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  • 1. Ahlström, Christer
    et al.
    Anund, Anna
    Fors, Carina
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    The effect of daylight versus darkness on driver sleepiness: a driving simulator study2018In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27, no 3, article id e12642Article in journal (Refereed)
    Abstract [en]

    Driver sleepiness studies are often carried out with alert drivers during daytime and sleep-deprived drivers during night-time. This design results in a mixture of different factors (e.g. circadian effects, homeostatic effects, light conditions) that may confound the results. The aim of this study was to investigate the effect of light conditions on driver sleepiness. Thirty young male drivers (23.6 ± 1.7 years old) participated in a driving simulator experiment where they drove on a rural road. A 2 × 2 design was used with the conditions daylight versus darkness, and daytime (full sleep) versus night-time (sleep deprived). The results show that light condition had an independent effect on the sleepiness variables. The subjective sleepiness measured by Karolinska Sleepiness Scale was higher, lateral position more left-oriented, speed lower, electroencephalogram alpha and theta higher, and blink durations were longer during darkness. The number of line crossings did not change significantly with light condition. The day/night condition had profound effects on most sleepiness indicators while controlling for light condition. The number of line crossings was higher during night driving, Karolinska Sleepiness Scale was higher, blink durations were longer and speed was lower. There were no significant interactions, indicating that light conditions have an additive effect on sleepiness. In conclusion, Karolinska Sleepiness Scale and blink durations increase primarily with sleep deprivation, but also as an effect of darkness. Line crossings are mainly driven by the need for sleep and the reduced alertness at the circadian nadir. Lane position is, however, more determined by light conditions than by sleepiness.

  • 2.
    Akerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hallvig, David
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Anund, Anna
    Fors, Carina
    Schwarz, Johanna F A
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Having to stop driving at night because of dangerous sleepiness - awareness, physiology and behaviour2013In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 22, no 4, p. 380-388Article in journal (Refereed)
    Abstract [en]

    A large number of accidents are due to the driver falling asleep at the wheel, but details of this link have not been studied on a real road. The purpose of the present study was to describe the development of sleepiness indicators, leading to the drive being terminated prematurely by the onboard expert driving instructor because of imminent danger. Eighteen individuals participated during a day drive and a night drive on a motorway (both 90 min). Eight drivers terminated (N) prematurely (after 43 min) because of sleep-related imminent danger [according to the driving instructor or their own judgement (two cases)]. The results showed very high sleepiness ratings (8.5 units on the Karolinska Sleepiness Scale) immediately before termination (<7 at a similar time interval for those 10 who completed the drive). Group N also showed significantly higher levels of sleep intrusions on the electroencephalography/electro-oculography (EEG/EOG) than those who completed the drive (group C). The sleep intrusions were increased in group N during the first 40 min of the night drive. During the day drive, sleep intrusions were increased significantly in group N. The night drive showed significant increases of all sleepiness indicators compared to the day drive, but also reduced speed and driving to the left in the lane. It was concluded that 44% of drivers during late-night driving became dangerously sleepy, and that this group showed higher perceived sleepiness and more sleep intrusions in the EEG/EOG.

  • 3. Filtness, Ashleigh J.
    et al.
    Anund, Anna
    Fors, Carina
    Ahlström, Christer
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University Nijmegen, Netherlands.
    Sleep-related eye symptoms and their potential for identifying driver sleepiness2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, no 5, p. 568-575Article in journal (Refereed)
    Abstract [en]

    The majority of individuals appear to have insight into their own sleepiness, but there is some evidence that this does not hold true for all, for example treated patients with obstructive sleep apnoea. Identification of sleep-related symptoms may help drivers determine their sleepiness, eye symptoms in particular show promise. Sixteen participants completed four motorway drives on two separate occasions. Drives were completed during daytime and night-time in both a driving simulator and on the real road. Ten eye symptoms were rated at the end of each drive, and compared with driving performance and subjective and objective sleep metrics recorded during driving. 'Eye strain', 'difficulty focusing', 'heavy eyelids' and 'difficulty keeping the eyes open' were identified as the four key sleep-related eye symptoms. Drives resulting in these eye symptoms were more likely to have high subjective sleepiness and more line crossings than drives where similar eye discomfort was not reported. Furthermore, drivers having unintentional line crossings were likely to have 'heavy eyelids' and 'difficulty keeping the eyes open'. Results suggest that drivers struggling to identify sleepiness could be assisted with the advice 'stop driving if you feel sleepy and/or have heavy eyelids or difficulty keeping your eyes open'.

