Lack of sleep can have serious consequences on the roadways. Drowsy driving is a major threat to public safety.
To bring heightened awareness to the perils of driving while sleep deprived, the National Sleep Foundation declares November 5-12 as Drowsy Driving Prevention Week ®.
Anita Bhola, MD, FCCP, FAASM, discusses how lack of sleep contributes to motor vehicle accidents, the amount of sleep people should get to be at their best behind the wheel, and her best tips to remain alert while driving.
Drowsy Driving Awareness Week
Featured Speaker:
Anita Bhola, MD
Anita Bhola, MD, Medical Director of the St. Luke's Cornwall Hospital Center for Sleep Medicine clinic in Cornwall, NY, is a board-certified physician in Internal, Pulmonary, Critical Care and Sleep Medicine. Her practice includes both consultations with patients suffering from sleep disorders and interpretation of sleep studies. She has lectured extensively on many topics in sleep medicine at professional symposiums and to patients in community settings. She actively participates in A.W.A.K.E meetings, a sleep apnea patient support group. Her article about how sleep disorders can impact women and their careers was recently published in U.S. News & World Report. Transcription:
Drowsy Driving Awareness Week
Melanie Cole (Melanie): Have you ever felt so tired while you were driving that you actually nod off? Drowsy driving is becoming as much of a major public health crisis as drunk driving, and here to tell us about Drowsy Driving Awareness Week, and the implications of drowsy driving, is my guest, Dr. Anita Bhola. She's the Medical Director of the St. Luke's Cornwall Hospital Center for Sleep Medicine. Dr. Bhola, tell us about Drowsy Driving Awareness Week.
Dr. Anita Bhola, MD, FCCP, FAASM (Guest): Hi, Melanie. Thanks for having me back. So as you know, we moved our clocks back one hour this past weekend. Wasn't it wonderful to get that extra hour of sleep? But here's the thing, I'm not sure if we all actually took advantage of it. The days will be getting shorter, and it's getting darker earlier, and drivers adjust to this end of daylight savings time with- there's been increased traffic accidents that have been reported as drivers are adjusting.
So this podcast is actually very timely, because as of today, November 5, 2018, this kicks off the National Drowsy Driving Prevention Week. As you know, this is actually held every year sometime in November, and it's the National Sleep Foundation's public awareness campaign to educate drivers about sleep safety and this goes on the whole week with all kinds of campaigns.
As you know, drowsy driving is one of the most dangerous problems involving traffic safety, and we keep hearing about all kinds of crashes, whether it's the Amtrak, or the FedEx truck. We keep hearing about all kinds of drowsy driving related accidents. Estimates have shown that more than 60% of working Americans have admitted to driving while they're feeling sleepy, and almost 40% actually falling asleep at the wheel. And these are from stats from the National Sleep Foundation from almost ten years ago, so the numbers are actually getting worse than the previous estimates.
And there were studies done by the AAA Foundation of Traffic Safety that have shown that drowsy driving involves almost one in six deadly crashes, and one in eight crashes will result in hospitalization of the driver or the passenger. So this is a real major problem.
Melanie: So how does drowsy driving compare to driving under the influence, Dr. Bhola? Speak about fatigue versus alcohol.
Dr. Bhola: Sure. So like alcohol and drugs, sleep loss or fatigue, it impairs driving skills such as your hand eye coordination, the reaction time, your performance slows down, and this is sometimes detected in the lab in using driving simulators. So being awake for eighteen hours or more is equal to a blood alcohol level or concentration of 0.08, which is the legal limit for being called drunk in most states. And staying awake for eighteen hours or more is just as dangerous as excessive drinking.
Now, the paradoxical issue is that we have a breathalyzer that can reliably measure the patient's or person's state of intoxication, however we don't have any objective way of assessing somebody's state of sleep deprivation, and this makes it difficult for the police to know if drivers are actually able to, or fit to drive. I believe there's some research coming out of the UK developing a blood test that will enable them to actually be looking at biomarkers of sleep to see if a person is sleep deprived.
Melanie: Who do sleep-related crashes most commonly affect, Doctor? Who's most at risk for drowsy driving? We would typically think truck drivers, 2:00 or 3:00 in the morning, but that's not always the case, is it?
Dr. Bhola: No, that's not always the case. So actually most drowsy driving crashes happen between midnight and 6:00 AM, when the body's need for sleep is the greatest, or they occur in the mid-afternoon when we have this afternoon slump in our circadian rhythm. And typically the driver is alone, it could be a long rural boring dark road, or it could be a highway, there you go just veering off at high speed, and just drifting off and hitting a stationary object at very high speed.
So in addition to being- anybody who is sleep deprived obviously is at high risk for drowsy driving, but this one category that really deserves mention is young people. So almost 55% of drowsy driving crashes involve drivers that are less than twenty-five years of age. And we went over this in a previous podcast, that these drivers - eighteen to twenty-five, adolescents, especially males - they tend to stay up late, they sleep very little, their biological clocks are delayed, they have over-packed schedules. They're also inexperienced drivers, they're starting to experiment with drugs and alcohol, they could be texting, sometimes they drive at night.
And it's interesting to note that actually traffic crashes are the leading cause of death in young people in the United States, and that is really sad, and that is something that's totally preventable. And Driver's Ed courses, they seem to focus so much on distracted driving, and don't drive while- don't text while driving, but they don't really cover drowsy driving all that well, and I think that should be emphasized.
But in addition to young people, shift workers are at risk. Anybody who's working a night shift or a rotating shift, or working more than one job, or working more than sixty hours. This could include doctors, nurses, police officers. They're at risk for drowsy driving, and the risk is actually the highest when you're driving home after work. And then commercial drivers, as you mentioned, Melanie, are at risk for drowsy driving related accidents, especially those who are long haul drivers, and there is a higher incidence of sleep apnea in these patients as well.
Now in addition, anybody who is undiagnosed, who has an untreated or undiagnosed sleep disorder such as obstructive sleep apnea, narcolepsy would be at risk, and as a sleep specialist I see this a lot, and I always ask, and I'm looking for symptoms of drowsy driving during my consultations.
And then also, business travelers who could be getting off a plane, let's say in Europe in the morning after having spent the night in the plane, and are sleep deprived are experiencing jet lag as a result of traveling all these many time zones should be cautioned and not start driving immediately as soon as they get to their destination because they would be at risk for drowsy driving.
Melanie: How do you know, Dr. Bhola, if you're drowsy enough to fall asleep behind the wheel, or to be impaired enough to cause an accident? Are there some warning signs of sleepiness or fatigue? And then does things like coffee help?
Dr. Bhola: Right, so the problem is that most people actually don't realize how sleepy they are, or they're in denial, and the point is that when you're driving at seventy miles an hour, just four seconds of a lapse in vigilance, or what we call micro sleep - micro sleep is just a few seconds of sleep that occur during the day - that is enough at that speed for you to cross the length of a football field and result in a drowsy driving related crash.
So the warning signs, which we should all look out for, would be do you have difficulty focusing? Are you yawning frequently? Are your eyelids drooping? Do you have blurry vision? Are you rubbing your eyes and have a hard time keeping your eyes open? Is your head bobbing? Do you have trouble keeping your head up? And then also drifting from your lane. This actually- if you drift from your lane, a lot of the highways actually have these rumble strips now, so if you start driving over the rumble strips, that could be a very clear warning sign that you're drowsy because you're starting to veer off. Tailgating somebody, driving too close, or rear-ending somebody at a traffic light could also be signs that you're drowsy and need to rest, or if you're missing exits or missing signs.
Melanie: Does coffee help?
Dr. Bhola: Oh, yes. Yes, coffee does help to some extent. So one or two cups of coffee will increase your alertness for several hours. It does take about thirty minutes to enter the bloodstream, but it does help. Yes.
Melanie: And what's the recommended amount of sleep people should get to be at their best behind the wheel?
Dr. Bhola: So, typically seven to nine hours for an adult, and for teens it would be eight and a half to nine and a half hours.
