Up ng the famine and i went and id just got on the appropriations and said can i go to ethiopia . Sure. You may not remember the famine but it was very bad. I got in a cample up in a place run by world vision. And the embassy didnt let me spend the night. I said im going to spend the night. The guy from world vision sfed you spend the night ill spend the night. Right next to us was a camp run by mother theresa. It rained the next day. It was a life changing experience. We saw i mean, in the morning people died and we saw things. At just that trip to in 1985, attorney took me romania. Chalcesku. Those two trips with kind of book ends, human rights, the poor, the hungry and religious freedom. Since that time and also on thursday, thanksgiving day, well take an American History tour of various native american tribes. Thats at 10 00 a. M. Eastern following washington journal. Then at 1 30 attend the groundbreaking ceremony of the new Diplomacy Center in washington with former sex of state mplt and Supreme Court ustices thomas, alito and soto myor at 8 00. For our complete schedule go to cspan. Org. According to aaa Drowsy Driving is responsible for 400,000 traffic accidents each year. National Transportation Safety board hosted a meeting. This is just over an hour. Good morning. Welcome to the board room of the national Transportation Safety board. Its a wake awake, alert, alive. I am board member and it is my reside over the meeting today. My thanks to all of the panelists who will be provided their perspectives and considerable expertise today. We are calling this forum awake, alert, alive because every driver must be awake and alert to operate a vehicle safely. Sufficient, goodquality sleep is approximately to alertness and Human Performance and yet so Many Americans are on the road dangerously impaired by lack of sleep. We know this is a serious problem. The current estimates may only point to the tip of the iceberg. Driver fatigue may directly contribute to over 1200,000 roadway crashes annually. These are only policereported crashes. Theres some estimates that put the number of drowsing driver crashes at over a million a year. Conservative estimates suggest a thousand people are killed annually in these crashes while other data indicate that the 7500 lifes are lost every year. The number of crashes and fatalities attributed to fatigue is grossly underestimated. There is no roadway test. We do not have a fatiguea lieser as we do a breathalyzer. State reporting practices are inconsistent and theres little or no Police Training in determining sleepy driving. Self reporting is unreliable. Any resulting loss of life is tragedy, needless and preventable. A drowsy driver can be a deadly driver. Even one night losing two hours of sleep is sufficient to significantly impair our built, attention, reaction time, Decision Making can all be significantly reduced by 20 to 50 and driving many this condition, that could mean not reacting to the brake lights in front of us or not see the traffic light turning red. Fatigue alone can be deadly. It also multiplies the adverse effects of other forms of impairment. Drugs, alcohol and distraction. Every other form of i am parent may be exacerbated when we dont get enough sleep. Weve identified sleep as causal, contribute over or finding. The agency has issued more than 200 safety recommendations in such diverse areas as research, vehicle technologies, the treatment of sleep orders and hours of scheduling policies for commercial and bus drivers. Most people drive cars. They operate personal vehicles. For most of us, there are no hours of service or rest rules. We have to rely on our own experience for knowledge of fatigue and its affects. Unfortunately, our personal experience especially as it relates to selfdiagnosing fatigue is typically inaccurate. In january 2013, the ntsb investigated a collision involving three passenger vehicles. The collision happened at about 8 30 in the morning. A nurse was driving home after more than 13 hours on duty. She depart her lane, crossed over the median and entered a northbound lane traveling against the flow of traffic. Her car then struck another vehicle, pushing it into one lane over. This vehicle was struck again from behind by another car. One driver was fatally injured and the 234urs was transported to a hospital where she was treated for her injuries. She had fallen asleep. Shed worked night shifts for nine years and was familiar with the challenges of her schedule and yet her inverted work schedule along with her extended time awakening contributed to her falling asleep at the wheel. Todays forum offers us an opportunity to focus on the dangers of Drowsy Driving and on the countermeasures that can mitigate. Well identify what we know and what we dont. Only the most robust data on Drowsy Driving can lead to the most effective countermeasures. Well look another sleep disorders. We will hear about the challenges faced by young novice drivers. We will discuss irregular Work Schedules and how the same people we depend on for our 247 lifestyle are vulnerable to taking to the road in a too teegged state. We will hear about invehicle and onroad countermeasures