ST.

LIDETA LEMARYAM HEALTH SCIENCE AND BUSINESS COLLEGE

Department: Nursing TVET Year:1, Semester 1

Name: Yonas Sewunet

Summited to: summation date:

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Contents
1. Introduction..............................................................................................................................4
1.1. What is Drowsiness...........................................................................................................4
“What is so important about feeling a little drowsy?  If I move around and drink coffee during
the day, I can stay awake just fine.”............................................................................................5
2. Causes for Drowsiness.............................................................................................................8
2.1. the main cause causes of drowsiness..................................................................................14
2.1.1 Lifestyle factors................................................................................................................14
2.1.2 Mental state...................................................................................................................14
2.1.3 Medical conditions........................................................................................................15
2.1.4 Sleeping disorder..........................................................................................................15
3. How is drowsiness treated..................................................................................................16
3.1 Self-treatment......................................................................................................................16
3.2 Medical care.........................................................................................................................16
When to seek emergency care...................................................................................................17
4. How can drowsiness be prevented.........................................................................................19
Drowsiness: Causes, Treatments, and Prevention.....................................................................19
Cause of drowsiness..................................................................................................................19
Some sleep disorders which are associated with the symptom of daytime drowsiness include
the following:.............................................................................................................................25
Prevention of Drowsiness..........................................................................................................26
Take an inventory of your bedroom and sleeping environment to identify potential problems
...............................................................................................................................................26
Be sure you are spending enough time in bed each night.....................................................28
Keep a regular schedule of going to bed at night and getting up in the morning.................28
Limit your consumption of caffeine and meals near bedtime................................................29
Do not drink alcohol to “improve” your sleep......................................................................29
Put the brakes on your racing mind when you are trying to sleep........................................29
Talk to your physician...........................................................................................................30
5. What causes excessive sleepiness..........................................................................................31
5.1 Sleep deprivation.................................................................................................................31
5.2 Insomnia..................................................................................................................................32
Obstructive sleep apnea.........................................................................................................34

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 Restless legs syndrome..........................................................................................................35
Narcolepsy.............................................................................................................................35
Depression.............................................................................................................................36
Treatment...............................................................................................................................37
Certain medications...............................................................................................................37
Symptoms..................................................................................................................................38
Medications for Drowsiness...........................................................................................................39
What Causes Drowsiness?..........................................................................................................39
What are the Symptoms of Drowsiness?....................................................................................40
How is Drowsiness Diagnosed?.................................................................................................41
How is Drowsiness Treated?......................................................................................................41
Excessive Daytime Sleepiness...................................................................................................42
Sleepiness Caused by Sleep Deprivation...............................................................................42
Sleepiness Caused by Other Medical and Brain Conditions.................................................44
Getting Relief for Excessive Daytime Sleepiness.....................................................................44
6. “DRIVER DROWSINESS DETECTION SYSTEM................................................................46
6.1 HUMAN PSYCHOLOGY WITH CURRENT TECHNOLOGY.......................................46
6.2 FACTS & STATISTICS......................................................................................................46
References......................................................................................................................................49

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 1. Introduction

1.1. What is Drowsiness

Drowsiness refers to feeling more sleepy than normal during the day. People who are drowsy
may fall asleep in when they do not want to or at times which can lead to safety concerns. ready
to fall asleep the pills made her drowsy inducing or tending to induce sleep drowsy music
indolent, lethargic drowsy bureaucrats. On the other hand Feeling abnormally sleepy or tired
during the day is commonly known as drowsiness. Drowsiness may lead to additional symptoms,
such as forgetfulness or falling asleep at inappropriate times.

Feeling drowsy during the day is a sensation which we have all experienced after a night of poor
sleep It is a sensation of sleepiness, normally occurring at night as we falling asleep, weaving its
way into our waking consciousness in varying degrees.  This feeling can range from a vague
drowsiness which is merely annoying to an overwhelming, irresistible sensation of fighting to
remain awake.  The terms excessive daytime sleepiness or hypersomnia (from the Greek
meaning in excess and Latin meaning sleep) are also often used to refer to daytime drowsiness. 
If the sensation of drowsiness becomes overwhelming, we might actually fall asleep during the
day at times when it is crucial to remain awake and alert.  Learn how to fall asleep. We may even
“wake up” during the day without realizing we have fallen asleep.  Drowsiness which invades
our waking life at the wrong times can create a multitude of undesirable and possibly dangerous
consequences.

For most of us, feeling a little drowsy at times is not of great concern.  However, when
drowsiness begins to interfere with our ability to remain awake at work or school, driving a car,
reading, attending church, watching television, or in other quiet circumstances, fighting
drowsiness can begin to control our life.  When drowsiness intrudes into life to this extent, we
should consider the reasons for this drowsiness.

The most basic purpose of sleeping well at night is to keep us alert and functioning at our best
during the day.  Good quality sleep and adequate amounts of sleep are essential for good daytime
functioning.  When drowsiness begins to interfere with waking, it is possible that some aspect of
our nighttime sleep is disturbed or that there is another problem.  Drowsiness may be caused by a

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straightforward, simple issue such as having a busy schedule and not getting enough sleep at
night.  However, there may also be medical problems or serious sleep disorders such as sleep
apnea present.  In this article we will discuss the causes for drowsiness as well as how to
minimize drowsiness during our waking life.

Before we discuss possible causes for drowsiness, let’s review some common questions. 
Remember that whatever interrupts sleep at night or which causes us to lose time asleep during
the night potentially contributes to the development of daytime drowsiness.

“What is so important about feeling a little drowsy?  If I move around and drink coffee during
the day, I can stay awake just fine.”
After a night of sleep you should feel refreshed when you wake up.  If you require a stimulant
like caffeine which is present in coffee, tea, soft drinks, energy drinks, and chocolate to stay
awake, it is likely that you are not getting enough sleep or that your nighttime sleep is not of
good quality.  Furthermore, if you drink caffeine in the evening, this may cause your sleep that
night to be even more disturbed.  It is true that physical movement may also allow you to feel
more alert, but continuous movement is not a realistic means of keeping awake (soares, march
2020).

“Sometimes when I am at school or in a meeting at work, I seem to “zone out”.  Does this
mean that I am drowsy during the day?”

  Although losing focus in these situations is not necessarily a sign of sleepiness, it could mean
that you are momentarily drifting into sleep, sometimes for fractions of a second, without even
being aware of doing so.  The term microsleeps is one which is often applied to these very brief
sleep periods.  If you find that you repeatedly have a problem with concentration or fogginess in
your thinking, microsleeps may be affecting you.

“Aren’t some people just naturally sleepy?  My dad is sleepy, I’m sleepy, and my grandfather
is always falling asleep during the day.”

  There are some sleep disorders for example, narcolepsy, periodic limb movements, sleep
walking, and sleep apnea, which are known to have either a genetic basis or to run in families. 

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Of particular note is that older persons often seem to be “naturally” sleepy during the day. 
However, older people are more vulnerable to irregular sleep schedules and may not obtain
enough sleep at night.  In addition, the incidence of sleep disorders increases with advancing age.

“My spouse tells me that I am always asleep when I sit down to watch television.  I have even
been told that look like I am asleep when I am driving and I have been told that I start to drift
between lanes of traffic.  I don’t believe that it is possible to be asleep in these circumstances,
and not even know it.   I am positive that I am not asleep.” 

  No one chooses to sleep when they are driving a car.  Drowsy driving is clearly very dangerous
to the driver as well as to others.  However, sleepiness can become so extreme and overpowering
that you no longer have the voluntary choice to remain awake.

There is a stigma attached to falling asleep during the day in situations where you are supposed
to be awake.  Drowsy people may be labeled as being lazy or unmotivated, and they may be
accused of not “trying” to stay awake.  So, it is natural to deny being asleep in these situations. 
However, the physiology of your body, rather than your conscious mind, begins making the
decisions for you in conditions of extreme drowsiness.  As we discussed earlier, it is possible to
momentarily fall asleep without being aware of doing so.  Furthermore it is possible to be in the
lightest stage of sleep which is Stage 1 sleep and feel as though you are still awake. It is crucial
to recognize though that severe drowsiness leading to actually falling asleep is not under your
voluntary control.  This problem requires medical evaluation and treatment.  If you are told
repeatedly that you appear to be asleep in circumstances such driving a car, even though you do

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not feel as though you are asleep, you should not dismiss these observations.

Picture 1. people at drowsiness

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 2. Causes for Drowsiness
Drowsiness may be defined as the progressive loss of cortical processing efficiency, requiring a
greater volume of neural tissue to perform the same tasks. This loss of efficiency results in the
inability to sustain network function of the highest levels of complexity, so that cognitive
functions are gradually lost, starting with the most complex. The increased cortical recruitment is
reflected in an increase in the global level of coherence of cortical electrical activity, and the
measurement of this increase can be used as an objective measurement of drowsiness.

Studies of sleep deprivation reveal a more complex picture. Using cerebral PET, 24 h of sleep
deprivation result in a significant decrease of global cerebral glucose utilization, with regional
areas of decreased metabolism that were heterogeneous in the population examined, with the
areas most affected in the pre-frontal cortex and thalamus. The authors, among other
conclusions, felt that the decreased activity in the pre-frontal area explained much of the
cognitive deficits produced by sleep deprivation, and the purpose of sleep is ‘‘to restore and
sustain normal waking brain activity and behavior’’. Studies with fMRI reveal more of a mixed
result, with a decrease in the BOLD response during a verbal learning task in the pre-frontal
anterior cingulate and temporal lobes, and increased BOLD responses in both the pre-frontal and
lateral posterior parietal regions.

While these types of studies offer significant contributions to our knowledge of the physiologic
changes occurring with drowsiness, they remain several degrees removed from the actual
cognitive process. Tracking changes in the fMRI BOLD response or PET measurements of
cerebral glucose metabolism as a direct measure of changes in cognitive processing is akin to
attempting to determine which piece of music a symphony is playing by measuring the ongoing
caloric consumption of the individual musicians, then organizing that data by orchestra section
and tracking it over time. Empirical data In a recent study aimed at determining the impact of
sleep deprivation on the stability of receptive language localization with
magnetoencephalography, a healthy volunteer underwent sequential testing in six different states
of alertness. These consisted of morning and afternoon studies (to capture circadian peak and
trough alertness) after 24 h of sleep deprivation, after a normal night’s sleep, and after a normal
night’s sleep plus 100 mg of modafinil to create a state of heightened alertness. Dipole
localization of receptive language with magnetic source imaging (MSI) remained stable through

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all six states. The peak amplitude of the dipoles, however, progressively decreased with
increasing alertness, reaching a minimum with the morning study with modafinil added (the
point of maximal alertness). This initial observation triggered analysis of the MEG data using
inter-sensor calculations of coherence, and calculation of a global coherence metric for each state
of alertness. The latter revealed a linear drop with increasing alertness. Subsequent studies of
coherence maps of the entire sensor space revealed the drop in coherence was truly a global
effect rather than the result of marked decreases in narrow regions. Replication and validation of
these results is the goal of an ongoing study. Discussion Cognition can be thought of as the result
of layered processing of progressively more complex neural networks. For the highest-level
networks to function, all of the more basic subsidiary networks must first both function and
integrate. One example is reading. The most primitive elements of visual processing: lines,
edges, contrast as examples, are used to build networks of individual letter recognition. The
repetitive presentation of letters in different sizes, fonts, and orientations results in a network
able to generalize and recognize an ‘‘A’’ regardless of the particulars of presentation. Built upon
all the networks for letters and punctuation, networks for individual words are constructed. Upon
the individual word layer, phrase and sentence networks are built. This pattern is repeated, layer
upon layer, until the ‘‘spotlight’’ of consciousness rests at the pinnacle, allowing a reader to
perceive a story as a flow of images and ideas without any conscious perception of the reading
process itself. A demonstration of the presence of all these layers occurs whenever the reader
comes across a misspelled word, resulting in the jarring halt of the story flow and the immediate
focus of conscious perception on the misspelling. A principle that arises from study of artificial
neural networks, designed to mimic in a simple fashion their biologic counterparts, is that with
repetitive learning, the networks become progressively more efficient, with smaller numbers of
neurons and fewer connections required to perform the same task. One way to view this is in
terms of information density, progressively increasing to a theoretical maximum for any
particular task. While neural networks at first blush appear to be able to contain near infinite
amounts of information, both physiologic and mathematical constraints will likely lead to an
upper limit of information density and processing capacity for a given volume of neural tissue.
With increasing task complexity, once that maximum density is achieved the only way to
successfully complete the task is the recruitment of additional cortical tissue. The physiologic
state where cerebral cortex can perform cognitive processing with maximal efficiency and the

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highest level of information density can be thought of as the highest possible level of alertness.
Drowsiness may be defined as the progressive loss of cortical processing efficiency, resulting in
increased recruitment of cortical tissue to perform the same task. With a sufficient drop in
efficiency (and the consequent decrease in processing capacity and maximum information
density), the more basic networks require so much recruited processing power that the highest-
level networks are no longer sustainable. With increasing drowsiness, the result is a progressive
deterioration, then loss of those cognitive functions of the highest order, followed by those of the
next lower order, until the point where the ‘‘spotlight’’ of consciousness itself can no longer be
sustained (and the subject is asleep). For example, picture a politician, a master at public
speaking. At peak alertness, the politician has the ability to sense his (or her) audience’s response
as while speaking, and with subtlety tailor the content, cadence and emphasis to hold their level
of attention and produce a desired emotional response.

With drowsiness, may be able to still deliver the speech, completely accurate in terms of
wording, but with that ability lost (and the audience left feeling that particular speech was
somehow just not as compelling). With increased drowsiness, progressive impairments in
prosody can develop, and if politician becomes progressively more sleep-deprived, paraphasia
errors and word-finding difficulties can develop. Eventually even articulation becomes impaired
and the words become slurred. The order in which functions become impaired, and then lost, as a
subject becomes drowsy may reveal much about overall structure of the cognitive networks. In
turn, one of the purposes of sleep would be the physiologic restoration of cortical processing
efficiency. In recent years, Georgy Buskin and other have published extensive work on the study
of neuronal network oscillations, and how these oscillations can serve to create large temporally
linked assemblies of neuronal populations that can provide ‘‘temporal representation and long-
term consolidation of information’’. Gamma band ‘‘binding’’ has been postulated as a
mechanism for transiently linking the activity of distant neuronal assemblies, allowing for the
construction of whole cognitive perceptions from individual features. The synchronization of
these assemblies can be measured via calculations of coherence of the electrical activity within
specific frequency bands between different brain areas. A second critical concept is that
widespread slower frequencies can modulate faster local events. Slower frequency oscillations
reflect recruitment of large area local networks (with faster frequencies confined to progressively
smaller areas), so that measured coherence in the lower frequency bands may reflect the degree

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of local cortical recruitment. While tracing the complex interplay of neural networks responsible
for even relatively simple acts of cognition via changes in the detectable electromagnetic fields
they produce is a daunting task, demonstrating the loss of processing efficiency of these
networks over time (increasing drowsiness) may be easier to accomplish. If the level of
drowsiness remains effectively stable over the course of the task in question, the level of overall
network recruitment (both local and distal) may be measured with a linear coherence function
taken over the duration of the task. Simply put, with increasing drowsiness, the size of the
neuronal assemblies necessary to accomplish the same task will increase, and given the limits of
cortical processing density, the total number of tasks running simultaneously will drop. As a
result, the global level of coherence will progressively increase. This global coherence can be
measured, and that measurement should serve as a consistent and reproducible metric of
drowsiness.

Drowsiness/sleepiness is a serious issue that needs to be addressed for improvement in the safety
of road driving. Past statistical data on road accidents has shown enormous increases in car
crashes due to drowsy/sleepy feelings. This study comprehensively summarizes all aspects of the
drowsy state and its effects during car driving: its symptoms, causes, presentation actions, car
accident statistics, sleep stages, and the behavioral, physiological and neural activation changes
occurring during wakefulness and in the drowsy state.

 It considers drivers’ behavioral data and corresponding methodologies for its analysis, the
biomedical signals of the human body (including neuronal signals in the forms of electrical and
hemodynamic responses), and their use for drowsiness detection. All of the existing
methodologies, their uses and pros and cons, are comprehensively summarized. A detailed
survey of the data published by neuro-imaging methodology-, physiological signal-and
behavioral methodology-based studies in addition to studies using electro-mechanical installed
sensors are statistically and theoretically summarized, as are the different approaches to the
detection of drowsiness. Additionally, the neuronal activity occurring during the drowsy and
awake states is analyzed, and the important contributions of fNIRS, fMRI and EEG in this
context are discussed in detail well.

