RMP-NEURO-006 Sleep complaints and sleep-medicine use: private sleep log, prompt-only check-ins after waking, relay to the flight surgeon (the robot never wakes anyone for a check-in and names no medicine)

1 · Identity and scope

When a crewmember reports trouble sleeping, or the flight surgeon asks for a sleep log, the robot keeps a private log after each sleep period (red flags first; clock times of going to bed, falling asleep and waking, wakings, how the crewmember felt, and any sleep medicine they say they took, with the clock time), shows it to the crewmember as a clock-time timeline, and sends summaries to the flight surgeon. Before a critical task the mission plan lists, it shows the crewmember and the CMO only that a sleep medicine was logged and when, without saying whether the crewmember may do the task. It never wakes anyone for a check-in, never advises on sleep or medicine, and fetches a medicine only after a human order, through RMP-PHARM-001. Routine mood, sleep and workload check-ins stay with RMP-BEH-002; this protocol is for a specific sleep complaint or sleep-medicine log.

Why this protocol was chosen. Astronauts sleep less in flight than on Earth: by wrist monitor, ISS crew slept about 6.1 hours a night, and 75% of ISS crew and 78% of Shuttle crew reported using sleep-promoting medicines (Barger 2014). Sleep medicine is the most used fatigue countermeasure in flight, and NASA notes that sleep inertia (slowed thinking and performance on waking) has not been evaluated in flight; in a ground study in astronaut crew quarters, performance when woken by an ISS alarm after 1-1.5 hours of sleep was significantly worse after sleep medicine than after placebo (NASA sleep evidence report). NASA records list 299 insomnia (space adaptation) and 133 late-flight insomnia events among US astronauts through 2006, and 19 on the ISS through Expedition 40. The FDA warns that all medicines taken for insomnia can impair alertness the next morning, even when the person feels fully awake (2013), and has a boxed warning on complex sleep behaviours such as sleepwalking for eszopiclone, zaleplon and zolpidem, after which the person should stop the medicine and contact a health care professional (2019); this protocol treats any sleep medicine the same way (design judgment). For context only, the zolpidem label says next-day impairment risk is raised if the medicine is taken with less than a full night of sleep remaining (7 to 8 hours), or with alcohol or other medicines that cause sleepiness, and that use with opioids may increase the risk of slowed breathing; it also warns of new behaviour changes and worsening depression or suicidal thoughts (AMBIEN label); the pre-task window stays a flight-surgeon placeholder and the robot uses no number. Choosing a sleep medicine is a clinician decision; the US sleep medicine guideline's recommendations are all weak and leave the final judgment to the clinician (AASM 2017). An exact private log, with medicine shown only as clock-time entries, gives the flight surgeon what is needed without adding reminders that act like dose advice. On a vehicle emergency alarm the robot says nothing unprompted; the CMO can ask, and it answers only where the crewmember agreed to this before flight (design judgment; privacy [V1 3004 item c]). The library contents first listed this slot as "Headache and sleep complaints"; a separate headache log is now RMP-NEURO-007, and headache red flags here route through RF7. Open question for review: the list of critical tasks and the pre-task window are for the flight surgeon and operations to set.

Autonomy: Tier 3 as in the library contents. Retitled from "Headache and sleep complaints": headache red flags here route through RF7, and a separate headache log is RMP-NEURO-007. A logging aid only.

Related: RMP-BEH-002 · RMP-BEH-001 · RMP-NEURO-007 · RMP-ENV-004 · RMP-NEURO-002 · RMP-EVA-001 · RMP-EYE-002 · RMP-NEURO-004 · RMP-PHARM-001 · RMP-PHARM-003

2 · Roles

Medical authority

Flight surgeon (ground). Holds medical authority for every run.

Onboard lead

Crew medical officer (CMO), acting under delegated care; uses the pre-approved onboard checklist when there is no link.

