNA stability; and (4) essential input (Mg and Zn) effects on DNA repair. From these examples, we advance the case that widespread Omics profiling should serve as the foundation for aerospace medicine and research, explore methodological considerations to advance the field, and suggest why personalized medicine may become the standard of care for humans in space.

Effects of a Short Daytime Nap on the Cognitive Performance: A Systematic Review and Meta-Analysis.

Dutheil F, Danini B, Bagheri R +5 more · Int J Environ Res Public Health · 2021 · 91 citations

Encoding Difficulty Promotes Postlearning Changes in Sleep Spindle Activity during Napping

Christina Schmidt, Philippe Peigneux, Vincenzo Muto +6 more · Journal of Neuroscience · 2006 · 245 citations

Learning-dependent increases in sleep spindle density have been reported during nocturnal sleep immediately after the learning session. Here, we investigated experience-dependent changes in daytime sleep EEG activity after declarative learning of unrelated word pairs. At weekly intervals, 13 young male volunteers spent three 24 h sessions in the laboratory under carefully controlled homeostatic and circadian conditions. At approximately midday, subjects performed either one of two word-pair learning tasks or a matched nonlearning control task, in a counterbalanced order. The two learning lists differed in the level of concreteness of the words used, resulting in an easier and a more difficult associative encoding condition, as confirmed by performance at immediate cued recall. Subjects were then allowed to sleep for 4 h; afterward, delayed cued recall was tested. Compared with the control condition, sleep EEG spectral activity in the low spindle frequency range and the density of low-frequency sleep spindles (11.25-13.75 Hz) were both significantly increased in the left frontal cortex after the difficult but not after the easy encoding condition. Furthermore, we found positive correlations between these EEG changes during sleep and changes in memory performance between pre-nap and post-nap recall sessions. These results indicate that, like during nocturnal sleep, daytime sleep EEG oscillations including spindle activity are modified after declarative learning of word pairs. Furthermore, we demonstrate here that the nature of the learning material is a determinant factor for sleep-related alterations after declarative learning.

Exercise interventions for sleep and cognitive dysfunction in shift workers: a systematic review of randomized trials.

Algharbi FH, Nuhmani S, Alsubaiei M +2 more · Front Public Health · 2026 · 0 citations

Structured exercise, particularly aerobic or mixed modalities timed post-shift or delivered in the workplace, shows promise for improving sleep and cognitive function in shift workers, but more robust research is needed to establish consistent effects and specific guidelines for self-experimentation.

Effects of Hydration on Cognitive Function of Pilots

Paul D. Lindseth, Glenda Lindseth, Thomas V. Petros +2 more · Military Medicine · 2013 · 67 citations

The objective of this study was to examine the effect of fluid intake and possible dehydration on cognitive flight performance of pilots. A repeated-measures, counterbalanced, mixed study design was used to examine differences in working memory, spatial orientation, and cognitive flight performance of 40 randomly selected healthy pilots after having high and low fluid intakes. Serial weights were also analyzed to determine differences in cognitive flight performance of the dehydrated (1-3% weight loss) and hydrated study participants. Results showed flight performance and spatial cognition test scores were significantly (p < 0.05) poorer for pilots who had low fluid intakes and experienced dehydration in comparison to the hydrated pilots. These findings indicate fluid intake differences resulting in dehydration may have safety implications because peak cognitive performance among pilots is critical for flight safety.

Efficacy of Fatigue Countermeasures on Cognitive Performance and Operational Safety in Military Pilots: A Systematic Review.

Attiah Alzahrani A, Alessa MF, Musaad Alharbi F +1 more · Cureus · 2025

Pharmacological stimulants (caffeine and modafinil) are the most evidence-backed short-term fatigue countermeasures for military pilots, improving vigilance and reaction time during extended wakefulness, but no intervention fully restores baseline performance after more than 27 hours awake, and individual factors like sleep quality and innate fatigue vulnerability strongly moderate effectiveness.

Acute Effects of Oral Cannabinoids on Sleep and High-Density EEG in Insomnia: A Pilot Randomised Controlled Trial.

Suraev A, McGregor IS, McCartney D +15 more · J Sleep Res · 2026 · 8 citations

Acute neurocognitive and subjective effects of oral methamphetamine with low doses of alcohol: A randomised controlled trial.

Hayley AC, Shiferaw B, Rositano J +1 more · J Psychopharmacol · 2023 · 8 citations

No benefit adding eleutherococcus senticosus to stress management training in stress-related fatigue/weakness, impaired work or concentration, a randomized controlled study.