Driving is a complex task that requires the driver’s full attention. When the driver is not
completely engaged within this task, many factors can reduce his/her ability to detect and to react

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to risky situations. Drowsiness is a dangerous state that has been proven to have a significant
impact on road safety, reflecting drivers’ unsafe behavior. Williamson et al. conducted a study in
a driving simulator and found that drivers who reported higher levels of sleepiness were more
likely to have crashes and centerline crossings. In addition, slower reaction times were associated
with drowsy drivers in studies by He et al. and Morris et al. Drowsiness and fatigue are major
causes of road crashes, leading to an enormous number of injured people, deaths, and economic
costs to society. The National Highway Traffic Safety Association revealed that, in the United
States alone, 795 people died and more than 90,000 car crashes occurred because of drowsy
driving. Collisions can be multifactorial in their origin, and drowsiness and fatigue are not
measurable in the same way as the breath alcohol content. Due to this, statistics can be even
more worrying than current estimates As expected, several factors have influence the drowsiness
and fatigue evolution during driving. Ting et al. (identified time-on-task as the most well-known
cause of driver fatigue. Additionally, other studies correlated an increasing driving time with
increasing subjective sleepiness and fatigue, Sustainability;.mdpi.com/journal/sustainability
Sustainability longer blink durations, and increasing steering wheel movements. Sleep
deprivation is also a strong factor that clearly induces higher sleepiness levels, and even mild
levels of sleep deprivation (2 h) can result in driving performance impairment. Similarly, light
settings, the landscape or geometry’s monotony, traffic conditions, or the temperature are
examples of external factors with influence on the drowsiness development. On the other hand,
some studies introduce sociodemographic information in order to analyze if there is any
correlation between driver characteristics and his/her behavior. Age and gender are basic
information that can be easily obtained and analyzed, as long as the study has a representative
sample. For example, Wang and Xu mentioned, in their study, that group characteristics (such as
age and gender) were controlled, but added that “if it can be demonstrated that group
characteristics exist, we can build group-specific models that would simplify the model training
process by group determinants”. As the authors mentioned, these group-specific models are
important to analyze and determine the behavior of specific groups like women, men, or elderly
people, for instance. Another study stated that young drivers (30 years or less) showed a better
reaction time performance than elderly drivers, after 2 to 4 h of driving, but this scenario
changed after 8 h. This probably indicated that young people are more vulnerable to fatigue. In
addition, in a follow-up carried out in 2004, young drivers showed a 70% decrement in reaction

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time, compared to 15% for the elderly group. This study showed that there is a positive
correlation between driving duration and fatigue, and warned about the risks of overestimating
driving performance during sleep loss, mainly among groups of young drivers. To overcome this
issue, in view of promoting safe driving among the younger population, innovative and
computer-based education programs for those who are pre-licensed are beneficial tools to
elucidate the danger of driving in non-desired conditions, like drowsiness states, and, especially,
on dangerous roads that are more likely to induce those conditions. Fatigue is not easy to
measure externally, so it is crucial for drivers to be alert and learn to understand their own sleep
needs and self-evaluate their fatigue and drowsiness. One tool that has been widely used to
evaluate drowsiness is the Karolinska Sleepiness Scale (KSS). This method helps to measure the
subjective sleepiness level at a particular time, where the driver uses a 10-point scale (1-
Extremely alert, 2- Very alert, 3- alert, 4- Rather alert, 5- Neither alert nor sleepy, 6- Some signs
of sleepiness, 7- Sleepiness, but no effort to keep awake, 8- Sleepiness, but some effort to keep
awake, 9- Very sleepy, great effort to keep awake, fighting sleep, and 10- Extremely sleepy,
cannot keep awake). Despite being a subjective measure, generally, results from this scale
revealed great correlations with objective measures such as those provided by driving
performance and drivers’ biometric monitoring. As reported by Ahlström et al. when sleepiness
indicators revealed drowsy drivers (a higher blink duration, slower speed, and lane crossing), the
KSS values were also higher, which suggests that the KSS is a reliable indicator of sleepiness.
Previously, Otmani et al. also studied the effect of partial sleep deprivation and driving duration
on subsequent alertness and performance in car drivers. Regarding the KSS scores before and
during the test, they were higher in the sleep-deprived conditions. Furthermore, sleep deprivation
had strong interactions with the driving time, which was reflected in increasing drowsiness levels
with the time-on-task. Besides the existence of several technologies that aim to alert drivers
engaging in drowsiness states, most of these systems have poor inputs, resulting in a high
number of false alarms [19]. In this context, the present study aims to improve those inputs by
presenting a sensitive analysis of the influence of drivers’ attributes on drowsiness evolution and
the consequent impacts on driving performance. A better knowledge of this topic will contribute
to the development of more reliable technologies, tailored for each driver at any time, and which
are able to detect drowsiness and emit a warning before the driver engages in erratic behavior.
This research is supported by the results from the KSS and explores two main issues, driver

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characteristics and driving performance, by using distinct statistical models. In the first case,
KSS is the dependent variable which the driver characteristics will influence, and in the second
case the KSS is an independent variable that impacts the driving performance. Additionally, in
both analyses, Sustainability of 12 the driving time is included in order to consider the impact of
the time passing in addition to the effect of drowsiness. The findings of this study provide new
insights about the KSS relationships by using robust statistical models rather a simple variance
analysis. In the next section, the experimental design used in the study is described. The
methodological approach used to statistically analyses the KSS is presented in a separated
section.

2.1. the main cause causes of drowsiness

A variety of things may cause drowsiness. These can range from mental states and lifestyle
choices to serious medical conditions.

2.1.1 Lifestyle factors

Certain lifestyle factors may lead to increased drowsiness, such as working very long hours or
switching to a night shift. In most cases, your drowsiness will subside as your body adapts to
your new schedule.

2.1.2 Mental state

Drowsiness can also be a result of your mental, emotional, or psychological state.

Depression can greatly increase drowsiness, as can high levels of stress or anxiety. Boredom is

another known cause of drowsiness. If you’re experiencing any of these mental conditions,
you’re also likely to feel fatigued and apathetic.

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2.1.3 Medical conditions

Some medical conditions can cause drowsiness. One of the most common of these is diabetes.
Other conditions that may lead to drowsiness include those that cause chronic pain or affect your
metabolism or mental state, such as hypothyroidism or hyponatremia. Hyponatremia is when the
level of sodium in your blood is too low.

Other medical conditions known to cause drowsiness include infectious mononucleosis

(mono) and chronic fatigue syndrome (CFS).

Many medications, particularly antihistamines, tranquilizers, and sleeping pills, list drowsiness

as a possible side effect. These medications have a label that warns against driving or operating
heavy machinery while using these drugs.

Talk to your doctor if you experience prolonged drowsiness due to your medications. They may
prescribe an alternative or adjust your current dosage.

2.1.4 Sleeping disorder

Excessive drowsiness without a known cause can be a sign of a sleeping disorder. There’s a
range of sleeping disorders, and each has its own unique effects.

In obstructive sleep apnea, a blockage in your upper airways leads to snoring and pauses in your
breathing throughout the night. This causes you to wake up frequently with a choking sound.

Other sleep disorders include narcolepsy, restless leg syndrome (RLS), and delayed sleep phase
disorder (DSPS).

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 3. How is drowsiness treated

Treatment of drowsiness depends on its cause.

3.1 Self-treatment

Some drowsiness can be treated at home, especially if it’s the result of lifestyle factors, such as
working longer hours, or a mental state, such as stress.

In these cases, it may help to get plenty of rest and distract yourself. It’s also important to
investigate what’s causing the problem — like if it’s stress or anxiety — and take steps to reduce
the feeling.

3.2 Medical care

During your appointment, your doctor will try to identify the cause of your drowsiness by
discussing the symptom with you. They may ask you about how well you sleep and whether
you wake up frequently in the night.

Be prepared to answer questions about:

 your sleeping habits

 the amount of sleep you get

 if you snore

 how often you fall asleep during the day

 how often you feel drowsy during the day

Your doctor may ask you to keep a diary of your sleeping habits for a few days, documenting
how long you sleep at night and what you’re doing when you feel drowsy during the day.

They may also ask for specific details, such as if you actually fall asleep during the day and
whether you wake up feeling refreshed.

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If the doctor suspects that the cause is psychological, they may refer you to a counselor or
therapist to help you find a solution (gabhane, appril 2018).

Drowsiness that’s a side effect of medication is often curable. Your doctor may swap the
medication for a different type or change your dosage until the drowsiness subsides. Never
change your dosage or stop a prescription medication without first talking to your doctor.