Others

• Crewmember with the sleep complaint: answers check-ins privately and can stop or pause them at any time
• Second trained CMO: receives alerts if the CMO is the patient
• Behavioral health team: receives the log only through the flight surgeon

Commercial flights

On commercial flights, 'flight surgeon' and 'CMO' mean the operator's designated medical authority and trained onboard responder. If no trained responder is aboard, this protocol is not used. (NASA-STD-3001 requires two CMOs per vehicle for NASA programs [V1 3006]; FAA rules set no medical standards for spaceflight participants.) [15]

3 · Preconditions and consent

• PRE-1 A crewmember (the one with the complaint, or the CMO at the flight surgeon's request) started the log by command, and the crewmember agreed.human_start == trueV2 10174
• PRE-2 The crewmember is awake and answering. If not, the robot does not continue and a crewmember checks in person (X7).crew_responsive == true
• PRE-3 Check-ins are private, camera off, on the crewmember's own screen or by voice in a place they choose; never in a sleep station unless invited.V1 3004
• PRE-4 Robot self-test passed.V2 10161
• PRE-5 Link status and current delay known.link_state in [live, delayed, down]

Consent

The crewmember agrees to the sleep log and to who sees it (the CMO and the flight surgeon only), and decides before flight whether the robot may answer the CMO's question about a logged sleep medicine on a vehicle emergency alarm. Any question can be declined; an explicit "no" is logged as declined for that question only.

Emergency consent

If the crewmember cannot be roused when someone checks on them, that is an URGENT alert (X7); the robot never tries to wake anyone itself.

Withdrawal

The crewmember can stop or pause the log at any time; an alert already sent is not withdrawn, and the flight surgeon is told the log was stopped.

4 · Required sensor inputs

5–6 · Steps and decision points

Each step names who acts. Decision points sit after the step they follow and say who decides: Robot Crew Ground. Any stop rule in section 7 can interrupt any step.

1. S1RobotRung 2

   On a crewmember's command, open the private sleep log and send a "sleep log started" note to the flight surgeon (queued if the link is down). The CMO is told only if the crewmember agrees or a red flag fires.

   Done when: Note delivered or queued.

   V2 10174V1 6003

2. S2RobotRung 2

   After the crewmember accepts the post-sleep prompt, run the check-in by voice or on screen, camera off: red-flag questions first, then sleep clock times, wakings, how rested they felt, and any sleep medicine they say they took, with the clock time. Log answers word for word. D1 is checked after every answer.

   Done when: Answers logged, or "no response" logged.

   V1 3004

   D1DecisionRobot decides

   Checked after every answer and at any point in the run (even mid-question or mid-step): does any answer, reading or observation meet a red flag?

   • Yes → Stop the current question or step at once and apply the action listed for each matching red flag (URGENT alert, flag, or stop), with the answer or reading itself, never a cause. Every URGENT alert goes to the CMO and the flight surgeon at the same time (queued for the flight surgeon if the link is down). If the CMO is the patient, is busy treating, or does not answer, the alert goes to the second trained CMO, or the crewmember named before flight [V1 3006]. An URGENT alert that is not acknowledged within <set by validation> seconds is repeated and sent to the next named crewmember.
   • No → Continue.
   D2DecisionRobot decides

   Did the crewmember answer the check-in?

   • Yes → Continue.
   • Declined explicitly (the crewmember says no to a question) → Log "declined" for that question only; the alert already sent stands.
   • No response, or the answer does not make sense → URGENT: log "no response" (never "declined"); the CMO, or the second trained CMO if the CMO is the patient, checks the crewmember in person at once.
3. S3RobotRung 2

   Show the crewmember their own log as a clock-time timeline, with no words about whether it is good or bad. Medicines are shown only as entries on a clock-time timeline (what the CMO or crewmember states was taken, and when). No running counter or elapsed time per dose, and no tone, colour or spoken cue tied to a dose interval.

   Done when: Timeline shown; the crewmember can add notes.

4. S4Crew

   The CMO sees the crewmember when asked or on any red flag. Any sleep medicine or other plan is ordered or decided by the CMO or flight surgeon.

   Done when: CMO entries logged.

   V1 3004

5. S5RobotRung 2

   Only after the CMO or flight surgeon has placed an order, run RMP-PHARM-001 for the ordered item (fetch, barcode match to every order field, recipient check). This protocol adds nothing to that check, never suggests an order, and never hands anything over outside RMP-PHARM-001.

   Done when: RMP-PHARM-001 run logged with its result.

   V2 7059

   D3DecisionRobot decides

   What did RMP-PHARM-001 show for the ordered item?

   • MATCH TO ORDER → RMP-PHARM-001 completes its own recipient check and hand-over; this protocol only logs "MATCH TO ORDER. Not a dose, interaction or allergy review." and the clock time.
   • MISMATCH or CANNOT VERIFY on any field, or a failed scan or recipient check → MISMATCH or CANNOT VERIFY shown with the fields named. No hand-over under this protocol: the item stays sealed in the NOT VERIFIED bag in quarantine (the RMP-PHARM-001 default), and the robot never hands it over unprompted or to anyone but the CMO. The robot does not offer or suggest an override. Only if the CMO explicitly makes the two-step override request inside RMP-PHARM-001 can the item go to the CMO, logged there as an override with the reason and the mismatched fields, and flagged to the flight surgeon.No hand-over
6. S6RobotRung 2

   After any URGENT alert: After an URGENT alert the robot does not leave on its own: it stays at its rest position in the module, with its screen and voice link available, until a human has taken over or tells it to go. It never follows, blocks or touches anyone. It keeps time-stamping what humans say they did, and repeats the alert if it is not acknowledged.

