Participants

    The one participant being studied in detail was part of a larger research project studying the effects of sleepiness and attention deficits on Traumatic Brain Injured patients.  These participants were recruited with funding from Saint Anselm College and Suffolk University Graduate School of Psychology.  Institutional Review Board (IRB) approval was obtained from both Saint Anselm College and Suffolk University Graduate School of Psychology (see Appendix A).  Recruiting efforts were made mainly within southern New Hampshire and northern Massachusetts.  Advertisements were placed in local newspapers such as the Goffstown News, Hooksett News, Bedford News, Concord Monitor, Berlin Daily News and Union Leader and Press Releases appeared in the Goffstown News, Bedford News, Hooksett News, and Bow Times.  Flyers were hung locally at Saint Anselm College, the local Shop and Save, Manchester library, a local Martial Arts Center, the local Panera Bread, the local Police Station, and Manchester Art Museum (see Appendix B).
    Information regarding the study was also placed on the webpages of the New Hampshire Psychological Association, and Saint Anselm College Psychology homepage.  Researchers also met with staff from the Rehabilitation Medical Unit at Catholic Medical Center and asked if the staff could relay information about this study to their patients.  In addition, letters were sent to forty area neurologists and the Head Injury Association asking these professionals to relay information regarding the study to their patients as well (see Appendix C).  Follow-up calls were made to the neurologists and questions were handled if necessary.  If interested, participants were asked to call the Saint Anselm College Psychology Department.
The participants, if qualified, participated in the Hypersomnolence and Attention Deficits in Traumatic Brain Injury Research study. A fine-grain analysis was performed on one participant.  The information regarding this participant is not included due to confidentiality concerns.
    The International League Against Epilepsy describes epilepsy as being characterized by recurrent, unprovoked seizures originating from the medial or lateral temporal lobe and classifies it as Temporal Lobe Epilepsy (TLE) (Yko, Sahai, Passaro, Erasmo, 2001).  In combination with TLE, patients often experience hippocampal sclerosis and auras.  Antiepileptic drugs (AED’s) such as phenytoin, Phenobarbital, carbamazepine, valproate, etc. are prescribed to patients in an attempt to eliminate seizure activity.  Forty-seven to sixty percent of new onset partial seizures can be controlled by the first prescribed AED (Yko et al., 2001).
    No further information may be given in regards to Participant 1 for confidentiality reasons.

Materials

    A quiet room with a bed, fitted sheet, flat sheet, blanket, pillow, an EEG monitoring room, a quiet room for testing with a desk, 2 chairs, and a two-way mirror observation opportunity, Infa-red and Panasonic Color CCTV camera video monitoring system model #WV-CP414, overhead intercom, thermometer, Somnologica 3.1.1 programming with Embla headboard and processing Electroencephlograph (EEG) equipment manufactured by Flaga Medical Devices serial # F190004-SV, Radio Shack Ohm Meter model #22-221, 12 electrodes, 5 Conmed huggables, and materials necessary to perform a MSLT according to protocol set by Carskadon and Herman, (1999) were all necessary for the completion of the sleep study portion of this research project.  A tape recorder, pen, pencil, colored pencils, testing computer, “Quiet Testing in Progress” signs, lab coat, clock with stop watch, documents necessary for participant consent and tests were necessary for the remaining portions of the study.
Structured Phone Qualification Interview: The Structured Phone Qualification Interview sought to attain verbal consent and then proceeded to inquire about the circumstances surrounding the traumatic brain injury of the prospective participant including recency, severity, loss of consciousness.  Other questions inquired about whether the participant had difficulties with sleep and/or attention, medications, employment, and medical history (see Appendix D).
 Informed Consent. The Informed Consent notified the participant as to what type of study with which they were involved and obtained their consent. It explained the two-part nature of the study and its assessment of attention and hypersomnolence deficits related to truamatic brain injury (see Appendix E)
 Medical History Release. The Meidcal History Release obtained the consent of the participant for researchers to obtain medical history records in order to determine a more complete analysis of the data.  This enabled researchers to verify the TBI and obtain other extraneous information that could be of potential value in assessment (see Appendix F).
Demographic/Sleep Questionnaire.  The Demographic/Sleep Questionnaire asked the participant to provide self-report information regarding sex, age, date of birth, marital status, education, ethnicity, occupation and handedness, sleep patterns and sleep disturbances for day and night, information regarding occupation, medication, alcohol consumption, and present level of pain.  These were assessed by filling in the appropriate information, indicating “yes” or “no”.  Other information regarding sleep was obtained by requesting the participant fill out a four-point-likert-scale ranging from “rarely” to “always” (see Appendix G).
