Bus Driver Falls Asleep at the Wheel and Causes a Huge Series of Crashes

Recently a Michigan bus driver was involved in a horrendous accident, in which his bus plowed into a total of eight cars.  Take a look at this surveillance video:

You can see the driver calmly driving at the beginning, and then suddenly slamming his brakes as he sees that his vehicle is about to crash into another.  He pulls over to the shoulder and slow down, but he takes out car after car as he decelerates.  Amazingly, there was only one bus passenger onboard, and she was not injured; however, multiple people in the other vehicles were hurt.  This 65 year-old driver, who reported that he felt that he had probably fallen asleep behind the wheel, now faces charges for having caused this accident.

Unfortunately, similar accidents (though usually not this dramatic) occur on American roads every day.  It is estimated about 100,000 car accidents are reported every year in this country due to driving while drowsy or fatigued.

Why is drowsy driving so prevalent?  Well, there are several reasons:

1.  Daytime sleepiness can be a chronic issue that may not have resulted in substantial consequences for you . . . until you wreck your car.  In other words, if you have felt sleepy during the day for years, but have never been in a wreck, you may fool yourself into believing that you may never get into an accident due to falling asleep, which, of course, is completely faulty reasoning.

2.  Daytime sleepiness is not usually “painful,” per se–unless you’re in an accident because of it–and may not be viewed as an actual problem.  If you’re used to falling asleep peacefully in front of the TV every day, you may view that tendency as just a harmless “thing you do” instead of a potential concern or medical issue.

3.  Lots of people are chronically sleep-deprived, such as due to working several jobs, and so sleepiness may be viewed as just an inevitable component of everyday life.  This doesn’t make daytime sleepiness normal!

Ironically and tragically, because sleep disorders such as obstructive sleep apnea are becoming a substantially public policy issue because of their tendencies to cause fall-asleep car crashes, some professional drivers may choose to delay or even completely forego a medical evaluation for such problems for fear of losing their jobs or to spare themselves the hassle.

Bottom line:  excessive daytime sleepiness can kill you if you’re behind the wheel or operating machinery.  It’s better to pull over, rest, stop work, whatever it takes, than to keep on driving if you’re sleepy.  It’s just not worth it to keep going, man.  Imagine being the guy in the video.  And if you’re excessively sleepy during the day despite proper amounts of sleep at night, I strongly recommend seeking medical attention for this brutal problem.

 

Why Do Dogs Make Such Good Alarm Clocks?

Like most everyone else, I enjoy the occasional brief distraction from whatever serious thing I’m doing by popping up a quick funny video during breaks. A friend recently sent me this little clip of dogs forcing their humans out of slumber and out of their beds in the morning.

As fun as these videos are, there’s something instructive about them:  they reveal some hidden but important messages about sleep.  Here are a couple things you can learn as you enjoy watching them:

1.  Animals have sleep cycles like humans do.  In fact, even the most primitive creatures on the planet demonstrate some form of simple, behavioral rest with measurable regularity, and usually with timing that relates in some way to the earth’s 24-hour day-and-night cycle.  Why does your dog always awaken you at 6 a.m., including on days in which you want to sleep in?  Probably because she regularly awakens shortly prior to 6 a.m. every day, right in keeping with her body clock, and wants to play.  That’s what our Maltese, Molly, does.

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2.  Your dog awakens you in the morning when you want to sleep in probably because you’re sleep-deprived.  There’s likely not a lot of published literature support for what I’m about to write here, but I would venture to guess that most dogs, not having to toil every day at work or staying out late with the guys, are usually “sleep-sated,” meaning that they get as much sleep during a 24-hour period as their bodies and brains require–through nocturnal sleep and/or by napping during the day when the humans are away.  The amount of sleep a dog needs depends on his age, size and breed.  However, the vast majority of human adults require between 7.5 and 8 hours of sleep per night–and on a regular basis–to feel fully rested during the day.  How many people do you know that get that much sleep per night most or every night?  If you routinely get less than 7-8 hours of sleep per night, chances are good that your body and brain will attempt to “make up” the lost sleep by trying to “sleep in” when they get the chance–on weekends and days off, for example.  In other words, your dog is doing what you should be doing–getting proper amounts of sleep–and he is now on your bed, lapping at your ear to remind you that obeying your innate biological needs is the natural thing to do, the best thing to do.

I say dogs make great alarm clocks:  you can’t get too mad at them, there’s no “snooze” button, and they make sure you know you should wake up and get up not only sonically, but also tactilely:  with paws, claws, and slobber.  Have you ever awakened briefly at your usual time in the morning, following a long period of sleep deprivation and though you intend to sleep in, and wondered why you awakened at that time instead of sleeping straight through?  That’s your circadian rhythm telling you it’s your natural time to wake up.  Look at your dog as a big furry biological clock “by proxy:”  she obeys her body clock every day and wonders why you’re not doing the same.  Just another reason to love your dog:  she can teach you to love your sleep and respect your sleep needs!

