Drowsy Driving Prevention
Presentation by Siobhan Kuhar, MD, PhD, DABSM
Medical Director, Albany Regional Sleep Disorders Center
To quote prominent sleep physician, Dr. William Dement: "Drowsiness is the last step before falling asleep, not the first". Drowsiness means you are seconds away from falling asleep.
Dr. Dement goes on to explain that: "The crucial event that occurs as we fall asleep is an abrupt shut down of the neural processes that allow us to perceive the world around us. At one moment we are awake, and can see and hear. A fraction of a second later we are asleep, and we are completely blind and completely deaf."
Many sleep experts think of sleep as the "default program", the state that exists when we are no longer working to maintain wakefulness. When we can no longer resist sleep, when our alerting centers can no longer prevent sleep, we transition to sleep.
In my own experience as medical director of Albany Regional Sleep Disorders Center I frequently am asked to evaluate people who have had their driver's licenses suspended after a drowsy driving related car accident. It is without exception that the person was aware of being sleepy but not one can recall exactly what happened, they had fallen asleep for a brief moment. These are the people who survive, the people who had the "wake up call" so to speak.
Perhaps you've witnessed a child or adult fall asleep. For a period of time they are "drifting off" to sleep, they appear and behave "drowsy" and then they suddenly "fall" asleep, we sometimes say they went "out, like a light".
No one is aware of the exact moment of their own sleep onset, it occurs in a split second. Somewhere between being awake and being a sleep is this so called "drowsy" state.
Now, imagine what this could mean if you're behind the wheel of a car. At one moment you're aware of feeling drowsy and in a split second you can be asleep, completely unaware of this incredibly dangerous situation.
The state of drowsiness itself is a significant impairment while driving and has been shown in several studies to be as dangerous as driving drunk. In driving performance testing, 17 hours of sustained wakefulness was equivalent to driving with a blood alcohol content of 0.05%.
The National Highway Traffic Safety Administration estimates that each year drowsy driving results in 1,550 deaths and 71,000 injuries with 55% of these crashes involving drivers 25 years old and younger. In fact, the most at risk group are young men ages 19 years to 26 years.
Drowsiness causes: slow reaction times, impaired judgment and vision, decline in attention, decreased alertness, increased moodiness and aggressive behavior, problems with processing information and short term memory.
According to the National Sleep Foundation, signs of drowsiness while driving may include:
The best remedy for avoiding drowsy driving is getting enough sleep, that means 7-9 hours of good quality sleep for most adults, however, most people do not get enough sleep. According to the 2002 Sleep in America poll conducted by the National Sleep Foundation, nearly 40% of adults sleep less than 7 hours a night.
Our personal demands and lifestyle choices are in large part responsible for this trend. But our biggest problem is really our own ignorance about the importance of sleep and the impact that it has on every aspect of our lives.
Simply put, we don't value sleep, we don't appreciate or respect our need for sleep. It is what we do when the effects of our caffeine filled day cannot keep us awake any longer. It is a time when we can't text, twitter, talk on the phone or be entertained.
How much sleep is enough sleep will vary from person to person and changes as we age but an individuals sleep requirement stays consistent throughout their adult life.
Most of us need 7-9 hours of sleep at night to feel rested throughout the day. If every night you deprive yourself of an hour of sleep you create a sleep debt and this lost sleep accumulates progressively over time. This is what leads to sleep deprivation and drowsiness. The larger the sleep debt, the greater the tendency to feel drowsy and fall asleep.
In order to avoid the pressure for sleep we call drowsiness, your sleep debt must be zero! So try every day to give your body the sleep it needs especially if driving for extended lengths of time and distance. Avoid driving alone on long trips and take turns driving. Stop driving if you feel drowsy, pull off the road and take a nap, this is one circumstance when caffeine is recommended to help you stay awake.
Contrary to popular belief, caffeine is not a substitute for sleep but can improve alertness especially when combined with a nap.
