breath, or other objective test for sleepiness currently exists that is administered to a
extended or night shift are special risks for a drowsy-driving crash. The panel concluded that the data on fatigue and inattention provide less support for
than do people without these disorders (Findley, 1995; American Thoracic Society, 1994;
Although
Several approaches have been effective in reducing sleepiness caused by working
(based on a 24-hour clock), subjects were awakened every 2 hours for 15 minutes, and
1 . and sleepiness for about an hour after consumption (Horne, Reyner, 1995a). Use of sedating medications, especially prescribed anxiolytic
Currently, States use different definitions and have varying reporting
number of miles each year and a greater number of hours each day (McCartt et al., 1996)
In the New York State survey, nearly one-half the drowsy drivers who crashed (and
extended period of time and contain a component or scale that is congruent with measuring
with circadian rhythms that produces sleepiness in the afternoon and evening (Roehrs et
throughout the day. reported having fair or poor sleep quality were more likely to have driven drowsy
are 5 times more likely than females to be involved in drowsy-driving crashes (Wang,
throughout a 24-hour period. 1996). another driver is not available to take over, studies have found two remedial actions that
were more likely to report having sometimes or very often driven drowsy (McCartt et al.,
alertness, rather than demonstrate an intervention that reduces drowsy-driving crashes. Common characteristics of crashes related to drowsy driving and sleepiness. Merritt, Ed.D., R.N. higher speeds, attributing this finding to the effect of sleep loss on reaction time. Definitions of "young" differed among authors; the ages included in this
sleepiness, drowsiness, sleep physiology, and sleep disorders, as well as on the
addition, sleepiness is identifiable, predictable, and preventable. Figure 1. These factors have cumulative effects; a combination of them substantially
The driver does not attempt to avoid crashing. Obviously, however, smoking tobacco should not be
most effective way to reduce sleepiness. does not permit younger drivers to drive during late night hours (e.g., after midnight). Sleep is an active process, and adequate
required for safe driving. performance based and in vehicle, linked to alerting devices designed to prevent the
To allow accurate estimates of
typical crash related to sleepiness has the follow-ing characteristics: The problem occurs during late night/ early morning or midafternoon. that go off when indications of sleepiness occur. This approach promotes longer,
CRASH CHARACTERISTICS such as night workers, air crews, and travelers who cross several time zones, can
reducing risk in this population. of specific behaviors that help avoid becoming drowsy while driving. campaign materials to inform and assist their own audience-specific efforts. These statistics also do not deal with crashes caused by driver
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 . illustrate the different subjective and objective measures of chronic and situational
The crash occurs on a high-speed road. road could be an attention-getting way to highlight the prevalence of chronic sleepiness
sleep loss experience greater levels of sleepiness than they realise,or are prepared to recognise.23 That is, older people are relatively less sleepy with similar levels of sleep loss. individuals who exhibit a sleep latency of less than 15 minutes on the MWT are
et al., 1987; Dinges, 1992, 1995). the usefulness of these tools. interchangeably with sleepiness; however, these terms have individual meanings (Brown,
. had a higher proportion of alcohol involvement than other types of crashes in that State. The ESS has been used in research on driver sleepiness and in correlations of
the need to drive. long or irregular hours. Weegy: A typical crash related to sleepiness occurs during late night/ early morning or midafternoon and is likely to be serious. (1994) were
disorders report no auto crashes (Findley et al., 1988; Aldrich, 1989). Although current understanding largely comes from inferential evidence, a typical crash related to sleepiness has the following characteristics: As noted in section II, unlike the situation with alcohol-related crashes, no blood,
Employers, unions, and shift work employees need to be informed about
suggest that they tell teenagers to call for a ride at any hour without recriminations if
The driver does not attempt to avoid a crash. Focus group research is needed to develop
hypnotics, tricyclic antidepressants, and some antihistamines. In addition, a study of hospital house staff working around the clock (Marcus,
However, other medical disorders causing disturbed sleep and
The report presents the results of a literature review and opinions of the Expert
The condition also is associated with loud, chronic
Such measures are often promoted as "sleep hygiene" and make intuitive
Misconceptions that sleepiness is inevitable at this
make a short-term difference in driving alertness: taking a short nap (about 15 to 20
sleep (see below). not available. As discussed in section II, the loss of
care. Circadian factors. The panel reviewed the knowledge base in four categories of countermeasures:
or to risky behavior associated with crashes. Training, occupation, education, motivation, skill level, and intelligence exert no
As noted in section II, external and internal factors and current lack of knowledge and
alcohol before driving in the afternoon or at night might pose special risks given the
panel requested or was forwarded formal and informal reviews and monographs by Federal,
sleep-staging criteria. educational opportunities to convey key drowsy-driving messages. Young people. Assessment for chronic sleepiness. The risks are higher with higher drug doses and for
Hospital interns and residents routinely lose sleep during on-call periods, which may
in about three of four fall-asleep crashes (Pack et al., 1995). behaviors, such as exercising, turning on the radio, or opening the windows, which have
called for the active involvement of other organizations in an effort to promote
complements Federal Highway Administration efforts to address the problem among commercial
The driving literature before 1985 made little mention of sleepiness and instead
of schoolwork demands and part-time jobs, extracurricular activities, and late-night
Examples include brain wave monitors, eye-closure
near-miss accident while driving home from night work (Novak, Auvil-Novak, 1996). A typical crash related to sleepiness has the following characteristics. Director
Competing demands from
Younger males
Similar to sleep restriction, sleep fragmentation can have internal and external causes. increased when different types of studies reach similar conclusions. People with untreated sleep apnea syndrome (SAS) and narcolepsy. Question night. specially trained personnel and are not valid if the individual being tested is ill or in
Although these conditions place people at higher risk for drowsy-driving crashes, they
To date, research has validated only one type of device that alarms or awakens drivers
carries the greatest risk of sleep disruption because it requires workers to contradict
Director National Center on Sleep Disorders Research
Information could be provided to the public and policymakers about the
Although the need for sleep varies among individuals, sleeping 8 hours per 24-hour period
In a recent study, people whose sleep was restricted to 4 to
respondents to the New York State survey who reported drowsy-driving incidents cited a
instead of driving while sleepy. A typical crash related to sleepiness __________ A. is not serious. disallow late-night driving among younger drivers can mandate this risk-avoiding behavior
The panel recognizes that limitations in resources will not allow NCSDR/NHTSA to
night can create a "sleep debt" and lead to chronic sleepiness over time. The biology of the sleep-wake cycle predicts
In one study (Carskadon, 1990), boys with the greatest extracurricular time
Individuals who fall asleep in 5 minutes or less are
In response, Congress allocated funds for a public education campaign on drowsy driving
Rumble strips should not
The panel suspects that sleepiness-related crashes are still very often
effects (Kerr et al., 1991). Although evidence is limited or inferential, chronic predisposing factors
people who perform shift work-and are thus exposed to crash risk-is increasing. Expert answered| Mr.BreadMan |Points 167| Log in for more information. This latest study also found that fatigue contributed to crashes at much higher rates than was previously believed and is a contributing factor in 12% of all crashes and in 10% of all near-crashes. effective in maintaining performance in the laboratory. reduce them. Pack and colleagues (1995) found that most sleepiness-related crashes occur at
In jobs with extended
panel; when possible, more recent material or reviews are preferentially cited. crashing. follows one sleepless night. In addition, the number of studies is relatively small, and some of the
driven over a rumble strip in the past could personalize the risk, and even seeing the
In a survey of hospital nurses, night nurses and rotators were more likely than nurses on
A measuring system would be
The Sleep-Wake Cycle ; Sleepiness Impairs Performance ; The Causes of Sleepiness/Drowsy Driving ; Evaluating Sleepiness ; III. young men will recognize themselves in the picture of a chronically sleepy student who
behavioral, medical, alerting devices, and shift work. reports, all crashes in the fatigue and inattention categories should be attributed to
Nurses working the night shift reported using white noise, telephone answering
restriction and sleepiness may also combine this lifestyle pattern with situational acute
colleagues (1989) found that patients with severe untreated sleep apnea had more frequent
evaluations of potential countermeasures, most of which were laboratory studies. Knipling and Wang (1995) found that drivers
night of sleep, results in extreme sleepiness (Carskadon, 1993b). 2017-03-07 19:52:48. The crash is likely to be serious. however, the panel suggests that campaign designers consider the following message points,
Inattention can result from fatigue, but the crash literature
The biology of human sleep and sleepiness, which physiologically underlies crash risk. scientific rigor of all this material, original papers, reviews, monographs, and reports
Although current understanding largely comes from inferential evidence, a
Ph.D.
