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Sleepless in America

Causes, Consequences, and Help for the Sleep-Deprived

By Jan Yager, Ph.D.
ConsumerAffairs.com

May 27, 2007

Sleep • Sleep Apnea Can Be Dangerous • Afternoon Nap May Help Long-Term Memory • Lack of Deep Sleep May Increase Diabetes Risk • Sleepless in America • Sleep Disorders Can Hurt Kids' Grades • A Good Night's Sleep Essential to Heart Health • FDA Wants Stronger Warnings on Sleep Disorder Drugs • Sleep Apnea Common but Undiagnosed Among Pacemaker Patients • Americans May Be Relying Too Heavily on Sleeping Pills • Body Clock Findings May Help With Jet Lag, Insomnia • Sleep Apnea Heightens Risk of Stroke and Death • Nighttime Dying Linked to Sleep Apnea From Brain Cell Loss • Study Identifies Sleep Disorder Warning Signs In Kids • Laser Surgery and Sleep Apnea • Snore Formula Settles Federal Charges • Infomercial Doctor Agrees to Stifle SNORenz Claims

Have you ever gotten into your car feeling exhausted, but since you had to get to work, or somewhere important, you decided to make the trip anyway? Or maybe you got into a taxi cab, or onto a bus, and immediately felt like you should get off because the driver looked sleepy? If so, you’re not alone.

According to a poll conducted by the National Sleep Foundation, an estimated 60% of all adult drivers, or approximately 168 million men and women, admitted to driving when drowsy and more than one-third (or approximately 103 million people) admitted to having fallen asleep at the wheel.

They were the lucky ones because they lived to tell the tale.

Others were not so lucky: One conservative estimate from the National Highway Traffic Safety Administration reported that 1,550 men, women, and children die each year in the United States because of drowsy driving.

There are also an estimated 71,000 injuries and $12.5 billion in related costs for fatigue-related car accidents. Add to that the untold number of accidents or mistakes at work because of excessive sleepiness on the job and the students who perform poorly because they are sleep deprived and you can see that sleepiness is a condition in the United States with dramatic consequences.

Everyone knows that drinking and driving are dangerous, but there's only recently a growing concern about the risks of driving -- or working -- while drowsy.

Adolescents need a lot of sleep -- but with loads of homework, extracurricular activities and after-school jobs, they may not get it. Sleep-deprived students who fall asleep at their desks may get yelled at by their teachers. Even worse, those who are driving to and from school -- possibly with classmates in the car -- run the risk of falling asleep at the wheel, which can easily be fatal.

A 2006 poll of adolescents by the National Sleep Foundation discovered that 15% of the drivers in the tenth to twelfth grades admitted to driving while sleepy at least once a week and more than half (51%) of all the adolescent drivers polled had driven drowsy during the previous year.

The foundation also found that adults between the ages of 18 and 29, especially males, shift workers (those who work anything but the traditional 9 a.m. to 5 p.m. daytime shift), and adults with children at home are most at risk for drowsy driving. Shift workers who work from 11 PM to 7 AM may develop something called shift-work sleep disorder with an increased likelihood of excessive sleepiness or insomnia.

Some shift workers such as doctors, nurses, firefighters, and police officers have notoriously long work schedules with overtime as well as odd hours because their employers operate on a 24/7 basis.

A study conducted by Charles Czeisler, Baldino Professor of Sleep Medicine at Harvard Medical School, found that first-year medical interns who worked up 85 hours a week, including two extended shifts of up to 34 consecutive hours without sleep, made 36% more serious medical errors than those interns who switched to a more reasonable schedule. They worked 20 hours less a week and never more than 16 hours at a time.

In another study, Dr. Czeisler found that the odds of an intern getting into a car accident more than doubled as his or her work hours increased. Furthermore, fatigued interns got into near misses on the road five more times than alert drivers.

But as more companies operate multiple shifts, there are a more and more of us who also are experiencing the sleep deprivation associated with shift work.

Are You Getting Enough Sleep?

The consequences of sleepiness, or fatigue, are clear but what makes it a difficult condition to avoid is that there is no one standard for how many hours of sleep each individual requires to awaken refreshed and alert.

