Drowsy Driving


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Drowsy Driving and the commercial driver industry.

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  • National Sleep Foundation statistics
  • American Journal of Respiratory and Critical Care Medicine; 8/15/2004
  • National Highway Transportation Safety Administration; “Drowsy Driving and Automobile Crashes”
  • What is this word????????-should I break out my Websters!!! They are at the center of the epidemic and they don’t even know it
  • Drowsy Driving

    1. 1. Drowsy Driving Risky Business Medical Sleep Solutions 972-709-7190 Ed Charnock, MD Jack Gardner, MD
    2. 2. <ul><li>Over 5,000 fatalities </li></ul><ul><li>Sleepiness causes 31-41% of crashes of commercial vehicles </li></ul><ul><li>1,500-2,000 fatalities as a result of sleepiness </li></ul><ul><li>For every fatality, there are about 25 injuries </li></ul><ul><li>For every injury accident, there are 3.7 crashes with property damage </li></ul><ul><li>FMCSA, NTSB, NHTSA, AAA Foundation for Traffic Safety </li></ul>Sobering Statistics: Commercial Crashes Annually
    3. 3. Cost of Crashes <ul><li>$91,112 per crash </li></ul><ul><li>$3,450,000 per fatality crash </li></ul><ul><li>$12,500,000,000 monetary loss / yr </li></ul><ul><li>Cost of Driving Drowsy </li></ul><ul><li>> $4,000,000,000 per year </li></ul>
    4. 4. Why Am I Sleepy??? <ul><li>Reduced Sleep Time </li></ul><ul><li>Rotating / Split Work Shifts </li></ul><ul><li>Sleep Apnea </li></ul><ul><li>Other Sleep Disorders </li></ul><ul><li>Medications </li></ul>
    5. 5. DRIVERS – Sleeping Enough? <ul><li>5.5% Sleep < 4 hours per night </li></ul><ul><li>13.5% Sleep < 5 hours per night </li></ul><ul><li>35.3% Sleep < 6 hours per night </li></ul><ul><li>Pack, AASM Meeting, Seattle 2009 </li></ul>
    6. 6. Sleep Deprivation: Australian Experience <ul><li>Drivers --- </li></ul><ul><li>< 6 hours sleep per night </li></ul><ul><li>3 Times Increased Risk – </li></ul><ul><li>“ Dangerous Event” </li></ul><ul><li>2.5 Times Increased Risk – </li></ul><ul><li>“ Nodding Off” </li></ul><ul><li>85% of “fall asleep” crashes - Fatal - </li></ul>
    7. 7. <ul><ul><li>A Sleep Deprived Person </li></ul></ul><ul><ul><li>Can Go From Apparently Wide Awake to Fast Asleep in </li></ul></ul><ul><ul><li>Less than 10 Seconds </li></ul></ul>CNS SLEEP DISORDERS CENTER
    8. 8. “ I’m just tired…..” <ul><li>The effects of sleepiness include: </li></ul><ul><li>Slower reaction time </li></ul><ul><ul><li>Even small decrements in reaction time can have profound effects on crash risk, particularly at highway speeds. </li></ul></ul><ul><li>Reduced vigilance </li></ul><ul><ul><li>Performance on attention-based tasks, such as driving declines with sleepiness. This decline includes increased periods of non-responsiveness or delayed responding. </li></ul></ul><ul><li>Decreased information processing </li></ul><ul><ul><li>Processing and integrating information takes longer and the accuracy of short-term memory decreases. </li></ul></ul>
    9. 9. Would you let your drivers …operate while intoxicated? <ul><li>24 hours sustained wakefulness – </li></ul><ul><li>= BAC of 0.10 </li></ul><ul><li>Dawson and Reid 1997 </li></ul><ul><li>4 hours sleep per night x 6 nights – </li></ul><ul><li>Performance “worse than drunks” </li></ul><ul><li>Powell et al 2001 </li></ul><ul><li>Moderate sleep apnea – </li></ul><ul><li>Impairment > BAC of 0.08. </li></ul><ul><li>Powell et al 1999 </li></ul>
    10. 10. Sleep Apnea – What is it? <ul><li>Nighttime </li></ul><ul><li>Snoring </li></ul><ul><li>Gasping </li></ul><ul><li>Stop Breathing </li></ul><ul><li>Daytime </li></ul><ul><li>Sleepiness </li></ul><ul><li>Fatigue </li></ul><ul><li>Impaired Concentration </li></ul>
    11. 11. Why Care? <ul><li>Medical Reasons </li></ul><ul><li>High Blood Pressure </li></ul><ul><li>Heart Failure </li></ul><ul><li>Heart Attack </li></ul><ul><li>Arrhythmias </li></ul><ul><li>Stroke </li></ul><ul><li>Social Reasons </li></ul><ul><li>Excessive Sleepiness </li></ul><ul><li>Poor Concentration </li></ul><ul><li>Impaired Job Performance </li></ul><ul><li>Depressed Mood </li></ul><ul><li>Motor Vehicle Accidents </li></ul>
    12. 12. Sleep Apnea Facts <ul><li>28 percent of CDL holders have Sleep Apnea FMCSA 2002 </li></ul><ul><li>> 85% of the cases are undiagnosed </li></ul><ul><li>Risk of crash is 2 – 7 times increased in drivers with sleep apnea </li></ul>
