Observation and Observer Scales

Yawning has long been a traditional sign of sleepiness. Simple observation of eyelid closure, wandering direction of gaze, and eyes rolling upward are among the strongest indicators of sleepiness. Head nodding with eyes closed strongly suggests sleep onset. These observable events testify to manifest sleepiness. Some of the earliest attempts to index sleepiness involved the development of observer scales, one of which was used to grade individuals undergoing prolonged sleep deprivation. Studies conducted at Walter Reed Hospital in the 1960s employed the "Cognitive Disorganization Scale" (33). This five-point observer rating scale ranges from (1) slowing of mental processes, some difficulty thinking of words (no undue interference with normal communication) all the way to (5) rambling incoherent speech for brief periods, with failure to recognize errors, unable to straighten out jumble of incoherent thoughts when challenged.

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