After years of public education campaigns, it's practically common sense that drinking and driving don't mix.
But scientists say that motorists, physicians and government officials all need to realize that sleepy drivers can be just as deadly as drunk drivers.
Public health officials should devote more education and research to protect American drivers from falling asleep at the wheel, says a report published recently in the Journal of the American Medical Association (JAMA). And physicians, the study adds, must help prevent sleep-related accidents by identifying symptoms of fatigue or sleep deprivation.
The report was compiled by the AMA's Council on Scientific Affairs, whose members searched through several databases for articles related to drowsiness and driving from 1975 to 1997.
"Our main goal was to identify the factors that put people at special risk and to help people understand those risks," said Ronald Davis, chair of the Council on Scientific Affairs.
THOSE AT RISK
|
 Sleep-deprived drivers.
People who travel long distances without breaks.
Drivers who travel through the night or at other times when they are normally asleep.
People who drink alcohol or take medication that increases sleepiness.
People who drive alone. Drivers on long, rural, boring roads.
Frequent travelers, such as business travelers.
Young people.
Shift workers.
Commercial truck drivers.
People with undiagnosed, untreated sleep disorders.
Source: National Sleep Foundation -- Washington Post
|
Although drowsy driving has been directly linked to only 1 percent to 3 percent of the country's 6.8 million motor-vehicle accidents each year, the researchers and other highway-safety advocates said they believe the actual number is much higher. A recent survey of more than 1,000 Americans by the National Sleep Foundation found that 57 percent of the people they polled had driven while drowsy in the past year, and 23 percent had fallen asleep at the wheel.
"There is an under-reporting of sleep-related accidents because most people don't remember that they fell asleep at the wheel," says Dr. Virgil Wooten, director of the Sleep Disorders Center of Greater Cincinnati at Bethesda Hospital, Avondale, and Federal Aviation Administration (FAA) medical examiner studying fatigue and sleep disorders in pilots.
Near-death experiences
Sleep researcher Dr. Martin Scharf, director of the Tri-State Sleep Disorder Center in Springdale, agrees with JAMA's report that the risks that tired drivers pose to public safety are greatly underrated.
"I do a lot of public speaking, and I always ask the question, "Who here has nodded off while driving?' " Dr. Scharf says.
"Everyone raises their hands and laughs about it. I'll tell them, "Well, then, you've had a near-death experience. You only get one warning. The next wave of sleep in a situation like that comes on like a seizure. You're an accident waiting to happen.' "
Many people push themselves too hard and accumulate several hundred hours of sleep deprivation a year, he says. They're fatigued. Other people suffer from a variety of sleep illnesses, such as sleep apnea (a type of snoring that causes people to stop breathing for up to 10 seconds at a time) and narcolepsy (which causes suddensleep).
James Burks, 30, of Silverton, suffered from sleep apnea until surgery in June removed a blockage from the back of his windpipe. Before the operation, life was a tired haze, especially when he drove. One night, he fell asleep -- but did not crash -- while driving on Martin Luther King Drive. Ironically, he was heading home after visiting a sleep disorders clinic in Clifton.
His 15-minute commute to work at International Paper in Loveland was difficult. A free-lance writer, he had trouble staying awake at night to write.
"It was always extreme tiredness," he says. "I would wake up several times a night."
Mr. Burks had worked swing shift, regularly pulling first-, second- and third-shift duties in the same month for his previous employer. Even a switch to full-time day work at International Paper didn't help. Surgery finally corrected the problem.
Fatigue times
Mr. Burks' sleepiness didn't cause any auto accidents. The number directly attributable to fatigue is hard to track.
"The person doesn't either know or won't tell you," says Dr. Stephen Baxter, an emergency room physician at University Hospital. "It's easier to say "I swerved to avoid a deer' than to say "I fell asleep.' "
The type of crash can provide clues as to whether sleep was a factor, said Ricardo Martinez, an administrator with the National Highway Traffic Safety Administration (NHTSA). Sleep-related accidents often involve a single car that has driven off the side of the road during late-night or early-morning hours, he said.
The hours of maximum sleepiness are 2-7 a.m. and 2-5 p.m., according to the American Sleep Disorders Association and Sleep Research Society. These hours, which comprise exactly one-third of a day, accounted for 36.1 percent of fatal accidents and 41.6 percent of all accidents in 1988. Drivers should take a nap if they find themselves yawning every few seconds, their eyes closing without effort, or their car drifting to the side of the road and back. Common attempts to wake up, such as rolling down the window or turning up the radio, simply don't work, experts say. Caffeine is good for short-term alertness but will not decrease a person's physiological need for sleep.
After 14 years of struggling to stay awake as a commercial truck driver, Robert Goodfellow saw Dr. Scharf for help at Tri-State Sleep Disorder Center.
Mr. Goodfellow, 58, of Springfield, Ohio, was diagnosed with sleep apnea.
Even after a good night's sleep, "I'd be driving down the road and doze off," Mr. Goodfellow says. "I was fortunate to get off the road when I did."
He took an in-house job for the auto transport company for which he drove cross country. He now uses a device to increase breathing, but "I still have some problems when I drive my own van."
DANGER SIGNS
|
|
Be aware you may be too sleepy to be safe behind the wheel if:
Your eyes close or go out of focus by themselves.
You have trouble keeping your head up.
You can't stop yawning.
You have wandering, disconnected thoughts.
You don't remember the last few miles. You drift between lanes, tailgate, or miss traffic signs.
You keep jerking the car back into the lane.
You have drifted off the road and narrowly missed crashing.
Source: AAA Foundation for Traffic Safety
|
No fooling biology
The NHTSA, along with the National Center for Sleep Disorders Research, is planning to release a comprehensive report about drowsiness and driving later this summer. The NHTSA has also just launched a pilot program to award grants to states that plan to address the problem of fatigue and drowsy driving among shift workers, said spokesman Rae Tyson.
Dr. Wooten of the Greater Cincinnati sleep disorders center says that an Australian study shows shift workers are often just as impaired behind the wheel as drivers who use alcohol.
"We're often called on by industry and asked to find ways to trick the biology," Dr. Wooten says. "We need to get government and industry to understand you can't change it. The light-dark cycle has been entrenched in our nervous system for thousands of years." States around the country are addressing the problem by installing rumble strips on interstate highways.
Rumble strips are half-inch-deep grooves in the pavement between the highway and the shoulder. When a car drifts too far to the edge of the road and rolls over the rumble strips, it makes a loud noise and heavy vibration inside the car that can awaken a sleeping driver. The strips have been credited with reducing off-the-road crashes in the areas where they're used by up to 70 percent.
The Washington Post contributed to this report.
