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Like drunk driving: Fatigue can be as harmful
When one reads about an auto accident in which a car hits a tree or crosses the center line and collides with another vehicle, especially when the accident occurs in the early morning or early afternoon, his first thought is not that the driver was probably drunk, but rather that the driver probably fell asleep behind the wheel.
“Drowsy driving is more common — and deadly — than most people think,” said Dr. Kotch, a retired pulmonary physician and sleep specialist in Redding California, “and it is rarely listed as the cause of an accident. But there are circumstantial indicators,” he continued. “The weather is clear, a single car crosses over the center line or goes off the road and hits a tree or other object and there is no evidence of trying to stop — no skid marks to indicate braking. The hour of the accident is also a factor, based on circadian rhythms. There are several times in a 24-hour period where it is easier to fall asleep, but particularly between 2 and 4 p.m. and 1 and 5 a.m.
“A little investigation can generally confirm fatigue as the cause. A driver’s sleep habits during the prior few days can be assessed with a few questions to the driver’s friends and relatives — and employer. Did someone just come off a double shift? or Has the person been working a lot of hours? There have been lawsuits against employers, including restaurants and hospitals, whose employees have been involved in accidents after coming off a long shift.”
The National Sleep Foundation first conducted a survey about drowsy driving in 1998; the results were “shocking,” said Dr. Kotch. “Sixty percent of adults admitted to driving while drowsy and 37% had fallen asleep at the wheel; subsequent surveys have had similar results and other surveys show that drowsy driving as an accident cause is grossly underreported.”
In the sleep foundation’s 2005 Sleep in America poll, the numbers remained the same, and of the 37% — 103 million people — who said they have actually fallen asleep behind the wheel, 13% said they have done so at least once a month. Four percent, some 11 million drivers, admit to having an accident or near accident because they dozed off or were too tired to drive. The National Sleep Foundation is still tabulating the results of the 2007 study, but this year launched its first Drowsy Driving Prevention week, Nov. 5-11, to try to educate the public about the dangers of drowsy driving, particularly going into the holiday season.
The National Highway Traffic Safety Administration conservatively estimates that 100,000 police-reported crashes a year are a direct result of driver fatigue, resulting in an estimated 1,550 deaths, 71,000 injuries and $12.5 billion in monetary losses. Most sleep and accident experts believe those numbers are very low since there is no test to determine sleepiness like there is for intoxication, and state reporting practices in this regard are inconsistent.
Same as being drunk
Dr. Kotch said, however, that studies have shown that a person who has not slept in 18 hours functions at the same level as some who has a blood alcohol content of 0.08, which is considered legally drunk. Those who have not slept in 24 hours are functioning at the same level as someone with a blood alcohol level of 0.1. “And the combination of insufficient sleep and alcohol is especially deadly,” he added. “To bring the accident numbers down, there has to be the sentiment on the part of the public that something is wrong, that drowsy drivers are putting themselves and others at risk, much like what has been done with drunk driving.”
What can individuals do to prevent drowsy driving? “When tired,” said Dr. Kotch, “nothing really helps other than sleep. Caffeine does work, but only for about 30 minutes, so if you are close to your destination, it is worth stopping for. People will open windows, or turn their music up real loud, but that isn’t effective for more than a few minutes. Ideally, drivers who feel fatigued should pull off the road and take a nap. Of course, it is a problem to find a safe place to stop and sleep when you are traveling.”
The most extensive cause of drowsy driving, said Dr. Kotch, is lifestyle. “We’re a 24/7 society; people lead crowded lives... so what do they sacrifice first? — sleep. People stay up late regularly or during special events, like the World Series.
“Drowsy drivers are frequently young, 16-26 years old,” Dr. Kotch said. “Teens need nine hours of sleep for optimum function, but few get it; high school kids today are lucky to get six hours of sleep. The circadian rhythms of adolescents and teens are set so they have an easier time falling asleep later in the evening, 11 p.m. to 1 a.m., and they don’t really wake up until 8 or 9 in the morning. Teachers will tell you that the first period classes are frequently full of sleepy kids. Some areas have pushed back the high school starting time with very good results — the whole state of Minnesota did it and found that the students are performing much better.
“There are also a number of diseases that interfere with proper sleep and you have to look for these,” said Dr. Kotch. “The most common is sleep apnea. Intermittent obstruction of the upper airways interferes with continuous sleep and causes the patient to stop breathing and wake up many times an hour, 40, 50, 60 — I’ve even seen some people who wake up 100 times an hour — and they never get into the deep sleep levels required for real rest. This increases blood pressure, and people with sleep apnea frequently have heart disease and hypertension. The level of sleep apnea, as well as other sleeping problems, can be determined by a sleep study conducted in a certified sleep center.”
Dr. Kotch established the area’s first Sleep Disorders Center at Danbury Hospital in 1989, which at the time of its certification in 1995 was the only one in the state. He served as its director until he retired in 2004. He was affiliated with the hospital for 34 years as a pulmonary specialist, also serving as associate director of pulmonary medicine and medical director of pulmonary rehabilitation.
He established the hospital’s Pulmonary Rehab Center, which combines education about pulmonary disease with exercise, drugs and nutrition, in 1983, one of the first of its kind. Dr. Kotch’s interest in sleep disorders evolved out of helping patients achieve a better quality of life, which he calls his greatest professional satisfaction.
After retiring, he worked part time at the Sleep Disorders Center at Gaylord Hospital and two years ago affiliated with Bridgeport Hospital on a part-time basis, and currently teaches Bridgeport’s pulmonary fellows and attends their clinics; he recently retired from seeing patients. He also continues to deliver papers to pulmonary and sleep disorder professional groups in the United States and overseas.
Dr. Kotch observed that when sleep disorders first became an area of study, most practitioners were neurologists, psychologists and Ph.D.s. “Now more than half are pulmonary doctors looking at the connections between sleep disorders and heart and lung diseases, particularly COPD (chronic obstructive pulmonary disease), which is the fourth leading cause of death in the United States — it kills 120,000 annually — and is the only one of the top 10 killers that is increasing. Ninety percent of COPD cases, which is emphysema and chronic bronchitis, are related to smoking; 12 million Americans have been diagnosed with the disease, and studies indicate that the same number may have the disease and don’t know it.
“If you are having trouble sleeping, or feel tired all the time, see a doctor and find out what treatments can work for you. Not only will you feel better, but you will be less of a risk to yourself and others while driving,” Dr. Kotch said.
To learn more about sleep disorders and the fight against drowsy driving, see the National Sleep Foundation’s Web site at www.sleepfoundation.org.