  • 4.
    Garefelt, Johanna
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Sverke, Magnus
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Work and sleep – a prospective study of psychosocial work factors, physical work factors and work scheduling2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, no S1, p. 218-218, article id P706Article in journal (Refereed)
  • 5.
    Gerhardsson, Andreas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology. Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Axelsson, John
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Fischer, Håkan
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Schwarz, Johanna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Effect of sleep deprivation on emotional working memory2019In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 28, no 1, article id e12744Article in journal (Refereed)
    Abstract [en]

    The emotional dysregulation and impaired working memory found after sleep loss can have severe implications for our daily functioning. Considering the intertwined relationship between emotion and cognition in stimuli processing, there could be further implications of sleep deprivation in high‐complex emotional situations. Although studied separately, this interaction between emotion and cognitive processes has been neglected in sleep research. The aim of the present study was to investigate the effect of 1 night of sleep deprivation on emotional working memory. Sixty‐one healthy participants (mean age: 23.4 years) were either sleep deprived for 1 night (n = 30) or had a normal night’s sleep (n = 31). They performed an N‐back task with two levels of working memory load (1‐back and 3‐back) using positive, neutral and negative picture scenes. Sleep deprivation, compared with full night sleep, impaired emotional working memory accuracy, but not reaction times. The sleep‐deprived participants, but not the controls, responded faster to positive than to negative and neutral pictures. The effect of sleep deprivation was similar for both high and low working memory loads. The results showed that although detrimental in terms of accuracy, sleep deprivation did not impair working memory speed. In fact, our findings indicate that positive stimuli may facilitate working memory processing speed after sleep deprivation.

  • 6. Gonçalves, Marta
    et al.
    Amici, Roberto
    Lucas, Raquel
    Åkerstedt, Torbjörn
    ESRS Sleep & Driving Expert Panel, Regensburg, Germany; European Sleep Res Soc, Regensburg, Germany.
    Cirignotta, Fabio
    Horne, Jim
    Léger, Damien
    McNicholas, Walter T
    Partinen, Markku
    Téran-Santos, Joaquín
    Peigneux, Philippe
    Grote, Ludger
    Sleepiness at the wheel across Europe: a survey of 19 countries.2015In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 24, no 3, p. 242-53Article in journal (Refereed)
    Abstract [en]

    The European Sleep Research Society aimed to estimate the prevalence, determinants and consequences of falling asleep at the wheel. In total, 12 434 questionnaires were obtained from 19 countries using an anonymous online questionnaire that collected demographic and sleep-related data, driving behaviour, history of drowsy driving and accidents. Associations were quantified using multivariate logistic regression. The average prevalence of falling asleep at the wheel in the previous 2 years was 17%. Among respondents who fell asleep, the median prevalence of sleep-related accidents was 7.0% (13.2% involved hospital care and 3.6% caused fatalities). The most frequently perceived reasons for falling asleep at the wheel were poor sleep in the previous night (42.5%) and poor sleeping habits in general (34.1%). Falling asleep was more frequent in the Netherlands [odds ratio = 3.55 (95% confidence interval: 1.97; 6.39)] and Austria [2.34 (1.75; 3.13)], followed by Belgium [1.52 (1.28; 1.81)], Portugal [1.34 (1.13, 1.58)], Poland [1.22 (1.06; 1.40)] and France [1.20 (1.05; 1.38)]. Lower odds were found in Croatia [0.36 (0.21; 0.61)], Slovenia [0.62 (0.43; 0.89)] and Italy [0.65 (0.53; 0.79)]. Individual determinants of falling asleep were younger age; male gender [1.79 (1.61; 2.00)]; driving ≥20 000 km year [2.02 (1.74; 2.35)]; higher daytime sleepiness [7.49 (6.26; 8.95)] and high risk of obstructive sleep apnea syndrome [3.48 (2.78; 4.36) in men]. This Pan European survey demonstrates that drowsy driving is a major safety hazard throughout Europe. It emphasizes the importance of joint research and policy efforts to reduce the burden of sleepiness at the wheel for European drivers.

  • 7.
    Ingre, Michael
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    van Leeuwen, Wessel M A
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Klemets, T
    Ullvetter, C
    Hough, S
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Karlsson, D
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Validating and extending the three process model (TPM) of alertness in airline operations.2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, no S1, p. 264-264, article id P836Article in journal (Other academic)
  • 8.
    Kecklund, Göran
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Radun, Igor
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ingre, Michael
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Fors, C.
    Ihlström, J.
    Anund, A.
    Bus drivers’ working hours and their effects on sleep and fatigue2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, no S1, p. 286-287, article id P905Article in journal (Other academic)
  • 9.
    Lowden, Arne
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Nagai, Roberta
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Karolinska Institutet, Sweden.
    Mild, Kjell Hansson
    Hillert, Lena
    Effects of evening exposure to electromagnetic fields emitted by 3G mobile phones on health and night sleep EEG architecture2019In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 28, no 4, article id UNSP e12813Article in journal (Refereed)
    Abstract [en]