 Snoring/Sleep Apnea Worksheet. The Snoring/Sleep Apnea worksheet is a precautionary measure that looked to screen out participants that may have had sleep apnea and were unaware of their condition.  The is a measure asks for collar size, height, weight, and indications of handedness, snoring and nor gasping/choking.  These measurements assess the possibility of Sleep Apnea.  Participants with Sleep Apnea would not be viable for the purposes of this study (see Appendix H).
 Delis-Kaplan Executive Functioning System.  The Delis Kaplan Executive Functioning System is a comprehensive arrangement of test designs was compiled by Delis, Kaplan and Kramer (2001) to assess high-level cognitive functioning.  These tests are an attempt to fill the need for appropriate assessment of dysexecutive syndromes (Schmidt, 2003).  The following standardized tests compose the D-KEFS: Trail Making Test, Verbal Fluency Test, Design Fluency Test, Color-Word Interference Test, Sorting Test, Twenty Questions Test, Word Context Test, Tower Test, Proverb Test.  Reliability and validity for each subtest are stated in the D-KEFS  Technical Manual (Delis, Kaplan, Kramer, 2001).  Reliability was determined by internal consistency and test-retest reliability.  Validity was determined by inter-correlations of measures within individual D-KEFS tests.  Inter-correlations were run to be sure each subtest was measuring what it was supposed to measure and that that measurement was different amongst each subtest.
The D-KEFS Trail Making Test was originally developed by Partington in 1938 (D-KEFS Manual, 2001). Over time its name changed from Distributed Attention Test to Partington Pathways Test and then ultimately to the Trail Making Test (D-KEFS Manual, 2001).  The D-KEFS version is comprised of five conditions.  Condition 1 measures Visual Scanning.  It asks the respondent to put a slash through all of the number 3s present on the sheet before them.  Number Sequencing asks the participant to draw through the pattern in numerical order while condition 3 asks the same thing, this time with Letter Sequencing.  Number-Letter Switching is a primary executive function test.  The last condition measures motor speed by testing to see how long it takes the respondent to trace a pattern from start to end (see Appendix I).
The D-KEFS Verbal Fluency Test is a combination of the “FAS” and other verbal assessments.  The FAS asks the participant to say all words they can think of that begin with “F”, then those that begin with “A” and finally, those words that begin with “S”.  They have sixty seconds for each letter.  Superior convergent validity and discriminant validity were demonstrated (Spector, Paul. E., Fox, Suzy, 2003).  The other two sections allot sixty seconds to think of animals and sixty seconds to think of boys names.  The participant then has to alter between saying the name of a food and the name of a piece of furniture (see Appendix J).
The D-KEFS Design Fluency Test is composed of three conditions.  The participant is presented rows of boxes each containing an array of dots.  In each condition the participant must make 4 lines to make a design.  In Condition 1 he/she is allowed to only connect with filled dots.  In Condition 2, he/she is allowed to only connect the empty dots.  In Condition 3, he/she is required to switch between filled and empty dots.  Good inter-rater reliability was assessed (Carter, Shore, Harnadek, Kubu, 1998) (see Appendix K).
The D-KEFS Color-Word Interference Test is derived from the Stroop Test which was developed in 1935 for studying the effects of verbal interference.  Reliability and concurrent validity were ascertained  by means of a cross-validation study using a multiple discriminant analysis (Schuboe, Werner, Hentschel, and Uwe, 1977; Jensen and Rohwer, 1966).  The D-KEFS version contains three conditions.  In the first, the participant must read the words printed in different colors.  They must name the colors in which the words are printed.  Condition 2 consists of reading of words in black ink.  The participant must simply read the word.  Condition 3 required the participant to read the words printed and say the color ink of the words that were enclosed in a box. (see Appendix L).
The D-KEFS Sorting Test was made based upon the California Card Sorting Test.  This received good correlations between subset and total set of scores (Greve, Kevin W., Williams, Mary C., Crouch, John A., 1995) but other information on reliability and validity were not available.  The D-KEFS Sorting Test was developed in the late 1980’s (D-KEFS Manual, 2001).  The test consists of two conditions: (1) Free Sorting where the participant is asked to sort the cards into two groups, with three cards in each group and (2) sort recognition where the test administrator sorts the cards into two groups with three cards in each group.  The participant identifies and describes correct rules for each sort done by the administrator (see Appendix M).
