wakefulness, the more pressure builds for sleep and the more difficult it is to resist
The panel reviewed the knowledge base in four categories of countermeasures:
useful. Among New York State
typical patients tend to be overweight and middle aged or older, with a large collar size
impairment that could assist investigating officers in attributing a crash to sleepiness. categorically too sleepy to drive a motor vehicle (Mitler, Miller, 1996). Despite these caveats,
Although this evidence does not demonstrate a conclusive association between shift work
Training, occupation, education, motivation, skill level, and intelligence exert no
Although evidence is limited or inferential, chronic predisposing factors
In a recent study, people whose sleep was restricted to 4 to
behaviors, such as exercising, turning on the radio, or opening the windows, which have
The recommended action is not to start a long drive after one
Weegy: A typical crash related to sleepiness occurs during late night/ early morning or midafternoon and is likely to be serious. alcohol before driving in the afternoon or at night might pose special risks given the
passenger, talking on a cellular phone or CB radio, chewing gum or ice, or snacking. You can take effective steps to reduce your risks. Driving patterns, including both time of day and amount of time driven, can increase
followup survey, three of four Americans who reported getting as much or more sleep than
NHTSA data show that males
drive. In
during late night/early morning hours increases risk for all drivers because those hours
For example, "asleep with
Findley and
Internal or personal
snoring to repeated breathing interruptions, also increases the likelihood of crashes in a
But, in addition, when alcohol involvement was combined with fatigue
message that rumble strips are designed to arouse sleepy drivers before they drive off the
Another effective approach is to allow and
Scale (ESS) (Johns, 1991) is an eight-item, self-report measure that quantifies
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. reported having fair or poor sleep quality were more likely to have driven drowsy
(For more on this topic, see section
Experimental evidence shows that sleeping less than 4 consolidated hours per night impairs
However, with increasing age, the daily peak of SRVAs seems to shift to later in the day, and among those drivers aged 50-69 it is in the early afternoon.21 Furthermore, a crash is likely to be an altering circumstance. Night-, early morning-, and rotating-shift workers are often sleepy because their work
roadways with speed limits of 55 to 65 mph (Knipling, Wang, 1994; Wang, Knipling, Goodman,
acute risk factors and frequently being on the roads during nighttime hours (greater
A single vehicle leaves the roadway. However, other medical disorders causing disturbed sleep and
group is high school age and more likely to live at home with parents; members of the
period when sleep is usual (Brown, 1994). road could be an attention-getting way to highlight the prevalence of chronic sleepiness
methodological detail, outcome measures, and other variables, all of which precluded a
false The rate of alcohol involvement in fatal crashes is higher at night than during the day. p.m. before a 4 a.m. shift) is 2 to 4 hours shorter than night sleep (kerstedt, 1995a). (based on a 24-hour clock), subjects were awakened every 2 hours for 15 minutes, and
suggest that they tell teenagers to call for a ride at any hour without recriminations if
Some evidence exists that napping before a long
The biology of human sleep and sleepiness, which physiologically underlies crash risk. differences in individual tolerance to shift work (Harma, 1993); knowing more about the
Self-reports from drivers involved in crashes (with data collected either at the crash
five men (20.2 percent) and almost one in six women (15 percent) work other than a daytime
also works part-time, participates in extracurricular activities, and has an active social
A typical crash related to sleepiness __________ A.) people (Horne, Reyner, 1995a; Dinges et al., 1987; Philip et al., 1997). According to the NHTSA, the combination of _____ and _____ reduce the risk of serious crash-related head injury by 83 . disallow late-night driving among younger drivers can mandate this risk-avoiding behavior
Other rating tools that measure an individual's experience with sleepiness over an
Younger males
Countermeasures include following effective strategies for scheduling shift changes and,
Napping has the greatest effect on performance several hours after the nap (Dinges
Based on the literature,
at the wheel may be a major factor that motivates undiagnosed patients to seek medical
Virtually all studies that analyzed data by gender and age group found that young
The MSLT and MWT were developed for neuro- physiologic assessment and are sensitive to
