Why is it so difficult for OTR drivers to get a set sleep pattern? The medical name for a sleep or biological pattern is called the circadian rhythm. When you have a sleep schedule which is as erratic as truck drivers is it is impossible to establish a good sleep pattern. Instead of us drivers being able to set our own wake and sleep patterns, the nature of the industry dictates when we can sleep by the demands of the customers hours and the freight we need to pick up. It is critical to have a good sleep rhythm, without it our reactions drop dramatacially, we become more irratible, it makes you dumber til you are well rested again, less focused, and much more to. Plus this is not tackling the other damage it does to our bodies as well.
Every militray power in history that has had prisoners of war has used sleep deprivation and erratic schedules to break their prisoners morale and resolve. It also adversely affects the victims judgement, and physical performances. The fact we can't get sufficent relaxation and quality down time for batteries by getting some good shuteye means that we have to get our energy from other sources like high caloric foods, caffeine and nicotine as well as some drivers using uppers to hold sleep off longer do to the their jobs being threatened if they don't do over 100 hours a week of work. Plus since you are tired more often, you have less energy to use in exercising or doing other benificial activities for your health.
A couple good solutions to help fight having your inner clock mangled by management would be to either have all solo drivers get a set daily 12 hour assigned workshift, in which you must do all your work in to include on duty not driving or driving no matter what the freight might demand. The other is for all company trucks to be run as teams.
As it is now we are having our lifespans dramatically shortened in comparision with what the national average is. The average age of death for a truck driver is 61 years of age, 16 years sooner than the national average of 77. Does this figure into the account all the accidental deaths of drivers who drift off to sleep at the wheel then hit an abutment or flip their rigs, etc.?
What gives the trucking companies the right to take away 16 years of our life? Why is it we let let them torutre us by messing with our sleep patterns? Why are we letting the companies kill us for a miserly $10-12 an hour on average (if you are honest about all the hours you actually work this is what we average, sure we can work over 100 hours a week illegally, but we don't get paid any more per hour, nor do we get paid extra for overtime). The comapny workers have health sleep habits, and all the benefits of being home daily like a nice shower every day, regular comapny, and they make more than you do per hour. Even the newest office workers can expect to start out at $12/hr or better during their probatiionary period, then they go up to make more per hour than you actually do.
Why shoud we have physically destructive life threatening disruptions given to us by the companies we drive for? Do they not care about your health? How many times have you been sleeping or trying to get some much needed rest and your dispatcher starts calling you or sending you messeges on the Qualcomm and waking you up for minor or irrelevant reasons. The lives of other drivers, and anyone else we might hurt/kill in an accident as well as ourselves are all endangered becuase we can't get the rest we so badly need. Who are the companies and their dispatchers who squander a much needed resource so arbitrarily with no regard about our welfare and the rest of the driving publics well being, only caring about the profits of the company and how many hours they have to work at their $16 per hour or better.The office workers make more pay per hour than you do and get a good rest, where is the fairness in this when drivers are the ones who actually earn the money??
The way trucking is now driver you will die broke and broken having killed yourself for a company that treated you like a slave or prisoner of war and used torture, coercion by threatening to fire you for their failure to realize you are still only human and not a damned machine or animal. If you are doctoring your logs or speeding then you are doing exactaly what the bosses want. They want to to pay as little as they can while you work yourself to an early grave.
Below are some related articles I thought you might like to read from more offical sources than myself.
A number of key findings have been summarized by various authors over the past few years relating to fatigue and rest in the occupational setting involving continuous operations. The following list was generated from a review of several articles published by Rosekind (1995, 1996) and Dinges (1991, 1995). They are listed in the form of points to aid in grasping the significance of the findings. Those interested in a more detailed review of the findings should consult the original sources.
Sleep deprivation results in cognitive performance deficits.
Disruption of circadian rhythms leads to a decrease in performance.
Human beings are not very good at estimating their current level of alertness.
Repeated disruption of sleep schedules can lead to decreased performance.
Sleep inertia can lead to performance decrements
Inability to get regular sleep may lead to disruption of the circadian rhythm.
Short naps have been found to restore an individual�s capacity for performance under certain conditions.
Time off alone may not guarantee a rested workforce. Education, planning, and predictability are needed to maximize utilization of work/rest schedules.
With repeated loss of sleep a sleep debt builds up over time
With increased sleep loss and increased sleepiness a person may become vulnerable to performance problems
Quality of sleep is an important factor. Poor quality sleep can leave a person feeling fatigued and non-restored
There can be a discrepancy between how people are feeling and how sleepy they are physiologically.
Scientific evidence suggests that being on an altered shift schedule, like nights, does not lead to an altered internal circadian pattern.
Shift workers that go back and forth between shifts experience more difficulties between the circadian rhythms and sleep times.
Moving a shift schedule forward involves easier physiological adaptations
The following conclusions regarding the effects of sleep loss and sleepiness were abstracted from several articles written by David Dinges of the University of Pennsylvania (Dinges, 1991, 1995). They cover several aspects of research, which are relevant to transportation operations.
1. Fatigue affects performance
Fatigue erodes performance such as vigilance, sustained attention,
Four main processes affect performance decrements: circadian phase, acute sleep loss, cumulative sleep loss, and sleep inertia.
Fatigue can cause lapses or micro sleeps
Night work which interferes with the circadian rhythm can cause lapses to increase 4 to 10 fold
The longer one is awake beyond 14-16 hours the greater the occurrence of lapses.
Chronic under-sleeping creates a cumulative sleep debt, which can produce a cumulative increase in lapses on vigilance tasks.
