# 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) # Version 0.6 (Draft). CONCEPTUAL. NOT FOR CLINICAL USE. # Space Medicine Foundation robot-readable protocol library. Format: https://spacemedicinefoundation.org/robotic-medicine/protocols/schema/ # Every threshold marked must be set by the named owner (see the schema) before any use. schema_version: '0.3' version: '0.6' status: draft conceptual: true not_for_clinical_use: true max_autonomy: 2 missions: - leo - commercial - moon - mars updated: '2026-10-21' review: state: reviewed-ai-assisted requested: '2026-10-20' reviewed: '2026-10-20' human_clinician_review: false text: >- AI-assisted clinical and source review by the Medical Research Assistant, Oct 20, 2026 (batch 4 review, 28 required corrections and 23 optional suggestions); all required corrections, and the optional ones that could be verified, are applied in this version (see Corrections). No named human clinician has reviewed it. fixed_rules: flight_surgeon_is_medical_authority: true cmo_acts_under_delegated_care: true human_starts_and_restarts_robot: true robot_never_diagnoses: true no_drug_or_fluid_advice_by_robot: true safe_state_on_fault_or_no_response: true lost_link_pause_then_cmo_decides: true robot_lockouts: diagnosis: true drug_or_fluid_advice: true starting_stopping_or_adjusting_oxygen_or_any_medicine: true self_start_or_self_restart: true changing_own_protocol_thresholds_or_limits: true handing_over_a_mismatched_item_as_verified: true id: RMP-NEURO-006 slug: rmp-neuro-006 title: >- 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) category: neuro tier: 3 rung_note: >- 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. result_language: use: - logged, not interpreted - sent to flight surgeon - as reported by the crewmember - sleep medicine logged at never: - normal - no problem found - all clear - negative - any diagnosis or cause - insomnia - enough sleep - not enough sleep - rested - fit for duty - cleared - wait before - it has worn off - nothing serious - safe - mild - minor scope: summary: >- 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: >- 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. covers: - >- Trouble falling or staying asleep, waking too early, or feeling unrested, reported by a crewmember who is awake and answering, and any sleep-medicine log the flight surgeon asks for - Check-ins after each sleep period until the crewmember and flight surgeon close the log - >- Mood, stress and workload check-ins stay with RMP-BEH-002 (when both run, a single post-sleep check-in serves both); a headache with red-flag features goes to RF7; the headache log is RMP-NEURO-007 locked_out: - Waking a crewmember for a check-in, or entering a sleep station unless invited - >- Suggesting, choosing, fetching or dosing any sleep medicine or other medicine, or saying when to take it (a human order and RMP-PHARM-001 are needed) - >- Handing over any medicine outside RMP-PHARM-001, or after a MISMATCH or CANNOT VERIFY (the item stays quarantined; only the CMO can ask for it, through the RMP-PHARM-001 logged two-step override) - >- Dose-interval cues (any reminder, tone, colour, countdown or spoken cue tied to when a medicine was last taken) - >- Advising on sleep habits, light, caffeine, exercise or the work schedule (the flight surgeon and behavioral health team decide) - Saying whether a crewmember is rested, fit for a task, or past the effect of a medicine - Clearing or stopping anyone from a task - Sharing the log with anyone but the crewmember, the CMO and the flight surgeon - Recording in a sleep station, or using a camera during the check-in 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 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' robot_may: - >- Prompt the crewmember on their own screen after the end of a sleep period (prompt only; never wakes anyone) - >- Ask the red-flag and sleep questions by voice or on screen, camera off, and log answers word for word with clock times - Show the crewmember their own log as a clock-time timeline - >- Before a critical task the mission plan lists, show the crewmember and the CMO only "sleep medicine logged at " if one was logged within the window the flight surgeon set (this is not a fitness decision) - >- On a vehicle emergency alarm, if the CMO asks, say which crewmember logged a sleep medicine and when, only where the crewmember agreed to this before flight - Send summaries to the flight surgeon; alert the CMO and flight surgeon on a red flag - Run RMP-PHARM-001 for an item only after a human order robot_may_not: - Wake anyone for a check-in or enter a sleep station unless invited - Suggest, fetch or dose any medicine without a human order, or hand over a mismatched item - Say when a medicine may be taken, or that it has worn off - Say whether anyone is rested or fit for a task, or