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Difference between drowsiness/sedation and sleepiness

Difference between drowsiness/sedation and sleepiness


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I have been trying to understand the difference between drowsiness/sedation and sleepiness. The only article I was able to find that partly answers my question is "The difference between sedation and sleep" on ipnos.com.

I have experienced both, and they feel distinctly different. Sleepiness feels like a drive, but drowsiness/sedation feels like a state. My personal experience has been that sleeping when drowsy/sedated does not relieve the drowsiness/sedation, but sleeping when sleepy resolves the sleepiness.

Back to the question: what is the neurological/neurobiological/psychopharmacological difference between sleepiness and drowsiness/sedation, and why does sleep resolve the one but not the other?


Sedation

This is a forced state of drowsiness or sleep and as indicated in your Ipnos link, it will not necessarily help with drowsiness or sleepiness brought about due to problems with your circadian rhythm

Sedation is

the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure.

Drowsiness and Sleepiness

The terms drowsiness, sleepiness and hypnagogic period are often used to describe the same thing in the general domain, but but in the scientific domain there are important neurophysiological and psychophysiological differences.

Hypnagogic period

This is the neurophysiological and psychophysiological transition period from the wake to sleep state.

Drowsiness

This is the state of the transition period from the wake to sleep state that can be objectively measured, for example, by EEG (please see Hori et al., 1994)

Typical tests that describe the quality and quantity of the drowsyness are Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test (MWT) (Doghramji et al., 1997).

Sleepiness

This is the subjective state of the subject/patient. It can also be qualified and quantified, but only by rating scales such as the Stanford Sleepiness Scale (SSS), the Epworth Sleepiness Scale (ESS) (See also Johns, (1991)), the Karolinska Sleepiness Scale (Åkerstedt & Gillberg, 1990), etc.

References

Åkerstedt, T., & Gillberg, M. (1990). Subjective and objective sleepiness in the active individual, The International Journal of Neuroscience, 52(1-2): pp. 29-37)
DOI: 10.3109/0020745900899424 PMID: 2265922

Doghramji, K., Mitler, M. M., Sangal, R. B., Shapiro, C., Taylor, S., Walsleben, J., Belisle, C. Erman, M. K., Hayduk, R., Hosn, R., O'Malley, E. B., Sangal, J. M., Schutte, S. L., & Youakima, J. M. (1997). A normative study of the maintenance of wakefulness test (MWT), Electroencephalography and clinical neurophysiology 103(5): pp. 554-562.
DOI: 10.1016/S0013-4694(97)00010-2 PMCID: PMC2424234

Hori, T., Hayashi, M., & Morikawa, T. (1994). Topographical EEG changes and the hypnagogic experience. In R. D. Ogilvie & J. R. Harsh (Eds.), Sleep onset: Normal and abnormal processes (pp. 237-253).
DOI: 10.1037/10166-014

Johns, M. W. (1991). A new method for measuring daytime sleepiness: the Epworth sleepiness scale, Sleep 14(6): pp. 540-545
DOI: 10.1093/sleep/14.6.540 PMID: 1798888


Summary

States of consciousness vary over the course of the day and throughout our lives. Important factors in these changes are the biological rhythms, and, more specifically, the circadian rhythms generated by the suprachiasmatic nucleus (SCN). Typically, our biological clocks are aligned with our external environment, and light tends to be an important cue in setting this clock. When people travel across multiple time zones or work rotating shifts, they can experience disruptions of their circadian cycles that can lead to insomnia, sleepiness, and decreased alertness. Bright light therapy has shown to be promising in dealing with circadian disruptions. If people go extended periods of time without sleep, they will accrue a sleep debt and potentially experience a number of adverse psychological and physiological consequences.


Findings from controlled clinical trials indicate that 70 to 80 percent of insomnia patients benefit from cognitive-behavioral interventions. Although CBT is now considered the treatment of choice for chronic insomnia, no single treatment method is effective for all insomnia patients, so behavioral and pharmacological approaches sometimes need to be integrated.

More and more sleep disorder clinics are popping up across the country - there are now more than 300, with most hospitals offering sleep clinics. Look for those that offer more than just pharmacological treatment options.

Here are some tips for anyone, including those without serious sleep problems, that is looking for ways to get a good night's sleep:

Restrict the amount of time spent in bed as close as possible to the actual sleep time

Go to bed only when sleepy, not just fatigue but sleepy

If unable to sleep (e.g., within 20 min), get out of bed and go to another room and return to bed only when sleep is imminent

Use the bed and bedroom for sleep (and sex) only no eating, TV watching, radio listening, planning or problem solving in bed

Maintain a regular sleep schedule, particularly a strict arising time every morning regardless of the amount of sleep the night before


Method

Participants

Data were solicited from 430 volunteering junior resident doctors (M = 26.6 years, SD = 2.2 years 80.6% male, 16.4% female) from an urban teaching hospital in India over the course of 12 months. The sociodemographic factors (refer to Table 1) showed 80.6% of the participants were male and 19.4% were female. The age range of the respondents was from 21 to 37 years. Among the study participants 26.3% were married and 73.3% were unmarried. Of the 430 resident doctors contacted, 2 were excluded and 350 responded. The response rate was 81.77%. The study was approved by a university institutional review board and all participants provided written consent prior to being enrolled in the study.

TABLE 1 Socio Demographic and Lifestyle Profile of Study Participants

Prevalence of Sleepiness and Poor Sleep Hygiene

Of the 350 participants studied in the survey, 303 (86.6%) belonged to clinical departments and 47 (13.4%) to nonclinical departments. The clinical participants primarily came from the departments of anaesthesia (10.6%), medicine (16.9%), surgery (24%), and paediatrics (15.7%). The nonclinical participants primarily came from the departments of biochemistry (0.9%), microbiology (2.9%), pathology (1.4%), pharmacology (2.9%), community medicine (2.6%) and radio-diagnosis (2.6%).

Measures

Sleep assessment proforma

Information was collected on sociodemographics and sleep-related factors for descriptive purposes (Sandia National Laboratories & Sandia Corporation, 2007).

Epworth sleepiness scale

The ESS is an 8-item self-administered questionnaire producing scores that range from 0 (low sleepiness) to 24 (high sleepiness) with scores exceeding 10 indicating abnormal levels of sleepiness (Johns, Reference Johns 1991). The ESS has demonstrated good validity in correlating with objective measures of sleepiness and an ability to discriminate between control subjects and those with significant sleep disorders (Johns, Reference Johns 1991, Reference Johns 1992 Miletin & Hanly, Reference Miletin and Hanly 2003). Scores were evaluated as 0–9 normal, 10–12 mild EDS, 13–14 moderate EDS, >14 severe EDS (Zielinski et al., Reference Zielinski, Polakowska, Kurjata, Kupsc and Zgierska 1998).

Sleep hygiene index

The SHI is a 13-item self-administered Likert scale index that assesses behavioural patterns associated with sleep hygiene practices. Responses to each item are based on the frequency with which the person engages in the behaviour from 1 (never) to 5 (always). Items are summed to provide a global assessment of sleep hygiene with scores ranging from 13–65. Higher global scores are indicative of more maladaptive sleep hygiene practices (Mastin et al., Reference Mastin, Bryson and Corwyn 2006). For the purposes of this study, a score below 26 was considered good, 27–34 as average, and 35 and above was considered as poor sleep hygiene (Mastin et al., Reference Mastin, Bryson and Corwyn 2006). The internal consistency for the SHI is moderate (α = 0.66), and expected for an instrument with independent causal indicators. Mastin and colleagues ( Reference Mastin, Bryson and Corwyn 2006) demonstrated good test–retest reliability for the SHI (r = 0.71). The SHI has been correlated with the PSQI and ESS (Mastin et al., Reference Mastin, Bryson and Corwyn 2006).

Procedure

All participants completed a package that included a demographics form, SHI, ESS, sleep assessment questionnaire and informed consent. Participants were able to complete the package in less than 50 minutes. All data was stored in a secure location and subjects were assured all responses would remain confidential. Subjects were met in their respective department or place of work and, for those volunteering, appointments were made for data collection. Informed consent and sociodemographic data were collected followed by self-administration of the instruments in sequence of the sleep assessment proforma, ESS and SHI. The data collection was conducted mainly in the afternoons, postlunch sessions and early evening. A significant number of subjects (about 70%) were allowed to return the forms after completing them in their free time. Subjects who were pregnant, sick or admitted as patients to the hospital were excluded from the study.


Alcohol and Sleep FAQ

Does Alcohol Help You Sleep?

Alcohol may aid with sleep onset due to its sedative properties, allowing you to fall asleep more quickly. However, people who drink before bed often experience disruptions later in their sleep cycle as liver enzymes metabolize alcohol. This can also lead to excessive daytime sleepiness and other issues the following day. Furthermore, drinking to fall asleep can build a tolerance, forcing you to consume more alcohol each successive night in order to experience the sedative effects.

Does Alcohol Affect Men and Women Differently?

On average, women exhibit signs of intoxication earlier and with lower doses of alcohol than men. This can mostly be attributed to two factors. First, women tend to weigh less than men and those with lower body weights often become intoxicated more quickly. Most women also have a lower amount of water in their bodies than men. Alcohol circulates through water in the body, so women are more likely to have higher blood alcohol concentrations than men after consuming the same amount of alcohol.

What Is the Difference Between Moderate Drinking and Heavy Drinking?

Definitions vary by source, but the following measurements are generally considered to constitute a single serving of alcohol:

  • 12 ounces of beer with 5% alcohol content
  • 5 ounces of wine with 12% alcohol content
  • 1 ounce of liquor or distilled spirits with 40% alcohol content

Moderate drinking is loosely defined as up to two drinks per day for men and one drink per day for women. Heavy drinking means more than 15 drinks per week for men and more than eight drinks per week for women.

Will a Small Amount of Alcohol Affect My Sleep?

Drinking to excess will probably have a more negative impact on sleep than light or moderate alcohol consumption. However, since the effects of alcohol are different from person to person, even small amounts of alcohol can reduce sleep quality for some people.

One 2018 study compared sleep quality among subjects who consumed different amounts of alcohol. The findings are as follows:

  • Low amounts of alcohol (fewer than two servings per day for men or one serving per day for women) decreased sleep quality by 9.3%.
  • Moderate amounts of alcohol (two servings per day for men or one serving per day for women) decreased sleep quality by 24%.
  • High amounts of alcohol (more than two servings per day for men or one serving per day for women) decreased sleep quality by 39.2%.

When Should I Stop Drinking Prior To Bed To Minimize Sleep Disruption?

To reduce the risk of sleep disruptions, you should stop drinking alcohol at least four hours before bedtime.


What You Can Do

If your medicine makes you feel worn out, don’t stop taking it. You can try other ways to fight the side effect and get an energy boost:

  • Get some exercise, like a quick walk or some stretches.
  • Take deep breaths.
  • Drink a little bit of caffeine, like coffee or tea.

If you’re taking an over-the-counter medication, ask your doctor or pharmacist if there are “non-drowsy” versions of it you can use instead. It’s important to ask to make sure it won’t affect any other medications you’re taking.

Continued

Your doctor can help you handle any fatigue you feel from prescription medications. They might:

  • Change your medication
  • Change your dose
  • Tell you to take your medicine at a different time, like in the evening or before bed
  • Prescribe a medication to help you feel alert and awake

Don’t take any medications that are supposed to help you stay awake, unless your doctor says it’s OK.

Sources

National Sleep Foundation: “Sleepiness, Medication & Drugs: Why Your OTC Medications and Prescription Drugs Might Make You Tired.”

National Institute of Mental Health: “Brain Basics.”

FDA: “Caution: Some Over-the-Counter Medicines May Affect Your Driving.”

National Capital Poison Center: “Antihistamines: Using Them Safely.”

Mayo Clinic: “Tricyclic Antidepressants and Tetracyclic Antidepressants.”

County of San Mateo Health System: “Benzodiazepines.”

American Heart Association: “Types of Blood Pressure Medications.”

American Cancer Society: “What Causes Cancer-related Fatigue?”

Spine-health: “Muscle Relaxants.”

Cedars-Sinai: “Muscle Relaxants for Orthopedic Conditions.”

Breastcancer.org: “Narcotic Analgesics (Opioids).”

Epilepsy Foundation: “How Medicines Work.”

Cleveland Clinic: “Epilepsy Medications.”

Kaiser Permanente: “How to Prevent Tiredness or Fatigue Caused by Your Medicines.”


What are other symptoms of POTS besides the extreme fatigue?

People with POTS may experience different symptoms to a different extent. These symptoms may include but are not limited to:

  • Dizziness when standing
  • Nausea and vomiting
  • Lightheadedness and fainting
  • Brain fog
  • Muscle pain and cramps
  • Headaches
  • Excessive sweating
  • Shakiness

Some people feel as though their heart is beating really fast or skipping a beat. This is called heart palpitations.


Summary

Sleepiness and fatigue are two interrelated, but distinct phenomena observed in a number of psychiatric, medical and primary sleep disorders. 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’.

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. 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.

Fatigue is an equally complex phenomenon, its nature captured by a number of conceptualizations and definitions. 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.


Combating Drowsiness Caused by Antipsychotics

People who are new to taking an antipsychotic, or are taking higher doses, can experience some side effects. One of the most common is drowsiness.

Antipsychotics are a class of medications that are typically used to manage symptoms of psychosis, which may occur in schizophrenia or bipolar disorder. These meds may also be prescribed for several other mental health conditions.

In some people, drowsiness is mild and goes away over time. In others, this side effect can be severe, interfering with daily tasks at work and school, or in relationships.

If you suspect your antipsychotic medication is causing extreme daytime drowsiness — and it’s unwelcome — you can take certain steps to combat this feeling.

Antipsychotic medications are believed to help manage your moods by affecting neurotransmitters in your brain, specifically dopamine, the “feel good” neurotransmitter.

These drugs are considered the first-line treatment for people with schizophrenia, and used in many people with bipolar disorder. They can be prescribed for other conditions as well.

There are two different types of antipsychotic medications: first generation (typical) and second generation (atypical).

Second generation antipsychotics are now more often prescribed than first generation due to fewer side effects. However, they can still cause side effects, including drowsiness — sometimes called sleepiness, somnolence, or sedation.

Typical antipsychotics include:

  • chlorpromazine (Thorazine)
  • fluphenazine (Prolixin)
  • haloperidol (Haldol)
  • perphenazine (Trilafon)
  • pimozide (Orap)
  • thiothixene (Navane)
  • aripiprazole (Abilify)
  • asenapine (Saphris)
  • cariprazine (Vraylar)
  • clozapine (Clozaril)
  • lurasidone (Latuda)
  • olanzapine (Zyprexa)
  • quetiapine (Seroquel)
  • risperidone (Risperdal)
  • ziprasidone (Geodon)
  • paliperidone (Invega)

Drowsiness with antipsychotics

Depending on the person, drowsiness can either be considered a welcome, positive side effect or a negative, unwanted one.

During an episode of mania in bipolar disorder, people can go without sleep for days at a time without feeling tired. In many conditions, insomnia can occur as well, especially during periods of depression.

In cases such as these, drowsiness can be a welcome side effect.

On the other hand, when you want or need to stay awake — like during the day or at work — drowsiness may not be desired.


Contents

Mental fatigue [ edit | edit source ]

In addition to physical, fatigue also includes mental fatigue, not necessarily including any muscle fatigue. Such a mental fatigue, in turn, can manifest itself both as somnolence (decreased wakefulness) or just as a general decrease of attention, not necessarily including sleepiness. In any case, this can be dangerous when performing tasks that require constant concentration, such as driving a vehicle. For instance, a person who is sufficiently somnolent may experience microsleeps. However, objective cognitive testing should be done to differentiate the neurocognitive deficits of brain disease from those attributable to tiredness.

Physical fatigue [ edit | edit source ]

Physical fatigue or muscle weakness (or "lack of strength") is a direct term for the inability to exert force with ones muscles to the degree that would be expected given the individual's general physical fitness. A test of strength is often used during a diagnosis of a muscular disorder before the etiology can be identified. Such etiology depends on the type of muscle weakness, which can be true or perceived as well as central or peripheral. True weakness is substantial, while perceived rather is a sensation of having to put more effort to do the same task. On the other hand, central muscle weakness is an overall exhaustion of the whole body, while peripheral weakness is an exhaustion of individual muscles.

There are seen to be two main types of physical fatigue Central and Peripheral.

  • Central Fatigue The central component to fatigue is generally described in terms of a reduction in the neural drive or nerve-based motor command to working muscles that results in a decline in the force output (Gandevia, 2001 Kay et al., 2001 Kent-Braun, 1999 Vandewalle et al., 1991). It has been suggested that the reduced neural drive during exercise may be a protective mechanism to prevent organ failure if the work was continued at the same intensity (Bigland-Ritchie & Woods, 1984 Noakes, 2000). The exact mechanisms of central fatigue are unknown although there has been a great deal of interest in the role of serotonergic pathways (Davis, 1995 Newsholme et al., 1987 Newsholme et al., 1995).
  • Peripheral Fatigue Fatigue during physical work is considered an ability for the body to supply sufficient energy to the contracting muscles to meet the increased energy demand. This is the most common case of physical fatigue-effecting a national average of 72% of adults in the work force in 2002. This causes contractile dysfunction that is manifested in the eventual reduction or lack of ability of a single muscle or local group of muscles to do work. The insufficiency of energy, i.e. sub-optimal aerobic metabolism, generally results in the accumulation of lactic acid and other acidic anaerobic metabolic by-products in the muscle, causing the stereotypical burning sensation of local muscle fatigue.

The fundamental difference between the peripheral and central theories of fatigue is that the peripheral model of fatigue assumes failure at one or more sites in the chain that initiates muscle contraction. Peripheral regulation is therefore dependent on the localised metabolic chemical conditions of the local muscle affected, whereas the central model of fatigue is an intregrated mechanism that works to preserve the integrity of the system by initiating fatigue through muscle derecruitment, based on collective feedback from the periphery, before cellular or organ failure occurs. Therefore the feedback that is read by this central regulator could include chemical and mechanical as well as cognitive cues. The significance of each of these factors will depend on the nature of the fatigue-inducing work that is being performed.


Combating Drowsiness Caused by Antipsychotics

People who are new to taking an antipsychotic, or are taking higher doses, can experience some side effects. One of the most common is drowsiness.

Antipsychotics are a class of medications that are typically used to manage symptoms of psychosis, which may occur in schizophrenia or bipolar disorder. These meds may also be prescribed for several other mental health conditions.

In some people, drowsiness is mild and goes away over time. In others, this side effect can be severe, interfering with daily tasks at work and school, or in relationships.

If you suspect your antipsychotic medication is causing extreme daytime drowsiness — and it’s unwelcome — you can take certain steps to combat this feeling.

Antipsychotic medications are believed to help manage your moods by affecting neurotransmitters in your brain, specifically dopamine, the “feel good” neurotransmitter.

These drugs are considered the first-line treatment for people with schizophrenia, and used in many people with bipolar disorder. They can be prescribed for other conditions as well.

There are two different types of antipsychotic medications: first generation (typical) and second generation (atypical).

Second generation antipsychotics are now more often prescribed than first generation due to fewer side effects. However, they can still cause side effects, including drowsiness — sometimes called sleepiness, somnolence, or sedation.

Typical antipsychotics include:

  • chlorpromazine (Thorazine)
  • fluphenazine (Prolixin)
  • haloperidol (Haldol)
  • perphenazine (Trilafon)
  • pimozide (Orap)
  • thiothixene (Navane)
  • aripiprazole (Abilify)
  • asenapine (Saphris)
  • cariprazine (Vraylar)
  • clozapine (Clozaril)
  • lurasidone (Latuda)
  • olanzapine (Zyprexa)
  • quetiapine (Seroquel)
  • risperidone (Risperdal)
  • ziprasidone (Geodon)
  • paliperidone (Invega)

Drowsiness with antipsychotics

Depending on the person, drowsiness can either be considered a welcome, positive side effect or a negative, unwanted one.

During an episode of mania in bipolar disorder, people can go without sleep for days at a time without feeling tired. In many conditions, insomnia can occur as well, especially during periods of depression.

In cases such as these, drowsiness can be a welcome side effect.

On the other hand, when you want or need to stay awake — like during the day or at work — drowsiness may not be desired.


What You Can Do

If your medicine makes you feel worn out, don’t stop taking it. You can try other ways to fight the side effect and get an energy boost:

  • Get some exercise, like a quick walk or some stretches.
  • Take deep breaths.
  • Drink a little bit of caffeine, like coffee or tea.

If you’re taking an over-the-counter medication, ask your doctor or pharmacist if there are “non-drowsy” versions of it you can use instead. It’s important to ask to make sure it won’t affect any other medications you’re taking.

