Chrono-City Bad Kissingen: a blueprint for future urban design

Transcription

Bad
Kissingen
Bad Kissingen:
a blueprint for future urban design
Groningen,
10 - 05 - 2013
Course:
Orientation on International Scientific Careers
Editors:
Bich Phuong Nguyen
Elbrich Postma
David Ekkers
Fabian Degener
Thomas Meijer
Contents
Bad Kissingen:
The first ChronoCity in the world
Ellbrich Postma
4
Work and school times
Thomas Meijer
Shift work and diet
Bich Phuong Nguyen
6
10
Chronobiology in the hospital
Elbrich Postma
12
Optimising urban lighting
David Ekkers
16
The Bad Kissingen ChronoCity App
Fabian Degener
20
“Chrono-City” Bad Kissingen:
A blueprint for future urban design
David Ekkers
24
References
25
Contact
26
Bad Kissingen: the first ChronoCity in the world
Ellbrich Postma
M
any people regard sleep just as
‘something that has to be done’.
This, inter alia, has resulted in
a decrease of the average time people
sleep at night [1]. Society to a great extent seems to have lost the awareness of
the importance of sleep in daily life. But,
sleep is important to maintain health.
For example, sleep deprivation has been
linked to obesity. Also, daily function- introduces light at non-optimal times and
ing is affected by too little sleep. Longer thus interferes with circadian synchronisareaction times, memory difficulties and tion and the timing of sleep. The circadian
problems concentrating immediately oc- clock in humans is only sensitive to the efcur after just one night with too few hours fects of light at specific times of day. Light
of sleep.
is only able to advance the clock in the
morning. If we are not exposed to morning
Healthy sleep requires our biological cir- light, delayed sleep phase and circadian
cadian clocks to be synchronised to the misalignment results. In addition, improper
natural alternations of light and darkness. light exposure in the evenings exacerbates
Circadian entrainment or synchronisation this problem.
specifies sleep to specific times of day or
phases, leading to a variety of chronotypes Obviously, sleep is more than only going
[2]. Chronotype (phase of entrainment) is to bed, falling asleep and waking up in the
assessed as the midpoint of sleep on free morning. Sleep is complex and many procdays (MSF) corrected for sleep deficit on esses play a role in how good and when
workdays (MSFsc). Earlier chronotypes people sleep. Although the reasons of why
(‘larks’) get tired earlier in the evening humans (and finally all animals) have to
and wake up earlier in the morning. Later sleep are still not known, we do know that
chronotypes (‘owls’) stay up later in the sleep depends on both individual behavevening and sleep later in the morning. iours and biology. The biological diversity
Figure 1.1 illustrates the distribution of becomes manifest, for instance, in the indichronotypes in central Europe. As can be vidual timing of sleep, core body temperaseen from Fig. 1.1 the average MSFsc is ture or melatonin production. The peaks and
centred at around 04:30 h. Before the intro- troughs in our behaviours and physiology
duction of electric light to peoples’ homes, differ between chronotypes.
the main light sources were the sun, moon Work and school often starts early in the
and campfires. The modern 24/7-lifestyle morning. This is convenient for earlier
4
Bad Kissingen - ChronoCity
chronotypes, but not for later chronotypes.
The late chronotypes are forced to wake up
at a time which is earlier than their biological clocks tells and hence sleep too short.
About 80% of the general population rely
on alarm clocks on workdays. The need to
use an alarm clock to wake up is by definition an indicator of a chronic state of sleep
deprivation. The mismatch between internal,
biological time and external, social time has
been termed social jetlag [3]. The amount of
social jetlag has been shown to be significantly positively correlated with the probability of being a smoker and overweight.
We here present the results of five projects
that all nicely dovetail with each other: Four
projects deal with the following questions:
How does modern lifestyle affect (I) work
and school hours; (II) diet in shift-workers;
(III) caretaking in the hospital and (IV) urban lighting? Our fifth project proposes the
first chronobiology App, bringing circadian
knowledge & science to the people. Our
project aims to make chronobiology central
to society. Bad Kissingen is worldwide the
first “Chrono-City” applying chronobiology in its societal and economic communal framework of living, education, work,
well-being, health, mobility and sleep. The
aim is to obtain significant insights into the
interactions between chronobiology and the
manifold structures of the society, to design
innovative and directly applicable solutions
to promote optimal sleep and recuperation
in everyday life: To keep the society healthy,
happy & productive.
Figure 1.1 - The middle of sleep phase on free days corrected for the sleep dept correceted during work days [2].
5
Work and school times
Thomas Meijer
M
odern industrialised societies
mean synchronised work and
sleep pattern. Schools and universities, for example, often start early
between 08:00 h and 09:00 h. In addition,
work starts between 07:30 h and 09:00 h
for many employees. Such times are convenient for dropping off kids at school
and for the day planning of the family, but
such early times lead to insufficient sleep
in a significant number of people. The
biological sleep timing not only varies between individuals (chronotypes, with e.g.
‘early larks’ and ‘late owls’) making early
commitments a big challenge for especially later chronotypes, but sleep timing
and chronotype also vary with age (Figure
2.1). Notably, the changes in sleep timing
are most dramatic in teenagers, who show
significant delays in sleep timing. The
maximal delay for females is at the age of
19.5 and for males at the age of 21. From
then onwards people gradually become
earlier chronotypes again [4]. Obviously,
conflicts arise when social schedules collide with individual sleep timings.