    13. 13. <ul><li>An industry “Joint Statement” issued in September 2006 recommends that all CMV drivers with typical signs of sleep apnea be tested and treated. </li></ul><ul><li>The “Joint Statement” is expected to influence an updated DOT guideline in the future </li></ul>New DOT Guidelines Coming
    14. 14. Sleep Apnea – Which driver is at risk? <ul><li>Question on the CDME – </li></ul><ul><li>“ Sleep disorders, pauses in breathing while asleep, daytime sleepiness, loud snoring” </li></ul>
    15. 15. Self Reporting – No Problem? <ul><li>1443 consecutive CDME’s </li></ul><ul><li>190 (13%) met criteria for </li></ul><ul><li>probable sleep apnea requiring a sleep study </li></ul><ul><li>Zero drivers checked “yes” </li></ul><ul><li>to the CDME question </li></ul><ul><li>56 of 190 drivers applied with a new carrier after declining employment because of requiring a sleep study. JOEM 3/08 </li></ul>
    16. 16. Prevalence of Sleep Apnea Sjostrom et al. Thorax 2002 Logan et al. J. Hypertension 2001 Javaheri et al. Circulation 1999 O’Keefe, Patterson. Obes Surgery 2004 Einhorn et al. Amer Diab 2005 Somers et al. ATS Pres. 2004
    17. 17. Obesity and FMCSA <ul><li>Medical Expert Panel – </li></ul><ul><li>sleep study for BMI > 33 </li></ul><ul><li>32% Drivers have a BMI > 33 </li></ul><ul><li>Medical Advisory Board – </li></ul><ul><li>sleep study for BMI > 30 </li></ul><ul><li>42% Drivers have a BMI > 30 </li></ul>
    18. 18. Sleep Study <ul><li>Respiration </li></ul><ul><li>Oxygen Saturation </li></ul><ul><li>Snoring </li></ul><ul><li>Arousals </li></ul><ul><li>Sleep Stages </li></ul><ul><li>Heart rhythm </li></ul><ul><li>Leg movements </li></ul>CNS SLEEP DISORDERS CENTER
    19. 19. <ul><li>Several studies documented improved driver skills with CPAP treatment. </li></ul><ul><li> JOEM, Vol 48, #9, Sept 2006 </li></ul><ul><li>CPAP reduces risk of crash by 80% </li></ul><ul><li>Eur Respir J, 1996, 9 </li></ul>Treatment with CPAP Does it make a difference?
    20. 20. A Success Story – <ul><li>Medical Cost Reduction </li></ul><ul><li>Among 348 drivers diagnosed with OSA and treated, medical costs dropped 50% per month. </li></ul><ul><li>Accident Reduction </li></ul><ul><li>A 73% reduction in preventable driving accidents among drivers with OSA treated with CPAP therapy. </li></ul><ul><li>Reduced Turnover </li></ul><ul><li>Driver retention was 2 times greater among drivers treated for sleep apnea compared to the general driver population. </li></ul><ul><li>Increased Productivity </li></ul><ul><li>Healthier, more rested drivers translate into more on-time deliveries , less time lost due to illnesses, and more freight miles logged. </li></ul>Schneider National Sleep Apnea Screening and Treatment Program
    21. 21. <ul><li>Reduce risk of hypertension, heart disease, and stroke </li></ul><ul><li>Reduce the risk of fatigue related accidents </li></ul><ul><li>Reduce legal expenses </li></ul><ul><li>Reduce medical expenses </li></ul><ul><li>It’s the right thing to do! </li></ul>Why Treat Sleep Apnea?
    22. 22. <ul><li>Web based </li></ul><ul><li>Probably implemented </li></ul><ul><li>within 2 years </li></ul><ul><li>New standards with certification of physicians who provide DOT examinations </li></ul><ul><li>Certification exam is being prepared </li></ul><ul><li>No reliance on self reporting screens </li></ul>National Registry Certified Medical Examiners
    23. 23. Risk How much is acceptable? “ Don’t Ask – Don’t Tell” This approach is coming to an end!
    24. 24. <ul><li>Board Certified Sleep Physicians </li></ul><ul><li>Accredited Sleep Center by the AASM </li></ul><ul><li>Sleep Disorders Center since 1989 </li></ul><ul><li>Management – full range of sleep disorders </li></ul><ul><li>Clinical consultations and sleep studies </li></ul><ul><li>DME Program with support </li></ul><ul><li>Compliance Program </li></ul>Who are we?
    25. 25. Contact Us Medical Sleep Solutions 972-709-7190 www.medical sleep.com [email_address] [email_address] Desoto Location: 1001 Robbie Mince Way DeSoto, TX 75115 Methodist Dallas Location: 221 W. Colorado Suite 210 Dallas, TX 75208
    26. 26. For More Information www.drowsydriving.org www2.nsc.org www.nhtsa.com www.fmcsa.gov www.sleepfoundation.org