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Cassie J Hilditch

Publications and source records attributed to Cassie J Hilditch.

18 records
All sourcesNASA NTRSDOE OSTI
NASA NTRS2023

Sleep Issues in Aviation and Space

This article describes the factors that cause sleep issues in aviation and spaceflight. There are many causes of sleep disruption that are common to both domains, including, irregular schedules, circadian misalignment, and inadequate sleep environment. There are also factors that are unique to each type of operation that may lead to the manifestation of sleep disorders among these populations. Each of these factors, and their subsequent impact on sleep, are reviewed in this article.

Astronaut↗
NASA NTRS2022

Sex Differences in Perceptions of Sleep Inertia Following Nighttime Awakenings

Study Objectives: The influence of biological sex on sleep inertia symptoms is currently unknown. We investigated the role of sex differences in the subjective experience and objective cognitive manifestation of sleep inertia following nighttime awakenings. Methods: Thirty-two healthy adults (16 female, 25.91 ± 5.63 years) completed a one-week at-home study with one experimental night during which sleep was measured by polysomnography and participants were awakened during their habitual sleep time. Participants completed a psychomotor vigilance task (PVT), Karolinska Sleepiness Scale (KSS), visual analog mood scales, and a descending subtraction task (DST) prior to sleep (baseline) and at 2, 12, 22, and 32 minutes after awakening. A series of mixed-effects models with Bonferroni-corrected post-hoc tests were used to examine the main effects of test bout and sex, and their interaction, with a random effect of participant, and order of wake-up and sleep history as covariates. Results: All outcomes except for percent correct on the DST showed a significant main effect of test bout, with worse performance after waking compared to baseline (all p s < .003). Significant effects of sex ( p = .002) and sex × test bout ( p = .01; R 2 M = .49, R 2 C = .69) were observed for KSS, with females reporting a greater increase in sleepiness from baseline to after waking compared to males. Conclusions : These results suggest that while females reported feeling sleepier than males following nighttime awakenings, their cognitive performance was comparable. Future research is needed to determine whether perceptions of sleepiness influence decision-making during the transition from sleep to wakefulness.

Sleep inertia↗
NASA NTRS2022

Fatigue in Short-Haul Operations: Regulations and Research

Short-haul multi-segment flight operations are conducted within Part 117 table limits for Flight Time and Flight Duty Period, yet there are few data available regarding the impact on sleep, workload, and performance in these operations. The Civil Aerospace Medical Institute (CAMI) has invested in the planning and execution of a study that will result in data characterizing the effects of short-haul multi-segment flight operations on cumulative sleep loss and pilot workload across trip pairings. Scientific researchers from CAMI, in collaboration with NASA Ames Research Center, are currently running an operational field study to examine the human factors and elements of pilot performance associated with short-haul multi-segment flight operations to better understand the impact of sleep disruption and workload across trip pairings. The first half of this presentation will provide a brief overview of current duty and rest requirements and identify gaps in current operational research data. The second half of the presentation will focus on results from a focus group study which developed the scope of the larger field study, followed by an overview of the current field study.

short-haul↗
NASA NTRS2022

Fatigue, Schedules, Sleep, and Sleepiness in U.S. Commercial Pilots During COVID-19

Introduction: COVID-19 has had a significant impact on the aviation industry. While reduced flying capacity may intuitively translate to reduced fatigue risk by way of fewer flights and duty hours, the actual impact of the pandemic on pilot fatigue is unknown. Methods: We surveyed US commercial airline pilots in late 2020 (n = 669) and early 2021 (n = 156) to assess the impact of COVID-19 on schedules and fatigue during the pandemic. Results: Overall, pilots reported reduced flight and duty hours compared to pre-pandemic. Average sleep on workdays was slightly shorter in late 2020 (6.88 h) and recovered to pre-pandemic levels in early 2021 (6.95 h). Similarly, the frequency of sleepiness on days off and in-flight increased in late 2020, with 54% of pilots reporting an increase in in-flight sleepiness, then returned to pre-pandemic levels in early 2021. The use of in-flight sleepiness countermeasures remained the same across assessed time points. Pilots highlighted several factors which impacted their sleep and job performance, including limited access to nutritional food during duty days and layovers, reduced access to exercise facilities during layovers, increased stress due to job insecurity and health concerns, increased distractions and workload, and changes to scheduling. Discussion: Despite a reduction in flights and duty days, COVID-19 led to increased sleepiness on days off and in-flight, potentially due to the negative impact of lack of access to essential needs and heightened stress on sleep. Operators need to monitor the change in these COVID-19 related risks as the industry returns to full service.

