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Article History

Received: 29 May 2025

Accepted: 6 October 2025

First Online: 14 November 2025

Declarations

:

: Ethics approval was conducted in accordance with U.S. Code of Federal Regulations 49 CFR 11/45 CFR 46. Institutional Review Board (IRB) approval was by Mass General Brigham/Brigham and Women’s Hospital (BWH) and the FAA Civil Aerospace Medical Institute (CAMI) recorded under FAA IRB Numbers 19026 and 202014, with protection under an NIH Certificate of Confidentiality (CC-OD-21–2237).

: All participants provided written informed consent.

: The authors declare that they have no competing interests, with the exception of Elizabeth B. Klerman and Charles A. Czeisler as follows.Dr. Klerman reports: (i) consulting: Circadian Therapeutics, National Sleep Foundation, Yale University Press; (ii) honoraria: American Academy of Sleep Medicine Foundation, Sleep Research Society, Sleep Research Society Foundation; (iii) travel support: European Biological Rhythms Society, Lighten up/EPFL Pavilions, Sante Fe Institute, Sleep Research Society, Society for Research in Biological Rhythms, World Sleep Foundation; (iv) other: Partner is founder and CSO of Chronsulting.Dr. Czeisler reports grants and contracts to Brigham and Women’s Hospital from Axsome Therapeutics, CDC Foundation, City of San Francisco, Dayzz Live Well, Delta Airlines, Jazz Pharmaceuticals PLC Inc, Puget Sound Pilots, Regeneron Pharmaceuticals/Sanofi during the conduct of the study; reports personal fees from Axsome Therapeutics, Associated Professional Sleep Societies, Bryte Foundation, Clement Law Firm, Institute of Digital Media and Child Development, Klarman Family Foundation, Law Offices of James L Mitchell, Law Office of Yolanda Huang, Massachusetts Medical Society, National Council for Mental Wellbeing, National Sleep Foundation, Puget Sound Pilots, Rabb and Rabb LLC, Stephans Law firm, Reyes Law Firm, Cloward Trial Lawyers, Haglund Kelley LLP., Adam Dvid Law Firm, Law offices of James Mitchell, Paul Byrd Law firm PLLC, Smith Lacine LLP, Covington and Burling LLP, Perdue & kidd, Segal Law Firm, Shaked Law Firm, P.A., Simpson & Simpson, Tencent Holdings Ltd, Teva Pharma Australia, The Armstrong Firm, PLLC, Vanda Pharmaceuticals Inc, With Deep, Inc. and Zehl Law Firm, during the conduct of the study; reports research/education support to Brigham and Women’s Hospital from Abbaszadeh Foundation, Alexandra Drane, Apnimed, Inc., Avadel Pharmaceuticals, Bryte Foundation, Zoll, Illumination Technology, Casey Feldman Foundation, Cephalon, DR Capital, Eisai Co., LTD, f.lux Software, LLC, Idorsia Pharmaceuticals LTD, Mary Ann & Stanley Snider via Combined Jewish Philanthropies, Harmony Biosciences LLC, Jazz Pharmaceuticals PLC, Inc, Johnson & Johnson, NeuroCare, Inc., Optum, Peter Brown and Margaret Hamburg, Philips Respironics Inc, Regional Home Care, ResMed Foundation, San Francisco Bar Pilots, Sleep Number Corp., Stuart F. and Diana L. Quan Charitable Fund, Summus, Inc., Axsome Theraputics, Takeda Pharmaceutical Co., LTD, Teva Pharmaceuticals Industries Ltd, ResMed, Sanofi, Philips, Vanda Pharmaceuticals and Whoop, Inc., during the conduct of the study; and is the incumbent of an endowed professorship provided to Harvard University by Cephalon Inc. during the conduct of the study; report serving as an expert witness in legal cases, e.g., those involving Advanced Power Technologies, Aegis Chemical Solutions LLC, Amtrak, Bombardier, Inc., Casper Sleep Inc, C&J Energy Services, Delta Airlines/Comair, Enterprise Rent-A-Car, FedEx, Greyhound Lines, Inc., Puget Sound Pilots, Steel Warehouse, FedEx, Greyhound Lines, Product & Logistics Services LLC, San Francisco Sheriff’s Department, Schlumberger Technology Corp., Union Pacific Railroad, UPS, and Vanda Pharmaceuticals during the conduct of the study; reports having an equity interest in Vanda Pharmaceuticals, With Deep, Inc, and Signos, Inc. during the conduct of the study; and reports receiving royalties from McGraw Hill, Massachusetts Medical Society, and Philips Respironics for the Actiwatch-2 and Actiwatch Spectrum devices during the conduct of the study. Dr. Czeisler’ s interests were reviewed and are managed by the Brigham and Women’s Hospital and Mass General Brigham in accordance with their conflict-of-interest policies.