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Arousal from Sleep by

Emergency Alarms:

Implications from the Scientific

Literature

V. J. Pezoldt

Harold P. Van Cott

Consumer Sciences Division

Center for Consumer Product Technology

National Engineering Laboratory

National Bureau of Standards

Washington, D.C. 20234

June 1978

Prepared for the Center for Fire Research, in support of: HEW-NBS Fire/Life Safety Program

Sponsored by:

U.S. Public Health Service

QC ’"“Department of Health, Education and Welfare

no Washington, D.C. 20203

. U56

78-1484

IWijnal Sores, of Standards MPR 1 7 m rs* rr( a ** ** ^ V r*--. v ^ - \ NBSIR 78-1484 (HEW)

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j AROUSAL FROM SLEEP BY

EMERGENCY ALARMS:

IMPLICATIONS FROM THE SCIENTIFIC

LITERATURE

V. J. Pezoldt

Harold P. Van Cott

Consumer Sciences Division

Center for Consumer Product Technology

National Engineering Laboratory

National Bureau of Standards

Washington, D C. 20234

June 1978

Prepared for the Center for Fire Research, in support of: HEW-NBS Fire/Life Safety Program

Sponsored by:

U.S. Public Health Service

Department of Health, Education and Welfare

Washington, D.C. 20203

f\JtS

'

, (s/PSlPL

U.S. DEPARTMENT OF COMMERCE, Juanita M. Kreps, Secretary

Dr. Sidney Harman, Under Secretary

Jordan J. Baruch, Assistant Secretary for Science and Technology

NATIONAL BUREAU OF STANDARDS, Ernest Ambler, Director

PREFACE

This report is a product of a joint effort of the

Department of Health, Education and Welfare and the National

Bureau of Standards Center for Fire Research. The program

is a five-year activity initiated in 1975. It consists of

projects in the areas of: decision analysis, fire and smoke

detection, smoke movement and control, automatic extinguishment,

and behavior of institutional populations in fire situations.

This report contains a review of the sleep research and

other literature which pertains to the effectiveness of external

signals, especially the intensity and other characteristics of

sound, in awakening people from sleep. This information should

prove useful in evaluating fire protection systems that rely

on alarms to awaken building occupants and assist in the

design of the sound characteristics of such alarms. The

requirements for needed future research are highlighted.
'v
Table of Contents

Page

Acknowledgements iii

Abstract v

The Phenomena of Sleep 1

Arousal Thresholds and Depth of Sleep 8

Arousal Thresholds as a Function of Physical

Signal Characteristics 9

Arousal as a Function of Signal Meaningfulness

and Sleeper Motivation 12

Arousal as a Function of Noise 14

Arousal by Non-Auditory Stimuli 15

Arousal and Drugs 15

Conclusions and Implications for the Design

of Emergency Alarms 16

Performance After Sudden Arousal 18

Recommendations for Future Studies of

Arousal by Emergency Alarms 20

l

Acknowledgements

The authors wish to acknowledge the contributions of

Dr. Wilse B. Webb and his staff at the University of

Florida in providing us with use of their sleep research

library from which many of the references cited in this

report originated.

Abstract

A review of the sleep research and other scientific

literature pertaining to the arousal of sleeping individuals

by external stimuli is reported. This effort was undertaken

to provide information about the characteristics of emergency

alarms which will reliably awaken a sleeping population,

especially nursing home residents, in the event of fire.

The literature reviewed does not provide an adequate basis

for specifying signal characteristics which will offer a high

assurance of producing arousal. Among the factors that

influence the intensity of a signal which will produce arousal

are the age and physical/mental condition of the sleeper,

drug use, sleep stage, time of night, and meaningfulness

or personal significance of the signal. Data relevant to these

variables arediscussed as is the problem of performance

following abrupt arousal. Recommendations regarding stimulus

characteristics, measures of arousal and the experimental

environment for future studies of arousal by emergency

alarms are presented.

v
-
AROUSAL FROM SLEEP BY EMERGENCY ALARMS:

IMPLICATIONS FROM THE SCIENTIFIC LITERATURE

The National Fire Protection Association estimates that

6,200 people died in residential fires in the United States in

1976 (Derry, 1977) . Many of these deaths are believed to involve

sleeping persons. One approach to the reduction of fire

fatalities that occur while persons are sleeping is to identify

and incorporate into the design of emergency alarms, signal

characteristics that will reliably arouse a large percentage of

sleepers to an awakening state.

Of particular interest in this report are the

determinants of arousal from sleep of individuals representative

of the population residing in nursing homes and similar limited

care institutional facilities. This population is composed

primarily of elderly individuals who may during both day and

night be under the influence of one or more forms of medication,

including sedatives, and who may be suffering from a variety of

physical and emotional problems which may affect depth of sleep,

speed of arousal from sleep, and the ability to respond

adaptively to an emergency alarm by choosing and implementing an

appropriate series of evasive and protective responses.

This report examines the scientific literature which

bears upon those signal characteristics which reliably awaken the

sleeping individual and the behaviors that occur in the postarousal state. Particular emphasis was placed on the

identification and analysis of research on the independent

variables of signal type and signal properties, age, sex, and

medical condition that affect arousal, particularly as evidenced

in the sleep literature.

This report does not address the important question of

the desirability or appropriateness of waking people in the event

of fire. Arguments can be advanced which suggest that under

certain institutional and emergency conditions it may be

preferable not to arouse individuals. No position regarding this

issue is taken here. Rather, the question addressed is concerned

with how to awaken individuals in emergency situations.

