The Perils of Drowsy Driving

It’s 1 a.m.  You debated all day about how good of an idea it would be to drive all night to get to West Palm Beach, but the advantages of taking the chance won out:  you’d beat the traffic, and the time you’d save by getting there by early morning would make the challenge of pulling an all-nighter worth it.  So now you’re on a highway, quite alone and in pitch darkness.  The road is straight and monotonous.  You start to count the mile markers out of boredom.  After an hour and a half, things start to look blurry.  A hazy veil starts to descend slowly over your eyes and upon your brain.  You realize what is happening, and you shake your head violently to become more alert.  You roll down the windows, but the Florida late spring night air bathes your car interior with humid heat.  You crank your car stereo up to eleven.  Passing sign says, “rest stop, 40 miles.”  You push on, propelled by your determination and time.  You sing loudly to the Def Leppard song playing on the only rock and roll station you can find on this desolate stretch of road.  Soon, however, without realizing it, you gradually become silent.  You feel yourself giving in despite yourself.  You suddenly find yourself parked in the rest stop, but for the life of you you cannot recall how you got there.


Many of us (myself included) have been in this situation before.  You would not believe the stories I hear from some of my patients, who have fallen asleep behind the wheel of their 18-wheelers, behind the wheel of their school buses, or at the controls of their motorcycles on the freeway.  It should frighten you to know that many many thousands of people in the United States drive drowsy, including right next to you, every day.

Here are some sobering statistics.

According to the National Highway Traffic Safety Administration, over 100,000 police-reported motor vehicle accidents occur in the United States each year due to drowsiness; this number is likely an underestimation of the total number of fall-asleep car crashes in this country, because undoubtedly there are many accidents (particularly single-car crashes) that are never reported.  Due to these 100,000 crashes, roughly 40,000 injuries occur every year, and 1,550 people die per year.

According to an NHTSA-sponsored telephone survey report entitled “National Survey of Distracted and Drowsy Driving Attitudes and Behaviors,” 37% of drivers polled have nodded off for at least a moment or fallen asleep while driving at least once in their lives while driving; 8% have fallen asleep driving within the past six months.  Falling asleep behind the wheel appears most common among drivers age 21-29 and males, and least common among drivers over age 64 and females.

71% of 18-29 year-olds have reported being drowsy while driving.  50% of 30-64 year-olds have reported being drowsy while driving.

It makes sense that people are found to be most likely to fall asleep driving in the early morning hours, particularly 2-7 a.m.  People are also particularly at risk after having driven for long periods of time (3-4 hours or more) or if they are sleep-deprived (i.e., under 6 hours of sleep) the night prior to driving.  Paradoxically, the faster people drive, the statistically more likely they will become involved in a fall-asleep car crash, presumably because unlike in-city driving with all its starts and stops, highway driving is continuous, sedentary, and monotonous, making one predisposed to drowsiness prone to head-bobbing and dozing at exactly the time in which being alert is the most necessary.

You’ve probably heard that drowsy driving is every bit as dangerous as drunk driving.  I would go one step further and say that drowsy driving is in some ways more dangerous than drunk driving, simply because there are just so many drowsy drivers out there all the time, particularly at night, but also during the day.

So, some simple tips to reduce your likelihood of falling asleep behind the wheel:

1.  Get proper amounts of sleep each night, and particularly the night before a trip.
2.  Avoid driving, particularly long distances, late at night if you can possibly help it.
3.  If you HAVE to drive late at night, bring a driving buddy.  Consider coffee or a caffeine-containing energy drink.  Some rest stops have free coffee to prevent drowsy driving, but don’t count on coffee being available to you in this way.  Be prepared.
4.  Take a break frequently, even if you’re not drowsy.  Find rest stops, pull over, get some fresh air, walk about.
5.  Pull over and take a nap if you have to, and lock your car doors.  Better to show up late than to show up dead.
6.  NEVER, EVER operate a vehicle or machinery if you’re drowsy or fatigued.  Period.