    Studies on sleep after exposure to radiofrequency electromagnetic fields have shown mixed results. We investigated the effects of double-blind radiofrequency exposure to 1,930-1,990 MHz, UMTS 3G signalling standard, time-averaged 10 g specific absorption rate of 1.6 W kg(-1) on self-evaluated sleepiness and objective electroencephalogram architecture during sleep. Eighteen subjects aged 18-19 years underwent 3.0 hr of controlled exposure on two consecutive days 19:45-23:00 hours (including 15-min break); active or sham prior to sleep, followed by full-night 7.5 hr polysomnographic recordings in a sleep laboratory. In a cross-over design, the procedure was repeated a week later with the second condition. The results for sleep electroencephalogram architecture showed no change after radiofrequency exposure in sleep stages compared with sham, but power spectrum analyses showed a reduction of activity within the slow spindle range (11.0-12.75 Hz). No differences were found for self-evaluated health symptoms, performance on the Stroop colour word test during exposure or for sleep quality. These results confirm previous findings that radiofrequency post-exposure in the evening has very little influence on electroencephalogram architecture but possible on spindle range activity.

  • 10.
    Lowden, Arne
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    van der Zande, BMI
    Geerdinc, L
    Change to higher illuminance and light colour temperature in open office, implications for sleep and sleepiness in Scandinavian winter2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, no Suppl., p. 178-179, article id P586Article in journal (Other academic)
  • 11.
    Magnusson Hanson, Linda L.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Peristera, Paraskevi
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Chungkham, Holendro S.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Indian Statistical Institute, North-East Centre, India.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Psychosocial work characteristics, sleep disturbances and risk of subsequent depressive symptoms: a study of time-varying effect modification2017In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 26, no 3, p. 266-276Article in journal (Refereed)
    Abstract [en]

    Job strain and low social support at work are recognized risk factors for depression. However, people with poor sleep may represent a high-risk group more likely to benefit from interventions against work stress. The present study examined whether the associations between these work stressors and depressive symptoms differed by strata of sleep disturbances (effect modification/effect moderation) considering repeat measures of work characteristics and sleep. The study was based on five biennial measurements of the Swedish Longitudinal Occupational Survey of Health, including 1537 respondents recurrently in paid work, from an originally representative sample of the Swedish working population. High work demands, low decision authority and low social support were measured waves 2 and 4, sleep disturbances (putative moderator/modifier) waves 1 and 3, and depressive symptoms (outcome) wave 5. Causal effect modification, whether the effect of working conditions differed by strata of sleep disturbances, was analysed by structural nested mean modelling estimated using a regression-with-residuals with inverse-probability-of-treatment weighting approach. High demands and low social support, but not low decision authority, influenced subsequent depressive symptoms. The relationship between social support and depressive symptoms was not apparently modified by sleep disturbances. However, disturbed sleep wave 3 modified the effect of high demands wave 4 (coefficient 1.77, P<0.05) on depressive symptoms wave 5. The results indicate that high job demands is a stronger risk factor for depressive symptoms in people with pre-existing sleep disturbances, suggesting that targeted workplace interventions may be more effective when it comes to preventing negative effects of job demands.

  • 12.
    Petersen, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    D'Onofrio, Paolo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Akerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Exercise is associated with changes in sleep architecture during stress2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, no Suppl. 1Article in journal (Other academic)
  • 13.
    Petersen, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    D'Onofrio, Paolo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Axelsson, John
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Thank god it's Friday - sleep improved2017In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 26, no 5, p. 567-571Article in journal (Refereed)
    Abstract [en]

    The weekend is usually seen as a window of recovery. Thus, sleep before a day off may be less impaired than that before a workday. However, very few polysomnographical studies have investigated this hypothesis. Therefore, the aim of the present study was to compare sleep before a workday with that before a weekend. Seventeen teachers participated. Sleep was recorded with polysomnography on one weekday night during the workweek, and on a workday (Friday) followed by a day off. Sleep diaries and actigraphs were also used. Weekend sleep showed delayed bedtime and time of rising, a longer total sleep time (45 min), increased N3 and N1, and decreased N2 and REM. Sleep spindles were reduced. The results remained after truncation to the shortest common sleep duration (5 h). The increase in N3 from weekday sleep to Friday night sleep was positively correlated with N1 change (r = 0.853, P <= 0.001), and negatively correlated with N2 change (r = -0.614, P <= 0.001). Subjective ratings showed that weekend sleep was associated with less awakening problems and lower subjective arousal during the day. The authors concluded that weekend sleep was longer, and showed increased N3 and N1. The authors suggest that the N3 increase before the day off is a result of lower stress, while the N1 increase may be an effect of sleep spindle suppression via the increase of N3 (which would suppress sleep spindles), thus reducing N2 and enhancing N1.

