Monthly Archives: March 2014

Chicago O’Hare Train Accident Thought Related to Operator Sleepiness

You probably have heard by now about the recent commuter train derailment at Chicago’s O’Hare International Airport.  In the early morning of Monday, March 24, a Chicago Transit Authority (CTA) blue line train jumped its rails and crashed into an escalator, injuring more than 30 people.

 

It is so weird to see photos of such destruction in a place that I am so familiar with.

Anyhow, this morning it was announced that the train operator informed investigators from the National Transportation Safety Board (NTSB) that she had fallen asleep at the controls before the accident.

Here is the surveillance video that captured the incident:

According to lead investigator Ted Turpin, the train operator indicated that she had “dozed off prior to entering the [O’Hare] station and did not awake again until the train hit close to the end of the bumper.”  She also told investigators that in an earlier incident, in February, she had fallen asleep at the controls and subsequently overshot a train stop.

This accident at O’Hare occurred at 2:50 a.m. CST.

It kind of goes without saying that drowsy driving is dangerous, but you may be surprised as to how big of a deal this problem actually is.  According to the National Highway Traffic Safety Administration (NHTSA), roughly 100,000 police-reported motor vehicle accidents occur in the United States each year; of these, roughly 40,000 injuries occur and 1,550 people die.  These statistics don’t include the accidents that are never reported.  Unfortunately, work and driving accidents in the early morning are far too common, though usually not quite as dramatic as this particular event.  Many of these NHTSA-reported vehicular accidents occur in the early morning, between 2 and 7 a.m.

Further complicating matters is the fact that this tendency toward drowsy driving can be related to many potential underlying causes:  work schedules (particularly schedules that rotate in terms of the timing), home circumstances and social obligations, chronic sleep deprivation, a need to work two jobs, undiagnosed sleep disorders, and irregular sleep schedules.  Many of us can relate to most, if not all, of these causes, which again speaks to how common and problematic drowsy driving can be.

I can’t emphasize the following take-home points enough:

1.  NEVER DRIVE OR OPERATE MACHINERY (including any kind of vehicle) IF YOU ARE DROWSY!!!  It simply isn’t worth it to retain your job or get somewhere on time by risking your life or the life of others around you.  Pull over, stop your work, speak with your supervisor, whatever it takes.

2.  ALWAYS STRIVE TO GET PROPER AMOUNTS OF SLEEP (which for most adults is between 7.5 and 8 hours per night) AND KEEP YOUR SLEEP SCHEDULES REGULAR.  In other words, get as much sleep as your body needs, and get this much sleep regularly, every day at around the same time of day, even if you work night shifts.

3.  If you don’t know WHY you are drowsy when you’re supposed to be awake, SEEK MEDICAL ATTENTION.  If you are sleepy despite proper amounts of sleep and regular sleep timing, you may have an intrinsic sleep disorder.  Fixing abnormal sleepiness is one of the functions of a physician sleep specialist.

In closing, I want to give a shout-out to our nation’s first responders.  May we never take them for granted.  We’ve had a lot of disasters recently, it seems, including one geographically very close to me (the tragic, huge March 22 mudslide in Oso, Washington).  Here is a link for those who wish to help in the Oso landslide relief efforts:

http://www.king5.com/news/breaker1/Northwest-Response-Oso-Mudslide-Relief-252007821.html

Stay SAFE, everyone.

Happy Insomnia Awareness Day!: Insomnia, Defined

The American Academy of Sleep Medicine (AASM) has declared today, March 10, Insomnia Awareness Day this year.  The timing of this auspicious occasion is in keeping with the daylight savings time change from over the weekend.

We in sleep medicine circles call today “Black Monday,” the first workday following the one-hour time change each spring.  Our body clocks don’t like making changes in their sleep shifts, even if only by a mere hour; anyone who has experienced jet lag knows what I mean.  As you know, “springing forward” one hour means having to get up one hour earlier than what our body clocks are accustomed to and thus “prefer.”  For those who do not adjust their bedtime schedules accordingly, getting up to get to work, school, or appointments on Black Monday becomes all the more difficult.  At the same time, the mild dysregulation of sleep scheduling can also lead to insomnia, particularly if there is already baseline insomnia to begin with.

 

I’ve covered insomnia in previous posts, and I will go over it and its management in future posts too, because it is such a huge, prevalent clinical problem and growing public health concern.  For the purposes of today’s Insomnia Awareness Day post, however, I will concentrate simply on what insomnia means.

The definition of insomnia, as accepted by the AASM, is the “subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and that results in some form of daytime impairment.”  [Schutte-Rodin S; Broch L; Buysse D; Dorsey C; Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008;4(5):487-504].

As such, insomnia is by its very nature subjective, meaning that you can have insomnia no matter how much actual sleep you really get, and implying that the time spent awake in bed is bothersome.  Among the many impairments associated with insomnia are a feeling of unrefreshing sleep, low energy levels during the day, daytime sleepiness, emotional problems (like depression and anxiety), morning headaches, difficulties with memory and concentration, reduced work productivity, and a propensity toward industrial and motor vehicle accidents.

This definition is important.  You can have insomnia even if you get a full 8 hours of sleep each night (such as if you are spending 12 hours trying to sleep each night).  Conversely, 4 hours spent in bed spent awake each night casually watching television but not trying to sleep do not constitute insomnia.  Note also that the definition does not address potential causes, of which there are hundreds–causes can range from a can of Mountain Dew at 10 p.m. to one’s mental perception of dread and frustration associated with previous difficulties falling asleep.  The definition of insomnia also helps provide a rough roadmap to therapy.  My own practice philosophy for patients with chronic insomnia (i.e., insomnia that lasts for a month or longer) is to identify the underlying causes and to improve the insomnia by improving or resolving the problems causing it.

From a clinical perspective, chronic insomnia management can range from relatively straight-forward to extremely challenging.  Doctors that identify themselves as “physician sleep specialists” should have the expertise and willingness to handle cases of insomnia, including the tough ones.  Enlist their help should your insomnia become sufficiently problematic.  Help IS available.

Sleep well tonight, everyone.  Black Monday is almost at its end!