Sleep is a physiologic recuperative state that may be negatively affected by factors such as psychosocial and work stress as well as external stimuli like noise. Chronic sleep loss is a common problem in today's society, and it may have significant health repercussions such as cognitive impairment, and depressed mood, and negative effects on cardiovascular, endocrine, and immune function. This article reviews the definition of disturbed sleep versus sleep deprivation as well as the effects of noise on sleep. We review the various health effects of chronic partial sleep loss with a focus on the neuroendocrine/hormonal, cardiovascular, and mental health repercussions.

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There is an ample number of laboratory and field studies which provide sufficient evidence that aircraft noise disturbs sleep and, depending on traffic volume and noise levels, may impair behavior and well-being during the day. Although clinical sleep disorders have been shown to be associated with increased risk of cardiovascular diseases, only little is known about the long-term effects of aircraft noise disturbed sleep on health. National and international laws and guidelines try to limit aircraft noise exposure facilitating active and passive noise control to prevent relevant sleep disturbances and its consequences. Adopting the harmonized indicator of the European Union Directive 2002/49/EC, the WHO Night Noise Guideline for Europe (NNG) defines four Lnight , outside ranges associated with different risk levels of sleep disturbance and other health effects (<30, 30-40, 40-55, and >55 dBA). Although traffic patterns differing in number and noise levels of events that lead to varying degrees of sleep disturbance may result in the same Lnight , simulations of nights with up to 200 aircraft noise events per night nicely corroborate expert opinion guidelines formulated in WHO's NNG. In the future, large scale field studies on the effects of nocturnal (aircraft) noise on sleep are needed. They should involve representative samples of the population including vulnerable groups like children and chronically ill subjects. Optimally, these studies are prospective in nature and examine the long-term consequences of noise-induced sleep disturbances. Furthermore, epidemiological case-control studies on the association of nocturnal (aircraft) noise exposure and cardiovascular disease are needed. Despite the existing gaps in knowledge on long-term health effects, sufficient data are available for defining limit values, guidelines and protection concepts, which should be updated with the availability of new data.

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There is growing interest in carrying out further research to understand and reduce the impact of aircraft noise on airport neighborhood in anticipation of the projected substantial increase in global aviation. Soundscapes provide new analytical methods and a broader, more comprehensive appreciation of the aural environment, which may have a useful role in understanding noise-induced sleep disturbance and annoyance. Current noise metrics like Leq do not provide a common language to report noise environment to residents, which is a key obstacle to effective noise management and acceptance. Non-auditory effects complicate the production of consistent dose-response functions for aircraft noise affecting sleep and annoyance. There are various end-points that can be chosen to assess the degree of sleep disturbance, which has detracted from the clarity of results that has been communicated to wider audiences. The World Health Organization (WHO-Europe) has produced Night Noise Guidelines for Europe, which act as a clear guide for airports and planners to work towards. Methodological inadequacies and the need for simpler techniques to record sleep will be considered with the exciting potential to greatly increase cost-effective field data acquisition, which is needed for large scale epidemiological studies

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In the 1980s/90s, a number of socio-acoustic surveys and laboratory studies on railway noise effects have observed less reported disturbance/interference with sleep at the same exposure level compared with other modes of transportation. This lower grade of disturbance has received the label "railway bonus", was implemented in noise legislation in a number of European countries and was applied in planning and environmental impact assessments. However, majority of the studies investigating physiological outcomes did not find the bespoke difference. In a telephone survey (N=1643) we investigated the relationship between railway noise and sleep medication intake and the impact of railway noise events on motility parameters during night was assessed with contact-free high resolution actimetry devices. Multiple logistic regression analysis with cubic splines was applied to assess the probability of sleep medication use based on railway sound level and nine covariates. The non-linear exposure-response curve showed a statistically significant leveling off around 60 dB (A), Lden. Age, health status and trauma history were the most important covariates. The results were supported also by a similar analysis based on the indicator "night time noise annoyance". No railway bonus could be observed above 55 dB(A), Lden. In the actimetry study, the slope of rise of train noise events proved to be almost as important a predictor for motility reactions as was the maximum sound pressure level - an observation which confirms similar findings from laboratory experiments and field studies on aircraft noise and sleep disturbance. Legislation using a railway bonus will underestimate the noise impact by about 10 dB (A), Lden under the conditions comparable with those in the survey study. The choice of the noise calculation method may influence the threshold for guideline setting.