and other strategies to reduce the risk of Drowsy Driving cashes. Perhaps just as importantly, we will provide a public setting to exam the dangers of Drowsy Driving. For awake and alert driving to become the expected norm, we must play a prominent preventive role. This for all of us is for nurses, doctors, Law Enforcement officers and security guards driving home after their shift. Its for the utility worker driving home after fixing the powerlines after a storm. It is for any of us who have ever driven with too little sleep. A crash can happen literally in the blink of an eye. It is our hope that this forum is one step toward a national waking about the safety risk of Drowsy Driving. Now i will turn to dr. Janay price who has done an outstanding job in organizing this forum. Dr. Price. Thank you. For safety purposes, please note the emergency exits. You can use the rear doors that you came through. To enter the conference center, theres also a set of emergency doors up front. If you havent done so, please silence your electronic devices. Todays forum has been designed to get to several topics relative to Drowsy Driving. We will begin with an introduction and the scope of the problem. This morning we will have panels addressing workplace factors. Concerns as novice drivers. A group from the National Organization for youth safety will join us during the novice driver panel. After lunch we will have panel discussions. The final panel of the day will address countermeasures and future directions. Each panel will open with presentations by panelists followed by a facilitated question and answer period led by our ntsb technical chairs. Our staffer and panelist byos as well as the agenda are available needs Forum Website www. Drug. Presentations provided by our speakers and a video archiver of the webcast will be available on our website. Attendees or others who wish to submit written comments for inclusion in the forms may do so until november 7. Submissions should address one or more of the topic areas and should be submitted. Gov. Niccally to ntsb there are a variety of lunch options. Take the escalators up one floor and walk straight ahead. Youll find restaurants as well as a food court. Handouts are available in the lobby and on the website. We appreciate your cooperation in helping us keep on schedule during panels and breaks. One note to our presenters about breaks. We will have panel photos in the morning. Panels for the importantly panels during the morning break and for the afternoon panels in the afternoon break. Well meet right here. I now turn to our first technical chair, mr. Dennis collins to introduce the first panel. Mr. Collins. Thank you, dr. Price. Presenters, when speaking, please push the button on the microphone. A green light indicates the microphone is on. Please bring your microphone close and press the button to turn it off when youre done speaking. The first panel covers an introduction and the scope of the problem. Our panelists are dr. David, chief of the division of sleep and director of the unit for experimental psychiatry at that Time University of pennsylvanias perlman school of aaa and brian teft of the foundation for safety. Dr. Dinges. Good morning. Thank you for inviting me to speak at this important meeting. Im going to begin by setting the stage for the biological effects of drowsiness that make it so terrificcally dangerous when we drive. Next slide, please. The first thing to remind those listening and looking at these slides are that as near as we know right now, all animals need to sleep, and humans are no exception. Sleep an essential part of our health and survival. We have to do it on a daily basis. We have to achieve Healthy Sleep and we need sleep that is of adequate duration to ensure that we dont have uncontrolled drowsiness and sleepiness during the daytime. This slide is just a reminder that when we bont dont receive adequate sleep, we tend to fall asleep very rapidly. The graph going down on the left shows that the longer were awake, the more rapidly we will fall asleep and the more rapidly we will transition into a stainl of sleep where we cannot recover even if were alerted. The graph on the right reminds us that the depth and intensity of that sleep is an inherent part of the sleep system attempting to recover the brain from the terrific need for sleep and to give it the sleep that is essential, and other speakers will talk about what happens to drowsiness and waking functions when you dont receive that depth of sleep. Next slide. Why dont people obtain enough sleep . This is the only the only thing ill say here is what we now know in our modern lifestyle is that substantial portions of the population shown here in the yellow bars on the left do not achieve even seven hours sleep a night. The bulk of the evidence in the sleep field points to the fact that once large segments of the population are sleeping less than seven hours, we get an increase in excessive sleepyness, accidentrelated sleepiness as well as obesity, diabetes, cardiovascular problems. So there are significant safety and Health Consequences to chronically undersleeping. Yet we have large segjmingts of the