Sleep

10(4):343-353, Raven Press, New York

© 1987, Association of Professional Sleep Societies

Subjective Ratings of Sleepiness-The

Underlying Circadian Mechanisms

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Timothy H. Monk

Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine,

Pittsburgh, Pennsylvania, U.S.A.

Summary: Previous field and laboratory studies have revealed that there is a
diurnal variation in subjective sleepiness that is different in form to that of
objective sleepiness and many measures of performance efficiency. The worst
subjective sleepiness occurs at the trough in the circadian temperature rhythm,
the least subjective sleepiness about 7 h before the peak in temperature. A
series of forced de synchronization experiments, in which the endogenous cir-
cadian oscillator controlling the temperature rhythm ran at a different period to
the sleep/wake cycle, revealed that these findings can be explained by postu-
lating subjective sleepiness to be under the control of both factors, with min-
imum sleepiness occurring at the peak in temperature in terms of the tempera-
ture cycle and about 6 h after waking in terms of the sleep/wake cycle. Key
Words: Alertness-Circadian-Human-Sleepiness-Subjective ratings.

INTRODUCTION
Background
As there are dramatic changes over the day in an individual's physiological make-up
(1), it is not surprising that psychological variables also show a diurnal variation, even
in individuals who are well-slept and living on a "normal" routine. Thus, there are
reliable changes over the day in mood (2), subjective (3-5) and objective sleepiness
(6,7), and the ability to perform various tasks (8). Although there are some individuals
who are extreme in their preference for either early morning ("larks" or M-types) or
late evening ("owls" or E-types) activity (9), a sizable majority (about 80%) fall into
neither extreme category, and for them generalizations can be made about the way in
which these variables fluctuate over the day (10).
The diversity of the many physiological circadian rhythms renders it inappropriate to
speak of a single composite "physiological rhythm." Rather there are many different
physiological circadian rhythms, showing different peak timings, levels of lability, and
rates of phase adjustment to a change in routine. A similar argument holds for the
"psychological" variables. Thus, while performance speed at simple repetitive (11,12)

Accepted for publication March 1987.

Address correspondence and reprint requests to Dr. Timothy H. Monk at Sleep Evaluation Center,
Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, U.S.A.

343
344 T. H.MONK

and serial search (13) tasks peaks with temperature in the evening, cognitive perfor-
mance speed peaks in the late morning (14) and short-term memory in the early- to
mid-morning (15,16). These differences in phase are also associated with different rates
of phase adjustment to a change in routine (17) and with differences in free-running
period (18,19) and underlying oscillatory control (20).
One must therefore be careful in making generalizations about the diurnal variation
in global variables like "mood," "ability to perform," or "sleepiness," as the form
that the variation will take will depend on the way in which the variable is measured.

