Accident prevention

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Counter-measures to reduce the risk of a motor vehicle accident [20] due to sleepiness include:

1 Avoiding sleep deprivation and, if possible, shift work before driving, together with encouraging good sleep hygiene practices and a greater awareness of the problems of driving while sleepy.

2 Treat any underlying sleep disorder. Effective treatment of obstructive sleep apnoeas with nasal continuous positive airway pressure (CPAP) treatment reduces the risk of road traffic accidents [21].

3 If driving after sleep deprivation is unavoidable, it is best to nap for 15-30 min before starting driving and to take 50-100 mg caffeine [22]. This has a stimulant effect within 15-30 min. Activities such as keeping the car windows open and playing music may have a brief beneficial stimulant action, but can encourage sleepiness in some people.

4 It is essential to stop driving before sleepiness becomes marked and it is probably those drivers who ignore this warning symptom who are most likely to be involved in fatal accidents.

5 Road design. The design of roads has a large influence on the frequency of sleep-related accidents. Accident blackspots on motorways are usually due to a combination of a previous monotonous stretch of driving, coupled with a complex junction or slip road system. Warning signs on motorways alerting drivers to be aware of sleepiness and the provision of laybys on major roads, so that drivers can stop to sleep, should be encouraged. Ridged surfaces (rumble strips) are effective in alerting drivers to a lane change and have significantly reduced accident rates.

6 Detection of driver's sleepiness. Equipment to detect the driver's blink rate or eye closure, which then alerts the driver, has been introduced, but is unlikely to be effective since accidents frequently occur before these signs develop. It is preferable to stop driving at the onset of sleepiness rather than to wait until this late stage before attempting to detect it.

7 Increase public awareness. Prevention of sleep-related motor vehicle accidents involves increasing public awareness and altering public policies regarding roads and driving.

8 Medical care. The physician has a role in educating patients about the risks of driving while sleepy, in diagnosing any underlying sleep disorder, in giving sleep hygiene advice, especially for shift workers, and in assessing whether or not the patient is fit to drive. This decision is influenced not only by the degree of sleepiness, but also by the presence of any underlying sleep disorder and the distance that is usually driven and the time of day. The doctor has a duty to inform the patient that he or she should notify the Driver and Vehicle Licensing Agency (DVLA) and the driver's insurance company of any sleep disorder that may impair the ability to drive. It is not the doctor's role to make these notifications except in exceptional circumstances when the duty to society as a whole may outweigh the duty of confidentiality to the individual patient because of a substantial risk from an accident and the patient's unwillingness or inability to notify the authorities.

9 Driver licensing. Legislation has to balance the costs to society of the dangers while driving against the loss of individual liberty, including for instance the loss of employment if driving is prevented. There are wide international variations in the regulations and criteria for revoking driving licences.

The DVLA are responsible for identifying drivers with sleep disorders who are likely to be a source of danger while driving. 'Likely' in this sense is interpreted as 'more than a bare possibility'. The DVLA do not require notification of EDS due to poor sleep hygiene, sleep deprivation, shift work or sedative medication. The patient has a legal duty to report narcolepsy, irrespective of the extent of any perceived difficulty with driving. Approximately 2500 patients with obstructive sleep apnoeas and 300 with narcolepsy are identified each year in the UK. This is probably considerably fewer than the total number that are diagnosed with these conditions.

Medical disorders which affect the ability to drive may require a report from the doctor caring for the patient before a licence is issued, whether it is for a restricted period, such as 1-3 years before being reviewed, or for a longer period. In general, the licence is usually retained in those with obstructive sleep apnoeas if these are satisfactorily controlled with nasal continuous positive airway pressure (CPAP) for around 3 months and if there is satisfactory compliance with treatment.

The DVLA do not continue to supervise drivers with obstructive sleep apnoeas who have Group 1 licences (vehicles less than 3.5 tonnes), but those with Group 2 licences (vehicles weighing more than 3.5 tonnes or with more than eight passenger seats) require annual assessment for at least 2 years to establish whether improvement with CPAP has been maintained. Treatment of excessive daytime sleepiness and cataplexy in narcolepsy usually enables the licence to be retained for a limited period.

Falling asleep while driving is not a defence in law by itself and is regarded as evidence of a lack of due care and attention. The act of falling asleep is in effect a self-induced automatism (page 197) for which the subject is considered guilty. The driver has a duty of care not to drive while sleepy, whatever the cause of the sleepiness may be.

The law assumes that there is adequate warning of sufficient sleepiness that might cause lapses of attention or sleep to be entered. The ability to recall the sleepiness before the accident is often denied, particularly by younger drivers, but is not a defence since it is felt that sleepiness would have been recognizable at the time, even if it is not later recalled. Driving while under the influence of sedative medication, even if it is medically prescribed, is not a defence.

Driving while sleepy is well documented in arousal disorders, such as sleep walking, but the defendant has to demonstrate that the episode involved an automatism, which is distinct from simply feeling sleepy or having microsleeps while driving. Driving without any awareness of the surroundings is normal if the mind is preoccupied, and is distinct from driving while sleepy or during an automatism.

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Healthy Sleep

Healthy Sleep

A Guide to Natural Sleep Remedies. Many of us experience the occasional night of sleeplessness without any consequences. It is when the occasional night here and there becomes a pattern of several nights in arow that you are faced with a sleeping problem. Repeated loss of sleep affects all areas of your life The physical, the mental, and theemotional. Sleep deprivation can affect your overall daily performance and may even havean effecton your personality.

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