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Sleepless America: The Deadly Cost of Fatigue in Transportation

By Mark Rosekind

When you step onto a bus, airplane, or train there is a sacred trust that the operators have taken all reasonable measures to ensure you arrive safely at your destination, every time. When you turn the ignition on in your own vehicle, you join this sacred trust, to ensure that you, your passengers, and those around you will arrive safely at your destinations, every time. Next week, America prepares to turn its clocks ahead and collectively as a nation we each lose an hour of sleep. In one night, this will generate a 300 million-hour national sleep debt and in the few days it takes our bodies to adjust, our nation will accumulate over a billion hours of lost sleep. In transportation, this lost sleep kills, injures, and costs billions of dollars.

National Sleep Awareness Week, March 3 through 10, highlights the tragedies that result from sleep loss and operating vehicles while fatigued. http://www.sleepfoundation.org/event/national-sleep-awareness-week-2013 Just three years ago 10 people died when a truck plowed into seven cars and caused a massive pile-up on Interstate 44 near Miami, Oklahoma. It was the worst highway accident in the state’s history. The driver suffered from a deadly combination of an altered work schedule, acute sleep loss, and sleep apnea. He never even touched the brakes.

The hour we lose when clocks are set forward every spring offers our already sleep-deprived country a glimpse into the dangers of operating vehicles while fatigued. Perhaps the most basic requirement for safely operating any vehicle is to be awake, and though necessary, just being awake is not sufficient. Safe travel requires every vehicle operator to have obtained optimal sleep and be wide-awake and maximally alert, every time. There is a 17 percent increase in crashes on our roadways on the Monday following the time change. But fatigue safety risks are a life-threatening concern far beyond this annual clock change. Every year, an estimated one million roadway crashes and near-misses are likely fatigue-related, with thousands of people losing their lives and being injured. Fatigue-related tragedies are played out across every hour of the day throughout our nation’s transportation system.

The National Transportation Safety Board (NTSB) has long been interested in fatigue and has identified it as a probable cause or contributing factor in accidents across all modes of transportation that have resulted in many lost lives and injuries. The NTSB has issued over 200 safety recommendations focused on fatigue across all transportation modes. These safety recommendations have addressed diverse areas such as hours of service regulations, scheduling policies, education and training, diagnosis and treatment of sleep disorders, research, and vehicle technologies. But after all this, are we safer?

The societal “wake up call” is just beginning to be answered. For example, a little over a year ago, the Federal Aviation Administration issued new hours of service rules for pilots and the Federal Motor Carrier Administration issued new rules for commercial truck drivers. While representing the most significant changes in over 70 years, and incorporating many science-based elements, the aviation rules do not cover all pilots, and the truck rules face court challenges and fall short on addressing sleep disorders, especially sleep apnea, one cause of the Oklahoma accident. These are important developments that represent real progress, and need to be embraced and applauded. But so much more needs to be done.

Airplanes, buses, trains, trucks, and ships are complex machines that require the full attention of the operator, maintenance personnel, and other individuals performing safety-critical functions, and our lives depend on it. The sad fact is that for all the information we have on the perils of fatigue, American society still characterizes pushing the sleep envelope as “hardworking,” “results-oriented,” and “dedicated” but when it comes to operating any kind of vehicle – fatigue can be deadly. Reducing fatigue risks in transportation is everyone’s ongoing responsibility: companies, the government, individual operators, and travel consumers. And when you are behind the wheel, every moment requires you to be wide-awake and alert.

This year when we all spring forward, lose an hour in some other part of your life. Get the sleep you need and then maintain that sleep amount throughout the year. Sleep as if your life and those around you depend on it.

Mark R. Rosekind, Ph.D. is a Member of the National Transportation Safety Board and an internationally recognized expert in the field of sleep and fatigue science.