Sleep inertia creates lapses.
2. Fatigue produces a variety of performance decrements:
Performance variability
Slowed physical and mental reaction time
Increase in number of work related errors
Increased tendency to persistently repeat behaviors
Increase in false responding
Increases memory errors
Decreased vigilance
Reduced motivation and laxity
3. Magnitude of fatigue effects vary by individual
This limited review should serve to alert readers that the "science of fatigue and alertness" is still in its infancy. Those looking for definitive "proof" of a particular point of view are likely to be disappointed. The results of investigations to this point can only be used to generate basic guidelines to follow in developing fatigue countermeasures.
http://www.du.edu/~psherry/fatigue/effects.html
It is possible that the effects of low levels of blood alcohol may have an interaction with circadian rhythms that produces sleepiness in the afternoon and evening (Roehrs et al., 1994; Horne, Baumber, 1991; Horne, Gibbons, 1991). The panel speculated that drinking alcohol before driving in the afternoon or at night might pose special risks given the circadian effects.
INTERACTIONS AMONG FACTORS INCREASE OVERALL RISK
Some of the crash-related factors have been studied more than others. The panel could not find evidence to determine whether chronic or acute situations pose the greater risk for crashes. However, it is clear that these factors are cumulative, and any combination of chronic and acute factors substantially increases crash risk. For example, people with chronic sleep loss who drive in the early morning hours are likely to be at greater risk than are early morning drivers who slept well the night before and usually get enough sleep.
V. POPULATION GROUPS AT HIGHEST RISK
All drivers who experience the chronic or acute situations described in section IV are at risk for drowsy driving and drowsy-driving crashes. Although no one is immune from risk, research to date clearly identifies three broad population groups at high risk for drowsy-driving crashes. Their higher risk is based on (1) evidence from crash data of a greater absolute or relative number of fall-asleep crashes and/or (2) increased intermediate risk, based on subjective reports of their having higher levels of sleepiness and more of the chronic or acute factors that underlie risk for everyone. The three groups at high risk are young people, shift workers, and people with untreated sleep conditions.
YOUNG PEOPLE, ESPECIALLY YOUNG MEN
Virtually all studies that analyzed data by gender and age group found that young people, and males in particular, were the most likely to be involved in fall-asleep crashes (Pack et al., 1995; Horne, Reyner, 1995b; Maycock, 1996; Knipling, Wang, 1994). Definitions of "young" differed among authors; the ages included in this category fell between 16 and 29.
Young people. Knipling and Wang (1995) found that drivers younger than 30 accounted for almost two-thirds of drowsy-driving crashes, despite representing only about one-fourth of licensed drivers. These drivers were four times more likely to have such a crash than were drivers ages 30 years or older. In Pack and colleagues' study (1995), 20 was the peak age of occurrence of drowsy-driving crashes, whereas in New York State the greatest number of drowsy drivers (on self-report) were within the 25-to-34 age group (McCartt et al., 1996), and both the 18-to-24 and 25-to-39 age groups were overrepresented in fall-asleep crashes (New York State Task Force, 1996).
Horne and Reyner (1995a) suggest that a combination of having more of the chronic and acute risk factors and frequently being on the roads during nighttime hours (greater exposure) may explain the greater incidence of drowsiness-related crashes in youth. Carskadon (1990) offers a variety of age-specific reasons for the involvement of younger people, particularly adolescents. During this period, young people are learning to drive, experimenting and taking risks, and testing limits. At the same time, this age group is at risk for excessive sleepiness because of the following:
Maturational changes that increase the need for sleep.
Changes in sleep patterns that reduce nighttime sleep or lead to circadian disruptions.
Cultural and lifestyle factors leading to insufficient sleep, especially a combination of schoolwork demands and part-time jobs, extracurricular activities, and late-night socializing. In one study (Carskadon, 1990), boys with the greatest extracurricular time commitments were most likely to report falling asleep at the wheel. The subgroup at greatest risk comprised the brightest, most energetic, hardest working teens.
The panel felt that vulnerability may be further increased when young people use alcohol or other drugs because sleepy youth are likely to be unaware of the interaction of sleepiness and alcohol and may not recognize related impairments they experience.
Males. In North Carolina, males were found to be at the wheel in about three of four fall-asleep crashes (Pack et al., 1995). NHTSA data show that males are 5 times more likely than females to be involved in drowsy-driving crashes (Wang, Knipling, Goodman, 1996). The reasons young males have more crashes than do young females are not clear because both young men and young women are likely to be chronically sleep-deprived.
SHIFT WORKERS
Most shift workers have at least occasional sleep disturbances, and approximately one-third complain of fatigue (�kerstedt, 1995a, 1995b, 1995c). Older shift workers appear to have more sleep-related difficulties than do younger workers, but no gender differences have been found (Harma, 1993). Night shift workers typically get 1.5 fewer hours of sleep per 24 hours as compared with day workers. The midnight to 8 a.m. shift carries the greatest risk of sleep disruption because it requires workers to contradict circadian patterns in order to sleep during the day (Kessler, 1992).
Investigations have demonstrated that circadian phase disruptions caused by rotating shift work are associated with lapses of attention, increased reaction time, and decreased performance (Dinges et al., 1987; Hamilton et al., 1972; Williams et al., 1959). A study of hospital nurses reached similar conclusions based on "real world" experiences. Rotating shifts (working four or more day or evening shifts and four night shifts or more within a month) caused the most severe sleep disruptions of any work schedule. Nurses on rotating schedules reported more "accidents" (including auto crashes, on-the-job errors, and on-the-job personal injuries due to sleepiness) and more near-miss crashes than did nurses on other schedules (Gold et al., 1992). About 95 percent of night nurses working 12-hour shifts reported having had an automobile accident or near-miss accident while driving home from night work (Novak, Auvil-Novak, 1996).