  • 14.
    Petersen, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    D'Onofrio, Paolo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Nilsson, Jens
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Stress vulnerability and the effects of moderate daily stress on sleep polysomnography and subjective sleepiness2013In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 22, no 1, p. 50-57Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate if and how sleep physiology is affected by naturally occurring high work stress and identify individual differences in the response of sleep to stress. Probable upcoming stress levels were estimated through weekly web questionnaire ratings. Based on the modified FIRST-scale (Ford insomnia response to stress) participants were grouped into high (n = 9) or low (n = 19) sensitivity to stress related sleep disturbances (Drake et al., 2004). Sleep was recorded in 28 teachers with polysomnography, sleep diaries and actigraphs during one high stress and one low stress condition in the participants home. EEG showed a decrease in sleep efficiency during the high stress condition. Significant interactions between group and condition were seen for REM sleep, arousals and stage transitions. The sensitive group had an increase in arousals and stage transitions during the high stress condition and a decrease in REM, whereas the opposite was seen in the resilient group. Diary ratings during the high stress condition showed higher bedtime stress and lower ratings on the awakening index (insufficient sleep and difficulties awakening). Ratings also showed lower cognitive function and preoccupation with work thoughts in the evening. KSS ratings of sleepiness increased during stress for the sensitive group. Saliva samples of cortisol showed no effect of stress. It was concluded that moderate daily stress is associated with a moderate negative effect on sleep sleep efficiency and fragmentation. A slightly stronger effect was seen in the sensitive group.

  • 15. Rongen, E. F. E. R.
    et al.
    Rost-Ernst, A. E. W. G.
    Kloos, R.
    van Leeuwen, Wessel M. A.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Sleep and fatigue among officers on board gas tankers2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, no Suppl. 1, p. 173-173Article in journal (Other academic)
  • 16. Salo, P
    et al.
    Ala-Mursula, L
    Rod, NH
    Tucker, Philip
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Pentti, J
    Kivimäki, M
    Vahtera, J
    Work time control and sleep disturbances2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, no Suppl. 1, p. 138-138Article in journal (Other academic)
  • 17.
    Schwarz, Johanna
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Axelsson, John
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Gerhardsson, Andreas
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Tamm, Sandra
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Fischer, Håkan
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Mood impairment is stronger in young than in older adults after sleep deprivation2019In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 28, no 4, article id e12801Article in journal (Refereed)
    Abstract [en]

    Sleep deprivation commonly impairs affective regulation and causes worse mood. However, the majority of previous research concerns young adults. Because susceptibility to sleep deprivation and emotion regulation change distinctively across adult age, we tested here the hypothesis that the effect of sleep deprivation on mood is stronger in young than in older adults. In an experimental design, young (18–30 years) and older adults (60–72 years) participated in either a sleep control (young, n = 63; older, n = 47) or a total sleep deprivation condition (young, n = 61; older, n = 47). Sleepiness, mood and common symptoms of sleep deprivation were measured using established questionnaires and ratings. Sleep‐deprived participants felt more sleepy, stressed and cold, and reported lower vigour and positive affect, regardless of age. All the other outcome measures (negative affect, depression, confusion, tension, anger, fatigue, total mood disturbance, hunger, cognitive attenuation, irritability) showed a weaker response to sleep deprivation in the older group, as indicated by age*sleep deprivation interactions (ps < 0.05). The results show that older adults are emotionally less affected by sleep deprivation than young adults. This tolerance was mainly related to an attenuated increase in negative mood. This could possibly be related to the well‐known positivity effect, which suggests that older adults prioritize regulating their emotions to optimize well‐being. The results also highlight that caution is warranted when generalizing results from sleep deprivation studies across the adult lifespan.

  • 18.
    Schwarz, Johanna F. A.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ingre, Michael
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Fors, Carina
    Anund, Anna
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Taillard, Jacques
    Phillip, Pierre
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    In-car countermeasures open window and music revisited on the real road: popular but hardly effective against driver sleepiness2012In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 21, no 5, p. 595-599Article in journal (Refereed)
    Abstract [en]

    This study investigated the effects of two very commonly used countermeasures against driver sleepiness, opening the window and listening to music, on subjective and physiological sleepiness measures during real road driving. In total, 24 individuals participated in the study. Sixteen participants received intermittent 10-min intervals of: (i) open window (2 cm opened); and (ii) listening to music, during both day and night driving on an open motorway. Both subjective sleepiness and physiological sleepiness (blink duration) was estimated to be significantly reduced when subjects listened to music, but the effect was only minor compared with the pronounced effects of night driving and driving duration. Open window had no attenuating effect on either sleepiness measure. No significant long-term effects beyond the actual countermeasure application intervals occurred, as shown by comparison to the control group (n = 8). Thus, despite their popularity, opening the window and listening to music cannot be recommended as sole countermeasures against driver sleepiness.