Although eight hours is considered the average number of necessary hours, there are those, especially teens, who may need nine to ten hours of sleep nightly, adults who are just fine on just six or seven hours of sleep and senior citizens who typically require less sleep than those who are younger.

The number of hours count but how restful those hours of sleep are for an individual also has to be considered as well. If someone has insomnia -- defined as an inability to get to sleep, and stay asleep, without frequent awakenings -- he or she may “sleep” for ten hours with only five hours of actual sleep.

The rest of the time is spent tossing and turning and that may result in awaking exhausted and fatigued, not as a refreshed as with just seven hours of restful sleep.

Anyway you look at it, research supports the association between less sleep and an increased risk of having a car accident. For example, a study by the AAA foundation for Traffic Safety found that those who slept 6 to 8 hours a night were twice as likely to be involved in a crash as those sleeping 8 hours or more and those sleeping less than 5 hours were 4 to 5 times more likely to be in a car accident.

A study from Australia showed that going without sleep for 18 or 24 hours can be even more dangerous than driving drunk with that sleep deprivation causing someone to have a blood alcohol concentration (BAC) of .05 and .10, respectively (A BAC level of .08 is considered legally drunk.)

Here are just a few examples of the catastrophic results of sleep deprivation:

In 2003, a 60-year-old New York tour bus driver was convicted of manslaughter, assault, reckless driving and reckless endangerment, and sentenced to 10 years in prison, because he fell asleep at the wheel after staying out all night and getting only 3-1/2 hours of sleep over two days, causing an accident that led to the deaths of 5 passengers between the ages of 15 and 30.

In 2005, an airplane crashed at an airport in Nova Scotia killing the 7-member crew. Investigators concluded that crew fatigue, as well as inadequate training, caused the crash, although the airline denied that fatigue was a factor.

Warning Signs

What are the warning signs of excessive sleepiness?

According to The National Sleep Foundation, there are specific signs that indicate you’re driving exhausted but many of these signs will also apply to work or school-related situations:

• You’re having trouble keeping your eyes focused on the road;
• You can’t stop yawning;
• You can’t remember driving the last couple of miles;
• You missed an exit or a traffic sign;
• You are daydreaming or have wandering or disconnected thoughts;
• You’re rubbing your eyes;
• You're having trouble keeping your head up; and
• You're drifting from your lane, driving too close to the car in front of you, or hitting a shoulder on the highway

If you’re driving and you see a car weaving in and out of the lane, that could be a sign that someone is sleepy. The best to to do? Stay as far away as you can. If you have a cell phone, you may want to call the state police to report it.

Causes of Drowsiness

What increases the likelihood of drowsy driving or excessive sleepiness?

It's simple. The most obvious cause of driver fatigue is getting too little sleep the night before.

According to Charles Pollak, M.D., Director of the Center for Sleep Medicine at Weill Cornell Medicine Center based in New York City, since most sleep-deprived individuals make up for the lost sleep by getting more of it over the weekends, Mondays are not that bad in terms of sleep deprivation. But, Dr. Pollak points out, “Tuesdays are a little worse, Wednesdays and Thursdays are even worse, and Fridays are the worst day of all in terms of daytime sleepiness.”

There are, of course, other possible causes for sleepiness -- such as sleep apnea, which is the cessation of breathing during sleep. This is most common in middle-aged men who are overweight but there are also women who get sleep apnea.

Sleep apnea can only be diagnosed through a session in the sleep laboratory. It can be treated very effectively, using a device that clamps onto your nose, called a nasal CPAP (Continuous Positive Airway Pressure), says Dr. Pollak. The consists of an air pump and a mask placed over the face to aid in breathing.

“It’s wise to treat sleep apnea not just because it will get rid of the sleepiness but it will also stave off the development of cardiovascular problems which can develop because of it along with high blood pressure, heart disease, or stroke,” Pollak said.

The sleep disorder known as narcolepsy can also cause excessive sleepiness but narcolepsy, which is associated with cataplexy, or the sudden loss of muscle power, is a relatively rare condition thought to occur in approximately 40 out of 100,000 persons, at about the same rate as multiple sclerosis.