In addition to making you a safer driver, avoiding sleep deprivation will make you better able to learn and sleep has been shown to be essential in the process of developing memory.
Why do we need sleep? Wouldn't it be nice if we didn't? Imagine a truly 24 hour day, a day 1/3 longer! Oh the people you could "friend" or "chat" if only you had 8 more hours in the day!
No one actually knows for sure why we sleep, it is one of Sciences great frontiers. Sleep affects every part of our life including health, safety, mood, learning, appearance, relationships and productivity.
All animals sleep and we know a lot about what happens when you deprive human beings or other animals of sleep, but why this is essential for life is actually not well understood. In fact, a lot of research on the effects of sleep deprivation on the brain have been done on college students just like you!
To sum up, Sleep is critical to our ability to stay awake and alert. Sleeping 7-9 hours a night can help us keep our sleep debt low and improve on our health and safety. Driving when drowsy is extremely dangerous as it impairs our judgment and puts the driver and those around us at risk for injury and even death.
Make sleep a priority tonight and every night!
SLEEPING AND DRIVING DON'T MIX!
When you are behind the wheel of a car, being sleepy is dangerous. Although most people know how dangerous drinking and driving is, they may not fully realize that drowsy driving can be just as fatal as driving drunk. Like drugs or alcohol, sleepiness slows reaction time, decreases awareness, impairs judgment and increases your risk of a crash.
However, it's difficult to attribute crashes to sleepiness because there is no standardized test for drowsiness, as there is for intoxication. This lack of standard criteria for determining when a driver is sleepy may be one reason there is little or no police training in identifying drowsiness as a crash factor.
Each year in NYS approximately, 2,800 people are involved in police reported crashes where "fatigued or fell asleep" was designated in the report. About fifty percent of the crashes occur between 11:00 p.m. and 8:00 a.m. Sixteen to twenty-four year old male drivers have the highest fatigue related motor vehicle crash rates. This type of crash often results in tragic consequences resulting in serious or fatal injuries.
NEW YORK STATE PARTNERSHIP AGAINST DROWSY DRIVING (NYPDD)
In 1994, a Task Force on Drowsy Driving was created in New York State. The original task force coordinated statewide efforts to reduce drowsy driving. In 1994, the Task Force submitted a report with recommendations to the Governor, and the Task Force met periodically to monitor the implementation of the recommendations and developed new initiatives. The original task force included representatives of the medical and research communities, state and federal agencies, the state legislature, and private sector organizations who worked together to make New York a leader in saving lives.
The member organizations of the Task Force had implemented a wide array of countermeasures, including the following:
To date, statewide efforts continue under the New York State Partnership Against Drowsy Driving (NYPDD). New York's Partnership Against Drowsy Driving (NYPDD), which was created in 2004, is a joint effort to educate the public and high-risk groups about the dangers of drowsy driving and promote the adoption of preventive strategies. Members of the NYPDD include representatives from the New York State Governor's Traffic Safety Committee (GTSC), New York State Thruway Authority, New York State Police, New York State Department of Motor Vehicles (DMV), New York State Motor Truck Association, New York State Association of Traffic Safety Boards, New York State Movers and Warehousemen's Association and New York State Department of Transportation. Partners meet regularly to share traffic data on drowsy driving and work cooperatively to conduct projects to raise public awareness of the risks of drowsy driving and encourage the adoption of prevention strategies among the general public and high-risk populations.
Fatigue-related crashes tend to be single-vehicle crashes in which a car or truck leaves the roadway and then turns over or hits a fixed object. It has been estimated that between 40 and 60 percent of these "run-off-road" (or ROR) crashes are due to driver fatigue, drowsiness or inattention. Run-off-road crashes constitute a serious highway safety problem, accounting for one-third of all traffic fatalities nationally and two-thirds of fatalities in rural areas.
