IV. AudioMagic Natural Sleep as part of the Sleep Enhancement Fatigue Reduction Training (SEFRT)

Studied: AudioMagic Natural Sleep program as part of the Sleep Enhancement Fatigue Reduction Training (SEFRT) with Air Force Pilots and shift workers
Conducted by: Christopher Alsten, Ph.D.
Funded by: U. S. Air Force

The Air Force contracted with my company, Inner Health, Inc., to evaluate the effectiveness of our programs for improving sleep and reducing the fatigue experienced by jet-lagged Air Force pilots and air crews, along with the effect on shiftworker fatigue. The result was the Sleep Enhancement Fatigue Reduction Training (SEFRT) program, which incorporated the most recent versions of the 3D AudioMagic™ Natural Sleep programs, and included a separate instruction booklet further detailing sleep enhancement and fatigue reduction techniques.

For Dr. Alsten and the research team's evaluation of the SEFRT, a group of 69 participants (45 pilots and 24 shift workers) underwent a battery of tests and wore small actigraphs around their wrists in order to measure their sleep objectively as they charted their sleep, mood levels, and fatigue levels. The pilots and aircrew members did this during a multi-day flight over several time zones and, following a 3-week “training period” of listening to the various SEFRT programs every night, in bed, they repeated the flight taking the same measurements.  

The USAF flight crew evaluation involved a baseline trip before the SEFRT Training and another identical trip after the training. Then a comparison was done between the two trips (repeated measures study). A third element, a “washout” period with white noise, was attempted as part of a subsequent active placebo trip evaluation. However, only a few aircrew members were able to schedule this third trip during the study period due to time constraints. (We believe this was exacerbated by the fact that it spread throughout the squadron that we were going to take away the “Sleep Training”, something that worked, and replace it with “white noise” instead. Those who had used the white noise did not like it and knew it "did not work.")

In the second study, conducted this time with shiftworkers, an active placebo (a choice of white noise and several pieces of relaxing music) was provided as training material first in the repeated measures protocol. The results of this placebo "training" were evaluated and then the SEFRT Training was provided and the results of the actual training were evaluated. Although many liked the music to go to sleep this active placebo control did not have any effect while the SEFRT training had a very significant effect as reported in the USAF Shiftwork page. Neither group was provided any additional sleep hygiene information, cognitive behavioral therapy instructions or similar information.

Among the findings
  • Numerous participants (and their spouses) provided comments to evaluators regarding the impact of the program on the quality of their sleep
  • Many shiftworking program users were able to distinguish fellow program users from the control (placebo) group by their mood and energy levels
  • Both aircrew members and shiftworkers reduced caffeine intake by an average of 35%
  • By training's end, total stress levels were cut nearly in half in both groups
  • Those participants who were hospital staff working graveyard shift and sleeping during the day showed an objective increase in hours slept per day from 5 hours and 15 minutes to 6 hours and 10 minutes
  • Participants reported a 29% increase in how deeply they felt they slept, and a 78% improvement in how rested they felt after waking
  • On Profile of Mood States* testing, program users showed a statistically significant improvement in nearly all of the subscales whereas the placebo group did not
  • Participants showed an 18% improvement in job satisfaction and a 56% improvement in all-around self-perceived health
  • Digestive complaints lessened noticeably and cardiovascular problems decreased measurably
  • Participants showed an increased adaptability to and recovery from circadian disruption
  • Self-reported quality-of-life measures improved
It is likely that the program users' overall reduction in chronic fatigue resulted primarily from decreased circadian rhythm disruption and reduction in “sleep debt” due to improvements in sleep quantity and quality along with the program's enhanced relaxation component. What follows are some sample quotes from the study:

Air Crew

I feel better and less fatigued during the entire mission and it was easier to readjust to home time when I returned. C-5A Pilot

I’m glad I used it. It was easy, didn’t take much time and has made a real difference. C-5A Pilot

Normally I don’t have a problem getting to sleep when the mission schedule or responsibilities in the cockpit permit a nap. When I have a shift in my rest cycle (night sleep to day sleep) I automatically use the [programs] to help put me to sleep. They are very effective. C-5A Pilot

Now when I have an early morning departure, I’m able to go to sleep at times that I wouldn’t normally be able to, in preparation for the mission. C-141 Pilot

I am still using the [programs] and have found them to help me calm down and get to sleep much faster, no matter how tired or alert I am. KC-135 Pilot

With the training, I can get to sleep easier and sleep deeper and longer than before. KC-10 Flight Engineer

I get more sleep during layovers and feel less stressed since going through the sleep training. C-5A Pilot

I have memory of the first 5 minutes or so of the voice then I’m usually asleep. KC-10 Pilot

Only a few times in the past 8 years have I ever gone into a deep sleep in the aircraft. On the first use of the tapes I went into a deep sleep with dreams and was awakened only due to increased temperature in the aircraft cabin. KC-10 Boom Operator

I’m never tired in the afternoon, but knowing that I was leaving on a very demanding trip at 10 p.m. I decided to try to get a nap.  With the help of the tapes I had no trouble falling asleep. KC-10 Boom Operator

Overall, in comparing this to previous relaxation/visualization tapes I have worked with in the past, I found this type to be quite effective. USAF Flight Surgeon

Shiftworkers

I can sleep an extra hour after my first midshift and feel much better after my second consecutive midshift. Air Traffic Controller

I now sleep two hours longer when I first change over to nightshifts and I don’t feel as wiped out during the second night. Air Traffic Controller

Now when I’m working nights, I get more and better sleep during the day and I don't feel as tired at work. Air Traffic Controller

Not only am I sleeping and feeling better, especially when I change shifts, but I’ve noticed that everyone else on my shift that is also using the sleep program, seems to be more alert and in a better mood on the job making it easier to interact and communicate with each other. Supervisor, Air Traffic Controller

I could really imagine the place and feel myself relax because of the 3D sound and descriptive phrases. Air Traffic Controller


The views and conclusions represent the authors own and do not reflect the official policy of the US Air Force nor do they constitute an endorsement.
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