The transition from sleep to wakefulness entails a temporary period of reduced alertness and impaired performance known as sleep inertia. The extent to which its severity varies with task and cognitive processes remains unclear. We examined sleep inertia in alertness, attention, working memory and cognitive throughput with the Karolinska Sleepiness Scale (KSS), the Psychomotor Vigilance Task (PVT), n-back and add tasks, respectively. The tasks were administered 2 hours before bedtime and at regular intervals for four hours, starting immediately after awakening in the morning, in eleven participants, in a four-way cross-over laboratory design. We also investigated whether exposure to Blue-Enhanced or Bright Blue-Enhanced white light would reduce sleep inertia. Alertness and all cognitive processes were impaired immediately upon awakening (p<0.01). However, alertness and sustained attention were more affected than cognitive throughput and working memory. Moreover, speed was more affected than accuracy of responses. The light conditions had no differential effect on performance except in the 3-back task (p<0.01), where response times (RT) at the end of four hours in the two Blue-Enhanced white light conditions were faster (200 ms) than at wake time. We conclude that the effect of sleep inertia varies with cognitive domain and that it’s spectral/intensity response to light is different from that of sleepiness. That is, just increasing blue-wavelength in light may not be sufficient to reduce sleep inertia. These findings have implications for critical professions like medicine, law-enforcement etc., in which, personnel routinely wake up from night-time sleep to respond to emergency situations.

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SUMMAR Y The effect of artificial dawn during the last 30 min of sleep on subsequent dissipation of sleep inertia was investigated, including possible involvement of cortisol and thermoregulatory processes. Sixteen healthy subjects who reported difficulty with waking up participated in random order in a control and an artificial dawn night. Sleep inertia severity was measured by subjective ratings of sleepiness and activation, and by performance on an addition and a reaction time task measured at 1, 15, 30, 45, 60, and 90 min after waking up at habitual wake up time at workdays. At all intervals, saliva samples were collected for cortisol analysis. Sleep electroencephalogram was recorded during the 30 min prior to waking up; core body temperature and skin temperatures were recorded continuously until 90 min after waking up. Subjective sleepiness was significantly decreased and subjective activation increased after waking up in the artificial dawn condition as compared with control, in which lights were turned on at waking up. These effects can be explained by effects of artificial dawn on skin temperature and amount of wakefulness during the 30 min prior to the alarm. Artificial dawn accelerated the decline in skin temperature and in the distal-to-proximal skin temperature gradient after getting up. No significant effects of artificial dawn on performance, core body temperature, and cortisol were found. These results suggest that the physiology underlying the positive effects of artificial dawn on the dissipation of sleep inertia involves light sleep and an accelerated skin temperature decline after awakening.

A new photometric measure of light intensity that takes into account the relatively large contribution of the ipRGCs to the non-image forming (NIF) system was recently proposed. We set out to revise publications reporting on alertness scores as measured by the Karolinska Sleepiness Scale (KSS) under different light conditions in order to assess the extendibility of the equivalent-melanopic function to NIF responses in humans. The KSS response (-Δ KSS) to the different light conditions used on previous studies, preferably including a comparison to a dim light condition, was assessed. Based on the light descriptions of the different studies, the equivalent melanopic lux (m-illuminance) was calculated. The -Δ KSS was plotted against photopic-illuminance and m-illuminance, and fitted to a sigmoidal function already shown to described KSS responses to different light intensities. The root mean-squared error and r(2) were used as criteria to explain the best-describing light unit measurement. Studies that compared only the influence of light under otherwise same conditions and in which participants were not totally sleep deprived were included. Our results show that the effects of light on KSS are better explained by a melanopic unit measurement than by photopic lux. The present analysis allowed for the construction of a melanopic alertness response curve. This curve needs to be validated with appropriate designs. Nonetheless, it may serve as starting point for the development of hypothesis of predictions on the relative changes in KSS under a given condition due to changes in light properties.

Light is an important environmental stimulus for the entrainment of the circadian clock and for increasing alertness. The intrinsically photosensitive ganglion cells in the retina play an important role in transferring this light information to the circadian system and they are elicited in particular by short-wavelength light. Exposure to short wavelengths is reduced, for instance, in elderly people due to yellowing of the ocular lenses. This reduction may be involved in the disrupted circadian rhythms observed in aged subjects. Here, we tested the effects of reduced blue light exposure in young healthy subjects (n = 15) by using soft orange contact lenses (SOCL). We showed (as expected) that a reduction in the melatonin suppressing effect of light is observed when subjects wear the SOCL. However, after chronic exposure to reduced (short wavelength) light for two consecutive weeks we observed an increase in sensitivity of the melatonin suppression response. The response normalized as if it took place under a polychromatic light pulse. No differences were found in the dim light melatonin onset or in the amplitude of the melatonin rhythms after chronic reduced blue light exposure. The effects on sleep parameters were limited. Our results demonstrate that the non-visual light system of healthy young subjects is capable of adapting to changes in the spectral composition of environmental light exposure. The present results emphasize the importance of considering not only the short-term effects of changes in environmental light characteristics.