Waking up too early at a time when the
circadian clock still signals sleep, leads to
sleep deprivation. Many studies have shown
that sleep deprivation has negative effects.
After six days of 4 hours of sleep glucose
uptake effectiveness was comparable with
diabetes type II patients [5]. Furthermore,
tired people show impaired performance
and alertness [6] and suffer from emotional
Figure 2.1 - Chronotype changes
during life. Children have a early
chronotype “Lark”. This changes during adolescents. The sleep
rhythm delays. The delay continues
for women til they reach an age of
19.5 years. For men this is 21.5
years. Not only does the delay take
longer it goes faster as well. resulting in an difference between men
and women of about 0.7 hours (or 40
- 45 minutes).
After the peaks the sleep rhythm
progresses. Resulting in an earlier
sleep rhythm. At the age of 55 the
sleep rhythm is about the same as
before adolescents [4].
6
Figure 2.2 - Example of flexible school hours.
instability [7]. Late sleep type students have day can be planned due to parents’ choices
lower school achievements compared to and that of the children (Figure 2.2). These
early sleep type students [8].Clearly, well- experimental Dutch schools are open 50
rested students and employees are more weeks per year. More than 70% of the parproductive and healthy.
ents with children in these schools tell to
experience less stress with organising the
What are the possibilities for people to get household and their work. Because of the
more sleep? The solution sounds simple: non-mandatory “walk-in” and “walk-out”
start schools and work later. But, at what hours, parents have more time with their
time should schools start? Is there a perfect children and were also able to better plan
time? And, what are the consequences for holidays (Figure 2.3). Therefore, the flexall parties involved? These questions are ible school times can serve a good model
complex and they should be separated for for new school schedules in Bad Kissingen.
elementary school, secondary school and
the working population.
Secondary school, or “Sekundarstufe I“,
starts at age ten to sixteen years old. ChilFigure 2.2- The flexible school hour scheme dren shift to a later sleeping type and they
[10]. The oldest children that attend elemen- become more independent. Because they
tary school are ten years old. Children at become more independent they can manage
that age have a MSFsc of 03:20 h. Since to get to school on their own. Therefore,
children at that age need about 9 hours of less consideration is needed for dropping
sleep [9], they biologically should sleep off and picking up the kids. At the beginuntil 07:50 h and could be at school around ning of secondary school, age of ten, the
08:50. However, young teachers and parents children can be at school at 09:00 with a
are not likely to have this early sleep rhythm. full night rest. However, nearing the end of
So what time is the best starting time when secondary school at age sixteen, the MSFsc
different chronotypes are involved? In the is around 04:20 for women and 04:40 for
Netherlands seven schools are experiment- men. The average adolescent male has had
ing with flexible starting times. The children a full night rest when waking up at 09:10.
can be dropped off between 08:00 h and To accommodate for a somewhat later than
10:00 h and are picked up again between average sleep time and assuming scholars
16:00 h and 18:00 h. During the day there need about an hour to prepare for school, it
are four mandatory hours. The rest of the is recommended to start the first lessons at
7
10:30 to 11 o’clock. For secondary school end of the day. Teachers faced rush hour and
it is recommended to have a progressively had less time for themselves. Parents also
later starting time as students mature, in- reported that they did not like the hour they
stead of flexible starting times.
lost with their children. However, they also
stated that the children were less grumpy
The concept of later start times of schools in the morning and easier to handle during
has been considered already. In Minneapo- the day. For the Minneapolis school district
lis, U.S.A. a school district shifted their the shift was a success.
school hours from 07:15 to 08:40. Wahlstrom and colleagues intensively observed To alter the starting times in Bad Kissingen
the effects of the transition in a 4-year study and to make this successful, a couple of
[11]. Many parents thought their children factors should be taken into account. Even
would only use the later start time as an though implementing flexible starting times
excuse to go to bed later. That was not the for elementary school has many benefits, it
case. The observed sleep time remained is also more expensive. Experiments with
at 22:45 both before and after the change. Dutch schools showed that the extra costs
This demonstrates that the natural biologi- for having flexible hours are comparable
cal sleep rhythm of the students truly is the to costs of three days of after-school day
motivator the go to bed. Most results of care[12]. Therefore, it must be taken into
this study were positive. A questionnaire account that families with lower income
filled in by the students showed they felt might not be able to abide by. Flexible
less tired during the day, suffered less from school times can lead to a variable number
depression and sickness and less problems of children present. Therefore the teachwith oversleeping. However, some students ers work hours will also be more variable.
complained about the longer school day, be- New rules and agreements must be made to
cause the last lessons were also shifted back. ensure quality of the lessons and happiness
They said they had to hurry to go to sport of the employees.
practice and did not have enough time to go
home and relax before practice. From the For the secondary schools it is most imporcounsellors’ and teachers’ point of view the tant to have an accommodating organisadelay in starting time was mostly positive tion of the first lessons. Not only must their
as well. Teachers where satisfied because sleeping rhythms be taken into account, but
the students paid more attention in class. also how much time they need to arrive at
Teachers were also able to integrate daily school. The feasibility to teach 50 weeks of
events easier in their program. The counsel- the year depends on the amount of students.
lors noticed that fewer students were sent It would be a positive aspect if the students
to them for disturbing the class. However, could choose whether they wanted to stay
some teachers had the same complaint just longer at school or give away some holidays
like the students about the hour shift at the in return of shorter school days. Another
8
School and work times
Figure 2.3 - Overall opinions of parents about the flexible school hours, one year after implenmentation.
