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.

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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.

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!

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.

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.

 

Woman Sleepwalks Onto Subway Tracks

Stories like this one from yesterday seem far too common these days.  Here is some remarkable surveillance camera video recently released, demonstrating a Boston-area woman ambling slowly forward and right into a subway station pit and onto the subway tracks.

Amazingly, this woman wasn’t seriously injured in the incident, and by report she later told authorities that she had fallen asleep on a nearby bench and that she probably sleepwalked onto the tracks.  According to the clock on the video, this incident took place at 8:41 in the morning.

Here’s just a brief word on sleepwalking, a fairly common phenomenon particularly in children, teenagers, and young adults.  Sleepwalking is a form of non-REM parasomnia–in other words, an unusual movement or behavior occurring during or immediately out of non-REM sleep (i.e., non-dream sleep).  Such events tend to occur more frequently if you are in a position in which you tend to have a lot of deep non-REM sleep (such as if you are sleep-deprived) or if there is something in or around you that causes abrupt arousals from sleep.  In the case of this particular woman, I have not been able to find a lot of specific information in the media pertaining to why this incident occurred, but if she had fallen asleep waiting for her train around 8 or 9 in the morning, chances are probably good that she had been sleep-deprived (otherwise she probably wouldn’t have fallen asleep there in the first place), and being in an environment with lots of loud noises (have you ever been in a T-station in or around Boston?), well, this seems like a set-up for a possible sleepwalking event.

Our modern world is crazy.  Our lives are fast and furious; we work hard, we study hard, we play hard.  But our busy lifestyles don’t make the need for sleep any less important.  Most adults need around 7.5 to 8 hours of sleep per night to feel fully rested.  Ask yourself how often you are making time for that much sleep at night.  My main take-home point for you this afternoon:  getting proper amounts of sleep, and regularly, may prevent a whole host of potential problems during the day, ranging from reduced work productivity to fall-asleep car crashes to unusual behaviors such as sleepwalking.  And perhaps getting proper amounts of sleep each night may even save your life.

 

Sleep well, everyone, and stay safe!