Sleep deprived driving
Encyclopedia
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. According to the United States Department of Transportation, male drivers admit to have fallen asleep while driving twice as much as female drivers.
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.
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
This is a narrowing or closure of the airway during sleep causing multiple disturbances 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
It has been estimated that between 16% and 60% of all accidents have sleep deprivation as a cause. 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. Accidents related to sleep deprivation are most likely to happen in the early to midafternoon, and in the very early morning hours. Sleep deprivation was blamed a major cause of the Selby rail crash
in which 10 people died and 82 were injured.
Driver fatigue is a contributing factor in 12% of all crashes and 10% of all near-crashes. 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. Drivers with obstructive sleep apnea
(OSA) have a 7-fold increased risk of being involved in a motor vehicle crash . It is estimated the 2.4-3.9 million licensed commercial drivers in the US have OSA out of the estimated 18 million total Americans . The Federal Motor Carrier Safety Administration (FMCSA) says that as many 28 percent of commercial driver’s license (CDL) holders have sleep apnea
Total costs attributed to sleep apnea-related crashes:
Treatment:
Moderate and severe sleep apnea are disqualifying conditions for acquiring a CDL.
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
Not all cases of sleep apnea are restricted from obtaining a CDL:
Criteria that lead to disqualification:
endorsed physician reporting in 1999, but deferred to the states on whether such notification should be mandatory or permissive. 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."
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.
Automobile
An automobile, autocar, motor car or car is a wheeled motor vehicle used for transporting passengers, which also carries its own engine or motor...
while being cognitively impaired by a lack of sleep
Sleep
Sleep is a naturally recurring state characterized by reduced or absent consciousness, relatively suspended sensory activity, and inactivity of nearly all voluntary muscles. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and is more easily reversible than...
. Sleep deprivation
Sleep deprivation
Sleep deprivation is the condition of not having enough sleep; it can be either chronic or acute. A chronic sleep-restricted state can cause fatigue, daytime sleepiness, clumsiness and weight loss or weight gain. It adversely affects the brain and cognitive function. Few studies have compared the...
is a major cause of motor vehicle accidents, and it can impair the human brain as much as alcohol
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
can. According to a 1998 survey, 23% of adults have fallen asleep while driving. According to the United States Department of Transportation, male drivers admit to have fallen asleep while driving twice as much as female drivers.
In the United States, 250,000 drivers fall asleep at the wheel everyday, according to the Division of Sleep Medicine at Harvard Medical School
Harvard Medical School
Harvard Medical School is the graduate medical school of Harvard University. It is located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts....
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.
The effects of sleep deprivation on driving performance
Sleep deprivation has been proven to affect driving ability in three areas:- It impairs coordination.
- It causes longer reaction times.
- It impairs judgment.
Fatigue can often be caused by sleep apnea
Sleep apnea
Sleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low...
. 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
This is a narrowing or closure of the airway during sleep causing multiple disturbances 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
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. Men under 30 are more likely to be in an accident caused by sleep deprivation.Accidents
Selby rail crash
The Great Heck rail crash, widely known as the Selby rail crash, was a high-speed train accident that occurred at Great Heck near Selby, North Yorkshire, England on the morning of 28 February 2001...
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 .Driver fatigue is a contributing factor in 12% of all crashes and 10% of all near-crashes. 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. Drivers with obstructive sleep apnea
Sleep apnea
Sleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low...
(OSA) have a 7-fold increased risk of being involved in a motor vehicle crash . It is estimated the 2.4-3.9 million licensed commercial drivers in the US have OSA out of the estimated 18 million total Americans . The Federal Motor Carrier Safety Administration (FMCSA) says that as many 28 percent of commercial driver’s license (CDL) holders have sleep apnea
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)
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
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
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
Physician reporting
Six US states require physicians to report patients who drive while impaired, including those who may be chronically sleep-deprived. 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. The American Medical AssociationAmerican Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
endorsed physician reporting in 1999, but deferred to the states on whether such notification should be mandatory or permissive. An authority on professional confidentiality, Jacob Appel
Jacob M. Appel
Jacob M. Appel is an American author, bioethicist and social critic. He is best known for his short stories, his work as a playwright, and his writing in the fields of reproductive ethics, organ donation, neuroethics and euthanasia....
of New York University
New York University
New York University is a private, nonsectarian research university based in New York City. NYU's main campus is situated in the Greenwich Village section of Manhattan...
, 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."
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 stripsRumble Strips
Rumble Strips may refer to:* Rumble strip, the road safety feature* The Rumble Strips, the British band...
in the US, which cause a noise when drivers wander out of their lane. The Government of Western Australia
Government of Western Australia
The formation of the Government of Western Australia is prescribed in its Constitution, which dates from 1890, although it has been amended many times since then...
recently introduced a "Driver Reviver" program where drivers can receive free coffee to help them stay awake.
External links
- http://www.tompkins-co.org/wellness/drowsydriving/index.htm
- http://drowsydriverawarenessday.com