[12]
positive aspect of this flexibility is that the less of the occupation. Everybody should
family can choose when they will go on know what their sleeping habits are and
holidays instead of restricted to the fixed try to fit them in their profession. Starting
free days of the current system. Many par- time of employees with desk jobs could
ents that participate in the “flexible school be shifted from the standard 09:00 up to
hours” experiment are positive about this. 11:00. But by doing so, they should also stay
It provides parent with the opportunity to two hours longer or they should be able to
go on holiday outside the expensive holiday work overtime in the weekends or during
season.
their free days. In the end it is important for
employers to know what type of sleeping
For working people it is hard to give one rhythm their employees have. Talk with
proper advice when they should start work. them and make schemes so people with
Apart from the different jobs and attendance an early sleeping habit can arrive in the
demands, working people cover a broad morning while the later chronotypes can
spectrum of chronotypes: from the early to arrive later.
the late types. Nevertheless, a good night
sleep is important for everybody regard-
9
Shift work and diet
Bich Phuong Nguyen
The town of Bad Kissingen has a diverse occupational pool which includes physicians,
nurses, bar and restaurant employees and
commuting industrial shift workers. This
workforce has highly varying working hours
and many have to deal with both day and
night work.
Shift work demands high flexibility,
which cannot always be balanced with the
employee’s private schedule. Sleep deprivation, irregular meal times and conflict between
the work schedule and family life are common problems among shift workers [13]. As
a result, shift workers, and especially night
shift workers, have a hard time to maintain
a healthy lifestyle. Studies report increased
obesity rates among night shift workers compared to their day-shift working colleagues. In
addition, night shift workers have a higher risk
of developing cardiovascular diseases, diabetes type II and metabolic syndrome [14,15].
Humans are day active
Health complications stemming
from having irregular lifestyles are subjected to chronobiology studies. Humans have
evolved to synchronise their metabolic processes to environmental changes by responding
to external signals, such as light and food.
Biological processes concerning ingesting,
using and storing energy occur during the day,
while at night repair and growth processes
dominate. For this reason, food absorption and
the subjective satiety are decreased at night
[13]. Fluctuations in proteins and hormones,
which are involved in metabolic homeostasis,
are fine tuned by the internal clock. Thereby,
the human body can optimally prepare for
the absorption and digestion of nutrients during meal times [16]. However, shift workers
have to fit their normal routine into alternating
10
work schedules. Day workers are much less
troubled than shift workers, who need to be active when their internal clock is programmed
on sleep. Thus, metabolic processes are not
sufficiently adjusted to shift labour.
Night shift: a shift to weight gain
Switching from day to night shift work does
not only change the time points of eating,
but can also affect the choice and quantity
of food taken. A part of why shift workers
gain weight, might be related to changes in
diet and alternating eating times. Closer examination of the diet composition reveals
decreased dietary fibre intake and increased
intake of carbohydrates and lipids [13,15]. An
increased intake of carbohydrates and lipids
might result from a shift worker’s preference
to have several snacks at night instead of having one proper meal. A reason for this is that
at night the body is not in a fully optimised
state to digest food. Consequently, workers
might simply not be hungry enough for a full
meal [17]. Additionally, on a tight schedule,
snacks are more convenient because they save
time to eat. For example, enjoying a nutritious
meal might not be priority if work-load is
high and the number of staff members low, as
often is the case with night shifts [13]. Finally,
a lack of canteens that are open at night to
serve warm and healthy meals might also be
the reason for the increased snacking by shift
workers. As a result, some shift workers are
‘forced’ to consume sweets, chips and soft
drinks from the vending machines.
Few studies report higher caloric
intake of night shift workers compared to
their day working colleagues. Night workers
might eat more to compensate for the energy
loss that they suffer from sleep deprivation.
Contributing to this, are that the hormones
that are involved in absorption and digestion
of food have different plasma concentrations
at different time points of the day [18]. The
gastric hormone leptin, which is a signal of
satiety, is reduced during the evening[19].
Lack of sleep or poor sleep quality, as seen
among night shift workers, enhances plasma
concentrations of gastric hormone ghrelin. Ghrelin promotes the consumption of food [18].
These two factors contribute to the choice of
bigger portion sizes during evening meals.
during the day; -anticipation of food aids the
body in absorbing and processing important
nutrients; -cooking with family often leads to
a healther meal composition; -having a meal
after night shift before sleep, can prevent sleep
disturbance caused by hunger.
