ULØ, Alm.del - 2012-13 - Bilag 12: Henvendelse af 13/10-12 fra Peter Prinds, vedrørende vindmøllers indvirkning på lokalbefolkningen

ContentsSummary1. Introduction1.1 Author’s qualifications and expertise1.2 N&NS brief1.3 Scope of report1.4 Source material2. Background2.1 Introduction2.2 Sleep, sleep physiology and effects of noise2.3 Psychological factors and noise sensitivity2.4 Masking of turbine noise3. Wind turbine noise, sleep and health3.1 Introduction3.2 Epidemiological and anecdotal studies3.3 Expert opinion3.4 Studies of health related effects3.5 Sleep disturbance and health effects3.6 Conclusions4. ETSU-R-974.1. ETSU-R-974.2. Conclusions5. Overall Conclusions and Recommendations5.1 General Conclusions5.2. Consultation Questions6. BibliographyFigures and Tables

SummaryThe principle purpose in regulating the noise emissions of industrial wind turbinesis the protection of the sleep of those living nearby. Adequate sleep is essential forhuman health and well being.Current guidance, ETSU-R-97, was formulated in 1997 and has never beenrevised despite considerable research and evidence of harm. Wind turbine noisediffers from other sources of noise, such as traffic, in character and in causingannoyance. “Annoyance” in this context constitutes a degree of stress sufficient toimpair health. Wind turbine noise cannot be treated in the same way as other noisesources. Evidence from a range of sources, set out in this paper, shows thatcurrent guidance permits industrial wind turbines to be sited too close to residentialproperties for the preservation of sleep and health of the residents. My expertopinion is that the minimum setback of large (>2MW) industrial wind turbinesshould be at least 1.5km from residential properties.Legal opinion is clear that guidance such as ETSU-R-97 can be set aside ifrelevant evidence is presented that was not available to those that framed theguidance. The evidence presented constitute material considerations and it istherefore entirely reasonable for a planning authority to enforce a minimum setbackdistance on the grounds of noise and health.The evidence provided here leads me answer the following questions from theNorthumberland Council Core Strategy Issues and Options report thus:Question 58 - Public health impact must be considered when assessing renewableand low carbon energy schemes.Question 61- The council should have a recommended separation distance forturbines from houses on health grounds and the current body of evidence wouldsupport a distance of at least 1.5kmCD HanningJuly 2012Page 3 of 46

1.1.1. My name is Dr Christopher Hanning, Honorary Consultant in SleepDisorders Medicine to the University Hospitals of Leicester NHS Trust,based at Leicester General Hospital, having retired in September 2007 asConsultant in Sleep Disorders Medicine. In 1969, I obtained a First classHonours BSc in Physiology and, in 1972, qualified in medicine, MB, BS,MRCS, LRCP from St Bartholomew’s Hospital Medical School. After initialtraining in anaesthesia, I became a Fellow of the Royal College ofAnaesthetists by examination in 1976 and was awarded a doctorate fromthe University of Leicester in 1996. I was appointed Senior Lecturer inAnaesthesia and Honorary Consultant Anaesthetist to Leicester GeneralHospital in 1981. In 1996, I was appointed Consultant Anaesthetist with aspecial interest in Sleep Medicine to Leicester General Hospital andHonorary Senior Lecturer to the University of Leicester.1.1.2. My interest in sleep and its disorders began over 30 years ago and hasgrown ever since. I founded and ran the Leicester Sleep Disorders Service,one of the longest standing and largest services in the country, untilretirement. The University Hospitals of Leicester NHS Trust named theSleep Laboratory after me as a mark of its esteem. I was a founder memberand President of the British Sleep Society and its honorary secretary for fouryears and have written and lectured extensively on sleep and its disordersand continue to be involved in research. My expertise in this field has beenaccepted by the civil, criminal and family courts. I have been accepted as anexpert on sleep disturbance related to wind turbine noise by the OntarioHigh Court and Environmental Review Tribunals. I chaired the Advisorypanel of the SOMNIA study and sit on the Advisory panel for the MedicatedSleep and Wakefulness study, both major projects investigating sleepquality in the elderly, and sit on Advisory panels for several companies withinterests in sleep medicine. I am an Associate Member of the General

1.2.1. My brief from N&NS was to review the potential consequences of windturbine noise and, in particular, its effect on sleep and health and to makerecommendations with regard to minimum setback distances in the Local Plan. Iwas asked particularly to consider Questions 58 and 61 of the Consultation:“Doyou agree or disagree with the Council’s approach to contributing to the delivery ofrenewable energy?”and“In the absence of new national guidance should the CoreStrategy include minimum or recommended separation distances betweencommercial scale wind developments and residential properties and other sensitivedevelopments?”

1.4.1. A full list of the publications cited and other source material is given inSection 7 and are cited in the text. Where several articles come to the sameconclusion, only the most recent may be cited, in the interests of brevity. Asfar as possible, articles published in peer reviewed journals are cited.However, it is inevitable that some of the material is available only on theinternet reflecting the paucity ofparticularly in the UK.government sponsored research,

2.1.1. There can be no reasonable doubt that industrial wind turbines whethersingly or in groups (“wind farms”) generate sufficient noise to disturb thesleep and impair the health of those living nearby and this is now widelyaccepted. A recently published peer reviewed editorial in the British MedicalJournal (Hanning 2012) states: “Alarge body of evidence now exists tosuggest that wind turbines disturb sleep and impair health at distances andexternal noise levels that are permitted in most jurisdictions, including theUnited Kingdom.” “When seeking to generate renewable energy throughwind, governments must ensure that the public will not suffer harm fromadditional ambient noise”.An Ontario Environmental Review Tribunal heardevidence from over 20 expert witnesses (including the author) in 2011 andconcluded “…the debate should not be simplified to one about whetherwind turbines can cause harm to humans. The evidence presented to theTribunal demonstrates that they can, if facilities are placed too close toresidents. The debate has now evolved to one of degree.” (Case Nos. 10-121 and 10-122. p 207).In reviewing potential health impacts of sustainableenergy sources, three leading members of the National Institute ofEnvironmental Health Sciences, part of the US National Institutes of Health,state:“Wind energy will undoubtedly create noise, which increases stress,which in turn increases the risk of cardiovascular disease and cancer.”(Gohlke et al. 2008). Section 5.1.1 of the draft New Zealand standard onwind farm noise, 2009, states:“Limits for wind farm noise are required toprovide protection against sleep disturbance and maintain reasonableresidential amenity.”ETSU-R-97 is predicated in part on earlier WHOguidelines and was intended to avoid sleep disturbance. As will bedemonstrated, the ETSU-R-97 night time limits were set too high to preventsleep disturbance. Reports from many different locations and differentcountries have a common set of symptoms and have been documented byFrey and Hadden (2012). New cases are documented regularly on theInternet. The symptoms include sleep disturbance, fatigue, headaches,Page 6 of 46

