SLEEP MEDICINE DROWSY DRIVING - AN EPIDEMIC? by Robert Turner RPSGT T
he National Highway Traffic Safety Administration estimates that 100,000 police-reported crashes are the direct result of
driver fatigue each year. Unfortunately, there is no "Breathalyzer" test to prove someone is too drowsy to drive. Many states do not have a code on accident reporting forms to indicate fatigue as a factor. However, countries in Europe that have better reporting mechanisms estimate 10 to 30 percent of crashes are related to drowsy driving. A 2000 National Sleep Foundation poll revealed that nearly half of the adults in the US admitted to driving while drowsy. A similar National Sleep Foundation survey in 2001 showed that one in five respondents admitted to actually falling asleep while driving. Studies from Australia show that being awake for 18 hours resulted in impairment equivalent to a blood alcohol level of .05 and after 24 hour the equivalent of 0.1. Most states use a blood alcohol level of .08 as legally drunk. The cost of driving while drowsy is difficult to quantify. There
are a few notable examples. In October of 1997 a drowsy driver in Prince William County Virginia dozed off and crossed the dou- ble yellow line with the resulting accident causing two deaths. The sentence for the driver was five years in prison. In Texas, a jury found Holiday Inn and one of its employees guilty of negligence due to the employee falling asleep while driving and killing a woman in a head-on collision. The judgment against Holiday Inn and the employee ordered payment $5.8 million to the woman’s family. Victims and their families received between $100,000 and $20 million in judgements due to drowsy driving accidents. In 1997, a driver crossed three lanes of highway traffic and
hit the car of Maggie McDonnell killing the 20 year-old college student. The driver admitted that he had been awake for 30 hours and had been using drugs. The first trial ended in a deadlocked jury. During the second trial, the judge would not allow consid- eration of the driver’s sleep deprivation since New Jersey did not have any law against driving drowsy. Maggie’s mother, Carole Mc- Donnell, has been successful in getting the law changed. In June of 2003, the New Jersey Senate passed the bill known as "Mag- gie’s Law, establishing fatigued driving as recklessness under the vehicular homicide statute. There is movement to enact federal legislation to address drowsy driving and undoubtedly many other states will. There is a great deal of evidence that drowsy driving is both
dangerous and costly. How can you determine the risk factors for drowsy driving? A National Sleep Foundation poll showed that males and individuals with children living at home reported higher rates of driving while drowsy. Individuals between the ages of 18 – 29 are more likely to drive while drowsy. Shift work-
26 Focus Journal Fall 2011
ers are more likely to drive drowsy. The AAA Foundation for Traffic Safety report that people who sleep six to seven hours a night are twice as likely to be involved in drowsy driving accident than those sleep 8 hours or more. The risk jumps to 4-5 times for people who sleep less than five hours a night. Other research shows that commercial drivers and people with undiagnosed sleep disorders such as sleep apnea and acute insomnia are at a greater risk for drowsy driving crashes. Sleep deprivation increases the risk in a simple for- mula. Less sleep equals greater risk. There is a natural in- crease in physiologic sleepiness between 4:00 – 6:00 a.m. and 2:00 – 4:00 p.m. that corresponds with peak times for crashes. If you are in one of the risk groups, you need to take
steps to reduce the likelihood of falling asleep while driving. You first need to become familiar with the warning signs of sleepiness. The initial warning signs may relate to your eyes such as trouble focusing, frequent blinking, or heavy eyelids. Another warning sign is trouble keeping your head up. Once your head has dropped, you have already been asleep. Most people are aware that yawning is a common sign of sleepi- ness. If you have trouble remembering the last few miles driven or miss exits, you are likely drowsy. If you are drifting from your lane or hitting a shoulder rumble strip, drowsiness is probably a factor. The most reliable factor for you may dif- fer, but becoming familiar with your own warning signs can help you institute counter-fatigue measure. Many people have a variety of methods to overcome fa-
tigue/sleepiness. Many of the methods are not effective. Blasting the radio is useless. Despite the temperature of the outside air, opening a window does not work. Eating sun- flower seeds is a trick used by some that has not been shown to have a significant effect on alertness. You may have a va- riety of other "tricks" that work for you, but make sure there is empirical evidence to support your decision on what coun- termeasure to use. The best way to overcome sleepiness is to sleep. This is
as simple as taking a nap. Even a 15 to 20-minute nap will improve your alertness. You can accomplish this by changing drivers so you can sleep or stopping in a safe, well-lit areas to allow you time to sleep. Caffeine, either from coffee or other caffeinated beverages can help in the short-term with alert- ness, but it takes about 30 minutes to enter the bloodstream. With Daylight Savings Time approaching, you should be aware of the increased danger of sleepy drivers. Many of us
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