The Phenomena of Sleep

Although the emphasis of this report is on arousal by

means of external signals, arousal is closely related to sleep,

its depth and its duration. Therefore, it is important to

understand the phenomena of sleep before considering the process

of arousal.
Sleep has been the subject of great fascination probably

for as long as people have recognized that they sleep. The

scientific study of sleep, however, has a relatively short, but

prolific history. Webb (1977) dates the experimental analysis of

sleep from Kohlschutter ' s attempt to measure arousal thresholds

during sleep in 1862. Modern sleep research provides us with a good description, if not a full explanation, of much of the sleep

process. Much of the progress in sleep research is attributable

to the discovery of consistent, quantifiable patterns of brain

activity during sleep as recorded on the electroencephalograph

(EEG) . From the pioneering work of Loomis, Harvey and Hobart

(1937), Davis, et al. (1937) and, more recently. Dement and

Kleitman (1957) in the identification and measurement of human

brain potentials during sleep, a generally accepted means of

describing sleep in terms of EEG patterns has evolved. Although

various investigators employ somewhat different measurement

methods and criteria, there is a high degree of uniformity among

the procedures used. Most researchers use criteria similar to

those established by Rechtschaf fen and Kales (1968) who refined

the scoring system of Dement and Kleitman (1957). EEG records,

obtained by amplifying the electrical potentials from scalp

electrodes, are analyzed in short (typically 30-60s) epochs which

are assigned to the various sleep stages on the basis of the

amplitude and frequency of the EEG pattern and associated

electrooculograph (EOG) records.

The scoring criteria for sleep classification used by

Webb (1969) is typical. Each 60s epoch is scored independently

and assigned to one of six classification categories using the

following crtieria:

Stage 0: At least 30s of 8-12 Hz (alpha waves) of

occipital activity with a minimum of

2 0y V . This is a resting, waking state

with eyes closed which precedes sleep.

Stage 1: Less than 30s of 8-12 Hz of 20yV occipital

activity and no more than one well defined

sleep spindle or K-complex. "Sleep spindles"

are very brief bursts (0.5 - 2s) of

13-16 Hz waves. "K-complexes " are sharp

rises and falls and recovery of the EEG.

Stage 2: An epoch containing at least two well

defined sleep spindles or K-complexes, or

one of each, and no more than 12s of

0.5 - 3 Hz (delta waves).

2
Stage 3: An epoch containing at least 13s of 0.5 - 3 Hz,

20yV or higher activity, but less than

30s of this activity.

Stage 4: An epoch containing at least 30s of 0.5 - 3 Hz,

20pV or higher slow wave activity.

Stage 1-REM: A stage 1 EEG plus evidence of conjugate

rapid eye movements (REM) as evidenced by

EOG recordings of the movement of the

eyeball

.

Minor variations in this classification system are

common. Often stages 3 and 4 are not differentiated from each

other. They may be reported as a single stage referred to as

stage 3-4, slow-wave or delta sleep. In other cases, the various

stages are summarized dichotomously , with descending stage 1 and

stages 2, 3, and 4 described as non-REM (NREM) sleep and

ascending stage 1-REM described as REM sleep. The discovery of

rapid eye movements (REM) during sleep (Aserinsky and Kleitman,

1953) has provided the source for much of the modern sleep

research since dreaming is considered to occur primarily, though

not exclusively, during REM sleep.

The functional significance of the various sleep stages

has not been clearly established and is the subject of

considerable controversy. There is, however, general agreement

about the relatively stable, cyclic nature of the sleep stages

within individuals. Changes from stage to stage are generally

sequential from stage 1 through stage 4 and from stage 4 to stage

1. Abrupt changes from stage 4 to stage 2 or 1, however, do

occur. REM sleep typically emerges from and returns to stage 2

(Webb, 1969) . REMs typically first appear approximately 90

minutes after sleep onset and reappear every 90-100 minutes

thereafter throughout the sleep period (Johnson, 1973). The

cyclic occurrence of the sleep stages is illustrated in Figure 1,

adapted from Webb (1971) . As evidenced in Figure 1 and by additional data from

Webb (1969), the time spent in the various sleep stages is not

distributed equally across the total night of sleep. Rather,

stage 4 occurs predominantly in the first third of the night,

while REM sleep is increasingly predominant in the last third.

Davies (1976) reports a similar trend based on his review of

several studies. That is, delta (stages 3 and 4) occurs

predominantly in the first half of the sleep period with

successive delta periods becoming progressively shorter, whereas

REM appears predominantly, though not exclussively , in the second

half of the night. Successive REM periods become progressively

longer

.

3
NIGHT

1

HU

REM

39V1S d331S

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Figure

1.

Cyclic

progression

of

sleep

stages

for

one

subject

across

three

uninterrupted

nights.

(Source:

Webb,

1971)
Some normative data revealing consistencies in the

proportion of total sleep in each stage as a function of age is

available from Webb (1969) and Webb and Agnew (1969) . Table 1

provides a comparison of the percent of sleep in each stage for

six age groups. Webb concludes, from the data summarized in

Table 1, that each individual appears to be programmed for

certain overall amounts of the various stages and, although there

are consistencies among people in the same age group, these

tendencies vary from individual to individual. Again, Davies

(1976) reports very similar data, i.e., for young adults

approximately 50 percent of total sleep time is in stage 2, 20

percent in stages 3 and 4, 25 percent in REM sleep and 5 percent

in stages 0 and 1.

Several conclusions about the sleep of the elderly which

have important implications for the design of effective emergency

alarms can be drawn from the sleep literature. As shown in Table

1, the distribution of sleep in the EEG stages varies as a function of age. As will be seen later, the different EEG

defined stages demonstrate different responsivity to a given

signal

.