Hospital interns and residents routinely lose sleep during on-call periods, which may last 24 hours or more. A survey of house staff at a large urban medical school found that respondents averaged 3 hours of sleep during 33-hour on-call shifts, much of which was fragmented by frequent interruptions (Marcus, Loughlin, 1996). About 25 percent reported that they had been involved in a motor vehicle crash, 40 percent of which occurred while driving home from work after an on-call night. Others reported frequently falling asleep at the wheel without crashing, for example, while stopped at a traffic light.
Although this evidence does not demonstrate a conclusive association between shift work and crashes, the panel believes that shift workers' increased risks for sleepiness are likely to translate into an increased risk for automobile crashes. Competing demands from family, second jobs, and recreation often further restrict the hours available for sleep and further disrupt the sleep schedule.
The panel also designated shift workers as a high-risk group because the number of people who perform shift work-and are thus exposed to crash risk-is increasing. This sector is growing at a rate of 3 percent per year, as businesses such as overnight deliveries, round-the-clock computer operations, overnight cleaning crews, 24-hour markets, and continuous-operation factories prosper and expand. Currently about one in five men (20.2 percent) and almost one in six women (15 percent) work other than a daytime shift, including evening, night, rotating, split, and irregular shifts (Kessler, 1992).
PEOPLE WITH UNTREATED SLEEP APNEA SYNDROME AND NARCOLEPSY
Although the absolute number of crashes is low, crash risk is increased among people with untreated sleep apnea syndrome (SAS) and narcolepsy. The proportion of crashes is higher for people with untreated narcolepsy than it is for people with untreated SAS. However, because SAS is more common than narcolepsy, the absolute number of crashes is higher for those with untreated SAS (Aldrich, 1989). In addition, patients with untreated SAS or narcolepsy perform less well on driving simulation and vigilance or attention tests than do people without these disorders (Findley, 1995; American Thoracic Society, 1994; Haraldsson et al., 1990). Undiagnosed sleep-disordered breathing, ranging from habitual snoring to repeated breathing interruptions, also increases the likelihood of crashes in a dose-response manner (Stradling et al., 1991; Philip et al., 1996; Hanning, Welch, 1996; Ohayon, Priest, Caulet, et al., 1997).
Although these conditions place people at higher risk for drowsy-driving crashes, they are not invariably linked with impaired driving. For example, many people with these disorders report no auto crashes (Findley et al., 1988; Aldrich, 1989). Findley and colleagues (1989) found that patients with severe untreated sleep apnea had more frequent crashes than did those with untreated mild apnea. A patient who can recognize impending uncontrollable sleepiness and take precautions is less likely to be at risk than one who is unaware of or denies his or her sleepiness (Aldrich, 1989).
Sleep apnea syndrome is somewhat more common among males than among females, and typical patients tend to be overweight and middle aged or older, with a large collar size and history of loud snoring; however, women and men without this profile also have the disorder (American Thoracic Society, 1994). People with narcolepsy are as likely to be female as male, and the disorder usually begins in adolescence. The time from onset of symptoms to diagnosis of narcolepsy averages 10 years (American Thoracic Society, 1994; National Commission on Sleep Disorders Research, 1993). Currently, many people with these conditions are undiagnosed and untreated, unaware of the potentially serious consequences of driving while drowsy, or unaware of the seriousness of the difficulty they may experience in maintaining alertness (Arbus et al., 1991; Hansotia, 1997). Falling asleep at the wheel may be a major factor that motivates undiagnosed patients to seek medical care. The matter is rarely raised in driver or law enforcement education, and even health care professionals may not recognize a history of sleepiness as a risk factor for fall-asleep crashes. Medical systems have been successful in identifying only a fraction of the population with symptomatic sleep apnea (Strohl, Redline, 1996).
VI. COUNTERMEASURES
The panel reviewed the knowledge base in four categories of countermeasures: behavioral, medical, alerting devices, and shift work. They found only a few scientific evaluations of potential countermeasures, most of which were laboratory studies. Reports that exist tend to address the biological feasibility of reducing drowsiness or improving alertness, rather than demonstrate an intervention that reduces drowsy-driving crashes. As noted earlier, more research is needed on this topic.
Countermeasures for drowsy driving aim either to prevent it or to ameliorate it after it occurs. The panel concluded that preventing drowsiness with adequate sleep before driving is both easier and much more successful than any remedial measure reviewed. Methods of obtaining adequate sustained sleep include creating a positive sleep environment (a room that is cool, quiet, and dark) and sleeping at regularly scheduled times. Such measures are often promoted as "sleep hygiene" and make intuitive sense; however, few rigorous studies support all sleep hygiene claims.
The panel noted that the wake-up effects from remedial approaches to existing sleepiness do not last long. At best they can help sleepy drivers stay awake and alert long enough to find a motel, call for a ride, or stop driving and sleep. They are not a substitute for good sleep habits and should not be viewed as a "driving strategy" that can get drowsy drivers safely to their destination.