Rumble strips are proving to be a valuable tool in the effort to prevent fatigue-related crashes. They are comprised of raised or grooved patterns installed in shoulder pavements or directly in travel lanes. Drive over one and you will immediately understand why they are called "rumble" strips. When a vehicle's tires pass over them, the driver is alerted by a sudden and loud rumbling sound accompanied by a jarring vibration of the vehicle.
Shoulder rumble strips are an effective way to grab a driver's attention and to warn them that they are about to leave the road. Rumble strips can reduce run-off-road crashes by an estimated 20 to 50 percent. As an example, the New York State Thruway experienced a 34 percent decrease in run-off-road crashes after rumble strips were installed. This is all the more impressive considering that overall crash rates increased by more than 11 percent at the same time.
Rumble strips can also be used to warn motorists of upcoming changes in the roadway or situations which demand a driver's immediate attention. For example, they may be used at toll plazas, in work zones, and before dangerous intersections.
How many highway crashes are attributable to drowsiness or fatigue?
Police-reported crash data underestimates the scope of the problem, because the involvement of drowsiness or fatigue is difficult for police to detect. Based on police accident reports, about one (1) percent of all crashes and about three (3) percent of fatal crashes are due to the driver falling asleep. New York's survey indicated that three (3) percent of drivers had a crash at some point when they fell asleep at the wheel, and two (2) percent had crashed due to drowsiness.
Which groups are at risk for drowsy driving?
Based on the crash data and survey and focus group research, the following groups of drivers are most at risk: young drivers; male drivers; persons who work long hours, nontraditional work schedules, and/or rotating shifts; commercial drivers; persons who have been drinking or have taken certain medications; and persons with undiagnosed sleep disorders. All drivers are at risk in certain situations, for example, when driving long distances without rest breaks.
What are the warning signs of fatigue?
Failure to remember the last few miles driven; wandering or disconnected thoughts; difficulty focusing, keeping eyes open, keeping head up; drifting from lane; yawning repeatedly; tailgating or missing signs; jerking car back into lane.
What can be done to help prevent drowsy driving?
Get a good night's sleep; drive with a passenger; schedule regular stops; avoid alcohol or medications that impair performance; seek medical help for a suspected sleep disorder.
What should a driver do if he/she becomes drowsy while driving?
Recognize the warning signs of fatigue; find a safe place to stop; take a brief nap (20 to 40 minutes); drink coffee to promote short-term alertness.
What programs are underway in New York to prevent drowsy driving?
Since 1994, partners involved in alerting the public to the dangers of driving while drowsy/fatigued have implemented a number of countermeasures, including public information and education programs for the general public and for high risk groups, such as commercial drivers; integration of sleep topics into driver training programs; improved crash reporting; installation of rumble strips along the Thruway and interstate roadways; police training; and research.
then you may be suffering from drowsiness or fatigue. Continuing to drive in this condition puts you at serious risk of being involved in a fatigue-related crash. You should pull over in a safe place and get some rest before resuming your trip.
Tips to avoid driving while tired:
To avoid falling asleep at the wheel, motorists are advised to take turns driving or take frequent breaks: Every two hours or 100 miles!
"TRICKS" THAT DO NOT WORK
Opening the window, turning on the air conditioning, or playing loud music are not effective in keeping drivers alert for any extended period of time.
SLEEP IQ TEST
Think you know a lot about drowsy driving? -- Take the Sleep Quiz (from the AAA Foundation for Traffic Safety).
OTHER FATIGUE-RELATED SOURCES:
National Sleep Foundation http://www.sleepfoundation.org
AAA Foundation for Traffic Safety http://aaafoundation.org/
National Heart, Lung and Blood Institute http://www.nhlbi.nih.gov/health/public/sleep/index.htm
Federal Motor Carrier Highway Safety Administration http://www.fmcsa.dot.gov/
Sleep Quest http://www.SleepQuest.com
American Sleep Apnea Association http://www.sleepapnea.org
National Institutes of Health, National Medical Library PUBMED (Sleep Research) http://www.ncbi.nlm.nih.gov/pubmed