In the morning
After work shift, tiredness and physical-exhaustion prevail and workers long for
the comforts of their homes. However, most A refuge for shift workers
Bad Kissingen as a town can stimuworkers then first have to commute home, others for example have young ones to feed late their shift workers to live a healthier life
and some drop down on bed as soon as they style. Creating a pleasant environment for
step into the house. Either way, most workers shift workers when they eat, can even counterare tired and the amount of sleep they can balance stress from work. Dining facilities that
obtain before the next work shift is the main are available throughout the night can provide
motivator for not having a meal and going healthy and nutritious snacks and take-away
to bed immediately. As a consequence, shift breakfasts. They can accommodate night shift
workers might have disturbed sleep because workers in having a convenient, but healthy
of hunger [13]. If shift workers decide to have alternative to microwave meals. Placement of
meals before bed time, then many have to such dining halls in areas with high demand
choose between a less time consuming mi- of shift work staff will ease the use of such
crowave meal and a healthy but more time dining halls. For example: near the hospital
consuming home cooked meal. Shift workers or near the train station. Especially the latter
with family might take that extra mile to cook is appealing to commuting shift workers.
Life of shift workers can be ima nutritious breakfast for the benefit of their family. For that same reason, shift workers proved with these little contributions. Shift
that decide to eat alone might rather choose workers are the most extreme example of
social jetlag and Bad Kissingen can be the
the convenient microwave alternative.
city that accommodates shift workers in their
reversed work and social routine. Bad KissinReconsiderations
Timing of the meal is important for gen can be the city that offers shift workers a
food absorption and food preference. A way to little bit of relief after a long night of labour.
prevent unhealthy (over)-eating when starting By taking care of, for example, food supply
shift work, is by having the main meals at shift workers might be able to manage their
regular times during the day, together with work schedules with their social schedules in
family or colleagues. Important reasons for a better and healthier manner. Thereby, the
stress that shift work produces is lessened. By
this are that:
-social contact and a pleasant environment offering such services shift workers will have
decrease stress; -the body digests food better a reason to build a home in Bad Kissingen.
11
Elbrich Postma
H
ospitals are places of healing,
rest and recovery. Good sleep is
pivotal to recovery, but are hospitals the place where people have their
best sleep? And, what do we know about
sleep and recovery in hospitals? Fairly little! Of course, there are very good clinics taking thorough care of their patients
at every level. However, most hospitals
run rather strict schedules irrespective of
an individual’s sleep behaviour. Notably, As people get older, they often have more
chronotype specific treatment and sleep problems with their health. This results
schedules in hospitals do not exist.
in a high number of elderly people in the
hospital. Therefore, it is of utmost imporBut, where is the problem? Sleep and im- tance to take sleep in elderly people also
mune function are tightly linked and chronic into account when daily routines are being
insufficient sleep can lead to serious health modified.
problems. Insufficient sleep, for example,
can trigger innate immune responses (e.g. Sleep in the elderly often is fragmented and
increase in pro-inflammatory mediators shows reduced deep sleep. During sleep
[20]), diabetes [21] and can further lead to more time is spent in lighter sleep stages,
cardiovascular diseases [22]. In turn, in- which leads to more awakenings/arousals
crease in the pro-inflammatory cytokine during the night. Sleep onset also gets earinterleukin-1ß can also cause sleep distur- lier in the elderly, resulting in earlier waking
bances: a vicious circle.
up times [20]. These changes in sleep can
cause an increase in the susceptibility to
By ignoring individual sleep needs, any diseases and can play a role in the onset of
treatment and medical intervention will age-related diseases.
unnecessarily be compromised. In most
hospitals, patients are woken up early in Elderly suffering from age-related dementhe morning because of daily routines. This tias are also affected by problems with their
results in sleep deprivation in a considerable sleep-wake rhythm. Disturbances in their
number of people, especially later chrono- sleep-wake rhythm especially are a burden
types, leading to the aforementioned health to caregivers and are an important factor
disturbances.
for institutionalisation [23]. The stability of
12
the rest-activity rhythm can be increased by
exposure to bright light in patients who are
demented, but still have an intact vision[24].
As society is growing older, it is important to
think of ways to help elderly people to live
a healthy and self-determined life as long
as possible. Support to maintain healthy
sleep-wake rhythms when people stay in
hospitals would be a great step forward.
(MCTQ) to assess chronotype. This simple questionnaire takes about two minutes
to complete. The MCTQ asks for the sleep
times on both workdays and free days separately. Based on the outcome of the MCTQ
the patient will be allocated to an early or
late chronotype room. These rooms will
differ in waking time, because the waking times will be adjusted to the (average)
chronotype of the patients in these rooms.
Our aims
Depending on the waking time, also the timing of turning off the lights will be adjusted.
Wake up timing by chronotype by introduc- This will help to promote healthy sleep
ing rooms for earlier and later chronotypes: and adequate circadian synchronisation for
This would especially be useful for patients optimal recovery.
with longer stays. How to approach this
aim? At admission each patient completes However, before this idea can be applied,
the Munich Chronotype Questionnaire more investigations are needed to define
13
Hospital room with enough sunlight. This way patients can easlier adjust to the circadian rhythm and will
heal faster.
and elucidate daily routines in hospitals.