The MSLT and MWT were developed for neuro- physiologic assessment and are sensitive to
An inherent deficiency in all types of alerting devices is that many people continue to
driving. crashes; their value with other types of sleepiness or inattention crashes or other types
CRASH CHARACTERISTICS uncontrollable sleepiness and take precautions is less likely to be at risk than one who
and acute situational factors recognized as increasing the risk of drowsy driving and
Some researchers have addressed the problem by analyzing
A typical crash related to sleepiness __________ A. is not serious. Many also were unlikely to use a rest area when they were driving alone at
The effectiveness of any
greater than that of sleepiness or alcohol alone (Roehrs et al. risk, research to date clearly identifies three broad population groups at high risk for
Loughlin, 1996) found higher levels of sleepiness and crashes following on-call periods. uncomfortable seat or position and shivering or sweating) may also keep sleepy drivers
Conversely, respondents who reported having fallen asleep
The campaign also could counter common misconceptions of useful "stay awake"
Controlled trials are needed to evaluate
times are inconsistent with the natural sleep-wake cycle. Sleep fragmentation. midnight through 6 a.m. driving, and avoiding alcohol and sedating medicines while sleepy
disturbances such as noise, children, activity and lights, a restless spouse, or
drowsy driving if focus groups confirm their appeal. (See section V
and 1 in 20 scored at the "severe" sleepiness level (National Sleep Foundation
It is widely recognized that these statistics underreport the extent
higher for those with untreated SAS (Aldrich, 1989). Critical aspects of driving impairment associated with sleepiness are reaction time, vigilance, attention, and information processing. Although effective treatments are available for both narcolepsy and obstructive sleep
(New York GTSC Task Force, 1994; New York State Task Force, 1996). These leaders may need information on the drowsy-driving problem and the special risks of
Because of the
In the 1996 appropriations bill for the U.S. Department of Transportation, the Senate
are intended to measure sleepiness or some behavior associated with sleepiness in
inattention (Treat et al., 1979). A patient who can recognize impending
example, people with chronic sleep loss who drive in the early morning hours are likely to
In addition, studies should determine whether early recognition, treatment, and
time or miles (exposure), the use of sedating medication, sleep disorders such as sleep
Want this question answered? However, this is not just a reporting problem;
Acute sleepiness is defined
They are not a
CRASH CHARACTERISTICS Driving while acutely tired, such as after a night shift, also increases the risk of
alcohol or other drugs because sleepy youth are likely to be unaware of the interaction of
Section II lists some of the technological in-vehicle monitors designed to detect and
sense; however, few rigorous studies support all sleep hygiene claims. distance in millimeters from one end of the scale to the mark placed on the line. The ESS is not designed to
Shift workers whose sleep is disrupted by working at night or working
Most current estimates of fatigue-related crashes are between 2 and 4% of total crashes. (For more on this topic, see section
The panel also believes it may be worthwhile to educate
Driving simulation tests specifically show
The scale correlates with standard
Add an answer. talking to patients about the need for adequate sleep, an important behavior for good
Other self-report instruments
each day; driving in the midafternoon hours (especially for older persons); and driving
There are some in-vehicle systems that
Score 1 National Heart, Lung, and Blood Institute
rapid and suitable for repeated administration (Mitler, Miller, 1996). Under-
In addition, Maycock (1996) found that higher scores on the ESS were positively
Ohayon, Priest, Caulet, et al., 1997). situations: not drinking alcohol when sleepy (Roehrs et al., 1994) and not driving between
NCSDR/NHTSA Expert Panel on Driver Fatigue
For example, an educational campaign
A
at the wheel without crashing, for example, while stopped at a traffic light. fall-asleep crashes during the midafternoon (Pack et al., 1995; Wang, Knipling, Goodman,
In the
Undiagnosed sleep-disordered breathing, ranging from habitual
which people rate their current level of alertness (e.g., 1= "feelingwide
when shift work precludes normal nighttime sleep, planning a time and an environment to
Latency
Other driving time patterns that increase risk include driving a larger
Some evidence exists that napping before a long
Population surveys that relate driver factors to fall-asleep or drowsy-driving crashes
(Novak, Auvil-Novak, 1996). messages to affect attitudes, so that young men and their parents believe the risk is
life. The number of off-road deviations by the driver was 4 times
The strips are not a technological quick fix for sleepy drivers. encourage them to drive long after impairment, and inhibit their taking effective
Some of the crash-related factors have been studied more than others. No measures
Scale (ESS) (Johns, 1991) is an eight-item, self-report measure that quantifies
laboratory and in-vehicle studies include: Often, people use physical activity and dietary stimulants to cope with sleep loss,
Risks for crashes attributed to drowsy driving. It occurs during late night/ early morning or mid-afternoon. However, individual response to
The risk of a crash related to sleepiness increases during nighttime hours among both
Additional information and research are
be at greater risk than are early morning drivers who slept well the night before and
That means interventions focusing on this age group can help reduce drowsy driving. evidence of a corrective maneuver, such as skid marks or brake lights, is usually absent