  • 19.
    Schwarz, Johanna F. A.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    Lindberg, Eva
    Gruber, Georg
    Fischer, Håkan
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Theorell-Haglöw, Jenny
    Age affects sleep microstructure more than sleep macrostructure2017In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 26, no 3, p. 277-287Article in journal (Refereed)
    Abstract [en]

    It is well known that the quantity and quality of physiological sleep changes across age. However, so far the effect of age on sleep microstructure has been mostly addressed in small samples. The current study examines the effect of age on several measures of sleep macro- and microstructure in 211 women (22–71 years old) of the ‘Sleep and Health in Women’ study for whom ambulatory polysomnography was registered. Older age was associated with significantly lower fast spindle (effect size f2 = 0.32) and K-complex density (f2 = 0.19) during N2 sleep, as well as slow-wave activity (log) in N3 sleep (f2 = 0.21). Moreover, total sleep time (f2 = 0.10), N3 sleep (min) (f2 = 0.10), rapid eye movement sleep (min) (f2 = 0.11) and sigma (log) (f2 = 0.05) and slow-wave activity (log) during non-rapid eye movement sleep (f2 = 0.09) were reduced, and N1 sleep (f2 = 0.03) was increased in older age. No significant effects of age were observed on slow spindle density, rapid eye movement density and beta power (log) during non-rapid eye movement sleep. In conclusion, effect sizes indicate that traditional sleep stage scoring may underestimate age-related changes in sleep.

  • 20.
    Watling, Christopher N.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Queensland University of Technology (QUT), Australia.
    Young drivers who continue to drive while sleepy: What are the associated sleep- and driving-related factors?2019In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869Article in journal (Refereed)
    Abstract [en]

    Crashes due to sleepiness account for a substantial proportion of road crash incidents. The purpose of the current study was to examine several sleep-related factors and driving-related factors for their association with self-reports of continuing to drive while sleepy. In total 257 young drivers aged 18-25 years completed an online survey that assessed factors such as sleep quality, sleep duration and consistency, excessive daytime sleepiness, experiences with sleepiness and their driving-related behaviours. The results demonstrate that being older, having a perceived ability to overcome sleepiness, committing more highway code violations and having experienced a sleep-related close call were positively associated with an increased likelihood of continuing to drive while sleepy. The obtained results highlight the acceptance of risky driving behaviours among some younger drivers. Younger drivers' risky driving behaviour is certainly a road safety concern given the impairment associated with sleepiness and their over-representation in road crash incidents.

  • 21.
    Watling, Christopher N.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Queensland University of Technology, Australia.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University, Netherlands.
    Anund, Anna
    Do repeated rumble strip hits improve driver alertness?2016In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 25, no 2, p. 241-247Article in journal (Refereed)
    Abstract [en]

    Driving while sleepy is associated with increased crash risk. Rumble strips are designed to alert a sleepy or inattentive driver when they deviate outside their driving lane. The current study sought to examine the effects of repeated rumble strip hits on levels of physiological and subjective sleepiness as well as simulated driving performance. In total, 36 regular shift workers drove a high-fidelity moving base simulator on a simulated road with rumble strips installed at the shoulder and centre line after a working a full night shift. The results show that, on average, the first rumble strip occurred after 20 min of driving, with subsequent hits occurring 10 min later, with the last three occurring approximately every 5 min thereafter. Specifically, it was found that the first rumble strip hit reduced physiological sleepiness; however, subsequent hits did not increase alertness. Moreover, the results also demonstrate that increased subjective sleepiness levels, via the Karolinska Sleepiness Scale, were associated with a greater probability of hitting a rumble strip. The present results suggest that sleepiness is very resilient to even strongly arousing stimuli, with physiological and subjective sleepiness increasing over the duration of the drive, despite the interference caused by rumble strips.

