微睡眠是指一小段維持幾秒到半分鐘不等的陷入睡眠或者睡意昏沉的時間，在此期間，人不對任何感官知覺有所反應而處於無意識狀態。International Classification of Sleep Disorders Diagnostic and Coding Manual page 343Poudel G R Innes C R Bones P J Watts R Jones R D 2012 Losing the struggle to stay awake Divergent thalamic and cortical activity during microsleeps Human Brain Mapping 00000000 微睡眠主要表現為在一小會兒失去意識後重新清醒，或者在清醒和昏睡的狀態之間快速切換。在行為學中，微睡眠的主要表徵為眼簾下垂、瞼閉遲緩、緩緩點頭。在電生理層面，微睡眠被定義為腦電圖代表著清醒狀態背景活動的 813 Hz 的活動為 47 Hz 的活動所取代。一些專家透過以上述的若干行為學指標來判斷微睡眠狀態，其餘多以腦電圖特徵為鑑定依據。 儘管睡眠正常的人在重複單調工作時也可能會產生微睡眠，但微睡眠往往是睡眠不足的後果。Chou Y H Chuang C C Zao J K Ko L W Lin C T 2011 August An fMRI study of abruptawake episodes during behavioral microsleeps In Engineering in Medicine and Biology Society EMBC 2011 Annual International Conference of the IEEE pp 50605063 IEEE 微睡眠在例如開車、使用重型裝置等需要高度警覺的環境下極其危險。人們經歷微睡眠時往往意識不到自己的微睡眠狀態，反倒以為自己一直專注工作或者只是覺得自己走了一會兒神。 與神經系統關聯 微睡眠時，大腦和睡意相關的區域活躍度增加，和醒意相關的區域活躍度下降。但因為存在單調的工作也可以導致微睡眠較為複雜的神經調節，且每個人的大腦結構有所差異，故客觀判斷與微睡眠相關的神經活動較為困難。因此建立對照用實驗組並進行對照檢驗極其重要。 一項對正常休息過的人同時透過眼影片測試、行為反應測試、腦電圖、功能性核磁共振測試的實驗中，20 名參與者需要看著操縱桿在螢幕上以上下左右四個方向移動長達 50 分鐘，動，過半數參與者在盯著操縱桿這一持續視覺運動任務時發生了腦電圖意義上的微睡眠，同時負責保持醒意的丘腦、中腦、後扣帶皮層活動減弱。 Chou 2011 的實驗檢測了五位受試者從微睡眠狀態被刺激甦醒時的神經啟用模式，發現視覺區、額葉區、邊緣葉在收到直接刺激時的啟用，以及前皮質、顳葉、主要運動皮質區、島葉在醒後的啟用，由此得出 思考判斷能力滯後與甦醒後恢復，並有可能導致危險 的結論。 睡眠及睡意的產生由多種化學物質調節。多巴胺被認為促進了睡意，而腺苷被認為提升了醒意，共同參與微睡眠在內的睡眠調節。微睡眠狀態下， 加強，抑制了基底核的視覺處理。視覺處理通路被抑制後，負責釋放多巴胺的細胞並不透過基底核的相同通路去抑制，導致了微睡眠發生和神經處理能力的下降。Silkis I G 2010 Analysis of the effects of neuromodulators on the generation of spontaneous pontinegeniculateoccipital PGO waves Neurochemical Journal 4 3 170177 生理學研究 微睡眠和許多疾病關聯。睡眠呼吸暫停是最為流行的與微睡眠相關疾病，影響了 1000 到 1500 萬人。Kanagala R Murali N S Friedman P A Ammash N M Gersh B J Ballman K V Somers V K 2003 Obstructive sleep apnea and the recurrence of atrial fibrillation Circulation 107 20 25892594 其他關聯疾病包括發作性嗜睡病、嗜睡症、精神分裂症等。微睡眠片刻往往被患者忽視，不常作為臨床診斷指標，多項睡眠測試常被用來偵測微睡眠。Tufik S SantosSilva R Taddei J A Bittencourt L R A 2010 Obstructive sleep apnea syndrome in the Sao Paulo epidemiologic sleep study Sleep Medicine Reviews 11 5 441446 由於反覆出現的微睡眠常常會影響正常的日常生活，多數臨床研究致力於利用藥物手段減少微睡眠在內的日間過剩的睡意。莫達非尼在此方面幾乎無副作用，故而在藥物選擇上十分流行；新藥研發中往往會有和莫達非尼及安慰劑的效果比較。莫達非尼也有用來治療或正被測試治療精神分裂症、發作性昏睡、猝倒症、睡眠呼吸暫停。在莫達非尼擴大治療物件和新藥與之比較療效的過程中，各類造成嗜睡疾病的藥物干預手段的研究正在完善。 微睡眠有時是藥物治療的副作用，例如用於治療帕金森病的多巴胺刺激藥物，昏睡是、羅匹尼羅等的負面作用之一。這些藥物可以在 50 開車中的帕金森病人中導致突然起效的睡意。Hobson D E Lang A E Martin W W Razmy A Rivest J Fleming J 2002 Excessive daytime sleepiness and suddenonset sleep in Parkinson diseaseJAMA The Journal of the American Medical Association 287 4 455463 Chicago 因此臨床研究也致力於減輕這種負面作用。 