sleep↗
NASA NTRS2021

Circadian Rhythms and Homeostatic Mechanisms for Sleep Regulation

This chapter examines circadian rhythms and homeostatic mechanisms for sleep regulation. It reviews the current evidence describing the two-process model of sleep regulation and how to assess disruption to either of these sleep drives. This chapter also reviews the role of the photic and non-photic resetting of the circadian rhythm and describes how some aspects of modern society can cause sleep and circadian disruption. Furthermore, this chapter describes how misalignment between the circadian rhythm and sleep homeostat, such as occurs during jet lag and shiftwork, can lead to sleep disruption. The short and long-term consequences of circadian misalignment are also reviewed.

Sleep↗
NASA NTRS2020

Mitigating fatigue on the flight deck: how is controlled rest used in practice?

Controlled Rest (CR) refers to a short, voluntary nap opportunity taken by pilots on the flight deck as a countermeasure to unanticipated sleepiness in flight. This study explores the profile of CR use in a long-haul commercial airline. Forty-four pilots wore actiwatches and filled in an application-based sleep/work diary for approximately 2 weeks resulting in complete records from 239 flights. Timing of sleep periods and flight schedules were analyzed relative to home-base time. Pearson correlations were used to assess the influence of pilot demographics on CR use. A mixed-effects logistic regression was used to analyze the impact of schedule factors on CR. CR was taken on 46% (n=110) of flights, with 80% (n=106/133) of all CR attempts estimated by actigraphy to have successfully achieved sleep. Average sleep duration during successful rest periods was estimated as 31.7 ± 12.2 minutes. CR was more frequent on return (60%, n=71) vs. outbound flights (33%, n=39); 2-pilot (69%, n=83) vs. >2-pilot flights (23%, n=27); <10h (63%, n=80) vs. >10h duration flights (27%, n=30); and night (55%, n=76) vs. day flights (34%, n=34) (all p≤0.001). There was no significant difference for direction of travel (eastbound: 51%, n= 57; westbound: 40%, n= 44; p=0.059). Of note, 22% (n=26) of augmented flights contained both CR and bunk rest. Data from this airline show that CR is most commonly used as a countermeasure to sleepiness on flights <10h duration (2-pilot crews) and home-base nighttime flights. Future studies are required to determine the generalizability of these results to other airlines.

sleepiness↗
NASA NTRSDate not supplied

Sleep, Sleepiness, and Performance Across Three In-Flight Bunk Rest Opportunities

Introduction: Airline pilots are required to take a rest break in a bunk during long-haul flights in an effort to reduce sleepiness during critical phases of flight. It is unclear, however, whether each rest break affords equal opportunity for sleep. We aimed to characterize sleep, sleepiness, and performance outcomes across three in-flight rest breaks during long-haul flights. Methods: Thirty-seven pilots wore actiwatches and completed sleep diaries for approximately two weeks while flying a variety of long-haul routes (n=126 flights). Self-reported in-flight bunk rest (BR) periods were used to set rest intervals and sleep was estimated within these intervals using actigraphy software (wake threshold set to medium). Pilots provided Karolinska Sleepiness Scale ratings (KSS) and performed a 5-minute psychomotor vigilance task (PVT) before landing. A linear mixed-effects model with participant included as a random effect and allowed to vary by intercept was used to assess differences between BR opportunities. Results : The majority (97%, n=122) of bunk rest periods contained sleep (as estimated by actigraphy). The mean (+/- standard deviation) sleep duration for the first, middle, and third BR opportunity was 152.8 (69.7), 149.2 (44.1), 125.2 (44.9) minutes, respectively. There was a significant effect of BR opportunity for sleep duration (F2,54 = 3.747, p=.03) and KSS (F2,44 = 7.869, p=.001). Bonferroni adjusted planned pairwise contrasts revealed that pilots using the third BR obtained significantly less sleep than in the first BR (p=.029). KSS ratings prior to landing were higher for the third BR compared to both the first (p=.001) and middle BR (p=.017). There were no significant differences for PVT speed or lapses (all p>05). Conclusion: These results suggest that the last rest break is associated with shorter sleep, lower alertness, and no differences in performance relative to the other rest breaks. Further analysis is required to determine whether the higher KSS ratings following the third rest break are associated with sleep inertia, or whether other factors may be involved.