population undersleeping. The graph on the right reminds us that part of that, a major part of why people do not get adequate sleep is work and travel. They spend extra time at work, extra time getting up early to get to work, and while those may seem like normal routine activities, theyve become so problematic that theyre eating up the time that one would should spend sleeping and they force us to compress our sleep down into a shorter and shorter period during the workweek, then people make a desperate effort to recover on the weekend but that recovery is usually inadequate. Two days of extra sleep usually will not repair us. Chronic sleep restrix is an inherent part of modern lifestyle and jobs for many people and that is where where one of the source offs problems are. Youll hear other speakers talk about sleep disorders, etc. Now, we know that this is occurring in the brain. Many people think its thrort drive drowsy because its a willful event that somehow it hasnt got anything to do with biology and you can just will yourself to overcome it. Unfortunately, people get away with it without crashing, sew they get the belief in their heads that it doesnt matter if youre tired, its ok to drive, youll be safe, youll be careful, because you have a good intention. But intentions wont, as we know really prevent this biology from turning on. This is just a brain scan showing that major areas of the brain in blufere, frontal part of the brain, the associate active soshe active part of the brain, the upper back part of the brain, the central core of the brain are all showing changes in activity that are consistent with the brain falling asleep while we try to stay awake and drive. Theres aing terrific change going on that we cannot easily control. Slapping yourself in the face or turning the radio up or chewing gum or singing will not prevent this from occurring. And if it does prevent it, its no more than a second or two. It actually swront a lasting benefit. Its not the same as sleep. The brain needs sleep. Obviously, you cant sleep and drive at the same time. Would you just click on this video . One of the hallmark features of the the sleep falling asleep driving is that the eyelids will close. We ail know this. But we dont understand that tights muscle 06 our eyelids that are losing tone due to the pressure of sleep. Sleep and drowsiness not only makes our brain blink on and off and not Pay Attention but it also causes muscle relaxation, including the eyelids. The eyelids will come down. This is a simulator. This is not a real driving experience. Were not putting this young lady at risk. Youll see in this Virginia Tech film, shes falling asleep and the head dips back and the eyelids close because theres loss of muscle tony. When the eyelid the eye rolls back. You can see she almost ran off the road in the simulator. This is what we all know Drowsy Driving is. So many people have done it many their lives that we dont enter any have any trouble recognizing yes, thats whats occurring but we dont appreciate how staggeringly dangerous this is. On the left side in yellow, this young lady is working on a Vigilance Task but shes been sleep deprived. On the right side shes working on the task and she isnt sleep deprived. The graphs below show you that over time, the depraff on the left says that initially she works ok. As soon as we sleep deprive her halfway along that grambings up goes her lapses of attention and up go the frequency of her eyelids drooping. On the righthand side she may be bored but she can work for hours on end without falling asleep. People who think that Drowsy Drivings due to just being bored when youre driving or bad scenery are wrong. Its due to you not sleeping enough. Boredom is driving when youre not interested in what youre looking at. Sleepiness and drowsiness is the trying of the brain is to work. We know among all the tests that have looked at, attention in particular and alertness are the number one affects of sleep loss. By 235r, they occur more frequently and more profoundly than the effects on memory, reasoning and many other areas. And thats best illustrated by this somewhat complicated slide. Listen to these heart beats. These are actually reaction times of people when theyre fully alert and pressing a button so each quick heart sbeath a Fast Reaction time. Theres nothing wrong. Were explaining this heartbeat just to give you the appointment that the brain is zead as you go here. Click on that top one again and shut it off and well click on the bottom one. Ok. Now, heres the drowsy driver equivalent. They start out and theyre fine. As they drive along, they start to have hes lapse, thats one. Thats your eyelids down. Youre not responding. Youre not responding. Youre not monitoring. Now youre back again. No, now youre going to go again. This is the hallmark feature of sleep loss. Click on than and look to the right. We know where in the brain that is. In the brain you can see the response times in the sleepy driver whereas the alert driver is steady as you go. This is that fighting sleepiness that people experience driving down the rolled. By the time youre doing that, you are at grave risk, you really