  • 22.
    Åkerstedt, Torbjorn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    Schwarz, Johanna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    Gruber, Georg
    Theorell-Haglöw, Jenny
    Lindberg, Eva
    Short sleep-poor sleep? A polysomnographic study in a large population-based sample of women2019In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 28, no 4, article id e12812Article in journal (Refereed)
    Abstract [en]

    There is a lack of studies on the association between total sleep time (TST) and other polysomnographical parameters. A key question is whether a short sleep is an expression of habitual short sleep, or whether it reflects temporary impairment. The purpose of the present study was to investigate the association between TST and amount of sleep stages and sleep continuity measures, in a large population-based sample of women (n = 385), sleeping at home in a normal daily life setting. The results show that sleep efficiency, N1 (min), N2 (min), REM (min), REM% and proportion of long sleep segments, increased with increasing TST, whereas the number of awakenings/hr, the number of arousals/hr, N1% and REM intensity decreased. In addition, longer sleep was more associated with TST being perceived as of usual duration and with better subjective sleep quality. TST was not associated with habitual reported sleep duration. It was concluded that short TST of a recorded sleep in a real-life context may be an indicator of poor objective sleep quality for that particular sleep episode. Because individuals clearly perceived this reduction, it appears that self-reports of poor sleep quality often may be seen as indicators of poor sleep quality. It is also concluded that PSG-recorded sleep duration does not reflect habitual reported sleep duration in the present real-life context.

  • 23.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet.
    Anund, Anna
    Axelsson, John
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Subjective sleepiness is a sensitive indicator of insufficient sleep and impaired waking function2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, no 3, p. 240-252Article in journal (Refereed)
    Abstract [en]

    The main consequence of insufficient sleep is sleepiness. While measures of sleep latency, continuous encephalographical/electro-oculographical (EEG/EOG) recording and performance tests are useful indicators of sleepiness in the laboratory and clinic, they are not easily implemented in large, real-life field studies. Subjective ratings of sleepiness, which are easily applied and unobtrusive, are an alternative, but whether they measure sleepiness sensitively, reliably and validly remains uncertain. This review brings together research relevant to these issues. It is focused on the Karolinska Sleepiness Scale (KSS), which is a nine-point Likert-type scale. The diurnal pattern of sleepiness is U-shaped, with high KSS values in the morning and late evening, and with great stability across years. KSS values increase sensitively during acute total and repeated partial sleep deprivation and night work, including night driving. The effect sizes range between 1.5 and 3. The relation to driving performance or EEG/EOG indicators of sleepiness is highly significant, strongly curvilinear and consistent across individuals. High (>6) KSS values are associated particularly with impaired driving performance and sleep intrusions in the EEG. KSS values are also increased in many clinical conditions such as sleep apnea, depression and burnout. The context has a strong influence on KSS ratings. Thus, physical activity, social interaction and light exposure will reduce KSS values by 1-2 units. In contrast, time-on-task in a monotonous context will increase KSS values by 1-2 units. In summary, subjective ratings of sleepiness as described here is as sensitive and valid an indicator of sleepiness as objective measures, and particularly suitable for field studies.

  • 24.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Axelsson, John
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Orsini, Nicola
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    The daily variation in sleepiness and its relation to the preceding sleep episode - a prospective study across 42days of normal living2013In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 22, no 3, p. 258-265Article in journal (Refereed)
    Abstract [en]

    Sleepiness is linked to accidents and reduced performance, and is usually attributed to short/poor prior sleep and sleepiness. However, while the link between reduced sleep and subsequent sleepiness is well established in laboratory experiments of sleep reduction, very little is known about the day-to-day variation of sleepiness in everyday life and its relation to the immediately preceding sleep episode. The purpose of the present study was to investigate the characteristics of this relation across 42 consecutive days. Fifty volunteers participated. Self-reports of sleep were given in the morning and recorded with actigraphy; health was rated in the evening; and sleepiness was rated at eight points during the day (on a scale of 1-9). Results from mixed-model regression analyses showed that, on average, total sleep time predicted sleepiness during the rest of the day across the 42 days, with sleepiness increasing with shorter preceding sleep (β = -0.15 units h(-1) , P < 0.001). Sleepiness also increased with earlier time of rising and lower-rated sleep quality. Days off reduced sleepiness, but was accounted for by sleep. Self-rated health improved when sleepiness was low during the same day (β = -0.36 unit unit(-1) of rated health, P < 0.001), but the two were measured simultaneously. Napping was related to high sleepiness during the same day. Actigraphy measures of sleep duration showed similar, but somewhat weaker, effects than diary measures. It was concluded that the main determinants of daytime sleepiness in a real-life day-to-day context were short sleep, poor sleep and early rising, and that days with high sleepiness ended with ratings of poorer health.