Finally, certain dogs, like pugs and boxers (dogs with thick necks) are also predisposed to snoring and obstructive sleep apnea, but I suppose that is a topic for another day.  Enjoy the remainder of your weekend, this first weekend of 2015!  Cheers!

Help Your Child Sleep Well While “Back to School”

All you parents know what’s right around the corner, if it hasn’t already happened: the start of the new school year! At least for us in the Pacific Northwest, school doesn’t start for another week, so we have one more glorious week of sun and freedom before the beginning of fall classes.  But for many of you elsewhere, school has already started in earnest.

 

One of the many concerns parents have as they transition back into the school year is how their children’s sleep habits will change. Many of us know the drill, from our children’s experiences or our own: all the staying up late on weekends, sleeping in ’til noon on Saturdays and Sundays, the Herculean effort necessary to get out of bed in the morning, especially on Mondays. Though this ritual is very common, particularly for teenagers, the stress and conflict arising from this chronic problem can wreck your family life, not to mention your grades.

This pattern, called delayed sleep phase, arises from the adolescent brain’s natural tendency to cycle its sleep-wake rhythms in a timing scheme that is longer than the 24-hour day. Many of us recall what it was like to be younger and wanting to stay up later and sleep in later if given the chance. The problem with this tendency is that children and teenagers usually engage in activities (i.e., school) that obligate them to entrain their sleep-wake behavior to the 24-hour clock. This conflicts with their biological inclination to go to bed later, resulting in sleep deprivation which makes it more difficult to awaken early in the morning and be awake and alert for classes. Friday night comes ’round, they stay up late, sleep in big-time on weekend days, and then find it impossible to fall asleep early Sunday night because their body clock’s sleep-wake phase has now been delayed from all the sleeping in, so all the sleep debt and sleep deprivation then roll into the new school week, perpetuating the cycle.

There is ongoing controversy about what can and should be done to improve this problem for young people and their families. Though some schools around the country have options of starting classes later in the day, many or most of us parents are obliged to ensure that our children are out of bed and ready for school at times earlier than what they, and their body clocks, “want.”

So what can be done? We can’t change our kids’ brains, though sometimes it’d be great if we could, right? Here are a few tips to help weary parents get their kids sleeping better as we kick off this new school year. As you will see below, these recommendations may be quick to read and absorb, but whether they are easy is another matter. The unfortunate reality is that making these sleep problems substantially better likely will be difficult, at least at first, requiring communication, motivation and insight from the child and patience and support from the parent.  Ready? Here goes.

1.  Minimize the “sleeping in” on non-school days by setting the alarm clock for reasonably similar times each day to the extent you can.  Kids hate this most of all.  Sleeping in dysregulates your body clock, causing nocturnal insomnia and daytime fatigue.  Sleep schedule dysregulation is why we have jet lag, for example.  If your child has to awaken for school at 6 a.m., say, but sleeps in ’til noon on weekends, and then tries to go to sleep early Sunday night, such abrupt changes in the brain would be the equivalent of flying from the west coast to the Bahamas, for example, and back, every week.  Regulating the wake-up time may well require a hard sell to the teenager; I’d rather the teen sleep in until 8 a.m. than until noon.  This lifestyle modification (and it’s a big one) gets substantially easier if done diligently for a couple weeks, but I won’t lie, it’ll be painful for all involved at first.  The child may need some, er, parental assistance in getting up on weekends.  A second alarm clock is also an option.  Put one alarm clock on the nightstand, and then put the second one further away, set for 2 minutes after the first clock, so that your teen will need to physically get out of bed to turn it off.  Make sure the second alarm clock is loud, and the more obnoxious the better.

2.  Don’t go to bed until substantially sleepy.  If the first step is done properly and done the same way every day, then this second step should fall naturally into place eventually, because the resulting sleep deprivation should make your teen become drowsy gradually earlier in the evening on weekends.  Force your child to go to bed too early, however, and residual insomnia results.  Taking advantage of children’s sleep needs allows them to fall asleep quickly and earlier (including on Sunday nights) and at the same time get proper amounts of sleep (which for children and teens can be 9-10 hours per night), both of which are important in physical and cognitive development and proper performance in school.

3.  Declare a curfew from light and technology.  Light exposure greatly impacts our levels of wakefulness and alertness; add to this the perceived need to always be constantly “plugged in” socially through mobile devices, and you have a recipe for “up all night.”  Shield your child’s bedroom from outside light and noise, such as with black thick curtains, particularly as these summer months continue to wane.  Start dimming your home’s ambient light several hours prior to the projected bedtime.  And, finally and importantly, I recommend laying off lit-screen gadgets (including iPads, laptops, and smart phones) 2-3 hours prior to the projected bedtime.

