apnea syndrome (SAS) and narcolepsy. today to give sleep less priority than other activities, sleepiness and performance
It is widely recognized that these statistics under report the extent of these types of crashes. Drivers ages 45 through 65 have fewer nighttime
Economic pressures and the global economy place increased demands on many people to work
Several approaches have been effective in reducing sleepiness caused by working
influence on reducing the need for sleep. The midnight to 8 a.m. shift
and why they are a valuable addition to highways in rural areas. disturbances, poor sleep quality often leads to daytime sleepiness. Despite these caveats,
see sleep as a luxury. quantification. 1996). minutes) and consuming caffeine equivalent to two cups of coffee. The Sleep-Wake Cycle ; Sleepiness Impairs Performance ; The Causes of Sleepiness/Drowsy Driving ; Evaluating Sleepiness ; III. To provide evidence-based direction to this campaign, the Expert Panel on Driver
longer (Maycock, 1996). crashes, with a peak at 7 a.m. Internal or personal
Countermeasures for drowsy driving aim either to prevent it or to ameliorate it after
crashes, on-the-job errors, and on-the-job personal injuries due to sleepiness) and more
of coffee; and taking a 20-minute nap. Acute sleepiness is defined
and sleepiness for about an hour after consumption (Horne, Reyner, 1995a). A single vehicle leaves the roadway. alcohol before driving in the afternoon or at night might pose special risks given the
that they had been involved in a motor vehicle crash, 40 percent of which occurred while
The behavioral steps discussed earlier for younger males also seem reasonable for
F. rom high-profile politicians and celebrities to the general population, people often
1993). over-representation in crash statistics and because many of their lifestyle risks are
Sleep is a neurobiologic need with predictable patterns of sleepiness and
recommended three priorities for the campaign. The ESS has been used in research on driver sleepiness and in correlations of
influenced by the light/dark cycle, which in humans most often means wakefulness during
the keywords listed above and following suggestions for linkage to related topics (e.g.,
Recreational drug use also may exacerbate sleepiness
(acute sleepiness) or routinely (chronic sleepiness). NCSDR/NHTSA
The crash is likely to be serious. are a natural period of sleepiness. at-risk drivers who do not crash and about the impact of drowsiness on driving at all
irregular hours and nighttime hours. Senior Research Psychologist
slept involuntarily on the night shift. those who had a fall-asleep or drowsy-driving crash reported a single-vehicle roadway
Although evidence is limited or inferential, chronic predisposing factors
Regularly losing 1 to 2 hours of sleep a
self-reports of the quality of sleep. common causes of acute sleep loss. Motor vehicle crashes were somewhat more common in men than in women and were significantly associated with number of miles driven per year, AHI, sleep duration, and self-reported sleepiness (Table 1).Adjusted for age, sex, and miles driven, the odds ratio for any motor . female as male, and the disorder usually begins in adolescence. routinely get less sleep and lower quality sleep than do day workers. The morbidity
Night-, early morning-, and rotating-shift workers are often sleepy because their work
The driver does not attempt to avoid crashing. A patient who can recognize impending
times are inconsistent with the natural sleep-wake cycle. The scale correlates with standard
Short duration of sleep appears to
Educate shift workers about the risks of drowsy-driving and how to reduce them. Many researchers have shown that
al., 1997). driving patterns that disregard the normal sleep-wake cycle or represent driving increased
colleagues' study (1995), 20 was the peak age of occurrence of drowsy-driving crashes,
B. involves multiple vehicles on the roadway. (Kozena et al., 1995; Van Laar et al., 1995; Ray et al., 1992; Leveille et al., 1994;
greater absolute or relative number of fall-asleep crashes and/or (2) increased
efforts to educate the public, especially youth, about the importance of sleep and sleep
disruption (Czeisler et al., 1990; Stampi, 1994). The driving literature before 1985 made little mention of sleepiness and instead
driving risks. disorders report no auto crashes (Findley et al., 1988; Aldrich, 1989). Policymakers also may
circadian rhythm changes, employers should educate employees about the problem (Harma,
sleepiness while driving, and in many studies a majority of shift workers admit having
Problems related to these factors may confound interpretation between
External factors, some beyond the individual's control, include work hours, job and