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The present study is specifically restricted to perceptions of subjective sleepiness and
the circadian mechanisms underlying them. We shall discuss previously published field
and laboratory studies and a new set of time isolation studies. As contemporary circa-
dian rhythms research (21,22) has focused on the circadian body temperature rhythm
and the sleep/wake cycle (and the oscillators or processes underlying them), subjective
alertness/sleepiness will be discussed in reference to these two cycles. No claim is
made about whether such perceptions are in any way predictive of performance, affec-
tive state, or ability to fall asleep. They would, though, appear to be important in the
thinking human creature as a determinant of the decision to go to bed and are certainly
worthy of study.
Quantifying subjective sleepiness
There are various techniques available for quantifying perceptions of subjective
sleepiness in the normal healthy individual. The four most popular are (a) checking a
sentence describing one's state (Stanford Sleepiness Scale) (23), (b) mood adjective
check lists, in which subjects ascribe ratings of agreement to long lists of adjectives (3),
(c) simple numerical ratings scales (24), and (d) Visual Analogue Scales (VAS), in
which subjects place a mark on a line labeled "very sleepy" at one end and "very
alert" at the other (25,26). By measuring the distance of the mark from the left end of
the line, a VAS score can be obtained that allows a continuum of response, without the
subject being able to "anchor" onto a particular numerical value (27). The resulting
"fine-grained" response is more sensitive than some of the other techniques when
nonpathological levels of subjective sleepiness are being measured and comparisons
are made '''within'' rather than "between" subjects (2). It also has the advantage of
brevity compared to mood adjective check lists.
Previous studies
In a review of a number of studies, Folkard (4) found that there was usually a mid-
day (or early afternoon) peak in subjective alertness (i.e., minimum in subjective sleep-
iness) for normal subjects on a diurnal ("day-oriented") routine. This result is rather
surprising in view of the conventional wisdom [and premise of the arousal theory used
to explain circadian performance variation (28)] that alertness should be parallel to
body temperature, showing a peak in the late afternoon or evening, and to the findings
of the multiple sleep latency test (MSLT) (6,7) that objective sleepiness is greatest in
the early afternoon. The circadian rhythm of subjective sleepiness would thus seem not
to be simply the reflection of an "arousal rhythm" parallel to the temperature rhythm,
or an indicant of the "gates" to sleep that are revealed by the MSLT. Rather, it ap-
pears to be a complex mixture of circadian processes. The aim of this article is to
unravel that mixture.
Clearly, it is illogical to ask someone how sleepy they feel when they are actually
asleep. By their very definition, ratings of subjective alertness are effectively barred

Sleep. Vol. 10. No.4, /987

 SUBJECTIVE SLEEPINESS 345

from the sleep time of the individual. Alertness ratings are thus usually restricted to the
"normal" hours (7:00 a.m. to midnight) of wakefulness. However, either by keeping
subjects awake continuously, or by studying nightworkers, one can obtain sensible
readings through the night hours.
Froberg (29) used the former technique keeping subjects continuously awake in a
72-h temporal isolation experiment, with constant conditions, uniform food intake, and
no knowledge of clock time. Although subjective alertness showed the expected de-
creasing trend over the vigil, there was also a clear circadian rhythm in both subjective

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alertness and body temperature (Fig. O. More importantly, the two rhythms were par-
allel, showing identical times of peak and trough and a statistically reliable correlation
(r = 0.683, p < 0.01). This suggests that, in this situation at least, the endogenous
circadian oscillator responsible for the body temperature rhythm (referred to hence-
forth as "the temperature oscillator") is also a determinant of subjective alertness.
We have recently studied a group of shiftworkers (30). Every 2 h, while on shift, the
subjects gave ratings of alertness and measured their oral temperature. By averaging
over a whole month, it was possible to obtain 24-h cycles for each measure (Fig. 2).
The shift system was a rapidly rotating one, with never more than 3 night shifts in a
row. There was thus insufficient time for phase adjustment to occur, and indeed [as
discussed in a separate publication (31)], these subjects had an average body tempera-
tUre rhythm that was strikingly close to that found in normal dayworkers, showing a
trough at 6:00 a.m. and a peak at 8:00 p.m. The troughs of temperature and alertness
coincided, but the same was not true for the peaks. The temperature rhythm showed
the usual peak at about 8:00 p.m., whereas the alertness rhythms had two peaks, one

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FIG. 1. Circadian rhythms in body temperature and self-rated alertness from 15 subjects experiencing 72 h of
sleep deprivation in temporal isolation (29).

Sleep, Vol. 10, No.4, 1987

346 T.R.MONK

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FIG. 2. Circadian rhythms in oral temperature (e--e) and subjective alertness (0- - - - -0). Two cycles
of the 12 points defining each rhythm have been plotted (30).