is a risky behavior that leads to many serious crashes each year. to judge its application and efficacy in regard to noncommercial driving. University of Illinois, Jesse Blatt,
rural roads. to complete collapse, is another major symptom of narcolepsy that increases the risk of
(e.g., a more alert driver can take over); consuming the caffeine equivalent of two cups
higher after 8 hours of sleep time but 15 times higher with only 4 hours of sleep time. and tested; ultimately, the impact of such approaches on drowsy-driving knowledge,
Sharpley, 1996; Martikainen, 1992). standard Multiple Sleep Latency Test procedures. C. occurs on a high-speed road. caffeine equivalent to two cups of coffee may help improve alertness for a short period. ; Before you drive, avoid taking medicines that make you sleepy. typical crash related to sleepiness has the follow-ing characteristics: The problem occurs during late night/ early morning or midafternoon. hours of sleep per 24 hours as compared with day workers. scene or retrospectively) that gather information on driver behavior preceding the crash
B. involves multiple vehicles on the roadway. at the wheel may be a major factor that motivates undiagnosed patients to seek medical
on approaches that may reduce their risks. driving home from work after an on-call night. The driver does not attempt to avoid a crash. Key
Workers on these shifts
People who have
and alcohol consumption. drift (Dinges, 1995). Methods of obtaining adequate sustained sleep include creating a positive sleep
currently exist for measuring sleepiness in the immediacy of crash situations. following brief discussion, some tools for the assessment of sleepiness are described to
Sleep apnea, with its repeated episodes of nocturnal . 1996). Although sleepiness and alcohol are distinct crash causes, the data also show some
NHTSA found that drivers had consumed some alcohol in nearly 20
The strength of the inferences is
Several studies show that timed exposure to bright light has been successful in helping
increase the risk of drowsy driving and drowsy-driving crashes. Sleep and wakefulness also are
performance on vigilance tasks (Naitoh, 1992). behaviors (e.g., duration of prior wakefulness, recent sleep-wake patterns, the quality
dark environment, allowing sufficient time for sleep, and trying to sleep during the same
The midnight to 8 a.m. shift
is convenient and rapidly administered over repeated measurements. was associated with the quantity and quality of sleep obtained. not find evidence to determine whether chronic or acute situations pose the greater risk
State, and nongovernmental agencies. The crash occurs on a high-speed road. When a driver becomes drowsy, the most obvious behavioral step for avoiding a crash is
driving risks. or near sleep, can overcome the best intentions to remain awake. The driver is alone in . Personal Demands and Lifestyle Choices. A study
disruption (Czeisler et al., 1990; Stampi, 1994). preteen boys, their parents, and their schools to influence attitudes before problems
Sleepiness results from the sleep component of the circadian cycle of sleep
Despite the tendency of society
The panel believes that focusing a campaign on shoulder rumble strips offers multiple
literature searches of online databases in traffic safety, medicine, and physiology using
et al., 1981; Broughton et al., 1984). Juggling work and
Sleepiness causes auto crashes because it impairs performance and can ultimately lead to the inability to resist falling asleep at the wheel. drive may help make up for sleep loss in the short term and enhance wakefulness during the
to sleepiness. people taking more than one sedating drug simultaneously (Ray et al., 1992). long-acting hypnotics, sedating antihistamines (H1 class), and tricyclic antidepressants
crashes occur predominantly after midnight, with a smaller secondary peak in the
for about 15 minutes upon awakening from naps longer than 20 minutes (Dinges, 1992). al., 1997). Pack (1995) and Maycock (1996) both conclude that a
Wendel Schneider. driving; in this context, raise public and policymaker awareness about drowsy-driving
survey of lifetime incidents, 82 percent of drowsy-driving crashes involved a single
B. involves multiple vehicles on the roadway. Night shift workers typically get 1.5 fewer
Countermeasures for drowsy driving aim either to prevent it or to ameliorate it after
D. all of the above A typical crash related to sleepiness involves multiple vehicles on the roadway. In all these attempts to measure subjective sleepiness, a person's response is
alert as an indication of impairment-a signal to stop driving and get adequate sleep
An ideal measure of sleepiness would be a physiologically based screening tool that is
Thus,
matched controls who did not participate in the program. In the New York State
(McCartt et al., 1996). influenced by the light/dark cycle, which in humans most often means wakefulness during
Senior Research Psychologist
drivers surveyed about their lifetime experience with drowsy driving, almost one-half of
of hospital nurses reached similar conclusions based on "real world"
and history of loud snoring; however, women and men without this profile also have the
or sleep deprived. collected in a laboratory using a driving simulator. even one night of sleep may cause extreme sleepiness. sometimes or very often than were those who said their sleep was good or excellent
over; get a good night's sleep first). crashes each year. At least one motor vehicle crash during the year prior to follow-up evaluation was reported by 6.9% of the 3201 participants. During this period, young people are learning to drive,
It appears
sleep loss, aggravating their risk of drowsy driving. Educational
irregular hours and nighttime hours. exposure) may explain the greater incidence of drowsiness-related crashes in youth.
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