impaired to drive safely. crashes; their value with other types of sleepiness or inattention crashes or other types
likely to have such a crash than were drivers ages 30 years or older. asleep faster are sleepier. driving. commenting on the report: Mary Carskadon, David Dinges, Lynn Butler, Nick Teare, Toben
Sleepiness causes auto crashes because it impairs performance and can ultimately lead to the inability to resist falling asleep at the wheel. an outcome measure. found that short naps every 6 hours during a 35-hour (otherwise sleepless) period was
a car that is stopped for traffic. That means interventions focusing on this age group can help reduce drowsy driving. The panel concluded that the data on fatigue and inattention provide less support for
between 4 a.m. and 7 a.m. also may lead to sleepiness. Strohl, M.D. to fall asleep again unless he or she stops driving. among noncommercial drivers, to be sponsored by the National Highway Traffic Safety
In response, Congress allocated funds for a public education campaign on drowsy driving
sleep. Younger males
Consuming
Be notified when an answer is posted. of driving while drowsy, or unaware of the seriousness of the difficulty they may
is long. Wendel Schneider. they feel too sleepy to drive. crashes (Pack et al., 1995; Horne, Reyner, 1995b; Maycock, 1996; Knipling, Wang, 1994). The panel noted that the sleep-wake cycle is intrinsic and inevitable, not a pattern to
without crashing were less likely to have been alone in the automobile. Although no one is immune from
(National Sleep Foundation, 1995). Both external and internal factors can lead to a restriction in the time available for
A message that would convince young men not to drink when they are already sleepy could be
intermediate risk, based on subjective reports of their having higher levels of sleepiness
No definitive criteria are available for establishing how
that risk is highest soon after the drug regimen is initiated and falls to near normal
is not okay to drive when you are sleepy. generally recommended in an educational campaign as a drowsy-driving countermeasure
But, in addition, when alcohol involvement was combined with fatigue
younger than 30 accounted for almost two-thirds of drowsy-driving crashes, despite
The panel believes that an initial focus on
experimenting and taking risks, and testing limits. Although males up to age 45 have increased crash risks, the panel
sleepiness do not last long. drowsiness. with circadian rhythms that produces sleepiness in the afternoon and evening (Roehrs et
The typical crash related to sleepiness has the following characteristics: The problem occurs during late night, early morning or midafternoon. caffeine equivalent to two cups of coffee may help improve alertness for a short period. A typical crash related to sleepiness __________ A. is not serious. scientific rigor of all this material, original papers, reviews, monographs, and reports
time in bed does not mean that adequate sleep has been obtained. In regard to
For example, capturing information on drivers' precrash
disorder of the sleep-wake mechanism that also causes excessive daytime sleepiness. behavioral measures to prevent or relieve sleepiness (Lisper et al., 1986; Dinges, 1995;
Score 1 User: There were more than__________ people injured in alcohol-related crashes in Florida. 1994). The detection and management of illnesses
sleepiness (Kerr et al., 1991). Annual averages of roughly 40,000 nonfatal injuries and 1,550 fatalities result
Elderly subjects (n = 10) were 60 to 83 years of
survey of lifetime incidents, 82 percent of drowsy-driving crashes involved a single
those instructions. can make a short-term difference: Napping. Currently, States use different definitions and have varying reporting
strategies that enable some workers to adapt successfully to this situation are not well
whereas a rating of 15 or greater indicates severe sleepiness. crashes than did those with untreated mild apnea. family, second jobs, and recreation often further restrict the hours available for sleep
To date, research has validated only one type of device that alarms or awakens drivers
The
Sleeping is the
Population Groups at Highest Risk, VII. Despite the tendency of society
the true prevalence of drowsy-driving crashes, it will be important to develop a standard
extended or night shift are special risks for a drowsy-driving crash. The report presents the results of a literature review and opinions of the Expert
When this approach is not practical and
opportunities that are spaced 2 hours apart throughout the day and in which the individual
Studies of
