Death before dawn

by Swami Subramaniam

From The Hindu Oct 7, 2018 (https://www.thehindu.com/opinion/open-page/death-before-dawn/article25144489.ece)

Dozing off at the wheel is causing a growing number of casualties on Indian roads

Recently, a young family travelling on a Kerala road met with a road accident. A gruesome tragedy. But this accident did not draw attention because it was horrific. It drew attention because of the people involved – the family of violinist Balabhaskar who plays the violin virtually as an extension of his arms. If not for the involvement of a celebrity the news would have barely drawn any comment. Early morning road accidents caused by sleepy drivers are so common today that hardly a day goes by without a report in the newspapers of an early morning traffic accident.

Worldwide, accidents caused by sleepy drivers have reached epidemic proportions. Of the 37,461 fatalities from motor vehicle accidents in the United States in 2016, some 20% were attributed to sleep-deprived drivers. In the absence of accurate official estimates, if we were to take a similar percentage for India there might have been 30,000 deaths on Indian roads due to sleepy drivers in 2016 alone. (This number is likely to be an underestimate since road accident deaths are under-reported in India.)

Several factors underlie the epidemic-scale rise in the number of traffic accidents. There are more vehicles on the road. Newly constructed highways create opportunities for unregulated increases in the speed of traffic. There is also a temptation to speed, given the powerful engines fitted in today’s vehicles. Capping this, you have sleepy drivers coasting along on automatic transmission and cruise control on often unlit stretches of smooth and straight highways with no seeming distractions – a recipe for drowsy drivers to nod off for the critical few seconds and lose control. Fatality rates per kilometre are the highest on our national highways, at 0.67 deaths per kilometre a year.

Traffic accidents caused by sleepy drivers quite often take place in the early morning hours, between 2 a.m. and 6 a.m. There is a physiological reason why we are the drowsiest at this time. The body’s natural circadian rhythm induces a nadir of alertness around 3 to 4 a.m. If you have been driving all night without sleep, then you are already as impaired as someone who is drunk. If you add to this the circadian nadir for alertness that kicks in around 3 a.m. you have a double whammy that can force even the most resolute driver to nod off at the wheel.

Sleepy drivers are indeed the equivalent of drunk drivers. Studies have shown that after a mere 17-19 hours of being awake, reaction time and coordination are impaired to levels comparable to someone who is legally drunk. While we have a campaign to stop drunk driving, there is not enough popular attention given to the fact that driving while drowsy is probably a more significant factor in road accidents (just by accounting for the fact that there is a higher percentage of drowsy drivers compared to drunk drivers). Sleep deprivation due to sleep disorders such as insomnia and obstructive sleep apnoea are also significant factors in the increasing occurrence of driving while sleepy. Unlike drunk driving, there is not (yet) a simple and objective test to measure how sleepy someone may be. It is left to the discretion of the driver to self-assess how sleepy he or she is and decide whether to stop and take some rest.

Taxi drivers, who are paid hourly, do not have the luxury of stopping for rest while their passengers sleep. Long and unpredictable work-hours dictated by the whims of passengers, poor nutrition while on the road, and a sedentary work lifestyle contribute to generally poor health and obesity, both of which are linked to sleep disturbances. It should, therefore, not come as a surprise that even the most experienced among drivers will helplessly nod off at the wheel every now and then, resulting in an extremely high rate of traffic accidents for taxi drivers.

Accidents caused by sleepy drivers are preventable. The most straightforward and best preventive measure is to refrain from driving when sleepy. At all costs, except in an emergency, driving through the night and into the early morning hours should be avoided. For those who do not have the choice, naps of about 20 minutes combined with caffeine can improve alertness. Such a nap and caffeine break taken every two-three hours can help maintain a desirable level of alertness.

At a policy level, the government needs to pay attention to this hidden epidemic. Similar to Section 185 of the Motor Vehicles Act that covers driving under the influence of alcohol or drugs, there is a need for legislation that, at the minimum, mandates sleep-breaks for drivers of modes of public transport, including taxis. Infrastructure and messaging/signage on public highways should promote the concept of taking periodic nap-breaks while driving.

However, the only way to comprehensively mitigate this problem is to create increased awareness of the risks of driving while sleepy.

Poor sleep also has consequences for health that goes beyond traffic accidents, and for a long time we have ignored the hazards of poor quality sleep. It is time the government orchestrated the delivery of a public health message emphasising the importance of good sleep. Since such a health intervention will not cost anything, it will provide tremendous bang for the healthcare buck.

(Dr. