Tag Archives: excessive daytime sleepiness

Texting Drivers? Ask Tracy Morgan About Drowsy Drivers

I do a fair bit of driving.  I live in Seattle, home to long, crazy commutes.  You see a lot of stuff on Puget Sound highways:  multi-lane weavers, left-lane cruising taxi drivers, packs of wheelie-popping crotch-rocketers, hyper-caffeinated road-ragers.

Something that I see more and more of these days:  a Prius ahead of me, starting to hug those lane-dividing lines, slowly moving further and further to one side, followed by a quick correction back to the center of the lane, and then followed by another slow drift to the lane’s outer boundaries.  Then it rolls over some of those turtles on the side of the highway before it corrects yet again. I speed up to get away from this car and its impaired driver.  I look over as I pass, and sure enough:  the young driver is staring at his or her lap, poking furiously at a smart phone while putting everyone on the road at risk.

 

Everyone has seen these drivers on the road in recent years.  But another, more insidious problem has long lurked on our roads, something much less obvious than but just as dangerous as texting drivers:  drowsy drivers.  According to the National Highway Traffic Safety Administration, roughly 100,000 motor vehicle accidents are reported to occur due to driver sleepiness/fatigue in the United States every year.  Those are just the reported accidents; there are likely thousands more that occur every year that are not reported.  A 2005 National Sleep Foundation poll revealed that 60% of American drivers reported driving while drowsy at least once in the previous year, and 37% fell asleep behind the wheel at least once in the previous year.

These basic statistics should make you concerned, not just because there are so many drowsy drivers out there, but because of how casually so many people routinely drive while sleepy.  They flirt with disaster every day by doing so.

Around 12:55 a.m. one late night in June 2014, a Wal-Mart truck crashed into a van carrying, among other people, the actor and comedian Tracy Morgan, killing one van occupant and critically injuring Morgan.  Earlier this week the National Transportation Safety Board announced its conclusion that driver fatigue likely played a role in the accident:  the truck driver reportedly had driven 800 miles throughout the night prior to the accident, and had been awake for more than 28 hours straight.  The driver, Kevin Roper, now has been charged with vehicular homicide.

What to do with truck driver fatigue is a difficult, complex, and emotionally and politically charged issue.  Work hours, industry culture, the need to “get there on time,” and financial issues all contribute to the debate regarding how to improve safety on our highways.  From a clinical perspective, however, I can tell you that a great many people–truck drivers or not–simply don’t sleep as long as their bodies require.  The substantial majority of adults require around 7-8 hours of sleep per night, and let’s be honest with ourselves, many of us don’t get that much on an average night.  One of the most common causes of daytime sleepiness is chronic sleep deprivation, which is associated all sorts of long-term and short-term consequences, from poor work performance to medical problems to fall-asleep car crashes.

For those who struggle to stay awake during the day and find themselves nodding off while they are driving despite getting proper amounts of sleep per night, consider informing your doctor and consider a sleep medicine evaluation.  There are many potential causes of excessive daytime sleepiness, including many sleep disorders.

Final word, which at this point is painfully obvious:  regardless of the cause, never drive if you’re drowsy!  Spare yourself the tragedy of injury and death, as well as the guilt stemming from having caused a fall-asleep car crash.

Have a safe weekend, everyone.

Participate in Sleep Apnea Research!

I hope you are enjoying this hot and crazy summer!

As you know, we in clinical sleep medicine are here for you.  Without patients in need of help for their sleeping problems, there would be no physician sleep specialists, no sleep centers, no sleep medicine.

Sleep medicine is an independent medial subspecialty, just like cardiology, pulmonology, and neurology.  Though sleep medicine remains focused on the clinical evaluation and management of sleep disorders, it also must continue to move forward in innovation and search for answers to unknowns in our field.  These essential aspects of our work can only be accomplished through research.

An organization called SAPCON (Sleep Apnea Patient Centered Outcomes Network) is dedicated to promoting sleep apnea research around the country.  Organized in conjunction with the American Sleep Apnea Association, it is one of the largest networks to advance sleep apnea research.  My friend and mentor, Dr. Vishesh Kapur (Professor of Medicine, University of Washington; Steering Committee Member, SAPCON), asked me recently to spread the word about SAPCON, which has created a website designed to develop a sleep apnea patient community that will learn about and contribute to sleep apnea research.  Sleep apnea apnea patients may now easily connect with health care providers and researchers to share ideas and needs.  As Dr. Kapur puts it, through the website “patients will be able to learn what is new in sleep apnea research, suggest new areas of focus for sleep apnea research, and participate in research if they choose to.”  The website also contains valuable online tools to help you manage your sleep apnea.

The website:  www.myapnea.org

I encourage sleep apnea patients and their loved ones to visit the site and see all that it has to offer.

Stay cool and sleep well this summer, everyone!

 

Alaska Airlines Cargo Worker Falls Asleep in Plane Cargo Compartment

Here’s a recent story from right here in my home base of Seattle, Washington:

Six days ago, as Alaska Airlines flight #448 took off from SeaTac International Airport, passengers heard someone pounding from below the cabin.  A cargo worker was trapped in the cargo compartment of the now airborne Boeing 737.  This as-of-yet unidentified man, an employee of contractor Menzies Aviation, called 911 upon realizing he was trapped in the belly of the plane.  Upon learning of the presence of someone in the compartment, the pilot turned around for a hasty but safe emergency landing back at SeaTac.  No one was injured.

 

Turns out that this man had fallen asleep in the cargo compartment and he later awakened to find himself–and the plane–airborne and on its way to Los Angeles.  The Federal Aviation Administration is investigating the incident, and by report the man is on administrative leave; furthermore, according to an Alaska Airlines spokesperson he has been “permanently banned from ever working again on an Alaska Airlines operation.”

It’s not clear from the news reports why the contractor was asleep in the cargo compartment; by report he passed a drug test subsequent to the event.  However, this incident took place around 2:30 in the afternoon on a Monday.  From a physician sleep specialist’s perspective, here are some important potential reasons for someone to end up snoozing in the wrong place at the wrong time:

—Irregular sleep schedules, which could be related to a wide variety of causes, from insomnia to some late weekend nights to flip-flopping work shifts (it’s not yet clear if this man’s particular work scheduling involved occasional or recent night-time work).

—Chronic sleep deprivation.  Most adults require 7.5-8 hours of sleep per night regularly to feel fully rested during the day, and the most common cause of sleepiness in the U.S. is sleep deprivation.

—Undiagnosed and/or untreated sleep disorders.  There are about 100 sleep disorders, ranging from breathing disorders (such as obstructive sleep apnea) to movement disorders (such as periodic limb movement disorder).  Commonly associated with excessive daytime sleepiness, these intrinsic sleep disorders often can persist for many years before coming to the attention of a healthcare provider.

I should note here that it’s not necessarily abnormal to feel a little sleepy or “let down” in the mid-afternoon.  Our natural tendency to become slightly drowsy or fatigued during that time of day is called the “circadian dip” or “circadian low;” it also provides the reasoning for the “siestas” commonly found in some cultures.  However, warningless sleep attacks and irresistible urges to sleep during that time suggest that more than just the circadian low may be at work.

 

Though I understand that Alaska Airlines does not permit people to “sleep on the job,” my real concern here is why this person experienced a sudden sleep attack or felt compelled to take a nap in the compartment in the first place.  I hope that this gentleman has been or will soon be properly evaluated in this regard.

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.

April Fool’s Day Wake-Up Pranks, 2014

Well, Happy April Fools’ Day once again, everyone!

Last year I posted some funny sleep-related April Fools’ pranks:

https://sleephelpdesk.com/2013/04/01/april-fools-day-wake-up-pranks/

To expand on this tradition I’m posting some more humor today.  I present here some of my more favorite sleep-related practical jokes.  This year I’ve had a hard time finding video sufficiently clean to include in this post.  I’ve done my best to screen for language and out-and-out meanness.  As always, do not try any of these pranks at home.

 

Our first gag comes from Japan, land of crazy, well-orchestrated, and televised practical jokes.  The pranks the Japanese show on television would never float here in the U.S., where people sue other people just for looking at them wrong.  This is way over the top, quite literally.  I would hate to be the guy pranked here.  Check it out.

Here is a guy pretending to be so sleepy that he sleeps standing up, leaning in on other people, and generally freaking people out, especially the last guy.  For the record, falling asleep in public places is quite common, though usually not as dramatically as depicted here; people think of narcolepsy when they hear of people falling asleep in public like this, but actually the most common cause of sleepiness is sleep deprivation, such as from pulling an all-nighter.

Anyone who has seen the Japanese or American versions of The Ring will find this instantly familiar and hilarious.  The women who was pranked seemed to take the joke in her stride.

The classic wake-up prank involves an air horn.  There are hundreds of examples of this form of rude awakening on the web.  Here’s a quick one featuring the Burger King!

I also love rude awakenings in the car, particularly the ones that involve screaming and scaring the pants off of the unsuspecting, slumbering passenger.  You know what I’m talkin’ ’bout.  Here’s a nice example:

And here, at last, is my very favorite sleep-related prank video of the year.  It’s short and silent, but hilarious:  for a brief period of time, this man becomes a guitar hero to all who slumber.  Enjoy!

OK, OK, I have to give you one more.  This is a repeat from last year, but it’s so great I have to post it again.  Have a great day!

“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.