Drowsy Driving and Sleep Apnea

By Admin

According to estimates by the American Academy of Sleep Medicine (AASM), the number of automobile accidents due to drowsy driving averages over 300,000 a year in the U.S. alone, including over 6,000 fatalities. Drowsy driving is a danger for anyone, but people with sleep apnea should be particularly careful about their sleep habits and treatment adherence on a daily basis. While it is easy to fall asleep and forget to attach your CPAP device, the consequences can be immediate and potentially devastating. Each time this happens you are putting yourself at risk of experiencing sleep apnea symptoms, which can then lead to fragmented sleep and daytime sleepiness. At the same time, using CPAP regularly but not giving yourself enough sleep time can have the same results. The consequences of not getting proper sleep can be as simple as a difficult morning or as extreme as a deadly automobile accident. But the benefits of good sleep hygiene and consistent therapy are both immediate and lasting, leading to improved health and restlessness while at the same time keeping you safe in your day-to-day activities. Drowsy driving is an issue that should be taken much more seriously in our culture, especially when considering the high prevalence of sleep disorders in metropolitan areas. If we’re going to trust those around us to make safe decisions when they drive, we should start by trusting ourselves to do the right thing and prioritize our sleep health.

Under the Influence

AASM President Dr. Kelly Carden describes drowsy driving as “similar to drunk driving with regards to the delays in reaction time and impairment in decision-making,” And like drunk driving, it is entirely preventable but can be difficult to avoid due to social norms and lifestyles. Most of us have experienced drowsiness while driving at some point in our lives. Since many of us drive on a daily basis, the chances of being tired at some point in our commute is very high. Research by the National Sleep Foundation and Drowsydriving.org reported that about half of U.S. adult drivers admit to driving while tired regularly, and over 40 percent admit to falling asleep while driving at least once in their lives. Another study by the AAA Foundation for Traffic Safety makes the case that drowsy accidents are underreported in America. According to the AAA, one of the reasons for the underreporting is that people don’t always admit to being drowsy during accident reports. And if an accident involves a fatality, it can be difficult to determine if the deceased fell asleep before the crash. Unlike with alcohol-related accidents, physical evidence is often limited in drowsy-related crashes. No simple test such as a breathalyzer or blood test exists for drowsiness, and self-reporting is extremely unreliable. As a result, government records of drowsy driving accidents may not present the full extent of the problem. The AAA and other organizations make up for this limitation by using trained accident investigators and multiple imputation methods to achieve more accurate estimates. While further research is needed for a clear assessment of the problem, these studies present a clearer picture of the dangers of drowsy driving as one of the leading causes of death in America.

According to some assessments, nearly 30 million Americans have sleep apnea, and over 23 million remain untreated for the condition. But even among those who adhere to treatment, there is always a chance that sleep problems will develop. Sleep apnea is a complex phenomenon with a wide range of potential comorbid conditions, many of which have their own sleep-related symptoms occurring alongside the apnea or hypopnea events. Add routine sleep debt, occupational demands, and other daily stress to this mix and you have a recipe for drowsiness, especially when considering the current pandemic and all the additional anxieties that can accumulate as a result. Though some people may be driving less due to quarantines or social distancing, many are also having more sleep problems, which increases their chances of having an accident.

As far back as the 1990s studies have recognized a strong link between sleep apnea and the risk of automobile accidents, with some concluding the risk as twice that of an individual without sleep apnea. One study found that predictors of obstructive sleep apnea (OSA) also qualified as predictors of accidents. For example, body mass index (BMI) in particular has a high potential to predict risk levels for accidents among patients with sleep apnea. In addition, apnea-hypopnea index (AHI) scores, daytime sleepiness, and even oxygen saturation levels may contribute to disease severity and therefore heightened risk levels for automobile crashes. This explains how untreated sleep apnea sufferers can be particularly susceptible to motor vehicle crashes. Some may not even realize that their sleep is fragmented. Getting tired at certain times of the day is normal, but nodding off at the wheel is not. It is up to each individual to live a safe and healthy life, and anyone with sleep problems should seek professional help.

The Solution: Sleep Health and Safety

Sleep specialists around the world are actively engaged in broad-based efforts to increase public awareness on drowsy driving and its prevention. But the problem involves social and cultural norms that are extremely difficult to target. In 2016, a national compendium titled “Asleep at the Wheel” was organized by the National Highway Traffic Safety Administration (NHTSA) and other sleep organizations to develop effective strategies for reducing the number of drowsy-related accidents. One of the primary conclusions drawn from the event was that popular attitudes about sleep and driving need to change in order to prevent drowsy accidents in the future. As stated on the program synopsis, “Effectively dealing with the drowsy-driving problem requires fundamental changes to societal norms and especially attitudes about drowsy driving.” And the first step to making these changes is making sleep a higher priority for all of us. We can’t expect to have a perfect sleep every night, but we can work toward that goal and recognize when it’s not safe to get behind the wheel.

Warning Signs and Recommendations

In addition to requests for further research on the issue of drowsy driving, the AASM and other sleep health organizations have recommended that people educate themselves on the issue and recognize how important it is to remain consistent with proper sleep health and safety measures. The most obvious solution is to get proper sleep before driving, but drivers are not always in control of their own circumstances, especially when sleep disorders are involved. In these cases it is recommended that drivers avoid long trips alone or at night, and to get off the road as soon as possible when feeling drowsy or recognizing the signs of drowsiness.

The AASM published the following warning signs in a position statement on drowsy driving. Some of these signs, such as yawning, are commonly known as indicators of lost sleep, but others, like problems with memory or missing signs, may be less noticeable as sleep-loss symptoms:

Yawning or inability to keep your eyes open
“Nodding off” or having trouble keeping your head up
Inability to remember recent moments, for example, driving the last few miles
Missing road signs or turns
Driving slowly or following too close to other cars
Drifting into the adjacent lane or shoulder

If you notice one of these signs, it’s time to pull off the road at the next available stop. In more severe cases you may want to pull into the shoulder and use your hazard lights to get a moment of rest. Also keep in mind that simple tricks such as turning up music or opening a window will do little to offset the need for sleep, but coffee can help in the short term to make you more alert.

These recommendations may seem simple, but they are daily solutions that can save your life or the lives of others. As Dr. Carden points out on the AASM website, “There is no substitute for healthy sleep. Regular, healthy sleep is essential for staying awake at the wheel and protecting yourself and others from avoidable, potentially life-threatening accidents.” The AASM, like many health organizations, places a lot of emphasis on individual responsibility, and this message tends to resonate with sleep apnea patients who depend on routine therapy compliance to stay healthy. These two issues, drowsy driving and sleep apnea, have received a considerable amount of media attention in recent years, and it is the hope of the AASM and other sleep health organizations that more public awareness will translate into safer practices in the U.S. as well as abroad.

National Drowsy Driving Prevention Week is scheduled for Nov. 1-8, 2020. Online presentations, public education services, and other promotional events will be scheduled in advance. Visit the official Drowsy Driving Prevention Week website for more information.