clear or stop anyone - Advise on sleep habits or the schedule - Start without a human command or an accepted prompt commercial: >- 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.) preconditions: - id: PRE-1 text: >- 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. check: human_start == true refs: - V2 10174 - id: PRE-2 text: >- The crewmember is awake and answering. If not, the robot does not continue and a crewmember checks in person (X7). check: crew_responsive == true - id: PRE-3 text: >- 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. refs: - V1 3004 - id: PRE-4 text: Robot self-test passed. refs: - V2 10161 - id: PRE-5 text: Link status and current delay known. check: link_state in [live, delayed, down] consent: standard: >- 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: >- 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. inputs: - id: IN-1 name: >- Red-flag questions: sleepwalking or doing things while not fully awake, or not remembering things done, after a sleep medicine; thoughts of self-harm or of not wanting to be alive; feeling very drowsy before a critical task; a sleep medicine taken that was not ordered, more than ordered, or with alcohol, an opioid pain medicine or another medicine that causes sleepiness; low or worsening mood or a new change in behaviour; a sudden severe headache, or a headache with fever, weakness, confusion or a vision change source: Crewmember, by voice or on screen required: true if_missing: Log "no response"; URGENT; the CMO checks in person. Never logged as declined. - id: IN-2 name: >- Clock times of going to bed, falling asleep, waking and getting up, the number of wakings, and how rested the crewmember felt, in their own words source: Crewmember, by voice or on screen required: true if_missing: Log "no response" and apply D2. - id: IN-3 name: Sleep medicine the crewmember says they took, with the clock time (shown as a timeline entry only) source: Crewmember, by voice or on screen; dose log (RMP-PHARM-003) required: false if_missing: Log "not stated"; a missing answer is never treated as "none". - id: IN-4 name: >- Sleep-station noise, light and temperature as the crewmember describes them, and the work schedule from the mission plan (read only) source: Crewmember; mission plan required: false if_missing: Log "not available". - id: IN-5 name: Wearable sleep data the crewmember chooses to share (read only) source: Wearable sleep monitor required: false if_missing: Log "not shared". - id: IN-6 name: >- Critical tasks listed in the mission plan (for example a spacewalk, robotic arm work, docking or an emergency drill), and the window the flight surgeon set for the pre-task notice source: Mission plan; flight surgeon required: false if_missing: No pre-task notice is shown; tell the CMO. - id: IN-7 name: Orders placed by the CMO or flight surgeon source: Medical record required: false if_missing: Treat as no order; the robot fetches no medicine. - id: IN-8 name: Link status and delay source: Communications system required: true if_missing: Treat as link down. steps: - id: S1 actor: robot rung: 2 action: >- 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. success: Note delivered or queued. refs: - V2 10174 - V1 6003 - id: S2 actor: robot rung: 2 action: >- 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. success: Answers logged, or "no response" logged. refs: - V1 3004 - id: S3 actor: robot rung: 2 action: >- 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. success: Timeline shown; the crewmember can add notes. - id: S4 actor: crew action: >- 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. success: CMO entries logged. refs: - V1 3004 - id: S5 actor: robot rung: 2 action: >- 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. success: RMP-PHARM-001 run logged with its result. refs: - V2 7059 - id: S6 actor: robot rung: 2 action: >- 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. success: Robot at rest in the module until a human releases it; alert acknowledged or escalated. refs: - V2 10173 - V1 3006 - id: S7 actor: robot rung: 2 action: >- Before a critical task the mission plan lists, if a sleep medicine was logged within the hours the flight surgeon set, show the crewmember and the CMO only "sleep medicine logged at " (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. success: Notice shown to the crewmember and CMO only; logged. refs: - V1 6003 - id: S8 actor: robot rung: 2 action: >- Every 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. success: Summary delivered or queued. refs: - V1 6003 - V1 7001 - V1 7003 - id: S9 actor: ground action: >- 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. success: Decision logged. refs: - V1 3004 - id: S10 actor: robot rung: 2 action: >- 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. success: Each prompt