多數微睡眠在臨床上並不顯著。感到睏倦的人往往喜歡去使用一項無需處方的刺激劑，例如含咖啡中的咖啡因。高頻率的低劑量咖啡因的攝入在對延長清醒情況下保持注意力確實有效，因為咖啡因是腺苷的競爭性拮抗劑，實驗也從而證實腺苷在保持清醒中的作用。Wyatt J K Cajochen C Cecco A R D Czeisler C A Dijk D J 2004 Lowdose repeated caffeine administration for circadianphasedependent performance degradation during extended wakefulness SLEEPNEW YORK THEN WESTCHESTER 27 3 374382 其它刺激劑還包括阿得拉爾、苯丙胺、可卡因和菸草等。Jacobs A 2005 The Adderall advantage New York Times 31Gawin F H Ellinwood E H 1988 Cocaine and other stimulants actions abuse and treatment The New England Journal of Medicine 測試途徑 偵測微睡眠的方法有很多，惟尚無對最優偵測和分類微睡眠方案的定論。簡單的方式諸如心理測驗、語言測試、行為測試（如打哈欠測試和眼影片測試）；複雜的也有如軟體輔助的腦電圖、核磁共振、眼電圖、多導睡眠圖。多項測試可能可以使得診斷更為準確。 方式 描述 多項生理睡眠檢查 PSG 多項生理睡眠檢查，縮寫為 PSG，檢查了睡眠期間的多項身體機能，包括了透過腦電圖檢測大腦活動、透過眼電圖檢測眼部活動以及對骨骼肌和心律的檢測。 腦電圖 EEG 腦電圖，縮寫 EEG，透過不同置於頭皮上的多電極記錄了大腦在 2040 分鐘內的自發電活動 Davidson P R Jones R D Peiris M T R 2006 January Detecting Behavioral Microsleeps using EEG and LSTM Recurrent Neural Networks InEngineering in Medicine and Biology Society 2005 IEEEEMBS 2005 27th Annual International Conference of the pp 57545757 IEEE 微睡眠期間，腦電圖中的活動為更低頻率的活動所取代。Boyle L N Tippin J Paul A Rizzo M 2008 Driver performance in the moments surrounding a microsleep Transportation research part F traffic psychology and behaviour 11 2 126136 功能性磁共振成像 fMRI 功能性核磁共振技術即用核磁共振技術掃描血液流動以檢測大腦有哪些活躍區域、何種活動情況。Chou Y H Chuang C C Zao J K Ko L W Lin C T 2011 August An fMRI study of abruptawake episodes during behavioral microsleeps InEngineering in Medicine and Biology Society EMBC 2011 Annual International Conference of the IEEE pp 50605063 IEEE 心理測試 包括心理測時法、Karolinska 睡意量表 Krajewski J Wieland R Batliner A 2008 An acoustic framework for detecting fatigue in speech based HumanComputerInteraction In Computers Helping People with Special Needs pp 5461 Springer Berlin Heidelberg、維持清醒測試 Gast H Schindler K Rummel C Herrmann U S Roth C Hess C W Mathis J 2011 EEG correlation and power during maintenance of wakefulness test after sleepdeprivation Clinical Neurophysiology 122 10 20252031、等。Blaivas A J Patel R Hom D Antigua K Ashtyani H 2007 Quantifying microsleep to help assess subjective sleepiness Sleep Medicine Reviews8 2 156159 EOG 眼電圖測量視網膜的靜息電勢。Sommer D Chen M Golz M Trutschel U Mandic D 2005 Fusion of state space and frequencydomain features for improved microsleep detection In Artificial Neural Networks Formal Models and Their ApplicationsICANN 2005 pp 753759 Springer Berlin Heidelberg 眼影片測試 透過觀察眨眼等眼部活動判斷微睡眠狀態。