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NASA NTRS2020

A Summary Of: Collecting Sleep, Circadian, Fatigue, and Performance Data in Complex Operational Environments

Sleep loss and circadian misalignment contribute to a meaningful proportion of operational accidents and incidents. Countermeasures and work scheduling designs aimed at mitigating fatigue are typically evaluated in controlled laboratory environments, but the effectiveness of translating such strategies to operational environments can be challenging to assess. This manuscript summarizes an approach for collecting sleep, circadian, fatigue, and performance data in a complex operational environment. We studied 44 airline pilots over 34 days while they flew a fixed schedule, which included a baseline data collection with 5 days of mid-morning flights, four early flights, four high-workload mid-day flights, and four late flights that landed after midnight. Each work block was separated by 3-4 days of rest. To assess sleep, participants wore a wrist-worn research-validated activity monitor continuously and completed daily sleep diaries. To assess the circadian phase, pilots were asked to collect all urine produced in four or eight hourly bins during the 24 h after each duty block for the assessment of 6-sulfatoxymelatonin (aMT6s), which is a biomarker of the circadian rhythm. To assess subjective fatigue and objective performance, participants were provided with a touchscreen device used to complete the Samn-Perelli Fatigue Scale and Psychomotor Vigilance Task (PVT) during and after each flight, and at wake-time, mid-day, and bedtime. Using these methods, it was found that sleep duration was reduced during early starts and late finishes relative to baseline. Circadian phase shifted according to duty schedule, but there was a wide range in the aMT6s peak between individuals on each schedule. PVT performance was worse on the early, high-workload, and late schedules relative to baseline. Overall, the combination of these methods was practical and effective for assessing the influence of sleep loss and circadian phase on fatigue and performance in a complex operational environment.

Arsintescu, Lucica↗
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

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

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

The Impact of Controlled Rest on Self-Reported Sleepiness 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 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 NTRS2011

Molecular Mechanisms of Circadian Regulation During Spaceflight

Disruption of the regular environmental circadian cues in addition to stringent and demanding operational schedules are two main factors that undoubtedly impact sleep patterns and vigilant performance in the astronaut crews during spaceflight. Most research is focused on the behavioral aspects of the risk of circadian desynchronization, characterized by fatigue and health and performance decrement. A common countermeasure for circadian re-entrainment utilizes blue-green light to entrain the circadian clock and mitigate this risk. However, an effective countermeasure targeting the photoreceptor system requires that the basic circadian molecular machinery remains intact during spaceflight. The molecular clock consists of sets of proteins that perform different functions within the clock machinery: circadian oscillators (genes whose expression levels cycle during the day, keep the pass of cellular time and regulate downstream effector genes), the effector or output genes (those which impact the physiology of the tissue or organism), and the input genes (responsible for sensing the environmental cues that allow circadian entrainment). The main environmental cue is light. As opposed to the known photoreceptors (rods and cones), the non-visual light stimulus is received by a subset of the population of retinal ganglion cells called intrinsically photosensitive retinal ganglion cells (ipRGC) that express melanopsin (opsin 4 -Opn4-) as the photoreceptor. We hypothesize that spaceflight may affect ipRGC and melanopsin expression, which may be a contributing cause of circadian disruption during spaceflight. To answer this question, eyes from albino Balb/cJ mice aboard STS-133 were collected for histological analysis and gene expression profiling of the retina at 1 and 7 days after landing. Both vivarium and AEM (animal enclosure module) mice were used as ground controls. Opn4 expression was analyzed by real time RT/qPCR and retinal sections were stained for Opn4 immunofluorescence. Opn4 was decreased (abrogated in one case) in retinas that concurrently showed higher evidence of oxidative stress. We propose that oxidative stress can lead to a decrease in melanopsin expression, likely via ipRGC loss or impairment, and thus, it can be a contributing factor to circadian disruption during spaceflight. Countermeasures contemplating the use of light should therefore be complemented with melanopsin expression maintenance and/or reduction in oxidative stress.

