Sleep-deprived driving

Sleep-deprived driving is the operation of a motor vehicle while being cognitively impaired by a lack of sleep. Sleep deprivation is a major cause of motor vehicle accidents, and it can impair the human brain as much as alcohol can. According to a 1998 survey, 23% of adults have fallen asleep while driving.^[1] According to the United States Department of Transportation, male drivers admit to have fallen asleep while driving twice as much as female drivers.^[2]

In the United States, 250,000 drivers fall asleep at the wheel everyday, according to the Division of Sleep Medicine at Harvard Medical School and in a national poll by the National Sleep Foundation, 54% of adult drivers said they had driven while drowsy during the past year with 28% saying they had actually fallen asleep while driving. According to the National Highway Traffic Safety Administration, drowsy driving is a factor in more than 100,000 crashes, resulting in 1,550 deaths and 40,000 injuries annually.^[3]

The effects of sleep deprivation on driving performance

Sleep deprivation has been proven to affect driving ability in three areas:^[4]

1. It impairs coordination.
2. It causes longer reaction times.
3. It impairs judgment.

Fatigue can often be caused by sleep apnea. Obstructive sleep apnea (OSA) is a serious syndrome characterized by pauses in breathing that prevent air from flowing into or out of a sleeping person’s airways, resulting in excessive daytime sleepiness; sleep attacks, psychomotor deficits, and disrupted nighttime sleep ^[5] This is a narrowing or closure of the airway during sleep causing multiple disturbances ^[6] OSA also causes fatigue from disruptions in sleep which causes a decrease in alertness. This causes delays in psychomotor awareness and oculomotor activity.

The Effects of Sleepiness and Fatigue include:

• Impaired reaction time, judgment, and vision

• Problems with information processing and short-term memory

• Decreased performance, vigilance, and motivation

• Increased moodiness and aggressive behaviors

• More “microsleeps”—brief (2–3 seconds) sleep episodes^[7]

The effects of sleep deprivation compared to the effects of alcohol

Numerous studies have found that sleep deprivation can affect driving as much as (and sometimes more than) alcohol. British researchers have found that driving after 17 to 18 hours of being awake is as harmful as driving with a blood alcohol level of .05%, the legal limit in many European countries.^[4] Men under 30 are more likely to be in an accident caused by sleep deprivation.^[8]

Accidents

Unique warning sign on Interstate 15 in Utah

It has been estimated that between 16% and 60% of all accidents have sleep deprivation as a cause.^[4] Between 1989 and 1993, it has been estimated that an average of 1,544 people were killed annually in the US as a result of sleep-deprived driving.^[1] Accidents related to sleep deprivation are most likely to happen in the early to midafternoon, and in the very early morning hours.^[9] Sleep deprivation was blamed a major cause of the Selby rail crash in which 10 people died and 82 were injured.

Sleep-deprived driving in truckers and in the military

Sleep-deprived driving is a major problem in truckers and in the military. The US military estimates that approximately 9% of crashes resulting in death or serious injury during Operation Desert Storm and Operation Desert Shield were caused by sleep-deprived driving ^[1].

Driver fatigue is a contributing factor in 12% of all crashes and 10% of all near-crashes^[10]. There is a greater potential for injury with increasing size of vehicle and cargo type. Traffic fatalities are high and many of them are due to driver fatigue, yet sleepy driving is preventable^[11]. Drivers with obstructive sleep apnea (OSA) have a 7-fold increased risk of being involved in a motor vehicle crash ^[5]. It is estimated the 2.4-3.9 million licensed commercial drivers in the US have OSA ^[5] out of the estimated 18 million total Americans ^[12]. The Federal Motor Carrier Safety Administration (FMCSA) says that as many 28 percent of commercial driver’s license (CDL) holders have sleep apnea ^[13]

Total costs attributed to sleep apnea-related crashes:

• 2000: $15.9 billion and 1,400 lives. Truck drivers had a higher total number of fatalities than other occupations in 2009.

Treatment:

• Cost: $3.18 billion with 70% effectiveness of CPAP treatment
• Savings: $11.1 billion in collision costs and 980 lives annually (National Safety Council)

^[12]

Prevalence of Sleep Apnea among Commercial Drivers

Research sponsored by the Federal Motor Carrier Safety Administration and American Trucking Associations found:

• Almost one-third (28%) of commercial truck drivers have some degree of sleep apnea
• 17.6% have mild sleep apnea
• 5.8% have moderate sleep apnea
• 4.7% have severe sleep apnea ^[12]

Moderate and severe sleep apnea are disqualifying conditions for acquiring a CDL.

Regulations

A physical exam is required to get a CDL. The physical includes health history and respiratory dysfunction but rarely detects sleep apnea.

Screening for sleep apnea includes: high risk based on Berlin questionnaire, a BMI greater than 33 kg/m2, and at risk based on clinical evaluation.