If no cause for your drowsiness is apparent, you may need to undergo some tests. Most are
usually noninvasive and painless. Your doctor could request any of the following:

 complete blood count (CBC)

 urine tests

 electroencephalogram (EEG)

 CT scan of the head

If your doctor suspects that you may have obstructive sleep apnea, RLS, or another sleep
disorder, they may schedule a sleep study test. For this test, you’ll spend the night in the hospital
or a sleep center under the observation and care of a sleep specialist.

Your blood pressure, heart rate, heart rhythm, breathing, oxygenation, brain waves, and certain
body movements will be monitored throughout the night for any signs of a sleep disorder.

When to seek emergency care

You should seek medical attention if you begin to feel drowsy after you:

 start a new medication

 take an overdose of medication

 sustain a head injury

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 become exposed to the cold

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 4. How can drowsiness be prevented

A regular amount of sleep each night can often prevent drowsiness. Most adults require about
eight hours of sleep to feel fully refreshed. Some people may need more, especially those with
medical conditions or a particularly active lifestyle.

For more sleep support, check out our sleep shop.

Talk to your doctor as soon as possible if you experience any changes in your mood, signs of
depression, or uncontrollable feelings of stress and anxiety.

Drowsiness: Causes, Treatments, and Prevention

 Drowsiness during the day  is an important problem which can decrease the quality of
life.

 The severity can range from mild daytime sleepiness to irresistible episodes of falling
asleep in dangerous situations.

 There are many causes for drowsiness including shortened or irregular nighttime sleep,
disturbances in the sleeping environment, poor sleep habits, sleep disorders, and medical
conditions.

 If daytime drowsiness is persistent, consultation with a physician is indicated to

determine the cause

Cause of drowsiness
There are many different causes for daytime drowsiness.  In general, anything which delays,
interrupts, or shortens your sleep has the potential to cause drowsiness during the day.  These
same factors also apply to shift workers who work at night and sleep during the day.  Here are
some of the most common causes associated with daytime drowsiness.

Your sleeping environment may be disturbing you

If you are drowsy during the day, your bedroom environment may be contributing to poor quality
nighttime sleep.  Some of these factors may seem relatively unimportant or trivial.  However,

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nothing is unimportant if it bothers you when you are trying to sleep.  Consider whether the
following aspects of your sleeping environment may be bothering you.

 My bed is not comfortable

 My pillows are too lumpy or too flat

 My bedcovers feel too heavy

 My pajamas or bed clothes are not comfortable

 The curtains let in light from the outside

 The temperature in the room frequently seems too hot or too cold

 There are noises in the house, such as appliances or heating and air conditioning units
going on and off, which wake me

 My cat or dog comes in and out of my room at night or my pet sleeps in my bed

 Sometimes I don’t feel secure or safe in my bedroom

 The LED displays on my alarm clock and other electronics in the room are bright

 My bed partner snores loudly

 My bed partner thrashes and moves during sleep

 My bed partner has a different time of going to bed from me

 Other people, including babies and children, in my house wake me up during the night

 I leave the television on when I am in bed trying to sleep

 I leave my cell phone on when I sleep or I sleep with my cell phone in bed with me so
that I can answer calls and reply to texts during the night

 Outside noises such as garbage trucks or traffic wake me up

 There are other noises or disruptions unique to my sleeping environment

Shift workers who work at night and sleep during the day may face even more challenges in
eliminating these disturbing elements from their sleeping environment…

 You may not be getting enough sleep at night

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It may seem obvious, but if you do not get enough sleep at night, you will invariably feel drowsy
during the day.  We are a very sleep deprived society, and most adults do not regularly obtain
sufficient sleep.  There is a myth that sleep is a waste of time, and we often hear reports that
public and business figures can function effectively on three or four hours of sleep per night. 
However, there is a great deal of research which suggests that not enough sleep can be associated
with serious medical conditions such as high blood pressure or diabetes.  There is also evidence
to suggest that insufficient amounts of sleep may even affect how long we live.

So what is the ideal amount of sleep that we should obtain at night?  It is recommended that at
least seven hours of sleep per night for adults is optimal.  Even children and teenagers may not
obtain an ideal amount of sleep.  Guidelines from the AASM published last year suggest the
following sleep amounts per 24 hours (including daytime naps) to promote good health for the
following age groups.

 Infants (4-12 months) 12 – 16 hours

 Children (1-2 years) 11 – 14 hours

 Children (3-5 years) 10 – 13 hours

 Children (6-12 years)   9 – 12 hours

 Teenagers (13-18 years)   8 – 10 hours

Your schedule of sleep and waking times may not be regular

We have emphasized how important it is to have an adequate number of sleeping hours each
night to keep ourselves from becoming drowsy during the day.  Besides the amount of sleep we
should obtain, there is a second important factor in determining how refreshed we feel during the
day.  This second factor is the regular timing of sleep during each 24 hour period.  This is
referred to as the circadian (a term from the Latin meaning about a day) timing of sleep during
each 24 period of day and night.

Besides a normal amount of sleep each night, we must also maintain a regular schedule of going
to bed each night and getting up each morning during each 24 hour period.  There are significant
changes in body temperature and hormone secretions that vary according to circadian cycles of

21
sleep and waking.  For example, it is well known that there is a decline in body temperature in
the evening hours anticipating the time of sleep onset and a rise in body temperature which
occurs in anticipation of waking.

Keeping a regular sleep-wake schedule is crucial for good sleep.  Most of us usually keep a fairly
regular schedule of sleeping and waking times during the work week.  But then the weekend
comes.  We often feel on weekends as though we are finally free to go to bed and get up
whenever we want, without paying much attention to our schedule.  Nothing could be further
from our biology in keeping our sleep on track.

Since we often do not have a pressing need to wake up early on a Saturday morning for work, we
may stay up much later than usual on a Friday night.  As a result we may stay asleep longer and
wake up later on a Saturday morning…  This pattern is often repeated again from Saturday night
to Sunday morning.  By altering our time of going to bed later and then getting up several hours
later, even for just a weekend, we send our sleep-wake cycle confusing messages about when we
should sleep and wake.  Then, on Sunday night, it may be very difficult to fall asleep at our
normal work week time and very difficult, if not impossible, to wake up on time for work on
Monday morning.  We should also be aware that taking prolonged daytime naps lasting more
than 30 minutes or so can result in producing irregularity in our sleep schedule.

You do not have a regular bedtime routine

  Everyone has had the experience of a stressful day and then having trouble falling asleep.  To
help yourself fall asleep when you finally do get into bed, plan on mentally and physically
relaxing to prepare yourself for sleep.  Taking a few minutes to sort out problems from the day,
eating a small snack, or reading before you turn out the lights can help you fall asleep.  Besides
mental relaxation, mild stretching exercises or deep breathing exercises can help you physically
relax.  A relaxed mind and a relaxed body will help ease your transition to sleep so that you to
obtain your usual amount of sleep and do not feel drowsy the next day.

You drink caffeine or eat heavy meals too close to bedtime

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  Caffeine is a stimulant, and it is contained in beverages such as coffee, tea, soda, and energy
drinks.  Chocolate also contains caffeine.  Caffeine can result in nighttime sleep disruption and
then drowsiness may be increased the next day.

Your favorite heavy or spicy meal may cause an upset stomach and prevent you from falling
asleep.  A light snack before bed, however, may be of help in falling asleep.  .

You exercise too close to bedtime

  In addition to good quality sleep and a balanced diet, regular exercise is one of the foundations
for good health.  Studies have shown that exercise can improve sleep quality.  However, the
timing of exercise is important so that it does not interfere with our sleep.  Often in our busy
lives it is difficult to schedule exercise during the day.  If you cannot fit exercise in during the
day, then exercise in the evening hours may be your only option.  However, following exercise,
you may feel more awake immediately afterwards due to elevations in heart rate or blood
pressure.  If you then try to sleep immediately after exercise, you may have trouble falling
asleep.  You should allow a cool down period lasting a couple of hours before trying to sleep.

  You use alcohol to fall asleep

  Alcohol can result in falling asleep more quickly at the beginning of the night, and there is a
myth that alcohol is beneficial for sleep.  Many people do use alcohol as a temporary “sleeping
pill”.  However, studies have shown that even though alcohol can speed up the process of falling
asleep, alcohol invariably causes frequent brief awakenings and restless sleep, resulting in
daytime drowsiness.