accepted, postponed or answered; log closed by a human. refs: - V2 10174 decisions: - id: D1 after: S2 decided_by: robot question: >- 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? branches: - if: 'Yes' then: >- 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 seconds is repeated and sent to the next named crewmember. - if: 'No' then: Continue. - id: D2 after: S2 decided_by: robot question: Did the crewmember answer the check-in? branches: - if: 'Yes' then: Continue. - if: Declined explicitly (the crewmember says no to a question) then: Log "declined" for that question only; the alert already sent stands. - if: No response, or the answer does not make sense then: >- 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. - id: D3 after: S5 decided_by: robot question: What did RMP-PHARM-001 show for the ordered item? branches: - if: MATCH TO ORDER then: >- 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. - if: MISMATCH or CANNOT VERIFY on any field, or a failed scan or recipient check then: >- 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. handoff: none - id: D4 after: S9 decided_by: ground question: What is the plan (medicine, schedule, work limits, further steps)? branches: - if: Link live then: Flight surgeon decides; robot logs. - if: Link down or delay too long then: >- The CMO decides under the pre-approved onboard checklist; the flight surgeon reviews the log at the next contact. stop_rules: - id: X1 trigger: The patient (or the crewmember being examined) says stop, or withdraws consent action: >- Robot stops all motion at once, backs away to its rest position and tells the CMO. Recording stops unless the patient agrees to keep it running. level: stop refs: - V2 10165 - id: X2 trigger: Any crewmember presses stop or takes over control action: Protective stop; robot holds its stopped position; only a human may restart it. level: safe-state refs: - V2 10165 - V2 10168 - V2 10174 - id: X3 trigger: Robot fault, sensor fault, or a force, speed or reach limit is reached action: Protective stop and hand control to the CMO; log the fault. level: safe-state refs: - V2 10172 - V2 10168 - id: X4 trigger: CMO is asked to take over and does not respond (for example, the CMO is the patient) action: Robot stays stopped; the next named crewmember is called. level: safe-state refs: - V2 10173 - V2 7045 - id: X5 trigger: Loss of link, or delay longer than the limit for live guidance action: >- Only the robot pauses; crew care never waits for the link or the robot. Robot pauses any movement in its stopped position and tells the CMO. The CMO decides whether to continue offline under the pre-approved onboard checklist; the robot resumes only on the CMO's confirmation. Everything is logged and sent to the flight surgeon at the next contact. level: pause refs: - V2 10172 - V2 10173 - id: X6 trigger: An URGENT alert is not acknowledged within the set time action: >- Robot repeats the alert and sends it to the next named crewmember (the second trained CMO first if the CMO is the patient), and keeps repeating at the set interval. It stays where it is: it does not leave on its own. level: urgent refs: - V1 3006 - V2 10173 - id: X7 trigger: The crewmember stops responding, or seems confused or drowsy, at any point action: >- URGENT alert at once, even mid-question or mid-step; the robot stops its current task, stays at its rest position and does not continue the run; a crewmember checks in person. level: urgent - id: X8 trigger: A crewmember asks the robot what is wrong, or for medicine, fluid or treatment advice action: >- Robot declines, says it cannot assess or advise, and routes the question to the CMO or flight surgeon. level: stop - id: X9 trigger: The crewmember is asleep, or in a sleep station without inviting the robot action: >- Robot does not approach, speak or prompt aloud; the check-in waits for the crewmember's own screen prompt to be accepted. level: stop - id: X10 trigger: A vehicle emergency alarm (the vehicle emergency stop rule) action: >- Robot stops its current task, says nothing unprompted, moves to its rest position clear of the crew and holds; the crew follow the vehicle emergency procedure. It answers the CMO only as S7 allows, and resumes only on a crewmember's command. level: safe-state refs: - V2 10172 - V2 10173 red_flags: - id: RF1 sign: >- Sleepwalking, doing things while not fully awake, or not remembering things done, after taking a sleep medicine, as the crewmember or another crewmember reports threshold: any action: URGENT alert to the CMO and flight surgeon; the robot says only what was reported source: fdacsb - id: RF2 sign: Talk of self-harm or suicide, or of not wanting to be alive threshold: any (if not sure, treat as yes) action: >- URGENT private alert to the flight surgeon now, mid-question if need be; the CMO if the link is down or delayed (the