The D-KEFS Tower Test was developed from earlier tests such as the Towers of Hanoi, London, and Toronto.  Anderson, Anderson, and Lajoie (1996) provided validation and standardization for the pediatric population.  The D-KEFS model provides an improved version specifically for the study of planning and problem-solving in patients with frontal activity.  This task includes five disks that vary in size and a board with three pegs.  Each task begins with the examiner placing the disks in a pre-determined arrangement.  The participant is shown an “ending position” of the disks and is asked to move the disks on the board with the least amount of moves in the least amount of time.  The participant is not allowed to move any more than one at a time and cannot place a larger disk on top of a smaller disk (D-KEFS Manual, 2001) (see Appendix N).
The D-KEFS Proverb Test is an alteration of the verbal comprehension subsets of the Wechsler IQ Scales.  The original D-KEFS test was created in 1988 by Delis, Kramer, and Kaplan.  It was originally called the California Proverb Test.  It consists of eight sayings that are presented in two conditions: (1)Free Inquiry and (2) Multiple Choice.  The first condition presents the participant with a common clequed phrase and asks the participant to describe its meaning.  The second condition present the same phrases, but provides multiple choice answers from which the participant may choose to the best option.  This test measures the nature of an individual’s verbal abstraction skills (D-KEFS Manual, 2001) (see Appendix O).
The D-KEFS Twenty Questions Test was first developed by Mosher and Hornsby in 1966.  The task is designed to assess concept-formation skills.  Modifications were made to the D-KEFS version, including nature of stimulus objects, hierarchical organization, and the quantification of multiple process measures.  The participant is presented with a page with 30 common objects.  By asking yes and no questions the participant must find the target object (D-KEFS Manual, 2001) (see Appenix P).
The D-KEFS Word Context Test was designed by Werner and Kaplan in 1952 to assess the acquisition of word meanings in children.  The participant is provided with a mystery word and is shown five clue sentences to determine the meaning of the word.  This tests verbal modality and deductive reasoning, integration of much information, hypothesis testing and flexibility of thinking (D-KEFS Manual, 2001) (see Appendix Q).
The Radial Arm Maze. The Radial Arm Maze is a computerized tool to examine functions of memory.  Validity was measured by Olton, David (1987) by means of the assessment of four criteria: operational, psychological, ethological, and neural. The participant is asked to navigate his way through a maze with eight arms.  The objective is to find all the “Goals” at the end of the arms.  The participant must go through and find each goal without going back into any arm twice and without going into an arm that does not contain a goal.  When this is accomplished twice in a row, proficiency is attained.  Otherwise, the test is cancelled after twenty minutes of unsuccessful attempts. (see Appendix R)
Brown Sleep Lab Diary.  The participant is asked to record a log of their daily activities such as working, showering, napping, going to bed in the evening, waking in the morning, and any unusual events of the day or any consumption of alcohol, medication, tobacco, or caffeine.  The Brown Sleep Lab Diary was developed by Mary Carskadon (2000) but has remained an unpublished assessment and thus no data on reliability nor validity are available (see Appendix S).
 Mini Mitter Actiwatch Activity Monitor.  The Actiwatch monitors gross motor activity over a long period of time.  It can be used to monitor activity throughout the day and the night in order to assess sleep/wake patterns, periodic limb movements, level of pain, mood, and level of energy.  Some of the recent research done using the Actiwatch in studies includes the assessment of non-24-hour sleep-wake syndrome after traumatic brain injuries (Caliyurt, and Boivin, 2002), assessment of sleep in insomnia patients (Means, Edinger, and Husain, 2002), effects of prolonged work, sleep deprivation, and caloric restriction on physical performance (Pandof, Nindl, Leone, Castellani, Tharion, and Montain, 2002), and nighttime sleepiness, daytime sleepiness, and pain in cancer patients (Alley, Parker, de l’Aune, 2001).  In this study, the Actiwatch was used to measure the participants’ activity level throughout the day and the night over the course of 3-5 days to monitor their sleep/ wake stages in order to determine sleepiness in the traumatically brain injured population and also to determine the reliability of self-report by comparing the Brown Sleep Lab Diary (Carskadon, 2000) to the results from the Actiwatch.  Along with the Actiwatch, the participant is provided with the Mini Mitter Actiwatch Activity Monitor Instructions (see Appendix).  These explain that the button on the Actiwatch needs to be pushed when the participant goes to bed, when he/she wakes up in the morning, before the watch is taken off (e.g.- when showering, participating in contact sports, etc.), and after the watch is placed back on the wrist.  The watch is to be placed on the wrist of the non-dominant hand (see Appendix T).
