Alarm Tones, Voice Warnings, and Musical Treatments: A Systematic Review of Auditory Countermeasures for Sleep Inertia in Abrupt and Casual Awakenings

Abstract

Sleep inertia is a measurable decline in cognition some people experience upon and following awakening. However, a systematic review of the current up to date evidence of audio as a countermeasure has yet to be reported. Thus, to amend this gap in knowledge, the authors conducted this systematic review beginning with searches in three primary databases for studies published between the inception date of each journal and the year 2020. Search terms contained “Sleep Inertia” paired with: “Sound”; “Noise”; “Music”; “Alarm”; “Alarm Tone”; “Alarm Sound”; “Alarm Noise”; “Alarm Music”; “Alarm Clock”; “Fire Alarm”, and “Smoke Alarm”. From 341 study results, twelve were identified for inclusion against a priori conditions. A structured narrative synthesis approach generated three key auditory stimulus themes-(i) Noise, (ii) Emergency tone sequences; Voice Alarms and Hybrids, and (iii) Music. Across themes, participants have been assessed in two situational categories: emergency, and non-emergency awakenings. The results indicate that for children awakening in emergency conditions, a low pitch alarm or voice warnings appear to be more effective in counteracting the effects of sleep inertia than alarms with higher frequencies. For adults abruptly awakened, there is insufficient evidence to support firm conclusions regarding alarm types and voice signals. Positive results have been found in non-emergency awakenings for musical treatments in adults who preferred popular music, and alarms with melodic qualities. The results observed reflect the potential for sound, voice, and musical treatments to counteract sleep inertia post-awakening, and emphasize the requirements for further research in this domain.

Identifying Targets for Innovation in Amazon Reviews of Bedwetting Alarms: Thematic Analysis

“…A recent study that evaluated sound options for residential fire alarms found that low-frequency tones, the voice of a female stranger, and the voice of the child's mother were significantly more effective at waking children than high-frequency tones [14]. This is consistent with the findings of a systemic review on the effectiveness of different alarm types on sleep inertia [15]. Based on our findings and prior evidence, bedwetting alarms require more alarm tone and volume options, and it is recommended that device developers ensure that low-frequency and voice tones are incorporated to maximize their effectiveness.…”

Using Wake-Up Tasks for Morning Behavior Change: Development and Usability Study

“…Various studies aimed to determine how to escape sleep inertia quickly and effectively [36]. For example, McFarlane et al [37][38][39] explored auditory factors, such as alarm sounds, to decrease the influence of sleep inertia, and Hilditch et al [40] attempted to induce arousal using light of specific frequencies. Additionally, physical activity has been addressed as the primary countermeasure to sleep inertia.…”

On-call work and sleep: the importance of switching on during a callout and switching off after a call

“…While potential countermeasures have been evaluated as options, more research is needed. These reactive countermeasures include but are not limited to: a) bright light 35) ; b) caffeinated gum 36) ; c) sound 37) ; and d) exercise 38,39) . For example, in a proof-of-concept study by Kovac, Vincent 40) , exercise completed immediately upon waking during the night increased noradrenaline levels and reduced sleepiness levels after 5 minutes 40) .…”

“…While potential countermeasures have been evaluated as options, more research is needed. These reactive countermeasures include but are not limited to: a) bright light 35 ) ; b) caffeinated gum 36 ) ; c) sound 37 ) ; and d) exercise 38 , 39 ) .…”

“…Improved reaction time lasted between 12–18 min after chewing the caffeinated gum compared to the placebo gum, suggesting that caffeine could be a more effective countermeasure compared to bright light, given the faster cognitive performance improvements. Sound has also been investigated as a reactive countermeasure for sleep inertia 11 , 37 ) and has shown the potential to improve performance under certain conditions. In a study by Hayashi et al 41 ) , music was played at 60 dB for 20 min after waking from a nap, with reduced subjective sleepiness observed.…”