Several researchers have demonstrated a marked decrease

in stage 4 with increased age. A detailed account of a series of

studies conducted at the University of Florida (Williams, Karacan

and Hursch, 1974) indicates that after the age of 30,

consistently fewer men than women exhibit stage 4 and, in the

oldest group studied, stage 4 was completely absent in men and

present in only five out of ten women. Typical of the Florida

results are those reported by Agnew, Webb and Williams (1967) who

found that 16 healthy 50-60 year old males exhibited stage 4 an

average of only 2.7 percent of total sleep time over three nights

of testing. For individual subjects, stage 4 ranged from 0 - 10.3 percent of total sleep time. Kales, et al . (1967), in a study of 10 drug-free, normal 64-87 year old subjects, report an

average of 1.4 percent of total sleep time in stage 4. Data from

Brezinova (1975) shows older subjects experienced as many

episodes of delta and REM sleep as did younger subjects, but

episodes of these stages were shorter in older subjects, thereby

accumulating less total time in these states. Although all of

these studies indicate decreased stage 4 as a function of

increased age it is difficult to specify an absolute value for

stage 4 in the elderly. Individual differences and, to a lesser

extent, differences in scoring procedures and laboratory

artifacts probably account for discrepancies between the values

obtained in different studies. Feinberg, Koresko and Heller

(1967), for example, report a mean of 7.3 percent (range 0 - 20.4

percent) of total sleep time exhibited stage 4 for 15 normal 65-

5
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96 year old subjects (mean = 77 years) . Studies relating amount

of stage 3 sleep as a function of age are less consistent. Some

studies (e.g., Agnew, Webb and Williams, 1967) demonstrate a decrease in stage 3 with increased age and others (e.g.,

Feinberg, Koresko and Heller, 1967; Kales, et al . , 1967) report

an increase in stage 3 compared to younger subjects. The

importance of stages 3 and 4 will be seen in the review of

arousal threshold data which suggest that a greater signal

intensity may be necessary to arouse individuals from stage 3 and

4 sleep than from stage 2 and REM.

Studies of the sleep of the elderly also indicate an

increased latency to sleep onset (Agnew and Webb, 1971; Feinberg,

Koresko and Heller, 1967) and an increase in spontaneous

awakenings with increased age. Webb and Swinburne (1971) report

a mean of 4.6 and 5.6 night arousals for males and females

respectively, 66-96 years old. Williams, Karacan and Hursch

(1974) suggest that "sleep efficiency," as defined by the total

sleep time/total time in bed is gradually reduced with age from

age 30 for men and 50 for women. From the mid 50's on, the

reduction in sleep efficiency becomes more marked for both sexes.

Tune (1969, 1969a) reports similar data. However, contrary to

Williams, et al.. Tune found that women are more prone to report

sleep disruptions than men, particularly after the age of 50.

Feinberg, Koresko and Heller (1967) report a mean of 5.4

spontaneous awakenings per night among their 65-96 year old

subjects compared to only 3.1 such awakenings for 19-36 year old

subjects. Feinberg, et al., further suggest that their elderly

subjects awakened more rapidly from all stages of sleep than did

younger subjects, noting that "while grogginess seemed to persist

for rather prolonged periods after EEG arousal in children and

young adults, elderly normal subjects appeared fully alert within

minutes of EEG arousal."

In addition to the characteristic changes in sleep

patterns that accompany normal aging, several other factors which

affect sleep patterns should be noted as they may be relevant to

populations residing in nursing homes or similar institutions.

Regardless of the effects of age, Monroe (1967) found several

differences between self-reported good and poor sleepers. "Good

sleepers" demonstrate more total time asleep, less time in stage

2 and more time in REM than "poor sleepers." "Poor sleepers," on

the other hand, took longer to reach delta sleep and longer to

reach the first REM period of the night. The proportion of time

spent in delta sleep, however, was about the same for good and

poor sleepers.

7
Pathological aging, as evidenced in patients diagnosed

as suffering chronic brain syndrome, tends to accentuate the

changes seen in normal aging (Feinberg, Koresko and Heller,

1967) . Similar results are apparent with clinically depressed

patients who demonstrate more stage 0 (awake), less stage 4, and

slightly longer latencies to sleep onset than non-depressed

,

matched subjects (Gresham, Agnew and Williams, 1965). Depressed

subjects also show greater sensitivity to external sources of

noise than do normal subjects (Zung, Wilson and Dodson, 1964)

.

The finding that a greater proportion of light sleep

occurs in the elderly than the young has implications for

arousing a nursing home population. It suggests that the elderly

may be easier to arouse at almost any time during sleep than the

young, unless there is some other extenuating factor, such as

medication or hearing impairment. The higher frequency of

spontaneous awakenings of the elderly compared with the young

also suggests that other things being equal, the characteristics

of alarms to be used in nursing homes may not need to be the same

as for a younger population of, say, college dormitory students.

Arousal Thresholds and Depth of Sleep

An area of sleep research which provides potentially

useful data regarding signal characteristics which will reliably

awaken sleeping individuals in emergency situations is that which

focuses on the problem of depth of sleep. Davies (1976) notes

that "it is generally assumed that sleep stages vary in depth,

the depth of sleep becoming progressively greater from stage 1 to

stage 4." There has been, however, considerable controversy

regarding depth of sleep. Measures of auditory arousal or

awakening thresholds (AATs ) have been employed by many

investigators to address the issue of depth of sleep. It is from

such threshold studies that some gross approximations of

appropriate signal levels for emergency alarms can be obtained.

