Drowsiness

What is somnolence?

Drowsiness is a sleep disorder, an exaggerated sleep attitude. One has a strong need to sleep or even sleeps for prolonged periods (hypersomnia). The patient sleeps during the day. He/she sleeps when he/she remains still or in public events for example.

Causes of drowsiness

Drowsiness may be due to various causes:

  • Diabetes.
  • Chronic pain.
  • Insomnia problems.
  • Highly variable work shifts.
  • Sleep apnea.
  • Narcolepsy.
  • Medications that influence sleep such as tranquilizers or sleeping pills.
  • Hypercalcemia: excess of calcium in the blood.
  • Hypothyroidism.
  • Lack of sleep.

It produces a strong need to sleep.

What is the treatment?

To treat drowsiness, it is necessary to identify the cause of the drowsiness and treat that cause. A personalized diagnosis by a neurologist or the help of a psychologist will be needed, depending on what is preventing the patient from sleeping well. The aim of treatment for drowsiness is to achieve the necessary conditions for the patient to get enough rest during the hours of sleep.

The measurement of sleepiness is complex. The various conceptual theoretical frameworks and different putative mechanisms have given rise to different operational concepts. Consequently, there are currently several instruments for measuring sleepiness, but most of them show little agreement with each other and many are limited in scope.

Three classes of methods have been proposed: those that infer sleepiness from:

  • Behavioral measurements.
  • Self-assessment of sleepiness using scales.
  • Direct electrophysiological measurements.

Behavioral measurements:

  • Behavioral observation: based on the simple observation of the individual’s behavior. The best known of these is yawning, but there are also spontaneous oculomotor activity, frequency of eye closure known as blinking, facial expressions and head movement known as nodding.
  • Functioning tests: used to measure the effects of sleepiness on different aspects of functioning. Variations on the reaction time test, which is the most popular measure of functioning, in addition to the psychomotor vigilance test, and driving simulators.
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Self-assessment using scales: These are the cheapest, easiest and simplest instruments to specifically measure subjective sleepiness:

  • Acute drowsiness level: Stanford drowsiness scale, Karolinska drowsiness scale, and analogous visual scales.
  • Global sleepiness level: Epworth Sleepiness Scale (ESE) and the Vigil Sleep Activity Inventory.

Neurophysiological tests: TLMS and Wakefulness Maintenance Test, designed under the premise of objectively quantifying sleepiness. There are also other physiological tests such as polysomnography, pupillometry and evoked brain potentials.

At present there is much discussion about the existence of a definitive test for the measurement of sleepiness. Years ago the TLMS was considered as such, but this tool has the disadvantage of being difficult to apply because it requires sophisticated and time-consuming equipment, and its detractors argue that it only measures some aspects of sleepiness.