dizziness, nausea, changes in mood and inability to concentrate and havebeen named “wind turbine syndrome” by Dr Nina Pierpont (2009). Theexperiences of the Davis (2008) family from Lincolnshire whose homes werearound 900m from wind turbines make salutary reading. The noise, sleepdisturbance and ill health eventually drove them from their homes. TheDavises subsequently took the developers and land owners to the HighCourt. An out of court settlement was reached before judgement had beenmade. Similar stories have been reported from around the world, usually inanecdotal form but in considerable numbers.2.1.2. Phillips, an epidemiologist, has reviewed all of the anecdotal cases andcase series and, in a peer reviewed journal, contends that the quantity,consistency and ubiquity of the complaints isprima facieepidemiologicalevidence of a causal link between wind turbine noise, sleep disruption and illhealth (Phillips 2011).2.1.3 The World Health Organisation Environmental Burden of Disease –European countries project (WHO EBoDE) (WHO, 2011) selected nineenvironmental stressors for study, including noise (S6).“The health effectsof environmental noise were selected to cover psychosocial (sleepdisturbance), cardiovascular effects (elevated blood pressure, IschaemicHeart Disease including myocardial infarction) and learning performance.”These choices emphasise the importance that WHO place upon the effectsof environmental noise on sleep disturbance.

2.2.1. Sleep is a universal phenomenon. Every living organism contains, within itsDNA, genes for a body clock which regulates an activity-inactivity cycle. Inmammals, including humans, this is expressed as one or more sleepperiods per 24 hours. Sleep was previously thought to be a period ofwithdrawal from the world designed to allow the body to recuperate andrepair itself. However, modern research has shown that sleep is primarily bythe brain and for the brain. The major purpose of sleep seems to be thePage 7 of 46

proper laying down and storage of memories, hence the need for adequatesleep in children to facilitate learning and the poor memory and cognitivefunction in adults with impaired sleep from whatever cause.2.2.2. Inadequate sleep has been associated not just with fatigue, sleepiness andcognitive impairment but also with an increased risk of obesity, impairedglucose tolerance (risk of diabetes), high blood pressure, heart disease,cancer, depression and impaired immunity as shown by susceptibility to thecommon cold virus. Sleepy people have an increased risk of road trafficaccidents. Sleepiness, as a symptom, has as much impact on health asepilepsy and arthritis. It is not insignificant.2.2.3 Humans have two types of sleep, slow wave (SWS) and rapid eye movement(REM). SWS is the deep sleep which occurs early in the night while REM ordreaming sleep occurs mostly in the second half of the night. Sleep isarranged in a succession of cycles, each lasting about 90 minutes. Wecommonly wake between cycles, particularly between the second and third,third and fourth and fourth and fifth cycles. Awakenings are not rememberedif they are less than 30 seconds in duration. As we age, awakeningsbecome more likely and longer so we start to remember them.Even while deeply asleep, the brain is processing sounds and decidingwhether they merit awakening either because the sound has meaning orconstitutes a threat. For example, at the same noise level, awakening ismore likely when one’s name is called rather than a non-specific noise.Similarly, a mother will wake when her baby cries but not for a passing car.2.2.4. Noise interferes with sleep in several ways. Firstly, it may be sufficientlyaudible and annoying to prevent the onset of sleep or the return to sleepfollowing an awakening. It is clear also that some types of noise are moreannoying than others. Constant noise is less annoying than irregular noisewhich varies in frequency and loudness, for example, snoring, particularly ifaccompanied by the snorts of sleep apnoea (breath holding). The swishingor thumping impulsive noise associated with wind turbines seems to bePage 8 of 46

particularly annoying as the frequency and loudness varies with changes inwind speed and local atmospheric conditions and the character of the noisemay be perceived as threatening. While there is no doubt of the occurrenceof these noises and their audibility over long distances, up to 3-4km in somereports, the actual cause has not yet been fully elucidated (Bowdler 2008).Despite recommendations by the Government’s own Noise Working Group,government sponsored research in this area has been stopped. Stigwood(2008), an independent noise consultant, has demonstrated that this noisepattern is common with large turbines.2.2.5. Secondly, noise experienced during sleep may arouse or awaken thesleeper. A sufficiently loud or prolonged noise will result in full awakeningwhich may be long enough to recall. Short awakenings are not recalled as,during the transition from sleep to wakefulness, one of the last functions torecover is memory (strictly, the transfer of information from short term tolong term memory). The reverse is true for the transition from wakefulnessto sleep. Thus only awakenings of longer than 20-30 seconds aresubsequently recalled. Research that relies on recalled awakenings alonewill therefore underestimate the effect.2.2.6. Noise insufficient to cause awakening may cause an arousal. An arousal isbrief, often only a few seconds long, with the sleeper moving from a deeplevel of sleep to a lighter level and back to a deeper level. Because fullwakefulness is not reached, the sleeper has no memory of the event but thesleep has been disrupted just as effectively as if wakefulness had occurred.It is possible for several hundred arousals to occur each night without thesufferer being able to recall any of them. The sleep, because it is broken, isunrefreshing resulting in sleepiness, fatigue, headaches and poor memoryand concentration (Martin 1997), many of the symptoms of “wind turbinesyndrome”. Arousals are associated not just with an increase in brain activitybut also with physiological changes, an increase in heart rate and bloodpressure, which are thought to be responsible for the increase incardiovascular risk. A clear relationship between high blood pressure andaircraft noise exposure has been shown by the HYENA consortium (JarupPage 9 of 46