 Epworth Sleepiness Scale (ESS).  The Epworth Sleepiness Scale(ESS) is a quick measure of degree of daytime sleepiness.  It is comprised of a three-point likert-scale to assess the chance of dozing in specified situations.  The likert-scale ranges from 0-2, with 0 being “no chance of falling asleep” and 2 “high chance of falling asleep”.  Evidence of ESS as a reliable method in determining persistent daytime sleepiness in adults was provided by Johns (1992) (see Appendix U).
 Profile of Mood States. The Profile of Mood States (POMS) is a sixty-five question measure using a likert-scale that assesses mood.  The assessment asks the participant to respond to the degree ( 0= “not at all” to 4= “extremely”) to which they agree with the adjective provided according to “how you have been feeling during the past week including today”.  It was originally published by McNair, Lorr and Droppleman in 1971.  The POMS was designed to measure mood states for patients undergoing therapy but has since been expanded to areas of use beyond the clinical setting, especially in the area of sport and exercise psychology (LeUnes, Burger, 1998).  Reliability was determined through measures of internal consistency and test-retest reliability while validity was determined by means of concurrent validity measures (McNair, Lorr, and Droppleman, 1992) (see sample items in Appendix V).
 Symptom Checklist- 90- Revised (SCL-90-R). Designed as a likert-scale ranging from 0= “not at all” to 4= “extremely”, the Symptom Checklist –90-Revised asks participants to comment on how much a problem has distressed or bothered them during the past 7 days including today.  There are 90 symptoms listed to which the participant is asked to respond.  The SCL-90R measures levels of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism.  Validity was determined through analysis of internal structure , factorial invariance and convergent-discriminant validity (Derogatis, 1994).  In addition, Dergotis, Rickels, Rock (1976) performed a concurrent validation study and found convergent validity between the SCL-90 and the MMPI.  Also, the construct validity of the dimensional structure of the SCL-90 was determined by Derogatis and Clearly (1977).  Reliability was assessed by means of internal consistency reliability and test-retest reliability (Derogatis, 1994) (see Appendix W for sample items).
Stanford Sleepiness Scale (SSS).   The Stanford Sleepiness Scale measures sleepiness at time of study.  The participant is asked to check off which degree of sleepiness characterizes them at that particular moment in time.  Hobbes (1973) looked into the SSS measure in comparision to the Epworth measure.  He found the SSS to be reliable and valid according his sample (see Appendix X).
 California Verbal Learning Test- Second Edition (CVLT-II). The CVLT was revised in 2000 by Delis, Kramer, Kaplan, and Ober and is geared towards people aged 16-89.  This assessment measures skills in verbal learning and memory.  It assesses the amount of information remembered and measures by which strategy it is remembered.  It measures recall and recognition of two different word lists to assess both immediate and delayed memory.  The first word list was read to the participant and the participant was asked to recall five times while the second list serves as an interference.  This is followed by short-delay free-recall and then the short-delay cued- recall and yes/no recognition trials.  After waiting 20-minutes, the participant is asked to recall the first list.  Literature involving the viability of the CVLT include work on Korsakoff’s Syndrome, Alzheimer’s Disease, Huntington’s Disease, Older vs. Younger Non-Clinical Adults, Males vs. Females, Anterior Temporal Lobectomy, Head Injury, etc. (Delis, Kramer, Kaplan, and Ober, 2000).  The first edition of this test was one of the first clinical tools to incorporate cognitive science and components of learning and memory.  Although exact figures of reliability and validity are not known, there have been 298 articles as of June 1999 that incorporate the use of the CVLT (Delis et al., 2000).  The original instrument was revised based upon critiques (see Appendix Z).