Continued

Your doctor can help you handle any fatigue you feel from prescription medications. They might:

  • Change your medication
  • Change your dose
  • Tell you to take your medicine at a different time, like in the evening or before bed
  • Prescribe a medication to help you feel alert and awake

Don’t take any medications that are supposed to help you stay awake, unless your doctor says it’s OK.

Sources

National Sleep Foundation: “Sleepiness, Medication & Drugs: Why Your OTC Medications and Prescription Drugs Might Make You Tired.”

National Institute of Mental Health: “Brain Basics.”

FDA: “Caution: Some Over-the-Counter Medicines May Affect Your Driving.”

National Capital Poison Center: “Antihistamines: Using Them Safely.”

Mayo Clinic: “Tricyclic Antidepressants and Tetracyclic Antidepressants.”

County of San Mateo Health System: “Benzodiazepines.”

American Heart Association: “Types of Blood Pressure Medications.”

American Cancer Society: “What Causes Cancer-related Fatigue?”

Spine-health: “Muscle Relaxants.”

Cedars-Sinai: “Muscle Relaxants for Orthopedic Conditions.”

Breastcancer.org: “Narcotic Analgesics (Opioids).”

Epilepsy Foundation: “How Medicines Work.”

Cleveland Clinic: “Epilepsy Medications.”

Kaiser Permanente: “How to Prevent Tiredness or Fatigue Caused by Your Medicines.”


What are other symptoms of POTS besides the extreme fatigue?

People with POTS may experience different symptoms to a different extent. These symptoms may include but are not limited to:

  • Dizziness when standing
  • Nausea and vomiting
  • Lightheadedness and fainting
  • Brain fog
  • Muscle pain and cramps
  • Headaches
  • Excessive sweating
  • Shakiness

Some people feel as though their heart is beating really fast or skipping a beat. This is called heart palpitations.


Summary

States of consciousness vary over the course of the day and throughout our lives. Important factors in these changes are the biological rhythms, and, more specifically, the circadian rhythms generated by the suprachiasmatic nucleus (SCN). Typically, our biological clocks are aligned with our external environment, and light tends to be an important cue in setting this clock. When people travel across multiple time zones or work rotating shifts, they can experience disruptions of their circadian cycles that can lead to insomnia, sleepiness, and decreased alertness. Bright light therapy has shown to be promising in dealing with circadian disruptions. If people go extended periods of time without sleep, they will accrue a sleep debt and potentially experience a number of adverse psychological and physiological consequences.


Findings from controlled clinical trials indicate that 70 to 80 percent of insomnia patients benefit from cognitive-behavioral interventions. Although CBT is now considered the treatment of choice for chronic insomnia, no single treatment method is effective for all insomnia patients, so behavioral and pharmacological approaches sometimes need to be integrated.

More and more sleep disorder clinics are popping up across the country - there are now more than 300, with most hospitals offering sleep clinics. Look for those that offer more than just pharmacological treatment options.

Here are some tips for anyone, including those without serious sleep problems, that is looking for ways to get a good night's sleep:

Restrict the amount of time spent in bed as close as possible to the actual sleep time

Go to bed only when sleepy, not just fatigue but sleepy

If unable to sleep (e.g., within 20 min), get out of bed and go to another room and return to bed only when sleep is imminent

Use the bed and bedroom for sleep (and sex) only no eating, TV watching, radio listening, planning or problem solving in bed

Maintain a regular sleep schedule, particularly a strict arising time every morning regardless of the amount of sleep the night before


Method

Participants

Data were solicited from 430 volunteering junior resident doctors (M = 26.6 years, SD = 2.2 years 80.6% male, 16.4% female) from an urban teaching hospital in India over the course of 12 months. The sociodemographic factors (refer to Table 1) showed 80.6% of the participants were male and 19.4% were female. The age range of the respondents was from 21 to 37 years. Among the study participants 26.3% were married and 73.3% were unmarried. Of the 430 resident doctors contacted, 2 were excluded and 350 responded. The response rate was 81.77%. The study was approved by a university institutional review board and all participants provided written consent prior to being enrolled in the study.