In an exhaustive review of the depth of sleep

literature, Bonnet (1975) introduces the topic of threshold

measurement by noting that "behavioral responsivity as a function

of signal intensity is an intuitively obvious way to approach

sleep and one that seems fairly simple. Unfortunately, it is not

simple." Neither is it a simple matter to use threshold measures

directly to suggest signal intensities (or other characteristics)

necessary for emergency alarms. Much of the difficulty in

applying these data arises from the fact that they were not

obtained for the purpose of specifying alarm criteria. Specific

problems associated with these data include (1) the criteria of

arousal or awakening used; (2) the lack of adequate specification

8
of the signals employed; (3) the existence of experimental

artifacts which confound direct application to fire alarms; and

C4) the very wide variability reported among similar individuals

(thus making generalizations to entire populations difficult)

Since most threshold studies have been performed with young

adults, generalization to the elderly, nursing home resident

becomes even more tenuous. Nevertheless, AAT data are some of

the best data currently available.

As Bonnet (1975) notes, threshold experiments present a large number of possible choices regarding stimulus selection

(e.g., frequency, rise-time, impulse characteristics), method of

presentation, stimulus duration and number of stimulus

presentations, etc. There is also a wide choice of response

measures, including EEG stage changes, physiological changes, EEG

defined arousal (presence of alpha rhythm) and behavioral

indications of awakening, e.g., button pressing or vocalizations.

Arousal Thresholds as a Function of Physical

Signal Characteristics

Using a 500 Hz tone, increased in 5 dB steps with a 10s

inter stimulus interval (ISI) until the subject responded,

Rechtschaf f en and Lentzner (1960, reported in Bonnet, 1975)

provide data to support the notion that sleep stage is related to

sleep depth. A greater intensity was required to obtain a response from stage 4 than from stage 3; and from stage 3 than

from stage 2, which was in turn greater than the intensity

required for a response from stage 1. Watson and Rechtschaf fen

(1969) , using a similar ascending method of limits with a 1000 Hz

tone, report a maximum AAT of about 60 dB for stage 2 and REM.

In both of these studies, sustained alpha (8 - 12 Hz) activity

was the response. Although alpha activity is typically

accompanied by behavioral awakening, it is not synonymous with

behaviorally defined awakening. Langford, Meddis and Pearson

(1974) reported considerably lower arousal latencies from stage 2

and REM for the onset of alpha rhythm than for pressing a microswitch taped to the subject's finger.

Rechtschaf fen , Hauri and Zeitlein (1966) used a variant

of the method of constant stimili rather than the ascending

method of limits in a threshold study because of the possibility

that stimuli which gradually increased in intensity may be

incorporated into dreams. Over all stages of sleep the median

AAT was about 65 dB above background level for a 2000 Hz tone of

5s duration. The response required was a vocalization of the

number of "blips" presented at an intensity 5 dB below the signal

tone a few seconds after the signal. Individual differences in

9
this study resulted in AATs ranging from 15 - 100 dB above

background. Therefore, the median AAT should not be used as any

absolute measure of awakening threshold. While Rechtschaf f en

,

Hauri, and Zeitlein found no evidence of incorporation of the

stimulus tone in REM sleep dreaming, Bradly and Meddis (1974)

did, based on subject reports. Using a white noise stimulus of

5s duration increased in 4 dB steps with a 5s ISI, they found a 10 dB difference in AAT as a function of dream incorporation.

The mean "unincorporated arousal" AAT was 59.9 dBA, while the

mean for those arousals in which the signal was incorporated in a dream was 69.9 dBA. Again, the range of AATs was fairly large:

48-79 dBA.

In a study using a bell (otherwise unspecified) as the

arousal stimulus and a behavioral response consisting of lifting

a telephone receiver, Shapiro, Goodenough and Gryler (1963)

report a mean AAT of 55 dB . This study employed an ascending

series of signals of 10s duration with an ISI of 5s between 6 dB

steps

.

Keefe, Johnson and Hunter (1971) using a 1000 Hz tone

of 5s duration presented in 5 dB steps with 55s between signals,

report AATs for REM, slow wave sleep (stages 3 and 4), stage 2

day sleep and stage 2 night sleep. Mean AATs, respectively, were

74, 75, 61, and 76 dB . Unfortunately, the difference between day

and night stage 2 arousals and the similarity among the AATs for

the night sleep are difficult to evaluate because a between

subjects rather than a repeated measures design was employed.

The relatively large ISI (55s) used in this study reduces the

likelihood of any additive effects of the increasing stimuli

intensity. This may account for the somewhat higher mean AATs

reported in this study than those previously reported. If this

is indeed the case, it provides an important consideration in

attempting to determine the "true" AAT for an alarm signal,

namely, AATs derived from studies with short ISIs probably

overestimate the responsivity of subjects to a tone of a given

intensity

.

Differences in AAT between "light" and "deep" sleepers

were investigated by Zimmerman (1970) . Using an ascending series

(800 Hz tone, Is duration, 5 dB steps, 8s ISI) with subjects

responding "I am awake," Zimmerman reports a median AAT of 65 dBA

over all sleep stages and all subjects. However, when the

subjects were divided into "light" and "deep" sleepers and the

data presented separately for the various sleep stages, a different picture emerges. Table 2 is a summary of Zimmerman's

data. Several features of these data are worthy of note. First,

the AAT from stage 2 sleep decreases, for both light and deep

10
TABLE 2 Auditory Awakening Thresholds (in dB) for a Light Sleep Group (LSG)

and a Deep Sleep Group (DSG) on Each of Seven Awakenings*

Awaking Sleep Stage Means

LSG

(dB)

DSG

#1 4 78.4 85 .

#2 2 60.3 75 .

#3 REM 56.6 70.9

#4 3 57. 8 74 . 7

# 5 2 55.7 70.3

#6 REM 55 .

72.3

#7 2 51 . 1 66 .

* Source: Zimmerman, 1970.

11
sleepers, as arousals are instigated later in the night. That

is, the AAT for arousal #2 is higher than #5 is higher than #7.