  • 25.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Ghilotti, Francesca
    Grotta, Alessandra
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Zhao, Hongwei
    Adami, Hans-Olov
    Trolle-Lagerros, Ylva
    Bellocco, Rino
    Sleep duration and mortality - Does weekend sleep matter?2019In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 28, no 1, article id e12712Article in journal (Refereed)
    Abstract [en]

    Previous studies have found a U-shaped relationship between mortality and (weekday) sleep duration. We here address the association of both weekday and weekend sleep duration with overall mortality. A cohort of 43,880 subjects was followed for 13 years through record-linkages. Cox proportional hazards regression models with attained age as time-scale were fitted to estimate multivariable-adjusted hazard ratios and 95% confidence intervals for mortality; stratified analyses on age (<65 years, >= 65 years) were conducted. Among individuals <65 years old, short sleep (<= 5 hr) during weekends at baseline was associated with a 52% higher mortality rate (hazard ratios 1.52; 95% confidence intervals 1.15-2.02) compared with the reference group (7 hr), while no association was observed for long (>= 9 hr) weekend sleep. When, instead, different combinations of weekday and weekend sleep durations were analysed, we observed a detrimental association with consistently sleeping <= 5 hr (hazard ratios 1.65; 95% confidence intervals 1.22-2.23) or >= 8 hr (hazard ratios 1.25; 95% confidence intervals 1.05-1.50), compared with consistently sleeping 6-7 hr per day (reference). The mortality rate among participants with short sleep during weekdays, but long sleep during weekends, did not differ from the rate of the reference group. Among individuals >= 65 years old, no association between weekend sleep or weekday/weekend sleep durations and mortality was observed. In conclusion, short, but not long, weekend sleep was associated with an increased mortality in subjects <65 years. In the same age group, short sleep (or long sleep) on both weekdays and weekend showed increased mortality. Possibly, long weekend sleep may compensate for short weekday sleep.

  • 26.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    Hallvig, David
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    Normative data on the diurnal pattern of the Karolinska Sleepiness Scale ratings and its relation to age, sex, work, stress, sleep quality and sickness absence/illness in a large sample of daytime workers2017In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 26, no 5, p. 559-566Article in journal (Refereed)
    Abstract [en]

    Self-rated sleepiness responds to sleep loss, time of day and work schedules. There is, however, a lack of a normative reference showing the diurnal pattern during a normal working day, compared with a day off, as well as differences depending on stress, sleep quality, sex, age and being sick listed. The present study sought to provide such data for the Karolinska Sleepiness Scale. Participants were 431 individuals working in medium-sized public service units. Sleepiness (Karolinska Sleepiness Scale, scale 1-9) was rated at six times a day for a working week and 2 days off (>90.000 ratings). The results show a clear circadian pattern, with high values during the morning (4.5 at 07:00 hours) and evening (6.0 at 22:00 hours), and with low values (3-4) during the 10:0016: 00 hours span. Women had significantly higher (0.5 units) Karolinska Sleepiness Scale values than men, as did younger individuals (0.3 units), those with stress (1.3 units above the low-stress group) and those with poor sleep quality (1.0 units above those with qood sleep quality). Days off showed reduced sleepiness (0.7 units), while being sick listed was associated with an increased sleepiness (0.8 units). Multiple regression analysis of mean sleepiness during the working week yielded mean daytime stress, mean sleep quality, age, and sex as predictors (not sleep duration). Improved sleep quality accounted for the reduced sleepiness during days off, but reduced stress was a second factor. Similar results were obtained in a longitudinal mixed-model regression analysis across the 7 days of the week. The percentage of ratings at Karolinska Sleepiness Scale risk levels (8 + 9) was 6.6%, but most of these were obtained at 22:00 hours. It was concluded that sleepiness ratings are strongly associated with time of day, sleep quality, stress, work day/day off, being ill, age, and sex.

  • 27.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ingre, Michael
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Anund, Anna
    Sandberg, David
    Wahde, Mattias
    Philip, Pierre
    Kronberg, Peter
    Reaction of sleepiness indicators to partial sleep deprivation, time of day and time on task in a driving simulator - the DROWSI project2010In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 19, no 2, p. 298-309Article in journal (Refereed)
    Abstract [en]

    Studies of driving and sleepiness indicators have mainly focused on prior sleep reduction. The present study sought to identify sleepiness indicators responsive to several potential regulators of sleepiness: sleep loss, time of day (TOD) and time on task (TOT) during simulator driving. Thirteen subjects drove a high-fidelity moving base simulator in six 1-h sessions across a 24-h period, after normal sleep duration (8 h) and after partial sleep deprivation (PSD; 4 h). The results showed clear main effects of TOD (night) and TOT but not for PSD, although the latter strongly interacted with TOD. The most sensitive variable was subjective sleepiness, the standard deviation of lateral position (SDLAT) and measures of eye closure [duration, speed (slow), amplitude (low)]. Measures of electroencephalography and line crossings (LCs) showed only modest responses. For most variables individual differences vastly exceeded those of the fixed effects, except for subjective sleepiness and SDLAT. In a multiple regression analysis, SDLAT, amplitude/peak eye-lid closing velocity and blink duration predicted subjective sleepiness bouts with a sensitivity and specificity of about 70%, but were mutually redundant. The prediction of LCs gave considerably weaker, but similar results. In summary, SDLAT and eye closure variables could be candidates for use in sleepiness-monitoring devices. However, individual differences are considerable and there is need for research on how to identify and predict individual differences in susceptibility to sleepiness.