sleepiness↗
NASA NTRSDate not supplied

The Influence of Self-Reported Distractions on the Psychomotor Vigilance Task (PVT) in Laboratory and Field Environments

Introduction: The Psychomotor Vigilance Task (PVT) is a measure of vigilant attention that is commonly used in laboratory environments to assess the neurobehavioral impact of sleep loss and circadian misalignment. The PVT has been increasing in popularity for use in field environments; however, the potential for distraction is higher in the field compared to the lab. It is unclear how distractions experienced by individuals taking the PVT in the real world may influence reaction time metrics. We investigated the influence of self-reported distraction on PVT outcomes across laboratory and field environments. Methods: We examined PVT data from five studies including short (n=36 participants, 3799 PVTs) and long-haul (n=75 participants, 3283 PVTs) airline personnel, control center personnel (n=5 participants, 96 PVTs), and healthy individuals who participated in a study involving at-home and laboratory assessments (n=12 participants, 486 and 310 PVTs). Individuals in all of the studies were asked to complete the five-minute NASA PVT at least three times daily. Participants were asked to indicate the number of distractions they experienced immediately after each PVT. Mean PVT reaction time (RT) and number of distractions were computed for each study and overall. Results: Participants reported more distractions in field environments compared to the lab (short-haul=1.29 +/- 1.48, long-haul=0.66 +/- 1.07, control-center=1.20 +/- 1.37, at-home=0.86 +/- 1.36, laboratory=0.46 +/- 1.07) Across all studies, we found that PVT RT slowed as self-reported distractions increased (all studies combined: 0 distractions=PVT RT 274.4ms; 1=284.6ms; 2=302.9ms; 3=321.2ms; >4=409.3ms). These findings were similar for healthy participants completing PVTs at home (0 distractions=287.1ms; 1=309.9ms; 2=328.3ms; 3=369.8ms; >4=385.1ms) but were less consistent during in-lab assessments (0 distractions=278.7ms; 1=316.2ms; 2=396.2ms; 3=370.4ms; >4=354.4ms). These findings were similar for other PVT outcomes. Conclusion: Participants reported more distractions in field environments compared to the laboratory. Our findings suggest that the number of distractions that individuals report experiencing while taking a PVT increases the reaction time registered by the device. Researchers should collect information about distractions during the PVT and should be aware that distractions may influence the recorded PVT reaction time.