Responsivity to auditory stimulation, therefore, appears to

increase as a function of time of night. This result may be

interpreted as being contrary to results reported by Williams, et

al. (1964) that show a behavioral response (button pressing)

decreases for stage 2 as a function of time of night, suggesting

that responsivity decreases as the night passes. One should

also note the considerably higher AAT for stage 4 than for the

other sleep stages.

Agnew, Shaw and Webb (unpublished manuscript, personal

communication, Webb, 1977) further demonstrate the resistance of

stage 4 to arousal by auditory stimuli. Of 36 arousal attempts

during stage 4 (ascending series, 1000 Hz tone, 5 dB steps)

verbally indicated arousals were obtained only seven times at

less than 100 dB (Mean = 70 dB) ; five arousals were obtained only

after a 100 dB signal was presented for 60s; and in 24 cases 70s

of the 100 dB signal failed to produce arousal.

Arousal as a Function of Signal Meaningfulness

and Sleeper Motivation

Thus far we have been concerned only with the intensity

of relatively meaningless stimuli used to arouse subjects from

sleep. Several studies point to the importance of the

meaningfulness or motivating qualities of the signal.

Zung and Wilson (1961) found no significant differences

in EEG stage changes as a function of familiarity or

unfamiliarity with a variety of auditory stimuli including door

chimes, trains, cars, telephones, Chinese gongs, artillery fire,

bagpipes and monkey howls. However, subjects who were paid

(i.e., motivated) on the basis of their ability to awaken to

specific sounds (a telephone or bagpipes) responded more

frequently to "motivating" stimuli than to "non-motivating"

stimuli in all stages of sleep except stage 4. Zung and Wilson

conclude that familiarity/unfamiliarity per se is not important,

rather the motivating quality of a sound is the feature that

evokes responses (in this case awakening) to some sounds and not

to others.

Using essentially the same methodology, Wilson and Zung

(1966) tested for sex differences in responses to meaningful

(motivating) and neutral (non-motivating) sounds. In terms of

the percent of sleep stage-change responses to neutral stimuli,

females demonstrated a higher response rate than males.

12
Response rates to motivating stimuli did not differ as a function

of sex; both males and females demonstrated a higher response

rate to motivating than to neutral stimuli.

Williams, Morlock and Morlock (1963) informed subjects

that either a 700 or 1300 Hz tone presented at low intensity (40

dB) was critical and the other was not. The subject was to

respond to the critical signal by pressing a microswitch and

disregard the non-critical signal. Under conditions of simple

instruction, the proportion of signals to which responses were

made were very low in stage 2, delta and REM (approximately .28,

.08, and .05 respectively). On nights in which negative

reinforcement (flashing lights, intense fire alarm, shock to the

leg) resulted if there was no response to the critical signal,

response rates were increased in all stages of sleep (stage 2 - .48, delta - .12, and REM - .68).

Oswald, Taylor, and Triesman (1960) report a study in

which subjects were instructed to awaken and clench their left

fist whenever a name was spoken. They found that subjects

reponded more often to their own name than to a designated signal

name, and more often to the signal name than any other name.

Oswald et al., also found that a subject's own name was more

likely to produce a K-complex in the EEG record when played in

the normal forward direction than when the same stimuli was

played backward. Bonnet (1975) compared the results of Oswald et

al. with those of Howarth and Ellis (1961) who employed a methodology much like Oswald et al . , except that the subjects in

the latter study were awake. Bonnet concludes that

"discriminative capabilities in terms of the signal motivating

properties associated with one's own name appear at least as

great during sleep as during waking."

Langford, Meddis and Pearson (1974) instructed subjects

to respond by pressing a microswitch whenever they heard a sound

played over a loudspeaker while they slept. The subject's name

was played both forward and backward at 50 dBA (10 dBA above

background) during stage 2 and REM. Smaller response latencies

(i.e., faster reaction times) were found to names played forward

than names played backward for both sleep stages tested both for

the button press response and for the onset of alpha rhythm.

Reaction time, for both measures, was faster in REM than in stage

2. No interaction was found between sleep stage and stimulus

type

.

LeVere, Davis, Mills and Berger (1976) provide data

which they interpret as reaffirming the contention that the

cognitive value of a stimulus contributes to the sleep disruption

13
produced by an auditory stimulus. They suggest that those

stimuli which have a greater potential for intrusion into sleep

are those which have a consistent history of significance for the

individual. Those stimuli which do not have significance to the

individual are reacted to, if at all, solely on the basis of

their physical characteristics.

Arousal as a Function of Noise

The impact of environmental noise on both our waking and

sleeping behavior is an issue of increasing concern. Lukas

(1975, 1975a) provides an extensive review of the effects of

environmental noise on sleep and proposes a criterion for

assessing the effect. From a review of approximately 90 studies

which deal primarily with aircraft flyover noise and sonic booms,

Lukas selected about 20 studies which permitted an adequate

analysis of noise level and arousal criteria to identify the

functional relationship between sound level and the predicted

frequency of awakening or no sleep disturbance. Lukas suggests

that, on the basis of available data, the frequency of no sleep

disruption can be predicted more accurately than the frequency of

EEG defined arousal or behavioral awakening. Figures 2 and 3

show these relationships.

The measure of noise level used by Lukas is EPNdB . The

EPNdB concept takes into account the spectral characteristics and

duration of environmental noise which are not accounted for in

the more usual measures of dB or dBA. This measure was developed

for assessing the noise nuisance from aircraft (see Kryter, 1970)

and has meaning primarily in conjunction with such noises (Broch,

1969) .

In an unpublished manuscript, Lukas provides a figure

which shows the relationship between the percent of subjects

behaviorally awakened and noise level in dBA units. The righthand curve of Figure 4 is based on data from six studies

primarily involving aircraft noise. Based on this curve, one

would predict that approximately 80 percent of experimental

subjects would be awakened by a noise of about 80 dBA. The lefthand curve of Figure 4 is based on data from Steinicke (reported

in Lukas, 1975a). Steinicke ' s technique involved increasing

noise level without a period of silence between levels. Thus, as

the intensity increased, the signal duration also increased.