shouldnt be behind the wheel. You should pull off. You should get some sleep, get some rest. You should have slept adequately before you drive and youre going to hear me and other speakers say that. This is the grave risk of driving. Just because you get away with it for a mile or two doesnt mean you wont van uncontrolled sleep attack in the next hour. Theyll be come more and more repeated and more and more severe. As i just this just illustrates the lower right shows when you have plenty of sleep you dont have thighs lapses and when you do, theyre short so youre really stable. When we move you to six or four hours or no sleep at aller in a night, you see this dispersion of attention. Theyre completely unpredictable. If you can parallel dict the moment youre going to fall asleep, you might argue, ok, ill do something to correct it. But you cant do that. The brain does this against your will at a time when you realize, oh, my god, i realize i just slept this last period of time. You cant be operating a Motor Vehicle when that happens. Youre begging for a crash. In fact, it takes no more than a twosecond lapse of attention at 60 miles an hour with a fourdegree angle of drift thats just enough loss of steering control, just relax your muscles on the steering wheel, close your eyes for two seconds, you can completely be out of lane and off the road in four seconds. You can see how it takes very little of these lapses, these microsleeps to put you in grave danger. Not to mention if youre in close traffic. One of my messages is this isnt just highway phenomena. Drowsy driving, slowed reaction times are occurring in people who havent had adequate sleep in the city. Theyre occurring in density traffic. The studies done by the federal government have shown that in the washington, d. C. Area, they find Drowsy Driving occurring all over the metro area. We know theres highrisk events occurring even in traffic. This is just an illustration of the dynamics of this drowsiness. What you see in the upper graph that you dont have any of these lapses from drowsiness when youre getting normal sleep at night on the left. As you go a night without sleep, those lapses increase. You went actually a second night without sleep, theyd go even higher. The same thing happens if youre only getting, say, four or five or even six hours a sleep a night. They get progressively worse day after day. Down below you actually can see that segment of the night from midnight to 8 00 or y9 a. M. And you can see the high rate of Motor Vehicle crashes related to falling asleep at that time. You can see they ramp up at that time. It doesnt mean youre safe in the middle of the day if you havent slept the night before. You can absolutely have a Drowsy Driving crash at any time of day, but this shows the dynamic from one study done in North Carolina of people falling asleep and youre at a particularly high danger risk through the night and especially in the morning often people think they are safe because the sun is. Like is not powerfully enough to override this danger. Group innot the only society that have these crashes. Young adult males up to mid 40s have a high rate. Please. De, left, the less sleep you get, the more lapses you have every day. They are going up. On the right are how people felt about their sleepiness. Click on that. What you see in the middle graph is at the bottom graph is performance is getting worse across time. Our sense of how we are doing is changing. This means you cannot actually tell how dangerous you are driving. You need to Pay Attention to your behavior. If you are suddenly discovering your head is falling over, your eyes are closing, you almost rested out of the lane, you need to get off the road. There is no slap yourself are turn the radio on, and get off the road. Can you do that safely on most highways . The best way to go is prevention. Dont get out on the road sleep defined. Get adequate sleep. Plan your trip. Take adequate breaks, etc. This makes the point that even when we worked at night and are awake in the daytime, even when getting eight hours or trying to get eight hours of sleep, we are at a greater risk for lapses because we are awake at biological night and that puts pressure on the brain to go to sleep. Where program to sleep than. Risk. E at next slide. These functions are important to recall. You see three different graphs. Down is bad. It shows you how performance has deteriorated. See youre an airline highway m flying at night, you have a lower level of performance and deteriorate more rapidly. If you get adequate sleep and get treated for apnea, you can perform better. It is these functions that are so dangerous. You could rapidly deteriorate. Just be fully alert within minutes. People cannot understand how that is. Brain cannot do an immediate task when it hasnt had enough sleep. Hese tasks are dangerous a mortality rate nearly that of alcohol. Very serious injuries. You fall asleep. Youre no longer monitoring. You exit the roadway here and you dont engage in corrective actions to avoid hitting the pole or truck or tree. As a result, a high degree of Bodily Injury and mentality. Almost equivalent to high blood alcohol