Alcohol consumption alters the normal sequence of sleep stages during the night and most
notably suppresses rapid eye movement sleep (REM) sleep or dreaming sleep.  Additionally,
alcohol can suppress breathing during sleep.  The volume and frequency of snoring can increase,
indicating a partial blockage of the airway.  The airway can also become completely obstructed
resulting in the appearance of actual episodes of stopping breathing during sleep.  The duration
of these episodes ranges from 10 seconds or so to over a minute.  Only a few of these
nonbreathing episodes may appear, but it is not uncommon for several hundred episodes to occur

23
during sleep  Significant changes in heart rate, blood pressure, and oxygen levels typically
occur.  Each time that breathing stops and then begins again, there is a brief arousal from sleep.

You can see that using alcohol for sleep is not only decreases sleep quality, but also that there are
potentially dangerous effects on the functioning of your body.

You take medications or have a chronic illness

Many prescription medications and over the counter sleep aids like melatonin can disturb

nighttime sleep resulting in sleepiness during the day.  Prescription medications can also cause
drowsiness the day.  Some long acting sleeping pills which may improve your ability to fall
asleep at night can also “hang over” effects the next day, causing you to feel drowsy.  Most of
the newer sleeping pills do not have these kinds of daytime effects due to their shorter action. 
However, do not take a sleeping pill of any kind during the middle of the night in order to fall
back asleep since the effects of the sleeping pill may extend to your daytime hours.

If you notice that you seem to feel drowsier than usual during the day after taking a medication,
talk to your sleep doctor about the possible contribution of these medications in disturbing sleep
at night or in causing you to feel sleepy during the day.

Medical illnesses, hospitalizations, and chronic pain are frequently associated with disruption of
nighttime sleep and subsequent sleepiness during the day.  Once again it is important to talk to
your physician about your symptoms.

You may have a sleep disorder

If your daytime drowsiness is persistent despite your best efforts to follow these suggestions, it is
important to discuss this issue with your physician about your problem.  He or she may perform
various tests to determine if another medical problem is causing your drowsiness.  You may also
be referred to a Sleep Center for an overnight sleep test.  During this test, your brain and muscle
activity along with your breathing, heart rate, and oxygen levels are continuously recorded and
then analyzed.  Sometimes a daytime nap test, the Multiple Sleep Latency Test (MSLT), is also

24
performed to evaluate the degree of daytime sleepiness.  Both of these tests can determine if you
have a disorder which is specific to your sleep that cannot be detected during the day.

Some sleep disorders which are associated with the symptom of daytime drowsiness include the
following:
Sleep apnea is a disorder in which loud snoring, breath holding episodes accompanied by oxygen
decreases, and restlessness occurs during sleep.  A brief arousal from sleep occurs following
breath holding episodes when breathing begins again, resulting in a very brief arousal.  Hundreds
of these episodes are often present, severely disturbing sleep. During the day, drowsiness related
to sleep apnea can be extreme with patients often actually falling asleep driving a car or in other
dangerous situations.  Middle-aged males who are overweight and who have with a large neck, a
crowded throat often with tonsils present, and high blood pressure appear to be most likely to
have sleep apnea.  However, sleep apnea can affect both males and females of all ages from
babies to the elderly

Restless legs  are a creeping, crawling, uncomfortable, unpleasant sensations in the legs which
occurs sitting quietly during the day, but which becomes most disruptive as someone is trying to
fall asleep.  The only relief of these sensations is to walk or move the legs, but then the sensation
returns requiring further movement.  It is not hard to imagine how this disorder could prevent
you from falling asleep or waking up during the night.

Periodic limb movements frequently accompany restless legs.  These leg movements are
repetitive, rhythmic jerking movements most often of the legs, but which can also occur in the
arms, during sleep.  Periodic limb movements are often completely unknown to the sleeper, but a
bed partner is able to observe these rhythmic movements.  Hundreds of these jerking movements
during sleep result in brief arousals and awakenings and then sleepiness during the day.  If a
person with restless legs is finally able to fall asleep at night, they often have periodic limb
movements during sleep.

Narcolepsy is associated with extreme sleepiness during the day, and it is thought to be a less
common sleep disorder than sleep apnea or restless legs/periodic limb movements.  Narcolepsy
is associated with an abnormality in the timing of REM sleep (rapid eye movement) or dreaming

25
sleep.  Symptoms of narcolepsy can include cataplexy (loss of muscle tone during the day with
strong emotions), sleep paralysis (an inability to move upon falling asleep or waking up), and
hypnagogic hallucinations (vivid, dreamlike experiences which occur during waking before sleep
onset).

Circadian rhythm disturbances are a misalignment between a desired schedule of sleeping and

waking times and the times that you actually feel like sleeping and waking.  In advanced sleep
phase syndrome if your desired sleep times are between 10 pm and 6 am, you may feel, for
example, ready to sleep at 7 pm and then wake up early at 3 am.  In delayed sleep phase
syndrome, you may not feel sleepy, for example, until 1 am and then wake up late at 9 am.  In
both of these situations you can feel drowsy during the day at times when you want to remain
alert.

Sleep walking, sleep talking, night terrors, nightmares, enuresis (bed wetting), bruxism (tooth

grinding), and REM behavior disorder (RBD) are all disorders which can disturb sleep and cause
sleepiness during the day.  Some of these disorders such as sleep walking, enuresis, and night
terrors (awakenings during the night with screaming or crying but the sleeper has no memory of
the event) are most common in children.  In adults, RBD is associated with vigorous and
sometime injurious behavior to themselves and their bed partner.  This disorder occurs during
REM sleep, a sleep stage in which there is normally muscle paralysis and an inability to move.

These are some of the most common sleep disorders which can disturb sleep and which can
result in drowsiness during the day.  There are also other sleep disorders which are associated
with daytime sleepiness that can be diagnosed with overnight sleep studies.  If you are aware of
unusual behavior during sleep or others sleeping around you report that you have these
symptoms, talk to your physician.  A comprehensive evaluation of these sleep problems can be
obtained in Sleep Clinics (loba, may 2020).

Prevention of Drowsiness
 How can daytime drowsiness be improved or prevented?  Here are some suggestions to improve
your nighttime sleep and decrease daytime drowsiness.

Take an inventory of your bedroom and sleeping environment to identify potential problems

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  Examine your bedroom and sleeping environment carefully to identify what might be bothering
your sleep at night and causing you to feel drowsy during the day.  Some possible remedies for
issues which you might discover include the following.

 If your mattress feels uncomfortable and there are obvious lumps or bumps in the
mattress, you might consider replacing it. However, there is not a “magic” mattress which
will assure that you have a perfect night of sleep.  You should pick a mattress that feels
comfortable to you.  Changing your pillows, bedcovers, and bedclothes may increase
your comfort.  Examine and if necessary replace your curtains or blinds so that your
bedroom is dark and light from street lights or early morning light does not shine in your
room.  Black out curtains may also be helpful.

 Most people sleep more comfortably in a room which is cool rather than warm. Lowering
your thermostat to decrease the temperature during your time in bed may improve your
sleep…

 Try to identify sources of noise in your room and house which wake you during the night
and eliminate them.  A room fan or a “white noise” machine may help mask sounds.  You
might also consider soft earplugs to muffle noises.

 Pets can be surprisingly disruptive to sleep by jumping off and on the bed or coming in
and out of the room at night. Consider training your pet to stay off your bed and to sleep
in his/her own dedicated sleeping area away from your bed.

 Feeling secure in your house and bedroom is important for relaxation and sleep. If you
have security concerns about your locks or access to your home, address these issues.

 That tiny little light on your alarm clock can be a surprising source of sleep disruption.
Turn your clock around so that you cannot see its light or check the time when you
should be trying to sleep.  Turn off or cover the lights on other electronic equipment in
your bedroom.

 The sleep problems of other persons in your household also become your sleep problems
if your sleep is disturbed by them. A snoring, thrashing bed partner can be a source of
sleep disruption, often forcing one or the other person to sleep in a separate room.  If your
partner’s sleep has become your sleep problem, observe your partner closely for an

27
 interrupted pattern of snoring and if there are breath holding episodes during sleep.  Also
observe any patterns of jerking or twitching movements during sleep.  Consultation with
a physician may result in a referral to a Sleep Center for evaluation, diagnosis and
treatment of your partner’s sleep problem.

If your child is having difficulty with sleep or he/she is drowsy during the day, follow these same
suggestions for making sure that your child’s sleeping environment and sleep habits encourage
good sleep.  Also be aware that children of all ages, like adults, can have sleep disorders which
are diagnosed and treated in a Sleep Center.

