Elsevier

Sleep Medicine Clinics

Volume 14, Issue 4, December 2019, Pages 407-412
Sleep Medicine Clinics

Sleep Restriction, Sleep Hygiene, and Driving Safety: The Importance of Situational Sleepiness

https://doi.org/10.1016/j.jsmc.2019.07.002Get rights and content

Section snippets

Key points

  • Chronic sleep restriction impacts drivers in developed countries.

  • Sleepiness at the wheel is a better predictor of accident risk than the Epworth sleepiness scale.

  • Inappropriate line crossings are strong warnings of future sleep-related accidents.

  • Road safety campaigns should address not only acute but also chronic sleep deprivation all year long.

Physiologic factors modulating sleepiness

Sleepiness is a complex symptom that may be confused with fatigue. Technically, sleepiness occurs when chronobiological or homeostatic sleep pressure increases to force the brain to go from a state of arousal to a state of sleep. Alerting systems are then stimulated and somewhat prevent the occurrence of sleep.

The first and most common factor involved in sleepiness is extended wakefulness or sleep deprivation, which significantly increases homeostatic pressure and generates excessive daytime

Quantifying sleepiness: differences between neutral and “at risk” sleepiness

Sleepiness can be defined as a subjective perception or as an objective measure via electrophysiological measurements. The Stanford Sleepiness Scale (SSS)10 and the Karolinska Scale11 have been used in many sleep deprivation protocols and in healthy subjects. They measure instantaneous sleepiness via straightforward questions. Because they focus on a short period of time, they hardly reflect the mean level of sleepiness over days or weeks; yet these data are required to quantify the impact of

Nonprofessional drivers

In the 1990s, Philip and colleagues17 conducted a series of studies investigating the role of sleep deprivation and sleepiness at the wheel among large populations of highway drivers. At that time when air conditioning was not widespread in automobiles in Europe, public health campaigns recommended leaving early in the morning or late at night to avoid heat and traffic jams. A first study demonstrated that time of departure was closely related to sleep restriction and that sleep-related

Future considerations

Although much has already been done in this field, many questions remain unanswered. At the diagnostic level there is still no simple objective measure to quantify the risk to drivers, unlike other accident risk factors that can be easily assessed, such as by using a breathalyzer for alcohol testing. Ideally, one need a somnotest to quantify the driving risk, but up to now driving simulators or electroencephalogram (EEG) measures have provided only indirect and variable estimations of the

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      The lack of sleep and poor sleep quality can impair cognition, decision making, psychomotor function, mood, and immune function among others [8,9]. Moreover, sleep disturbances are considered risk factors for cardiovascular diseases, dementia, obesity, diabetes, depression, pain, cancer, driving accidents, and overall mortality [10–16]. Insomnia is the most common sleep disorder [17,18].

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    Disclosure Statement: None to declared.

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