BEHAVIORAL INTERVENTIONS
In addition to getting adequate sleep before driving, drivers can plan ahead to reduce the risk of drowsy driving in other ways. Some evidence exists that napping before a long drive may help make up for sleep loss in the short term and enhance wakefulness during the drive. Napping has the greatest effect on performance several hours after the nap (Dinges et al., 1987; Dinges, 1992, 1995). Two other proven interventions avoid known problem situations: not drinking alcohol when sleepy (Roehrs et al., 1994) and not driving between midnight and 6 a.m. (Mitler et al., 1988; �kerstedt, 1995c), especially well into the period when sleep is usual (Brown, 1994). Graduated driver-licensing programs that disallow late-night driving among younger drivers can mandate this risk-avoiding behavior (Waller, 1989; Frith, Perkins, 1992).
When a driver becomes drowsy, the most obvious behavioral step for avoiding a crash is to stop driving and sleep for an extended period. When this approach is not practical and another driver is not available to take over, studies have found two remedial actions that can make a short-term difference:
Napping. Taking a break for a short nap (about 15 to 20 minutes) has been shown to improve subsequent performance, even among sleep-deprived people (Horne, Reyner, 1995a; Dinges et al., 1987; Philip et al., 1997). Naitoh (1992) found that short naps every 6 hours during a 35-hour (otherwise sleepless) period was effective in maintaining performance in the laboratory. However, nappers are often groggy for about 15 minutes upon awakening from naps longer than 20 minutes (Dinges, 1992). Practical issues with this strategy include the inability of some people to take short naps and the need for secure rest areas. The New York State survey found that about one-third of drivers had needed or wanted to stop in the past year, but a rest area was not available. Many also were unlikely to use a rest area when they were driving alone at night.
Consuming caffeine. Caffeine, even in low doses, significantly improves alertness in sleepy people (but only marginally in those already alert) (Regina et al., 1974; Lumley et al., 1987; Griffiths et al., 1990; Lorist et al., 1994). The minimum dose needed can be obtained in about two cups of percolated coffee, although caffeine content of coffee varies widely (Fox, 1993). Caffeine also is available in other forms such as caffeine-fortified soft drinks and tablets. In driving simulators, sleep-deprived drivers who consumed caffeine reduced lane deviations, potential crashes, and sleepiness for about an hour after consumption (Horne, Reyner, 1995a).
In addition, limited evidence suggests that physical discomfort (such as sitting in an uncomfortable seat or position and shivering or sweating) may also keep sleepy drivers awake (�kerstedt, Ficca, 1997). Nicotine can improve short-term performance significantly in people with cognitive or attention performance impairments such as those from sleepiness (Kerr et al., 1991). Obviously, however, smoking tobacco should not be generally recommended in an educational campaign as a drowsy-driving countermeasure because the well-established risks substantially outweigh the possible benefits. The panel found no evidence of effectiveness for commonly accepted remedial approaches such as brief exercise (e.g., getting out of the car and walking around for a few minutes) (Horne, 1988), listening to the car radio, or opening the car windows (Horne, Reyner, 1995a). The panel found no studies evaluating other driver-reported steps such as talking to another passenger, talking on a cellular phone or CB radio, chewing gum or ice, or snacking. One study suggests that talking on a cellular phone while driving is associated with increased crash risk (Redelmeier, Tibshirani, 1997).
MEDICAL INTERVENTIONS TO TREAT NARCOLEPSY AND SLEEP APNEA SYNDROME
Although effective treatments are available for both narcolepsy and obstructive sleep apnea, relief of sleepiness and related symptoms is not always easily achievable for all patients (Broughton et al., 1981; Haraldsson et al., 1995). Although treatment can improve driving simulator performance (Findley et al., 1989), individual performance varies. A few studies to date have evaluated crash experiences of patients successfully treated for these disorders and found a positive effect (Cassel et al., 1996; Haraldsson et al., 1995). An impediment to diagnosis is a lack of physician education on the recognition of sleepiness and sleep disorders (National Commission on Sleep Disorders Research, 1993).
ALERTING DEVICES
To date, research has validated only one type of device that alarms or awakens drivers who are drowsy or asleep-shoulder rumble strips placed on high-speed, controlled-access, rural roads. A recent synthesis of reports on the effectiveness of rumble strips shows that they reduce drive-off-the-road crashes by 30 to 50 percent-the only countermeasure the panel found in any category that has a demonstrated effect on crashes. Rumble strips also appear to be a relatively low-cost solution with a positive benefit-to-cost ratio (Garder, Alexander, 1995; National Sleep Foundation, June 1997). However, the effectiveness of rumble strips has been demonstrated only in drive-off-the-highway crashes; their value with other types of sleepiness or inattention crashes or other types of roads has not been studied.
Section II lists some of the technological in-vehicle monitors designed to detect and evaluate driver sleepiness. Some of these devices contain alarms or other alerting devices that go off when indications of sleepiness occur. Controlled trials are needed to evaluate the usefulness of these tools.
An inherent deficiency in all types of alerting devices is that many people continue to drive even when they know they are drowsy and fighting to stay awake. Although an effective alerting device may prevent one crash, a driver who falls asleep once is likely to fall asleep again unless he or she stops driving. Some safety experts have expressed concern that alerting devices may in fact give drivers a false sense of security, encourage them to drive long after impairment, and inhibit their taking effective behavioral measures to prevent or relieve sleepiness (Lisper et al., 1986; Dinges, 1995; Horne, Reyner, 1995a).
SHIFT WORK MEASURES
Research has shown that effective steps are available for both employers and employees to reduce the likelihood of excessive sleepiness and drowsy driving. Because of the complexity of the issues involved (Rosekind et al., 1995), a combination of alertness management approaches is likely to be most effective. Researchers also have found differences in individual tolerance to shift work (Harma, 1993); knowing more about the biological and behavioral factors that determine these differences could provide direction for future educational efforts.