 Do not sleep with your television on, even though you may believe that you need the
television to sleep. The light and the sound from the television will invariably disturb
your sleep.  If you feel as though your bedroom is “too quiet” when you get into bed to
sleep, a white noise machine when you sleep or relaxing music at a low volume may
help.

 Do not take your cell phone to bed with you. Unless you are expecting emergency calls
do not plan on answering your cell phone during the night.  Do not text on your cell
phone when you are trying to sleep.  Ideally, your cell phone will be off during the night,
but this, of course, is not always possible.

Be sure you are spending enough time in bed each night.

As we previously discussed, recent guidelines from the American Academy of Sleep Medicine
recommend at least seven hours of sleep per night for adults with more sleep required for
children and adolescents.  Plan your schedule so that you obtain at least this amount of sleep
each night.  You may find that you require more than seven hours of sleep to feel fully alert
during the day, and you should increase your sleep amounts, if necessary, to feel at your most
alert.  Remember that at least seven hours of sleep, not the total amount of sleep averaged across
several days, is your goal.  You cannot “make up” lost sleep, so plan on this amount during both
the work week and on weekends.

Keep a regular schedule of going to bed at night and getting up in the morning.

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Besides getting enough sleep at night, it is of importance to follow a regular schedule both
during the work week and on weekends.  This allows your body to establish a regular 24 hour
cycle of sleeping and waking times.

It is very helpful to keep a daily diary to track both the amounts and timing of sleep.    By
recording the time you go to bed and get up in the morning over a period of two to four weeks,
you will be able to determine if you are keeping a regular schedule with enough time in bed at
night.

Limit your consumption of caffeine and meals near bedtime

  Do not drink caffeine containing beverages including coffee, tea, or energy drinks in the
evening.  Chocolate contains caffeine and may also bother your sleep.  Do not eat spicy or heavy
meals in the evening.

Do not drink alcohol to “improve” your sleep

The myth of alcohol being “good” for sleep is only a myth.  However, many people believe that
alcohol is beneficial for sleep.  In fact alcohol causes fragmented sleep as well as alterations in
normal sleep patterns as well as suppression of the respiratory system.  Do not drink alcohol
before bed.

Put the brakes on your racing mind when you are trying to sleep

  You have had a busy day at work or at home with problems, both big and small, popping up like
uninvited weeds in a well manicured lawn.  At last you are in bed, it is quiet and you have finally
have uninterrupted time to think about these problems and try to find solutions.  This is probably
the worst time to think about your problems since your mind will start to fight sleepiness when
you should be sleeping.  However, it is easier said than done to make yourself to stop thinking so
that you can sleep, and much of the time we are unsuccessful in controlling our thoughts so
easily.

If you know that this often happens as you are falling asleep, a relaxing bedtime routine will
help.  Plan to allot time for thinking about these issues before you get in bed.  You can schedule

29
time before getting into bed to think about, devise solutions for, and even write down your
thoughts before trying to sleep.  Once this scheduled “thinking time” is over, you can devote
yourself to falling asleep

Talk to your physician

You may be reluctant to discuss daytime drowsiness with your physician because it may seem to
you that sleepiness is a trivial problem in comparison to other serious diseases.  Nothing could be
further from the truth.  There is recognition in the medical community of the serious
consequences of sleep disorders.  Not only can daytime drowsiness can have significant impact
upon our quality of life, but it may be a sign of a serious medical conditions such as sleep apnea. 
Drowsiness may also be the result of medications or a symptom of some other medical condition
not specifically related to sleep.  There have been remarkable advances in our understanding and
treatment of sleep and sleep disorders in the last decade, and your physician will be able to assist
you in finding an answer.  In addition to talking to your physician, you may also want contact an
AASM accredited Sleep Center in your area.  These facilities are staffed by physicians board
certified in sleep medicine that can answer your questions or direct you to literature on sleep and
sleep disorders.

As we have seen, drowsiness during the day can have many different causes, but there are
solutions.  Try to assess your own sleep habits with a critical eye and then discuss the problem
with your physician.  We typically feel at our best and most productive after a night of good
sleep so make the goal of quality sleep a part of your overall good health.

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 5. What causes excessive sleepiness
It is normal for people to feel sleepy from time to time, particularly after a long day. However,
excessive sleepiness can be disruptive and make it difficult for a person to go about their normal
daily activities.

Some of the more common causes of excessive sleepiness include not sleeping long enough and
having poor quality sleep.

In some cases, excessive sleepiness may be due to a sleep disorder or another underlying health
condition.

Read on to learn about the various causes of excessive sleepiness, along with their symptoms and
treatment options.

Excessive sleepiness can be difficult to quantify, as it may mean different things to different
people.

In general, it is a feeling of fatigue or sleepiness that lasts throughout the day or for many days.

Excessive sleepiness is a relatively common issue. A 2019 study in Nature Communications

Trusted Source notes that 10–20% of people deal with excessive sleepiness to some degree.

There are several possible causes of excessive sleepiness, each of which has different treatments.

5.1 Sleep deprivation

Sleep deprivation occurs when a person does not get enough sleep. The American Academy of
Sleep Medicine (AASM) note that adults need between 7 and 8 hours of sleep each night to feel
alert and well-rested the following day.

However, according to the AASM, about 20% of adults fail to get enough sleep.

31
A person who does not get enough sleep during the night is likely to experience excessive
sleepiness the next day. People who regularly fail to get enough sleep may feel constantly tired.

Some common causes of sleep deprivation include:

 excessive or inconsistent work hours

 personal obligations

 an underlying medical condition

Underlying medical causes require their own specific treatments. In most other cases, simple
lifestyle changes can usually improve the duration and quality of a person’s sleep.

5.2 Insomnia

Insomnia is a sleep condition in which people have difficulty sleeping. People who have
insomnia tend to feel excessively sleepy but are unable to fall or stay asleep.

People may experience insomnia in different ways. Some common symptoms include:

 being unable to get to sleep

 waking continually throughout the night

 waking very early in the morning and being unable to fall back to sleep

Insomnia can be difficult to diagnose. The Centers for Disease Control and Prevention
(CDC)Trusted Source note that doctors generally only diagnose insomnia by ruling out other
potential sleep disorders.

Treatment

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Treatment for insomnia may involve a combination of therapies. Examples include:

 sedative-hypnotic medications

 antidepressants

 behavioral techniques to promote regular sleep

Picture 2.the nurse treats drowsiness case

Obstructive sleep apnea

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Sleep apnea is a disorder in which a person temporarily stops breathing during sleep. It is a
relatively common cause of excessive daytime sleepiness.

There are two types of sleep apnea:

 Obstructive sleep apnea (OSA): OSA occurs when the soft tissues in the back of the
throat collapse, blocking the airflow.

 Central sleep apnea (CSA): CSA occurs when the brain fails to signal to the respiratory
muscles to breathe.

Some people experience mixed sleep apnea, which is a combination of OSA and CSA.

Episodes of sleep apnea may occur dozens or even hundreds of times in a single night. As a
result, they can greatly disturb a person’s sleep cycle.

Common symptoms of sleep apnea include very loud snoring and gasping for air throughout the
night.

During an episode of sleep apnea, a person’s body becomes temporarily starved of oxygen. This
lack of oxygen may lead to other issues, such as an irregular heartbeat. Over time, this can lead
to serious chronic conditions, such as high blood pressure and heart disease.

Sleep apnea commonly occurs when a person is overweight. When this is the case, weight loss
will be the first recommended treatment.

Two common treatments for sleep apnea include:

 Positive airway pressure devices: These devices consist of a machine that attaches to a
mask, which the person wears over their face. The machine supplies pressurized air into a
person’s throat while they sleep. The air prevents the throat from collapsing.

34
  Oral appliances: These are similar to a mouthguard or orthodontic appliance. The devices
hold the lower jaw forward slightly during sleep. This positioning prevents the soft
tissues in the back of the throat from collapsing and blocking the airways.

Restless legs syndrome

Restless legs syndrome (RLS) refers to an uncontrollable urge to move the legs when they are at
rest. The condition usually also causes uncomfortable sensations in the legs.

RLS may occur during both wakefulness and sleep. People who experience RLS when awake
may have difficulty getting to sleep.

If RLS happens during sleep, it may cause a person’s legs to spasm or jerk repeatedly throughout
the night. While this may not be enough to wake the person, it can prevent them from reaching
the stages of deep, restful sleep. As a result, the person may feel sluggish and tired the following
day.

Some scientists believe that RLS is due to abnormalities in the neurotransmitter dopamine, which
plays a role in controlling muscle movements.