nearly coinciding with the temperature peak, the other occurring considerably earlier
(at about mid-day). The coincidence of the two troughs again confirms the importance
of the temperature oscillator as a determinant of alertness, but the mid-day peak in
alertness suggests that in this situation, i.e., subjects who were not time isolated and
were sleeping normally (at night) while on daywork, some other factor was coming into
play.
This difference in the time of peak between the two measures was confirmed in our
two studies on normal diurnal subjects (36 students, 38 members of the general public)
(5). Figure 3 shows the results of the second of those studies.
Clearly, the most parsimonious explanation for the difference is that although the
temperature oscillator is certainly one determinant of subjective sleepiness, the pro-
cess that controls the sleep/wake cycle [be it like an oscillator (21,32) or capacitor (22)
in action] would also seem to be having an effect. This is not implausible, in view of the
obvious link between sleepiness and going to bed! Indeed, one might conceive of the
subjective sleepiness rhythm as the means by which the physiological circadian system
makes its wishes known to the conscious mind, making the required circadian behavior
become the desired circadian behavior.
If one is to tease apart the influence of the "temperature oscillator" and "sleep/wake
cycle mechanism" on subjective sleepiness, it is necessary to separate them in some
way. We have done this using a forced desynchronization technique in which the tem-
perature oscillator is made to run at a different period to that of the sleep/wake cycle.

METHODS
The analyses reported here comprise one small aspect of a multifaceted series of
studies carried out at Montefiore Medical Center and Cornell University Medical Col-
lege by J. E. Fookson, M. L. Moline, C. P. Pollak, and the late E. D. Weitzman, in
collaboration with the present author. Other aspects of these studies have been and will
be reported elsewhere (33,34).
Resources and environment
Each subject lived alone in a special time-isolated apartment that allowed no knowl-
edge of clock time or external time cues. The facility is described in detail in a separate

Sleep, Vol. 10, No.4, 1987

 SUBJECTIVE SLEEPINESS 347

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FIG. 3. Time of day effects in subjective alertness and oral temperature (± 1 SE) for 38 subjects studied over
8 days (5).

publication (35). Social interaction with the technicians (who brought the subjects food
and supervised data collection) was allowed, but the technicians worked a totally
random shift schedule and were specially trained not to give any time cues.
Throughout the experiment, subjects were told when to go to bed, get up, and take
their meals. Lights were extinguished at bedtime and did not come on again until the
prescribed wake-time, at which time the subject was aroused from sleep if necessary
and required to get out of bed. This time will be referred to henceforth as "wake-
time," although subjects sometimes awoke spontaneously before it (but were not al-
lowed to get out of bed). Sleep at all other times was forbidden, and compliance was
monitored using closed-circuit TV.

Measures taken
A broad range of psychological and physiological measures were taken. This report
will concentrate on measures of subjective sleepiness that were assessed using a com-
puterized VAS technique, comprising a question "How sleepy do you feel?" with a
IO-cm line below it with the label "very little" at the left end and "very much" at the

Sleep, Vol. 10, No.4, 1987

348 T. H.MONK

right. Subjects moved a cursor to a position on the line that corresponded to their level
of sleepiness at that moment, considering the whole line to represent their own normal
range. The measure taken was the distance from the left end in (0-36) arbitrary units.
The VAS technique has been used widely in our own laboratory, involving more than
2,000 subject-sessions, as well as in many previous studies in which other psycholog-
ical measures were evaluated (27,36,37). Assessments were made at waketime and at
bedtime, and every time the subject used the bathroom or requested something to eat.
This corresponded to about 6 times per day.

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Rectal temperatures were continuously monitored using a thermister inserted 10 cm
into the rectum and connected to a computer that translated the changes in resistance
into measures of temperature, recording the temperature every minute around the
clock.

Experimental procedure
The four experiments to be described each lasted several months and were con-
cerned with several different manipulations of day length and their effect on sleep and
the circadian system. These manipulations were accomplished by either stretching or
shrinking an individual's whole daily routine for several weeks, so that the cycle re-
tained its integrity, but at a period length that was different to 24 h. This analysis will be
restricted to day lengths which were engineered to be beyond the range of entrainment
of the temperature oscillator. Under those conditions, a "desynchronization" was in-
duced, with the sleep/wake cycle being driven at one period length (e.g., 26 h), while
the temperature oscillator ran independently at a different period, corresponding to its
"natural" or "free-running" period (typically close to 25 h). That "natural" period
was assessed using a periodogram technique applied to the minute-by-minute around-
the-clock temperature readings (38). Table 1 presents details of the lengths of these
sections, the period lengths of sleep/wake cycle and temperature oscillator, and the age
and sex of the subjects.