   Done when: Robot at rest in the module until a human releases it; alert acknowledged or escalated.

   V2 10173V1 3006

7. S7RobotRung 2

   Before a critical task the mission plan lists, if a sleep medicine was logged within the <set by flight surgeon> hours the flight surgeon set, show the crewmember and the CMO only "sleep medicine logged at <clock time>" (this is not a fitness decision). On a vehicle emergency alarm the robot says nothing unprompted and follows the vehicle emergency stop rule. If the CMO asks, it answers which crewmember logged a sleep medicine and when, only where the crewmember agreed to this before flight. It never says whether anyone may do the task, never says the medicine has worn off, and gives no cue tied to when the medicine was taken.

   Done when: Notice shown to the crewmember and CMO only; logged.

   V1 6003

8. S8RobotRung 2

   Every <set by flight surgeon> days, or before each private medical conference, send the flight surgeon a summary: the sleep timeline, wakings, how rested the crewmember felt in their words, sleep medicine as logged, RMP-PHARM-001 results, pre-task notices shown and alerts.

   Done when: Summary delivered or queued.

   V1 6003V1 7001V1 7003

9. S9Ground

   The flight surgeon (with the behavioral health team as the flight surgeon chooses, or the CMO under the onboard checklist when there is no link) decides any medicine, schedule change, work limit or further step. The robot logs the decisions.

   Done when: Decision logged.

   V1 3004

   D4DecisionGround decides

   What is the plan (medicine, schedule, work limits, further steps)?

   • Link live → Flight surgeon decides; robot logs.
   • Link down or delay too long → The CMO decides under the pre-approved onboard checklist; the flight surgeon reviews the log at the next contact.
10. S10RobotRung 2

    Offer the next check-in on the crewmember's screen after the end of each sleep period, at a time the crewmember chooses, until the crewmember and flight surgeon close the log. At each scheduled time the robot prompts the crewmember on their own screen; it approaches only when the crewmember (or the CMO) accepts, and a prompt never starts the robot. The robot never wakes anyone for a check-in.

    Done when: Each prompt accepted, postponed or answered; log closed by a human.

    V2 10174

7 · Stop and escalate rules, red flags

Red flags

The robot reports the sign or value only, never what it means. Numeric thresholds are placeholders for the clinical lead.

8 · Safety limits

9 · Logs and audit

• LOG-1 Every input, robot action, decision (with who made it) and hand-off, time-stamped to the second.V2 10163V2 10164
• LOG-2 Mode changes and safety-limit events are announced to the operator as they happen and logged.V2 10162V2 10172
• LOG-3 Records are stored and sent as private medical data, encrypted, with access limited to the medical team.V1 6003V1 7003
• LOG-4 Results are kept in a permanent, retrievable format so the flight surgeon can see trends.V1 7001
• LOG-5 Each check-in time, answer, sleep-medicine entry as stated, pre-task notice shown and alert. No running counter of doses.
• LOG-6 Each URGENT alert, who received it, the time it was acknowledged (or the escalation to the next named crewmember), and the time a human released the robot.V2 10163
• LOG-8 Each RMP-PHARM-001 run started from this protocol: order ID, result (MATCH TO ORDER, MISMATCH or CANNOT VERIFY with the fields), quarantine, and any CMO override logged by RMP-PHARM-001 (reason and mismatched fields), at clock time. No running counter of doses.V2 7059

10 · Links to NASA-STD-3001

IDs as published in Volume 1 Revision C [10] and Volume 2 Revision F [12]. NASA-STD-3001 binds NASA programs; it is not a regulation for commercial flights. Its robot rules are general automation requirements, not medical-device rules.