Certain lifestyle changes may be beneficial for people with milder cases of RLS. These include:

 adopting good sleeping habits

 exercising regularly

 quitting smoking

People with more severe cases of RLS may need medication to regulate the levels of dopamine
and iron in the body.

Narcolepsy

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Narcolepsy is a neurological condition that causes a person to fall asleep suddenly and at
inappropriate times.

People with narcolepsy usually experience extreme and persistent sleepiness throughout the day.
Most people with this condition will also have one or more of the following symptoms:

 sleep disturbances

 sleep paralysis

 hallucinations

Treatment

Treatment usually involves stimulant medications, which help the person stay awake.
Antidepressant medications may help control hallucinations and episodes of sleep paralysis.

Doctors may also recommend that people take a few good naps throughout the day, as this can
improve narcolepsy symptoms.

Depression

Depression may contribute to sleep issues, including excessive daytime sleepiness, as well as

oversleeping, or sleep that is not restful. Likewise, sleep issues may contribute to symptoms of
depression.

General fatigue and daytime tiredness are common among people with depression. Other
symptoms of depression include:

 feelings of sadness

 feelings of hopelessness or despair

 feelings of anxiety

36
  difficulty concentrating

 difficulty remembering details

Treatment

Treatment for depression may involve drug therapy, psychotherapy, or a combination of the two.

Several different types of antidepressant medication are available. A person can talk to their
doctor about which medication would be most appropriate for them.

Common psychotherapies for depression include cognitive behavioral therapy (CBT) and

interpersonal therapy. According to the Anxiety and Depression Association of America, these
therapies appear to be particularly effective in treating depression.

Certain medications

In some cases, daytime sleepiness may be a side effect of a particular medication, such as:

 antihistamines

 antipsychotics

 antidepressants

 anxiety medications

 high blood pressure medications

It is important to discuss the side effects of any medication with a doctor. If side effects such as
sleepiness are too difficult to deal with, the doctor may recommend a change in medication or
dosage.

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Symptoms

Excessive sleepiness is not a disorder in itself but a symptom of insufficient sleep or an

underlying health condition.

People who experience excessive sleepiness may notice the following:

 fatigue

 mental fog

 inability to focus

 grogginess

 sluggishness

Excessive sleepiness may also cause:

 difficulty waking up or getting out of bed in the morning

 feeling sluggish and unmotivated throughout the day

 napping frequently throughout the day

 falling asleep at inappropriate times, such as while driving or during meals

 lapses in attention

 loss of appetite

 difficulty remembering events throughout the day

 difficulty concentrating

 irritation

 poor performance in work or school activities

A person may experience additional symptoms if their excessive sleepiness is the result of an
underlying health condition (deslater, september 2008).

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Medications for Drowsiness

Other names: Sleepiness - during the day

Drowsiness is the term used to describe feeling excessively sleepy or tired during the day.

What Causes Drowsiness?

Drowsiness may be caused by a wide variety of medical conditions, medications, and lifestyle
choices. Generally, anything that disturbs night-time sleep can lead to daytime drowsiness.

Some common causes of drowsiness include:

 Insufficient sleep at night (going to bed too late or waking up too early)

 Changes to your sleep schedule (such as flying across several time zones)

 Sleep disorders (eg, narcolepsy, restless legs syndrome, sleep apnea)

 Alcohol

 Blue light exposure

 Boredom

 Chronic pain

 Dietary reasons (eg, too much caffeine, eating too late at night)

 Head injury

 Hypothermia

 Medical conditions, such as asthma, chronic fatigue syndrome, diabetes, gastrointestinal

disorders, low thyroid levels, metabolic abnormalities

 Medications (such as sedating antihistamines, benzodiazepines, some pain relievers)

 Mental health disturbances, such as anxiety or depression

39
  Neurological conditions, such as Parkinson’s disease

 Nicotine

 Stress or worry

 Using electronic devices at night.

What are the Symptoms of Drowsiness?

Common symptoms of drowsiness include:

 Daydreaming

 Difficulty focusing

 Disconnected thoughts

 Feeling abnormally sleepy during the day

 Frequent yawning

 Forgetfulness

 Falling asleep at inappropriate times

 Having to take naps throughout the day

 Heavy eyelids

 Inability to sleep at night

 Low motivation

 Missing exits or road signs when driving

 Trouble keeping your head up.

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How is Drowsiness Diagnosed?

If you are experiencing persistent, unexplained, daytime drowsiness, see your doctor. Your
doctor will ask you questions about how well you sleep and your sleep schedule and they may
ask you to keep a diary of your day-to-day life and sleep for a few days to get a clearer idea of
how often you fall asleep during the day.

Further tests may be conducted depending on whether the doctor thinks you may have an
underlying medical condition. If the cause is psychological, they may refer you to a counselor or
therapist, or if it is due to a medication, they may try to swap that medicine out for something
else or reduce the dosage. Never stop medicine yourself without first talking to your doctor.

How is Drowsiness Treated?

Treatment depends on the cause and may include:

 Avoiding blue light and electronic screens for at least two hours before going to bed

 Exercising more during the day

 Improving your sleep schedule (such as always going to bed at a certain time and waking
up at a certain time, even in the weekends)

 Listening to podcasts that help you to switch off

 Medication

 Meditation

 Psychotherapy

 Relaxation treatments

 Treatment of the underlying cause (if identified and treatable).

 Uncontrollable yawning, heavy eyelids, and the powerful urge to doze off during the day
are signs of excessive sleepiness. Struggling to stay awake can drag down performance at

41
 school and work, put strain on social and personal relationships, and create serious risks
when driving.
 If you experience persistent drowsiness, it’s normal to wonder, “why am I always
sleepy?”
 The most common causes of excessive sleepiness are sleep deprivation and disorders like
sleep apnea and insomnia. Depression and other psychiatric problems, certain
medications, and medical conditions affecting the brain and body can cause daytime
drowsiness as well.
 Recognizing excessive daytime sleepiness (EDS) is a first step toward addressing the
problem. Working with a doctor to identify its cause and improve sleep habits can
enhance your daily productivity, mood, and overall health.

Excessive Daytime Sleepiness

Excessive daytime sleepiness is a difficulty staying awake or alert1 when you need to. Many
experts define EDS as distinct from fatigue2, which involves strong feelings of physical
exhaustion, but the two conditions may overlap.

Recent research points to excessive sleepiness being a significant problem. The Sleep in America
Poll for 2020 by the National Sleep Foundation found that nearly half of Americans report
feeling sleepy between three and seven days per week.Forty percent of adults said that their
drowsiness interferes with daily activities at least occasionally.

Some resources refer to EDS as hypersomnia, which describes disorders of excess sleep.
However, hypersomnia is a broader term that includes issues like sleeping too much at night that
are distinct from extreme drowsiness during the day or in situations when alertness is required.

Sleepiness Caused by Sleep Deprivation

Lack of sleep is widely considered to be the most common cause of excessive sleepiness3. Sleep
deprivation may be short-term or chronic and can itself be caused by numerous sleep
disorders and other medical conditions4:

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  Failure to Prioritize Sleep: Choosing to stay up late to watch a series or wake up early to
go to the gym are examples of how sleep can get bumped down the list of priorities and
crowded out of a busy schedule. This can cause drowsiness the next day, and the problem
can accumulate over time. When these choices cause lack of sleep over an extended
period of time, it is known as insufficient sleep syndrome5.
 Insomnia: This condition includes a range of problems that make it hard to fall asleep or
stay asleep for as long as you want. Insomnia is often related to other sleep problems
described here that give rise to excessive sleepiness.
 Sleep Apnea: Obstructive sleep apnea (OSA) is a breathing disorder characterized by
brief pauses in breathing during the night. It creates fragmented sleep that typically
causes daytime drowsiness and may affect up to 20% of adults6. Central sleep apnea
(CSA) is less common but can also cause disturbed sleep.
 Restless Leg Syndrome (RLS): This condition causes a strong sensation of needing to
move one’s extremities, particularly the legs, and is a known risk for disrupting total
sleep time and sleep quality.
 Circadian Rhythm Sleep-Wake Disorders: When a person’s sleep schedule is misaligned
with their local day-night cycle, it can cause short and fragmented sleep. Examples
include jet lag and sleeping problems among shift workers.
 Poor Sleep Quality: Sleep insufficiency isn’t just about a low quantity of sleep; it’s also
about sleep quality. People who don’t smoothly progress through sleep cycles may fail to
get enough deep sleep or REM sleep. As a result, they may not wake up refreshed even if
they sleep for the recommended number of hours.
 Pain: Virtually any ailment that induces pain, including arthritis, fibromyalgia, or
herniated disks, can complicate sleep and make a person prone to drowsiness7 during the
day.
 Frequent Nighttime Urination: This condition, known as nocturia, involves needing to get
up from bed during the night to pee and is estimated to affect8 up to one out of three older
adults and one out of five younger people.