2008) and between traffic noise and high blood pressure for adults(Barregard 2009) and, worryingly, for preschool children (Belojevic 2008).The MESA study has suggested a link between exposure to traffic andalterations in heart function (Van Hee 2009) and Selander and colleagues(2009) have suggested a link with myocardial infarction (heart attack) butneither could separate noise effects from pollution. Arousals occur naturallyduring sleep and increase with age (Boselli 1998), as do awakenings whichmay make the elderly more vulnerable to wind turbine noise. Arousals maybe caused by sound events as low as 32 dB(A) and awakenings with eventsof 42dB(A) (Muzet and Miedema 2005). Arousals in SWS may trigger aparasomnia (sleep walking, night terrors etc.). Pierpont (2009) notes thatparasomnias developed in some of the children exposed to turbine noise inher study group.2.2.7. Arousals are caused by aircraft, railway and traffic noise. In one study ofaircraft noise, arousals were four times more likely to result than awakeningsand resulted in daytime sleepiness (Basner 2011). Freight trains are morelikely to cause arousals than passenger trains, presumably because theyare slower, generating more low frequency noise and taking longer to pass(Saremi 2008). The noise of wind turbines has been likened to a “passingtrain that never passes” which may explain why wind turbine noise is proneto cause sleep disruption. A recent study of over 18000 subjects has showna link between exposure to traffic noise and “the risk of getting up tired andnot rested in the morning (de Kluizenaar, 2009). This study, together withthat of Basner (2011) confirms that excessive noise disturbs sleepsufficiently to impair its restorative properties and adds credence to theanecdotal reports of those living near wind turbines.2.2.8. Noise character is an important factor in determining whether an arousaloccurs. Solet and colleagues (Solet et al. 2010) in a study of the effects ofnoise on hospital inpatients determined the likelihood of an arousal atdifferent sound levels for a range of sounds from telephone, intravenousfluid pump alarm, conversation, door closing, a jet aircraft passing and ahelicopter landing (Figure 1, see end of text). Those sounds with anPage 10 of 46

impulsive quality (telephone and alarm) were much more likely to cause anarousal than steadier noises such as conversation. The noise least likely tocause an arousal was the jet aircraft. Note too that for the most arousingnoises, at 40dB LAeq10sec, 80-90% of the stimuli caused an arousal. It isevident that arousals will still occur at noise levels well below 35dBA.2.2.9. Studies of different alarm signals have shown that arousals and awakeningsoccur at lower sound levels with low frequency sounds than those of higherfrequency (Bruck 2009). Repeated short beeps of 400-520Hz were mostintrusive, leading to arousal and awakening. Wind turbine noise often has aconsiderable low frequency component and has an impulsive nature whichmay, in part, explain its adverse effect on sleep. A recent laboratory study ofthe effects of air, road and rail traffic noise on sleep showed that thedifferences were explained by sound pressure level rise time, faster risesbeing more likely to arouse (Basner 2011). A characteristic of wind turbinenoise is the rapid rise time which may explain, in part it’s propensity todisturb sleep.2.2.10. It is often claimed that continual exposure to a noise results in habituation,i.e. one gets used to the noise. There is no research to confirm thisassertion. A recent small study (Pirrera et al. 2009) looking at the effects oftraffic noise on sleep efficiency suggests that habituation does not occur.Griefahn and colleagues (2008) have found that the increases in heart ratewith traffic noise induced arousals show no habituation.2.2.11. Sleep disturbance and impairment of the ability to return to sleep is nottrivial as almost all of us can testify. The elderly may be more vulnerable, notjust because they have more spontaneous awakenings than the young butbecause their high frequency hearing loss may remove some of the maskingof the lower frequency noise characteristic of wind turbines. In the shortterm, the resulting deprivation of sleep results in daytime fatigue andsleepiness, poor concentration and memory function. Accident risksincrease. In the longer term, sleep deprivation is linked to depression,weight gain, diabetes, high blood pressure and heart disease. There is aPage 11 of 46

very large body of literature but please see the 2009 WHO/EU Night NoiseGuidelines for Europe (WHO, 2009) for a fuller consideration.2.2.12. Sleep spindles are short bursts of high frequency oscillation seen in thebrain’s electrical activity (electroencephalogram, EEG) during SWS and area marker of sleep stability. Recent research has shown that subjects with ahigher spindle rate are less likely to show an arousal in response to atransient noise than a subject with a lesser rate and are less likely to reportthat noise disturbs their sleep (Dang-Vu et al., 2010). The spindle ratedecreases with age, explaining the vulnerability of the elderly to noiseinduced sleep disruption. Insomniacs, when asleep, do not have necessarilyhave reduced spindle counts, thus suggesting that sensitivity to noise whileasleep is not purely psychological but has a physical basis thus confirmingthe finding that noise sensitivity is, to a large degree, inherited.A plot of sound level against the probability of stable sleep is presented(Figure 2 see end of text). This is effectively an inverted dose-responsecurve of log sound pressure against the likelihood of an arousal. The studyonly examined noise stimuli of 40-70dB(A). However, it is reasonable toextrapolate backwards to lower noise levels. For subjects with a low spindlerate, even at a stimulus level of 35dB(A) there would be an approximate50% probability of an arousal and a 30% probability at 30dB(A). Thesubjects were 26.3 (� 7.5) years of age. Older subjects would be expectedto have even fewer spindles and to be even more sensitive to noise. Thisstudy confirms the findings of Solet that sleep disturbance can occur atsound levels below 35dBA.

both a lowered annoyance level and an enhanced cortisol response, aphysiological marker of stress. Noise sensitivity is considered to be a stable,partly heritable, personality trait; the noise sensitive being at one end of acontinuum with the noise tolerant at the other. It is often implied that thosewho are highly annoyed by noise, including wind turbine noise, aremotivated simply by a dislike of the noise source or are psychologicallydisturbed in some way. This is simply not the case, the response of thenoise sensitive being as normal a reaction as that of the noise tolerant.2.3.2. The noise sensitive are more likely to have stress related disorders, anxiety,headaches etc and worse sleep than the average. They are more likely tobe found in the countryside where noise disturbance is less. Pedersen(2004) reported that 50% of her rural subjects were rather or very noisesensitive. Noise sensitivity is more likely in those with brain injury,psychological disorders such as dyslexia and Autistic Spectrum Disorderand increased community noise may exacerbate depression in susceptibleindividuals.Flindell and Stallen (1999) listed factors influencing the degree ofannoyance to noise:

Perceived predictability of the noise level changingPerceived control, either by the individual or othersTrust and recognition of those managing the noise sourceVoice, the extent to which concerns are listened toGeneral attitudes, fear of crashes and awareness of benefitsPersonal benefits, how one benefits from the noise sourceCompensation, how one is compensated due to noise exposureSensitivity to noiseHome ownership, concern about plummeting house valuesAccessibility to information relating to the noise source

Disempowerment and loss of control is a common theme from reports ofthose subjected to excessive wind turbine noise. The impulsive character ofthe noise is perceived as threatening and it can not be escaped beingaudible within the home, the usual source of refuge and quiet to permitrestoration (Pedersen 2008), a considerable loss of amenity. The end resultis fear and anger at loss of control over the living environment withincreased stress responses including increased difficulty in initiating andmaintaining sleep. The increased wakefulness at night and the lower qualitysleep increase the impact of nocturnal turbine noise on sleep, increasing thedaytime fatigue and stress and so on in a reinforcing cycle.2.3.3. The psychological response to noise and noise sensitivity is a complex areaand an excellent review is given by Shepherd, a psychoacoustician(Shepherd 2010).2.4.Masking of turbine noise