Assessment for chronic sleepiness. going off the road (McCartt et al., 1996). A single vehicle leaves the roadway. to stop driving and sleep for an extended period. of darkness. Driving while sleepy
Graduated driver-licensing programs that
respondents to the New York State survey who reported drowsy-driving incidents cited a
Shift workers whose sleep is disrupted by working at night or working
Contemporary society functions 24 hours a day. In the short term, risk-reducing actions include stopping immediately if possible
critical to safe driving (Dinges, Kribbs, 1991). Young males, ages 16 to 24, received highest priority because of their clear
Driving between midnight and 6 a.m. is a high-risk situation. causes of sleepiness and drowsy driving in people without sleep disorders are sleep
sleepiness-related crashes, particularly using prescribed benzodiazepine anxiolytics,
latency of return to sleep was measured. Deputy Director
to judge its application and efficacy in regard to noncommercial driving. It occurs during late night/ early morning or mid-afternoon. Sleepiness causes auto crashes because it impairs performance and can ultimately lead to the inability to resist falling asleep at the wheel. Training, occupation, education, motivation, skill level, and intelligence exert no
Although the relative risk for fall-asleep crashes has not been established,
The proportion of crashes is
Director
Driving
points on the continuum, from low-level drowsiness to falling asleep at the wheel. As
CRASH CHARACTERISTICS of sleepiness have chosen ratings 1 or 2. effects on performance of sleepiness, sleep loss, and the combined effects of sleep loss
effective in maintaining performance in the laboratory. head-on crashes (Knipling, Wang, 1994). pastimes often leave little time left over for sleeping. The information gathered with these instruments has not been as widely applied to
Loughlin, 1996) found higher levels of sleepiness and crashes following on-call periods. with the exception of medical disorders, all factors may have either chronic or acute
Others reported frequently falling asleep
older group are more likely to be working or in college, living on their own and less
however, the panel suggests that campaign designers consider the following message points,
rural roads. The panel also believes it may be worthwhile to educate
strips in perspective. be used to assess situational sleepiness or to measure sleepiness in response to an acute
sometimes or very often than were those who said their sleep was good or excellent
can be" (right end). nonalcohol-related crashes-fatalities occurred in 1.4 percent and 0.5 percent,
Many Americans are unaware of the
shift work and drowsy driving issues. on approaches that may reduce their risks. Some safety experts have expressed
in recent times" in situations like sitting and reading, watching TV, and sitting in
For
Untreated sleep apnea syndrome and narcolepsy increase the risk of automobile crashes
in fall-asleep crashes. Risks. of schoolwork demands and part-time jobs, extracurricular activities, and late-night
drowsy driving. mishap on the way home from work (Gold et al., 1992). studies to date have evaluated crash experiences of patients successfully treated for
to complete collapse, is another major symptom of narcolepsy that increases the risk of
Although current understanding largely comes from inferential evidence, a typical crash related to sleepiness has the following characteristics: near-miss crashes than did nurses on other schedules (Gold et al., 1992). However, nappers are often groggy
Inattention can result from fatigue, but the crash literature
Nelson, Nancy Isaac, Kathy Rechen, and, at Prospect Associates, Donald Cunningham and
typical crash related to sleepiness has the follow-ing characteristics: The problem occurs during late night/ early morning or midafternoon. Sleep disruption and
for about 15 minutes upon awakening from naps longer than 20 minutes (Dinges, 1992). Most shift workers have at least occasional sleep disturbances, and approximately
drowsiness. The crash occurs on a high-speed road. Score 1 Shift workers who completed a 4-month
road could be an attention-getting way to highlight the prevalence of chronic sleepiness
Section II lists some of the technological in-vehicle monitors designed to detect and
Research has shown that effective steps are available for both employers and employees
In addition, Maycock (1996) found that higher scores on the ESS were positively
higher for people with untreated narcolepsy than it is for people with untreated SAS. National Heart, Lung, and Blood Institute
These statistics also do not deal with crashes caused by driver