1988), listening to the car radio, or opening the car windows (Horne, Reyner, 1995a). Wilkins and colleagues (1997) confirmed that crashes attributed to driver fatigue have
of interventions that would be effective with this group. Although current understanding largely comes from inferential evidence, a typical crash related to sleepiness has the following characteristics: When this approach is not practical and
Retrospective studies that compare crash histories of drivers with sleep disorders with
not find evidence to determine whether chronic or acute situations pose the greater risk
reported in the categories of fatigue and inattention, and it reached consensus that
The driver is alone in . last 24 hours or more. As a result, our understanding of drowsy-driving crashes is based on subjective
before driving is both easier and much more successful than any remedial measure reviewed. People with narcolepsy are as likely to be
The effectiveness of any
scientific rigor of all this material, original papers, reviews, monographs, and reports
et al., 1995). Knipling and Wang (1995) found that drivers
in people with cognitive or attention performance impairments such as those from
The problem occurs during late-night hours. al., 1997). also identifies preoccupation, distractions inside the vehicle, and other behaviors as
example, people with chronic sleep loss who drive in the early morning hours are likely to
generally recommended in an educational campaign as a drowsy-driving countermeasure
Subjective and objective tools are available to approximate or detect
One in three of the adult
Panel members noted the possibility that more crashes occur on
Young people (ages 16 to 29), especially males. How does a crash relate to sleepiness? survey of lifetime incidents, 82 percent of drowsy-driving crashes involved a single
Externally,
Institutes of Health, and the National Highway Traffic Safety Administration (NHTSA), is
Maturational changes that increase the need for sleep. The crash is likely to be serious. head-on crashes (Knipling, Wang, 1994). (e.g., a more alert driver can take over); consuming the caffeine equivalent of two cups
Population Groups at Highest Risk, VII. The panel also designated shift workers as a high-risk group because the number of
Key
The reasons young males have more crashes than do young females
Sleepiness causes auto crashes because it impairs performance and can ultimately lead to the inability to resist falling asleep at the wheel. apnea syndrome (SAS) and narcolepsy. People also asked. identified a number of chronic predisposing factors and acute situational factors that
driving risk, surveys of the general population suggest that knowledge of the risk is
they feel too sleepy to drive. There is insufficient evidence at present
true Exceeding the speed limit or driving too fast for conditions is not a contributing factor in the vast majority of fatal motor vehicle crashes. The driver does not attempt to avoid a crash. In addition, a study of hospital house staff working around the clock (Marcus,
A patient who can recognize impending
CRASH CHARACTERISTICS In addition to getting adequate sleep before driving, drivers can plan ahead to reduce
NHTSA figures show that most drowsiness- or fatigue-related crashes occur on higher speed
Similar to sleep restriction, sleep fragmentation can have internal and external causes. A recent synthesis of reports on the effectiveness of rumble strips shows
In the New York State survey, nearly one-half the drowsy drivers who crashed (and
All factors may interact, and
disturbances, poor sleep quality often leads to daytime sleepiness. Sleepiness, also referred to as drowsiness, is defined in this report as the need to
Thus,
The driver does not attempt to avoid the crash. than do people without these disorders (Findley, 1995; American Thoracic Society, 1994;
without crashing were less likely to have been alone in the automobile. increase the risk of drowsy driving and drowsy-driving crashes. lifestyle-related risks. family responsibilities, combining work and education, and making time for enjoyable
have higher risks than do females or other age groups across all drug classes. ; Before you drive, avoid taking medicines that make you sleepy. Expert answered| Mr.BreadMan |Points 167| Log in for more information. Driving
sleep-deprived drivers who consumed caffeine reduced lane deviations, potential crashes,
The Stanford Sleepiness
dependent on both the presentation of the instructions and the subject's interpretation of
steps include planning sleep and naps before long trips, scheduling trips to avoid
circadian patterns in order to sleep during the day (Kessler, 1992). However, because SAS is more common than narcolepsy, the absolute number of crashes is
Laboratory studies using a driver simulator or performance tests that examine the
is common, and 7 to 9 hours is needed to optimize performance (Carskadon, Roth, 1991). Countermeasures for drowsy driving aim either to prevent it or to ameliorate it after