This likely accounts for the discrepancy between Steinicke'

s

results and those based on other investigations.

Data contained in the figures presented here are based

on studies of "college and middle age" men and women. Each

function would probably be displaced to the left for older

subjects

.

14
o

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SLOPE

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16

Figure

3.

Frequency

of

arousal

or

behavioral

awakening

from

sleep

as

a

function

of

noise

level.

(Source:

Lukas,

1975)
Figure 4. Frequency of arousal or behavioral

awakening as a function of noise level.

(Source: Lukas, unpublished)

17
Arousal by Non-Auditory Stimuli

Although all of the arousal threshold studies reviewed

for this report have employed auditory stimuli, it should be

recognized that other stimulus modalities might also be employed

in alarm systems. Kravontka (1975), for example, describes a

visual fire signal system for deaf school children. This system,

of course, is designed for alerting building occupants who are

awake. Considerably different problems than those addressed by

Kravontka are encountered by severely hearing-impaired

individuals who are sleeping.

Several investigations have utilized other non-auditory

stimuli to produce arousal. Pisano, Rosadini, Rossi and Zattoni

(1966) evaluated depth of sleep by studying the intensity of

painful electric stimuli to the forearm necessary to produce

arousal. Schmidt and Birns (1971) used a cold thermal stimulus

in an investigation of the behavioral arousal threshold of

sleeping infants. Differences in olfactory thresholds for

infants in two sleep states were investigated by Murray and

Campbell (1970) . Although these and other stimuli clearly are

capable of producing arousal, there does not appear to exist a body of literature which might suggest recommendations for

appropriate signal characteristics for alarms using non-auditory

stimuli

.

Arousal and Drugs

Although there is substantial literature on the effects

of drugs on sleep, very little data are available regarding the

effects of drugs on human arousal thresholds. Given the high

probability of regular drug use (tranquilizers, sleeping pills,

pain relieving medication, etc.) among residents in nursing homes

or other facilities for the aged, the effects of drugs on the

ease with which people can be aroused in emergency situations

becomes extremely important. It is clear that certain drugs do

alter normal sleep patterns. Williams, Agnew and Webb (1966),

for example, report that a single 200 mg dose of sodium

pentobarbital administered just prior to sleep produced a significant reduction in REM and a slight increase in stage 4

when compared with the effects of a placebo. A single 800 mg

dose of the tranquilizer meprobamate resulted in no change in the

basic sleep pattern. However, 1200 mg of meprobamate at bedtime

produced a decrease in REM. Secobarbital, a hypnotic prescribed

to facilitate sleep, has been shown to alter sleep patterns by

decreasing the time spent awake and in REM and increasing the

amount of stage 2 (Potvin, et al., 1975).

18
Only two threshold studies were identified which

demonstrate the effects of drugs on arousal thresholds. Bonnet

(doctoral dissertation reported by Webb, personal communication,

1977) found a substantial increase in stage 2 arousal threshold

after a single administration before sleep of 30 mg flurazepam or

100 mg pentobarbital. The effect was especially pronounced early

in the night, but persisted at least six to seven hours into the

sleep period. Caffeine, on the other hand, reduced waking

thresholds and increased sleep onset latencies. Bonnet (1975)

reports a pilot study involving threshold measurements after

administration of Quaalude (methaqualene ) . Fifteen minutes

before retiring, two subjects were given a standard 300 mg

Quaalude tablet. Thresholds were determined using an ascending

series and a button push response. Stage 2 AATs increased about

8 dB throughout the night as compared to a non-drug baseline

night

.

The relationship between drug use and effects on sleep

is best understood for alcohol. Williams and Salamy (1972), in

an extensive review of the effects of alcohol on sleep, note

significant differences between the sleep of the chronic

alcoholic and the moderate user. Sober, chronic alcoholics who

are not delerious or hallucinating demonstrate normal amounts of

REM sleep, but, with few exceptions, exhibit almost no short-wave

(stage 3-4) sleep. Large increases in REM can occur during

withdrawal from chronic intake of alcohol, amphetamines,

barbiturates and morphine. Moderate or single doses of alcohol

tend to cause early onset of sleep, small increases in cardiorespiratory rates accompanied by decreased motility and transient

increases in delta sleep with a delay or inhibition of REM.

The little available data relevant to the effects of

drugs on arousal from sleep clearly leave many questions

unanswered. While it appears evident that at least some commonly

used drugs do have a deleterious effect on arousal, very little

can be said about the relationship between chronic use of drugs

and the response of sleeping individuals to emergency alarms.

Conclusions and Implications for the Design of

Emergency Alarms

The review of the literature in the preceding sections

leads to the conclusion that currently available data do not

provide an adequate basis for specifying the signal

characteristics which will offer a high assurance of awakening a sleeping population. This conclusion is largely attributable to

the fact that most of the research reviewed was not oriented

19
specifically toward providing such information. However, a number of generalizations regarding signaled arousals can be

made. These generalizations have value primarily as hypotheses

to be tested, rather than as principles to be incorporated into

alarm specifications.

It is clear that the intensity of a signal sufficient to

produce arousal is highly variable; individual differences in

threshold are large. Generally, greater intensities are required

to arouse subjects from delta sleep (stages 3 and 4) than from

stage 2, which in turn requires a greater intensity than stage 1.

The placement of REM sleep in this hierarchy is less clear, but

when only intensity is considered, a signal which will produce

arousal from stage 4 is also likely to produce arousal from REM.

