This SleepSomatics blog article is part one of a six part series on CPAP Therapy, Bi-PAP (or Bi-Level) Therapy, and Treating Sleep-Disordered Breathing (Sleep Apnea) with Non-Invasive PAP Therapy.
Part One: Drowsy Driving Kills
Drunk driving kills nearly 30 Americans daily. Texting and distracted driving kills more than 9 Americans daily. What about drowsy (or fatigued) driving from untreated sleep disorders like sleep apnea? The AAA Foundation for Traffic Safety estimates a staggering 1 in 5 automobile fatalities are caused by drowsy drivers.
Drowsy Driving Kills
Driving drowsy or sleep deprived significantly reduces a driver’s ability to safely operate a motor vehicle. The effect of sleep deprivation on driving is similar to alcohol or drug intoxication.
Sleep deprivation’s fatal consequences are well-known (if anecdotally) to most Americans. Sleep-deprived individuals have been implicated in their fatal roles in the Chernobyl nuclear power plant meltdown in Ukraine, the Exxon Valdez oil tanker spill in Alaska, and even NASA’s space shuttle Challenger explosion.
“Drowsiness is similar to alcohol in how it compromises driving ability by reducing alertness and attentiveness, delaying reaction times, and hindering decision-making skills. Drowsy driving is deadly, but it’s also completely avoidable.”
A recent scientific study at Washington State University (WSU) concluded that sleep deprivation impedes a person’s critical decision making skills in critical moments requiring immediate reaction. This study has implications not only for high risk occupations but also for commercial and regular drivers.
From Hans Van Dongen, director of the WSU Sleep and Performance Research Center at WSU Spokane:
“People in high-stakes environments are held accountable for their actions when they are fatigued just like everyone else … However, we now know that when someone is sleep-deprived their brain simply can't process feedback from their actions and changing circumstances … Our findings tell us that putting sleep-deprived people in perilous environments is an inherently risky business and raises a number of medical, legal and financial implications.”
Teens and Drowsy Driving
Adolescents and teens are at a particularly higher risk for drowsy driving because of a combination of factors:
- Increased "blue light-emitting" smart phone and electronic usage prior to bed is reducing total night sleep in American teens.
- Early school start times conflict with post-puberty circadian rhythms and exacerbate later sleep times caused by electronics usage in the bedroom. These two problems combine to increase teens' "sleep debt," substantially increasing their risk for auto-related accidents.
- Increased prescription or abuse of antidepressants, benzodiazepines, stimulants, and similar medications and substances that suppress the onset and total night indices of restorative sleep, particularly cognitively-restorative REM sleep.
The average start time for public high schools in the United States is 7:59 AM -- far earlier than the hormonal sleep pattern that adolescents and teenagers are biologically designed to sleep. A National Sleep Foundation survey found that a staggering 87% of high school students received less than the AAP-recommended 8.5 - 9.5 hours of sleep on school nights. These are the same high school students who are driving themselves out on public roads to school each day.
To increase refreshing, restorative total night sleep in children and teens, many organizations now advocate later school start times, including the American Academy of Pediatrics, the National Sleep Foundation, and Start School Later.
From Judith Owens, MD, FAAP, lead author of the American Academy of Pediatrics policy statement, “School Start Times for Adolescents,” published in the September 2014 issue of Pediatrics:
“Chronic sleep loss in children and adolescents is one of the most common – and easily fixable – public health issues in the U.S. today ... The research is clear that adolescents who get enough sleep have a reduced risk of being overweight or suffering depression, are less likely to be involved in automobile accidents, and have better grades, higher standardized test scores and an overall better quality of life,” Dr. Owens said. “Studies have shown that delaying early school start times is one key factor that can help adolescents get the sleep they need to grow and learn.”
Studies are demonstrating the relationship between teen drowsy driving and school start times. When high schools in Fayette County, Kentucky, changed start times from 7:30 AM to 8:30 AM, teenager automotive accident rates dropped by more than 16%. In another study comparing teen car accidents between two Virginia counties with start times differing from 7:20 AM and 8:40 AM, accidents in the early-morning start time were 40% higher.
Drowsy Driving, Commercial Drivers Licenses (CDL) drivers, and Truck Drivers
Drowsy driving is implicated in numerous truck accidents and fatalities. The problem of big rig or semi trucks careening off the road and killing other motorists is frequently being attributed to excessive sleepiness, sleep deprivation, and sleep apnea. The nationwide epidemic of drowsy driving fatalities has led to proposed federal regulations and calls for increased fines on companies employing commercial drivers.