For example, would it be possible to serve In addition, besides chronotype-specific
breakfast individually for earlier and later schedules for patients, of course, also
chronotypes? New schedules for operations chronotype-specific work schedules for
and treatments would have to be arranged. those who work in the hospital are enHowever, by taking chronotype into account, visioned. Working in shifts that match
it will be possible to perform treatments and chronotype does lead to more satisfaction
therapies at an optimal biological time. The at work and better health and sleep among
individuality in humans in their timing of staff. This is beneficial for the hospital, acsleep, behaviour and physiology shows that cording to an investigation by Martin A.
treatments based on external (social) time Makary. A survey among patients showed
alone often lead to sub-optimal outcomes. that patient satisfaction scores were higher
Obviously, studies to investigate and verify when hospital staff was more satisfied with
re-designs of daily routines in hospitals their workplace culture [25].Bad Kissingen
would have to be done in close coopera- uniquely offers all opportunities necessary
tion with doctors, nurses and volunteer- to come closer to a medical system that proing patients. From initial discussions with motes chronotype-specific health & work
health representatives, we already learned schedules for everyone involved – doctors,
that individual solutions – as we propose nurses and patients, with significant reduchere – are highly warranted.
tions in health expenses.
14
Natural lighting conditions in the clinic
rooms:
the patients will get moderate exercise and
daylight at the same time. But why should
this be done?
Adjusted lighting helps to maintain the biological rhythm. Beneficial effects on wound Research has shown that moderate exerhealing through natural light in hospital cise can decrease the pro-inflammatory
rooms has been shown [26]. Rooms located cytokines and increase anti-inflammatory
to the east get more daylight, as opposed cytokines. These changes in cytokine levels
to rooms directed north. In addition, light- lead towards a more pronounced day-night
ing conditions that mirror dawn, dusk and rhythm, which enhances physical and mentwilights would be best. More research has tal quality of life, which is important for
to be done before this idea can be optimised healing [20].
in hospitals.
Especially for elderly people more daylight
and moderate exercise would be beneficial.
Program to motivate patients towards
As people age, their sight often worsens.
more daylight and exercise:
This can limit the amount of light they can
receive. An increase in daytime lighting
It would be of interest to develop a pro- levels can counteract the age-dependent loss
gram which would activate patients. Pa- of retinal light exposure in elderly people.
tients should be stimulated to get up, go The suggested program stimulates towards
outside and get (moderate) exercise. One more daylight time and could help elderly
way would be to organise daily walks in people in the hospital to improve their sleep
the garden of the hospital or in the beauti- and with that their healing process.
ful parks of Bad Kissingen. In this way,
15
David Ekkers
T
source: pro-Bad Kissingen
o date, 50% of the human popula- deeply rooted in our social lives. Howtion worldwide live in urban areas. ever, not everything that glitters is gold,
It is estimated that by 2050 this and urban lighting is accompanied by unfigure will have risen to 65-85%, with wanted and adverse side effects. Besides
current urbanisation of already 74% in that watching stars at night becomes more
Germany [27]. This development goes and more impossible in modern cities, too
hand in hand with increased use of artifi- much artificial light (light pollution) also
cial light. Obviously, urban lighting plays affects human health negatively. Humans
important roles in modern lifestyle, from need light to entrain their internal biologiincreasing road safety to commercial ad- cal clocks to the 24-hour day, but light at
vertisements. Lighting is at many levels improper times of the day interferes with
Bad Kissingen at night
16
source: international dark sky parks
this process. Delayed sleep, sleep loss and
disturbed physiological rhythms are the
result [28] [29]. For example, artificial
lighting has been shown to reduce sleep
quality by impacting sleep-wake rhythms
[30] [31] [32]. Further, also the natural
environment is affected by urban lighting,
because animals – as humans – have internal clocks and rely on healthy entrainment. For example, disturbed navigation
pattern in migratory birds [32] or foraging
behaviour in nocturnal animals [33] has
been reported.
Dark sky park
Innovative solutions in urban lighting
When assessing the optimal use of urban effect to road safety can be expected highest.
lighting a compromise must be made be- In turn, less lighting is needed for visual
tween functionality and negative side ef- purposes when our eyes are adapted to darkfects. Key in such an assessment would ness. In addition, also the effect of light on
be to analyse when functional benefits and the internal biological clock varies across
negative side effects are highest and lowest the 24-hour day. Hence, to accommodate
in space (where) and time (when). The fol- environmental lighting to the susceptibililowing 3 strategies are proposed to optimise ties of the human eye and the internal clock
urban lighting.
must be envisioned to prevent unintended
effects of urban lighting and light pollution.
1. Timing of light
Light can be provided at times when it is
Most forms of urban lighting, such as street most needed and useful and be turned off
lighting and advertisements, are continu- or dimmed when it can be expected being
ously turned on. It is important to consider most harmful.
at which time of the day the light has the
largest benefit and when it is most polluting. 2. Light implementation
Lighting at both sides of a road or advertise- Urban lights scatter large amounts of light
ments is, obviously, most needed at around to unwanted directions. This scattering is
dusk and dawn, for at these times of day due to unwanted diverging of light beams
traffic is heaviest, and thus the advantageous caused by the light source itself, its reflec-
17
Fig. 5.1 The relative spectral sensitivity of the human eye of
both photopic and scotopic vision. The wavelength range at
with melatonin is most severely suppressed is indicated by the
red square. ePlantScience.com 2009 ©
tor and/or shade and the angle at which
light is aimed. Scattered light, for example, obscures vision of drivers, wastes energy and can also disturb sleep in humans.