levels. Heres the good news. This is a study from walter reed. Restrict people to three hours a night in the laboratory to look at what happens. One group got seven hours. Another got 10 hours. The more you sleep ahead of time, the better you can tolerate the effects of any restriction that is on your sleep period when forced to get up in the middle of the night to check on a baby or go to work. You have to get your sleep. You have to treat sleep as a highpriority item every day to prevent these its relative debts oppose these risk for Drowsy Driving. Next slide. The brain is the organ of behavior. Withrain needs help adequate daily duration. No question about it. Thousands of studies support the statement. It is unequivocal. We know that you got to penetrate this message to the public. Whether professionally or just driving to pick up children or whatever. And sleep is inadequate, the brain has a slower response and lapses into micro sleep that result in the waxing and waning of attention slowed reaction times and pose a serious crest risk. Lapsespiness increases, get more frequent and longer in duration. There is loss of muscle tone. Contributes to a greater driving risk. Want to start having this comment it wont get any better unless you get off the road. Get some sleep. Take some kind of countermeasure. Next. , twoeepiness lapses seconds is enough to result in you being completely off the road out of the lane. It takes little to have a catastrophe. Such crashes involve Bodily Injury that is severe or fatality. There is little corrective action in a timely manner. Times evenreaction without frequent lapses of attention could cause problems in congested traffic. Even if you are not falling asleep, if your sleep be in the morning and you could have slow reaction times that will get you in trouble. Finally, people are unable to judge their ability even when lapsing repeatedly. They think they are oh k. It is essential they do not drive to maintain alertness. Plan your driving based on who has slept the most and is most fit. If you must drive overnight have someone else with you to watch you. Have someone watch you. Dont let everyone go to sleep. The driver will go to sleep. I think that is my final message. Thank you. Thank you. Aaanext speaker of the foundation for Traffic Safety. You. Ank i have been asked to talk about drowsyvalence of arriving on the road and in traffic crashes. In this presentation, i will be talking about recent research into the prevalence in drowsy drivers on the road both in terms of drivers falling asleep while driving as well as drivers who are highly fatigue did not asleep. Ill also talk about studies of actual Motor Vehicle crashes that estimates the number and proportion of crashes involving fatigue and drowsiness. Next slide. It National Surveys that have been done by the national highway Traffic Safety , traffication, the cdc safety, the motoring public has been asked whether they have fallen asleep or nodded off while driving. Of five americans report having fallen asleep while driving at some point in their life. Consistently across any study that has look at this, about 11 report having done so within the approximately 4 of american drivers report having fallen asleep at the wheel within the past 30 days. If these statistics are likely to be underreported. Studies have shown that a person has to be asleep on average 24 realize theye they were just asleep. Underestimatesy of the frequencies which people fall asleep at the wheel. In addition, the Aaa Foundation in a survey we do a driving ,ehaviors and drivers attitudes in the past 30 days, how often have even when you retired had a hard time keeping your eyes open . Of americanquarter drivers consistently reported having done that at least once in the past month. 2 report having done that very often regularly. Next slide. In terms of the pole of ofwsiness toll drowsiness, 2. 4 of fatal 2 injury crashes. Statistics that these are based on were brought with a number of limitations that result in their likely being substantial underestimates of the scope of the problem. Fatigulizer. A driver who is alert and awake and unharmed and able to talk about what happened to me be willing to admit to that police that they were drowsy. Again, they may not realize or remember that they were asleep. One has to be out for 24 minutes he for the are likely to realize they were sleeping. In the case of more severe crashes and crashes resulting in fatalities. The driver may be unconscious or deceased. It is difficult for the police to ascertain what happened. Another more subtle and more insidious limitation of the data is that in many states, the forms that Police Officers used to indicate what happened in a crash contains a simple series of checkboxes to indicate whether the driver was perhaps drowsy, impaired by alcohol, angry, emotional, distracted, etc. The when officer would indicate a driver is drowsy is by checking the locks. Box. If the driver was an drowsy, they wouldnt check the drowsy box. Unfortunately this creates a problems in interpreting the data after the fact. The way that it would be indicated the driver was not it would behe way indicated