before bedtime) (Richardson et al., 1982; see figure 1). 1994). instead of sleep, and work hours and demands are a major cause of sleep loss. not been shown to prevent sleep attacks. management of sleepiness and sleep disorders reduce crash risk or incidence. The panel identified three major categories in which more evidence is needed: Quantification of the problem. Sleepiness causes auto crashes because it impairs performance and can ultimately lead to the inability to resist falling asleep at the wheel. Some safety experts have expressed
Laboratory studies using a driver simulator or performance tests that examine the
literature searches of online databases in traffic safety, medicine, and physiology using
Sleepiness leads to crashes because it impairs elements of human performance that are
latency of return to sleep was measured. (McCartt et al., 1996). The average fatality in an alcohol-related traffic crash costs $1.1 million. Because of the
In lieu of an objective measure Contemporary society functions 24 hours a day. breath, or other objective test for sleepiness currently exists that is administered to a
Division of Pulmonary and Critical Care Medicine
Laboratory tools for measuring sleepiness include the Multiple Sleep Latency Test
A single vehicle leaves the roadway. currently exist for measuring sleepiness in the immediacy of crash situations. without crashing were less likely to have been alone in the automobile. effective alerting device may prevent one crash, a driver who falls asleep once is likely
noncommercial crashes, investigators have begun to collect and analyze data for instances
approximately every 24 hours. sleep disrupt and fragment sleep. is instructed to try to fall asleep. Self-reports from drivers involved in crashes (with data collected either at the crash
alertness, rather than demonstrate an intervention that reduces drowsy-driving crashes. manner by which law enforce- ment officers can assess and report crashes resulting from
impaired to drive safely. may rely on surrogate mea- sures of sleepiness, such as duration of sleep in a recent
categorically too sleepy to drive a motor vehicle (Mitler, Miller, 1996). drive even when they know they are drowsy and fighting to stay awake. Wakefulness Test (MWT) (Mitler et al., 1982). Pack and colleagues (1995) found that most sleepiness-related crashes occur at
because the well-established risks substantially outweigh the possible benefits. Naitoh (1992)
drowsy driving if focus groups confirm their appeal. Undiagnosed sleep-disordered breathing, ranging from habitual
The report presents the results of a literature review and opinions of the Expert
Score 1 User: There were more than__________ people injured in alcohol-related crashes in Florida. Successful strategies from drinking and driving campaigns might also be adapted to
In
Although these conditions place people at higher risk for drowsy-driving crashes, they
however, the panel suggests that campaign designers consider the following message points,
Panel members noted the possibility that more crashes occur on
panel; when possible, more recent material or reviews are preferentially cited. assessments of noncommercial crashes. minutes) and consuming caffeine equivalent to two cups of coffee. It is possible that the effects of low levels of blood alcohol may have an interaction
and affect other performance variables), mechanical problems, or other factors and by
facilitate napping for night shift workers (Dinges, 1992; Naitoh, 1992). roadways with speed limits of 55 to 65 mph (Knipling, Wang, 1994; Wang, Knipling, Goodman,
Homeostasis relates to the neurobiological need to sleep; the longer the period of
For example, an educational campaign
studies do not represent large numbers of crashes or feature crash numbers or frequency as
drowsiness peaking from late evening until dawn (Wylie et al., 1996). Policymakers also may
In all these attempts to measure subjective sleepiness, a person's response is
shift, including evening, night, rotating, split, and irregular shifts (Kessler, 1992). a.m.; driving a substantial number of miles each year and/or a substantial number of hours
encourage them to drive long after impairment, and inhibit their taking effective
Caffeine also is available
they feel too sleepy to drive. annually on average from 2009 to 2013, there were over 72,000 police-reported crashes involving drowsy driv - . Want this question answered? British study (Maycock, 1996), respondents said that working the night shift led to
begin. Police crash reports are the traditional source of information on crash-related behaviors. Externally,
However, unlike the situation with alcohol-related crashes, no blood, breath, or other measurable test is currently available to quantify levels of sleepiness at the crash site. crash reports in North Carolina showed the majority of the nonalcohol, drowsy-driving
performance measures, is sensitive to sleep loss, and can be administered repeatedly
Studies were performed in the morning
specially trained personnel and are not valid if the individual being tested is ill or in
daylight and sleep during darkness. can be" (right end). interfering with circadian sleep patterns. attitudes about sleep cause many Americans to get inadequate sleep either occasionally
initiatives, the panel recommended the following three priority areas: Educate young males (ages 16 to 24) about drowsy driving and how to
A number of studies indicate that using certain medications increases the risk of
night. driving patterns that disregard the normal sleep-wake cycle or represent driving increased
sense; however, few rigorous studies support all sleep hygiene claims. Economic pressures and the global economy place increased demands on many people to work
The driver does not attempt to avoid crashing. number of miles each year and a greater number of hours each day (McCartt et al., 1996)
CRASH CHARACTERISTICS Training, occupation, education, motivation, skill level, and intelligence exert no
sufficient sleep-as a public health benefit as well as a means to reduce the risk of
or relevant work, sleep, and other lifestyle habits. in developing successful educational approaches. long-acting hypnotics, sedating antihistamines (H1 class), and tricyclic antidepressants
The sleep-wake cycle is governed by both homeostatic and circadian factors. significantly improves alertness in sleepy people (but only marginally in those already
1 . Consuming
other shifts to report nodding off at work and at the wheel and having had a driving
a better understanding of young men's perceptions of fall-asleep crash risk and the kinds
psychophysiologic, and crash-prevention domains. The crash is likely to be serious. of specific behaviors that help avoid becoming drowsy while driving. The MSLT mea- sures the tendency to fall
Shift workers, many of whom are already chronically sleep deprived, are at extra
combination of chronic and acute factors substantially increases crash risk. driving during this period for all drivers and especially for younger ones. required for safe driving. 1988), listening to the car radio, or opening the car windows (Horne, Reyner, 1995a). excessive daytime sleepiness could pose risks. Consumption of alcohol, which interacts with and adds to
in people with cognitive or attention performance impairments such as those from
Sleep is a neurobiologic need with predictable patterns of sleepiness and
Personal Demands and Lifestyle Choices. You can take effective steps if you become sleepy while driving. Characteristics of Drowsy-Driving Crashes, V.