Many of the effects of light pollution are
still subject to investigations but evidence
is accumulating that light pollution must
be considered as a serious problem. The
scattering of light can be minimised when
a light source is more accurately directed
towards its target. Sophisticated know-how
to achieve this goal does exist. Solutions
include directional light beams and the use
of reflectors. In addition, low angle light
with respect to the horizontal axis should
be avoided because of its polluting effects
over a greater area, because light at these
angles travels longer distances, which increases the chance that this light reaches
unwanted areas.
perature [34][29]. Nocturnal exposure to
light suppresses melatonin secretion and
compromises sleep, with concomitant potential to phase shift circadian clocks. The
chronodisrupting effect of light is greatest
at wavelengths between 420 to 540 nm
(Figure 5.1) [35]. Therefore, light sources
that are to be used in the evenings and at
night should be designed to emit longer
wavelengths primarily. To still allow for
optimal contrast perception (between 400
and 620 nm; maximum at 500 nm; Figure
5.1), lights omitting wavelengths between
540 and 560 nm appear most useful [32].
New lighting technologies do already allow
for light emission at specific wavelengths.
Light emitting diode (LED) technology
can be used to tackle these innovations.
LED lighting lends itself to be easily programmed to provide lighting at preset times.
LED street lights that are already on the
market reduce light scattering already by
about 50%, compared to conventional street
lighting. The scattering can even be further
reduced by the use of reflectors and shades
to limit the angle of light emission. Technologies that make more use of directing
the light, e.g. by using lenses, is currently
under development. Finally, LED lighting
can be spectrally attuned to specific wavelengths, thereby maximising their field of
application.
An ‘enlightened’ vision for Bad Kissingen. The ‘LED light district’.
Historically, Bad Kissingen is renowned for
its medicinal springs, with records dating
back to the year 823 A.D. The town has cur3. Light type
rently established itself as Germany’s most
The hormone melatonin, which is produced well-known spa leisure centre. The focus
by the pineal gland around evening, in- on health and well-being in Bad Kissingen
duces sleep and decreases core body tem- could further be expanded by introducing
18
large urbanised areas is no longer possible. The park’s initiative is aimed at saving
energy costs, reducing the production of
greenhouse gasses, and foremost creating
awareness of the effects of light pollution.
The internationally acknowledged certification as a “dark sky park” by the IDA
(the international dark-sky association)
will establish the new field of “dark sky
tourism” for astronomers, photographers,
naturalists and everyone else alike – right
in the neighbourhood of Bad Kissingen.
Similar approaches shall also be envisioned
for Bad Kissingen. It would therefore be a
great opportunity for Bad Kissingen to join
The first ‘Dark sky park’ of Germany
forces with this “starlight initiative” of the
Notably, part of the large nature reserve Rhön Biosphere Reserve.
“Rhön Biosphere Reserve” is situated in By applying these ideas Bad Kissthe district of Bad Kissingen. This nature ingen is on its way to be at the front and
reserve is aiming to be the first “starlight leading the implementation of optimised
park” of Germany. The park wants to pre- urban lighting, which will provide a new
serve vision to the starlit skies, which in impulse to both tourism and business.
Source: Duitsland reisgids
innovative and sustainable urban lighting
designs. A first step would be to apply optimised urban lighting in the town centre.
Warmer coloured light that changes spectrum and intensity parallel to the natural
progression of dawn and dusk (on a daily
and also seasonal basis) will lead to better
sleep quality for the residents of Bad Kissingen and a more eco-friendly town. This
makes the city centre more attractive and
a place where people enjoy to stay. Smart
marketing of this innovating and unique
use of lighting will add value to a spa stay
at Bad Kissingen.
Part of the Hochrhöner trail
19
Fabian Degener
B
ad Kissingen is worldwide the
first city applying chronobiology in its societal and economic
communal framework of living, education, work, health and mobility. The aim utes do you need to fall asleep on working
is to obtain insights into the interactions days vs. free days?, among others. Regardbetween chronobiology and the manifold less of the errors made by guessing all the
structures of the society, to design inno- answers to these questions, not everybody
vative and directly applicable solutions to goes to bed at the same time each day. The
promote optimal sleep and recuperation in time needed to actually fall asleep might
everyday life: To keep the society healthy, differ even more, depending on the activhappy & productive. The ChronoCity app ity during the day, consumption of coffee,
will allow users to assess their chronotype tea or alcohol, as well as a late dinner or
automatically and more precisely than the current emotional state. In order to get
conventional methods and may provide a rid of all these huge deviations made by
platform to distribute knowledge obtained guessing the answers to the MCTQ selfin all our projects.
assessment test, sleep timing needs to be
measured precisely with all its variations.
How can we make Bad Kissingen’s citi- Ideally, this is measured in a large group of
zens and visitors curious about Chrono- socio-ecological comparable people, like an
biology and help them to figure out entire city. And that is exactly what the Bad
their individual chronotype?
Kissingen ChronoCity App does.
