Don’t be a victim of Drowsy Driver! By Navin Jain, MD, Sleep Specialist. (Published in Healthy Living 2006) Mostly, when a driver dies in a crash due to falling asleep while driving, crashes are much severe because driver did not react to situation and three or four other people may also be killed. You are driving on a dark night, and your eyelids droop and your head starts to nod. Yawning becomes almost constant and your vision seem to blur. You blink hard, focus your eyes and suddenly realize that you’ve veered onto the shoulder or into oncoming traffic for a moment and quickly straighten the wheel. This time you were lucky; next time you could become the latest victim of the tragedy of drowsy driving. Drowsy driving causes more than 100,000 police-reported crashes, 71,000 injuries and 1,550 deaths each year. But the problem may be more serious than we think.   According to testimony presented to a congressional committee, drowsy driving is a "silent killer," because crash incidents are underreported, state reporting practices are inconsistent, and self-reporting is unreliable.  Sleep related catastrophic accidents on railroads have been identified.   Falling asleep at wheel has been the cause of several catastrophic accidents including accidental grounding of Exxon Valdez in Prince William Sound in Alaska in 1989. Nearly three-quarters of adults in America drive a car to and from work, and many are drowsy drivers. More than one- fourth of respondents in Sleep in America Poll in 2000  said they have driven drowsy to or from work at least a few days a month, 12 percent drove drowsy a few days a week, and four percent said they drove drowsy every day or almost every day.  Federal Motor Carrier Safety Administration announced revised Hours of Service Rules for long haul truck drivers.  It allows long haul trcuk drivers to drive a maximum of 11 hours per day after 10 consecutive off duty hours.  It also prohibited them from driving after 14 hours during a single shift.  New rules allow more off-duty time for sleep and personal time.    Sleep deprivation and fatigue make lapses of attention more likely to occur, and may play a role in behavior that can lead to crashes attributed to other causes. When driving drowsy, you may become stressed, or impatient and will often tend to drive faster. "Driving while tired can be as hazardous as driving while drunk" . A study by researchers in Australia showed that being awake for 18 hours produced an impairment equal to a blood alcohol concentration (BAC) of .05, and .10 after 24 hours; BAC of .08 is considered legally drunk. The crashes related to drowsy driving tend to be much severe that if driver were to awake and attentive. Since all humans require sleep on a daily basis, any driver can succumb to fatigue or be at a higher risk for experiencing a decrease of alertness or microsleep when they have not obtained adequate sleep, both in quality and quantity.  Sleep deprivation increases the risk of a sleep-related crash; the less sleep, the greater the risk. According to a study by the AAA Foundation for Traffic Safety, people who sleep six to seven hours a night are twice as likely to be involved in such a crash as those sleeping 8 hours or more, while people sleeping less than 5 hours increased their risk four to five times.  There are many underlying causes of sleepiness, drowsiness, fatigue and drowsy driving. They include sleep loss from restriction, interruption or fragmentation; chronic sleep debt; circadian factors associated with driving patterns or work schedules; time on task; the use of sedating medications; and the consumption of alcohol when already tired. These factors have cumulative effects and a combination of any of these increases crash risk greatly. The risk of having a crash due to drowsy driving is not uniformly distributed across the globe. The crashes tend to occur at times when sleepiness is most pronounced based on your biological clock, for example, during the night and in the mid-afternoon. Thus individuals who drive at night are much more likely to have fall-asleep crashes. Also, people who are excessively sleepy either because of lifestyle factors or because of an untreated sleep disorder (sleep apnea, insomnia, narcolepsy, restless leg syndrome) are more likely to have crashes related to excessive daytime sleepiness.  