Zanello, Susana↗
NASA NTRS2012

Molecular Mechanisms of Circadian Regulation During Spaceflight

The physiology of both vertebrates and invertebrates follows internal rhythms coordinated in phase with the 24-hour daily light cycle. This circadian clock is governed by a central pacemaker, the suprachiasmatic nucleus (SCN) in the brain. However, peripheral circadian clocks or oscillators have been identified in most tissues. How the central and peripheral oscillators are synchronized is still being elucidated. Light is the main environmental cue that entrains the circadian clock. Under the absence of a light stimulus, the clock continues its oscillation in a free-running condition. In general, three functional compartments of the circadian clock are defined. The vertebrate retina contains endogenous clocks that control many aspects of retinal physiology, including retinal sensitivity to light, neurohormone synthesis (melatonin and dopamine), rod disk shedding, signalling pathways and gene expression. Neurons with putative local circadian rhythm generation are found among all the major neuron populations in the mammalian retina. In the mouse, clock genes and function are more localized to the inner retinal and ganglion cell layers. The photoreceptor, however, secrete melatonin which may still serve a an important circadian signal. The reception and transmission of the non-visual photic stimulus resides in a small subpopulation (1-3%) or retinal ganglion cells (RGC) that express the pigment melanopsin (Opn4) and are called intrisically photoreceptive RGC (ipRGC). Melanopsin peak absorption is at 420 nm and all the axons of the ipRGC reach the SCN. A common countermeasure for circadian re-entrainment utilizes blue-green light to entrain the circadian clock and mitigate the risk of fatigue and health and performance decrement due to circadian rhythm disruption. However, an effective countermeasure targeting the photoreceptor system requires that the basic circadian molecular machinery remains intact during spaceflight. We hypothesize that spaceflight may affect ipRGC and melanopsin expression, which may be a contributing cause of circadian disruption during spaceflight.

Zanello, S. B.↗
NASA NTRS2011

Legacy of Environmental Research During the Space Shuttle Program

The Space Shuttle Program provided many opportunities to study the role of spaceflight on human life for over the last 30 years and represents the longest and largest U.S. human spaceflight program. Risks to crewmembers were included in the research areas of nutrition, microbiology, toxicology, radiation, and sleep quality. To better understand the Shuttle environment, Crew Health Care System was developed. As part of this system, the Environmental Health Subsystem was developed to monitor the atmosphere for gaseous contaminants and microbial contamination levels and to monitor water quality and radiation. This program expended a great deal of effort in studying and mitigating risks related to contaminations due to food, water, air, surfaces, crewmembers, and payloads including those with animals. As the Shuttle had limited stowage space and food selection, the development of nutritional requirements for crewmembers was imperative. As the Shuttle was a reusable vehicle, microbial contamination was of great concern. The development of monitoring instruments that could withstand the space environment took several years and many variations to come up with a suitable instrument. Research with space radiation provided an improved understanding of the various sources of ionizing radiation and the development of monitoring instrumentation for space weather and the human exposure within the orbiter's cabin. Space toxicology matured to include the management of offgassing products that could pollute the crewmembers air quality. The Shuttle Program implemented a 5-level toxicity rating system and developed new monitoring instrumentation to detect toxic compounds. The environment of space caused circadian desynchrony, sleep deficiency, and fatigue leading to much research and major emphasis on countermeasures. Outcomes of the research in these areas were countermeasures, operational protocols, and hardware. Learning Objectives: This symposium will provide an overview of the major environmental lessons learned and the development of countermeasures, monitoring hardware, and procedures.