2.4.1. One of principles of ETSU-R-97 methodology is that background noisemasks turbine noise. This is not the case as has been shown by a numberof studies.2.4.2. Nelson (2007), in a small laboratory based study examined the ability ofbackground noise to mask turbine noise. When background noise andturbine noise were adjusted to the same loudness, the residual perceivedloudness of the turbine noise was approximately half of its unmasked value(1.8sone). Even when the background noise was increased from 41 to49dB(A) the turbine noise was not fully masked. Hayes, of the HayesMcKenzie Partnership (Hayes 2007) has interpreted this by stating inevidence that:“one would expect the wind turbine (warranted to be free oftonal noise) to be audible even if the turbine noise was 10 - 15 dB below the

background noise level”.It can be inferred that if tonal noise is present, theturbine noise will be audible at a greater level below background noise.2.4.3. Bolin (2009) has reported an experimental study of the masking of windturbine noise by vegetation noise (leaves rustling etc). Subjects wereexposed to vegetation noise in a laboratory and turbine noise introduced atvarying sound pressures and vice versa and a threshold for detectiondetermined. The results were compared with the Moore and Glasbergmethods for calculating masking. The results suggest that:“....existingmodels of partial masking overestimate the ability to conceal wind turbinenoise in ambient sounds.”In other words, wind turbine noise is not maskedas well as current models predict and is thus more intrusive. This is inaccord with the work of Nelson, van den Berg, Miedema and Pedersen(2010) who show that traffic noise does not mask wind turbine noise as wellas predicted.2.4.4. It is quite clear that Hayes’ evidence that turbine noise is audible 10-15dBbelow background is entirely correct. This basic premise of ETSU-R-97 isthus false.2.4.5. Sound with the impulsive characteristics of wind turbine noise is chosen foralarm systems because of its audibility below background noise as well aswell as its ability to arouse a sleeper. These characteristics of wind turbinenoise are probably the reason why it is more annoying than other noisesources such as road traffic and why it appears to cause more sleepdisturbance.

farm noise acknowledges that sleep disturbance is the major adverseconsequence of wind turbine noise for humans.3.1.2 Unfortunatelyallgovernment and industry sponsored research in this areahas usedreported awakeningsfrom sleep as an index of the effects ofturbine noise and tend to dismiss the subjective symptoms. Because mostof the sleep disturbance is not recalled, this approach seriouslyunderestimatesthe effects of wind turbine noise on sleep.3.1.3. In my expert opinion, the weight of evidence is that large industrial windturbines pose an unacceptable risk to the sleep quality and health ofreceptors who live within 1.5km.3.1.4. I base my opinion on the following groups of evidence:1. Epidemiological studies and anecdotal reports of harm following exposure towind turbine noise.2. Opinions from other experts as to appropriate setback distances.3. Studies of health related effects such as annoyance. Some of these studieshave commented on the effects of sleep but have not used appropriateoutcome measures.4. Studies of health effects and sleep disturbance.3.2.Epidemiological and anecdotal studies.

3.2.1. There are a large number of anecdotal reports and surveys. In the interestsof brevity, they will not be detailed here but are described in an onlinereview (Hanning 2010). One survey is particularly worthy of mention,WindVoice (Krogh 2011), as the results have been published in a peer-reviewed journal. WindVoice is a self-reporting survey of communitiesaffected by wind turbine noise. As of July 2010, 144 responses had beenreceived of which 118 reported one or more health effects. 84 (58%)reported sleep disturbance and 85 (59%). There were no age differencesbetween those that reported sleep disturbance (51.5 yr (19-79)) and thosethat did not (52.2 yr (26-86)). All bar five of those reporting sleepPage 16 of 46

disturbance live within 1500m of the turbines adding further support to aminimum setback of at least that distance.3.2.2. The anecdotal reports are commonly dismissed in industry sponsoredreviews (for example, Colby et al. 2009) as not acceptable evidence.Phillips, an epidemiologist, in a peer reviewed article (Phillips 2011) hasexamined these claims, reviewed the evidence and concluded:“There is overwhelming evidence that wind turbines cause serious healthproblems in nearby residents, usually stress-disorder type diseases, at anontrivial rate. The bulk of the evidence takes the form of thousands ofadverse event reports. There is also a small amount of systematically-gathered data. The adverse event reports provide compelling evidence ofthe seriousness of the problems and of causation in this case because oftheir volume, the ease of observing exposure and outcome incidence, andcase-crossover data. Proponents of turbines have sought to deny theseproblems by making a collection of contradictory claims including that theevidence does not "count", the outcomes are not "real" diseases, theoutcomes are the victims' own fault, and that acoustical models cannotexplain why there are health problems so the problems must not exist.These claims appeared to have swayed many non-expert observers, thoughthey are easily debunked.”

3.3.3. The weight of expert opinion is that wind turbine noise adversely effectshealth at distances of at least 1.5km.3.4. Studies of health related effects.3.4.1. Phipps and others (2007) surveyed 1100 New Zealand households sited upto 3.5 km from a wind farm, 604 responded. 75% of all respondents reportedbeing able to hear the noise. Two separate developments have placed over100 turbines with capacities from 600kW to 1.65MW in a hilly tomountainous area. It has been suggested that mountainous areas mayallow low frequency noise to travel further which may explain the longdistance over which the turbines were heard. This suggestion tends to beconfirmed by a recent study which is detailed below for convenience.Phipps (2007a) has reported a further analysis of this data. All subjects livedmore than 2km from the turbines, 85% living within 3.5km. 13% of 284respondents heard the turbines at night either frequently or most of the time.42 households reported occasional sleep disturbance from turbine noiseand 26 were disturbed either frequently or most of the time. Phippsconcludes that the New Zealand Standard for Wind Turbine Noise should bemodified so that “the sound level from the wind farm should not exceed, atany residential site, and at any of the nominated wind speeds, thebackground sound level (L95) by more than 5 dBA, or a level of 30 dBA L95,whichever is less.”3.4.2. Van den Berg (2004) found that residents up to 1900 m from a wind farmexpressed annoyance with the noise, a finding replicated in his more recentstudy reported below. Dr Amanda Harry (2007), a UK GP, conductedPage 18 of 46

surveys of a number of residents living near several different turbine sitesand reported a similar constellation of symptoms from all sites. A study of 42respondents showed that 81% felt their health had been affected, in 76% itwas sufficiently severe to consult a doctor and 73% felt their life quality hadbeen adversely impacted. This study is open to criticism for its design whichinvited symptom reporting and was not controlled. While the proportion ofthose affected may be questioned it nevertheless indicates strongly thatsome subjects are severely affected by wind turbine noise at distancesthought by governments and the industry to be safe.