EMPLOYER MANAGEMENT OF WORK SCHEDULES
Several approaches have been effective in reducing sleepiness caused by working irregular hours and nighttime hours. To minimize disruption and help employees adjust to circadian rhythm changes, employers should educate employees about the problem (Harma, 1993). In addition, periods of work longer than 8 hours have been shown to impair task performance and increase crashes. For example, performance appears worse with a 12-hour, 4-day week schedule than with an 8-hour, 6-day week (Brown, 1994). In jobs with extended hours, the scheduling of work and rest periods to conform to circadian rhythms promotes better sleep and performance (Stampi, 1994). Another effective approach is to allow and facilitate napping for night shift workers (Dinges, 1992; Naitoh, 1992).
EMPLOYEE BEHAVIORAL STEPS
Shift workers themselves can take steps to reduce their risks of drowsy driving by planning time and creating an environment for uninterrupted, restorative sleep (good sleep hygiene) (Minors, Waterhouse, 1981; Rosa, 1990). Shift workers who completed a 4-month physical training program reported sleeping longer and feeling less fatigue than did matched controls who did not participate in the program. However, individual response to the stresses of shift work varies (Harma, 1993), and the background factors or coping strategies that enable some workers to adapt successfully to this situation are not well defined. The behavioral steps discussed earlier for younger males also seem reasonable for reducing risk in this population.
Nurses working the night shift reported using white noise, telephone answering machines, and light-darkening shades to improve the quality and quantity of daytime sleep (Novak, Auvil-Novak, 1996).
USING BRIGHT LIGHT TREATMENTS
Several studies show that timed exposure to bright light has been successful in helping shift workers and those suffering from jet lag adapt to and overcome circadian phase disruption (Czeisler et al., 1990; Stampi, 1994). This approach promotes longer, uninterrupted sleep, which may help reduce sleepiness on the job and behind the wheel. The panel did not find data linking such treatment to changes in rates of crashes or industrial accidents.
VII. FOCUSING AN EDUCATIONAL CAMPAIGN: PANEL RECOMMENDATIONS
To assist the NCSDR/NHTSA in developing its educational initiatives, the panel recommended three priorities for the campaign
Educate young males (ages 16 to 24) about drowsy driving and how to reduce lifestyle-related risks.
Promote shoulder rumble strips as an effective countermeasure for drowsy driving; in this context, raise public awareness about drowsy-driving risks and how to reduce them.
Educate shift workers about the risks of drowsy-driving and how to reduce them.
EDUCATE YOUNG MALES ABOUT DROWSY DRIVING AND HOW TO REDUCE LIFESTYLE-RELATED RISKS
Young males, ages 16 to 24, received highest priority because of their clear over-representation in crash statistics and because many of their lifestyle risks are amenable to change. Although males up to age 45 have increased crash risks, the panel targeted only the younger group to enable specific tailoring of educational messages to this population's needs and preferences. In fact, campaign designers may want to segment further, creating different messages for the 16-to-18 and 19-to-24 age groups. The younger group is high school age and more likely to live at home with parents; members of the older group are more likely to be working or in college, living on their own and less subject to parental authority. The panel also believes it may be worthwhile to educate preteen boys, their parents, and their schools to influence attitudes before problems begin. The messages might be the following: sleepiness is not inevitable for teens, and it is not okay to drive when you are sleepy.
The panel recognized that the risk-taking behaviors of younger men will be a challenge in developing successful educational approaches. Focus group research is needed to develop a better understanding of young men's perceptions of fall-asleep crash risk and the kinds of interventions that would be effective with this group. Based on the literature, however, the panel suggests that campaign designers consider the following message points, many of which are appropriate for all public audiences:
Sleepiness is a serious risk for young male drivers. Although little is known about the knowledge and attitudes of this group regarding sleepiness and driving risk, surveys of the general population suggest that knowledge of the risk is likely to be low and awareness will need to be raised. It also will be important for messages to affect attitudes, so that young men and their parents believe the risk is serious and young men are vulnerable. Misconceptions that sleepiness is inevitable at this age and that chronic sleepiness is a safe lifestyle choice need to be overcome. Under- standing the concept of sleep debt could be useful, as could recognizing the uncontrollable nature of falling asleep at high levels of drowsiness.
Driving between midnight and 6 a.m. is a high-risk situation. Scheduling a trip at another time is a simple way to reduce risk, especially if the drive is long.
An active lifestyle that restricts sleep is a special risk. Many young men will recognize themselves in the picture of a chronically sleepy student who also works part-time, participates in extracurricular activities, and has an active social life. The "all nighter" represents an acute risk because extreme tiredness follows one sleepless night. The recommended action is not to start a long drive after one or more sleepless nights (e.g., do not drive home from college the day your exams are over; get a good night's sleep first).
Drinking alcohol increases sleepiness, and the combination of alcohol and sleepiness decreases performance and increases risk, even at low levels of alcohol use. A message that would convince young men not to drink when they are already sleepy could be useful. However, focus groups of youth in New York State revealed that drowsy-driving messages could be lost or ignored if paired with "don't drink and drive" messages, which some believe are already overemphasized (New York GTSC Sleep Task Force, 1994).
You can take effective steps if you become sleepy while driving. These steps include stopping driving altogether, if possible; consuming the caffeine equivalent of two cups of coffee; taking a 20-minute nap, and after the nap, driving to the closest safe resting spot, such as a motel, friend's house, or home; and sleeping.