Statistical techniques
As subjective sleepiness could only be sampled during wakefulness, sampling was
irregularly spaced, and standard periodogram, autocorrelation, or Fourier techniques
could not be applied. Instead, a sinusoid fitting technique (39) was used. For each
subject, this technique was applied separately at the period of the (imposed) sleep/
wake cyCle and at the "natural" period of the temperature oscillator. At each period, a
least-squares cosine curve-fitting procedure was used, involving the solution of three
simultaneous equations in order to derive estimates of acrophase (time of cosine peak),

TABLE 1. Study details

Temp.osc. No. of
Subject Imposed day cycle Length of mood test
code Agelsex length (h) length (h) study (h) sessions
PBOI 221M 25.8 24.8 1052 155"
PB02 221M 25.8 24.3 1271 334
PB03 251M 26.0 24.5 936 230
PB04 191M 23.0 24.3 406 123

Temperature oscillator cycle length was determined by periodogram analysis of minute-by-minute temper-
ature readings.
" More sessions were given, data were lost due to equipment malfunction.

Sleep. Vol. 10, No.4, 1987

 SUBJECTIVE SLEEPINESS 349

mesor (mean level of curve), and rhythm amplitude (peak level minus mesor). These
estimates comprised the parameters of the cosine curve that best fit the observed data
at that particular period. Measures of goodness of fit were also obtained, including an
F ratio to assess statistical reliability. All of the fits reported here were significant at
the 5% level or better.
This particular technique has been used extensively in this (19,34) and other (40)
laboratories and has been shown to give period (frequency) information that can be as
reliable as that obtained by applying standard periodogram techniques to around-the-

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clock frequent samples (41).
One drawback of the sinusoid-fitting technique is the assumption that it makes re-
garding the (sinusoidal) shape of the rhythms to which it is applied. We therefore per-
formed two secondary analyses, using techniques that made no assumptions about the
shape of the rhythm. The first involved simple correlation. Each subjective sleepiness
rating was paired with the subject's rectal temperature at the time the rating was taken,
and a correlation coefficient was calculated for each subject. The second analysis in-
volved creating a "time of day" function for each subject. Average subjective sleepi-
ness was plotted as a function of "hours since wake-up."
Subjects
The four subjects were all healthy, young (19-25 years old) men who were paid an
honorarium for their participation. All had passed rigorous screening procedures re-
garding their physical and mental health. None were habitual nappers.

RESULTS
Primary analysis
Unlike the strictly 24-h environment of the world outside, "day lengths" in temporal
isolation studies can be arbitrarily defined according to the dictates (imposed day
lengths) of the experimenter and/or the circadian behavior of the subject. In analyzing
this study, we defined two "day lengths." "Temperature oscillator days" were defined
by the temperature oscillator period (tau) obtained by periodogram analysis and listed
in Table 1. As these "days" were out of synchrony with both clock time and the im-
posed sleep/wake cycle, a special time marker was required for them. For this marker
we used the acrophase (time of sinusoid peak) of the sinusoid fitted to the rectal tem-
perature rhythm at the temperature oscillator tau. Thus, the time measure used the
distance in time from peak temperature, with positive numbers indicating later times,
negative numbers earlier times, and zero a coincidence with peak temperature. The
second "day length" we defined was simply that of the "sleep/wake cycle days" en-
forced during the experiment. Here, the measure taken was the hours passed since the
subject was told to get up ("wake-time").
Sinusoids were then fitted to the time series defining the subjective sleepiness
rhythm separately for "temperature oscillator days" and for "sleep/wake cycle days."
The time of least subjective sleepiness (180 0 after the acrophase) was then obtained for
each and the results summarized in Table 2.
The fact that a coherent pattern of results was obtained both in terms of temperature
oscillator days (where least sleepiness coincided with peak temperature) and in terms
of sleep/wake cycle days (where least sleepiness occurred about 6 h after getting out of
bed), bespeaks the importance of both mechanisms as determinants of subjective
sleepiness.