Lane, Helen W.↗
NASA NTRS2018

Evaluation of the Validity of Bio-Mathematical Models in Predicting Fatigue in an Operational Environment

During long-duration spaceflight missions, crewmembers and ground-support staff experience irregular sleep schedules, erratic natural light patterns, and high workload due to mission demands. Such conditions can cause circadian misalignment and sleep loss, which in turn cause deficits in cognitive performance. While bio-mathematical models have been implemented within workplace settings to predict fatigue profiles, the accuracy of sleep-wake models under conditions of non-traditional shiftwork is little known. Thus, the present study aims to evaluate the validity of four sleep-wake models (e.g., SAFTE-FAST, the Unified Model of Performance, the Adenosine-Circadian Model, and the State-Space Model) designed to predict human performance and fatigue levels against objective measures of performance in a spaceflight analog. To accomplish this aim, we will collect Psychomotor Vigilance Task (PVT) data from four crews (n=16) in the Human Exploration Research Analog (HERA) over 45 days. HERA is a closed, 3-story habitat at Johnson Space Center where inhabitants are exposed to extreme space exploration scenarios under varying sleep-wake conditions. The PVT is a simple reaction time test that involves minimal learning, making it sensitive to the effects of sleep loss and circadian misalignment. Findings from this study will help inform work scheduling and implementation of effective countermeasures (e.g., caffeine, lighting) to improve work efficiency and combat fatigue, as well as offer valuable insight into the applicability of bio-mathematical fatigue models in future space exploration missions.

fatigue↗
NASA NTRS1996

Alterations in Skeletal Muscle With Disuse Atrophy: The Effects of Countermeasures

The specific aims of this project concerned three general areas: (1) studies on the contractile function of single skinned fibers designed to determine the time course and cellular basis of the Hindlimb Suspension (HS) induced increase in fiber Vo (maximal shortening velocity), and the decrease in peak tension (Po); (2) studies designed to understand the effect of HS on single fiber substrate utilization during contractile activity, and how if at all such changes contribute to the increased muscle fatigue associated with HS; and (3) studies evaluating the effectiveness of standing and ladder climbing as countermeasures to the deleterious effects of HS. We have constructed all of the necessary equipment, and are currently conducting preliminary studies on T-tubular charge movement. A list of publications from this contract is included at the end of this report. The three objectives are (1) Functional Studies on the Single Skinned Fiber; (2) Fiber Substrate Utilization and Muscle Fatugue with Contracting Activity and (3) Exercise Countermeasures.

Fitts, Robert H.↗
NASA NTRS1989

Effectiveness of Circadian countermeasures in simulated transmeridian flight schedules

The symptoms of jet-lag commonly afflict travelers who cross time zones. Insomnia during the new night, daytime fatigue, malaise, sleepiness, and gastrointestinal disturbances can occur for as long as 3 weeks after jet travel across even a few time zones. These symptoms are largely due to the slow rate of adjustment of the internal circadian timing system to the new time zone. Since business (or pleasure) can be seriously interrupted by such symptoms, it is important to determine ways to speed up the adjustment process to ameliorate the symptoms. Airline pilots have reported that they frequently nap to counter jet lag symptoms, and that they view this as a useful technique. Napping as a countermeasure would be attractive since it is practical and would take advantage of a naturally occurring phase of sleepiness after lunch. Napping also makes sense since insomnia is a common jet lag symptom. Thus, a laboratory simulation of jet lag was designed to test the ability of napping to increase the rate of adjustment following a time zone shift in a population of middle-aged men.

Moline, Margaret L.↗
NASA NTRS1994

Circadian countermeasures for shiftworkers during USMP-2: A report to mission management

People who must work at night experience a number of physiological and psychological difficulties. These include sleepiness and fatigue at work, poor daytime sleep, gastrointestinal distress, impaired concentration and performance, disturbed mood, and increased health complaints and risk of disease. These difficulties arise because nocturnal work and daytime sleep take place at inappropriate phases of the body's circadian rhythms. Intense artificial light can shift the phase of human circadian rhythms, and can thus be used to promote adaptation to shifted work schedules. The first attempts to investigate the efficacy of light treatment for MSFC POCC shiftworkers took place during USML-1 and ATLAS-2. The findings from these studies led to the development of a Circadian Countermeasures Program that was implemented during USMP-2. Light treatment and other circadian countermeasures were employed to promote adjustment to mission shiftwork in POCC cadre volunteers. Treatment protocols were designed and customized for each volunteer's work hours and personal preferences. Treatment protocols included some or all of the following: scheduled self-administration of intense light, scheduled avoidance or attenuation of sunlight at other times, and sleep schedules. Data from post-mission questionnaires indicated that volunteers found the program to be effective, convenient, and beneficial.

