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Sleepy? Wake Up!

Sleepy? Wake Up!

How many patients who come to my office do you think complain of fatigue or being sleepy? Most of them. It is a fair conclusion that almost everyone feels tired, exhausted or sleepy at some point in their lives. I remember working as a young physician in residency and staying up without sleep for thirty-six to forty hours at a time when I was on call in the hospital overnight. Every other night call meant every other night without sleeping. If one add two years of having interrupted sleep every night in my specialty training to the three years of not getting enough sleep, most people would describe me as being permanently sleep deprived. I evaluated hundreds of overdosed and poisoned patients, but got very little sleep doing it.

When I worked in the emergency department, the shift work was sporadic. I worked twelve hour shifts and the shifts altered between night and day, my sleep pattern was totally messed up. Not to mention that my migraine headaches were out of control. There comes a time in everyone's life that change is necessary to make our own health better. I had my epiphany while working in Memphis at the Med, now referred to as Regional One Medical Center.

I recently ran across a headline of an article that stated: Drowsy - and Dangerous. It was in a throw away magazine delivered to my residence bimonthly. I believe the magazine is called AAALiving.

The article described results from a new research study related to possible relationship between lack of sleep and car crash rates. Yep. The study was sponsored by the AAA Foundation for Traffic Safety. I never knew there was a AAA foundation for Traffic Safety, much less a group of scientists studying the effects of sleep deprivation on auto accident risk predictors.

At first blush, I believed that anyone desiring to reduce the risk of car crashes is researching towards a noble goal. Amazingly, scientists actually researched the effects of some parameter associated with car crashes and of course, ultimately reduce one's risk for a car crash.

The study examined data from four thousand car crashes between 2005 and 2007 involving seven thousand drivers. Seems commonsensical, almost two drivers for every car crash. What is not revealed in the study report is from where the data the Foundation looked at came. Was this a self reporting data set that was gathered after all the legal issues were ironed out? Was there an exclusion from the study if alcohol or other drugs were taken that could contribute to sleepiness while driving? Was it data from a phone app accessed by the crash investigator after the accident?

The results of the study showed that car crash risk for sleep-deprived drivers increased steadily compared with drivers who slept seven hours or more. I ask you: how many patients do I see daily that has a lifestyle that allows them to sleep seven hours straight or more per night? The crash risk rate for someone having six to seven hours of sleep was 1.3x (times) higher than that of a person who had seven or more hours of sleep. The crash risk rates were 1.9x, 4.3x, 11.5x for persons who had five to six hours of sleep, four to five hours of sleep and less than four hours of sleep the night before, respectively. So just having five hours of sleep per night means you have an elevated crash risk rate of 4.3x that of someone who had seven or more hours of sleep.

The study also revealed that many of the people who had less than seven hours of sleep had no signs or symptoms of drowsiness, such as yawning or drifting out of their traffic lanes. Nearly fifty percent (that means less than half) of drivers who fell asleep and crashed reported that they felt slightly drowsy or not at all drowsy according to a previous study performed by the AAA Foundation for Traffic Safety.

What was the conclusion of the study? Get seven hours or more sleep before you drive your car, especially on a long trip. There was a secondary conclusion: if one is typically awake during daylight hours, then avoid driving during the night or through the night. Logical conclusions and considerations for people who are truly interested in making sure we are all safer driving vehicles and reducing the risk of crash for everyone.

I somehow believe that the study results will go quietly into the night. I believe there will be consequences of the results in legislative agendas of both Federal and/or State laws about driving under impairment. New Federal regulations are forcing truck drivers with large neck sizes to have sleep apnea studies (without sleep apnea) before they are allowed certification for truck driving. In addition, those same drivers must see a cardiologist and get their blessing every year if they have had stents placed in their coronary arteries. I wonder if the AAA study looked into sleep apnea as a risk factor for car crashes and did not report their findings yet.

What would happen if the Tennessee State legislature decided to pass a law that stated that anyone who had less than seven or more hours of sleep before an accident could be held liable or even criminally charged for impaired driving due to sleep deprivation? The law may just single out only those people who had less than four hours of sleep before their accident. Everyone working the night shift anywhere would be liable for an automobile accident and could possibly face criminal charges because they were drowsy after a night shift. And insurance underwriters could make sure that anyone having less than five hours of sleep before their accident will not be covered under their liability and collision coverage. If someone did not report being sleep deprived, how would they even know?

Sleep apps on your smart phones allegedly creates records of your sleep: how many hours you slept and when; how deep your sleep was; whether it is considered restorative sleep or not. The point is, the State's Legislation may permit the access to your phone's sleep app to determine the cause of your accident: Impairment due to sleep deprivation. Phone apps that record your sleep may be inaccurate, but so are alcohol breath analyzers, but they were the used to project blood alcohol levels for years without scrutiny or scientific validation.

Insurance companies do not spend money for the greater good of mankind, if they did, they would be broke. They invest in what will make them less culpable if there was a car crash for a member of their Plan. They make money by not paying for something they want you to believe they will pay for: the old game of bait and switch. Read the fine print.

We already have an insurance crisis in this country on every level. The liability of living your life is more expensive than what anyone is willing to pay for your life. Everyone knows that anything contributing to slowed reaction time, lack of judgment and impaired vision will put you in all sorts of disturbed places, especially disturbed driving. How many circumstances in our lives contribute to the reduced acuity of at least one of those three key elements of living life safely? Some people with anxiety drive better under the influence of Xanax® than without it. Go figure that one out.

So what would my advice be for you if you have an app on your phone that records your sleep activity and automatically sends it to the cloud for safe keeping? Seriously? Delete the app before it's too late.

Wake Up!

Doc

Posted by Amanda Sanders at 9:50 AM
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