Effects of artificial dawn on subjective ratings of sleep inertia and dim light melatonin onset Gimenez, Marina C.; Hessels, Martijn; van de Werken, Maan; de Vries, Bonnie; Beersma, Domien G. M.; Gordijn, Marijke C. M. Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. The timing of work and social requirements has a negative impact on performance and well-being of a significant proportion of the population in our modern society due to a phenomenon known as social jetlag. During workdays, in the early morning, late chronotypes, in particular, suffer from a combination of a nonoptimal circadian phase and sleep deprivation. Sleep inertia, a transient period of lowered arousal after awakening, therefore, becomes more severe. In the present home study, the authors tested whether the use of an alarm clock with artificial dawn could reduce complaints of sleep inertia in people having difficulties in waking up early. The authors also examined whether these improvements were accompanied by a shift in the melatonin rhythm. Two studies were performed: Study 1: three conditions (0, 50, and 250 lux) and Study 2: two conditions (0 lux and self-selected dawn-light intensity). Each condition lasted 2 weeks. In both studies, the use of the artificial dawn resulted in a significant reduction of sleep inertia complaints. However, no significant shift in the onset of melatonin was observed after 2 weeks of using the artificial dawn of 250 lux or 50 lux compared to the control condition. A multilevel analysis revealed that only the presence of the artificial dawn, rather than shift in the dim light melatonin onset or timing of sleep offset, is related to the observed reduction of sleep inertia complaints. Mechanisms other than shift of circadian rhythms are needed to explain the positive results on sleep inertia of waking up with a dawn signal. (Author correspondence: m.c.gimenez@rug.nl)

SUMMARYIrregular 24 h light/dark cycles with night-time light exposure and a low amplitude are disruptive for sleep, mood and circadian rhythms. Nevertheless such lighting conditions are quite common in medical care facilities. A controlled clinical trial among 196 cardiology ward patients (mean age 66.5 AE 13.1 years SD) investigated how a patient room lighting intervention affects sleep, appraisal and mood across hospitalization. Patients were either assigned to a standardly-lit room or to a room with an interventional lighting system offering a dynamic 24 h light/ dark cycle with low nocturnal light exposure and 2 h of bright light (1750 lux) during daytime. Measures included wrist actigraphy and questionnaires assessing alertness, sleep quality, anxiety, depression and lighting appraisal. The median length of hospitalization was 5 days in both study arms. Subjective scores on sleep, alertness, anxiety and depression did not differ between arms. Lighting appraisal in intervention rooms was better as compared to standardly-lit rooms, both in patients (P < 0.001) and staff (P < 0.005). Actigraphic sleep duration of patients improved by 5.9 min (95% CI: 0.6-11.2; P = 0.03 intervention 9 time effect) per hospitalization day with interventional lighting instead of standard lighting. After 5 days of hospitalization, sleep duration in the lighting intervention rooms increased by 29 min, or a relative 7.3%, as compared to standardly-lit rooms. A 24 h lighting system with enhanced daytime brightness and restricted nocturnal light exposure can improve some aspects of appraisal and objective sleep in hospital patients. More clinical research is needed to establish the best lighting strategy to promote healing and wellbeing within healthcare settings. IN TROD UCTI ONImpaired sleep is a known hospital stressor, and hospitalized patients struggle to get sufficient sleep at night due to factors like discomfort, worries, noise, inappropriate light exposure and pain (Manian and Manian, 2015;Pisani et al., 2015;Redeker and Hedges, 2002;Volicer and Bohannon, 1975). Sleep is an important factor to promote the wellbeing and recovery of patients. The human sleep-wake pattern is strongly regulated by the central circadian pacemaker residing in the suprachiasmatic nuclei within the hypothalamus. This pacemaker uses light-dark information to initiate and control the timing, alignment and stability of the endogenous 24 h patterns in our sleep, physiology, alertness and mood. Proper timing of the light exposure is critical: brighter daytime light conditions are associated with better mood and sleep quality (Ancoli-Israel et al.,

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