Poudel G R Innes C R Bones P J Jones R D 2010 August The relationship between behavioural microsleeps visuomotor performance and EEG theta In Engineering in Medicine and Biology Society EMBC 2010 Annual International Conference of the IEEE pp 44524455 IEEEMalla A M Davidson P R Bones P J Green R Jones R D 2010 August Automated videobased measurement of eye closure for detecting behavioral microsleep In Engineering in Medicine and Biology Society EMBC 2010 Annual International Conference of the IEEE pp 67416744 IEEE 打哈欠測試 測量一段時間內打哈欠的次數。Noor H A M Ibrahim R 2010 Fatigue detector using eyelid blinking and mouth yawning In Computer Vision and Graphics pp 134141 Springer Berlin Heidelberg 語言測試 觀測人說話時的表情和節律來判斷睡眠狀態。Krajewski J Batliner A Wieland R 2008 December Multiple classifier applied on predicting microsleep from speech In Pattern Recognition 2008 ICPR 2008 19th International Conference on pp 14 IEEEKrajewski J Golz M Sommer D Wieland R 2009 January Genetic algorithm based feature selection applied on predicting microsleep from speech In 4th European Conference of the International Federation for Medical and Biological Engineering pp 184187 Springer Berlin Heidelberg 儘管有人試圖透過主要是腦電圖或者眼動測試來進行微睡眠總分類，現階段仍然存在不同條件下偵測到的不同種類的微睡眠。Galley N Schleicher R Galley L 2003 Oculomotor Indicators of Driver Fatigue Driver Behaviour and Training v III 1 97Karolinska 睡意量表之類的主觀自述型別的心理測試儘管和腦電圖被認為有正關聯，但很難區別睡意的程度而存在侷限性。Shahid A Wilkinson K Marcu S 2012 Karolinska Sleepiness Scale KSS In STOP THAT and One Hundred Other Sleep Scales pp 209210 Springer New York 未來的研究需要更加註重小而微的客觀現象，例如更短間隔內的腦電波細節等，來揭示電活動和行為活動的關係，以獲得更高的偵測準確率。Cvetkovic D Cosic I 2011 Sleep Onset Process as an Altered State of Consciousness In States of Consciousness pp 157185 Springer Berlin Heidelberg 如此，微睡眠可以自然而然地和不同的清醒狀態區別出來。Baars B J 2013 A scientific approach to silent consciousness Frontiers in Psychology 4 社會危害性 在美國，單單疲勞駕駛一項每年就造成 1550 死 40000 傷，使得睡眠不足成為重要的公共安全議題。Insufficient Sleep Is a Public Health Epidemic httpswwwcdcgovfeaturesdssleep US Department of Transportation National Highway Traffic Safety Administration National Center on Sleep Disorders Research National Heart Lung and Blood Institute Drowsy driving and automobile crashes National Highway Traffic Safety Administration Web Site Available at httpwwwnhtsagovpeopleinjurydrowsy_driving1DrowsyhtmlNCSDRNHTSAExternal Web Site Icon Accessed February 10 2011 微睡眠主要表現為在一小會兒失去意識後重新清醒，或者在清醒和昏睡的狀態之間快速切換。在行車途中，疲勞駕駛的司機會可能會經歷無知覺的幾秒鐘，這便是微睡眠的具體例子。司機很難發現自己失去了的幾秒鐘，但微睡眠期間的駕駛卻有極大造成交通事故的風險。 歷史上，不少交通事故在微睡眠期間發生。微睡眠狀態下的駕駛被指間接造成了 2003 年發生：火車司機心臟病發，而值班守衛卻被監察者指在微睡眠狀態，只是列車異常速度無法被正常響應。