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This article reviews event-related potentials (ERPs) the minute responses of the human brain that are elicited by external auditory stimuli and how the ERPs can be used to measure sleep disturbance. ERPs consist of a series of negative- and positive-going components. A negative component peaking at about 100 ms, N1, is thought to reflect the outcome of a transient detector system, activated by change in the transient energy in an acoustic stimulus. Its output and thus the amplitude of N1 increases as the intensity level of the stimulus is increased and when the rate of presentation is slowed. When the output reaches a certain critical level, operations of the central executive are interrupted and attention is switched to the auditory channel. This switching of attention is thought to be indexed by a later positivity, P3a, peaking between 250 and 300 ms. In order to sleep, consciousness for all but the most relevant of stimuli must be prevented. Thus, during sleep onset and definitive non-rapid eye movement (NREM) sleep, the amplitude of N1 diminishes to near-baseline level. The amplitude of P2, peaking from 180 to 200 ms, is however larger in NREM sleep than in wakefulness. P2 is thought to reflect an inhibitory process protecting sleep from irrelevant disturbance. As stimulus input becomes increasingly obtrusive, the amplitude of P2 also increases. With increasing obtrusiveness particularly when stimuli are presented slowly, a later large negativity, peaking at about 350 ms, N350, becomes apparent. N350 is unique to sleep, its amplitude also increasing as the stimulus becomes more obtrusive. Many authors postulate that when the N350 reaches a critical amplitude, a very large amplitude N550, a component of the K-Complex is elicited. The K-Complex can only be elicited during NREM sleep. The P2, N350 and N550 processes are thus conceived as sleep protective mechanisms, activated sequentially as the risk for disturbance increases. During REM sleep, the transient detector system again becomes somewhat activated, the amplitude of N1 reaching from 15 to 40% of its waking level. Very intense and/or very infrequently presented stimuli might elicit a P3-like deflection suggesting an intrusion into some aspect of consciousness. The types of experimental paradigms used in most ERP studies are quite different from those used in the study of noise and its effects on sleep. ERP studies will need to employ procedures that have greater ecological generalization; stimulus intensity needs to be lower, less abrupt, with much longer durations, and importantly, stimuli should be presented much less often.

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Several relationships between intruding noises (largely aircraft) and sleep disturbance have been inferred from the findings of a handful of field studies. Comparisons of sleep disturbance rates predicted by the various relationships are complicated by inconsistent data collection methods and definitions of predictor variables and predicted quantities. None of the relationships is grounded in theory-based understanding, and some depend on questionable statistical assumptions and analysis procedures. The credibility, generalizability, and utility of sleep disturbance predictions are also limited by small and nonrepresentative samples of test participants, and by restricted (airport-specific and relatively short duration) circumstances of exposure. Although expedient relationships may be the best available, their predictions are of only limited utility for policy analysis and regulatory purposes, because they account for very little variance in the association between environmental noise and sleep disturbance, have characteristically shallow slopes, have not been well validated in field settings, are highly context-dependent, and do not squarely address the roles and relative importance of nonacoustic factors in sleep disturbance. Such relationships offer the appearance more than the substance of precision and objectivity. Truly useful, population-level prediction and genuine understanding of noise-induced sleep disturbance will remain beyond reach for the foreseeable future, until the findings of field studies of broader scope and more sophisticated design become available.