Is Daytime Sleepiness a Problem?


The answer, of course, is yes.  However, it may not necessary feel like a problem to the sleepy person.  Why?  Because if you’re used to feeling a certain way during the day for years, and if there’s no pain or other immediately negative consequence involved, then that way feels tolerable for years and thus becomes normal–to you–because what feels normal is simply what you experience regularly and every day.

Here is a not-uncommon scenario in my clinic.  A man and his wife walk in.  I ask the gentleman if he feels sleepy during the day.  “Not at all,” he may tell me, or he may reply with a more vague “not any more than usual” or “not any more than anyone else.”  Does he tend to doze off if he’s in front of the TV, for example, I ask, or while reading at home?  “No, never,” he replies casually.  This is when the silent eye-rolling from his wife, who cajoled him for months into this visit, changes to an exasperated gasp.  The frustration now is just too much for her.  “He falls asleep all the time,” she tells me, much to the man’s annoyance.  “No I don’t!,” he exclaims, challenging her angrily with his eyes.  “You fall asleep at the dinner table!,” she returns.  “Every night!  Even when we have company!”  The exchange continues in its escalation, both voices now raised to the point in which they can be heard outside the clinic room.  There have been times in which I’ve had to intervene in a mounting spousal fight over this question of sleepiness.  It’s not like he thinks she’s deliberately lying.  He may believe she’s exaggerating, and may accuse her of being prone to exaggeration during this visit.  But the primary problem here is more inscrutable:  the manifestations of daytime sleepiness just don’t seem to be a problem to him like they are for her–what’s wrong with napping when you’re bored, after all–and therefore he doesn’t believe it signals the presence of a medical issue or something that needs to be acted upon or repaired.

There are several problems with this logic.  First, the tendency to drowse and fall asleep by accident, though not necessarily painful in and of itself, can in fact lead to things that are painful, like fall-asleep car crashes.  According to the National Highway Traffic Safety Administration, about 100,000 police-reported car accidents occur in the United States annually due to or associated with driver fatigue or sleepiness.  I’ve seen patients who admitted to me that they’ve fallen asleep behind the wheel of their 18-wheelers, or while driving their motorcycles on the freeway.  Tell me how this is not a dangerous problem.  Secondly, the idea that it’s normal to fall asleep by accident just because you’re sedentary or bored is not based on fact.  If you get proper amounts of sleep regularly and if there are no sleep disorders, you generally shouldn’t be falling asleep easily during the day, even if you’re bored.  Finally, and importantly, the tendency to struggle to stay awake is a symptom of something, not necessarily the problem itself but an indicator that something is wrong, wrong with the quantity of your sleep, the quality of your sleep, or both.

Excessive daytime sleepiness is an incredibly prevalent problem with far-reaching implications.  In 2008 the National Sleep Foundation conducted a survey (called The 2008 Sleep in America Poll).  Of its respondents, 36% nodded off behind the wheel during the previous year; 29% fell asleep at work or drowsed substantially at work; 20% had sex less often or lost interest in sex due to sleepiness; 14% missed family events, work functions, and leisure activities because they were too sleepy or had sleep problems.

The most common cause of daytime sleepiness is simple sleep deprivation.  The vast majority of human adults require between 7.5 and 8 hours of sleep per night regularly to feel awake and alert consistently during the day.  However, as you are probably well aware, many of us tend to get less than that, and often much less than that.  In addition, there are many medical sleep disorders, ranging from obstructive sleep apnea and periodic limb movement disorder to narcolepsy and idiopathic hypersomnia, for which daytime somnolence is an important clinical feature.  If you are struggling to stay awake during the day despite proper amounts of sleep each night, perhaps a sleep disorder needs to be uncovered and managed.

Bottom line:  daytime sleepiness is in fact a real problem, one that can directly and indirectly impact your quality of life.  Consider doing something about it.

Have a great week, everybody!  Cheers!