second CMO if the CMO is the person concerned), as agreed before flight; repeated and escalated if not acknowledged. The pre-flight plan for securing medicines and other means is followed, including sleep medicines. No risk rating. See RMP-BEH-002 and RMP-BEH-001. source: ng225 - id: RF3 sign: >- A sleep medicine taken that was not ordered, more than ordered, or together with alcohol, an opioid pain medicine, or another medicine that causes sleepiness, as the crewmember states threshold: any action: >- URGENT alert to the CMO and flight surgeon (queued if the link is down) with the words as stated; the CMO checks in person; if the crewmember is hard to wake or breathing seems slow, X7 applies; the robot does not comment on the amount source: ambien - id: RF4 sign: >- Feeling very drowsy, or the CMO notices drowsiness, before a critical task, with a sleep medicine logged threshold: within hours of the logged sleep medicine action: >- Flag to the CMO and flight surgeon at once; acknowledgment required; repeated and sent to the next named crewmember if not acknowledged within the X6 time (, as in X6); the robot never clears or stops anyone from the task (the FDA warns of next-morning impairment even when the person feels fully awake) source: fdazolp - id: RF5 sign: Short sleep, as logged threshold: >- less than hours a night for nights in a row (for context, ISS crew averaged about 6.1 hours a night by wrist monitor) action: Flag to the flight surgeon source: barger - id: RF6 sign: Trouble sleeping that goes on, or that the crewmember says affects their work or mood threshold: beyond nights, or any report that it affects work or mood action: Flag to the flight surgeon; see RMP-BEH-002 source: ersleep - id: RF7 sign: >- A sudden severe headache, a headache with fever, weakness, confusion or a change in vision, or a new headache after a spacewalk, a suited test or a pressure change threshold: any action: >- URGENT alert; see RMP-NEURO-002 and RMP-EYE-002, and RMP-EVA-001 (RF10) after a spacewalk, a suited test or a pressure change. The robot never says the headache is from poor sleep or carbon dioxide source: nice150 - id: RF8 sign: >- Low or worsening mood, or a new change in behaviour, while sleep medicine is logged, as the crewmember or CMO states threshold: any action: >- Flag privately to the flight surgeon; see RMP-BEH-002; RF2 applies to any mention of self-harm. The robot never links it to the medicine aloud source: ambien safety_limits: - id: L1 name: Contact with the crewmember value: not allowed enforced: Keep-out zone in the robot controller refs: - V2 10172 - id: L2 name: Waking a crewmember for a check-in value: not allowed enforced: No audible prompt or approach during a logged sleep period; screen prompt only - id: L3 name: Camera use during the check-in value: not allowed enforced: Camera off and indicator lit for this protocol - id: L4 name: Handing over a mismatched or unverified medicine under this protocol value: not allowed enforced: >- RMP-PHARM-001 quarantine is the default; only the CMO's logged two-step override inside RMP-PHARM-001 can release it - id: L5 name: Robot speed near the crewmember value: enforced: Hard limit in the controller refs: - V2 10172 - id: L6 name: Check-in length value: enforced: Timer; then the check-in ends logs: - id: LOG-1 text: Every input, robot action, decision (with who made it) and hand-off, time-stamped to the second. refs: - V2 10163 - V2 10164 - id: LOG-2 text: Mode changes and safety-limit events are announced to the operator as they happen and logged. refs: - V2 10162 - V2 10172 - id: LOG-3 text: >- Records are stored and sent as private medical data, encrypted, with access limited to the medical team. refs: - V1 6003 - V1 7003 - id: LOG-4 text: Results are kept in a permanent, retrievable format so the flight surgeon can see trends. refs: - V1 7001 - id: LOG-5 text: >- Each check-in time, answer, sleep-medicine entry as stated, pre-task notice shown and alert. No running counter of doses. - id: LOG-6 text: >- 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. refs: - V2 10163 - id: LOG-8 text: >- 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. refs: - V2 7059 requirements: - id: V1 3003 use: Monitoring of work and rest schedules and sleep in flight (item f). - id: V1 3004 use: >- In-mission care includes the history (d), monitoring and balancing the work and rest schedule (p) and private communication with ground medical and psychological support (r); administering and managing medicines (m) is a human capability. - id: V1 3006 use: >- Two trained CMOs per vehicle for NASA programs; the second trained CMO receives alerts when the CMO is the patient (see the commercial-flight note). - id: V1 6003 use: Logs and alerts sent to the ground are private medical communications. - id: V1 7001 use: Records kept so the flight