People tend to fall asleep more on high-speed, long, boring, rural highways. However, those who live in urban areas are more likely to doze off while driving compared to people in rural or suburban areas. The groups most at risk of sleep related motor vehicle crash include: ·        young people (especially males aged 16–29 because they deny sleepiness and more likely to continue driving despite feeling sleepy) ·        people with undiagnosed or untreated specific sleep related disorders-people with untreated obstructive sleep apnea or severe insomnia have been shown to have up to a seven times increased risk of falling asleep at the wheel ·        shift workers (especially those who work the night shift, have rotating shifts, or work more than one job) ·        commercial drivers (especially those who drive a high number of miles at night) ·        business travelers who spend many hours driving or may be experiencing jet lag. Are You at Risk for falling asleep while driving on your next trip? Before you drive, consider whether you are: ·        Sleep-deprived or fatigued (6 hours of sleep or less triples your risk) ·        Suffering from sleep loss (insomnia), poor quality sleep, or a sleep debt ·        Driving long distances without proper rest breaks ·        Driving through the night, mid-afternoon or when you would normally be asleep ·        Taking sedating medications (antidepressants, cold tablets, antihistamines) ·        Working more than 60 hours a week (increases your risk by 40%) ·        Working more than one job and your main job involves shift work ·        Drinking even small amounts of alcohol ·        Driving alone or on a long rural, dark or boring road Stop and Rest if you experience any of these while driving: ·        Difficulty focusing, frequent blinking, or heavy eyelids ·        Daydreaming; wandering/disconnected thoughts ·        Trouble remembering the last few miles driven; missing exits or traffic signs ·        Yawning repeatedly or rubbing your eyes ·        Trouble keeping your head up ·        Drifting from your lane, tailgating, or hitting a shoulder rumble strip ·        Feeling restless and irritable Some things that you think may work but usually do not work: ·        Turing volume of radio up ·        Rolling the windows down Countermeasures (to avoid falling asleep while driving) Before “hitting the road” ·        Get adequate sleep—most adults need 7-9 hours to maintain proper alertness during the day ·        Schedule proper breaks—about every 100 miles or 2 hours during long trips ·        Arrange for a travel companion—someone to talk with and share the driving ·        Avoid alcohol and sedating medications—check your labels or ask your doctor Countermeasures to Prevent a Fall-Asleep Crash While Driving ·        Watch for the warning signs of fatigue and take rest if needed ·        Stop driving—pull off at the next exit, rest area or find a place to sleep for the night ·        Take a nap—find a safe place to take a 15 to 20-minute nap .   ·        Consume caffeine—the equivalent of 2 cups of coffee can increase alertness for several hours ·        Try consuming caffeine before taking a short nap to get the benefits of both The problem of sleep deprivation and driver fatigue is complex. As with alcohol and drunk driving, overcoming the problems posed by sleep deprivation and drowsy driving will take the effort of many partners from the public and private sectors.  There is no test to determine sleepiness as there is for intoxication, i.e. a "Breathalyzer” but we may need one in near future.  In addition, recognition and appropriate treatment of sleep apnea and other sleep disorders is crucial to reduce health and economic impact of drowsy driving. The first federal bill focusing on drowsy driving was introduced in the House of Representatives in October 2002 by Rep. Robert Andrews (D-NJ). The bill calls for incentives for states and communities to develop traffic safety programs to reduce crashes related to driver fatigue and sleep deprivation. The legislation also calls for training for police officers, the creation of driver's education curriculum, standardized reporting of fatigue-related crashes on police report forms, and the promotion of countermeasures such as continuous shoulder rumble strips and rest areas. This bill, HR 5543, is also called "Maggie's Law: National Drowsy Driving Act of 2003." It was named after Maggie McDonnell, a 20-year old college student from Andrews' congressional district in New Jersey who was killed by a drowsy driver on July 20, 1997 at 11:30 a.m. when the car she was driving was hit head-on by a van that had crossed three lanes of traffic. The driver of the van told police he had not slept in 30 hours; he also admitted to smoking crack cocaine hours before the accident. Since the jury wasn't allowed to consider driver fatigue as a factor, he was only convicted of careless driving and fined $200.   In the State of New Jersey, individuals can be charged with vehicular homicide if it is determined that they have not slept for more than 24hours and have caused a fatal accident. Don’t be a victim of driving while sleepy.  Make sure to assess your risk before you drive and take appropriate rest.  If you feel you, or someone else you know may have a  tendency for falling asleep while driving, may have underlying sleep disorder, contact your physician or sleep disorder specialist in your area. Any sleep related questions can be directed to him by e-mail at toledosleepdoc@gmail.com.