TABLE 1 Socio Demographic and Lifestyle Profile of Study Participants

Prevalence of Sleepiness and Poor Sleep Hygiene

Of the 350 participants studied in the survey, 303 (86.6%) belonged to clinical departments and 47 (13.4%) to nonclinical departments. The clinical participants primarily came from the departments of anaesthesia (10.6%), medicine (16.9%), surgery (24%), and paediatrics (15.7%). The nonclinical participants primarily came from the departments of biochemistry (0.9%), microbiology (2.9%), pathology (1.4%), pharmacology (2.9%), community medicine (2.6%) and radio-diagnosis (2.6%).

Measures

Sleep assessment proforma

Information was collected on sociodemographics and sleep-related factors for descriptive purposes (Sandia National Laboratories & Sandia Corporation, 2007).

Epworth sleepiness scale

The ESS is an 8-item self-administered questionnaire producing scores that range from 0 (low sleepiness) to 24 (high sleepiness) with scores exceeding 10 indicating abnormal levels of sleepiness (Johns, Reference Johns 1991). The ESS has demonstrated good validity in correlating with objective measures of sleepiness and an ability to discriminate between control subjects and those with significant sleep disorders (Johns, Reference Johns 1991, Reference Johns 1992 Miletin & Hanly, Reference Miletin and Hanly 2003). Scores were evaluated as 0–9 normal, 10–12 mild EDS, 13–14 moderate EDS, >14 severe EDS (Zielinski et al., Reference Zielinski, Polakowska, Kurjata, Kupsc and Zgierska 1998).

Sleep hygiene index

The SHI is a 13-item self-administered Likert scale index that assesses behavioural patterns associated with sleep hygiene practices. Responses to each item are based on the frequency with which the person engages in the behaviour from 1 (never) to 5 (always). Items are summed to provide a global assessment of sleep hygiene with scores ranging from 13–65. Higher global scores are indicative of more maladaptive sleep hygiene practices (Mastin et al., Reference Mastin, Bryson and Corwyn 2006). For the purposes of this study, a score below 26 was considered good, 27–34 as average, and 35 and above was considered as poor sleep hygiene (Mastin et al., Reference Mastin, Bryson and Corwyn 2006). The internal consistency for the SHI is moderate (α = 0.66), and expected for an instrument with independent causal indicators. Mastin and colleagues ( Reference Mastin, Bryson and Corwyn 2006) demonstrated good test–retest reliability for the SHI (r = 0.71). The SHI has been correlated with the PSQI and ESS (Mastin et al., Reference Mastin, Bryson and Corwyn 2006).

Procedure

All participants completed a package that included a demographics form, SHI, ESS, sleep assessment questionnaire and informed consent. Participants were able to complete the package in less than 50 minutes. All data was stored in a secure location and subjects were assured all responses would remain confidential. Subjects were met in their respective department or place of work and, for those volunteering, appointments were made for data collection. Informed consent and sociodemographic data were collected followed by self-administration of the instruments in sequence of the sleep assessment proforma, ESS and SHI. The data collection was conducted mainly in the afternoons, postlunch sessions and early evening. A significant number of subjects (about 70%) were allowed to return the forms after completing them in their free time. Subjects who were pregnant, sick or admitted as patients to the hospital were excluded from the study.


Alcohol and Sleep FAQ

Does Alcohol Help You Sleep?

Alcohol may aid with sleep onset due to its sedative properties, allowing you to fall asleep more quickly. However, people who drink before bed often experience disruptions later in their sleep cycle as liver enzymes metabolize alcohol. This can also lead to excessive daytime sleepiness and other issues the following day. Furthermore, drinking to fall asleep can build a tolerance, forcing you to consume more alcohol each successive night in order to experience the sedative effects.

Does Alcohol Affect Men and Women Differently?

On average, women exhibit signs of intoxication earlier and with lower doses of alcohol than men. This can mostly be attributed to two factors. First, women tend to weigh less than men and those with lower body weights often become intoxicated more quickly. Most women also have a lower amount of water in their bodies than men. Alcohol circulates through water in the body, so women are more likely to have higher blood alcohol concentrations than men after consuming the same amount of alcohol.

What Is the Difference Between Moderate Drinking and Heavy Drinking?

Definitions vary by source, but the following measurements are generally considered to constitute a single serving of alcohol:

  • 12 ounces of beer with 5% alcohol content
  • 5 ounces of wine with 12% alcohol content
  • 1 ounce of liquor or distilled spirits with 40% alcohol content

Moderate drinking is loosely defined as up to two drinks per day for men and one drink per day for women. Heavy drinking means more than 15 drinks per week for men and more than eight drinks per week for women.