Melanie: So as we wrap up, Dr. Bhola, what can a person do to reduce their risk before they set off on the road? And what are some of your best tips to remain alert while driving?
Dr. Bhola: Right, so before you set off on the road, just make sure that you get a good night's sleep. Don't drive if you're sleepy. Avoid any sedating medications. Read the labels very carefully. If you're on antihistamines that are sedating, that could be a problem. Don't drink before you drive, and if you're really sleepy and you need to get someplace, get a ride home, or have your parents pick you up, or take a taxi, or use public transportation.
And then if you have symptoms of a sleep disorder such as snoring or daytime sleepiness, you need to talk to your doctor about getting evaluated and options for treatment, because you may have a disorder such as sleep apnea that could be causing the drowsiness.
Now once you're on the road, the way you can remain alert while driving and prevent a crash from happening, is if you're on a long trip, and once you're on the road, try and take a break every hundred miles, or every two hours or so. If you're traveling with somebody, switch drivers. And you know, drowsy drivers often feel that they could roll down the window, they could just have cold air blow at their face, or sometimes I've heard patients say they slap themselves in the face, or they chew gum, or they turn the radio on. But none of these are actually really proof to be helpful. It's very, very important to recognize the signs of drowsiness when you're on the road, or even before you get in the car, and just absolutely refuse to drive if you're sleep deprived. It's that simple.
And if you're already behind the wheel and you realize that you're nodding off, and you're a long way away from home, find the nearest rest area and pull over. You cannot continue driving, you just have to pull over, and drink some coffee to keep yourself alert before you take a short nap, maybe a twenty minute or thirty minute nap to get the benefits of both the caffeine and the nap before you can start driving again. And if you're still sleepy, you just need to find the nearest motel and check in there, especially if you're driving through the night.
So really the motto should be never push yourself. Drive alert, and make sure that you arrive alive on the other end. There are also these road signs that are going to be- they're the whole week. You pay attention to these, because they actually warn you against the perils of drowsy driving, and I wish they were there the whole year actually.
And then lastly, there are some- the automobile industry is coming up with some alerting technologies. Some of the cars have a steering wheel angle called a tension assistant and other gizmos out there that are geared towards prevention of drowsy driving related accidents.
Melanie: It's great information, and so important for people to hear, and they can listen to this podcast before they go driving so that they will not get drowsy, and make sure to be well-rested before you drive. Thank you so much, Dr. Bhola, for joining us today. This is Doc Talk presented by St. Luke's Cornwall Hospital. For more information, please visit www.StLukesCornwallHospital.org. That's www.StLukesCornwallHospital.org. I'm Melanie Cole, thanks so much for listening.
Drowsy Driving Awareness Week
Melanie Cole (Melanie): Have you ever felt so tired while you were driving that you actually nod off? Drowsy driving is becoming as much of a major public health crisis as drunk driving, and here to tell us about Drowsy Driving Awareness Week, and the implications of drowsy driving, is my guest, Dr. Anita Bhola. She's the Medical Director of the St. Luke's Cornwall Hospital Center for Sleep Medicine. Dr. Bhola, tell us about Drowsy Driving Awareness Week.
Dr. Anita Bhola, MD, FCCP, FAASM (Guest): Hi, Melanie. Thanks for having me back. So as you know, we moved our clocks back one hour this past weekend. Wasn't it wonderful to get that extra hour of sleep? But here's the thing, I'm not sure if we all actually took advantage of it. The days will be getting shorter, and it's getting darker earlier, and drivers adjust to this end of daylight savings time with- there's been increased traffic accidents that have been reported as drivers are adjusting.
So this podcast is actually very timely, because as of today, November 5, 2018, this kicks off the National Drowsy Driving Prevention Week. As you know, this is actually held every year sometime in November, and it's the National Sleep Foundation's public awareness campaign to educate drivers about sleep safety and this goes on the whole week with all kinds of campaigns.