From Jeffrey Durmer, MD, PhD, adjunct professor at Georgia State University Department of Health Professions:
“But in terms of actually combating the causes for drowsy driving, the DOT (the Department of Transportation) and its agencies, like the FAA and FMCSA, already have rules in place that specify hours of service for transportation workers in various positions. Groups like the FMCSA are actively in the process of developing, with formal rulemaking procedures, as mandated by President Obama in 2013, how to handle other causes for drowsy driving, like prevalent sleep disorders such as obstructive sleep apnea ... I think in the next five years what we’re going to see is concise rules that are regulating the behaviors of transportation workers through hours of service logging that are all electronic at this point, as well as obstructive sleep apnea screening, testing, and management. The real issue is getting those folks that are walking around not understanding that they have a risk for safety, but also their health, get them to the right medical management, and help them stay on therapy over the course of time.”
For CDL holders and truck drivers, the Federal Motor Carriage Safety Administration (FMCSA) recommends sleep apnea screening as part of a CDL Medical Examiner physical.
Regulating total nightly sleep may not be enough to prevent drowsy driving fatalities. The risk of a car crash or an actual car crash is 17% higher when the driver is interacting with a cell phone or electronic device. However, a five year study by the Insurance Institute for Highway Safety found that laws against distracted driving did not necessarily reduce fatalities. Therefore, it is unclear if laws or governmental regulations against drowsy driving will be effective without community support and individual accountability for corrective action and safe, well-rested driving.
Drivers with undiagnosed sleep disorders like obstructive sleep apnea may still represent significant risk to other drivers on the road. Untreated sleep disorders like sleep apnea and restless leg syndrome prevent sufferers from achieving sufficient restorative sleep (including, REM sleep) necessary for sufficient cognitive functioning the following day.
Signs of Drowsy Driving
The American Academy of Sleep Medicine (AASM) and the Centers for Disease Control and Prevention (CDC) have partnered with the social media campaign, Awake at the Wheel, to promote alert, safe driving.
From Awake at the Wheel, symptoms of drowsy or reduced driving capability:
- You keep yawning or are unable to keep your eyes open.
- You catch yourself “nodding off” and have trouble keeping your head up.
- You can’t remember driving the last few miles.
- You end up too close to cars in front of you.
- You miss road signs or drive past your turn.
- You drift into the other lane of traffic, onto the “rumble strip” or the shoulder of the road.
Examples of Drowsy Driving
From the AAA Foundation for Traffic Safety:
Solutions for Drowsy Driving
Individuals suffering from drowsy driving need accredited sleep testing to identify and treat the underlying sleep disorder or sleep disturbance and restore the sleep architecture. Technology has made effective sleep testing widely-available. New treatments for sleep apnea feature comfortable, whisper-quiet CPAP masks as small as 1.94 ounces. There no longer exists any excuses for ignoring drowsy driving and sleepiness.
How to Get Help for Drowsy Driving
One should never attempt to drive or operate a motor vehicle when tired, sleepy, or fatigued. Patients with untreated sleep disorders or complaints of suspected sleep-related problems should particularly be careful when driving and/or avoid driving until their healthcare provider has initiated corrective testing and/or treatment to reduce daytime symptoms. Particular demographics are at higher risk, including adolescents and teens, the overweight or obese, patients on psychiatric medications (including antidepressants, benzodiazepines, sedatives, and prescription sleep aides), commercial truck drivers and CDL operators, senior citizens and the elderly, patients prescribed pain medications, and all individuals who snore or display classic symptoms of sleep apnea.
Improving one’s sleep for safe, effective driving begins with ensuring uninterrupted, cognitively-restorative sleep. Sleep disorders can fragment the sleep architecture, reducing total night restorative sleep and contributing to exhaustion, fatigue, depression, and automobile accidents. Diagnosing 70+ sleep disorders and quantifying the sleep architecture begins with accredited sleep testing at SleepSomatics.
Concerned about your own drowsy or tired driving? Are you a commercial (CDL) driver who needs sleep testing? If you or someone you care about snores or is tired and fatigued during the day, sleep-disordered breathing (and sleep apnea) may be a serious risk. Get your sleep tested today by SleepSomatics, a professionally credentialed and accredited sleep disorders center serving Austin and Central Texas since 1999. Call 512.323.9253.
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This SleepSomatics blog article’s thumbnail image credit goes to: Sleep Mag.