06 April 2015

Today is Drowsy Driving Awareness Day in California: How sleep apnea fits into this concern, and why we should ALL be observing this day

Robyn and Phil Konstantin
California Highway Patrol officer Phil Konstantin's wife Robyn Konstantin died in a car accident after falling asleep behind the wheel in 1999.

Ten years ago the state of California passed a resolution unanimously proclaiming April 6 "Drowsy Driving Awareness Day."

Konstantin has become a relentless activist for awareness about the insidious dangers of drowsy driving. It can, and does, happen to everybody... good people who have driver fatigue: sleep-deprived parents of newborn children, teenagers driving to early morning swim practice, nurses coming off a double shift.

Fatigue (caused by whatever reason) can result in a specific phenomena called "microsleeps," in which your brain drops into nap-like periods that last from a few seconds up to 2 minutes. People with insomnia or sleep deprivation suffer from microsleeps. In that brief time, driving can result in the loss of control over a moving vehicle; whether on the highway or in town, this few seconds in artificial "autopilot" can and does result in injury, property damage and death, not only to drivers but to passengers and pedestrians and people in other cars.

Here's an ABC News report that might shake you up, and it should. Drowsy driving, comparable to drunken driving, kills. 

Statistics related to drowsy driving are staggering; what's more, the reality is probably worse than the facts show, as it's difficult to identify a drowsy driver if they don't admit (or even recognize) that they are fatigued. And taking driver fatigue into account for roadway collisions is still a newer practice.

How do sleep breathing disorders relate to drowsy driving? Sleep apnea leads to fragmented sleep that, over time, amounts to chronic sleep deprivation. It can also lead to insomnia, which also results in chronic sleep deprivation.

From the National Highway Traffic Safety Administration (NHTSA):
"In sleep apnea syndrome, brief interruptions of air flow and loss of oxygen during sleep disrupt and fragment sleep. The condition also is associated with loud, chronic snoring. Although people with untreated sleep apnea syndrome may not be aware of the brief disturbances, poor sleep quality often leads to daytime sleepiness."
Consider this: If someone has sleep apnea but does not have a sleep partner, they may never be told they snore loudly or choke in their sleep trying to get adequate oxygen. Also from the NHTSA:
"Although the absolute number of crashes is low, crash risk is increased among people with untreated sleep apnea syndrome (SAS)... In addition, patients with untreated SAS ... 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)."
This makes perfect sense if you understand that people who suffer ongoing, untreated apnea are essentially sleep deprived. And then there's this from the NHTSA:
"Currently, many people with [SAS] 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)."
This article in the Archives of Internal Medicine for the Journal of the American Medical Association actively calls for more active participation by the medical community to identify drivers at risk:
"Because drivers with untreated sleep apnea may cause a large number of preventable automobile accidents, physicians have specific duties involving these drivers. 

  • First, physicians must try to identify impaired drivers with sleep apnea before they have an accident; routinely asking patients about loud snoring and hypersomnolence may help identify these impaired drivers.
  • Second, physicians must consider the diagnosis of sleep apnea when examining patients who fall asleep while driving.
  • Next, physicians must warn their patients with sleep apnea about the risks of driving with untreated sleep apnea.
  • Finally, physicians must treat any seriously impaired driver with sleep apnea and keep these patients from driving until they can receive successful treatment.

If you suspect you have a sleep breathing problem (even as "innocent" as snoring), please have it checked out. SHC wants you to "Stay Alert, Arrive Alive!"

More statistics and information about Drowsy Driving can be found at this site sponsored by the National Sleep Foundation.

Here is the American Sleep Apnea Association position statement on driving and sleep apnea.