 Wechsler Abbreviated Scale of Intelligence (WASI).  The WASI is a half-hour assessment of verbal, non-verbal, and general cognitive functioning and is comprised of four individual assessments: Vocabulary, Similarities, Block Design, and Matrix Reasoning.  These subtests were chosen due to their high-load on a measure of general intelligence, high correlations between it and the WISC-III FSIQ and the WAIS-III FSIQ, and the recorded rate of high reliability (Wechsler Abbreviated Scale of Intelligence Manual, 1999).  The reliability coefficients for Vocabulary range from .90 to .98, for Similarities from .84 to .96, for Block Design from .90 to .94, and for Matrix Reasoning from .88 to .98 (WASI Manual, 1999).  The Manual (1999) also provides evidence for the validity of the WASI as it is highly correlated with the FSIQ scores of the full battery of tests.  The WASI accounts for 76% of the variance of the WISC-III and 85% fo the WAIS-III FSIQ.  The Vocabulary subtest consists of 42 items.  Each item is presented orally and visually.  This assessment requires a definition of the presented stimuli and measures expressive vocabulary, verbal knowledge and general intelligence.  The Block Design assesses spatial visualization, visual-motor coordination, and abstract conceptualization by asking the participant create 13 designs using the pattern blocks.  There are twenty-two verbal items asking the participant to accurately describe the similarities between the two items.  This measures verbal concept formation, abstract verbal reasoning ability and general intellectual ability (WASI Manual, 1999).  Lastly, the Matrix Reasoning is comprised of 35 incomplete patterns.  The participant is asked to complete these patterns in a display of nonverbal fluid reasoning and general intellectually ability (WASI Manual, 1999)(see Appendix 1).
 Interview Behavior Checklist.  The Interview Behavior Checklist was completed at the end of each session by the test administrator.  The checklist allowed for the assessment of observations in specific categories such as orientation, speech, affect/mood, attitude/manner, task orientation, and physical appearance.  This checklist is a part of the Pain Assessment Battery by Bruce N. Eimer, Ph.D. and Lyle M Allen III (1989) (see Appendix 2).
Vigil.  The Vigil was developed by Cegalis, John A., Cegalis, Stefan (1995) by ForThought, Ltd.  This is a computerized assessment that measures attention.  There are two versions, the “K” and the “AK”.  In the “K” version, the participant is required to press the space bar as soon as the letter “K” appears on the screen.  In the “AK” version, the participant is required to press the space bar every time the letter “K” is preceded by the letter “A” (see Appendix 3).
Debriefing.  The Debriefing form informs the participant as to the nature of the study. It informs that participant that the EEG was conducted to obtain sleep onset latency in order to assess sleepiness and the neuropsychological tests were administered to assess multiple forms of attention It declares that group information will be available but no personal information may be yielded (see Appendix 4).
MSLT Electrode Hook-up 10-20 System. The MSLT Electrode Hook-up 10-20 System was designed by Carskadon and Dement (2000) and remains unpublished.  It is a systematic procedure for the applications of electrodes in preparation for a Multiple Sleep Latencey Test along with a list of biocalibrations done to assess the impedence levels of each electrode (see Appendix 5).
Hypersomnolence and Attention Deficit in TBI Research Protocol.  The Hypersomnolence and Attention Deficit in TBI Research Protocol was developed by Carter, Shannon, Moes, Elisabeth, Kaplan, Edith, and Finn, Paul (2001).  It lists the order in which all of the tests for the study will be administered (see Appendix 6).

Procedure
The broad TBI study was conducted first and then the fine-grain analysis of participant ST was done ad hoc.  Internal Review Board (IRB) approval was obtained from both the Suffolk University Graduate Studies IRB and the Saint Anselm College Undergraduate Studies IRB.  Prior to testing all participants were screened via a telephone interview to determine qualification.  Verbal consent to participate in qualification interview was acquired.  Qualification was dependent upon time since TBI, current medication, history of epilepsy, prior sleep disorders, substance abuse, prior TBI, learning disabilities, ADHD and current shift employment.  Qualification was determined by the research team.  Once qualified, an appointment was made and directions to the Saint Anselm College Psychology Department were provided as necessary.  Upon arrival the participant was shown the testing facility, briefed on the nature of the study, and allowed to acclimate to the environment.  The participant was welcomed and asked to sign an informed consent.
    Before proceeding to sign the medical history release, the test administrator asked for a preferred name, asked if the participant needed glasses or was hearing impaired, and what type of medication or caffeine had been consumed that morning.  The participant was then given an Actiwatch accompanied by the Actiwatch Instructions.  He was shown how to wear the watch and how to run the watch.  Also he was given the Brown Sleep Diary and instructed to fill it out daily.  After fielding questions, he was asked to fill out the Demographic Questionnaire, the Epworth Sleepiness Scale, the Snoring/Apnea Worksheet, Profile of Mood States, Symptom Checklist-90-R and seven subsets of the Delis-Kaplan Executive Functioning System: Trail Making Test, Design Fluency Test, Sorting Test, Twenty Questions Test, Word Context Test, Tower Test, and the Proverb Test.  The final assessment of the day was the Wechsler Abbreviated Scale of Intelligence.