2009 年的造成飛機墜毀大西洋的法國航空 447 號班機空難中，機長曾報告說：我昨夜沒睡夠。只有一個小時，那不夠。 遂甩手給兩位副駕駛，後者未能在飛機遇到危險的時候合理處置，造成了事故。BEA final report section 15 page 24 PDF page 26 of 224 The crew had left Paris on Thursday 28 May 2009 in the morning and arrived in Rio de Janeiro in the evening of the same dayRevealed Pilot of Air France jet that crashed in Atlantic Ocean killing 228 people had just ONE HOUR sleep before flight The Daily Mail UK 20130315 切爾諾貝利核事故中，反應堆開始過熱的主要原因就是睡意昏沉的操作人員錯誤地關閉了製冷系統，最終導致了一系列事故發生。Coren Stanley Sleep Thieves An EyeOpening Exploration into the Science Mysteries of Sleep New York The Free Press 1996 p x 24144 因此，微睡眠常常在以及預防工傷和公共安全事故。相關資料如下： 44 深夜開車的司機會陷入危機行車安全的睡意中。Åkerstedt T Hallvig D Anund A Fors C Schwarz J Kecklund G 2013 Having to stop driving at night because of dangerous sleepinessawareness physiology and behaviour Journal of Sleep Research 極度勞累的工作流程會提升至多 35 的事故發生率。Sirois B Trutschel U Edwards D Sommer D Golz M 2010 January Predicting Accident Probability from Frequency of Microsleep Events In World Congress on Medical Physics and Biomedical Engineering September 712 2009 Munich Germany pp 22842286 Springer Berlin Heidelberg 長期微睡眠增加工人傷亡機率及缺勤率，降低工人生產效率。Swanson L M ARNEDT J Rosekind M R Belenky G Balkin T J Drake C 2011 Sleep disorders and work performance findings from the 2008 National Sleep Foundation Sleep in America poll Journal of Sleep Research 20 3 487494 美國疾病控制與預防中心研究指出，來自 12 州的 74571 的成年受訪者中，僅 353 稱自己 24 小時能有 7 小時睡眠，480 稱自己打鼾，379 稱自己近前一月至少一次無意識陷入睡眠，47 稱自己前一月至少一次在開車時陷入睡意。 美國國家公路交通安全管理局估計疲勞駕駛發生於 25 致命道路交通事故及 2 的致傷事故中。National Highway Traffic Safety Administration Traffic Safety Facts Crash Stats Drowsy Driving Washington DC DOT 2011 DOT HS 811 4492011 1993 年到 2009 年的 16 年間，疲勞駕駛造成的空難造成了 250 人死亡。Pilot fatigue is like having too much to drink CNN May 15 2009 httpwwwcnncom2009TRAVEL0515pilotfatiguebuffalocrash 例如無聊的課程等單調事務也會導致微睡眠狀態的發生，這時微睡眠也叫。Gurstelle E B De Oliveira J L 2004 Daytime parahypnagogia a state of consciousness that occurs when we almost fall asleep Medical Hypotheses 62 2 166168 參見 昏睡 入睡抽動 附錄：藥理文獻摘選 文獻標題 藥物干涉方式 研究疾病 Effects of BF2649 in the Treatment of Excessive Daytime Sleepiness in NarcolepsyEffects of BF2649 in the Treatment of Excessive Daytime Sleepiness in Narcolepsy httpclinicaltrialsgovct2showrecordNCT01638403 藥物：BF2649、藥物：莫達非尼、藥物：安慰劑 發作性睡病 Efficacy and Safety Study of BF2649 in the Treatment of Excessive Daytime Sleepiness in NarcolepsyEfficacy and Safety Study of BF2649 in the Treatment of Excessive Daytime Sleepiness in Narcolepsy