Chronotypes vary from extreme morning Functionality - More than just an alarm
types to extreme evening types with most clock.
of the people somewhere in-between. In
chronobiology, various self-assessment The Bad Kissingen ChronoCity App is
questionnaires have been developed like intelligent alarm clock, that monitors the
the MCTQ determine chronotypes and the users sleep with all its variations. The aim
difference of this endogenous clock to the of the app is to find out the users exact
real time, the social jet lag. The questions of chronotype and to give advice on how to
the MCTQ are: When do you go to bed on adjust the lifestyle in order to sleep better
working days vs. free days? How many min- and to feel better.
20
Example of user friendly interface of the ChtonCity application for mobile divices. One simple click
indicates the feeling of the user
The idea of monitoring sleep via a smart- in case the user did not get up.
phone is in fact not new. There are several Technically this is possible by the use of
apps on the market that can monitor sleep two different sensors: (1) a motion sensor,
to a certain intend. Unfortunately, none of a so-called accelerometer, which measures
these apps is using the knowledge obtained any kind of movement and (2) a gyro senin chronobiology to analyse this data and sor, measuring angular movement in any
thereby using its full potential. The Bad direction. Together, these sensors provide a
Kissingen ChronoCity App will not only highly sensitive measurement of all kinds of
monitor sleep, but actually give advice on body movements during the night by simply
how to improve sleep quality and how to putting the device on one side of the bed.
reduce social jet lag.
By using these measurements, the app
What the App actually does and how it
knows when the user goes to bed (time point
works.
of setting the alarm), time point of actually
falling asleep (sleep monitoring), time point
The main function of the app is an intelli- of waking up (by alarm or naturally), when
gent alarm clock. It goes off within a 30-60 the user in fact got up (closing the app or
minutes wake up phase, which ends at the no body movement at all detectable due to
desired wake-up time or, in case of a free empty bed) and to some extent, the quality
day, without a wake-up time. The free days of sleep (overall time in deep sleep and
(the days the user does not need to set an times of wake-ups during the night). This
alarm) are extremely important to determine incredible amount of highly accurate data of
the chronotype and the social jet-lag. By individual daily measurements is collected
monitoring the sleep, the app knows exactly and analysed automatically. The user gets
how deep the user is asleep and wakes him to know his or her exact chronotype and
or her up when in the lightest sleep phase. social jet-lag, which‘s accuracy is increasThe alarm stops when the smartphone is ing with every night.
touched, without the need of pushing any
buttons, and goes off again 10 minutes later
21
From Knowledge to Wisdom - How
knowing one‘s chronotype can lead to
better sleep and a healthier life.
By using the Bad Kissingen ChronoCity
App, sleep quality can be improved in three
different ways: (1) directly, by the softer and
more natural wake-up from a light sleep
phase compared to the very abrupt awakening from deep sleep of conventional alarm
clocks, (2) indirectly, by small adjustments
to the lifestyle and (3) consequently, by
accepting one‘s individual chronotype as
a fact and getting up earlier or later to get
the best and healthiest sleep possible.
(1) To understand the direct benefit of a softer awakening, one must know,
that there are several stages in between
awake and asleep, the so-called sleep phases.
Sleep phases are categorised in lighter sleep
phases, characterised by high responsiveness to the environment and skeletal muscle
activity, and deep sleep, characterised by
lowest responsiveness and paralysed muscles. Waking someone up who is in deep
sleep, as done frequently by conventional
alarm clocks, causes sleep inertia; a feeling
of grogginess, impaired alertness and strong
tendency of wanting to return to sleep[35].
The app in contrast, only wakes someone up
when in a lighter sleep phase. Thereby, there
is a smooth transition from being asleep to
waking up that brings immediate alertness
and a low tendency of falling asleep again
[36].
(2) As described before, the quality
of the conventional MCTQ questionnaire
is limited due to the problem of estimating
the sleep times from ones memory; this
error is completely solved by the app. The
other limiting factors are variations due to
the consumption of certain foods, activ-
22
ity during the day and fluctuation in mood.
These variations of sleep timing and sleep
quality are, of course, captured by the app,
but cannot be connected to its specific cause
automatically. Therefore a little questionnaire is integrated into the app to evaluate
the influence of these factors on sleep. In
order to keep the layout clean and to do
not bother the user, this questionnaire is
designed as minimalistic as possible and
just pops up when setting the alarm time,
asking whether certain foods have been
eaten, how exhausting the day was and what
the current emotional state is. The user does
not have to write a single word to answer
the questions, but only have to click at the
food that has been eaten and at one of five
smileys that describes best the current mood.
Having this simplified input method, rather
than open questions, is very important, since
the user is most likely already lying in bed
tiredly and ready to sleep. Clicking on the
icons is very intuitive and costs less than
five seconds, but gives a lot of information
when combined with the automatic sleep
phase analysis. This information is then
used to give advice for small adjustments
of the lifestyle concerning the daily activity
and consumption of different foods.
(3) For moderate early and the
average chronotypes, the softer awakening and small adjustments to the lifestyle
increase sleep quality sufficiently to feel
rested and alert during the morning and
throughout the day. For late and very early
chronotypes, the social jet lag might be too
big to be compensated by only increasing
sleep quality, rather than sleep duration. The
most obvious suggestion to increase sleep
duration would probably be going to bed
earlier. However, sleepiness is not induced
by rational decision (“I really have to sleep
right now to feel rested tomorrow morn- This helps the scientific community to get
ing!”), but by the endogenous circadian novel insights in chronotype-specific sleep
clock that defines the chronotype [37]. For problems, which will than lead to further
this reason a more consequent and thereby improvements for the user of the app, and
more efficient approach needs to be advised beyond.
to the user: Change your entire week sched- Summary and future prospective - A
ule to meet your chronotype and thereby short discussion on the potential, probyour sleep needs [38]. The calculated social lems and future prospective of the app
jet lag hereby serves as an orientation on and more.
the extent of the reorganisation.