behavior↗
NASA NTRSDate not supplied

Controlled Rest: Investigating the Use of an In-Flight Sleepiness Countermeasure

INTRODUCTION: Sleepiness is commonly reported amongst commercial airline pilots and is recognized as a safety risk due to its impact on performance. Controlled Rest (CR) refers to a short, voluntary nap opportunity taken by pilots on the flight deck as a countermeasure to unanticipated sleepiness in flight. This study explores the profile of CR use in a long-haul commercial airline. METHODS: Forty-four pilots filled in an application-based sleep/work diary and wore actiwatches for approximately 2 weeks. Complete data sets from 239 flights including sleep diaries, actigraphy, and schedules were merged and analyzed. Sleep diary entries were used to set CR intervals in the actigraphy software, which was then used to predict sleep within these intervals. All time-stamps of sleep periods and flight schedules were adjusted for home-base time of the pilots. Pearson Correlations were used to assess the influence of pilot demographics on CR use. A mixed-effects logistic regression was used to analyze the impact of schedule factors on CR. RESULTS: Pilots reported taking CR on 46% (n=110) of observed flights. Average CR attempt duration was 43.1 ± 11.0 minutes. Eighty-percent (n=106/133) of all CR attempts were estimated by actigraphy to have successfully achieved sleep with an average sleep duration during successful rest periods of 31.7 ± 12.2 minutes. Captains reported taking CR on 38% of flights (n=39/102), compared to First Officers reporting 52% (n=71/137) of flights with CR (p=0.131). Age, experience, BMI, and sleep need were not associated with the percentage of flights with CR (all p>0.244). The following schedule factors were associated with a higher frequency of CR: night (55%, n=76) vs. day flights (34%, n=34); <10h (63%, n=80) vs. >10h duration flights (27%, n=30); return (60%, n=71) vs. outbound flights (33%, n=39); and 2-pilot (69%, n=83) vs. >2-pilot flights (23%, n=27) (all p≤0.001). There was a trend for more CR on eastbound flights, but this was not significant (eastbound: 51%, n= 57; westbound: 40%, n= 44; p=0.059). Of note, 22% (n=26) of augmented flights (>2-pilots) contained both CR and Bunk Rest (in a designated rest facility). DISCUSSION: Data from this airline show that pilots commonly use CR to mitigate sleepiness in-flight, especially on flights <10h duration and during home-base nighttime flights. Future studies are required to determine generalizability of these results to other airlines.

sleepiness↗
NASA NTRSDate not supplied

Short-Haul Fatigue: Pilot Perspectives & Current Research

Introduction: There are few studies investigating the impact of fatigue in short-haul flight operations conducted under United States (U.S.) Federal Aviation Regulations (FAR) Part 117 flight and duty limitations and rest requirements. In order to understand the fatigue factors unique to short-haul operations, we conducted a series of focus groups across four major commercial passenger airlines in the US. The outcomes of this study were intended to inform the scope of a larger study of fatigue in short-haul operations. Methods: Ninety short-haul pilots were recruited through emails distributed by airline safety teams and labor representatives. Fourteen focus groups were conducted via an online conferencing platform in which participants were asked to identify, specific to short-haul: a) schedules and operations that lead to elevated fatigue; b) schedules and operations that are not fatiguing, and c) important fatigue factors to study. Data were collected anonymously and coded using conventional qualitative content analysis, with axial coding and summative analysis used to identify main themes and over-arching categories. Results: Participants had an average of 12,348 (6,483) lifetime flying hours with 71 (14.5) hours of monthly flying. Forty-six percent of participants were captains. The six fatigue factor categories identified were: circadian disruption (e.g., circadian switches, redeyes), high workload (e.g., hassle factors, number of flights per duty), inadequate rest opportunity (e.g., minimum rest layovers, quality of rest facilities), schedule changes (e.g., unpredictability), regulation and policy issues (e.g., scheduling up to FAR 117 limits), and long sits (e.g., long wait times between flights). Discussion: A field study informed by these results and designed to investigate the prevalence and impact of these factors in US short-haul operations is currently underway.

pilots↗
NASA NTRSDate not supplied

Light as a Reactive Countermeasure to Sleep Inertia: Translating Laboratory Findings to the Field

