Sleepy Drivers a Significant Public Health and Safety Concern

CHICAGO-Increased awareness and educational programs about the risk of falling asleep at the wheel are needed in order to protect the public health and safety of all drivers, according to an article in the June 17 issue of The Journal of the American Medical Association (JAMA).

James M. Lyznicki, M.S., M.P.H., Ronald M. Davis, M.D., and colleagues on the American Medical Association's Council on Scientific Affairs reviewed information derived from a number of databases and relevant journal articles to assess the contribution of driver sleepiness to highway motor vehicle crashes. They also reviewed recent recommendations to change federal hours-of- service regulations for commercial drivers.

They conclude: "To protect public health and safety, the American Medical Association recommends continued research on devices and technologies to detect the signs of sleepiness and prevent the deterioration of driver alertness and performance. Educational programs about the risks of falling asleep while driving are needed for physicians, the public and commercial truck drivers."

The Council determined that increased awareness of the relationship between sleepiness and motor vehicle crashes is needed in order to promote the health and safety of drivers and highway users. They say physicians can contribute by encouraging good sleep habits, recognizing and treating sleep-related problems, and counseling patients about the risks of driving while sleepy.

The Council reports that approximately I percent to 3 percent of all motor vehicle crashes in the United States are caused by driver sleepiness. The National Highway Traffic Safety Administration estimates that sleepiness is a causative factor in about 100,000 police reported crashes each year and about 4 percent of all fatal motor vehicle crashes each year.

"Sleepy drivers risk injury and death, not only from failing asleep while driving, but also from loss of attention or slowing of reactions during critical driving tasks or maneuvers," the Council writes. "Sleepy drivers are at particular risk for motor vehicle crashes because they may not perceive a potential crash threat or react quickly enough to take evasive action."

The Council believes the role of sleepiness in crashes is greatly underestimated for a number of reasons, including the fact that most accidents are caused by a number of factors and drivers and police officers may not be aware of the role that sleepiness plays. Also, sleepiness may be ignored when there are more obvious factors involved in accidents (such as excessive speed, bad weather, faulty equipment, use of alcohol or sedative drugs), police officers may not be trained to recognize sleepiness in drivers, and drivers themselves may not admit to being sleepy for fear of implicating themselves for being responsible for the accidents. Approximately 96 percent of sleep-related crashes involve passenger vehicle drivers and about 3 percent involve drivers of large trucks.

Those at increased risk for sleep-related crashes include:

• Young drivers aged 16 to 29 years (due to lifestyle demands of school and jobs, extracurricular activities, late-night socializing and poor sleep habits that prevent them from getting sufficient sleep)

• Shift workers who work nonstandard schedules, such as rotating or night shifts (due to the disruption of the body's normal sleep patterns, reduced opportunities for sleep and poor sleep quality)

• Drivers who use alcohol or other drugs (which have sedative effects on drivers)

• Drivers with sleep disorders (about 30 million to 40 million Americans suffer from obstructive sleep apnea, narcolepsy and chronic insomnia)

• Commercial truck drivers (likely to drive during normally sleepy times of the day; obtain inadequate sleep before driving or in the truck sleeper berth; work long, irregular or unreasonable schedules; have underlying., medical conditions such as sleep disorders; have inadequate rest facilities; and have economic pressures and incentives

"Drivers can minimize sleepiness by getting adequate sleep before a trip, avoiding the use of alcohol and other drugs and not driving between midnight and 6 a.m.," the authors write. "Drivers who have difficulty sleeping or experience excessive daytime sleepiness should seek medical attention to discuss their sleep habits and histories and determine their need for treatment or referral to a sleep specialist."

The authors also contend that reliable and objective tests or monitoring devices are needed to measure changes in driver performance and physiology and to warn drivers of changes due to sleepiness. They also contend that physicians have an important role in preventing sleep-related injuries and deaths by assessing and following up on excessive sleepiness in their patients and discussing the possible safety implications with them.