News from The Sleep Surgery Centre

 

Sleepy Driving: the hidden epidemic.

10% of all road accidents are sleep related, rising to 20 to 30% in commercial vehicle crashes. One in 5 Canadians admits to nodding off behind the wheel in the last 12 months. 31% of fatal crashes are due to a driver falling asleep and if you do fall asleep, you have a 1 in 3 chance of killing yourself or someone else. For comparison, in Canada 30% of vehicle deaths are alcohol-related, something for which people quite often go to prison.

Why then do people still drive sleepy? For lots of reasons, but one of them most certainly is that about 20% of the middle aged population have Obstructive Sleep Apnea (OSA), and only about 20% of those know they have it. It’s an even more terrifying fact that among truck drivers at least a quarter, and in some studies a half, have OSA. And OSA causes sleepiness, often overwhelming sleepiness. A recent review of all the studies done on OSA and road crashes showed an up-to-5 fold increased risk of crash in people with OSA¹. The other big reason why people don’t go to prison for this is that the driver, if still alive, wakes up remarkably when he’s finished crashing, and we have no breathalyser or blood test to measure his hidden tendency to sleepiness. However, while it’s a lot less detectable than alcohol, it is just as evil in its results, and just as preventable.

For instance, determining a person’s Body Mass Index and asking questions about snoring and daytime sleepiness provide good clues as to who may be at risk of crashing; and the severity of the sleep apnea found in an overnight sleep study is also predictive of crash risk¹. Once diagnosed, the basic treatment for OSA, Continuous Positive Airway pressure (CPAP), was found, in a recent overview of the research, to reduce the risk of crashes to the same as that of people without OSA². Daytime sleepiness improved after just one night of CPAP, and simulator driving performance after 2 days². Obviously for this treatment to be successful it must be sustained, and professional drivers need to be monitored on an indefinite basis unless they’re cured.

So…. if another cause of the road accident epidemic can easily be hugely reduced, why is this not happening? One reason is that people are understandably afraid of losing their driving license. If this is your concern, here are a few things to remember:

1. No doc can take your license away. Only the Superintendent of Motor Vehicles (SMV) can do that, and he has to weigh up more than just your medical condition.

2. No doc wants to report your medical condition to the SMV; quite the contrary.

3. No doc in BC is compelled by law to report you, unless he knows you are driving against medical advice (his or someone else’s), in which case - yes, the law says he must.

4. In fact, if you are willing to go straight on to CPAP, the issue of licencing need not even come up (see above), unless you need further testing first.

5. If you do need further testing, every doc who is worried about your driving will give you top priority, and/or arrange immediate treatment of your OSA while you are waiting.

6. Very few people lose their licenses even for a brief time, and those who do usually get them back in short order once they get on treatment.

So, for the sake of your fellow citizens, your loved ones, and yourself, don’t drive sleepy. If you do feel sleepy at the wheel, STOP. Pull over and have a 15 minute nap. Opening the windows and turning up the music has been shown not to work. You should not be driving. That drowsiness is the very last warning you will get of fatal unconsciousness. So stop. And after your nap, go straight to a sleep doc and have him check you out.

Remember, it’s just as bad as alcohol.

                  Dr. Richard R.J. Smyth, FRCS.                               Oct. 22^nd, 2011

 

References:

¹OSA and risk of motor vehicle crash: systemic review and meta-analysis. Tregear S et al, J Clin Sleep Med 2009 Dec; 5(6):573-81

²CPAP reduces risk of MVC among drivers with OSA: systematic review and meta-analysis. Tregear S et al. Sleep 2010; 33 (10):1373-80

 

 

 

Past Articles

Newsletter Fall 2011 - Sleep Apnea - When CPAP Fails - The efficacy of continuous positive airway pressure (CPAP) in the treatment of obstructive sleep apnea (OSA) is remarkable. In general, it works extremely well for those who use it. However the effectiveness of CPAP, which includes its tolerability and ease of usage, is in fact very disappointing. Only about 50% of patients end up using it. More>>

Newsletter Summer 2011 - Pediatric and Adolescent Sleep - Obstructive sleep apnea occurs in approximately 3% of children, probably more than that in preschoolers. Symptoms include severe snoring with witnessed apneic spells, enuresis, sleep inertia (difficulty getting going in the morning), poor attention and hyperactivity, and “failure to reach potential” in academics. More>>

Snoring and Carotid Artery Atherosclerosis- Carotid artery atherosclerosis (CAS) is a leading cause of ischemic stroke, which itself is the leading cause of disability in our North America(1). Studies have linked nocturnal hypoxemia and obstructive sleep apnea (OSA) with endothelial damage and arteriosclerosis(2,3). Until now snoring has not been studied as a possible factor. More>>

September 2010 - Sleep Surgery Centre - Helping the Community For over 9 yrs. - Looking back, I see that the Sleep Surgery Centre was incorporated almost exactly 9 years ago, and registered with the BC College of Physicians and Surgeons on July 10, 2001. Since that time my practice has been largely concerned with sleep disordered breathing, a phenomenon which you may know is prevalent in about 20% of the middle-aged population, and remains about 80% undiagnosed. More>>

Newsletter Winter 2009 - Multidisciplinary Management - Diagnosis & Treatment - Since its inception 7 years ago, the Sleep Surgery Centre(SSC) has been committed to INTEGRATED CARE for patients with Sleep Disordered Breathing (SDB). We believe that the condition requires multidisciplinary management both in diagnosis and treatment. More>>

Doctors Patients and Sleep - A survey of family practitioners in the United States has shown that doctors in general do not ask their patients about sleep. More>>

New Surgical Procedures for Snoring and Obstructive Sleep Apnea - Fall 2006 newsletter from the Sleep Surgery Centre. More>>
 

Sleep Apnea Often Goes Undetected - Dec 2004 From the Publishers of the New England Journal of Medicine

Sleep apnea, a common and debilitating disorder signaled by loud snoring, often goes unrecognized, according to researchers who say better diagnosis and treatment would cut the risk of accidents, heart attacks, and strokes. More>>
 

Integrated Care for Sleep Disordered Breathing - Summer 2003 newsletter from the Sleep Surgery Centre

The condition of sleep disordered breathing covers a wide range of clinical variability from mild snoring to severe sleep apnoea. Many patients, and their clinicians, are unaware where exactly on that continuum they stand. Moreover once accurately diagnosed, the morass of available treatment is confusing, and the advice given on management may depend more on the perspective of the consultant than on the optimal treatment for a particular patient. More>>

Sleep Apnea and Obesity - October 2011 - About 70% of sleep apneics are either overweight or obese. The majority of these are noted, on retrospective examination of their charts, to have put on weight significantly in the year prior to diagnosis. More>>

Laser or Radio-Frequency: Which is better for snoring? - Fall 2002 newsletter from the Sleep Surgery Centre

At the Sleep Surgery Centre patients are encouraged to become thoroughly informed about all forms of treatment for snoring and obstructive sleep apnea and to engage fully in the decision process concerning the best treatment for them. Not surprisingly, then, the question of whether the laser assisted uvulopalatoplasty (LAUP) or radio-frequency palatal myoplasty (RPM) is the best treatment often comes up. More>>