Sleepiness Caused by Other Medical and Brain Conditions

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A lack of sleep is not the only potential cause of excessive sleepiness. Medications, especially
sedatives, can make a person drowsy and disoriented during the day. Antidepressants, pain
medications, and over-the-counter antihistamines are just a few of the other types of medications
that can cause sleepiness. In addition, withdrawal from some drugs may provoke drowsiness.
Mental health disorders can frequently cause drowsiness. For example, it is believed that
nearly 80% of people with major depression9 have excessive daytime sleepiness. Bipolar
disorder10, post-traumatic stress disorder (PTSD), and general anxiety disorder are associated
with sleeping problems that may give rise to bouts of excessive sleepiness.
Several brain conditions can cause excessive daytime sleepiness. Narcolepsy is a prominent
example as it is a neurological condition in which the brain cannot properly regulate the sleep-
wake cycle. Narcolepsy affects around one in every 2,000 people and makes them prone to
falling asleep rapidly, including at inopportune times.
including dementia and Parkinson’s Disease are tied with sleeping difficulties and daytime
drowsiness. Traumatic brain injury (TBI) and concussions commonly cause sleeping problems,
and brain tumors or lesions may provoke excessive sleepiness. Infections,
including meningitis13 and those that cause  (swelling of the brain), can also lead to EDS.
Neurodevelopmental disorders like attention-deficit/hyperactivity disorder (ADHD), which
affects, cause a including daytime sleepiness. Up to 31% of children with have been found to
have daytime sleepiness, and sleeping issues may persist into adulthood for people with these
neurodevelopmental disorders.
beyond brain conditions can make a person sleepy during the day. Metabolic problems, including
diabetes and hypothyroidism, can be risk factors for drowsiness. Medical conditions like anemia,
abnormal blood sodium levels, and electrolyte imbalances can also provoke excessive sleepiness.

Getting Relief for Excessive Daytime Sleepiness

Relief is possible for most people with excessive sleepiness. The optimal treatment is tailored to
each person based on the specific cause or contributing factors.

Because EDS can be caused by both poor sleep habits and medical and brain conditions, there
are a diverse range of approaches to resolving it. A doctor is in the best position to identify and
tailor optimal treatment pathways for individuals.

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If drowsiness is derived from sleep deprivation, various steps can be taken to improve sleep
quality and quantity. Examples include continuous positive airway pressure (CPAP) machines
for sleep apnea and cognitive behavioral therapy for insomnia (CBT-I). Many sleep-focused
treatments will help facilitate improvements to sleep hygiene, which incorporates a person’s
sleep habits and bedroom environment, and whether they’re using the best mattress and pillow
for their needs.
If EDS is tied to another medical problem, treatment typically focuses on resolving that
underlying issue. Sleep hygiene improvements may be encouraged along with other treatments to
help people incorporate healthy sleep tips into their daily routines.

6. “DRIVER DROWSINESS DETECTION SYSTEM

6.1 HUMAN PSYCHOLOGY WITH CURRENT TECHNOLOGY
Humans have always invented machines and devised techniques to ease and protect their
lives, for mundane activities like traveling to work, or for more interesting purposes like
aircraft travel. With the advancement in technology, modes of transportation kept on
advancing and our dependency on it started increasing exponentially. It has greatly
affected our lives as we know it. Now, we can travel to places at a pace that even our

45
 grandparents wouldn’t have thought possible. In modern times, almost everyone in this
world uses some sort of transportation every day. Some people are rich enough to have
their own vehicles while others use public transportation. However, there are some rules
and codes of conduct for those who drive irrespective of their social status. One of them
is staying alert and active while driving. Neglecting our duties towards safer travel has
enabled hundreds of thousands of tragedies to get associated with this wonderful
invention every year. It may seem like a trivial thing to most folks but following rules
and regulations on the road is of utmost importance. While on road, an automobile wields
the most power and in irresponsible hands, it can be destructive and sometimes, that
carelessness can harm lives even of the people on the road. One kind of carelessness is
not admitting when we are too tired to drive. In order to monitor and prevent a
destructive outcome from such negligence, many researchers have written research
papers on driver drowsiness detection systems. But at times, some of the points and
observations made by the system are not accurate enough. Hence, to provide data and
another perspective on the problem at hand, in order to improve their implementations
and to further optimize the solution, this project has been done
6.2 FACTS & STATISTICS
Our current statistics reveal that just in 2015 in India alone, 148,707 people died due to
car related accidents. Of these, at least 21 percent were caused due to fatigue causing
drivers to make mistakes. This can be a relatively smaller number still, as among the
multiple causes that can lead to an accident, the involvement of fatigue as a cause is
generally grossly underestimated. Fatigue combined with bad infrastructure in developing
countries like India is a recipe for disaster. Fatigue, in general, is very difficult to measure
or observe unlike alcohol and drugs, which have clear key indicators and tests that are
available easily. Probably, the best solutions to this problem are awareness about fatigue-
related accidents and promoting drivers to admit fatigue when needed. The former is hard
and much more expensive to achieve, and the latter is not possible without the former as
driving for long hours is very lucrative. When there is an increased need for a job, the
wages associated with it increases leading to more and more people adopting it. Such is
the case for driving transport vehicles at night. Money motivates drivers to make unwise
decisions like driving all night even with fatigue. This is mainly because the drivers are

46
not themselves aware of the huge risk associated with driving when fatigued. Some
countries have imposed restrictions on the number of hours a driver can drive at a stretch,
but it is still not enough to solve this problem as its implementation is very difficult and
costly.
SUMMARY: The goal of this Safety IDEA was to develop a non-contact sensing
platform to monitor the physiological signals of drivers such as the electrocardiography
(ECG) and/or electroencephalography (EEG), from which the on-set and extent of
drowsiness can be detected. Clinical research has found physiological signals are good
indicators of drowsiness. Conventional bioelectrical signal measurement system requires
the electrodes to be in contact with the human body. That not only interferes with the
normal driver operation, but also is not feasible for long term monitoring purposes.
Therefore, a non-contact physiological signal sensing platform as developed in this
project will be very helpful to detect driver drowsiness and reduce crashes. Such sensors
can be integrated readily into a wireless health monitoring system for drivers. In this
project, we designed a non-contact ECG sensor based on high input impedance circuitry.
With delicate sensor electronics design, the bioelectrical signals associated with
electrocardiography (ECG), breathing, and eye blinking can be measured. This sensor
package can detect the ECG signals with an effective distance of up to 30 cm (11.81
inch) away from the body. It also provides sensitive measurement of physiological
signals such as heart rate, breathing, eye blinking etc. The sensor performance was
validated on a high fidelity driving simulator. Digital signal processing algorithms were
developed to remove the signal noise and simultaneously automate signal analyses. The
characteristics of physiological signals indicative of driver fatigue, i.e., the heart rate
(HR), heart rate variability (HRV), breath frequency and eye blinking frequency, can be
determined. A drowsiness indicator was developed by coupling the multiple
physiological parameters to achieve high reliability in drowsiness detection. Evaluation
of sensor performance was conducted under various conditions in this project. These
include evaluation under ordinary laboratory and office environmental conditions. Sensor
performance was also evaluated in a high fidelity driving simulator as well as an
operational truck. The sensor would have applications for railroad train operators and
truck drivers. Results of the evaluation indicate that the sensor is accurate, robust, and

47
 easily deployed. All of these evaluations point to great promise for this technology. This
project showed that the proposed sensing concept is feasible. Recommendations are made
for further development of the sensor prototype. 2 1. IDEA PRODUCT The anticipated
product of this project is a non-contact physiological signal sensing system that can be
integrated into vehicles to detect driver drowsiness and provide driver assistance under
naturalistic driving conditions. The non-contact sensing system will monitor vital
physiological signals such as ECG, EEG, breathing, and eye blinking, with a goal to
detect drowsiness and provide warning (Figure 1). Non-contact EC

References
deslater, j. (september 2008). definition of drpurpose for sleepowsiness one .
gabhane, j. (appril 2018). drowsiness ditectionand alert system.
loba, a. (may 2020). analysing driverdrowsiness: from cause to effect.
soares, s. (march 2020). drowsiness.

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