Sleep, Vol. 10, No.4, 1987

350 T. H. MONK

TABLE 2. Times of least subjective sleepiness

Time of least
Subject Period sleepiness

Temperature oscillator days (at length of temperature oscillator period)

Measure: difference in hours from temperature peak
PBO! 24.8 h - 2.09 h
PB02 24.3 h +0.56 h
PBm 24.5 h +0.79 h
PB04 24.3 h +0.25 h

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Mean -0.!2 h
Sleep/wake cycle days (at length of imposed sleep/wake cycle)
Measure: differences in hours from wake-time
PBO! 25.8 h + 5.74 h
PB02 25.8 h + 5.46 h
PB03 26.0 h + 8.08 h
PB04 23.0 h +6.48 h
Mean + 6.44 h

Secondary analyses
Since we have shown earlier (Fig. 2) that alertness rhythms are not perfectly sinu-
soidal, it is clearly desirable to verify the results summarized in Table 2 without re-
course to any assumptions about the shape of the data. (For technical reasons, these
analyses could not be performed on subject PB01.)
The coincidence of least sleepiness with peak temperature (Table 2, upper panel) was
tested by simply pairing each sleepiness rating with its associated rectal temperature
and calculating a correlation coefficient for each subject. The expected significant neg-
ative correlations (PB02: r = -0.395, df = 332, p < 0.001; PB03: r = -0.511, df =
228, P < 0.001; PB04: r = -0.320, df = 121, P < 0.01) confirmed that rises in tempera-
ture were indeed associated with a lessening of subjective sleepiness.
The occurrence of least sleepiness about 6 h after wake time (Table 2, lower panel)
was tested by indexing each subjective sleepiness rating by the number of hours since
wake-time that it occurred and averaging to give a "time of day function" for each
subject. The three time of day functions are plotted in Fig. 4. A good agreement was
found with the times of least sleepiness obtained by the sinusoid-fitting analysis.

DISCUSSION
These laboratory results very nicely integrate the findings from previous studies and
resolve the paradox regarding the apparent parallelism between alertness and tempera-
ture, but lack of coincidence in their peaks. Thus, a minimum in sleepiness 6 h after
wake-time corresponds, for most people's routines, to about 1:00 p.m., approximating
the time of peak subjective alertness found by Folkard (4) in his review and by the
present author in his field and laboratory experiments (2,5,30). The coincidence be-
tween temperature peak and minimum sleepiness at the temperature oscillator period
is in agreement with the parallelism between temperature and arousal presumed to
underlie the circadian variation in human performance efficiency (28), and also ex-
plains why Froberg (29) (see 'Fig. 1) obtained a perfect parallelism between subjective
sleepiness and body temperature when he suspended the sleep/wake cycle for 72 h.
The paradox that remains is the relation between subjective and objective measures
of sleepiness. Thus, it seems peculiar that subjects rate themselves as at their least
sleepy a few short hours before their peak objective sleepiness as measured by the

Sleep, Vol. /0, No.4, 1987

 SUBJECTIVE SLEEPINESS 351

PB02

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• , • nil.
I-IOlR) SINCE WAKf.-I.P

P803

I-IOlR) SINCE WAKE-I.P

. ~

PS04

HOURS SINCE WAKf.-lJ'

.
FIG. 4. Mean subjective sleepiness plotted as a function of time since wake-up. Each point represents the
mean of at least 43 ratings in PB02, 32 ratings in PB03, and 16 ratings in PB04.

MSLT. One possible explanation may be that objective sleepiness is related not to the
absolute level of subjective sleepiness, but to its rate of change. Thus, the rate of rise in
subjective sleepiness may be the prime determinant of an individual's ability to fall
asleep.