variety of reasons related to work patterns. Although people with untreated sleep apnea syndrome may not be aware of the brief
in which the driver may have fallen asleep. occupant (McCartt et al., 1996). The driver is alone in . Sleep is a neurobiologic need with predictable patterns of sleepiness and
crashes, on-the-job errors, and on-the-job personal injuries due to sleepiness) and more
Sleepiness leads to crashes because it impairs elements of human performance that are
apnea, relief of sleepiness and related symptoms is not always easily achievable for all
Other self-report instruments
Some of the crash-related factors have been studied more than others. The
literature searches of online databases in traffic safety, medicine, and physiology using
uninterrupted sleep, which may help reduce sleepiness on the job and behind the wheel. neurobiologically based sleepiness contributes to human error in a variety of settings,
They found only a few scientific
number of miles each year and a greater number of hours each day (McCartt et al., 1996)
Driving while sleepy
driving, a psychologically based conflict occurs between the disinclination to drive and
of the population with symptomatic sleep apnea (Strohl, Redline, 1996). CRASH CHARACTERISTICS A number of studies indicate that using certain medications increases the risk of
In addition, a higher reported frequency of
Relevant impairments identified in
Strohl, M.D. Reports
in developing successful educational approaches. whereas a rating of 15 or greater indicates severe sleepiness. the keywords listed above and following suggestions for linkage to related topics (e.g.,
If drivers
is not okay to drive when you are sleepy. found that short naps every 6 hours during a 35-hour (otherwise sleepless) period was
interchangeably with sleepiness; however, these terms have individual meanings (Brown,
In addition, Maycock (1996) found that higher scores on the ESS were positively
Consuming
Countermeasures. The resulting report outlines the following: In addition to summarizing what is known-and what remains unknown-from sleep and
rural roads. comprehensive review of these efforts is beyond the scope of the present report. nonalcohol-related crashes-fatalities occurred in 1.4 percent and 0.5 percent,
Be notified when an answer is posted. It also thanks Cathy Lonergan for logistical support. Undiagnosed sleep-disordered breathing, ranging from habitual
crashes (Pack et al., 1995; Horne, Reyner, 1995b; Maycock, 1996; Knipling, Wang, 1994). The ESS has been used in research on driver sleepiness and in correlations of
a fairly clear picture emerges from studies conducted to date of the typical crash related
and gatekeepers, such as industries where shift work is prevalent. management of sleepiness and sleep disorders reduce crash risk or incidence. likely to be low and awareness will need to be raised. of roads has not been studied. The Epworth Sleepiness
driving simulator performance (Findley et al., 1989), individual performance varies. driving drowsy was associated with working a rotating shift, working a greater number of
Effective countermeasures used to prevent drowsy driving and related crashes. irregular hours and nighttime hours. People whose sleep is out of phase with this cycle,
following: Shift work may increase the risk of drowsy-driving crashes. Educate shift workers about the risks of drowsy driving and how to
In the
had a higher proportion of alcohol involvement than other types of crashes in that State. those instructions. et al., 1981; Broughton et al., 1984). F. rom high-profile politicians and celebrities to the general population, people often
sleep can reduce sleep debt. In the more recent surveys and reporting of
Promote shoulder rumble strips as an effective countermeasure for drowsy driving; in
make a short-term difference in driving alertness: taking a short nap (about 15 to 20
evaluate driver sleepiness. asleep in a standardized sleep-promoting situation during four or five 20-minute nap
University of Illinois, Jesse Blatt,
Caffeine, even in low doses,
Many also were unlikely to use a rest area when they were driving alone at
diaries (Douglas et al., 1990) and the Sleep Disorders Questionnaire (Douglas et al.,
The three groups
NCSDR/NHTSA
Many Americans are unaware of the
of day was the most consistent factor influencing driver fatigue and alertness. Interaction between alcohol and sleepiness. needed on measures that increase or restore driver alertness or reduce crash risk or
shifts or more within a month) caused the most severe sleep disruptions of any work
hours per week, and more frequently driving for one's job (McCartt et al., 1996). What to do when awakened by driving over a rumble strip. The number of off-road deviations by the driver was 4 times
Drivers who reported having trouble staying awake during the day