As you know, drowsy driving is one of the most dangerous problems involving traffic safety, and we keep hearing about all kinds of crashes, whether it's the Amtrak, or the FedEx truck. We keep hearing about all kinds of drowsy driving related accidents. Estimates have shown that more than 60% of working Americans have admitted to driving while they're feeling sleepy, and almost 40% actually falling asleep at the wheel. And these are from stats from the National Sleep Foundation from almost ten years ago, so the numbers are actually getting worse than the previous estimates.
And there were studies done by the AAA Foundation of Traffic Safety that have shown that drowsy driving involves almost one in six deadly crashes, and one in eight crashes will result in hospitalization of the driver or the passenger. So this is a real major problem.
Melanie: So how does drowsy driving compare to driving under the influence, Dr. Bhola? Speak about fatigue versus alcohol.
Dr. Bhola: Sure. So like alcohol and drugs, sleep loss or fatigue, it impairs driving skills such as your hand eye coordination, the reaction time, your performance slows down, and this is sometimes detected in the lab in using driving simulators. So being awake for eighteen hours or more is equal to a blood alcohol level or concentration of 0.08, which is the legal limit for being called drunk in most states. And staying awake for eighteen hours or more is just as dangerous as excessive drinking.
Now, the paradoxical issue is that we have a breathalyzer that can reliably measure the patient's or person's state of intoxication, however we don't have any objective way of assessing somebody's state of sleep deprivation, and this makes it difficult for the police to know if drivers are actually able to, or fit to drive. I believe there's some research coming out of the UK developing a blood test that will enable them to actually be looking at biomarkers of sleep to see if a person is sleep deprived.
Melanie: Who do sleep-related crashes most commonly affect, Doctor? Who's most at risk for drowsy driving? We would typically think truck drivers, 2:00 or 3:00 in the morning, but that's not always the case, is it?
Dr. Bhola: No, that's not always the case. So actually most drowsy driving crashes happen between midnight and 6:00 AM, when the body's need for sleep is the greatest, or they occur in the mid-afternoon when we have this afternoon slump in our circadian rhythm. And typically the driver is alone, it could be a long rural boring dark road, or it could be a highway, there you go just veering off at high speed, and just drifting off and hitting a stationary object at very high speed.
So in addition to being- anybody who is sleep deprived obviously is at high risk for drowsy driving, but this one category that really deserves mention is young people. So almost 55% of drowsy driving crashes involve drivers that are less than twenty-five years of age. And we went over this in a previous podcast, that these drivers - eighteen to twenty-five, adolescents, especially males - they tend to stay up late, they sleep very little, their biological clocks are delayed, they have over-packed schedules. They're also inexperienced drivers, they're starting to experiment with drugs and alcohol, they could be texting, sometimes they drive at night.
And it's interesting to note that actually traffic crashes are the leading cause of death in young people in the United States, and that is really sad, and that is something that's totally preventable. And Driver's Ed courses, they seem to focus so much on distracted driving, and don't drive while- don't text while driving, but they don't really cover drowsy driving all that well, and I think that should be emphasized.
But in addition to young people, shift workers are at risk. Anybody who's working a night shift or a rotating shift, or working more than one job, or working more than sixty hours. This could include doctors, nurses, police officers. They're at risk for drowsy driving, and the risk is actually the highest when you're driving home after work. And then commercial drivers, as you mentioned, Melanie, are at risk for drowsy driving related accidents, especially those who are long haul drivers, and there is a higher incidence of sleep apnea in these patients as well.
Now in addition, anybody who is undiagnosed, who has an untreated or undiagnosed sleep disorder such as obstructive sleep apnea, narcolepsy would be at risk, and as a sleep specialist I see this a lot, and I always ask, and I'm looking for symptoms of drowsy driving during my consultations.
And then also, business travelers who could be getting off a plane, let's say in Europe in the morning after having spent the night in the plane, and are sleep deprived are experiencing jet lag as a result of traveling all these many time zones should be cautioned and not start driving immediately as soon as they get to their destination because they would be at risk for drowsy driving.
Melanie: How do you know, Dr. Bhola, if you're drowsy enough to fall asleep behind the wheel, or to be impaired enough to cause an accident? Are there some warning signs of sleepiness or fatigue? And then does things like coffee help?