Sleep inertia describes the brief period of impaired alertness, mood, and cognitive performance experienced after waking. Under laboratory settings, light exposure upon waking during a habitual sleep period has been shown to improve sleep inertia symptoms. We investigated whether a field-deployable light-emitting device would help to mitigate sleep inertia in a real-world setting. Thirty-six participants (18 female; 26.6 years ± 6.1) completed an at-home, within-subject, randomized crossover study. Participants followed their habitual sleep-wake schedule for five nights before an adaptation and experimental night. Forty-five minutes after bedtime on the experimental night, participants received a phone call and were instructed to wear light-emitting glasses with the light either on (light condition) or off (control). A 5-minute psychomotor vigilance task (PVT), the Karolinska Sleepiness Scale (KSS), visual analog scales of mood (VASmood), and a 3-minute descending subtraction task (DST) were performed starting at +2, +12, +22, and +32 minutes after the call. Participants then went back to sleep and were called 45 minutes after lights out for the opposite condition. A series of mixed-effects models were performed with fixed effects of test bout, condition, test bout × condition, and a random effect of participant. Covariates included pre-sleep baseline scores, randomization order, sex, and sleep history. Participants rated themselves as more alert and energetic in the light condition compared to the control condition (VASalert-sleepy p = .01; VASlethargic-energetic p = .001). There was no effect of condition for DST outcomes, but there was a significant improvement in DST total responses in the light condition in a subset of participants waking from N3 (p = .03). There was a significant effect of condition for PVT outcomes, with faster responses (p < .001) and fewer lapses (p < .001) in the control condition. Our results under naturalistic at-home settings suggest that, similar to the in-laboratory study findings, the light intervention improved subjective alertness and mood, while working memory improved after waking from N3. Future studies of light interventions should include measures of visual acuity and comfort to assess the full feasibility and efficacy of interventions in real-world environments.

sleep inertia↗
NASA NTRSDate not supplied

Investigating the Causes and Consequences of Controlled Rest on the Flight Deck

INTRODUCTION: Long and irregular working hours can lead to fatigue in aviation operations. In some regions, a short nap taken on the flight deck (known as controlled rest) can be used as a countermeasure to unexpected in-flight sleepiness. We aimed to investigate the impact of taking controlled rest on self-reported sleepiness at top-of-descent. METHODS: Data from 120 long-haul (> 6 h flight duration), unaugmented flights were analyzed (n = 31 pilots). Pilots wore actigraphs and completed sleep logs before and during trips. At pre-flight and top-of-descent, pilots completed a Karolinska Sleepiness Scale (KSS). A mixed-effects model was used to assess the impact of controlled rest on KSS at top-of-descent. Sleep duration in the 48 hours prior to departure, timing of the flight (day vs. night), and pre-flight KSS scores were included as covariates. RESULTS: Due to missing data, complete data from 83 flights (n = 29 participants) were available in the analyses of the KSS. There were no differences by controlled rest status for KSS scores at top-of-descent (estimated marginal means ± SEM with controlled rest: 5.10 ± 0.22, without controlled rest: 5.37 ± 0.29; p = .45, η2p = 0.01). DISCUSSION: Our results suggest that there is no difference in self-reported sleepiness at top-of-descent on flights in which controlled rest was taken compared to flights without controlled rest. Further research is necessary to determine the impact of controlled rest on objective measures of performance at top-of-descent.

aviation↗
NASA NTRSDate not supplied

Jet Lag, Sleep Timing, and Sleep Inertia

This chapter explores the causes, consequences, and countermeasures of jet lag, mistimed sleep, and sleep inertia. Jet lag can occur when rapidly crossing multiple time zones (e.g., trans-meridian travel for long-haul pilots). The desynchrony between the body’s biological clock, or circadian rhythm, and the new day-night cycle can lead to indigestion, sleep disturbances, fatigue, and cognitive impairments. Mistimed sleep can also occur within a time zone. In the case of night shiftwork, sleep is displaced to the daytime which leads to poor sleep and increased fatigue at night due to the combination of pressures from the two-process model of sleep regulation: sleep loss (homeostatic pressure); and being awake when the body is promoting sleep (circadian pressure). There is also a third process of sleep regulation called sleep inertia, which refers to the brief period of fatigue and impaired cognitive performance experienced after waking. Sleep inertia can be a fatigue risk for transportation workers who work on-call (e.g., emergency services) or who nap on shift (e.g., long-haul truck drivers) and are required to perform a safety-critical task soon after waking. For each of these fatigue risks, strategic exposure to bright light can be used to help realign sleep timing and to promote alertness.