Will a Small Amount of Alcohol Affect My Sleep?

Drinking to excess will probably have a more negative impact on sleep than light or moderate alcohol consumption. However, since the effects of alcohol are different from person to person, even small amounts of alcohol can reduce sleep quality for some people.

One 2018 study compared sleep quality among subjects who consumed different amounts of alcohol. The findings are as follows:

  • Low amounts of alcohol (fewer than two servings per day for men or one serving per day for women) decreased sleep quality by 9.3%.
  • Moderate amounts of alcohol (two servings per day for men or one serving per day for women) decreased sleep quality by 24%.
  • High amounts of alcohol (more than two servings per day for men or one serving per day for women) decreased sleep quality by 39.2%.

When Should I Stop Drinking Prior To Bed To Minimize Sleep Disruption?

To reduce the risk of sleep disruptions, you should stop drinking alcohol at least four hours before bedtime.


Contents

Mental fatigue [ edit | edit source ]

In addition to physical, fatigue also includes mental fatigue, not necessarily including any muscle fatigue. Such a mental fatigue, in turn, can manifest itself both as somnolence (decreased wakefulness) or just as a general decrease of attention, not necessarily including sleepiness. In any case, this can be dangerous when performing tasks that require constant concentration, such as driving a vehicle. For instance, a person who is sufficiently somnolent may experience microsleeps. However, objective cognitive testing should be done to differentiate the neurocognitive deficits of brain disease from those attributable to tiredness.

Physical fatigue [ edit | edit source ]

Physical fatigue or muscle weakness (or "lack of strength") is a direct term for the inability to exert force with ones muscles to the degree that would be expected given the individual's general physical fitness. A test of strength is often used during a diagnosis of a muscular disorder before the etiology can be identified. Such etiology depends on the type of muscle weakness, which can be true or perceived as well as central or peripheral. True weakness is substantial, while perceived rather is a sensation of having to put more effort to do the same task. On the other hand, central muscle weakness is an overall exhaustion of the whole body, while peripheral weakness is an exhaustion of individual muscles.

There are seen to be two main types of physical fatigue Central and Peripheral.

  • Central Fatigue The central component to fatigue is generally described in terms of a reduction in the neural drive or nerve-based motor command to working muscles that results in a decline in the force output (Gandevia, 2001 Kay et al., 2001 Kent-Braun, 1999 Vandewalle et al., 1991). It has been suggested that the reduced neural drive during exercise may be a protective mechanism to prevent organ failure if the work was continued at the same intensity (Bigland-Ritchie & Woods, 1984 Noakes, 2000). The exact mechanisms of central fatigue are unknown although there has been a great deal of interest in the role of serotonergic pathways (Davis, 1995 Newsholme et al., 1987 Newsholme et al., 1995).
  • Peripheral Fatigue Fatigue during physical work is considered an ability for the body to supply sufficient energy to the contracting muscles to meet the increased energy demand. This is the most common case of physical fatigue-effecting a national average of 72% of adults in the work force in 2002. This causes contractile dysfunction that is manifested in the eventual reduction or lack of ability of a single muscle or local group of muscles to do work. The insufficiency of energy, i.e. sub-optimal aerobic metabolism, generally results in the accumulation of lactic acid and other acidic anaerobic metabolic by-products in the muscle, causing the stereotypical burning sensation of local muscle fatigue.

The fundamental difference between the peripheral and central theories of fatigue is that the peripheral model of fatigue assumes failure at one or more sites in the chain that initiates muscle contraction. Peripheral regulation is therefore dependent on the localised metabolic chemical conditions of the local muscle affected, whereas the central model of fatigue is an intregrated mechanism that works to preserve the integrity of the system by initiating fatigue through muscle derecruitment, based on collective feedback from the periphery, before cellular or organ failure occurs. Therefore the feedback that is read by this central regulator could include chemical and mechanical as well as cognitive cues. The significance of each of these factors will depend on the nature of the fatigue-inducing work that is being performed.


Summary

Sleepiness and fatigue are two interrelated, but distinct phenomena observed in a number of psychiatric, medical and primary sleep disorders. 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’.

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. 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.

Fatigue is an equally complex phenomenon, its nature captured by a number of conceptualizations and definitions. 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.