Introspective Sleepiness Overview

There is an assortment of instruments available to assess introspective sleepiness (Table 1). These questionnaires are all self-administered and request the individual either to make a prediction about their behavior, estimate what they have done in the recent past, or to assess how they feel "right now" with respect to one or another descriptor. The instruments asking for self-report "right now" fall into a general category of testing called "momentary assessment." Such instruments are sensitive to oscillation occurring over the course of a day and can be extremely useful in scientific investigations. By contrast, assessment of how one felt during "the past month" provide more global estimates that may be more useful clinically.

Introspective sleepiness evaluation instruments rely on self-report. Thus, all of the advantages and disadvantages inherent in self-reported information apply. In one sense, when it comes to rating how sleepy someone is, there is no one in a better position to have knowledge than the person in question. Furthermore, when it comes to indicating how one feels, the person is the only one who can render an accurate judgment. However, the resultant index is inherently subjective. Sleepiness reduces self-awareness and has been shown to interfere with the ability to accurately judge internal states (i.e., it produces alexithymia). Self-reported sleepiness tends to follow an adaptation curve such that high levels over a long duration may regress toward the mean. This may be related to a resetting of an individual's reference point over time, develop from memory impairment, or both. Moreover, some individuals are minimizers or may even be in denial. They will report low values for everything, including sleepiness. By contrast, others are augmenters and generally provide high scores and extreme values, regardless of the specifics in question. Finally, responses are directly controlled by the individuals. If they have an agenda, they can further that agenda. For example, if an individual wants his motor vehicle driver license reinstated, he is unlikely to affirm excessive sleepiness when asked.

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