that we dont know whether the driver was drowsy or same. Exactly the an empty box. Next slide. I will be talking about the studies that have looked at data todepth on estimate the proportion and the number that involves driver drowsiness. The first study i will talk about is the one that was alluded to. In that study, they looked at area. Es in the d. C. Metro with the researchers reviewing video that occurred looking at the signatures of drowsiness , eyelidsnoted drooping, researchers were able to estimate the level of jobs in is of drivers. In all moderate to severe driver housing us. This is a study for the bulk of the driving was done in circumstances that arent typically associated with frequent drowsiness. Study that took a different approach to the problem was the study by dr. Stutts and colleagues. Researchers gathered a sample of Police Reported crashes. Based on the data and other information and the Police Reports, they developed a statistical model to predict the likelihood that the driver was trouser drowsy. The researchers applied this model to data from fatal crashes that occurred nationwide in years 20012003. When they did so, the estimated as many as 50 of drivers in fatal crashes were drowsy. In the authors own words, they fell in a conservative estimate. Statisticsl suggested about 2 of fatal crashes involved a drowsy tribe or. They labeled it a conservative estimate. Another study the gives us more insight into the prevalence of drowsiness in crashes is the national Motor Vehicle causation survey some of the national highway Traffic Safety administration. This is a study where teams of crash investigators looked at the causes and can should. Idding factors of the sample it was severe enough that Emergency Services were dispatched to the scene. The study had a fairly indepth perception of driver fatigue. This involves not only Police Reports of Drowsy Driving, the interviews by the investigators with the drivers and their family and others about whether they were fatigued at the time of the crash, work schedule, medications, etc. Is aside from videobased evidence, probably some of the strongest ascertain it we have of Drowsy Driving in crashes. This study only looked at crashes that occurred between 6 00 a. M. At midnight. It did investigate crashes that occurred between midnight and 6 a. M. When as you might assume Drowsy Driving is significantly more prevalent. Next slide. Excluding the hours swing Drowsy Driving crashes are known to occur, researchers found 2 of drivers involved in these crashes were asleep at the time. Fatigued. Nal 5 were nearly a third of crashes were unable to assess whether the driver was fatigued or not. This was suggest as many as 3 of all crashes involved a driver who was asleep. This is only out of the 60 of crashes were researchers could ascertain that. Next slide please. The last study i will talk about mythe study that i did for employer, the Aaa Foundation. This was a study that used the national highway Traffic SafetyAdministrations National automotive sampling system. He sample crashes in which a Motor Vehicle is total way from the scene. 19992008. Data over 47,000 crashes involved over 80,000 vehicle drivers in total. On drivers attentiveness was assessed not just from Police Reports, but interviews. 2 of drivers were drowsy. 45 ofhers reported cases they were not able to assess whether the driver was drowsy or not. The distinction between the driver not in drowsy and the investigators not being able to make a determination is important. I was able to use a statistical method of multiple to estimate the proportion were investigators couldnt make that determination. Yous a method in which build a model using data that is related to the probability a driver will be rousing or the operability will be drowsy or the probability. Identify otherl cases in the data where drivers drowsiness is actually known that are the most similar to the cases you are looking at and make a random draw from the distribution of the data were drowsiness is known to estimate the drowsiness in cases where investigators were not able to assess. Next slide. That is a message the national highway Traffic Safety administration has used since 2001 to estimate the proportion of fatal crashes. In 45 of cases, driver drowsiness was unknown. I estimate that 4 of drivers in. Ll crashes were drowsy 7 of the crashes involved at least one drowsy driver. Among the more severe crashes those in which an occupant was hospitalized as a result of injuries sustained, i estimate as many as a percent of the drivers were drowsy. 8 of the drivers were drowsy. 12 of drivers involved in fatal crashes were drowsy. 