3.4.3. Project WINDFARMperception. van den Berg and colleagues (2008) fromthe University of Groningen in the Netherlands have published a majorquestionnaire study of residents living within 2.5km of wind turbines, ProjectWINDFARMperception. A random selection of 1948 residents were sent asimilar questionnaire to that used by Pedersen in her studies in Sweden(2003, 2004, 2007 and 2008), questions on health, based on the validatedGeneral Heath Questionnaire (GHQ), were added. 725 (37%) replied whichis good for a survey of this type but, nevertheless, may be a weakness.Non-respondents were asked to complete a shortened questionnaire. Theirresponses did not differ from full respondents suggesting the latter arerepresentative of the population as a whole.Questions on wind turbine noise were interspersed with questions on otherenvironmental factors to avoid bias. The sound level at the residents’dwellings was calculated, knowing the turbine type and distance, accordingto the international ISO standard for sound propagation, the almost identicalDutch legal model and a simple (non spectral) calculation model. Theindicative sound level used was the sound level when the wind turbinesoperate at 8 m/s in daytime -that is: at high, but not maximum power.Ground absorption was set to 1.0, a 100% sound absorbing surface. Typicalvalues are around 0.5 and thus the sound levels may have been under-estimated. Noise exposure ranged between 24 and 54dB LAeq. It is worthnoting that the wind industry was approached for assistance in the researchbut refused. Complaints such as annoyance, waking from sleep, difficulty inPage 19 of 46

returning to sleep and other health complaints were related to the calculatednoise levels.Relevant conclusions include.“Sound was the most annoying aspect ofwind turbines”and was more of an annoyance at night. Interrupted sleepand difficulty in returning to sleep increased with calculated noise level asdid annoyance, both indoors and outdoors. Even at the lowest noise levels,20% of respondents reported disturbed sleep at least one night per month.At a calculated noise level of 30-35dB LAeq, 10% were rather or veryannoyed at wind turbine sound, 20% at 35-40dB LAeq and 25% at 40-43dBLAeq, equivalent to 38-41dB LA90, less than the permitted minimum ETSU-R-97 night time level.Project WINDFARMperception further found that“Three out of fourparticipants declare that swishing or lashing is a correct description of thesound from wind turbines. Perhaps the character of the sound is the causeof the relatively high degree of annoyance. Another possible cause is thatthe sound of modern wind turbines on average does not decrease at night,but rather becomes louder, whereas most other sources are less noisy atnight. At the highest sound levels in this study (45 decibel or higher) there isalso a higher prevalence of sleep disturbance."The lack of a control groupprevents this group from making firmer conclusions about turbine noise andsleep disturbance but it is clear that as ETSU-R-97 permits an exterior nighttime noise level of 43dB, relying on its calculations will guarantee disturbedsleep for many of those living nearby.van den Berg concluded also that, contrary to industry belief, road noisedoes not adequately mask turbine noise and reduce annoyance anddisturbance. In addition, the authors compared their results with studies byMiedema on the annoyance from road, rail and air related noise. Windturbine noise was several times more annoying than the other noise sourcesfor equivalent noise levels (Fig3).Similar data is given by Pedersen (2004)(Fig4)–see end of text.

With regard to health it was concluded that:“There is no indication that thesound from wind turbines had an effect on respondents’ health, except forthe interruption of sleep. At high levels of wind turbine sound (more than 45dB(A)) interruption of sleep was more likely than at low levels. Higher levelsof background sound from road traffic also increased the odds forinterrupted sleep. Annoyance from wind turbine sound was related todifficulties with falling asleep and to higher stress scores. From this study itcannot be concluded whether these health effects are caused by annoyanceor vice versa or whether both are related to another factor.”The conclusionsregarding general health are not justified from the data for the reasons givenbelow and must be disregarded.Project WINDFARMperception is currently the largest study in this field butthe study is not without considerable flaws. The study may be criticised forusing calculated noise levels and for not having a control group (residentsnot living near turbines). While several of the contributors have expertise inthe investigation of health matters, none has specific expertise in thephysiology and pathophysiology of sleep. The purpose of the study, as itstitle suggested, was the public perception of wind turbines and their noise.Health questions were added but were of a very general nature. The smallnumber of respondents suggests that any conclusions as to the apparentlack of an effect on health must be regarded as tentative.The analysis of reported sleep interruption and wind turbine sound levels isflawed by the use of subjects exposed to calculated external turbine soundlevels of <30dB(A) (p53) as the “controls”. It has been noted by severalstudies that calculated turbine noise is often less than measured noise andthat levels as low as 30dB(A) can cause annoyance (Pedersen 2007).Examination of the odds ratio for different calculated sound levels (Table7.42) shows that it increases progressively with increasing sound levelsstarting at 30-35dB(A) and becomes statistically significant for levels>45dB(A). If, as is not impossible, the “control” group had its sleep disturbedby wind turbine noise then the actual effect would be underestimated.

The major objection to the conclusions on health is that the study is grosslyunder-powered (insufficient subjects were studied for any degree ofstatistical confidence). Marked ill-health, “Wind turbine syndrome”, to thedegree reported by Pierpont (2009), does not seem to be common evenamongst those exposed to high noise levels. The study tried to detectchronic disease with the GHQ, which is a fairly crude instrument. Assumingthat “wind turbine syndrome” affects 1% of those exposed to calculatedsound levels >45dB(A) and that 25% of the general population suffer fromchronic disease (p47) then at least 30,000 subjects would need to bestudied in each group (>45dB(A) v <30dB(A)) to be able to prove adifference with 95% certainty. Even if a prevalence of “wind turbinesyndrome” of 5% of those exposed to >45dB(A) is assumed, then theremust be at least 1250 subjects in each group. It is possible also that thosewith a degree of ill health are more vulnerable and more likely to developsymptoms. A general health questionnaire will not detect such people andsymptom specific surveys will be required. This study therefore can notconclude that wind turbines do not cause ill health of any degree, it can noteven make conclusions about severe ill health.3.4.4. Pedersen, van den Berg and others (Pedersen 2009a&b) have furtheranalysed the data in an attempt to model a generalised dose-responserelationship for wind turbine noise. A noise metric, Lden, was calculated.Lden is based on long-term equivalent sound pressure levels adjusted forday (d), evening (e) and night). Penalties of 5 and 10dB are added forevening and night hours respectively to reflect the need for quietness atthose times. dB(A) LAeq values for wind turbines may be transformed toLden values by adding 4.7�1.5 dB (van den Berg 2008). Annoyance is usedas the principal human response to wind turbine noise in this analysis. Inthis context, “annoyance” is more than simply irritation but is a measure oflack of well-being in a wider sense (Pedersen 2009a) and is contrary to theWHO definition of health.Annoyance increased with increasing sound levels, both indoors andoutdoors. The proportion who were rather and very annoyed at differentPage 22 of 46