Now that I think about it, I’m pretty sure this last recommendation is actually what kids hate the most.  But complete these 3 steps, and utilize them consistently, and chances are your child will sleep better.

Best of luck to students and parents alike this upcoming school year!

 

Sleeping Yankees Fan Brings Up Important Point About Sleepiness

Recently 26 year-old Andrew Rector filed a lawsuit against ESPN, Major League Baseball Advanced Media, and the New York Yankees, claiming defamation stemming from broadcasted video of him fast asleep in the stands during an April Yankees vs. Red Sox baseball game.

 

Here is the video in question:

According to the filed materials, Mr. Rector was subjected to an “unending verbal crusade against the napping plaintiff” and an “avalanche of disparaging words against” him subsequent to the game.

In reporting this story, this morning’s television news programs often asked a question not terribly different from that of the commentators:  “how can anyone sleep through something as exciting as a close Yankees / Red Sox game?”

I’m not writing today to provide legal commentary.  However, this incident does bring up an important issue regarding sleep and our collective perception of sleepiness.

There has long been a widely held belief that you naturally fall asleep simply because you’re bored or inactive.  The corollary concept is that if you fall asleep when you’re not supposed to or when other people usually don’t, such as while at work or at an exciting event, you must be lazy, unmotivated, or dumb.  Over the years I’ve seen many patients whose clinic evaluations were initiated by getting fired, suspended or reprimanded for having fallen asleep on the job or in meetings.

I submit that such notions are ill-conceived and unfair.  If you regularly have proper amounts of sleep and if you are free of medications, substances, or medical conditions causing sleepiness, then you really shouldn’t be struggling to stay awake all day long just because you’re physically or mentally inactive.  It’s more accurate to say that a person who is prone to excessive drowsiness (regardless of the reason) tends to fall asleep by accident if sedentary.  The question then shifts to:  why is that person prone to being drowsy in the first place?

I mean, who knows why Rector was snoozing during the ball game?  Maybe he usually gets up at 3 a.m. to get to work, so the game was past his usual bedtime.  Perhaps he holds down two jobs.  Maybe he spent the previous night caring for a sick child.  Perhaps he has an undiagnosed sleep disorder.  Is it really right to make a judgment of a person’s character or work ethic based on a tendency to fall asleep when others are awake?

How “normal” is it to sleep through something exciting or otherwise stimulating?  In my younger years (prior to practicing sleep medicine), and in the setting of chronic sleep deprivation, I routinely slept through fire alarms, tornadoes, tornado alarms, neighborhood car crashes, earthquakes, and parties next door.  I slept through important lectures, grand rounds, and meetings due to not getting enough sleep.  Your ability to stay awake and your ability to arouse from sleep in response to a stimulus depend on a number of factors, including your age, how much sleep you usually get, how regular your sleep schedules are, how much sleep you happened to get the previous night, and what stage of sleep you happen to be in when the stimulus occurs.

I’m not saying it’s OK to sleep through important events, of course.  Here are my main points today.  If you are finding yourself falling asleep in inappropriate times, places, and circumstances, and particularly if your professional and personal lives suffer as a result:

1.  Work to identify the reason(s) for the sleepiness.  Often an underlying cause may be obvious and right under your nose, like getting 5 hours of sleep each night.  We are creatures of habit, though, so lifestyle choices that lead to chronic sleep deprivation may not feel like problems if you’ve engaged in them for a long time.

2.  If there is a specific lifestyle choice that is causing your sleepiness, make a change, even if the change is uncomfortable or inconvenient.

3.  Strive to get proper amounts of sleep (which for most adults is 7.5 – 8 hours per night) on a regular basis to the extent possible.

4.  Should you remain prone to falling asleep despite proper amounts of sleep and after excluding other potential causes, discuss your sleepiness with your doctor; your drowsiness may suggest the presence of an undiagnosed sleep disorder.  You may want to consider an evaluation at an accredited sleep center.

Stay healthy and awake this summer, everyone!

Final thing:  shout-out to my friend Doug, man, you’re an inspiration.

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.

“You’re Gonna Hear Me SNORE!”

I hope your holiday season has been great so far!  And it’s not over yet!

I recognize I’m posting this video late–it aired originally during the Thanksgiving holiday–but it’s worth posting now anyway; we’re still in holiday mode, after all, aren’t we?, and lots of people eat turkey at Christmas time!  Jimmy Fallon, Rashida Jones, and Carrie Underwood gave a hilarious musical performance about Thanksgiving traditions on Late Night With Jimmy Fallon.