Upon concluding the assessments, Day two was scheduled for four days later.  Throughout testing, judgments were made for nonverbal clues of irritation or frustration, the participant was made well-aware of the option of taking a break, using the facilities or leaving the assessment completely.   After making sure the participant didn’t have any questions regarding the Brown Sleep Lab Diary and the Actiwatch, the testing for part 1 was completed and he was brought to the Psychology Department Lobby and he departed.  The administrator then completed the Interview Behavior Checklist.
Four days later, the participant returned to the lab at 9:05 am to begin the second day of testing.  He was greeted and was invited to sit in the testing room where the Brown Sleep Lab Diary (BSLD) (Carskadon, 2000) and the Actiwatch were discussed.  The BSLD was surrendered and taken to be analyzed but the participant continued to wear the Actiwatch.  The participant filled out a free lunch order form.  After the paperwork we began testing.  The participant was read the directions for the computerized Vigil-K, was asked if there were any questions, and then was left alone in the room to complete the test.  Upon completion he was given the Snoring/ Sleep Apnea assessment.  He was asked if he needed to use the rest room before we began application of the electrodes according to the Introduction to Polysomnography: A manual for Research Apprentices (1999) which was developed by Carskadon (see Appendix ).  The participant was asked to lie down on the bed and the electrodes were placed in the Embla headboard (see Appendix).  The headboard was then plugged into the processing equipment and sent through the wall to the Somnologica program in the computer in the next room.  Impedance was checked and after receiving the green zone for impedance level, the participant was given the Stanford Sleepiness Scale and the pain scale.  Bio-Calibrations were given to set the baseline readings (see Appendix).  Upon completion research assistants shut the lights off and left the room.  The Somnologica program recorded the sleep waves from the first nap of the Multiple Sleep Latency Test (MSLT).  The participant was awoken either after three epochs of unequivocal sleep (1 epoch= 30 seconds) or after twenty minutes, whichever came first.  When the participant awoke, the Stanford Sleepiness Scale was administered.  The Embla headset was disconnected from the processing equipment and the participant was led into the testing room.
Part I of the CVLT-II, Trail Making (Trails I and II), and the Cancellation Test were next completed by the participant.  Next the participant attempted the Radial Arm Maze.  He then completed part 2 of the CVLT-II, FAS and D-KEFS Color Word assessments.  The participant was led back into the sleep lab and he completed the Vigil AK version.  We set up for the second nap and asked the participant to go to the rest room before we attached the Embla headboard to the processing equipment.  When the participant returned, the equipment was reconnected, impedance was checked, and the Stanford Sleepiness Scale was administered.  Bio-Calibrations were run, lights shut off, and the second nap of the MSLT was run until three epochs of unequivocal sleep was assessed or a period of twenty minutes elapsed.  Upon waking, the participant completed the Stanford Sleepiness Scale and the equipment was disconnected.  The participant was provided with his free lunch and was allotted 50 minutes to eat and relax.  He was instructed not to consume alcohol, nicotine, or caffeine, and was asked to refrain from napping or exercising.
    After lunch the testing resumed with the Vigil-K and then the participant was prepared for the third nap.  The participant was asked to go to the rest room if necessary and then the equipment was set up for the nap.  Impedance was checked and then the Stanford Sleepiness Scale was administered.  Bio-Calibrations were recorded and lights were shut off.  The third nap was run until three epochs of unequivocal sleep were recorded or twenty minutes elapsed.  Upon waking, the participant completed the Stanford Sleepiness Scale and then completed the self-administered computerized Microcog.  After completing the Microcog, the participant was led back into the testing room where the FAS alternate form and the Stroop test were administered.  Next, the participant was led back into the sleep lab and was assessed via the Vigil- AK.  At this point the Actiwatch was collected.  The participant was given the opportunity to go to the rest room and then the final nap was set up.  Impedance was checked, the Stanford Sleepiness Scale was administered, the Bio-Calibrations were taken, and the participant was asked to try to fall asleep.  Upon completing three epochs of unequivocal sleep or the elapse of twenty mintues, the participant was administered the Stanford Sleepiness Scale.  Upon concluding test administrations, the participant was debriefed and was provided with $50 compensation and he then departed from the building.
* Appendices were not provided due to conservation of length.  If these are desired please email me.