FROM THE SLEEP AND WAKE MEDICINE CLINICAL KNOWLEDGE CENTER
Drowsy Driving Prevention Week: CMEO and NSF Address Concerns

by Michelle Ostrander, PhD

In this week's issue of the Clinical Compass™, we highlight Drowsy Driving Prevention Week™ (DDPW), an awareness campaign launched by the National Sleep Foundation (NSF) that takes place this week from November 5-11, following the change back from Daylight Savings Time. The goal of DDPW is to save the lives of young drivers by underscoring the dangers of drowsy driving and providing resources for advocacy at the state level.

Drowsy driving is an enormous public health and safety concern in the United States. The National Highway Traffic Safety Administration estimates that 100,000 sleep-related crashes occur each year. These drowsy driving crashes cause 71,000 injuries and kill more than 1,550 people annually. According to the NSF, 60% of drivers admit to drowsy driving within the past year and 20% of drivers, or 32 million people, say they have fallen asleep behind the wheel.(1)

Young adults are a segment of the population at very high risk for drowsy driving crashes. According to data from fall-asleep crashes in North Carolina during 1990 to 1992, in 55% of fall-asleep crashes the driver was 25 years of age or younger.(2) The peak age at which fall-asleep crashes occurred was 20 years of age.

Why are young drivers at such high risk for fall-asleep crashes? Because they simply don't get enough sleep. Dr. Thomas Roth of the Henry Ford Hospital Sleep Disorders and Research Center in Detroit presented data at the worldsleep07 meeting in Cairns, Australia, indicating that young adults today sleep approximately 1.2 hours less than they did one century ago. According to Dr. David Dinges of the University of Pennsylvania, "The amount of sleep people get is influenced by lifestyle, and the more you work, the less sleep you get. And the other thing that's remarkable is the more you travel or commute, the less sleep you get." This clearly sets up a catch-22 situation as high levels of driving will decrease available time for sleep, which thus increases the risk of a sleep-related crash.

A comparison of the performance-impairing effects of "different doses" of sleep loss relative to ethanol "doses" found that sleep deprivation produced equivalent deficits in cognitive function relative to ethanol consumption, at the doses studied. According to Dr. Thomas Roth, "You can very simply translate the effects of alcohol into the effects of sleep loss. Not sleeping for one night, sleep -- total sleep deprivation, zero sleep gives you a blood alcohol level of 0.19, which most people cannot walk with. In most countries, the legal alcohol limit is about 0.05 and basically any sleep loss greater than two hours will give you legal levels of intoxication."

Why do sleep-related crashes occur? Because sleepiness arising from lack of sufficient sleep is associated with substantial cognitive impairments. These cognitive deficits include lapses of attention, learning and memory problems, cognitive slowing, impaired problem-solving capabilities, and microsleeps.(3) Microsleeps are short, spontaneous sleep episodes that may intrude upon wakefulness without a person being aware of them.

The public and lawmakers are slowly becoming aware of the problem of drowsy driving and measures are being instituted to battle this epidemic. New Jersey passed "Maggie's Law" in 2003, a drowsy-driving law that makes drivers liable for vehicular homicide if they have driven after being awake for 24 straight hours. Unfortunately, the number of sleep-related crashes has not diminished. According to the New Jersey Department of Transportation, there were 2,574 crashes attributed to drowsy driving in 2003; in 2006, there were 3,143 sleep-related crashes. Despite this, other states are following in New Jersey's footsteps and laws are pending in Illinois, New York, Kentucky, Mississippi, and Massachusetts.

As you turned back your clocks this weekend, the National Sleep Foundation and CME Outfitters, LLC, hope that you used the extra hour to catch up on your sleep so that you do not become a drowsy driver. For additional statistics and information on drowsy driving, please visit DrowsyDriving.org, a website by the NSF that is dedicated to education about the dangers of drowsy driving. For information on sleep-wake disorders please visit neuroscienceCME.com and participate in a live audioconference, Waking Up to the Problem of OSA: Consequences and Improved Recognition; a live videoconference, Combating the Consequences of Excessive Sleepiness; and an archived videoconference, Excessive Sleepiness and Psychiatric Illness: Many Sides to the Story. In addition, look for an archived webcast of a worldsleep07 symposium titled Excessive Sleepiness: A Neglected Area of Risk that features Dr. Roth, Dr. Dinges, and Dr. Terri Weaver; podcasts on sleep-wake medicine; and interactive patient cases coming soon to neuroscienceCME.com.
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