17 of fatal crashes involved at least one drowsy driver. Based on the number of People Killed in crashes each year, that would imply over 5000 people each year are killed in crashes involving a drowsy driver. Next slide please. A couple of comments and observations on these studies collectively. Provide theudy can answer. There is reasonable convergence across multiple studies that the proportion of crashes involving a drowsy driver a much higher in the reflected official statistics. Althoughof trends are the studies with the best ascertainment are also based on some of the less representative samples of drivers in crashes, we see the study with the best ascertainment of drowsiness goes with indepth interviews, those with video data of crashes estimates the highest proportion involving drowsiness. Probably unrealistic to expect solid ascertainment or drowsiness in data that is collected by officers who arrived at the scene of the crash. On the data front, it is thertant to distinguish driver was not drowsy verses where they cant make a determination. From most data we have. Summarize, survey show as many as two out of five drivers report having fallen asleep while driving at some point in their lives. 11 of drivers admit doing that in the past year. The past doing that in month that is consistent across multiple studies by different organizations over the span of a decade. Official statistics estimate 12 of crashes involve rousing the began likely study with the best data and Research Methods consistently show a much higher prevalence of Drowsy Driving. On the low end. On the highend come as many as driving asng drowsy the cause or can should bidding factor. The data tends to suggest the prevalence is on the highend of that range. Thank you. Thank you. In your presentation, you are very clear that there are severe and safety consequences. Could tellng if you us in simple, general terms what is affect in combating fatigue. The primary countermeasure is adequate sleep. Healthy sleep. It was your other speakers talk about what healthy and unHealthy Sleep is. Occur not too far before the driving episode. Sleeping one night and two days later driving with inadequate sleep. Commonly used way of coping with drowsiness is caffeinated beverages. There is evidence that caffeine no promote alertness, but drug is a substitute for sleep. Sleep. Ot a chemical it is forcing areas of your alertto use to be more. Blocking some molecules that produce sleep in the brain. They cannot block all of it. Sleep ispressure for , caffeine cannot stop drowsiness. It also doesnt last a day. You take a couple copy, it depends on how many how much caffeine is in the coffee and what your sensitivity is. None of it will last in your bloodstream more than 34 hours at most. Then you are faced with the problem of what do you do now if you are still drowsy . Sleep. L have to it wont keep you going indefinitely. It is probably the most common way people attempt to cope with sleepiness when they have to drive. It is a limited countermeasure. Alas, the options are quite limited. What are the medical implications . Im also wondering if you could speak briefly on the nature of differences with respect to fatigue and sleep. And problems does a post to you as a researcher . There are differences in how rapidly people will become impaired. Everyone becomes impaired. Thansome people longer others. As had typically, we dont understand the basis for it. Those who take longer to get impaired are the minority of the population. Youre not even sure that there always it is so is the same. We dont understand what it is that makes them less of vulnerable. Once you are awake too long, everyone will become impaired. It, it you dont feel doesnt mean fewer not experiencing drowsiness or lapses. The only way to be safe and certain is get adequate sleep. You cited 2009 data. I am wondering if you had a chance to look at anything more recent and if so, can comment briefly on what it shows. The data from 2009 is the last data that has been cited in official publications by the national Traffic Safety commission. Based ontistics are Data Collected annually and presently are available through 2012. 1. 6 ost recent show that of drivers involved in fatal crashes in 2012 were believed to be drowsy or fatigued at the time of the crash. What would you say is the general trend . Is there a trend, and if so, what direction is it heading . In the official statistics there does not seem to be much of a general trend. Proportion ande the official statistics may have. Ecreased slightly however, i think that is such a vast underestimate, i would not ink to the data published those sources as evidence of a trend or a lack thereof. In the evidence, this is based on the sample of about 5000 crashes each year that were investigated in depth. There was not evidence of an increasing or decreasing trend in the proportion of crashes that involved drowsiness. I would note in recent years the with injurieshes and deaths nationwide has increased, and that is a good thing. Believe theret is any evidence based on the that thelable data problem is increasing or decreasing as a share of crashes. If we use the most conservative estimate of the proportions of crashes that involves drowsy drivers and apply that to 2012 5000 we would estimate people were killed in crashes that involved a drowsy driver. You have some evidence in your presentation of multiple amputation. That one used alcoholrelated driving. Im wondering if they can use that for fatigue related crashes , and what would your opinion be on that . I believe it could be done, but i would only do it with the data from a couple of the studies are referred to in my