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Ready to Drive “are lights turned on ? ”

Ready to Drive “are lights turned on ? ”. Naim S. Bashir, MD, FAASM Diplomate American Board of Sleep Medicine. NH* Traffic Safety Administration. Data based on police reports Drowsiness as a causing factor in: 100,000 crashes per year 076,000 injuries per year 001,500 deaths per year.

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Ready to Drive “are lights turned on ? ”

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  1. Ready to Drive“are lights turned on?” Naim S. Bashir, MD, FAASM Diplomate American Board of Sleep Medicine

  2. NH* Traffic Safety Administration • Data based on police reports • Drowsiness as a causing factor in: • 100,000 crashes per year • 076,000 injuries per year • 001,500 deaths per year *National Highway

  3. NH* Traffic Safety Administration • Data based on public survey – past year • Drowsiness • 55% felt drowsy while driving • 02% felt drowsy and crashed • Fallen asleep • 23% fallen asleep while driving • 03% fallen asleep and crashed *National Highway

  4. What is drowsiness? “A state of impaired awareness associated with a desire or inclination to sleep ” • NOT ALWAYS • “Forced Wakefulness” • “Microsleeps”

  5. Sleep • Process – S (homeostatic) • Process – C (circadian)

  6. Process – S (homeostatic) SLEEP AWAKE

  7. Process – S (homeostatic) • Acute Sleep Deprivation • Legal limit for blood alcohol concentration (BAC) in all states is 0.08 • Awake 18 hours = BAC 0.05 • Awake 24 hours = BAC 0.10 • Chronic Sleep Deprivation – Sleep Debt

  8. Process – S (homeostatic) What happens in adolescents? SLEEP NEED 9.2 hours / night SLEEP SLEEP DEBT 16 hours / week AWAKE 6.9 hours / night

  9. Process – C (circadian) • Circadian pacemaker or “Biological Clock” • Resides at the base of the brain • Sets sleep / wake rhythm • Rhythm is altered by: • Light • Meals • Exercise • Social interaction • Melatonin MELATONIN LIGHT

  10. Process – C (circadian) ADULTS (7-8 hours) MELATONIN LIGHT 10:00 – 11:00 p.m. MAXIMUM SLEEPINESS 07:00 – 08:00 a.m. MAXIMUM ALERTNESS LIGHT EXPOSURE MEALS EXERCISE SOCIAL INTERACTION PHASE DELAY

  11. Process – C (circadian) ADULTS (8 hours) What happens in adolescents? MELATONIN LIGHT 10:00 – 11:00 p.m. MAXIMUM SLEEPINESS ADOLESCENTS (9.2 hours) 11:30 P.M. 08:30 – 09:00 a.m. MAXIMUM ALERTNESS PHYSIOLOGIC PHASE DELAY

  12. BED TIME RISE TIME THE NEXT DAY 12:30 p.m. ~ 6 hours SEVERE SLEEPINESS 06:30 a.m. 11:30 p.m. ~ 7 hours 06:30 a.m. • SUNDAY • MONDAY • TUESDAY • WEDNESDAY • THURSDAY • FRIDAY • SATURDAY ~ 7 hours 06:30 a.m. SCHOOL STARTS 7:20 ~ 7 hours 06:30 a.m. ~ 7 hours 06:30 a.m. 01:00 a.m. ~ 12 hours 01:00 p.m. ~ 12 hours 01:00 p.m. TYPICAL SCHEDULE OF AN ADOLESCENT (sleep need 9.2 hours)

  13. How alert is the adolescent driving to school at 07:00 a.m.? • Significant sleep debt to Process S • Irregularities in Process C • Severely sleepy / drowsy rather than in a state of maximal alertness • Force wakefulness – “micro-sleeps”

  14. Adolescent driver surveys • More than one half of the adolescent drivers drove drowsy in past year • 15% of drivers in 10th - 12th grades drove drowsy at least once in a week • One study of fall-asleep crashes indicated that drivers were young (under age of 26 years) in 55% of the crashes

  15. Causes of Sleepiness • Inadequate sleepiness • Presence of: • Medical disorders • Substance abuse • Mental disorders • Sleep disorders

  16. Sleep Disorders • Obstructive Sleep Apnea • Delayed Sleep Phase Syndrome • Narcolepsy • Restless Leg Syndrome • Periodic Limb Movement Disorder • Idiopathic Hypersomnia

  17. Diagnosis of Sleep Disorders • Consultation • History • Physical examination • Sleep Log Review • Nocturnal Polysomnography • Multiple Sleep Latency Testing

  18. Summary • Adolescent sleep need is about 9.2 hours of sleep per night • Shift in biological sleep / wake rhythm • Irregular sleep patterns are common • Sleep Disorders are not uncommon

  19. Drowsiness Prevention • Establish a bedtime routine • Set a desired bedtime • Avoid exercise 4 hours prior to bedtime • Avoid large meals prior to bedtime • Start preparing ~ 1 hour before bedtime • Bright light is best avoided • Limited exposure to computers or television is helpful • Social interactions are kept to a minimum (text messaging, telephone conversations) • Involvement in relaxing activities is helpful (warm bath, reading, meditation) • Preparing for next morning (lay out clothes, etc) may help get a little extra time to sleep

  20. Drowsiness Prevention • Set a regular wake time • Stay within 2 hours of week day wake time on weekends (week day rise time: 06:30 a.m. weekend rise time: 08:30 a.m.) • Napping – “30 minutes” • Get checked up for possible presence of a Sleep Disorder if sleepiness persits

  21. Drowsy Driving Prevention • Do not drive if you know that you a prone to becoming drowsy during the drive • Take a power nap • Drink a caffeinated beverage • Loud music and rolling down the windows do not work

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