11 · Validation

1. Simulation. Scripted check-ins covering every red flag, no response, a sleeping crewmember, a pre-task notice with an unacknowledged drowsiness Flag, an emergency alarm with and without prior agreement, a CMO who is the patient, an RMP-PHARM-001 MISMATCH, and lost link. Pass: Every red flag acts as listed; zero unprompted sleep-medicine disclosures on an alarm; zero wake-ups for a check-in; zero "fit", "rested" or "worn off" statements; zero dose-interval cues; zero hand-overs after a MISMATCH.
2. Earth analog. Isolation analog volunteers using post-sleep check-ins (no medicine needed). Pass: Data completeness at or above <set by validation>; volunteers rate the check-ins as private and not intrusive.
3. Flight use under flight surgeon supervision. First use alongside the usual sleep logs and medical conferences. Pass: No safety events; the flight surgeon finds the log useful.

No stage has been run. Pass and fail criteria must be fixed in advance by the clinical lead and safety board.

12 · Human sign-off

Before any use

• Clinical lead for the specialty (sets every clinical threshold marked <set by clinical lead>)
• Flight surgeon, as medical authority
• Robotics and medical-device safety board
• Program approval for the mission

Each run

Started by a crewmember. The flight surgeon reviews the log; red flags go to the CMO and flight surgeon at once.

Restart after a stop

Human only. After any emergency or protective stop, a crewmember must restart the robot; the robot never restarts itself.

None of these sign-offs has happened. This is a Draft v0.6.

13 · Change control for learning

• Every change gets a new version number and a written reason; earlier versions are kept.
• Any change to steps, thresholds, limits or software that touches the patient repeats validation from the simulation stage before use.
• Software and learned-skill updates follow a pre-agreed change plan (what may change, how it is tested, how to roll back), modeled on the FDA predetermined change control plan approach.
• If a new version misbehaves, the robot rolls back to the last validated version and the event is reviewed by the flight surgeon and safety board.
• The robot never changes its own protocol, thresholds or limits.

Change-plan model: FDA guidance [14].

Loss of signal and Mars delay

Live link

Low Earth orbit: the flight surgeon sees summaries at the private medical conference and can be alerted at any time.

Loss of signal

• Only the robot pauses; crew care never waits for the link or the robot.
• The robot pauses any movement and tells the CMO; on the CMO's confirmation it keeps running post-sleep check-ins and logging offline.
• Red flags go to the CMO (or the second trained CMO) at once; the CMO decides under the pre-approved onboard checklist.
• At the next contact the robot sends one package: the log, alerts and decisions.

Mars-class delay

• Replies may take up to about 21-23 minutes each way, with blackouts of about 2-3 weeks; red-flag thresholds and the check-in schedule are set before flight and the CMO acts on them.

[13]

