![]() The higher the index, the more sleep is disrupted. Sleep Fragmentation Index-Sleep Fragmentation is an index of restlessness during the sleep period expressed as a percentage. Wake after sleep onset-The total number of minutes the subject was awake after sleep onset occurred. Sleep efficiency (%)-Number of sleep minutes divided by the total number of minutes the subject was in bed. ![]() Total sleep time-The total number of minutes scored as “asleep.” Sleep was monitored during each flight and for 24 h at the destination with an ActiGraph wGT3X-BT activity monitor (ActiGraph, Pensacola, FL) worn on the nondominant wrist. The Liverpool Jet-Lag Questionnaire ( 15) was administered after 24 and 48 h at the destination. No group traveled in the summer, and we avoided any changes in time due to daylight savings time.įor each flight, the relevant basal insulin was adjusted as described below, and interstitial blood glucose was measured with blinded CGM (Freestyle Libre Pro, Abbott Diabetes Care). Most traveling was done in the winter and spring, and one group traveled in the fall. ![]() All participants and study staff traveled in the economy or coach section of the plane for all flights, and all flights were nonstop. Participants traveled in the same direction of travel as for the first trip but on the new basal insulin. After 2 weeks, the alternative basal insulin was started (glargine U100 to insulin degludec or insulin degludec to glargine U100), and the optimization protocol outlined above was repeated. The return to Santa Barbara was followed by a 2-week period where the participants returned to their original insulin regimen. After this, they flew to New York, NY, where they spent 72 h before returning to Honolulu, HI, to spend 72 h there and then returned to Santa Barbara, CA. Participants were recruited in Santa Barbara, CA, and traveled to Honolulu, HI, where they spent 2 days adjusting to that time zone.
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