Stewart, Karen T.↗
NASA NTRSDate not supplied

Monitoring Human Performance on Future Deep Space Missions Abstract

NASA and the commercial spacecraft community are working diligently to put the first woman on the moon in the 2024 timeframe. At the same time, NASA researchers are thinking about how to solve the even larger challenges that future deep space missions will bring. Space travel itself is difficult, but astronauts on deep space missions will face obstacles and unknowns never before experienced. In addition to the altered gravity and hostile/closed environment of a spacecraft, deep space crews will face increased radiation, isolation, and distance from Earth. During Extravehicular Activity (EVA, or “spacewalk”) operations, crew will experience increased physical and cognitive workload due to extended types, frequencies and durations of tasks performed on exploration missions in partial gravity environments. All of these stressors will impact crew physical and mental health and performance in difficult-to-anticipate ways. Crew autonomy may be one of the biggest challenges faced. Communication delays and blackouts will occur, and in those situations, the crew may not have access to the Mission Control Center (MCC). They may be forced to be solely dependent on each other and the available information onboard to stay alive, healthy, and achieve the mission. The only conceivable way to meet the challenges of Earth independence is to enable the crew to monitor their own health and performance -- preferably unobtrusively as they perform their duties. Technologies and techniques must be developed to aid the crew in these assessments. A deep space mission is expected to have relatively short periods of high cognitive demand, stress, and fatigue, alongside potentially long periods of cognitive underload during the transit, where boredom, loneliness, and depression can set in. Both ends of this spectrum are dangerous. Crew must be made aware when their task performance drops significantly, when their cognitive workload is too high, when they have lost situation awareness, or when they are too stressed or too fatigued to perform well. They must be able to identify these risks, and then mitigate them with countermeasures available onboard. A number of self-monitoring technologies are presently being explored by NASA to advance crew state determination capabilities. These range from real-time, physiological workload and situation awareness assessments, to crew health measurements determining physical and mental fitness for duty, to task performance metrics such as suit resource expenditures. For EVA tasks during surface exploration missions, biomedical information such as metabolic rate may be provided to crewmembers for situational awareness related to task performance efficiency. In addition, translation distances, hydration, nutrition, inspired CO2 exposure and other consumables usage rates may be useful input metrics for modeling individualized performance during tasks to inform crew or provide estimates of work efficiency. Oculomotor metrics such as gaze dwell time, pupilometry, and eye tracking collected in advanced helmet mounted displays could potentially be used to characterize crew situation awareness. This paper highlights some of these projects, and provides broader discussion about the need for advanced monitoring and smart technologies, as NASA takes the leap into the next generation of space exploration.

Kritina Holden↗
NASA NTRS2011

Fatigue Management in Spaceflight Operations

Sleep loss and fatigue remain an issue for crewmembers working on the International Space Station, and the ground crews who support them. Schedule shifts on the ISS are required for conducting mission operations. These shifts lead to tasks being performed during the biological night, and sleep scheduled during the biological day, for flight crews and the ground teams who support them. Other stressors have been recognized as hindering sleep in space; these include workload, thinking about upcoming tasks, environmental factors, and inadequate day/night cues. It is unknown if and how other factors such as microgravity, carbon dioxide levels, or increased radiation, may also play a part. Efforts are underway to standardize and provide care for crewmembers, ground controllers and other support personnel. Through collaborations between research and operations, evidenced-based clinical practice guidelines are being developed to equip flight surgeons with the tools and processes needed for treating circadian desynchrony (and subsequent sleep loss) caused by jet lag and shift work. The proper implementation of countermeasures such as schedules, lighting protocols, and cognitive behavioral education can hasten phase shifting, enhance sleep and optimize performance. This panel will focus on Fatigue Management in Spaceflight Operations. Speakers will present on research-based recommendations and technologies aimed at mitigating sleep loss, circadian desynchronization and fatigue on-orbit. Gaps in current mitigations and future recommendations will also be discussed.