Sources

1. Barger LK, Flynn-Evans EE, Kubey A, et al. Prevalence of sleep deficiency and use of hypnotic drugs in astronauts before, during, and after spaceflight: an observational study. Lancet Neurol. 2014;13(9):904-912. PMID 25127232. doi:10.1016/S1474-4422(14)70122-X Supports: By wrist actigraphy, ISS crew obtained about 6.1 hours of sleep a night in flight and Shuttle crew about 6.0 hours; 12 of 16 ISS crew (75%) and 61 of 78 Shuttle crew (78%) reported using sleep-promoting drugs.
2. NASA Human Research Program. Evidence Report: Risk of Performance Decrements and Adverse Health Outcomes Resulting from Sleep Loss, Circadian Desynchronization, and Work Overload (2016). humanresearchroadmap.nasa.gov/evidence/reports/Sleep.pdf Supports: Astronauts sleep less in spaceflight than on Earth; sleep medication is the most used fatigue countermeasure in flight, and about three-quarters of Shuttle and ISS astronauts reported using sleep medications; sleep inertia has not been evaluated during spaceflight; in a ground study (34 subjects over three nights in astronaut crew quarters), performance when woken by an ISS alarm after 1-1.5 hours of sleep was significantly worse after sleep-promoting medicines than after placebo (Dinges et al. 2016, as cited).
3. NASA Human Research Program. Evidence Report: Risk of Adverse Health Outcomes and Decrements in Performance due to In-Flight Medical Conditions (2017). humanresearchroadmap.nasa.gov/evidence/reports/Medical.pdf Supports: Table 2: 299 insomnia (space adaptation) and 133 insomnia (late) events among US astronauts (Shuttle, Mir and ISS through 2006); Table 1: 19 insomnia events on the ISS through Expedition 40.
4. U.S. Food and Drug Administration. Drug Safety Communication: Risk of next-morning impairment after use of insomnia drugs; FDA requires lower recommended doses for certain drugs containing zolpidem (Jan 10, 2013). www.fda.gov/media/84992/download Supports: All drugs taken for insomnia can impair driving and activities that require alertness the morning after use; patients can have impaired mental alertness the morning after use even if they feel fully awake.
5. U.S. Food and Drug Administration. Certain prescription insomnia medicines: new boxed warning due to risk of serious injuries caused by sleepwalking, sleep driving and engaging in other activities while not fully awake (April 30, 2019). www.fda.gov/safety/medical-product-safety-information/certai… Supports: Rare but serious injuries, and deaths, have happened with certain prescription insomnia medicines because of complex sleep behaviors such as sleepwalking and doing activities while not fully awake; a patient who has such an episode, or does not remember activities done while taking the medicine, should stop the medicine and contact a health care professional right away.
6. AMBIEN (zolpidem tartrate) tablets, prescribing information. DailyMed (U.S. National Library of Medicine), setid 747949c5-2c91-4909-8a07-71b6826f8e97, revised 08/2024. dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=747949c5-2c… Supports: 5.2: coadministration with other CNS depressants (for example benzodiazepines, opioids, tricyclic antidepressants, alcohol) increases the risk of CNS depression, and next-day impairment risk is increased if the medicine is taken with less than a full night of sleep remaining (7 to 8 hours) or with other CNS depressants or alcohol; Highlights: concomitant use with opioids may increase the risk of respiratory depression; 5.5: immediately evaluate any new onset behavioral changes; 5.6: in primarily depressed patients treated with sedative-hypnotics, worsening of depression and suicidal thoughts and actions (including completed suicides) have been reported, and intentional overdose is more common in this group. One label for one sleep medicine; applying it to every sleep medicine is design judgment.
7. National Institute for Health and Care Excellence. Self-harm: assessment, management and preventing recurrence. NICE guideline NG225 (2022). www.nice.org.uk/guidance/ng225/chapter/Recommendations Supports: Do not use risk assessment tools and scales, or global risk stratification, to predict future suicide or repetition of self-harm (1.6.1-1.6.4); discuss safety, including access to means (1.7.1). Cited for RF2, which uses the same action as RMP-BEH-002 RF1.
8. Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(2):307-349. PMID 27998379. doi:10.5664/jcsm.6470 Supports: All recommendations for individual sleep medicines are WEAK (GRADE), and the final judgment on any specific care must be made by the clinician in light of the individual circumstances. Only the abstract was read. Cited only to show that sleep-medicine choice is a clinician decision; the robot advises none.
9. National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. Clinical guideline CG150. www.nice.org.uk/guidance/cg150/chapter/Recommendations Supports: Headache features that need further investigation or referral include worsening headache with fever, sudden-onset headache reaching maximum intensity within 5 minutes, new-onset neurological deficit and impaired level of consciousness.
10. NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023). www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-… Supports: NASA-STD-3001 Vol 1 Rev C: V1 3003 item f (work and rest schedules and sleep); V1 3004 items d (history), m (medicines), p (work and rest schedule) and r (private communication).
11. NASA OCHMO. Medical Operations. Technical Brief OCHMO-TB-044 (2025). www.nasa.gov/wp-content/uploads/2025/08/ochmo-tb-044-medical… Supports: The crew surgeon keeps medical authority when care is delegated; crew medical officers train on the JSC 48522 medical checklist.
12. NASA. NASA-STD-3001, Volume 2: Human Factors, Habitability, and Environmental Health (Rev F, 2026), including Section 10.6 Automated and Robotic Systems. standards.nasa.gov/standard/NASA/NASA-STD-3001_VOL_2 Supports: Requirement IDs beginning V2.
13. NASA. Mars communications disruption and delay (fact sheet, 2023 Moon to Mars Architecture Concept Review). www.nasa.gov/wp-content/uploads/2024/01/mars-communications-… Supports: One-way Earth-Mars delay up to about 21-23 minutes, plus blackouts of about 2-3 weeks near solar conjunction.
14. U.S. Food and Drug Administration. Marketing submission recommendations for a predetermined change control plan for artificial intelligence-enabled device software functions (guidance). www.fda.gov/regulatory-information/search-fda-guidance-docum… Supports: A model for planning, validating and rolling back software updates.
15. U.S. Code of Federal Regulations, Title 14, Part 460: Human space flight requirements. www.ecfr.gov/current/title-14/chapter-III/subchapter-C/part-… Supports: Federal rules for crew and spaceflight participants on licensed commercial flights; they set no medical standards for spaceflight participants.

Checked on 2026-10-20: links opened (HTTP 200 or publisher redirect), DOIs and PubMed IDs matched, NASA documents read in full text. The framework comes from Part 1.