Arousal is obtainable with a progressively less intense

signal as the night progresses. However, this effect may be

confounded with sleep stage, sleep duration and circadian (daily)

rhythms

.

In certain respects, older individuals may be considered

easier to awaken than younger subjects due to the relatively low

proportion (in some individuals absence) of delta sleep and the

greater frequency of spontaneous arousals with increasing age.

Increasing age may also be associated with decreased arousal

thresholds within each stage of sleep. The presumed "advantages"

in terms of increased ease of arousal associated with advanced

age may be offset by the commonly found impairment in

sensory/perceptual functioning which also accompanies increased

age

.

Individuals with symptoms of depression will tend to

exhibit exaggerated degrees of the normal sleep changes

associated with age.

Stimuli which have personal significance or meaning may

produce arousal at lower levels of intensity than neutral

stimuli. Further, previously neutral stimuli can obtain

significance through learning or instruction. Clearly the

motivation of individuals to respond predisposes awakening

responses

.

It is conceivable that signals may be incorporated in

dreams and this may inhibit or delay awakening in response to a signal which would otherwise produce arousal.

Finally, the action of drugs on arousal, while not

firmly established, may reduce the probability of awakening to a given signal.

20
These general conclusions, while arrived at

independently, are compatable with those reached by the authors

of other papers dealing with the subject of arousal from sleep by

alarms (Bloom, 1971; Bixler, N.d.).

In addition to outlining the general conclusions drawn

from the sleep literature, it is appropriate to mention that

general principles for good alarm design have been provided by

several authors (e.g., Deatherage, 1972; McCormick, 1964;

Seminara, 1965). With few exceptions, however, these principles

offer little assistance in specifying criteria for alarms which

will reliably awaken people in fire situations. Signal design

and selection criteria for use in other specific applications are

also available. For example, Siegel and Crain (1960) provide

guidelines for presenting cautionary-warning information in

aircraft. Trucks and Adams (1975) specify procedures for auditory

signals in industrial environments, and Keating and Loftus

(1977) provide guidelines for vocal alarms directed at staff in

hospitals and nursing facilities. Within the fire community

there has been considerable controversy concerning the

development of a standard fire alarm signal. While proponents of

various signal types, for example the "slow whoop" (Humphreys,

1973; Gosswiller, 1975) and coded temporal patterns (Mande , 1975)

offer many valid advantages of one type or another, no

substantive information about arousal producing capabilities are

identified

.

Performance After Sudden Arousal

Given the situation in which an emergency alarm does

awaken an individual, it is then necessary that he or she be

capable of performing the appropriate life-safety activities.

Although literature which bears on this issue was not

exhaustively reviewed, several indications of post-arousal

performance decrement should be noted.

Tebbs (1972), in a review of post-awakening performance

as it relates to certain military operations suggests that "prior

research has demonstrated the performance decrements may range

from 25 percent to 360 percent. Yet, while it is well

established that performance decrements may be expected in the

post-arousal period, the determinants of the post-arousal

decrement have not been well established." Among the factors

which may affect post-arousal performance are: the sleep stage

preceding awakening, the time of night during which awakening

occurs, the nature of the required performance and the chronic

anxiety level of the individual awakened.

21
Johnson (1973) suggests that effective responding can be

expected to occur more quickly upon arousal from stage 2 or REM

sleep than upon arousal from slow-wave (stage 3-4) sleep.

Feinberg, Koresko and Heller (1967)/ however, note that on some

occasions elderly, chronic brain syndrome patients, awakened from

REM, displayed states of delerium with fixed ideas on which they

attempted to act. Scott (1969) found that performance on a battery of reaction time, detection threshold and cognitive tasks

showed marked decrement after abrupt arousal from all sleep

stages with some trend (non-significant) for performance

following REM awakenings to be superior to performance following

NREM arousals. However, as Scott points out, none of the tasks

on which his subjects were tested had the "arousing" quality

which "fire" may have.

A number of studies show decrements in grip strength

upon arousal (e.g.. More, Jenkins and Barker, 1922; Jenneret and

Webb, 1963; and Tebbs and Foulkes, 1966) . While the effects of

prior sleep length and sleep stage on this measure are somewhat

ambiguous, Tebbs and Foulkes suggest that for tasks which require

more intellectural involvement, it might be expected that

performance would be more impaired after arousal from REM due to

possible dream incorporation.

The transition from sleep to wakefulness is consistently

shown to require considerable time. Seminara and Shavelson

(1969) found that while the most rapid performance recovery by a space crew upon sudden arousal took place in the first threeminute period following arousal, the effects of drowsiness

persisted up to 9 to 12 minutes following the alarm. Langdon and

Hartman (1961) also provide data which indicate significant

performance decrements on a psychomotor task for 10 minutes

following arousal. Proficiency after 10 minutes approached but

did not reach pre-sleep levels.

It is likely that the performance decrements observed

upon abrupt arousal from sleep may be more severe if the

individual is under the influence of tranquilizing or hypnotic

drugs. Potvin, et al. (1975), found that the performance

following arousal from stage 4 of subjects who had received

secobarbital 1 to 1-1/2 hours earlier was slightly enhanced for

tasks involving predictable speed and coordination. However, the

drug impaired performance on unpredictable tasks requiring

coordination and fast reactions. The authors note that the

results of this study cannot be extended to prolonged use of

secobarbital or to individuals performing highly skilled tasks

under emergency conditions.

22
The implications of these data for performing life

preserving activities in a fire situation after abrupt arousal

are not immediately obvious. It is clear, however, that postarousal behavior in such emergency conditions must be considered

along with the evaluation of arousal per se. It is also

conceivable that there is an interaction between post-arousal

performance and the type of signal-producing arousal.