Sleep, Vol. 10, No.4, /987

352 T. H.MONK

However, the results do make sense from an intuitive point of view. As the duration
of a sleep episode is dependent on body temperature at sleep onset (42), it is clearly an
advantage to have the subjective sleepiness rhythm, which in a perfect world would
naturally precipitate the bedtime decision, also be under the influence of the tempera-
ture oscillator. However, because of the marked stability of that oscillator, subjective
sleepiness rhythms that were totally under its control would be inflexible in coping with
phase shifts and missed nights of sleep. The mixture of control from both temperature
oscillator and sleep/wake cycle mechanism ensures that the subjective sleepiness

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rhythm can guide the individual toward the bedtime choices that are most suitable for a
given routine, even when that routine is a changing one.

REFERENCES
1. Aschoff J, ed. Handbook of Behavioral Neurobiology, vol 4. New York: Plenum, 1981.
2. Monk TH, Fookson JE, Moline ML, Pollak CPo Diurnal variation in mood and performance in a time-
isolated environment. Chronobiolint 1985;2:185-293.
3. Thayer RE. Toward a psychological theory of multidimensional activation (arousal). Motivation & Emo-
tion 1978;2: 1-34.
4. Folkard S. Diurnal variational. In: Hockey GRJ, ed. Stress and fatigue in human performance. New
York: Wiley, 1983:245-72.
5. Monk TH, Leng VC, Folkard S, Weitzman ED. Circadian rhythms in subjective alertness and core body
temperature. Chronobiologia 1983; I 0:49-55.
6. Carskadon M, Dement W. Sleep tendency: an objective measure of sleep loss. Sleep Res 1977;6:200.
7. Richardson GS, Carskadon MA, Orav EJ, Dement WC. Circadian variation of sleep tendency in elderly
and young adult subjects. Sleep 1982;5:582-94.
8. Colquhoun WP. Rhythms in performance. In: Aschoff J, ed. Handbook of behavioral neurobiology, vol
4. New York: Plenum, 1981:333-48.
9. Horne JA, Ostberg O. A self-assessment questionnaire to determine morningness-eveningness in human
circadian rhythms. Int] Chronobiol 1976;4:97-110.
10. Folkard S, Monk TH. Circadian performance rhythms. In: Folkard S, Monk TH, eds. Hours of work-
temporal factors in work scheduling. New York: John Wiley & Sons, 1985:37-52.
11. Blake MJF. Time of day effects on performance in a range of tasks. Psychon Sci 1967;9:349-50.
12. Colquhoun WP. Circadian variations in mental efficiency. In: Colquhoun WP, ed. Biological rhythms and
human performance. London: Academic Press, 1971:39-107.
13. Monk TH. Temporal effects in visual search. In: Clare IN, Sinclair MA, eds. Search and the human
observer. London: Taylor & Francis, 1979:30-9.
14. Folkard S. Diurnal variation in logical reasoning. Br] Psychol 1975;66: 1-8.
15. Laird DA. Relative performance of college students as conditioned by time of day and day of week. ]
Exp Psychol 1925;8:50-63.
16. Folkard S, Monk TH. Circadian rhythms in human memory. Br] PsychoI1980;71:295-307.
17. Folkard S, Monk TH. Shiftwork and performance. Hum Factors 1979;21:483-92.
18. Folkard S, Wever RA, Wildgruber CM. Multioscillatory control of circadian rhythms in human perfor-
mance. Nature 1983;305:223-6.
19. Monk TH, Weitzman ED, Fookson JE, Moline ML. Circadian rhythms in human performance efficiency
under free-running conditions. Chronobiologia 1984;11:343-54.
20. Monk TH, Weitzman ED, Fookson JE, Moline ML, Kronauer RE, Gander PH. Task variables determine
which biological clock controls circadian rhythms in human performance. Nature 1983;304:543-5.
21. Wever R. The circadian multi-oscillator system of man. Int] ChronobioI1975;3: 19-55.
22. Borbely AA. A two-process model of sleep regulation. Hum Neurobiol 1982;1: 195-204.
23. Hoddes E, Zarcone V, Smythe H, Phillips R, Dement W. Quantification and sleepiness: a new approach.
Psychophysiology 1973; 10:431-6.
24. Wever R. The circadian system of man: results of experiments under temporal isolation. New York:
Springer-Verlag, 1979.
25. Folkard S, Monk TH, Lobban MC. Short and long-term adjustment of circadian rhythms in "perma-
nent" night nurses. Ergonomics 1978;21:785-99.
26. Weitzman ED, Czeisler CA, Zimmerman JC, Ronda JM, Knauer RS. Chronobiological disorders: ana-
lytic and therapeutic techniques. In: Guilleminault C, ed. Disorders of sleeping and waking: indications
and techniques. California: Addison-Wesley, 1982:297-329.
27. Folstein MF, Luria R. Reliability, validity and clinical application of the visual analogue mood scale.
Psychol Med 1973;3:479-86.