Please pay particular attention to what Rashida sings 1:29 into the clip.  She parodies Katy Perry’s song “Roar,” singing, “you’re gonna hear me SNORE!”

Drowsing and falling asleep in front of the television or fireplace after a big ol’ hyper-caloric meal are so common, they seem like natural components to our American holiday tradition.  The degree to which L-tryptophan in the turkey triggers an after-dinner snooze is questionable, actually.  However, there are so many reasons for sleep to take you over after a huge holiday meal:  sleep deprivation due to wrapping things up at work; family and friends coming into town; irregular work and sleep schedules; parties keeping you up late; alcohol, particularly when combined with certain medications; underlying medical problems; and undiagnosed sleep disorders.  Untreated sleep apnea, for example, may leave you both sleeping and snoring like a bear in your recliner, disturbing your house guests.

It’s always easier to say than to do, but keeping your sleep schedules as regular as possible and getting proper amounts of sleep during the holidays may well improve your levels of wakefulness and alertness during this time of year and may bring forth even more holiday cheer!  Have a great holiday week, everyone!

New York Train Derailment Thought Related to Operator Fatigue

Well, what many of us in the sleep health sciences feared might be the case appears to have been confirmed:  the operator of the New York commuter train that jumped off its rails early Sunday morning, December 1st, reportedly told federal investigators that he had “nodded” and “zoned out” just prior to the derailment.

 

The crash, which occurred in the Bronx and resulted in the death of four passengers and the injury of dozens, occurred when the train passed through a sharp turn at speeds much higher than recommended:  according to reports from the National Transportation Safety Board, onboard recorders clocked the train to be moving at a blazing-fast 82 miles per hour just prior to the crash (the speed limit at the track curve was 30 miles per hour).  Data also reportedly demonstrate that brakes were applied heavily and the throttle cut shortly (five seconds) before the locomotive and all seven coaches jumped off the tracks.  Reportedly, the train driver, 46 year-old William Rockefeller, told NTSB investigators that “I was in a daze” just prior to the crash.  Investigators appear to have have concluded that Rockefeller likely had experienced a “microsleep,” dozing briefly while operating the train.

I don’t know Rockefeller’s personal circumstances that may have been associated with this tragic incident.  But I can tell you in general terms is that excessive daytime sleepiness is a very common, under-recognized problem, one with the potential for huge adverse consequences for people who work in various industries, particularly ones that require substantial mental attention and high degrees of performance and concentration.  The medical literature abounds with data regarding the extent to which work performance may deteriorate with chronic sleep deprivation, for example.  As one may imagine, such mental deterioration may then lead to industrial accidents and fall-asleep vehicular crashes.  It is well known that excessive daytime sleepiness is associated with reduced performance and human error due to:

Slow or defective information processing
Non-response and/or delayed response
Slow (increased) reaction time
Reduced vigilance
Decreased situational awareness
Lapses in judgment
Reduced accuracy of short-term memory
Accelerated decrements in performance

There are several important problems associated with addressing the issue of excessive daytime sleepiness.  First, sleepiness during the day can be caused by all sorts of things, including deliberate sleep deprivation, irregular or rotating work schedules, jet lag, medications, alcohol, insomnia, or intrinsic sleep disorders such as untreated obstructive sleep apnea.  Second, daytime sleepiness is often insidious; it creeps up on you ’til before you know it, you’re struggling to stay awake and alert during the day every day.  Third, daytime sleepiness is not painful (until you get into a car wreck, of course), making it less likely that people will seek to have the problem evaluated by a health care professional.

So I’d like to provide some quick and dirty rules for you, in light of this most recent tragedy.

1.  Do what you can to get proper amounts of sleep.  The vast majority of adults require between 7.5 and 8 hours of sleep per night.  If you’re sleep-deprived, try going to bed tonight a little bit earlier than usual, like by 10-15 minutes.  A couple nights later, go to bed 10-15 minutes earlier than that.  Gradually increase the total amount of sleep per night, to as close to 7.5 to 8 hours per night as possible.  If you suddenly go to bed a couple hours earlier than you usually do, you may experience insomnia, and you may well end up going back to your usual pattern of sleep deprivation.

2.  Do what you can to get proper amounts of sleep regularly, i.e., as close to every night as you can.  Your body clock “wants” you to be regular in terms of your bed timing.  If you tend to “sleep in” on non-workdays, for example, the very fact that you are sleeping in may be an indicator that you need more sleep during other times of the week than what you’re allowing yourself to have.

3.  If you are struggling to stay awake and alert during the day despite proper amounts of sleep at night, seek medical attention.  You may want to see a person like me, a physician sleep specialist, if that is the case.

Sleep well, everyone, and stay safe.