  • 28.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Nilsonne, Gustav
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Fischer, Håkan
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    d'Onofrio, Paolo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Gruber, G.
    Schwarz, Johanna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Women sleep better and have a stronger response to late night curtailed sleep than men, particularly in older individuals - effects on polysomnographical sleep2016In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 25, p. 156-156, article id P206Article in journal (Refereed)
    Abstract [en]

    Objectives: Higher age is associated with poorer sleep and women report more sleep problems than men, despite indications of better physiological sleep. The purpose of the present study was to investigate whether a common daily life sleep problem, late night curtailed sleep, would have different effects depending on gender and age. Methods: 60 healthy individuals (equal groups of gender and age (20–30 and 65–75 years)) participated in an experiment with a full night’s sleep and one night with reduced sleep between 0400 h and 0700 h, in a balanced design. Sleep was recorded through standard polysomnography (PSG) at home. Results: The results showed the expected main effect of sleep loss. Older participants had a lower TST, N3%, sleep efficiency, but more N1%, longer N3 latency, and fewer awakenings. Women had more N3%, more REM%, more N3%, and shorter N3 latency compared with men. The curtailed late night sleep caused a stronger increase in N3%, and more pronounced reductions in REM%, a stronger reduction in N1%, and N3 latency in women than men. In the higher age group the N3% response in men was strongly attenuated compared to that of women. Conclusions: The results show that women, apart form getting more N3% and less N1% even in the normal sleep condition, have a stronger response to late night sleep, particularly in higher age groups.

  • 29.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Nilsonne, Gustav
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Tamm, Sandra
    D'onofrio, Paolo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Fischer, Håkan
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Schwarz, Johanna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Effects of late-night short-sleep on in-home polysomnography: relation to adult age and sex2018In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27, no 4, article id e12626Article in journal (Refereed)
    Abstract [en]

    Bedtime is frequently delayed by many factors in life, and a homeostatic response to the delay may compensate partly for increased time awake and shortened sleep. Because sleep becomes shorter with age and women complain of disturbed sleep more often than men, age and sex differences in the homeostatic response to a delayed bedtime may modify the homeostatic response. The purpose of the present study was to investigate the effect of late-night short-sleep (3 h with awakening at about 07:00 hours) on in-home recorded sleep in men and women in two age groups (20-30 and 65-75 years). Results (N = 59) showed that late-night short-sleep was associated with an increase in percentage of N3 sleep and a decrease in percentage of rapid eye movement sleep, as well as decreases in several measures of sleep discontinuity and rapid eye movement density. Men showed a smaller decrease in percentage of rapid eye movement sleep than women in response to late-night short-sleep, as did older individuals of both sexes compared with younger. Older men showed a weaker percentage of N3 sleep in response to late-night short-sleep than younger men. In general, men showed a greater percentage of rapid eye movement sleep and a lower percentage of N3 sleep than women, and older individuals showed a lower percentage of N3 sleep than younger. In particular, older men showed very low levels of percentage of N3 sleep. We conclude that older males show less of a homeostatic response to late-night short-sleep. This may be an indication of impaired capacity for recovery in older men. Future studies should investigate if this pattern can be linked to gender-associated differences in morbidity and mortality.

  • 30.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    Schwarz, Johanna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    Gruber, Georg
    Lindberg, Eva
    Theorell-Haglöw, Jenny
    The relation between polysomnography and subjective sleep and its dependence on age - poor sleep may become good sleep2016In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 25, no 5, p. 565-570Article in journal (Refereed)
    Abstract [en]

    Women complain more about sleep than men, but polysomnography (PSG) seems to suggest worse sleep in men. This raises the question of how women (or men) perceive objective (PSG) sleep. The present study sought to investigate the relation between morning subjective sleep quality and PSG variables in older and younger women. A representative sample of 251 women was analysed in age groups above and below 51.5 years (median). PSG was recorded at home during one night. Perceived poor sleep was related to short total sleep time (TST), long wake within total sleep time (WTSP), low sleep efficiency and a high number of awakenings. The older women showed lower TST and sleep efficiency and higher WTSP for a rating of good sleep than did the younger women. For these PSG variables the values for good sleep in the older group were similar to the values for poor sleep in the young group. It was concluded that women perceive different levels of sleep duration, sleep efficiency and wake after sleep onset relatively well, but that older women adjust their objective criteria for good sleep downwards. It was also concluded that age is an important factor in the relation between subjective and objective sleep.

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