Dr. Bhola: Right, so the problem is that most people actually don't realize how sleepy they are, or they're in denial, and the point is that when you're driving at seventy miles an hour, just four seconds of a lapse in vigilance, or what we call micro sleep - micro sleep is just a few seconds of sleep that occur during the day - that is enough at that speed for you to cross the length of a football field and result in a drowsy driving related crash.
So the warning signs, which we should all look out for, would be do you have difficulty focusing? Are you yawning frequently? Are your eyelids drooping? Do you have blurry vision? Are you rubbing your eyes and have a hard time keeping your eyes open? Is your head bobbing? Do you have trouble keeping your head up? And then also drifting from your lane. This actually- if you drift from your lane, a lot of the highways actually have these rumble strips now, so if you start driving over the rumble strips, that could be a very clear warning sign that you're drowsy because you're starting to veer off. Tailgating somebody, driving too close, or rear-ending somebody at a traffic light could also be signs that you're drowsy and need to rest, or if you're missing exits or missing signs.
Melanie: Does coffee help?
Dr. Bhola: Oh, yes. Yes, coffee does help to some extent. So one or two cups of coffee will increase your alertness for several hours. It does take about thirty minutes to enter the bloodstream, but it does help. Yes.
Melanie: And what's the recommended amount of sleep people should get to be at their best behind the wheel?
Dr. Bhola: So, typically seven to nine hours for an adult, and for teens it would be eight and a half to nine and a half hours.
Melanie: So as we wrap up, Dr. Bhola, what can a person do to reduce their risk before they set off on the road? And what are some of your best tips to remain alert while driving?
Dr. Bhola: Right, so before you set off on the road, just make sure that you get a good night's sleep. Don't drive if you're sleepy. Avoid any sedating medications. Read the labels very carefully. If you're on antihistamines that are sedating, that could be a problem. Don't drink before you drive, and if you're really sleepy and you need to get someplace, get a ride home, or have your parents pick you up, or take a taxi, or use public transportation.
And then if you have symptoms of a sleep disorder such as snoring or daytime sleepiness, you need to talk to your doctor about getting evaluated and options for treatment, because you may have a disorder such as sleep apnea that could be causing the drowsiness.
Now once you're on the road, the way you can remain alert while driving and prevent a crash from happening, is if you're on a long trip, and once you're on the road, try and take a break every hundred miles, or every two hours or so. If you're traveling with somebody, switch drivers. And you know, drowsy drivers often feel that they could roll down the window, they could just have cold air blow at their face, or sometimes I've heard patients say they slap themselves in the face, or they chew gum, or they turn the radio on. But none of these are actually really proof to be helpful. It's very, very important to recognize the signs of drowsiness when you're on the road, or even before you get in the car, and just absolutely refuse to drive if you're sleep deprived. It's that simple.
And if you're already behind the wheel and you realize that you're nodding off, and you're a long way away from home, find the nearest rest area and pull over. You cannot continue driving, you just have to pull over, and drink some coffee to keep yourself alert before you take a short nap, maybe a twenty minute or thirty minute nap to get the benefits of both the caffeine and the nap before you can start driving again. And if you're still sleepy, you just need to find the nearest motel and check in there, especially if you're driving through the night.
So really the motto should be never push yourself. Drive alert, and make sure that you arrive alive on the other end. There are also these road signs that are going to be- they're the whole week. You pay attention to these, because they actually warn you against the perils of drowsy driving, and I wish they were there the whole year actually.
And then lastly, there are some- the automobile industry is coming up with some alerting technologies. Some of the cars have a steering wheel angle called a tension assistant and other gizmos out there that are geared towards prevention of drowsy driving related accidents.
Melanie: It's great information, and so important for people to hear, and they can listen to this podcast before they go driving so that they will not get drowsy, and make sure to be well-rested before you drive. Thank you so much, Dr. Bhola, for joining us today. This is Doc Talk presented by St. Luke's Cornwall Hospital. For more information, please visit www.StLukesCornwallHospital.org. That's www.StLukesCornwallHospital.org. I'm Melanie Cole, thanks so much for listening.