defined. socializing, preparing for a trip or vacation, and "pulling all nighters" are
causes of sleepiness and drowsy driving in people without sleep disorders are sleep
lifestyle-related risks. Information could be provided to the public and policymakers about the
Sleepiness, also referred to as drowsiness, is defined in this report as the need to
The minimum dose needed can be obtained in about two cups of percolated coffee,
These drivers were four times more
Deprivation, Figure 4. risks and how to reduce them. and driving a longer time without taking a break or, more often, driving for 3 hours or
symptoms to diagnosis of narcolepsy averages 10 years (American Thoracic Society, 1994;
Risks. crashes than did those with untreated mild apnea. behavioral, medical, alerting devices, and shift work. . of alcohol, and the combination adversely affecting psychomotor skills to an extent
which people voluntarily adhere or can decide to ignore. The VAS is scored by measuring the
messages to affect attitudes, so that young men and their parents believe the risk is
between 4 a.m. and 7 a.m. also may lead to sleepiness. External factors, some beyond the individual's control, include work hours, job and
asleep in a standardized sleep-promoting situation during four or five 20-minute nap
crash. is long. restricting sleep by 1 or 2 hours a night can lead to chronic sleepiness. to reduce the likelihood of excessive sleepiness and drowsy driving. NHTSA General Estimates System data reflect the
at high risk are young people, shift workers, and people with untreated sleep conditions. or A typical crash related to sleepiness occurs on a high-speed road. amenable to change. respectively (Pack et al., 1995). complexity of the issues involved (Rosekind et al., 1995), a combination of alertness
category for reporting sleepiness as a crash cause. When this approach is not practical and
In addition to getting adequate sleep before driving, drivers can plan ahead to reduce
disorder of the sleep-wake mechanism that also causes excessive daytime sleepiness. How does a crash relate to sleepiness? pastimes often leave little time left over for sleeping. time in bed does not mean that adequate sleep has been obtained. As discussed in section II, the loss of
The time from onset of
roads in nonurban areas. 1994; Wilkinson, 1968;
(Kozena et al., 1995; Van Laar et al., 1995; Ray et al., 1992; Leveille et al., 1994;
followup survey, three of four Americans who reported getting as much or more sleep than
Potential sponsors may
as a need for sleep that is present at a particular point in time. In a 1997
Horne and Reyner (1995a) suggest that a combination of having more of the chronic and
management approaches is likely to be most effective. purpose and meaning of shoulder rumble strips, which alarm or awaken sleepy drivers whose
job-related duties (e.g., workers who are on call) can interrupt and reduce the quality
Several studies show that timed exposure to bright light has been successful in helping
a fairly clear picture emerges from studies conducted to date of the typical crash related
only those crashes known not to be caused by alcohol (because alcohol can cause sleepiness
near-miss accident while driving home from night work (Novak, Auvil-Novak, 1996). who are drowsy or asleep-shoulder rumble strips placed on high-speed, controlled-access,
In addition, the number of studies is relatively small, and some of the
to judge its application and efficacy in regard to noncommercial driving. The MSLT and MWT were developed for neuro- physiologic assessment and are sensitive to
Score .9915 User: The effect that an emotion has on your ability to drive depends upon the . al., 1997). 1996; Langlois et al., 1985; Lavie et al., 1986; Mitler et al., 1988; Horne, Reyner 1995b;
Critical aspects of driving impairment associated with sleepiness are reaction time, vigilance, attention, and information processing. The panel conducted
found that short naps every 6 hours during a 35-hour (otherwise sleepless) period was
Regularly losing 1 to 2 hours of sleep a
Promote shoulder rumble strips as an effective countermeasure for drowsy
one-third of drivers had needed or wanted to stop in the past year, but a rest area was
carries the greatest risk of sleep disruption because it requires workers to contradict
driven over a rumble strip in the past could personalize the risk, and even seeing the
of roads has not been studied. complements Federal Highway Administration efforts to address the problem among commercial
technology, alerting devices, industrial accidents, and shift work). Pack (1995) and Maycock (1996) both conclude that a
However, when they sit still, perform repetitive tasks
A single vehicle leaves the roadway. The resulting report outlines the following: In addition to summarizing what is known-and what remains unknown-from sleep and
most effective way to reduce sleepiness. experience sleep loss and sleep disruption that reduce alertness (kerstedt, 1995b; Samel
colleagues' study (1995), 20 was the peak age of occurrence of drowsy-driving crashes,
However, focus groups of youth in New York State revealed that drowsy-driving
The return to day work and morning shifts starting
was reported by police to have fallen asleep and the characteristics of the sleepy driver. However, it is clear that these factors are cumulative, and any
Sleep Loss ; Driving Patterns ; The Use of Sedating Medications ; Untreated Sleep Disorders: Sleep Apnea Syndrome and Narcolepsy masking their level of sleepiness. passenger, talking on a cellular phone or CB radio, chewing gum or ice, or snacking. an outcome measure. As noted earlier, the circadian pacemaker