Subjective perception of sleepiness in a driving simulator is different from that in the Maintenance of Wakefulness Test

• Sleepiness perception in the Maintenance of Wakefulness Test does not fit the perception while driving.
• Spontaneously perceived sleepiness is accurate in the driving condition.
• Nobody can fall asleep at the wheel without prior perception of sleepiness.

ObjectiveTo test whether sleep-deprived, healthy subjects who do not always signal spontaneously perceived sleepiness (SPS) before falling asleep during the Maintenance of Wakefulness Test (MWT) would do so in a driving simulator.MethodsTwenty-four healthy subjects (20–26 years old) underwent a MWT for 40 min and a driving simulator test for 1 h, before and after one night of sleep deprivation. Standard electroencephalography, electrooculography, submental electromyography, and face videography were recorded simultaneously to score wakefulness and sleep. Subjects were instructed to signal SPS as soon as they subjectively felt sleepy and to try to stay awake for as long as possible in every test. They were rewarded for both “appropriate” perception of SPS and staying awake for as long as possible.ResultsAfter sleep deprivation, seven subjects (29%) did not signal SPS before falling asleep in the MWT, but all subjects signalled SPS before falling asleep in the driving simulator (p < 0.004).ConclusionsThe previous results of an “inaccurate” SPS in the MWT were confirmed, and a perfect SPS was shown in the driving simulator. It was hypothesised that SPS is more accurate for tasks involving continuous feedback of performance, such as driving, compared to the less active situation of the MWT. Spontaneously perceived sleepiness in the MWT cannot be used to judge sleepiness perception while driving. Further studies are needed to define the accuracy of SPS in working tasks or occupations with minimal or no performance feedback.