Dark Side of Holidays: Sleep-Deprived Drivers

By JANE E. BRODY

he holiday season promises to bring a serious threat to thousands of of sleep-deprived Americans — a motor vehicle accident that could injure or kill the driver, passengers, pedestrians or people in other vehicles.

A recent poll by the National Sleep Foundation revealed that in the past year, half of Americans said they had driven drowsy at least once, and one in five drivers admitted to falling asleep at the wheel.

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Drowsy driving is estimated to cause about 20 percent of accidents, 1.2 million a year, more than drugs and alcohol combined. And the problem is getting worse as growing numbers of Americans become increasingly sleep-deprived in our 24/7 culture.

"There's a new definition of the shift worker," said Dr. Mark R. Rosekind, president of Alertness Solutions, a California-based company that provides advice and training on fatigue management.

"Every segment of our culture is now working round the clock: health care, transportation, public safety, technology, economics and banking, convenience stores and gas stations," Dr. Rosekind said. "People are getting less and less sleep and their body clocks are more disrupted. Drowsy driving is the consequence."

Now add to the day-to-day sleep disrupters the demands of holiday preparations and activities, like shopping, cooking, cleaning, traveling, dinners and parties with heavy meals and alcohol, and you have a recipe for disaster behind the wheel.

The combination of drowsiness with just one alcoholic drink can impair driving skills as much as four drinks will. With the typical college student's sleep debt, one beer has the impairing effect of a six-pack.

The problem of drowsy driving is especially risky for people 16 to 29. At a meeting last week sponsored by the foundation, Warren Mackey told how he lost his 17-year-old son, a promising basketball player, on a Sunday evening four years ago when he fell asleep at the wheel after getting only a few hours of sleep the night before. And Russell Burris told how he became paraplegic shortly after finishing high school in 1990 when he crashed his car after being awake for the previous 36 hours.

In driver education, Mr. Burris said, "I was told about the importance of a seat belt, I was warned about the dangers of drinking and driving, but no one ever mentioned what could happen if I drove while drowsy."

Signs of Trouble
 

"The brain is an opportunistic sleeper," said Richard Gelula, executive director of the foundation. If a person is sleep-deprived, he explained, the brain will lapse into sleep at the first sedentary chance it gets — in front of the television, at a concert or play, while driving a motor vehicle. "Let's face it, driving is not an exciting activity for the brain," he said.

The average person needs eight or more hours of sleep a night (teenagers need nine) to be fully rested, but most Americans are lucky to get six or seven, each night adding to an accumulating sleep debt.

A study by the AAA Foundation for Traffic Safety showed that people who slept six to seven hours a night were twice as likely to crash as those who slept eight hours or more, and people who slept less than five hours had a risk of crashing four to five times as great.

For those who must stay awake during the hours when people are biologically programmed to be sleeping, the problem is much worse. Most sleep-related crashes occur from 2 a.m. to 6 a.m., with a second peak in midafternoon, the traditional siesta time. Even if drowsy drivers do not fall asleep, alertness is greatly diminished, reaction time is much slower and the chance of causing accidents is greatly increased.

How can you tell if you are too tired to drive safely? First, assess your likelihood of dozing off under these circumstances: while sitting and reading, watching television, sitting inactive in a public place like a theater or a meeting, sitting quietly after a lunch without alcohol or riding as a passenger in a car for a hour.

The more often you fall asleep when you are supposed to be awake, the sleepier your brain is and the greater the chance of dozing off behind the wheel.

There are also telltale signs of impending sleep while driving, though many drivers are either unaware of them or choose to ignore them. They include repeated yawning, a sensation of heavy eyelids, difficulty focusing your eyes, trouble keeping your head up, daydreaming or having disconnected thoughts, drifting over the center line or too close to the edge of the road, inability to remember the last few miles, missing traffic signs or finding yourself tailgating.

To make matters worse, sometimes sleep can strike without warning. Drivers who live to tell the tale often report that they did not know they were about to fall asleep; it just happened.

At 60 miles an hour, in just a three-second doze, you will travel the length of a football field — far enough to run off the road or crash into a barricade or another vehicle.

Just such an accident killed a young woman and her five passengers when a trucker traveling at 65 miles an hour fell asleep and struck her station wagon. The trucker, who also died in the crash, had routinely cheated on his log and had been driving for 20 hours when the accident occurred.

What to Do
 

First and foremost, stop cheating on your sleep. Before starting out on a trip, be sure to get a full night's sleep. Plan ahead so that you're not up late getting ready to leave. Don't start out at night for a drive that will run into your usual bedtime hours or arise earlier than usual to get a head start.

On a long trip it is best to have at least two drivers who can take turns. A third person in the car who will stay awake and talk to the driver is even better. Especially if you are the only driver, take frequent breaks; at least once every two hours or 100 miles, pull off the road and walk around briskly for a while.

Avoid eating a big meal or one loaded with carbohydrates before driving. Instead, bring along light, preferably protein-rich snacks and nonsugary drinks to stave off hunger. Don't wear anything tight around your waist; instead put a hefty dose of caffeine under your belt.

But if you ordinarily consume lots of caffeine, you may be tolerant to its stimulant effect. Best to save this drug for when it is most needed. Also note that it takes 15 to 20 minutes for the caffeine you drink to reach your brain, so don't wait until you are beginning to feel sleepy.

Listen to informational or conversational programs or, better yet, play recordings of interesting books when driving monotonous roads. I've also found it helpful, especially on solo drives, to play music I can sing along with.

If you note the telltale signs of sleepiness, the best solution is to pull off the road into a safe area as soon as possible and take a nap. Bring along a kitchen timer or set your watch to awaken you in 20 minutes.

A longer sleep is more effective in the long run but can cause sleep inertia, necessitating about 15 minutes of physical activity and a cup of coffee to restore your alertness.

If it is not possible or safe to stop for a nap, two cups of coffee (or their caffeine equivalent of 300 milligrams) can keep you alert for about three hours if you are not tolerant.