Investigating the Effects of Exposure to Blue-Enriched Light or Peppermint Odor on Alertness, Mood, and Performance Upon Awakening from Deep Sleep at Night

Introduction: Sleep inertia refers the transient neurobehavioral impairments experienced immediately after waking from sleep. This period of reduced alertness and performance poses a significant safety risk to on-call workers who may be required to perform a safety-critical task immediately after waking (e.g., emergency services, health care, and military). In these operations, the need for a rapid return to full alertness is critical to mission safety and success. Several factors may exacerbate sleep inertia, resulting in greater impairment upon waking, including: waking from deep sleep, (i.e., slow wave sleep, SWS), waking at night, and waking following prior sleep loss. Awakenings under these conditions are common for on-call and extended shift workers who may need to perform safety-critical tasks soon after waking from unprotected sleep opportunities. Therefore, there is a need for evidence-based reactive countermeasures (i.e., used upon waking) to the cognitive consequences sleep inertia. Specifically, countermeasures that can rapidly restore alertness and performance immediately following sleep.

A recent review of the literature on reactive countermeasures highlighted several research gaps and promising candidates for further investigation. The review also emphasized the need for countermeasures that are operationally viable and readily deployed in occupational settings. This study aims to address the identified gaps and limitations by assessing the efficacy of exposure to two known acute alerting stimuli - blue-enriched light and peppermint odor - to improve cognitive performance, alertness, and mood immediately after waking from SWS at night.

Materials and Methods: Twelve participants completed a two-week within-subject, randomized, cross-over intervention study including two in-laboratory overnight visits. During each experimental week, the subjects experienced one intervention (light or peppermint) and a control condition upon awakening from SWS at night. The presentation order of the two conditions (intervention or control) at wake-up and the order of intervention (light or peppermint) by week was randomized by sex.
Prior to each in-laboratory visit, participants maintained a sleep schedule of 8.5 h for 5 nights and 5 h for one night. Compliance with this sleep schedule was confirmed by actigraphy. In the laboratory, participants went to bed at their habitual bedtime and were monitored by standard polysomnography. After at least five minutes of continuous SWS, participants were awoken and exposed, in a randomized order, to either the control or intervention condition.

During the hour after awakening from SWS (at 2, 17, 32, and 47 minutes after waking), participants completed a battery of tasks including a 5-minute psychomotor vigilance task (PVT), a subjective scale of alertness (Karolinska Sleepiness Scale, KSS), and visual analogue scales (VAS) of mood. Following this sleep inertia measurement period, all lights were turned off and participants were allowed to return to sleep. They were then awoken again from their subsequent SWS period and exposed to the alternative condition (control or intervention). Following this second awakening, participants were allowed to sleep until their habitual wake time and were then released from the laboratory. Participants then followed the at-home sleep schedule and returned to the laboratory for the second intervention (light or peppermint) following the procedures described above.

The light intervention involved exposure to a blue-enriched light canvas illuminated for 1 hour at a distance of ~56 cm from the participant (~200 lux and ~60 melanopic lux at angle of gaze). For the peppermint intervention, peppermint oil was pipetted onto a mask, and participants inhaled the odor with the mask covering the nose and mouth for 1 minute. The control condition for both weeks involved a dim, red ambient light (<1 lux). An odorless mask, without any oil pipetted onto the mask, was also worn in the peppermint control condition.

Results: Compared to the control condition, participants exposed to blue-enriched light had fewer PVT lapses (χ2 = 5.285, p = .022), reported feeling more alert (KSS: F1,77 = 4.955, p = .029; VASalert: F1,77 = 8.226, p = .005), and had improved mood (VAScheerful: F1,77 = 8.615, p = .004; VASdepressed: F1,77 = 4.649, p = .034; VASlethargic: F1,77 = 5.652, p = .020). Exposure to peppermint oil did not improve any outcome measures on any of the tasks compared to control condition (p > .05).

Conclusions: We found that participants had fewer lapses of attention upon awakening when exposed to blue-enriched light compared to dim, red light. In addition, participants reported feeling more alert, more cheerful, less depressed, and less lethargic in the blue-enriched light condition. Brief exposure to a peppermint odor, however, did not appear to improve performance, alertness, or mood under the experimental conditions. Our null results in the peppermint condition may have been due to methodological limitations such as the duration and method of administration. Given the need to mitigate the potential impact of sleep inertia on safety-critical tasks in on-call operations, our findings suggest that blue-enriched light exposure upon awakening may help to improve performance and alertness during the sleep inertia period following awakening from deep, nocturnal sleep.

We are currently exploring the potential mechanisms for the effect of light on cognitive performance upon awakening as well as investigating its application in real-world settings to explore the translational efficacy of this countermeasure to occupational environments. Continued exploration into light and other reactive countermeasures, and potentially their combination, is needed in order to provide evidence-based guidance on effective sleep inertia countermeasures to improve the alertness and performance of those required to perform safety-critical tasks soon after waking.