presentation. In both of those studies, researchers independent of the police make an independent determination of whether a driver was drowsy, and they distinguish between whether the driver was known to be attentive or drowsy or whether they could not make a determination. In the data published annually Traffic Safety administration, their reporting system and general estimate system, the data on driver only based on data from reports completed in the field by Police Officers, and in most cases i dont believe they distinction between whether a driver was known to be attentive or whether they couldnt tell whether the driver was drowsy or not. There is an indication in the data of whether there were no contributing factors apparent or whether the drivers condition at the time of the crash was unknown. However, the proportion at which they indicate the drivers condition was unknown was implausibly low, even among crashes in which one vehicle was involved. There was only one driver, and the driver was already deceased by the time the police arrived. Even in those crashes, they only report the drivers condition was unknown about one third of the time. Casese than 60 of the they report no contributing factors apparent. I am not sure how one could arrive at that determination when the only person involved in the crash was already deceased at the time of the investigation. Want to comment on the notion of prevalence changing. There is no question that rumble , mightor airbags, etc. Have made it safer or less likely to be lethal for someone who drives drowsy, but it is unclear there is evidence they have reduced Drowsy Driving. To not engage in the behavior to begin with. What they have done is try to alert people from catastrophic runoff from the road, but its not clear they have the evidence that has driving,evented drowsy and the risk factor is the impaired driver from drowsiness. If we dont have a concerted effort to teach children, adolescents are at great risk. Shift workers in the average person who pushes himself very hard and does not get adequate sleep, we do not make an effort to make sleep a priority in addition to what we can do with frozen vehicles to protect drivers. We are not dealing with the source here, which is insufficient sleep and operating a Motor Vehicle. I have just one question. Dr. , you spoke briefly about if a person is chronically or acutely sleep deprived, how much time does it take for a person to pay that sleep back, and if they have enough sleep, are they safe to perform after that . Thank you for the question. Not as easy as i would like it to be based on estimates. We have been studying this. It appears the old belief you can make it all up in one night is not supported by the evidence. Onlybelieves came about by allowing one night of sleep, and people look fine the next day, so they let them go home. When you keep them in the laboratory and study how safe they are, you realize in fact it takes more nights of steady sleep to get you back. It would be vastly better to not get sleep deprived than to itempt to recover from it. Realize that is a harsh message to the public who has gotten used to sleep deprivation, but the fact is prevention is the best way to go. Recovery takes longer, and it can take longer if you have other conditions causing the sleepiness or contributing to it. Medical conditions, etc. Thank you. With regards to the data, we talk about people being more drowsy in general, and you talk about people reporting they have driven while drowsy. Have surveys looked at the evidence as far as the risks of driving drowsy, and if so, do people make that link between their Drowsy Driving and the risks . It doesnt appear that they do. Looked at surveys, and in those surveys we asked people how much of a threat they perceive other drivers driving while they are sleepy are to their own personal safety as well as whether they consider it acceptable for a driver to drive when they are so tired they are having a hard time keeping their eyes open. Consistently a large majority of it ae report they consider serious threat to their safety that other drowsy drivers are out there, and they almost unanimously consider it completely unacceptable for a driver to drive while they are so tired. Over a quarter of them admitted to driving when they could not keep their eyes open. A large number of people report doing that fairly often or regularly. Thank you. Im going to ask you the hardest question first. In your understanding of all the data, give me the numbers. Pick whatever your you want, and dont say the data suggests. If we are trying to characterize the scope of the problem, how many lives are lost, how many injuries . Based on the most what iative estimates of consider credible as well as the most recent statistics on the number of injuries and deaths in the United States annually, i think 400,000 Police Related crashes involve Drowsy Driving as a contributing factor. Estimate i would approximately 115,000 crashes involve ainjuries drowsy driver. Thank you very much for being so direct about that. The caveats acknowledged. You identified a variety of different shortcomings in all the methodological approaches