. -
Sleep, Vol. 10, No.4, 1987
 SUBJECTIVE SLEEPINESS 353

28. Hockey GRI, Colquhoun WP. Diurnal variation in human performance: a review. In: Colquhoun WP, ed.
Aspects of human efficiency-diurnal rhythm and loss of sleep. London: English Universities Press,
1972:39-107.
29. Froberg JE. Twenty-four hour patterns in human performance, subjective and physiological variables
and differences between morning and evening active subjects. Bioi PsychoI1977;5: 119-34.
30. Monk TH, Embrey DE. A field study of circadian rhythms in actual and interpolated task performance.
In: Reinberg A, Vieux N, Andlauer P, eds. Night and shift work: biological and social aspects. Oxford:
Pergamon Press, 1981:473-80.
31. Monk TH. Advantages and disadvantages of rapidly rotating shift schedules-a circadian viewpoint.
Hum Factors 1986;28:553-7.

Downloaded from https://academic.oup.com/sleep/article/10/4/343/2742575 by guest on 02 August 2023

32. Kronauer RE, Czeisler CA, Pilato SF, Moore-Ede MC, Weitzman ED. Mathematical model of the
human circadian system with two interacting oscillators. Am J Physiol 1982;242 (Reg Integ Comp
PhysioI1l:R3-RI7).
33. Fookson IE, Weitzman ED, Monk TH, Moline ML, Mair BB, Pollak CP, Kronauer RE. Instrumentation
and experimental design in chronobiology. In: Lin JC, Feinberg BN, eds. Proceedings of the 7th annual
conference of the IEEE/Engineering in Medicine and Biology Society. New York: IEEE, 1985:1045-
1050.
34. Monk TH, Weitzman ED, Fookson JE, Moline ML, Kronauer RE, Gander PH. Task variables determine
which biological clock controls circadian rhythms in human performance. Nature 1983;304:543-5.
35. Monk TH, Fookson IE, Kream I, Moline ML, Pollak CP, Weitzman MB. Circadian factors during sus-
tained performance: background and methodology. Behav Res Meth Instru Comput 1985;17:19-26.
36. Freyd M. The graphic rating scale. JEd Psycholl923;14:83-102.
37. Bond A, Lader M. The use of analogue scales in rating subjective feelings. Br J Med Psychol
1974;47:211-8.
38. Fookson J, Weitzman ED, Czeisler CA, Zimmerman JC, Ronda I. Development of mathematical tech-
niques to describe chronophysiological rhythms in man during temporal isolation. In: Haus E, Cabat R,
eds. Chronobiology 1981-1983. New York: S. Karger, 1984.
39. Monk TH, Fort A. COSINA-a curve fitting program suitable for small computers. Int J Chronobiol
1983;8: 193-222.
40. Folkard S, Hume KI, Minors DS, Waterhouse JM, Watson FL. Independence of the circadian rhythm in
alertness from the sleep/wake cycle. Nature 1985;313:678-9.
41. Monk TH, Fookson IE. Circadian temperature rhythm power spectra-is equal sampling necessary?
Psychophysiology 1986;23:472-9.
42. Czeisler CA, Weitzman ED, Moore-Ede MC, Zimmerman Ie. Human sleep: its duration and organiza-
tion depend on its circadian phase. Science 1980;210:1264-7.

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