Successful strategies from drinking and driving campaigns might also be adapted to drowsy driving if focus groups confirm their appeal. For example, an educational campaign could suggest that teens call a friend or a parent for a ride or let a friend drive home instead of driving while sleepy. Complementary educational messages to parents might suggest that they tell teenagers to call for a ride at any hour without recriminations if they feel too sleepy to drive. In another alcohol strategy variation, parents might allow sleepy friends of teens to sleep over rather than drive home.
The campaign also could counter common misconceptions of useful "stay awake" behaviors, such as exercising, turning on the radio, or opening the windows, which have not been shown to prevent sleep attacks.
Messages to policymakers could promote the value of graduated driver licensing that does not permit younger drivers to drive during late night hours (e.g., after midnight). These leaders may need information on the drowsy-driving problem and the special risks of driving during this period for all drivers and especially for younger ones.
PROMOTE SHOULDER RUMBLE STRIPS AS AN EFFECTIVE COUNTERMEASURE FOR DROWSY DRIVING; IN THIS CONTEXT, RAISE PUBLIC AWARENESS ABOUT DROWSY-DRIVING RISKS AND HOW TO REDUCE THEM
The panel believes that focusing a campaign on shoulder rumble strips offers multiple educational opportunities to convey key drowsy-driving messages.
Messages to the general public can explain the following:
What rumble strips are and why they are increasingly being used. A message that rumble strips are designed to arouse sleepy drivers before they drive off the road could be an attention-getting way to highlight the prevalence of chronic sleepiness and point out the risks and possible consequences of drowsy driving. People who have driven over a rumble strip in the past could personalize the risk, and even seeing the strips on the highway in the future could repeatedly remind people of the message.
What to do when awakened by driving over a rumble strip. Rumble strips act as an alarm clock, alerting drivers to the fact that they are too impaired to drive safely. The key to safety is what the driver does after hearing the alarm. In the short term, risk-reducing actions include stopping immediately if possible (e.g., a more alert driver can take over); consuming the caffeine equivalent of two cups of coffee; and taking a 20-minute nap. Then the driver should get off the road (e.g., at a motel or rest stop) as soon as possible and sleep.
In the longer term, planning ahead can help people avoid driving while drowsy. Key steps include planning sleep and naps before long trips, scheduling trips to avoid midnight through 6 a.m. driving, and avoiding alcohol and sedating medicines while sleepy or sleep deprived.
The limitations of rumble strips. Rumble strips should not give drivers a false sense of security about driving while sleepy. The strips are useful as alerting devices, but they will not protect drivers who continue to drive while drowsy. Being awakened by driving over a rumble strip is a warning to change sleep and driving behaviors for safety. The strips are not a technological quick fix for sleepy drivers.
Messages to policymakers, especially from States in which rumble strips are not currently used, can emphasize what rumble strips are, their relative cost-effectiveness, and why they are a valuable addition to highways in rural areas. Policymakers also may need information on the risks of drowsy driving and crashes to put the need for rumble strips in perspective.
EDUCATE SHIFT WORKERS ABOUT THE RISKS OF DROWSY DRIVING AND HOW TO REDUCE THEM
Employers, unions, and shift workers are potential target audiences for education on shift work and drowsy driving issues. The panel believes that an initial focus on employees would complement and reinforce other drowsy-driving messages directed to the public. Although many shift workers are not in a position to change or affect their fundamental work situation, they and their families may benefit from information on their risks for drowsy driving and effective countermeasures. Key message points include the following:
Shift work may increase the risk of drowsy-driving crashes. Night-, early morning-, and rotating-shift workers are often sleepy because their work times are inconsistent with the natural sleep-wake cycle. Workers on these shifts routinely get less sleep and lower quality sleep than do day workers. Driving while sleepy is a risky behavior that leads to many serious crashes each year.
Driving between midnight and 6 a.m. and driving home immediately after an extended or night shift are special risks for a drowsy-driving crash. Driving during late night/early morning hours increases risk for all drivers because those hours are a natural period of sleepiness. Many drowsy-driving crashes occur at this time. Driving while acutely tired, such as after a night shift, also increases the risk of crashing. Shift workers, many of whom are already chronically sleep deprived, are at extra risk.
You can take effective steps to reduce your risks. First, it is important to give regular priority to getting good sleep by creating a quiet, cool, dark environment, allowing sufficient time for sleep, and trying to sleep during the same hours each day. Another strategy is to avoid driving home from work while sleepy (e.g., getting a ride from a family member, taking a cab, napping before heading home). Consuming caffeine equivalent to two cups of coffee may help improve alertness for a short period.
OTHER ORGANIZATIONS CAN PROVIDE DROWSY DRIVING EDUCATION
The panel recognizes that limitations in resources will not allow NCSDR/NHTSA to conduct all needed educational interventions. However, other sponsors can make an important contribution by disseminating messages to high-risk audiences, intermediaries, and gatekeepers, such as industries where shift work is prevalent. Potential sponsors may include consumer, voluntary, health care professional, and industry groups and other government agencies. The panel encourages such groups to use this report and resulting campaign materials to inform and assist their own audience-specific efforts. NCSDR/NHTSA efforts to educate the public, especially youth, about the importance of sleep and sleep hygiene should complement other initiatives and, in combination, reinforce messages on the prevention of fall-asleep crashes.
Government study on sleep deprivation
From www.etrucker.com
Smart Driving
Road Etiquette
By Tim Barton
Like it or not, trucks will continue to be the focus of safety studies and of public opinion.
Like the mother whose little Jimmy causes her to wonder just how he learned all his nasty habits, government agencies, safety professionals and scientists think long and hard about why drivers behave the way they do.
