Sudden early-morning awakening impairs immediate tactical planning in a changing ‘emergency’ scenario

Abstract

Summary This was a realistic military‐type exercise assessing unexpected, abrupt early‐morning awakening effects on immediate ‘executive function’ and the ability to comprehend and deal with a sudden emergency under a changing situation. Twenty (average age 21 years) healthy, highly motivated junior officer reservists were assigned randomly to two equal, independent groups, unforewarned as to what would happen. The experimental group was woken abruptly at 03 : 00 h (<3 h sleep) and confronted immediately with a ‘paper exercise’ of an enemy attack, requiring a feasible plan of engagement with minimal loss of resources, to be completed within 15 min. A control group slept until 07 : 30 h; they were then presented with the identical emergency 1 h later. Participants worked individually, under time pressure, receiving written information, map and other details, all containing relevant, irrelevant and misleading information. Halfway through, they were given (unexpectedly) a critical update necessitating a change of tactics. Performance was scored blind by instructors, under five categories. Eight of the experimental group versus three controls failed overall, with significant group differences on three specific categories relying on flexible decision‐making: ‘identification of available cover’, ‘use of available assets’ and ‘extraction of relevant from irrelevant information’. Other, logical and highly trained skills were unimpaired. Ours was a ‘worst case scenario’, combining short sleep, circadian ‘trough’ and sleep inertia, all of which differentiated the two groups, unlike typical laboratory studies. Nevertheless, it was relevant to real‐life situations involving highly motivated, trained individuals making critical innovative decisions in the early morning versus the normal waking day.

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“…Military personnel are often subjected to SD during combat operations or peacekeeping missions abroad [5][6][7]. Frequent SD of these military personnel could, conceivably, affect brain function and reduce their ability to perform at optimal levels [8][9][10][11].…”

Sleep inertia, sleep homeostatic and circadian influences on higher‐order cognitive functions

“…Cognitive control components of executive function are critical for modulation of other cognitive processes, such as looking in the correct direction when crossing the street while visiting a country where people drive on a different side of the road, or inhibition of inappropriate outbursts and behaviours in patients with dementia. Our findings may also have important implications for the millions of individuals working at adverse circadian phases, long working hours and/or immediately upon awaking (Horne and Moseley, 2011), including health-care professionals treating patients, with the acknowledgement that findings from laboratory studies may not translate directly to real world performance. Lastly, our findings highlight the importance of considering how sleep inertia, hours awake and circadian processes may influence clinical assessments of cognitive impairment.…”

“…Groeger et al (2011) have also shown working memory executive function to be influenced by sleep inertia following afternoon naps. Additional research is necessary to determine if other executive functions (Alvarez and Emory, 2006) are influenced primarily by circadian phase and test such executive functions under real world conditions (Horne and Moseley, 2011).…”

Waking up is the hardest thing I do all day: Sleep inertia and sleep drunkenness

“…The intensity and duration of sleep inertia vary based on situational factors, but its effects may last minutes to several hours. Sleep inertia is a normal phenomenon, but one with potentially dangerous ramifications, e.g., in health care workers or military personnel who are woken abruptly in the night and required to make cognitively-taxing decisions [1, 2]. In some disease states, a transitional period akin to markedly pronounced sleep inertia is present and is sometimes referred to as “sleep drunkenness”.…”