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 in last week's Journal of the American Medical Association. 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.
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.
Compiling statistics on the role of sleep in accidents is difficult because there is no accurate way of measuring a driver's level of drowsiness or of estimating the role sleepiness played in a crash. But 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. 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.
Drowsy drivers also display the same sorts of driving patterns as drunk drivers, as a 1996 survey by the American Automobile Association Foundation for Traffic Safety revealed. The survey of more than 100 state troopers and highway-patrol officers found that every officer polled had stopped a motorist who appeared drunk only to find out that the driver was extremely fatigued.
"The same sort of social stigma needs to be applied to sleeping and driving as it is to drinking and driving," said Richard Waldhorn, medical director of the Georgetown University Sleep Disorders Center.
Officers who stop drowsy drivers will suggest ways to wake up and do not usually issue citations unless there's been an accident, said Lt. Col. Gerald Massengill of the Virginia State Police. He pointed out that there is no law that prohibits driving while fatigued.
"It's a difficult problem for law-enforcement agencies," Massengill said. "Most of us, including our judges and prosecutors, have upon occasions been tired at the wheel. All of us can relate to it. It's more solvable from an education and awareness standpoint."
Heidi Wunder, a spokeswoman for the National Sleep Foundation, agreed that health officials need to highlight the problem because many people do not recognize the danger of drowsy driving or take the issue seriously.
"Americans don't yet recognize the value of sleep overall," Wunder said. "Sleep is thought of as something you can do without. Taking a nap is a sign of weakness."
But taking a nap is exactly what drivers should do 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, Wunder said. Caffeine is good for short-term alertness but will not decrease a person's physiological need for sleep.
Martinez, 43, said he wishes he had taken that advice when he was a young medical intern. On a cross-country drive with a friend, he fell asleep at the wheel while coasting on a straight stretch of highway. Martinez didn't even realize that he was dozing off.
"I don't remember the transition between reality and sleep," said Martinez, who once worked as an emergency-room physician. "All of a sudden I heard a change in the sound of the road. I woke up and found myself driving at an angle off the side of the road." He jerked the car back toward the road but spun around and ended up facing the wrong direction in his lane. Nonetheless he did not crash and got back on the road safely.
It is typical for drowsy drivers to not realize they are falling asleep, said Stephanie Faul, a spokeswoman for the AAA foundation. A study conducted about four years ago by William Dement of Stanford University found that people are poor judges of their own sleepiness and cannot predict when they will actually fall asleep.
"Sleep is a need like hunger and breathing," Faul said. "When you're body needs sleep, it can just click off."
The NHTSA, along with the National Center for Sleep Disorders Research, is planning to release a comprehensive report about drowsiness and driving 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.
States around the country are also seeking to address 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 creates a loud noise and heavy vibration inside the car that can help awaken a sleeping driver. The strips have been credited with reducing off-the-road crashes by up to 70 percent.
The scattered efforts in reducing drowsy-driver accidents are somewhat effective, but the health consequences of sleep deprivation are not well understood by the general population, said Dement, director of the Sleep Disorders Clinic at Stanford. Although sleep deprivation and undiagnosed, untreated sleep disorders affect more than 40 million Americans, the medical community and the public have not adequately addressed the problem, he said.
"It is really a crisis, one that most people don't see," he said. " . . . Most of the crashes don't need to happen."
-- 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
Those at risk include:
-- 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
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