Whitmire, Alexandra↗
NASA NTRSDate not supplied

Sleep and Performance in Space

This presentation summarizes challenges associated with sleeping in space. It reviews the factors associated with sleep loss during spaceflight, discusses the consequences of sleep loss during spaceflight, and also discusses countermeasures for sleep loss during spaceflight.

human performance↗
NASA NTRS2005

Cognitive Performance in Operational Environments

Optimal cognition during complex and sustained operations is a critical component for success in current and future military operations. "Cognitive Performance, Judgment, and Decision-making" (CPJD) is a newly organized U.S. Army Medical Research and Materiel Command research program focused on sustaining operational effectiveness of Future Force Warriors by developing paradigms through which militarily-relevant, higher-order cognitive performance, judgment, and decision-making can be assessed and sustained in individuals, small teams, and leaders of network-centric fighting units. CPJD evaluates the impact of stressors intrinsic to military operational environments (e.g., sleep deprivation, workload, fatigue, temperature extremes, altitude, environmental/physiological disruption) on military performance, evaluates noninvasive automated methods for monitoring and predicting cognitive performance, and investigates pharmaceutical strategies (e.g., stimulant countermeasures, hypnotics) to mitigate performance decrements. This manuscript describes the CPJD program, discusses the metrics utilized to relate militarily applied research findings to academic research, and discusses how the simulated combat capabilities of a synthetic battle laboratory may facilitate future cognitive performance research.

Russo, Michael↗
NASA NTRSDate not supplied

The Examination of Individual Factors and AFTE Training Outcomes

Introduction: Motion sickness is common among military aviators. It describes a specific group of symptoms that include epigastric awareness, nausea, pallor, sweating, salivation, and fatigue. Occurrences of these symptoms can pose a significant risk to safety and adversely impact mission success. Accordingly, researchers have developed specific interventions to act as countermeasures. For example, Autogenic Feedback Training Exercise has been empirically validated as a training method that mitigates the impact of motion sickness. However, it remains unclear the extent to which individual factors moderate (or mediate) the effects of this intervention. The examination of individual factors such as interoceptive accuracy (IA) and specific personality traits might provide insight into whom may benefit most from AFTE. Methods: Participants were administered the Big Five Inventory (BFI) and State Trait Anxiety Inventory (STAI). In addition, they were given an interoceptive accuracy task (i.e., heartbeat counting task). The participants’ reported value was then compared to the actual number of heart beats obtained via ECG. Completion of the IA task was followed by pre- AFTE and Post-AFTE rotating chair tests to evaluate motion sickness and the effects of AFTE training. Results: Participants (n=16) were evaluated on IA, personality factors (i.e., BFI & STAI) and performance on the rotating chair. IA was unrelated to personality traits (p > .05), but inversely related to state anxiety post training (p < .05). Finally, IA did not predict performance (i.e., rotations or minutes tolerated ?) on rotating chair F (1, 14) = 1.18, p> .05). Discussion:(1) IA is unrelated to personality traits as measured by BFI and STAI. (2) Individual factors are unrelated to AFTE training outcome. (3) AFTE training can be beneficial for all.

motion sickness↗
NASA NTRS2000

Behavioral Health Support of NASA Astronauts for International Space Station Missions

Two areas of focus for optimizing behavioral health and human performance during International Space Station missions are 1) sleep and circadian assessment and 2) behavioral medicine. The Mir experience provided the opportunity to examine the use and potential effectiveness of tools and procedures to support the behavioral health of the crew. The experience of NASA has shown that on-orbit performance can be better maintained if behavioral health, sleep, and circadian issues are effectively monitored and properly addressed. For example, schedules can be tailored based upon fatigue level of crews and other behavioral and cognitive indicators to maximize performance. Previous research and experience with long duration missions has resulted in the development and upgrade of tools used to monitor fatigue, stress, cognitive function, and behavioral health. Self-assessment and objective tools such as the Spaceflight Cognitive Assessment Tool have been developed and refined to effectively address behavioral medicine countermeasures in space.

Sipes, Walter↗