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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Easy Tips to Combat Summertime Insomnia

Don’t you love summer?  All the barbecues, outdoor festivals, vacations; school’s out, with all the freedom that goes with that.

I love summer as much as the next guy.  Many of my sleep patients don’t, however.  I’ve found that there are a couple of times of the year in which my patients experience a spike in their insomnia:  during the holidays, and during the summer.

There are several reasons why summertime can trigger or worsen difficulties falling and/or staying asleep.  First, many people and many families experience lifestyle changes during the summer as compared to during other times of the year:  kids can sleep in in the morning; vacations with jet lag; modifications in work hours or work timing; late-night parties and alcohol use.  These changes tend to dysregulate sleep schedules, leading to insomnia.  Second, it’s hot!  It’s hard to sleep when you’re sweltering and sweating in bed every night; we here in Seattle have been in a month-long heatwave, a major problem because most homes here have no air conditioning!  Third, because of the tilt of Earth’s axis during the summer, it’s light out late.  As most can easily understand, if the sun is still up in the evening, it feels naturally for YOU to stay up.  Exposure of your eyes–and hence your brain–to light has a profound impact on your sleep/wake cycles.  No wonder why people tend to have insomnia during these precious summer months!

So here are some pointers to improve your sleep for the remainder of this summer:

1.  Choose a time to awaken each morning, and stick with it.  Even if you’re not in school or not working, determine a preferred awakening time, set your alarm clock or smart phone for that time, and awaken and get out of bed that same time every morning, including weekends.  Your body clock “wants” regularity, no matter what your personal situation.  Sleeping in by several hours can throw off your body’s circadian rhythms, dysregulate your sleeping patterns, and promote delayed sleep phase.

2.  Keep your sleeping environment DARK.  Usually Venetian blinds suck at keeping out substantial light from your room when the sun is out late.  I recommend getting thick black curtains that completely cover up your bedroom window.

3.  Keep your sleeping environment QUIET.  Whether it’s motorcyclists or firecrackers outside your bedroom window, summertime often means lots of noise outside your bedroom.  Insulate your bedroom from the noise the best you can.  A fan near the bed can create a white-noise effect to drown out noises from outside.  Some may resort to sleeping in another, quieter room in the home, one that is further away from the street for example.

4.  Keep your sleeping environment COOL.  The fan in the room helps with this, obviously, if you don’t have AC.

5.  Avoid naps if you can.  Naps are tempting if you have the time and opportunity, particularly if you’re chronically sleep-deprived.  However, naps during certain times of the day–particularly the mid- to late afternoon–can cause substantial subsequent problems falling asleep later at night.

6.  Don’t spend too much time in bed.  Remember, most adults need about 7-8 hours of sleep per night, and your body generally won’t let you sleep more than what your body needs.

School is starting back up before you know it.  Enjoy the remainder of your summer!

 

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.

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.

 

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.