httpClinicalTrialsgovshowNCT01067222 藥物：BF2649、莫達非尼、安慰劑 發作性睡病、過度日間睡意、等睡眠障礙 Dose Range Finding Study of BF2649 Versus Placebo to Treat Excessive Daytime Sleepiness in Parkinsons Disease PatientsDose Range Finding Study of BF2649 Versus Placebo to Treat Excessive Daytime Sleepiness in Parkinsons Disease Patients httpClinicalTrialsgovshowNCT00642928 藥物：安慰劑、藥物：BF 2649 5 mg、藥物：BF 2649 10 mg、藥物：BF 2649 20 mg、藥物：BF2649 40 mg 過度日間睡意、帕金森氏症 A Study Of A Novel Compound For Excessive Daytime Sleepiness Associated With NarcolepsyA Study Of A Novel Compound For Excessive Daytime Sleepiness Associated With Narcolepsy httpClinicalTrialsgovshowNCT01006122 藥物：安慰劑、藥物：PF03654746 過度日間睡意、發作性睡病 Treatment of Refractory Excessive Daytime Sleepiness in Patients With Obstructive Sleep ApneaHypopnea Syndrome OSAHS Using Nasal Continuous Positive Airway Pressure nCPAP Therapy 0249015 Treatment of Refractory Excessive Daytime Sleepiness in Patients With Obstructive Sleep ApneaHypopnea Syndrome OSAHS Using Nasal Continuous Positive Airway Pressure nCPAP Therapy 0249015 httpClinicalTrialsgovshowNCT00620659 比較藥劑：MK0249 藥物：比較藥劑：安慰劑，藥物：比較藥劑：莫達非尼 阻塞性睡眠呼吸暫停、淺呼吸綜合症、過度日間睡意 Pitolisant to Assess Weekly Frequency of Cataplexy Attacks and EDS in Narcoleptic Patients HARMONY CTP Pitolisant to Assess Weekly Frequency of Cataplexy Attacks and EDS in Narcoleptic Patients HARMONY CTP httpClinicalTrialsgovshowNCT01800045 藥物：BF2649 藥物：安慰劑 伴猝倒症及過度日間睡意的發作性睡病 Comparison of Modafinil and Methylphenidate in Treatment of Excessive Daytime Sleepiness in Patients With Parkinsons DiseaseComparison of Modafinil and Methylphenidate in Treatment of Excessive Daytime Sleepiness in Patients With Parkinsons Disease httpClinicalTrialsgovshowNCT00393562 藥物：莫達非尼、藥物：哌甲酯 帕金森病 Modafinil Augmentation Therapy for Excessive Daytime Sleepiness and Negative Symptoms in Patients With SchizophreniaModafinil Augmentation Therapy for Excessive Daytime Sleepiness and Negative Symptoms in Patients With Schizophrenia httpClinicalTrialsgovshowNCT00546403 藥物：莫達非尼、藥物：安慰劑 精神分裂症 Efficacy and Safety of BF2649 in Excessive Daytime Sleepiness EDS in Parkinsons DiseaseEfficacy and Safety of BF2649 in Excessive Daytime Sleepiness EDS in Parkinsons Disease httpClinicalTrialsgovshowNCT01066442 藥物：BF2649 帕金森病 Trial of Xyrem for Excessive Daytime Sleepiness and Sleep Disturbance in Parkinsons Disease PD Trial of Xyrem for Excessive Daytime Sleepiness and Sleep Disturbance in Parkinsons Disease PD httpClinicalTrialsgovshowNCT00641186 藥物：Γ 羥基丁酸鈉 帕金森病 參考資料 文內註記 文內腳註 參閱作品 Category 睡眠