Driving between midnight and 6 a.m. is a high-risk situation. hours of sleep per 24 hours as compared with day workers. These steps include stopping driving altogether, if possible; consuming the caffeine
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,
younger drivers (25 years of age and younger) and drivers between the ages of 26 and 45. The crash is likely to be serious. The
higher for people with untreated narcolepsy than it is for people with untreated SAS. greater than that of sleepiness or alcohol alone (Roehrs et al. timing of sleepiness and wakefulness. For example, those who
instead of driving while sleepy. subjective sleep measures in this scale show strong covariation and relation to sleep
higher proportion of the most serious crashes are sleepiness related. Sleep-Wake Activity Inventory (Rosenthal et al., 1993b). attitudes, and behaviors will need to be examined. The "all nighter" represents an acute risk because extreme tiredness
Recreational drug use also may exacerbate sleepiness
and alcohol consumption. occurs during the late-night hours. (Dinges, 1995). socializing. can make a short-term difference: Napping. Appropriations Committee report noted that "NHTSA data indicate that in recent years
commercial and noncommercial driving. The key to safety is what the driver does after hearing the
not been shown to prevent sleep attacks. risk. minutes) and consuming caffeine equivalent to two cups of coffee. CRASH CHARACTERISTICS Driving while acutely tired, such as after a night shift, also increases the risk of
defined. Several studies show that timed exposure to bright light has been successful in helping
strict comparison. Most adults need at least 7 hours of sleep a day, and teens need at least 8 hours. conditions are undiagnosed and untreated, unaware of the potentially serious consequences
fall asleep, a process that is the result of both the circadian rhythm and the need to
disruption (Czeisler et al., 1990; Stampi, 1994). incidence. The crash will likely be serious B.) people taking more than one sedating drug simultaneously (Ray et al., 1992). studies do not represent large numbers of crashes or feature crash numbers or frequency as
A typical crash related to sleepiness has the following characteristics. and acute situational factors recognized as increasing the risk of drowsy driving and
Examples include brain wave monitors, eye-closure
substitute for good sleep habits and should not be viewed as a "driving
asleep faster are sleepier. First, it
Drivers ages 45 through 65 have fewer nighttime
crash risk (Redelmeier, Tibshirani, 1997). It is widely recognized that these statistics underreport the extent
Administration (NHTSA) and the National Center on Sleep Disorders Research (NCSDR) of the
Division of Pulmonary and Critical Care Medicine
Nurses on rotating schedules reported more "accidents" (including auto
The crash is likely to be serious. Workers on these shifts
Sleep-restrictive work patterns. are 5 times more likely than females to be involved in drowsy-driving crashes (Wang,
Shift workers who completed a 4-month
risk, research to date clearly identifies three broad population groups at high risk for
recommended three priorities for the campaign. and crashes, the panel believes that shift workers' increased risks for sleepiness are
scene or retrospectively) that gather information on driver behavior preceding the crash
well with behavioral indicators of sleepiness; in other words, people with obvious signs
Narcolepsy is a
"sleepiness" in a continuum along a 100-mm line (Wewers, Low, 1990). Office of Research and Traffic Records
extended or night shift are special risks for a drowsy-driving crash. performance of persons with sleep disorders compared with a control group. Sleep and wakefulness also are
The characteristics of drowsy-driving crashes reported below resemble the inclusion
Rumble strips act as an alarm clock, alerting drivers to the fact that they are too
of driving while drowsy, or unaware of the seriousness of the difficulty they may
D. all of the above A typical crash related to sleepiness involves multiple vehicles on the roadway. life. colleagues' study (1995), 20 was the peak age of occurrence of drowsy-driving crashes,
alcohol" crashes involved a higher percentage of young males than did crashes in
with untreated sleep apnea syndrome (SAS) and narcolepsy. However, rumble strips are not a solution for sleepy drivers, who must view any wake-up
C. occurs on a high-speed road. collected in a laboratory using a driving simulator. commitments were most likely to report falling asleep at the wheel. Shift work also can disturb sleep by
Pack (1995) and Maycock (1996) both conclude that a
associated with crashes. To minimize disruption and help employees adjust to
Critical aspects of driving impairment associated with sleepiness are reaction time, vigilance, attention, and information processing. 1996).