THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 11, Number 4, 2005, pp. 673–679 © Mary Ann Liebert, Inc. Using Acupressure to Modify Alertness in the Classroom: A Single-Blinded, Randomized, Cross-Over Trial RICHARD E. HARRIS, Ph.D., 1,2 JOANNE JETER, 2 M.D., PAUL CHAN, M.D., 2 PETER HIGGINS, M.D. Ph.D., 2 FENG-MING KONG, M.D., 2 REZA FAZEL, M.D., 2 CANDACE BRAMSON, M.D., 2 BRENDA GILLESPIE, Ph.D., 2 AND COHORT 11 OF THE UNIVERSITY OF MICHIGAN CLINICAL RESEARCH DESIGN AND STATISTICAL ANALYSIS PROGRAM 2* ABSTRACT Background: Previous reports have suggested that acupressure is effective in reducing pain and improving sleep quality; however, its effects on alertness have not been characterized. Objectives: The aim of this study was to determine whether two different acupressure treatments have op- posing effects on alertness in a full-day classroom setting. Design: This was a cross-over (two-treatments; three periods), single-blinded, randomized trial. Setting: The University of Michigan School of Public Health was the setting. Subjects: Students attending a course in clinical research design and statistical analysis at the University of Michigan participated in the study. Interventions and outcome measures: Blinded subjects were randomized to two acupressure treatment se- quences: stimulation–relaxation–relaxation or relaxation–stimulation–stimulation. Acupressure treatments were self administered over 3 consecutive days. Pre- and post-treatment alertness scores were assessed each day us- ing the Stanford Sleepiness Scale (SSS). Changes in the SSS score (afternoon - morning) were analyzed us- ing a mixed regression model of fixed and random effects. Important factors that were expected to affect alert- ness, such as caffeine and previous night’s sleep, were also assessed. Results: Baseline characteristics and protocol compliance were similar between the two sequences. Stimu- lation acupressure treatment yielded a 0.56-point greater difference in score on the SSS, corresponding to less fatigue, compared to the relaxation acupressure treatment (p = 0.019). Day of study (p = 0.004) and hours of overnight sleep (p = 0.042) also significantly affected the change in SSS scores. Incorporating participants’ be- liefs as to which treatment they received did not significantly alter the observed treatment effect. Conclusions: Acupressure at stimulation and relaxation points has differential effects on alertness in a class- room setting. Further research is necessary to confirm these findings and to determine whether stimulation and relaxation acupressure are equally effective in influencing alertness. 673 1 Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI. 2 Course on Clinical Research Design and Statistical Analysis, University of Michigan, School of Public Health. Ann Arbor MI. *Members of the University of Michigan Clinical Research Design and Statistical Analysis Program Cohort 11 are: Khawaja Afzal Ammar, Michelle Anderson, Ghassan Bachuwa, Adnan Beg, Devin Brown, Linda Brubaker, Steven Bruch, Giani Cazan-London, Bobby Clark, Paul Cronin, Brian DeSmet, Gary Hamman, Brent Hollenbeck, Jaquelyn Hunt, Susan Johnson, Sucheta Joshi, Liise Kayler, Aine Kelly, Kim Kenton, Wendy Marder, Mary Marzec, Gisele Neiva, Amanda Peltier, Panduranga Rao, Erik Roys, Joel Rubenstein, Jonathan Segal, T.P. Singh, Maran Thamilarasan, Courtney Thornburg, Kevin Townsend, Robert Welch, Jinping Xu, and Najeeb Zoubi.