surgeon can see trends. - id: V1 7003 use: Secure handling of medical records. - id: V2 7045 use: Usable by non-physician crew, including when the CMO is the patient. - id: V2 7046 use: Patient, caregiver and supplies restrained. - id: V2 7059 use: >- Medicines are fetched and inventory is tracked only through RMP-PHARM-001; a mismatched item is quarantined and this protocol never hands it over. - id: V2 10161 use: Robot shows its status and health. - id: V2 10162 use: Mode changes are announced to the operator. - id: V2 10163 use: Robot records and shares its data. - id: V2 10164 use: Shows whether the human or the robot is expected to act. - id: V2 10165 use: Human can override and shut down the robot. - id: V2 10168 use: Human can take over. - id: V2 10172 use: Protective stop when a limit is exceeded. - id: V2 10173 use: Robot stays stopped if no one takes over. - id: V2 10174 use: Only a human starts or restarts the robot. validation: - stage: simulation what: >- 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. - stage: Earth analog what: Isolation analog volunteers using post-sleep check-ins (no medicine needed). pass: >- Data completeness at or above ; volunteers rate the check-ins as private and not intrusive. - stage: flight use under flight surgeon supervision what: First use alongside the usual sleep logs and medical conferences. pass: No safety events; the flight surgeon finds the log useful. signoff: protocol: - Clinical lead for the specialty (sets every clinical threshold marked ) - Flight surgeon, as medical authority - Robotics and medical-device safety board - Program approval for the mission restart_after_stop: >- Human only. After any emergency or protective stop, a crewmember must restart the robot; the robot never restarts itself. each_run: >- Started by a crewmember. The flight surgeon reviews the log; red flags go to the CMO and flight surgeon at once. change_control: - 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. comms: live: >- 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_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. sources: - key: barger text: >- 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. url: https://doi.org/10.1016/S1474-4422(14)70122-X doi: 10.1016/S1474-4422(14)70122-X pmid: '25127232' 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. - key: ersleep text: >- NASA Human Research Program. Evidence Report: Risk of Performance Decrements and Adverse Health Outcomes Resulting from Sleep Loss, Circadian Desynchronization, and Work Overload (2016). url: https://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). - key: ermed text: >- NASA Human Research Program. Evidence Report: Risk of Adverse Health Outcomes and Decrements in Performance due to In-Flight Medical Conditions (2017). url: https://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. - key: fdazolp text: >- 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). url: https://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. - key: fdacsb text: >- 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). url: >- https://www.fda.gov/safety/medical-product-safety-information/certain-prescription-insomnia-medicines-new-boxed-warning-due-risk-serious-injuries-caused 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. - key: ambien text: >- AMBIEN (zolpidem tartrate) tablets, prescribing information. DailyMed (U.S. National Library of Medicine), setid 747949c5-2c91-4909-8a07-71b6826f8e97, revised 08/2024. url: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=747949c5-2c91-4909-8a07-71b6826f8e97 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. - key: ng225 text: >- National Institute for Health and Care Excellence. Self-harm: assessment, management and preventing recurrence. NICE guideline NG225 (2022). url: https://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. - key: aasm text: >- 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. url: https://doi.org/10.5664/jcsm.6470 doi: 10.5664/jcsm.6470 pmid: '27998379' 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. - key: nice150 text: >- National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. Clinical guideline CG150. url: https://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. - key: v1 text: 'NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023).' url: https://www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-rev-c-with-signature.pdf 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). - key: tb044 text: NASA OCHMO. Medical Operations. Technical Brief OCHMO-TB-044 (2025). url: https://www.nasa.gov/wp-content/uploads/2025/08/ochmo-tb-044-medical-operations.pdf supports: >- The crew surgeon keeps medical authority when care is delegated; crew medical officers train on the JSC 48522 medical checklist. - key: v2 text: >- NASA. NASA-STD-3001, Volume 