sound levels are shown in Table I. In summary, when outside, 18% wererather or very annoyed at sound levels of 35-40 and 40-45 dB LAeqcompared to 7% at 30-35dB LAeq and 2% at <30dB LAeq. When inside, theequivalent figures were 1% at <30dB LAeq, 4% at 30-35dB LAeq, 8% at 35-40dB LAeq and 18% at 40-45dB LAeq. Those respondents who had aneconomic interest in the turbines had lower levels of annoyance whilenegative views of the visual impact of turbines increased the likelihood ofannoyance.Although the authors do not seek to recommend minimum sound levels,they do note that turbine noise was more annoying than other sources, withthe possible exception of railway shunting yards and was more noticeable atnight. They conclude that:“...night time conditions should be treated ascrucial in recommendations for wind turbine noise limits.”Nevertheless, it isclear from this analysis that external predicted turbine sound levels shouldbe less than 35dB LAeq (33dB LA90), considerably less than those permittedby ETSU R 97, in order to reduce effects on nearby residents to acceptablelevels.3.4.5. Pedersen (2009a&b) has recently combined the datasets from three studies(Pedersen 2004 (SWE00)) and 2007 (SWE05) and van den Berg 2008(NL07)) as they used similar questionnaires giving a total of 1764 subjects.A strong correlation was seen in all studies between calculated A weightedsound pressure levels and outdoor annoyance as noted above.Even at sound pressures of 30-35 dB LAeq, 5-12% of subjects were veryannoyed. Correlations were found also between annoyance and symptomsof stress (headache, tiredness, tension and irritability) confirming that“annoyance” is more than irritation and is a marker of impaired health. Thesleep disturbance question did not ask causation of the sleep disturbanceand a background level would therefore be expected from other causes(traffic noise, weather, etc). Nevertheless, there was a clear increase inlevels of sleep disturbance with A-weighted sound pressure in studiesSWE00 and NL005. (Figure 5, See end of text). Pedersen states“In the firstPage 23 of 46

Swedish study (SWE00) the increase of respondents that reported sleepinterruption appears to be between the sound level interval 35-40 dB(A) and40-45 dB(A). The increase came at higher sound levels in the Dutch study(NL07); between the interval 40-45 dB(A) and >45 dB(A)”.All values areLAeq. There is no true measurement of background levels of sleepdisturbance as no study had a control group, it is difficult therefore todetermine at what sound pressure level turbine noise begins to have aneffect. but even the conservative levels suggested above are less thanthose permitted by ETSU R 97.3.4.6. The weight of evidence of the health related consequences of wind turbinenoise is that it adversely effects health at distances of at least 1.5km.3.5. Sleep disturbance and health effects.3.5.1. The Pedersen and van den Berg studies cited above, showed that asignificant proportion of receptors are affected at noise levels less thanthose permitted by ETSU R 97, even though they used an insensitivemeasure of sleep disturbance. The studies by Shepherd and Nissenbaumand colleagues show convincingly that wind turbine noise levels permittedunder ETSU R 97 have a serious adverse effect on sleep.

3.5.2. Dr Daniel Shepherd, (2012) a psychoacoustician from the University ofAuckland, New Zealand, has published, in a peer reviewed journal, acase-control study of the health status of residents living within 2km ofthe Makara windfarm. Health related quality of life (HRQoL) wasmeasured using the WHO QOL-BREF which has four subscales,physical, including sleep, psychological, social and environmental. Thequestionnaire was disguised as a general health survey by addingquestions on neighbourhood problems, amenity and noise and airpollution annoyance as distractors.34% (39) of those living within 2km of the Makara turbines responded andwere compared with 158 subjects from a socio-economic matched groupwho lived at least 8km from a turbine. Examination of a map of the areaPage 24 of 46

The turbine group had significantly lower (P = 0.017) mean physical HRQOLdomain scores than the comparison group. This was due to a difference inperceived sleep quality between the two areas (P = 0.006) and betweenself-reported energy levels (P= 0.028). The turbine group had significantlylower (P = 0.018) environmental QOL scores than the comparison group.The turbine group considered their environment to be less healthy (P <0.007) and were less satisfied with the conditions of their living space (P =0.031). Thirdly, mean ratings for an overall quality of life item wassignificantly lower (P =0.019) in the turbine group.

demonstrates that living within 2km of wind turbines is harmful to health. Toquote the authors:“Demonstrably, our data have also captured the effects ofwind turbine noise on sleep, reinforcing pervious studies suggesting that theacoustic characteristics of turbine noise are well suited to disturb the sleepof exposed individuals.”and“..we conclude that night-time wind turbinenoise limits should be set conservatively to minimise harm and, on the basisof our data, suggest that setback distances need to be greater than 2km inhilly terrain.”

3.5.3. Botha (2011) reports on sound monitoring carried out at the Makara windfarm. He notes that noise complaints were received immediately after thesite became operational in 2009. The operators adjusted the turbines toreduce the tonal character of the noise shortly thereafter. Botha states thatthe sound levels recorded were within those permitted by the then currentNew Zealand standard. It is important to note that Shepherd’s study wasconductedafterthe adjustments to the turbines that were intended toeliminate noise complaints and that the sleep and health impairmentsoccurred at levels permitted by NZ standards.3.5.4. Nissenbaum (2010) has presented the preliminary results of a study ofresidents living downwind and within 300-1100m (mean 800m) of a windfarm at Mars Hill, Maine, USA. The 28 1.5MW turbines are sited on a 200mhigh ridge overlooking the homes. 22 of about 35 adult residents havebeen interviewed so far and compared with a randomly selected controlgroup living a mean 6km away. 18/22 reported new or worsened sleeponset disturbance at least twice a week, for 9 at least 5 times per week(controls 1/28). 8/22 reported new or worsened headaches (controls 1/28)and 18/22 reported new or worsened mental health symptoms (stress12/22, anger 18/22, anxiety 8/22, hopelessness 12/22, depression 10/22)(controls 0/28).The 22 subjects received 15 new or increased prescriptions from theirphysicians in the 18 months between the start of turbine operation and thestudy, the majority for psychoactive medication (controls 4 prescriptions,none for psychoactive medication). 21/22 reported reduced quality of lifeand 20/22 considered moving away (controls 0/28 for both).