We showed how an app can be used to
Win-Win - Knowledge from the lab im- measure one’s chronotype more precisely,
plemented in the real world and vice easier and much more fun to use than conversa. An integrated feedback loop.
ventional methods, making it attractive for
people outside the scientific community.
The Bad Kissingen ChronoCity App is a The data-collection is anonymous and thus,
product of chronobiology research. It is de- not in conflict with privacy issues. However,
signed to translate knowledge from the lab collecting additional data, such as age, sex
into the real world, with the ultimate goal of or shift-work employment would help to
increase overall sleep quality and thereby analyse the data, but requires special perwell-being. As this approach has never been mission from the user. If the user is willing
used before, the app itself can be seen as a to support the research with his data, there
scientific experiment to investigate whether are many more ways to collect different
sleep quality can indeed be improved by types of information: Optional extensive onusing a relative simple smartphone appli- line questionnaires (www.thewep.org) could
cation. Therefore, a feedback mechanism be used, including conventional chronotype
must be implemented, to collect chronotype tests as a control or by heart rate monitors
information, sleep timing and sleep quality to capture activity and general stress during
data, as well as the influence of the indi- the day, et cetera.
vidual factors evaluated by the question- It remains to be seen whether peonaire on sleep timing and sleep quality on ple take advices given by a smartphone
a server. Using statistical analysis, not only application serious, especially if they afthe dynamics of individual chronotypes and fect substantial topics as working or school
chronotype distribution can be studied, but times. Reorganising ones entire week schedalso the effect of sleep influencing factors ule may sound impracticable to the user;
can be quantified. Newly made insights into after all, it is not. The other projects: flexible
the interplay of sleep, work and individual school schedules, flexible working hours,
lifestyle choices will at regular times be early and late rooms in hospitals and flexible
translated into software updates. Through lightning have shown, that breaking with
this approach, an integrated feedback loop old habits and paradigms can be challenging,
is established, providing a platform to gather but it is definitely worth trying.
information and to test new hypotheses.
23
Chrono-City Bad Kissingen:
a blueprint for future urban design
David Ekkers
T
he five strategies presented should
be regarded as a comprehensive
roadmap towards a ‘naturally’
synchronised society. The strategies presented on work and school days as well as
hospital treatments are supportive to the
natural differences in chronotypes. In this
approach individual differences in chronotypes are not suppressed to fit the average
needs, rather these individual differences
are accommodated by an increased flexibility of services and employers. This
results in a city designed to follow the
natural rhythms of its inhabitants rather
that dictating them. Expected results of
this approach to urban design would be
increased sleep quality and a decreased
social jet lag for inhabitants and visitors
alike. Leading to both, a better health and
wellbeing. This in turn will also increase
people’s productivity. The flexible living
environment created by these projects
could make Bad Kissingen more attractive to young people looking for a place to
work and/or live.
Awareness and ecology
Apart from the direct individual benefits,
there are societal gains in the implementation of these strategies to Bad Kissingen.
By applying chronobiology in projects
such as optimised urban lighting and the
ChronoCity App, an increased awareness
on the significance of natural rhythms for all
24
living organisms is created. This helps people to realise the importance of a high sleep
quality and its effects on the broad array of
our daily functions. The use of less light
during the night will directly benefit the
wildlife surrounding Bad Kissingen while
at the same time save energy. Decreasing
both the carbon and ecological footprint
of the city of Bad Kissingen. The awareness created through the implementation of
chronobiology in the urban design of Bad
Kissingen will be of value to all visitors of
Bad Kissingen.
Bad Kissingen as a forerunner in applying chronobiology in the socioeconomic
framework
As the first city to apply chronobiology in
its policy, there is an unique opportunity to
use Bad Kissingen as a model for other cities. By cooperating with universities and
employing the utilities of the ChronoCity App, valuable data could be collected
from Bad Kissingen. Bad Kissingen could
become internationally renowned as the
largest urban field experiment in chornobiology. This can transform Bad Kissingen
in an international chronobiology hotspot,
clustering knowledge derived from within
Bad Kissingen and from universities and
research institutes all over the world. The
expertise contracted through such activities could in turn attract business related
to chronobiology technologies.
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25
Bich Phuong Nguyen
biomedical science
[email protected]
Elbrich Postma
biology, behavioural & neurosciences
[email protected]
David Ekker
ecology and evolution
[email protected]
26
Fabian Degener
biomedical science
[email protected]
Thomas Meijer
moleculair biology & biotechnolgy
[email protected]
Dr. T. Kantermann
human chronobiology
supervisor
for more info about this subject and
this field of study see:
www.clocks-ontime.nl
27
Bad
Kissingen

Chrono-City Bad Kissingen: a blueprint for future urban design

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ChronoCity Bad Kissingen