Road Traffic Accidents II

Asleep at the Wheel?
Falling asleep at the wheel is a growing problem which accounts for one in ten of all U.K. road accidents. This means approximately 360 deaths and 24,000 injuries are directly attributable to sleep related causes (Dept. of Transport figures).

When people are suffering from sleep deprivation, a comfortable, warm, quiet car on a straight road, will prove very conducive to sleep. Considering the number of people involved in shift working and those working long or irregular hours, it is not surprising that the incidence of sleep related accidents is so high.

Human beings follow a circadian rhythm linked to light and darkness. If this natural rhythm is disturbed there is always a price to pay; there may be increased production of stress hormones (e.g. growth hormone and cortisol); menstrual cycles may also be disrupted. A common factor in all sleep disorders is the need for the body to balance periods of sleep and wakefulness. If normal patterns are disrupted, the system will attempt to balance itself. This has a direct impact on the need for sleep the next day and this can lead to tiredness, impaired judgement, language confusion, mood changes, lack of ability to concentrate, and slower reaction times.

Drugs and Driving Tricyclic Antidepressants
Whilst these drugs are effective in the management of sleep disturbance associated with depression, they also produce daytime sedation and slow reaction times. They increase the risk of accident by a factor of six (compare with alcohol at the legal limit which increases the risk of accident by a factor of four).

Benzodiazepines
These drugs are often prescribed to reduce stress and anxiety and have been associated with an increased risk of road traffic accident.

The Tayside Study (reported in the Lancet, 1988) found that the drivers under the age of forty-five on benzodiaze-pines were three times more likely to be involved in an accident than non-drug takers.

Sleep related problems contribute to a large number of road traffic accidents every year and these present a real public health risk. The use of drugs which bring the relief of sleep disorder, may also increase the risk of causing road traffic accidents. This may be due not only to the residual sedative effects, but subtler loss of judgement and psychomotor skills.

Too Tired Cartoon

Sleep hygiene is the preferred approach to sleep disorder:

1. Establish a regular bedtime schedule.
2. Avoid activities that are stimulating or require alertness at bedtime.
3. Avoid caffeine or spicy foods and alcohol before bed.
4. Avoid exercise within three hours of bedtime.
5. Make sure the bed and pillows are as comfortable as possible.
6. Block out noise and light. Proper management of sleep related disorder should involve diagnosis of the cause.
7. Sleeping tablets with a short action in the body should be used in the short-term only.


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