The study may be criticised for it’s relatively small numbers of subjectsbut the presence of a control group, well matched for age and gender,adds considerable power. All differences between the groups arestatistically highly significant. The turbine noise levels may be enhancedby the high concentration of turbines and the geography but the severesleep disturbance, psychiatric symptomatology and increased medicationrequirement in the study group confirms the potential of wind turbinenoise to adversely affect health at distances claimed to be safe.

A questionnaire was offered to all residents meeting inclusion criteria livingwithin 1.5 km of an IWT and to a random sample of residents meetinginclusion criteria living 3 to 7 km from an IWT between March and July of2010. The questionnaire comprised validated instruments relating to mentaland physical health (SF-36v2) (QualityMetric Inc.), sleep disturbance(Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale(ESS), in addition to headache functional inquiry questions and a series ofattitudinal questions relating specifically to changes with exposure to IWTnoise. The PSQI asks a series of questions about sleep and daytimefunctioning over the preceding few weeks to give an overall score of sleepquality. The ESS asks subjects to rate their likelihood, over the past fewweeks, of falling asleep in eight situations on a 0-3 scale. A typical score isabout 5 and scores >10 are deemed significantly sleepy.33 and 32 adults were identified as living within 1,500 m of the nearest IWT atthe Mars Hill (mean. 805 m, range 390-1,400) and Vinalhaven sites (mean771 m range 375-1,000) respectively. 23 and 15 adults at the Mars Hill andVinalhaven sites respectively completed questionnaires. Recruitment of controlgroup participants continued to approximately the same number as study groupparticipants, 25 and 16 for Mars Hill and Vinalhaven respectively.There were no significant differences between the groups with respect tohousehold size, age, or gender.Demographic dataDistance range from residence to nearest IWT (mean) in metersParameterSample sizeHousehold clustersMean ageMale/Female375-750 (601)18115010/8751-1,400 (964) 3,300-5,000 (4,181) 5,300-6,600(5,800)20142712102357655812/87/711/16

Both the ESS and PSQI are averaged measures, i.e. they ask the subject toassess their daytime sleepiness and sleep quality respectively, over aperiod of several weeks leading up to the present. For the ESS to increase,sleep must have been shortened or fragmented to a sufficient degree onsufficient nights for normal compensatory mechanisms to have beenovercome. It must be concluded that at least some of the residents livingnear the Vinalhaven and Mars Hill IWT installations have suffered seriousharm to their sleep and health.

Both studies have been submitted for publication in peer reviewedjournals and have been presented at a major international meeting onnoise and health, ICBEN 2011. Peer review by the organising committeeof the meeting led to acceptance and allocation to oral presentationrather than poster presentation. In addition, the data was presented asevidence to the Kent Breeze Environmental Review Tribunal, Ontario,Canada where it was subjected to intense scrutiny by expertscommissioned by the developers, Suncor, and the Ontario Ministry of theEnvironment. This scrutiny exceeded by a considerable margin thedegree of peer-review undertaken by academic journals which rarely, ifever, examine the raw data and the calculations as occurred here. Thetribunal concluded:“This case has successfully shown that the debateshould not be simplified to one about whether wind turbines can cause harmto humans. The evidence presented to the Tribunal demonstrates that theycan, if facilities are placed too close to residents. The debate has nowevolved to one of degree.”(p. 207).

The Tribunal was required to find that “serious” harm be caused toreceptors, a requirement of Ontario law, before allowing the appeal. While itwas convinced that harm occurs, it could not be persuaded that it met thedefinition of “serious”. The windfarm commenced operations in May 2011and the first law suit by residents has already been filed (Seglins 2011). Theaffected family who live 1.1km from the turbines claim“the wind turbineshave caused debilitating vertigo, sleep disturbance, headaches and ringingin the ears, as well as stress, depression and even suicidal thoughts.”Page 31 of 46

3.5.5. The weight of evidence from investigations of the effects of wind turbinenoise on sleep and health is conclusive that it causes adverse effects atdistances of at least 1.5km.3.6. Conclusions3.6.1. It is abundantly clear that wind turbine noise adversely effects sleep andhealth at setback distances and noise levels permitted by ETSU-R-97.There is no evidence at all that wind turbines are safe at these distancesand noise levels, not a single study. In contrast there is an increasingvolume of studies outlined here to the contrary.3.6.2. My recommendation for a minimum setback of 1.5km is based upon theavailable evidence. All of the relevant studies have been of communitiesexposed to a single wind farm. A considerably greater setback will beappropriate for those receptors whose properties have wind turbines on twoor more sides of their homes. Not only will such receptors likely to besubject to higher cumulative noise levels but changes in wind direction willbring no respite and they will be at greater risk to sleep and health.

4.1.1. ETSU-R-97 does not adequately protect the public from the impacts of windturbine noise. Those framing the guidance got it wrong. The documentadmits that the permitted noise levels were selected so as not to undulyfetter the introduction of wind energy into electricity generation. Theevidence presented above shows that they erred. Wind turbine size hasincreased since ETSU-R-97 was published which may be contributory.4.1.2. A DTI report by the Hayes McKenzie Partnership (HMP) published in 2006investigated low frequency noise at three UK wind farms (DTI 2006). ThePage 32 of 46

published conclusions were that all was well with ETSU-R-97. However,draft versions of the report (DTI 2006a,b,c) came to light as a result ofFreedom of Information requests. They show that HMP had recommended areduction of the ETSU-R-97 permitted night time limits to 38dB LA90 (40dBLAeq) in the absence of AM with a further penalty of up to 5dB in thepresence of modulation. These recommendations were removed from thefinal version of the report. No scientific explanation for their removal seemsto have been offered. It was stated in the draft:“The analysis of the external and internal noise levels indicates that it maybe appropriate to re-visit the issue of the absolute night-time noise criterionspecified within ETSU-R-97. To provide protection to wind farm neighbours,it would seem appropriate to reduce the absolute noise criterion for periodswhen background noise levels are low. In the absence of high levels ofmodulation, then a level of 38 dB LA90 (40 dB LAeq) will reduce levels to aninternal noise level which lies around or below 30 dB LAeq with windowsopen for ventilation. In the presence of high levels of aerodynamicmodulation of the incident noise, then a correction for the presence of thenoise should be considered.”