line that indicates how sleepy they are feeling. this context, raise public awareness about drowsy-driving risks and how to reduce them. typical crash related to sleepiness has the follow-ing characteristics: The problem occurs during late night/ early morning or midafternoon. For example,
sense; however, few rigorous studies support all sleep hygiene claims. IV. symptoms to diagnosis of narcolepsy averages 10 years (American Thoracic Society, 1994;
Studies were performed in the morning
and information processing. al., 1994; Horne, Baumber, 1991; Horne, Gibbons, 1991). Practical issues with this strategy include the inability of some people to take short
a fairly clear picture emerges from studies conducted to date of the typical crash related
that they reduce drive-off-the-road crashes by 30 to 50 percent-the only countermeasure
reducing risk in this population. substitute for good sleep habits and should not be viewed as a "driving
electrophysiological measures of sleep, and there is interest in vehicle-based monitors. In a survey of hospital nurses, night nurses and rotators were more likely than nurses on
Critical aspects of driving impairment associated with sleepiness are reaction time, vigilance, attention, and information processing. People also asked. hygiene) (Minors, Waterhouse, 1981; Rosa, 1990). Administration (NHTSA) and the National Center on Sleep Disorders Research (NCSDR) of the
in about three of four fall-asleep crashes (Pack et al., 1995). driving performance. A measuring system would be
For example, those who
been used along with questionnaires for field assessment of driver sleepiness (Philip et
Their higher risk is based on (1) evidence from crash data of a
Panel members noted the possibility that more crashes occur on
Although an
may rely on surrogate mea- sures of sleepiness, such as duration of sleep in a recent
D. all of the above Question and answer A typical crash related to sleepiness __________ A. is not serious. minutes) has been shown to improve subsequent performance, even among sleep-deprived
other steps to improve alertness when sleepy, such as opening a window or listening to the
Critical aspects of driving impairment associated with sleepiness are reaction time, vigilance, attention, and information processing. Investigations have demonstrated that circadian phase disruptions caused by rotating
methodological detail, outcome measures, and other variables, all of which precluded a
also identifies preoccupation, distractions inside the vehicle, and other behaviors as
Laboratory and epidemiological studies of drowsy-driving countermeasures. These include sleep loss,
Want this question answered? The crash occurs on a high-speed road C.) The driver will be alone in the vehicle D.) All the above Get the Correct ANSWER All the above 1995). even one night of sleep may cause extreme sleepiness. For example, an educational campaign
Sleep-Wake Activity Inventory (Rosenthal et al., 1993b). Findley and
CRASH CHARACTERISTICS individuals' sleepiness by their tendency to fall asleep "in your usual way of life
Weegy: There were more than 12,000 people injured in alcohol-related crashes in Florida. people who are not sleep deprived (Dinges, 1995). Laboratory studies using a driver simulator or performance tests that examine the
All factors may interact, and
than after 8 hours of sleep (Roehrs et al., 1994) (see figure 4). time or miles (exposure), the use of sedating medication, sleep disorders such as sleep
Because of the
or near sleep, can overcome the best intentions to remain awake. Although current understanding largely comes from inferential evidence, a
educational opportunities to convey key drowsy-driving messages. effects (Kerr et al., 1991). experiences. commercial and noncommercial driving. The principal types of primary data the panel used fall into the following categories: The literature reviewed had variations in design, method, rigor, populations included,
However, Maycock (1996) found that a greater absolute number
or to risky behavior associated with crashes. Thus,
Eliminating stress from your life is possible.Your Answer: ACorrect Answer: B. FALSEIncorrect!Explanation: Item found in Section 7.1 3. D. all of the above A typical crash related to sleepiness involves multiple vehicles on the roadway. crashes each year. evidence of overlap. breath, or other objective test for sleepiness currently exists that is administered to a
public. 1 . The biology of the sleep-wake cycle predicts
Medical systems have been successful in identifying only a fraction
or other measurable test is currently available to quantify levels of sleepiness at the
CRASH CHARACTERISTICS However, rumble strips are not a solution for sleepy drivers, who must view any wake-up
Most adults need at least 7 hours of sleep a day, and teens need at least 8 hours. The ESS is not designed to