Sleepiness is not always perceived before falling asleep in healthy, sleep-deprived subjects

Herrmann, Uli S.; Hess, Christian W.; Guggisberg, Adrian G.; Roth, Corinne; Gugger, Matthias; Mathis, Johannes

doi:10.1016/j.sleep.2010.03.015

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Volume 11, Issue 8 , Pages 747-751, September 2010

Sleepiness is not always perceived before falling asleep in healthy, sleep-deprived subjects

Uli S. Herrmann
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
Christian W. Hess
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
Adrian G. Guggisberg
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
Corinne Roth
- Department of Pneumology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
Matthias Gugger
- Department of Pneumology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
Johannes Mathis
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
- Corresponding author. Address: Department of Neurology, Inselspital, CH-3010 Bern, Switzerland. Tel.: +41 31 632 30 54; fax: +41 31 632 94 48.

Received 21 December 2009; received in revised form 23 March 2010; accepted 24 March 2010.

Abstract

Objective

To test whether subjects spontaneously signal sleepiness before falling asleep under monotonous conditions.

Methods

Twenty-eight healthy students were deprived of sleep for one night and then underwent a “maintenance-of-wakefulness test” (MWT) consisting of four 40-min trials. They were told to give a signal as soon as they felt sleepy and to try to stay awake as long as possible. In a first series of tests, the subjects were given no reward (nr); in a second series, monetary rewards (wr) were given both for an accurate perception of sleepiness and for staying awake longer.

Results

Seventeen of the 28 subjects (60.7%) did not signal sleepiness before a sleep fragment occurred in at least one of the four MWT trials. Women were more reliably aware of sleepiness than men in the nr trials (p=.02), while the men’s performance improved in the wr trials (p<.02), becoming equivalent to the women’s performance.

Conclusions

Our results cast doubt on the general assumption that one cannot fall asleep without feeling sleepy first. If similar results can be obtained in monotonous driving or working situations, this will imply that accidents caused by sleepiness or by falling asleep cannot necessarily be attributed to an individual’s negligence.

Keywords: Maintenance-of-wakefulness test, Sleepiness, Microsleep, Motor-vehicle accident, Subjective sleepiness, Healthy subjects