Sleepiness is a signal to go to bed: data and model simulations.

Study objectives Assess the validity of a subjective measure of sleepiness as an indicator of sleep drive by quantifying associations between intra-individual variation in evening sleepiness and bedtime, sleep duration, and next morning and subsequent evening sleepiness, in young adults. Methods Sleep timing and sleepiness were assessed in 19 students in late autumn and late spring on a total of 771 days. Karolinska Sleepiness Scales (KSS) were completed at half-hourly intervals at fixed clock times starting four hours prior to participants' habitual bedtime, and in the morning. Associations between sleepiness and sleep timing were evaluated by mixed model and non-parametric approaches and simulated with a mathematical model for the homeostatic and circadian regulation of sleepiness. Results Intra-individual variation in evening sleepiness was very large, covering four or five points on the 9-point KSS scale, and was significantly associated with subsequent sleep timing. On average, a one point higher KSS value was followed by 20 min earlier bedtime, which led to 11 min longer sleep, which correlated with lower sleepiness next morning and following evening. Associations between sleepiness and sleep timing were stronger in early compared to late sleepers. Model simulations indicated that the directions of associations between sleepiness and sleep timing are in accordance with their homeostatic and circadian regulation, even though much of the variance in evening sleepiness and details of its time course remain unexplained by the model. Conclusion Subjective sleepiness is a valid indicator of the drive for sleep which, if acted upon, can reduce insufficient sleep.