Recommendations for Future Studies of

Arousal by Emergency Alarms

The literature reviewed regarding sleep and arousal does

not provide the data required to recommend specifications for

emergency alarms which will reliably awaken a substantial portion

of the population in the event of a fire. This is not to suggest

that many current systems may not be adequate, but rather that

their efficacy in arousing sleeping individuals is largely

unknown. Although it is unlikely that any single experimental

effort will be capable of providing definitive alarm

specifications for every environment in which there is a need to

provide arousal-producing signals, many of the questions

surrounding alarm specification are amenable to empirical

solution. Some of the more important considerations which should

be taken into account in the design of such experiments are

discussed below.

Stimulus Characteristics and Presentation . A variety of

signal characteristics including intensity, frequency,

meaningfulness, and temporal pattern are appropriate for

investigation. It is recommended that the initial focus of

research should be to determine the signal intensity required to

arouse the specified sleeping population. Other signal

characteristics should be selected from existing alarm signals

including smoke detectors, fire bells, and horns, etc. Subjects

should be exposed to the experimental signal inf requently--no

more that one to three exposures per experimental night —to

minimize the effects of expectancy and any additive effects of

repeated stimulation.

Subjects . Because of large differences in sleep and

arousal as a function of age, sex, and physical and mental

condition, selection of subjects becomes crucial if any

generalizations regarding the "arousability " of alarms are to be

made. Generalizations about arousal of nursing home populations,

for example, made from studies of college students will be

tenuous at best. Selection of subjects should take into account

23
decrements in hearing associated with aging to assure that

experimental samples are representative of target populations.

The influence of drugs upon arousal, particularly sedatives,

provides an especially difficult problem for the researcher. The

most rigorous test of the effects of such drugs on arousal would

require a series of studies with specific drugs administered in

various controlled doses with the appropriate experimental

controls (including double blind paradigms and the use of

placebos, etc.). It may be more expedient to include individuals

who use such drugs in subject selection.

Experimental Environment . The choice of experimental

setting for a study of alarm intensities sufficient to produce

arousal is complicated by two incompatible requirements. First,

experimental arousals should be carried out under conditions as

much like those encountered in the normal sleep environment as

possible. That is, the best setting for such experiments would

be in the subjects' residence. Second, the sleep literature

clearly indicates that sleep stage as defined by EEG patterns is

an important determinant of arousability . Therefore, signals

should be presented during identified sleep stages, especially

stage 4 since in this stage individuals are particularly

resistant to external stimuli. The only practical environment

for the necessary recordings to be made is an established sleep

laboratory. It is suggested that a two-phase approach be

considered in any proposed research. The first, experimentally

rigorous phase, would be carried out under laboratory conditions

and the second, or validation phase, would be accomplished in a more natural, residental setting.

Measures of Arousal . As evidenced in the review of

sleep literature, arousal can be defined by a variety of criteria

including brain activity, behavioral responses and vocalizations.

For the purposes of alarm specification, it is recommended that

the subjects' response include a time dependent post-arousal task

that is in some way comparable to the appropriate response in an

actual fire situation. The response need not be physical

evacuation. It should, however, be sufficient to demonstrate

that the subjects have reached a level of arousal at which they

can perform relatively simple decision-making tasks or other

responses at a level comparable to the adaptive task.

Clearly, many other features of good experimental design

must be considered in developing a research program aimed at

empirically determining the characteristics of emergency signals

which will arouse individuals to a state in which appropriate

life saving action can be taken. The obvious necessity of

providing effective fire alarm systems, particularly in

institutional environments, suggests that such a research program

be instituted.

24
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NBS-114A ire: v, 7 - 73 )

U.S. DEPT. OF COMM. BIBLIOGRAPHIC DATA

SHEET

1. PUBLICATION OR REPORT NO. NBSIR 78-1484 (HEW)

2. Gov’t Accession

No.

3. Recipient’s Accession No.

4. TITLE AND SUBTITLE

Arousal from Sleep by Emergency Alarms:

Implications from the Scientific Literature

5. Publication Date June 1978

6. Performing Organization Code

7. AUTHOR(S)

V.J. Pezoldt and H. P. Van Cott

8. Performing Organ. Report No.

9. PERFORMING ORGANIZATION NAME AND ADDRESS

NATIONAL BUREAU OF STANDARDS

DEPARTMENT OF COMMERCE

WASHINGTON, D.C. 20234

10. Project/Task/Work Unit No.

11. Contract/Grant No.

12. Sponsoring Organization Name and Complete Address (Street, City, State, ZIP

)

Department of Health, Education and Welfare

Public Health Service

13. Type of Report & Period Covered

Final

14. Sponsoring Agency Code

15. SUPPLEMENTARY NOTES

16. ABSTRACT (A 200-word or less factual summary of most significant information. If document includes a significant

bibliography or literature survey, mention it here.) A review of the sleep research and other scientific literature

pertaining to the arousal of sleeping individuals by external

stimuli is reported. This effort was undertaken to provide

information about the characteristics of emergency alarms which will

reliably awaken a sleeping population, especially nursing home

residents, in the event of fire. The literature reviewed does not

provide an adequate basis for specifying signal characteristics

which will offer a high assurance of producing arousal. Among the

factors that influence the intensity of a signal which will produce

arousal are the age and physical/mental condition of the sleeper,

drug use, sleep stage, time of night, and meaningfulness or personal

significance of the signal. Data relevant to these variables are

discussed as is the problem of performance following abrupt arousal.

Recommendations regarding stimulus characteristics, measures of

arousal and the experimental environment for future studies of

arousal by emergency alarms are presented.

17. KEY WORDS (six to twelve entries; alphabetical order; capitalize only the first letter of the first key word unless a proper name; separated by semicolons) Alarms . arousal; auditory arousal thresholds;

emergency signals; fire alarms; sleep research

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