of cabin noise from commercial jet aircraft, other than the engines, is the Auxiliary Power Unit (APU), an on‑board generator used in aircraft to start the main engines, usually with compressed air, and to provide electrical power while the aircraft is on the ground. Other internal aircraft systems can also contribute, such as specialized electronic equipment in some military aircraft. Health effects Aircraft engines are the major source of noise and can exceed 140 decibels (dB) during takeoff. While airborne, the main sources of noise are the engines and the high speed turbulence over the fuselage. There are health consequences of elevated sound levels. Elevated workplace or other noise can cause hearing impairment, hypertension, ischemic heart disease, annoyance, sleep disturbance, and decreased school performance. Although some hearing loss occurs naturally with age, in many developed nations the impact of noise is sufficient to impair hearing over the course of a lifetime. Elevated noise levels can create stress, increase workplace accident rates, and stimulate aggression and other anti-social behaviors. Airport noise has been linked to high blood pressure. Aircraft noise increases risks of heart attacks. German environmental study A large-scale statistical analysis of the health effects of aircraft noise was undertaken in the late 2000s by Bernhard Greiser for the Umweltbundesamt, Germany's central environmental office. The health data of over one million residents around the Cologne airport were analysed for health effects correlating with aircraft noise. The results were then corrected for other noise influences in the residential areas, and for socioeconomic factors, to reduce possible skewing of the data.<ref name="Tödlicher Lärm' 2009, Page 45">Tödlicher Lärm—Spiegel, Nr. 51, 14 Dezember 2009, Page 45 </ref> The German study concluded that aircraft noise clearly and significantly impairs health. For example, a day-time average sound pressure level of 60 decibels increasing coronary heart disease by 61% in men and 80% in women. As another indicator, a night-time average sound pressure level of 55 decibels increased the risk of heart attacks by 66% in men and 139% in women. Statistically significant health effects did however start as early as from an average sound pressure level of 40 decibels. FAA advice The Federal Aviation Administration (FAA) regulates the maximum noise level that individual civil aircraft can emit through requiring aircraft to meet certain noise certification standards. These standards designate changes in maximum noise level requirements by "stage" designation. The U.S. noise standards are defined in the