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Cortisol awakening response (CAR), a considerable increase in cortisol concentrations post-awakening, is considered a reliable indicator of the reactivity of the hypothalamus-pituitary-adrenal axis (HPA). As noise has been shown to activate the HPA-axis, this analysis focuses on CAR as a possible indicator of noise-induced sleep disturbances. This analysis focuses on CAR using two studies. In Study 1, six women and six men (18-26 years) slept for 13 nights each in the laboratory. They were exposed to the noises of three different trains, each with 20, 40 or 80 pass-bys, with equivalent noise levels varying between 44 and 58 dBA, on nine nights. In Study 2, 23 persons slept first for four nights and then four days, in the laboratory; finally 23 persons slept in the reverse order. During six sleep periods, they were randomly exposed to road or rail traffic noises with L _Aeq varying between 42 and 56 dBA. To determine the CAR, salivary cortisol concentrations were ascertained in both studies after night sleep immediately after awakening, and 15 and 45 minutes later; in Study 2 also after 30 and 60 minutes later. The time of awakening was determined using the polysomnogram and the participants rated their subjective sleep quality every morning. Subjective sleep quality was rated worse after noisy when compared to quiet nights. CAR was, however, attenuated only after the noisiest nights in a subgroup of Study 2. These persons had just performed a sequence of four consecutive night shifts. They were obviously still in the process of re-adjustment to their usual day-oriented schedule and probably in a state of elevated vulnerability. The study concludes that nocturnal noise exposure affects the CAR only if a person is in a state of at least temporarily elevated vulnerability.

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Considering the scientific evidence on the threshold of night noise exposure indicated by L _night as defined in the Environmental Noise Directive (2002/49/EC), L _night value of 40 dB should be the target of the night noise guideline (NNG) to protect the public, including the most vulnerable groups such as children, the chronically ill and the elderly. L _night value of 55 dB is recommended as an interim target for countries which cannot follow NNG in the short term for various reasons and where policy-makers choose to adopt a stepwise approach. These guidelines may be considered an extension to the previous World Health Organization (WHO) guidelines for community noise (1999).

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Research on nighttime sleep disturbance due to community noise sources, particularly from exposure to aircraft noise, has been conducted for over a half decade. However, there are still no national environmental noise policies (i.e., laws and regulations) promulgated which prescribe a specific criterion for an exposure limit which is regulatory in nature. In the U.S., the new American National Standards Institute (ANSI) Noise Standard, ANSI S12.9-2008/Part 6, Quantities and Procedures for Description and Measurement of Environmental Sound - Part 6: Methods for Estimation of Awakenings Associated with Outdoor Noise Events Heard in Homes, does provide the currently recommended exposure-response relationship used in the U.S. In Europe, there has also been significant laboratory and field research on sleep disturbance, although the U.S. and European research publications often use different research methodologies, different noise metrics and different meta-analysis techniques. The current article will provide a brief overview of sleep disturbance research internationally to document the similarities and differences between the various research approaches and research results.

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Event-related potentials (ERPs) provide an exquisite means to measure the extent of processing of external stimuli during the sleep period. This study examines ERPs elicited by stimuli with physical characteristics akin to environmental noise encountered during sleep. Brief duration 40, 60 or 80 dB sound pressure level (SPL) tones were presented either rapidly (on average every two seconds) or slowly (on average every 10 seconds). The rates of presentation and intensity of the stimuli were similar to those observed in environmental studies of noise. ERPs were recorded from nine young adults during sleep and wakefulness. During wakefulness, the amplitude of an early negative ERP, N1, systematically increased as intensity level increased. A later positivity, the P3a, was apparent following the loudest 80 dB stimulus regardless of the rate of stimulus presentation; it was also apparent following the 60 dB stimulus, when stimuli were presented slowly. The appearance of the N1-P3a deflections suggests that operations of the central executive controlling ongoing cognitive activity was interrupted, forcing subjects to become aware of the obtrusive task-irrelevant stimuli. The auditory stimuli elicited very different ERP patterns during sleep. During non-rapid eye movement (NREM) sleep, the ERP was characterized by an enhanced (relative to wakefulness) early positivity, P2, followed by a very prominent negativity, the N350. Both deflections systematically varied in amplitude with stimulus intensity level; in addition, N350 was much larger when stimuli were presented at slow rates. The N350, a sleep-specific ERP, is thought to reflect the inhibition of processing of potentially sleep-disrupting stimulus input. During rapid eye movement (REM) sleep, a small amplitude N1 was apparent in the ERP, but only for the loudest, 80 dB stimulus. A small (nonsignificant) P3a-like deflection was also visible following the 80 dB stimulus, but only when stimuli were presented slowly. The findings of the present study offer, on one hand, an explanation of the means by which consciousness is prevented during sleep but also, on the other hand, an explanation of how sleep can be disrupted and possibly reversed, leading to an awakening.

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