The range of driver behavior being studied by experts generally falls into the category of driving and safety. Most recently, lifestyle patterns of eating, smoking, sleeping and stress management are also being studied.
Few studies focus on safe, healthy behavior. The most current trend is the research being done to see the longstanding problems in trucking as sociological or cultural problems. It is felt that solutions may come in the form of changing the culture of trucking. To the extent that truckers are citizens of this culture their behavior is a source of both the problems and solutions. To make positive changes in the culture there must be positive changes in the behavior of citizens; to make positive changes in the lives of citizens there must be changes in the culture. While one might wish drivers could be seen as role models, particularly for other drivers, research continues to focus on the negative.
Simply put, �Behavior is an observable act,� according to Larry Russell, manager of internal consulting at Behavioral Science Technology in Ojai, Calif. There are millions of observable behaviors, he says. Everything we do is a behavior. When scientists look at behavior, they chop it up into little segments for study. At BST the focus is on identifying what Russell calls �the critical few at-risk behaviors.� Russell says the term �at-risk� is used rather than �unsafe� because the word �unsafe� implies blame, and according to Russell, �A driver can have risk without causing it.� For instance, a driver can be involved in a crash without having caused an accident.
Nevertheless, the behavior of professional drivers is under constant scrutiny. It is under such intense study �because of the high mileage exposure of trucks and the oftentimes severe consequences of crashes,� according to the Federal Motor Carrier Safety Administration. Truckers who complain that all laws and law enforcement are directed at them often quote statistics showing that crash involvement is more often caused by the behavior of car drivers. While this is true, those who want to understand behavior as a means of making highways safer will continue to focus on trucks since �Total life cycle crash costs are more than four times greater for a combination-unit truck than for a passenger car,� according to FMCSA.
The first thing a professional driver must understand about his behavior is that it will continue to be the object of study, of enforcement and of the public�s opinion. Whatever a truck driver does, from calling himself �a stupid truck driver� to engaging in serious at-risk behavior on the highway, from maintaining personal hygiene to competing in the National Truck Driving Championships, makes a difference in the way trucking is seen by the rest of the country. Truck drivers are constantly in the public eye.
Given the research shift to a broader cultural focus, one might expect the definition of at-risk behavior to broaden also. Under this broader focus, at-risk behaviors might include poor dietary choices, chronic and acute fatigue, and an unwillingness to learn about stress, as well as behind-the-wheel behaviors like inattention, speeding and tailgating. This effort is only beginning. Recent reports in the trade press as well as in mainstream periodicals verify the need for this approach. The Bureau of Labor Statistics reveals that truck driving is one of the most dangerous occupations. Certainly the American highway sees more fatalities than any other worksite. And there is educated speculation among many researchers that truck drivers face a life span 15 years shorter than the national average for males.
Personal lifestyle choices can make the difference in staying healthier longer. Maintaining an accident-free driving record is a necessary � but not itself sufficient � step in the productivity of the professional. Drivers need to stop seeing themselves as drudges and wage slaves. They need to believe in their worth as human beings and as employees, often in the face of opposing attitudes.
To produce results, research must be able to measure what it studies. Since behavior is measurable and attitude is not, attitudes get very little attention. But attitude underlies the new approach of researchers to find safety solutions in the broader focus of the trucking culture. Even newer is the direction of some research and consulting firms that see the attitudes of employers as significant. Indeed, Dean Croke, director of Circadian Technologies, Inc., a leading research and consulting firm specializing in workforce optimization, believes, �There is too much emphasis on the driver.� Croke�s perspective is that safety is �a shared responsibility.� He says, �Driver behavior is symptomatic of how a business is run. Safe behavior is not a training or skill issue but a function of utilization.� Thus scheduling practices, productivity expectations, assessing fitness for duty, even employee health, are aspects of the driving task an employer can and should control to create a safer work environment.
According to Croke, this requires leadership from employers. He relates the story of a truck firm owner whose fleet was experiencing frequent crashes on the same stretch of road at the same time of night, near the end of a 10-hour run. The owner believed the problem was driver error, failing to recognize that his drivers were experiencing chronic fatigue. So it is that executives must often be educated to the realities of workforce hazards in order to stop using drivers as scapegoats. �Shared responsibility� is an idea whose time has come. But it is a concept complicated by other forces within the industry. Consider the notion, put forth by Croke, that �Trucking outfits can show enforcement agencies completely compliant hours-of-service records and still have drivers with chronic fatigue problems.�
There is the further problem of powerful trucking organizations unwilling to consider the physiological realities of sleep as evidenced in research. Groups lobby strenuously to protect the interests of their members, predominantly large trucking firms, and prevent changing hours-of-service regulations to reflect new scientific findings. Croke agrees with the assessment that such behavior puts profit above life. Thus it is often the behavior of top management rather than the behavior of drivers that needs changing.
Whether this behavior is the result of ignorance or conscious choices, the concept of shared responsibility requires that leadership accept its ethical and moral responsibilities to drivers and the public. As further research focusing on a cultural approach to safety deepens, smart drivers will continue to accept their responsibility to themselves and the public. At some point, drivers can become role models and educators. In the absence of strong leadership, it remains necessary for drivers to take the initiative to stand up for themselves. From small actions like sleeping when tired rather than when the log requires, to looking for employers who have wellness programs and realistic scheduling practices, the smart driver can make a difference in his life. By doing so, he will be contributing to the well being of the culture.
-------------------------------------------------------------------------------- Tips on How to Behave Like a Truck Driver
Don�t call yourself stupid. You�re only stupid if you think you�re stupid.