There are potential regulations proposed from an FMCSA expert panel that would increase the detection rate. These recommendations were proposed in 2008 ^[14]

Not all cases of sleep apnea are restricted from obtaining a CDL:

• AHI score less than or equal to 20 and no daytime sleepiness
• Effectively treated their sleep apnea

Criteria that lead to disqualification:

• Reported excess sleepiness
• Crash related to falling asleep
• Have a BMI greater than 33 kg/m2 (until a sleep study has been done)
• AHI score of greater than 20 and have not started treatment
• Undergone surgery for sleep apnea and waiting for 3 month evaluation ^[15]

Physician reporting

Six US states require physicians to report patients who drive while impaired, including those who may be chronically sleep-deprived.^[16] Another twenty-five US states permit physicians to violate doctor-patient confidentiality to report sleep-deprived drivers or those with sleeping disorders likely to impair driving, if they so choose.^[16] The American Medical Association endorsed physician reporting in 1999, but deferred to the states on whether such notification should be mandatory or permissive.^[16] An authority on professional confidentiality, Jacob Appel of New York University, has written that physician reporting is a double-edged sword, because it may deter some patients from seeking care. According to Appel, "Reporting may remove some dangerous drivers from the roads, but if in doing so it actually creates other dangerous drivers, by scaring them away from treatment, then society has sacrificed confidentiality for no tangible return in lives saved."^[16]

Government response to sleep-deprived driving

Governments had attempted to reduce sleep-deprived driving through education messages and by ingraining roads with dents, known as rumble strips in the US, which cause a noise when drivers wander out of their lane. The Government of Western Australia recently introduced a "Driver Reviver" program where drivers can receive free coffee to help them stay awake.^[17]

See also

• Sleep deprivation
• Driving
• sleep apnea

References

1. ^ ^{a b c} Peters, Robert D. "Effects of Partial and Total Sleep Deprivation on Driving Performance", US Department of Transportation, February 1999.
2. ^ Sleepdex. www.sleepdex.org/drowsy-driving.htm: "Drowsy Driving".
3. ^ Shift Work Disorder [1]
4. ^ ^{a b c} CNN. "Sleep deprivation as bad as alcohol impairment, study suggests", CNN, September 20, 2000.
5. ^ ^{a b c} [ScienceDaily. Retrieved March 16, 2011, from http://www.sciencedaily.com¬ /releases/2009/03/090311111002.htm "OSA and Obesity"]. ScienceDaily. Retrieved March 16, 2011, from http://www.sciencedaily.com¬ /releases/2009/03/090311111002.htm. 
6. ^ "FMCSA Sleep Apnea". http://www.fmcsa.dot.gov/safety-security/sleep-apnea/sleep-apnea.aspx. 
7. ^ "FMCSA Sleep Apnea". http://www.fmcsa.dot.gov/safety-security/sleep-apnea/sleep-apnea.aspx. 
8. ^ BMA. "Effects of sleep deprivation", British Medical Association, July 30, 2004.
9. ^ NASD. "Sleep Deprivation: Causes and Consequences", Nebraska Rural Health and Safety Coalition.
10. ^ "BLS". http://www.bls.gov/iif/oshwc/cfoi/cfch0008.pdf. 
11. ^ MASA, JUAN F.; MANUELA RUBIO, and LARRY J. FINDLEY, and Cooperative Group (October 2000). "Habitually Sleepy Drivers Have a High Frequency of Automobile Crashes Associated with Respiratory Disorders during Sleep". Am. J. Respir. Crit. Care Med 162 (4): 1407–1412. http://171.66.122.149/cgi/content/abstract/162/4/1407. Retrieved 25 April 2011. 
12. ^ ^{a b c} "FMCSA "recognizing"". http://www.fmcsa.dot.gov/documents/sleep-apnea/Recognizing-508.pdf. 
13. ^ "FMCSA Snoring". http://www.fmcsa.dot.gov/safety-security/sleep-apnea/drivers/snoring.aspx. 
14. ^ "Proposed". http://www.fmcsa.dot.gov/rules-regulations/administration/rulemakings/rule-programs/new_rulemakings.aspx?cat=proposed&sorder=2&sitem=published&pn=2. 
15. ^ "Proposed". http://www.fmcsa.dot.gov/rules-regulations/administration/rulemakings/rule-programs/new_rulemakings.aspx?cat=proposed&sorder=2&sitem=published&pn=2. 
16. ^ ^{a b c d} Appel, Jacob. Must Physicians Report Impaired Driving? Rethinking a Duty on a Collision Course with Itself. 20. Journal of Clinical Ethics. 
17. ^ http://www.driverreviver.com.au/

External links

• http://www.tompkins-co.org/wellness/drowsydriving/index.htm
• http://drowsydriverawarenessday.com