Schaffler K, Wolf OT, Burkart M · Pharmacopsychiatry · 2013 · 21 citations

A randomized controlled trial of cognitive-behavior therapy plus bright light therapy for adolescent delayed sleep phase disorder.

Gradisar M, Dohnt H, Gardner G +8 more · Sleep · 2011

Improving Elementary Teachers’ Well-Being through a Strengths-Based Intervention: A Multiple Baseline Single-Case Design

Mollie Mccullough · Digital Commons - University of South Florida (University of South Florida) · 2015 · 7 citations

Teaching is considered to be one of the most highly demanding professions, and one that is associated with high levels of stress and sometimes deleterious outcomes. Although research demonstrates that burnout and attrition are often associated with specific characteristics of the occupation (e.g., challenging workload, standardized testing, merit-based salary) minimal research focuses on how to better support teachers’ well-being. The field of positive psychology affords a new perspective in how to obtain quality mental health without solely focusing on psychopathology within a deficits-based approach. This includes the implementation of interventions (i.e., positive psychology interventions [PPI]) that target constructs of well-being (e.g., character strengths, hope, optimism, gratitude, etc.) and are associated with positive changes in authentic happiness. This study examined how a strength-based, PPI entitled Utilizing Signature Strengths in a New Way (Seligman, Steen, Park, &amp; Peterson, 2005) impacts dimensions of teacher well-being, as well as other relevant outcomes (i.e., flourishing, burnout) within the school context. Previous research has shown that strengths-based intervention to be the PPI with the most substantial impact and the longest lasting outcomes (Seligman et al., 2005). Utilizing a concurrent multiple baseline single-case design with eight teachers, the study evaluated the effects of the strengths-based PPI on teacher’s overall happiness (i.e., subjective well-being) as indicated by self-report measures of life satisfaction and positive and negative affect. The teachers exhibited significant gains in life satisfaction and reductions in negative affect from pre- to post-intervention that were also evident one month following the intervention. Although positive affect did not significantly change from pre- to post-intervention, a significant gain was apparent at one-month follow-up. Single-case analytic strategies (i.e., visual analysis, masked visual analysis, and hierarchical linear modeling) found that the intervention positively impacted teachers’ overall subjective well-being (composite of standardized life satisfaction, positive affect, and negative affect scores). Results for single indicators of subjective well-being found variability in basic effects among different individuals (i.e., some teachers benefited more than others) further supporting the theory of person-activity fit. Regarding the intervention’s effects on secondary outcomes that were examined only at pre, post, and one-month follow-up time points, findings indicated the teachers experienced a significant increase in work satisfaction immediately following the intervention, as well as a significant increase in feelings of flourishing at follow-up. Significant decreases in negative dimensions of teachers’ mental health including stress and burnout (i.e., emotional exhaustion) were also demonstrated. Findings from the current study provide initial support for the efficacy of a teacher-focused, strengths-based intervention and its ability to improve multiple components of teacher well-being within an elementary school. Implications for school psychologists and policy, contributions to the literature, and future directions are discussed.

Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Insomnia and Anxiety: A Double-blind, Randomized, Placebo-controlled Study.

Langade D, Kanchi S, Salve J +2 more · Cureus · 2019

Bidirectional effects of physical activity and sleep on health: evidence and future directions.

Clemente-Suárez VJ, Redondo-Flórez L, Beltrán-Velasco AI +5 more · Front Sports Act Living · 2026 · 1 citations

Analysis of sleep quality and its influencing factors among residents in Chengguan District of Lhasa.

Zhang L, Zhao H, Xu M +8 more · BMC Public Health · 2026 · 0 citations

Exposure to Short Wavelength-Enriched White Light and Exercise Improves Alertness and Performance in Operational NASA Flight Controllers Working Overnight Shifts.

Barger LK, Sullivan JP, Lockley SW +1 more · J Occup Environ Med · 2021 · 27 citations

Cardiac autonomic activity during sleep deprivation with and without caffeine administration.

Crooks E, Hansen DA, Satterfield BC +2 more · Physiol Behav · 2019 · 16 citations

Randomized, double-blind, placebo-controlled, crossover study of the effects of repeated-dose caffeine on neurobehavioral performance during 48 h of total sleep deprivation.

Hansen DA, Ramakrishnan S, Satterfield BC +4 more · Psychopharmacology (Berl) · 2019 · 26 citations

Caffeine improves reaction time, vigilance and logical reasoning during extended periods with restricted opportunities for sleep.

Kamimori GH, McLellan TM, Tate CM +3 more · Psychopharmacology (Berl) · 2015 · 97 citations