If you are fatalistic, meaning you believe you cannot affect when you are going to die, you can end up killing yourself and somebody else in the process. Being fatalistic makes you an at-risk driver.
Observing your own behavior can tell you when you are driving well and when you aren�t. Some guys even carry a tape recorder and document their moves for three or four minutes every once in a while. Then they play it back when there�s a free minute. You�d be surprised how helpful it can be.
You are under constant scrutiny. You know that. Don�t let it get to you. If people see you driving badly, things are bound to get worse.
Long-form physicals don�t tell you everything about your health. Go to a doctor and get a blood lipid test, a sugar test, and if you�re over 50, a colonoscopy. Don�t settle for a sigmoidoscopy. Studies show colonoscopies are much more thorough.
Your truckin� life is dangerous and unhealthy. It�s up to you to stay alive. The culture isn�t going to change fast enough to keep up with the heart disease or lung cancer you�re working on by smoking to ease the boredom you feel behind the wheel.
You have rights as an employee. Stick up for them.
The real victims of sleep deprivation
By Megan Lane and Brian Wheeler BBC News Online Magazine
Sleep deprivation is nowadays a source of light entertainment. But it has been used as a real instrument of torture around the world. Anyone who has experienced this desire [for sleep] knows that not even hunger and thirst are comparable with it.
Hallucinations, paranoia, disorientation - these are some of the symptoms of sleeplessness endured by the contestants on Channel 4's reality TV show Shattered. The 10 participants are starving themselves of sleep for a week in the hope of winning �100,000. The channel has vigorously denied claims that it is exploiting its contestants, and has safeguarded their welfare by using ethics and medical advisors.
But on leaving the show, contestant Craig North said: "It was like torture being deprived of sleep. It's not every day you try to spend 180 hours without any sleep."
Sleep deprivation is not like torture - it is a form of torture, a tactic favoured by the KGB and the Japanese in PoW camps in World War Two. The British Army was also accused of using sleep deprivation to extract information from suspected IRA members in 1971. "It is such a standard form of torture that basically everybody has used it at one time or another," says Andrew Hogg, of the Medical Foundation for the Care of Victims of Torture.
Psychosis
Going without sleep is intensely stressful, with unpredictable short and long-term effects. People lose the ability to act and think coherently. And as it leaves no physical mark on the victim, the interrogator can claim that they never laid a finger on those in their charge.
John Schlapobersky, consultant psychotherapist to the Medical Foundation for Victims of Torture, was himself tortured through sleep deprivation, in his case in apartheid South Africa in the 1960s.
"Making a programme in which people are deprived of sleep is like treating them with medication that will make them psychotic. It also demeans the experiences of those who have involuntarily gone through this form of torture. It is the equivalent of bear-baiting, and we banned that centuries ago. I was kept without sleep for a week in all. I can remember the details of the experience, although it took place 35 years ago. After two nights without sleep, the hallucinations start, and after three nights, people are having dreams while fairly awake, which is a form of psychosis. By the week's end, people lose their orientation in place and time - the people you're speaking to become people from your past; a window might become a view of the sea seen in your younger days. To deprive someone of sleep is to tamper with their equilibrium and their sanity."
KGB interrogation
Former Lithuanian freedom fighter and political prisoner Juozas Aleksiejunas was tortured with sleep deprivation by the KGB, just after the end of WWII. He was arrested for being a member of Lithuania's anti-Soviet partisan movement, which fought a guerrilla-style war against the USSR between 1944 and 1953. The KGB questioned him for three nights in succession and prevented him from sleeping during the day.
"It is difficult to think when there is no sleep. Human beings can almost lose consciousness because of it," he says. Mr Alekseijunas, who is now a pensioner and a former guide at a Lithuania's Museum of Genocide Victims in Vilnius, laughs when asked what sleep deprivation does to the mind.
"Try yourself to eat only 300g of bread, the daily ration we got in prison, during two months and after it not sleep for three days and nights. The desire to have some sleep was the only thing which I was dreaming about."
Guantanamo Bay
Sarah Green, of Amnesty International, says claims of this type of torture have increased in the past couple of years.
Guantanamo Bay has been the focus of concern "It is alleged that the Americans have used it in Guantanamo Bay and Iraq," says. The Pentagon has denied torturing Iraqi prisoners, but it has admitted using sleep deprivation and playing loud rock music to break prisoners' resistance. Ms Green says that other countries alleged to use sleep deprivation are China, Saudi Arabia - the British men accused of bomb attacks and imprisoned for two years say they were tortured in this way; the Saudis deny it - and Israel.
There, the Landau Commission in 1987 concluded that "non-violent psychological pressure" could be used in questioning prisoners who had information that could prevent terror attacks. Twelve years later, the Israeli Supreme Court effectively revoked this permission.
'Uninterrupted sleep'
Menachem Begin, the Israeli prime minister from 1977-83, was tortured by the KGB as a young man. In his book, White Nights: The Story of a Prisoner in Russia, he wrote of losing the will to resist when deprived of sleep.
"In the head of the interrogated prisoner, a haze begins to form. His spirit is wearied to death, his legs are unsteady, and he has one sole desire: to sleep... Anyone who has experienced this desire knows that not even hunger and thirst are comparable with it."
"I came across prisoners who signed what they were ordered to sign, only to get what the interrogator promised them. He did not promise them their liberty; he did not promise them food to sate themselves. He promised them - if they signed - uninterrupted sleep! And, having signed, there was nothing in the world that could move them to risk again such nights and such days."
Even the Brits know sleep loss and no set pattern is torture