Similarly, references to WHO guidance for the protection of sleepdisturbance which supported HMP’s recommendations for a reduction inETSU-R-97 night time noise limits were removed from the drafts. It wasstated:“If one takes the guidance within the WHO for the protection against sleepdisturbance of 30dB LAEq, and apply a 5 dB correction for the presence ofhigh levels of [aerodynamic] modulation within the incident noise, then thisgives rise to an internal noise criterion of 25dB LAeq. Based upon themeasured building attenuation performances at Site 1 & 2, then an externallevel between 35 – 40dB LAEq (33-38 dB LA90) would provide sufficientprotection to neighbouring occupants to minimise the risk of disturbancefrom the modulation of aerodynamic noise.”

4.1.3. The inadequacy of ETSU-R-97 is supported by others. Many expertacousticians have severely criticised ETSU-R-97, not least Mr Dick Bowdler(Bowdler 2005), a former member of the Government’s Noise WorkingGroup considering ETSU-R-97. A number of Her Majesty’s Inspectors havebeen equally critical, not least Mr Andrew Pykett and Ms Elizabeth Ord. Theoriginal recommendations by HMP, at least one of whose employees sat onthe NWG, for a reduction in the ETSU-R-97 night time noise limits to 33-38dBA suggests very strongly that it is inappropriate to continue to rely onETSU-R-97 as presently formulated.4.1.4. A recent authoritative review of ETSU-R-97,Where ETSU is silent(Cox etal., 2012) shows how the inadequacies of ETSU, particularly in themeasurement of background noise, allowance for wind shear, calculation ofturbine noise levels, allowance for tolerances in calculations and allowancefor excessive amplitude modulation have conspired to permit turbines tooclose to residences for the well being of the residents. The authorsrecommend a setback of at least 2km. This review provides ample evidenceas to why ETSU-R-97 should be disregarded.4.1.5. Government policy is that ETSU-R-97 should be used for the assessment ofthe likely impact of wind turbine noise and this was restated in a 2007 policystatement. Developers will often assert that, as it is government policy,ETSU-R-97 may not be questioned. However, as Mr Justice Mitting stated inajudicialreviewbroughtbytheRenewableEnergyFoundation(CO/9686/2007):“It will always be open to any objector to an application forpermission to develop a site as a windfarm, to contend that the Statement istechnically inadequate or erroneous.”David Forsdick, of LandmarkChambers, a leading barrister with particular expertise in planning matters,stated, at a seminar on renewable energy on the 1stOctober 2008 (Forsdick2008):“...., general policy and guidance cannot prevent consideration of:a. the specific facts of an individual case;

b. scientific information which suggests that the general methodology mayneed to be adjusted on the facts of an individual case; orc. actual experience elsewhere on the ground which shows that thegovernment approved methodology does not always accurately predict theimpacts.Thus, whilst it is undoubtedly true that it is not for parties to an inquiry toquestion the merits of government policy, their evidence on the matters inthe previous paragraph is plainly capable of constituting “other materialconsiderations” which the decision maker has to take into account and, in anappropriate case, reach a conclusion on.4.1.6. It would seem logical that the specific facts of an individual case wouldinclude the presence of particularly sensitive receptors. It is known thatabout 15% of the population is noise sensitive and that they are more likelyto found in quiet rural areas such as Northumberland. Given the usualpopulation within 1.5km of the proposed turbines, it is certain that suchreceptors will be present.4.2.Conclusions

ConclusionsGeneral ConclusionsThere is no published experimental evidence that wind turbines are safewith respect to sleep disturbance and health at the distances and noiselevels permitted by ETSU-R-97. Not a single paper can be offered, merelyunsubstantiated assertions and assumptions. In contrast, there is goodevidence, described above, that those receptors living with 1.5km of theproposed turbines are at significant risk of disturbance to their sleep andconsequent effects on their health.The evidence presented constitutes material evidence why it is entirelyreasonable for any Planning Authority to enforce a mandatory setbackdistance on the grounds of noise and health. In my expert opinion, thatsetback should be a minimum of 1.5km.

5.2. Consultation questions5.2.1 Question 58: I disagree with the Council’s approach to contributing to thedelivery of renewable energy particularly with regard to criterion a: “Theanticipated effects resulting from development, construction and operationsuch as air quality, atmospheric emissions, noise, odour, water pollution andthe disposal of waste.” The noise emitted from industrial wind turbines andthe need for setbacks of at least 1.5km makes wind energy inappropriate forthe great majority of the County of Northumberland.5.2.2 Question 61: The Core strategy must contain mandatory minimum setbackdistances of large scale industrial wind turbines from residential propertiesand other sensitive developments. The evidence presented here makes itclear that current guidance does not adequately protect residents. Adistance of at least 1.5km is recommended.

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Figure 2.Spindle rate and sleep stability. Observations were pooled amongsubjects in the lower and upper halves of the spindle rate distribution (ranges 4.57-5.44 and 5.58-6.14 spindles/min respectively) based on EEG lead C3 during stageN2. Corresponding sleep survival curves were derived from each pool in stage N2using the Kaplan-Meier (product-limit) method.Backward extrapolation of the response curve for low spindle rate subjects showsonly a 50% likelihood of stable sleep at noise levels of 35 dB(A) and 75% likelihoodfor those with high spindle rates. From Dang-Vu et al., 2010

PredictedA-weightedsound pressure levels dB(A)<30OutdoorsnDo not notice (%) (95%CI)Notice, but not annoyed (%) (95%CI)Slightly annoyed (%) (95%CI)Rather annoyed (%) (95%CI)Very annoyed (%) (95%CI)Indoors,nDo not notice (%) (95%CI)Notice, but not annoyed (%) (95%CI)Slightly annoyed (%) (95%CI)Rather annoyed (%) (95%CI)Very annoyed (%) (95%CI)17830–3521335–4015921(16–28)41(34–49)20 (15–27)12 (8–18)6 (3–10)15961(53–68)22 (16–29)9 (6–15)4 (2–8)4 (2–8)40–459313 (8–21)46 (36–56)23 (15–32)6 (3–13)12 (7–20)9437 (28–47)31(22–31)16 (10–25)6 (3–13)10 (5–17)>45658(3–17)58(46–70)22(13–33)6(2–15)6(2–15)6546(35–58)38(28–51)9(4–19)5(2–13)2(0–8)