Alcohol can also intensify the results of sleep deprivation so combining alcohol and exhaustion will impair someone even more than if he or she is not sleep-deprived.

The Most Dangeorus Times

There are certain times when drowsy driving or sleep deprivation is more likely to occur. Driving long distances without taking a break, especially on freeways or Interstates, may put you at greater risk for drowsy driving.

Mary Carskadon, Ph.D., Professor in the Psychiatry and Human Behavior Department at Brown University is a sleep researcher who has studied the impact of early start times for schools and adolescent sleep deprivation. She cites a study that found teenagers who had four or more electronic devices like video games, television, Internet access, or cell phones in their bedroom got thirty minutes less sleep at night.

At work, failure to take enough breaks, especially if you are doing repetitive and even boring work, might have the same sleep-inducing effect as driving too long on a highway.

What Can You Do?

Monitor your own activities to see when you are more likely to skimp on sleep. Be careful to either get a nap or avoid putting yourself and others in harm’s way by staying off the road or participating in potentially life-threatening activities at work (or working on projects that require attention to detail that you’re not able to provide given your sleepy state).

Are you taking a medication that could be causing drowsiness? If you are unable to discontinue use of the medication, or switching to a product that does not make you sleepy, you owe it to yourself and everyone else to avoid driving or operating heavy machinery as long are you are taking that drug, whether it is an over-the-counter or prescription drug with that soporific side effect.

What doesn’t work?

There are behaviors that drivers typically engage in when they start to feel fatigued. The consensus from experts and research is that the following won’t work for very long:

• Rolling down the car window;

• Turning up the radio; and

• Slapping your face

What does work?

• If you haven’t left home yet, go back to sleep and don’t get into the car until you are completely awake.
• If you’re already driving, stop the car without putting yourself in harm’s way and get out and walk around.
• If walking around doesn’t wake you up enough, if it is a safe situation, take a 20 minute nap.
• Coffee, tea, caffeinated soft drinks, or NoDoz®, an over-the-counter medication that contains caffeine, can offer short-term help but remember it may take 15 to 30 minutes for the awakening effect of the caffeine to kick in.

Also be careful that if you have any medical conditions that counter indicate having caffeine, such as a heart condition or atrial fibrillation, additional caffeine in any form can have potentially negative side effects. Dr. Pollak suggests that instead of using prescription or over-the-counter medications which could lead to abuse or dependency try to figure out what’s causing the sleepiness. If you can’t figure it out on your own, consider getting help from a physician or sleep expert.

Getting help

If you suffer from excessive sleepiness, first try to deal with this problem on your own by getting enough sleep. If you have a chronic fatigue problem, consult your family physician for help.

“If you’ve had a near miss or actually had an accident because of drowsy driving, talk to your doctor about it,” suggests Mark Rosekind, Ph.D. Says Dr. Rosekind, “You could have any of some ninety sleep disorders especially sleep apnea which we know puts someone at six times the risk for a car crash.”

Your family physician may be able to help you with your fatigue or he or she may refer you to a sleep center for an evaluation. The American Academy of Sleep Medicine (AASM), the national accrediting body for sleep disorders centers and laboratories, maintains a free listing of centers at the website www.sleepcenters.org. (In 2005, they launched an educational website with the URL www.sleepeducation.com.)

It’s Up to You

“Sleep loss creates risk, and you need to take action to literally save your life, be safer, be healthier, and to get better performance,” says Dr. Rosekind who used to direct the Center for Human Sleep Research at the Stanford University Sleep Disorders Clinic.

Knowing the risks that sleep deprivation exposes us to, perhaps we should revise the adage “Early to bed and early to rise…” to “Early to bed, not too early to rise, makes you and your loved ones healthy, wealthy, wise, and alive.”

Jan Yager, Ph.D. (www.drjanyager.com), a sociologist who writes about sleep, work, and relationships, among other topics, is the co-author, with Michael J. Thorpy, M.D. of The Encyclopedia of Sleep and Sleep Disorders, published by Facts on File, Inc., (www.factsonfile.com) (1991, 2nd edition, 2001, 3rd edition, with Charles Pollak, M.D., due out in June 2008).

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