The consequences of dozing off when intending to stay awake, e.g.
while driving or at work, are
potentially catastrophic. The accurate assessment of this tendency is important, but is currently
difficult. Several different methods give disparate results (1). A way out of this dilemma is suggested
that involves modification of existing concepts of sleep and wakefulness to conclude the powerful
influence of behaviour on sleep propensity. This propensity at a particular time depends,
hypothetically, on a mutually inhibitory interaction between a sleep and a wake drive, not on the
magnitude of either drive alone (2). Measurements of sleep propensity are partly situation-specific,
whether measured objectively by laboratory tests or subjectively by a questionnaire such as the
Epworth Sleepiness Scale. The latter is believed to measure a general characteristic, the average
sleep propensity across a range of specified situations in daily life. Any one situational sleep
propensity is not always an accurate predictor of another, even in the same subject (3). The Multiple
Sleep Latency test should not be a gold standard for such measurements. Wider discussion and more
research into "sleepiness" is needed (4).
Sleepiness and fatigue are terms commonly used in clinical practice and research (5). At times
sleepiness and fatigue are used interchangeably; however, each of them has distinct implications for
diagnosis and treatment (4). The objective of this article is to review the psychometric properties of
the measurements of sleepiness and fatigue. (3)Although there are objective and subject measures
to evaluate sleepiness, only rating scales are available to assess fatigue (6). Further research should
be directed toward exploring the potential mechanisms underlying the measurements of sleepiness
and fatigue. Establishing objective assessing instruments to evaluate fatigue and clarifying the
relationship between objective and subjective assessments of sleepiness are crucially needed (7).
Sleepiness and fatigue are two interrelated, but distinct phenomena; observed in a number of
psychiatric, medical and primary sleep disorders (4). Despite their different implications in terms of
diagnosis and treatment, these two terms are often used interchangeably, or merged under the more
general lay term of 'tired' (8). Sleepiness is multidimensional and has many causes (multidetermined)
and distinguished from fatigue by a presumed impairment of the normal arousal mechanism. Despite
its ubiquity, no clear consensus exits as yet as to what constitutes sleepiness (9). Definitions of
sleepiness, to date, are at best operational definitions, conceptualized so as to produce specific
assessment instruments. As a result, while a number of subjective and objective measurement tools
have been developed to measure sleepiness, each only captures a limited aspect of an otherwise
heterogeneous entity (8). Fatigue is an equally complex phenomenon, its nature captured by a
number of conceptualizations and definitions (10). Measures of fatigue have remained subjective,
with a 'gold standard' for its measurement remaining elusive. Despite a high prevalence and high
degree of morbidity, fatigue has remained a relatively under appreciated symptom, from both a
clinical and research point of view (8).
Bibilography
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Psychosomatic Research 2010, 69(1), 81–89. doi:10.1016/J.JPSYCHORES.2010.04.001.
2. Shen, J.; Barbera, J.; Shapiro, C. M. Distinguishing sleepiness and fatigue: focus on definition and
measurement. Sleep Medicine Reviews 2006, 10(1), 63–76. doi:10.1016/J.SMRV.2005.05.004.
3. Johns, M. W. Sleepiness in Different Situations Measured by the Epworth Sleepiness Scale. Sleep
1994, 17(8), 703–710. doi:10.1093/sleep/17.8.703.
4. Hoddes, E.; Zarcone, V.; Smythe, H.; Phillips, R.; Dement, W. C. Quantification of Sleepiness: A New
Approach. Psychophysiology 1973, 10(4), 431–436. doi:10.1111/j.1469-8986.1973.tb00801.x.
5. Johns, M. Rethinking the assessment of sleepiness. Sleep Medicine Reviews 1998, 2(1), 3–15.
doi:10.1016/S1087-0792(98)90050-8.
6. Campbell, S. S.; Tobler, I. Animal sleep: A review of sleep duration across phylogeny. Neuroscience
& Biobehavioral Reviews 1984, 8(3), 269–300. doi:10.1016/0149-7634(84)90054-X.
7. Cluydts, R.; De Valck, E.; Verstraeten, E.; Theys, P. Daytime sleepiness and its evaluation. Sleep
Medicine Reviews 2002, 6(2), 83–96. doi:10.1053/SMRV.2002.0191.
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doi:10.1007/S13311-012-0145-6.
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