2: Human Factors, Habitability, and Environmental Health (Rev F, 2026), including Section 10.6 Automated and Robotic Systems. url: https://standards.nasa.gov/standard/NASA/NASA-STD-3001_VOL_2 supports: Requirement IDs beginning V2. - key: marsdelay text: >- NASA. Mars communications disruption and delay (fact sheet, 2023 Moon to Mars Architecture Concept Review). url: https://www.nasa.gov/wp-content/uploads/2024/01/mars-communications-disruption-and-delay.pdf supports: >- One-way Earth-Mars delay up to about 21-23 minutes, plus blackouts of about 2-3 weeks near solar conjunction. - key: pccp text: >- U.S. Food and Drug Administration. Marketing submission recommendations for a predetermined change control plan for artificial intelligence-enabled device software functions (guidance). url: >- https://www.fda.gov/regulatory-information/search-fda-guidance-documents/marketing-submission-recommendations-predetermined-change-control-plan-artificial-intelligence supports: A model for planning, validating and rolling back software updates. - key: faa460 text: 'U.S. Code of Federal Regulations, Title 14, Part 460: Human space flight requirements.' url: https://www.ecfr.gov/current/title-14/chapter-III/subchapter-C/part-460 supports: >- Federal rules for crew and spaceflight participants on licensed commercial flights; they set no medical standards for spaceflight participants. corrections: - date: '2026-10-20' version: '0.2' source: >- AI-assisted clinical and source review by the Medical Research Assistant, Oct 20, 2026 (batch 4 review) items: - >- RF2 (self-harm) now matches RMP-BEH-002 RF1: a private URGENT alert to the flight surgeon, mid-question if need be, the CMO if the link is down, the means-securing plan including sleep medicines, no risk rating; NICE NG225 and the zolpidem label cited (item 20). - >- RF3 adds alcohol and an opioid pain medicine, alerts the flight surgeon too, and applies X7 if the crewmember is hard to wake or breathing seems slow (zolpidem label 5.2) (item 21). - >- RF4 (drowsy before a critical task) needs acknowledgment and escalates to the next named crewmember, as X6 does (item 22). - >- S7: on a vehicle emergency alarm the robot says nothing unprompted and follows a new vehicle emergency stop rule; it answers the CMO only where the crewmember agreed before flight. The pre-task notice is "not a fitness decision" (item 23). - >- New Flag for low or worsening mood or a new change in behaviour while sleep medicine is logged (zolpidem label 5.5, 5.6) (item 24). - >- Headache: a separate headache log is planned (RMP-NEURO-007) and the RF7 headache flag adds the RMP-EVA-001 RF10 route (items 27, 31). - >- Optional: the "why" states the FDA scope precisely (item 41) and gives the label's 7 to 8 hours as context only; the window stays a placeholder (item 42). - >- Review label set to the library wording: reviewed (AI-assisted), Oct 20, 2026; no named human clinician. - >- Planned protocols named in an action now show "(planned)", and each such action is complete without the link (item 51). - date: '2026-10-21' version: '0.3' source: Batch 5 editorial (AI-assisted), Oct 21, 2026 items: - >- Cross-links to batch 5 drafts no longer say "(planned)" now that those protocols exist as v0.1 drafts (RMP-NEURO-007, RMP-CARD-001, RMP-RESP-002, RMP-NEURO-002, RMP-NEURO-003, RMP-ENV-001). Clinical meaning unchanged. - date: '2026-10-21' version: '0.3' source: Batch 5 editorial (AI-assisted), Oct 21, 2026; batch 4 review item 49 items: - >- Inherited stop-rule and requirement wording: "holds a safe position" → "holds its stopped position"; "stays in its safe state" → "stays stopped"; "take over safely" → "take over"; "Robot stays safe if no one takes over" → "Robot stays stopped if no one takes over". Schema level name safe-state and never-word list entry "safe" unchanged. - date: '2026-10-21' version: '0.4' source: Batch 7 editorial (AI-assisted), Oct 21, 2026 items: - >- Cross-links to the batch 7 drafts no longer say "(planned)" now that those protocols exist as v0.1 drafts. - >- Citation labels changed to the site's year-only convention: "(approved for public release )" now reads "(YYYY)", and NASA-STD-3001 Volume 2 "Revision F (approved July 14, 2026)" now reads "(Rev F, 2026)" (sources: ermed, ersleep, v2). Editorial; no change to steps, thresholds or limits. - date: '2026-10-21' version: '0.5' source: Batch 7 review and batch 8 editorial (AI-assisted), Oct 21, 2026 items: - >- X5 and the comms loss-of-signal branch now open with "Only the robot pauses; crew care never waits for the link or the robot." (batch 7 review suggestion 29). Editorial; robot behaviour unchanged. - date: '2026-10-21' version: '0.6' source: Batch 13 editorial (AI-assisted), Oct 21, 2026 items: - The headache log is named as RMP-NEURO-007, which exists, instead of "planned" (wording only).