sleep inertia↗
NASA NTRSDate not supplied

Space Transport and Fatigue

Space travel presents numerous challenges to fatigue management. Fatigue in space results from many of the same challenges that shiftworkers face on Earth, including inadequate sleep, circadian misalignment, and elevated workload. However, spaceflight also presents unique challenges including circadian misalignment due to non-24- hour light-dark cycles, erratic work schedules due to operational constraints, a microgravity sleep environment, constraints to habitat design, and an isolated and confined living environment. These challenges can be mitigated with fatigue management strategies and countermeasures specifically targeted for space travel. Those strategies can include light interventions, advanced scheduling tools, improved habitat design, and pharmacological countermeasures. What is needed is a future-facing approach to most effectively manage the challenges that may arise as advancements in space travel continue to develop at a rapid pace.

sleep deprivation and performance↗
NASA NTRSDate not supplied

The Impact of Controlled Rest on Neurobehavioral Outcomes at Top-of-Descent

INTRODUCTION: Long and irregular working hours can lead to fatigue in aviation operations. In some regions, a short nap taken on the flight deck (known as controlled rest) can be used as a countermeasure to unexpected in-flight sleepiness. We aimed to investigate the impact of taking controlled rest on neurobehavioral measures at top-of-descent. METHODS: Data from 120 long-haul (> 6 h flight duration), unaugmented flights were analyzed (n = 31 pilots). Pilots wore actigraphs and completed sleep logs before and during trips. At pre-flight and top-of-descent, pilots completed a 5-minute psychomotor vigilance task (PVT) and Karolinska Sleepiness Scale (KSS). A series of mixed-effects models were conducted to assess the impact of controlled rest on outcome measures at top-of-descent. Sleep duration in the prior 48 hours, timing of the flight, and pre-flight scores for each measure were included as covariates. RESULTS: Due to missing data, complete data from 76 flights (n = 28 participants) were available in the models examining the PVT metrics, and data from 83 flights (n = 29 participants) were available in the analyses of the KSS. Pilots who took controlled rest had faster response speeds at top-of-descent (p = .03, η2p = 0.07; estimated marginal mean [EMM] = 4.19, standard error [SE] = 0.07, 95% CI [4.08, 4.29]) than those who did not take controlled rest (EMM = 4.00, SE = 0.05, 95% CI [3.86, 4.14]). There were no differences by controlled rest status for KSS scores and PVT lapses (p values > .05, η2p values ≤ 0.01). DISCUSSION: Our results suggest that taking controlled rest may improve vigilant attention at critical phases of flight and, thus, may be a useful fatigue management tool during unaugmented flights. Further research is necessary to determine the impact of factors on the decision to take controlled rest (e.g., airline culture, personal preference) and how the controlled rest policy is applied in practice.

aviation↗
NASA NTRSDate not supplied

Cabin Crew Alertness and Performance During Long-Haul Flights

INTRODUCTION: -Sleep loss and circadian disruption pose a significant risk in aviation. -Previous literature has shown that inflight rest facilities influence alertness and performance among pilots, but few studies have evaluated cabin crew. -The aim of this research was to assess alertness and performance among cabin crew members sleeping in different rest locations during a long-haul out-and-back trip. METHODS: -Twenty-nine cabin crewmembers flew the same long-haul route (outbound and inbound). -Participants were randomly assigned to fly on an aircraft with a bunk in both directions or to fly an aircraft with a bunk in one direction and with a high comfort jump seat (HCJS) in the other direction. -Throughout the study they completed a Karolinska Sleepiness Scale (KSS) and a 5-minute Psychomotor Vigilance Task (PVT) at the beginning and at the end of each flight. RESULTS: -A series of mixed-effects models were performed to assess the changes in KSS and PVT when crewmembers slept in the bunk during both directions of flight (bunk-only) compared to when sleep was obtained in the HCJS during one direction and bunk in the other (bunk + HCJS). -There was no significant difference in KSS alertness between the two conditions. - There were no significant differences in PVT response speed or lapses between the two conditions. CONCLUSIONS: -Limitations: small number of participants. Our study stopped abruptly because of the COVID-19 pandemic which limited our sample size. -Further research is needed to understand how other factors such as duty start time and workload might influence the sleep of cabin crewmembers during long-haul flights.

long-haul↗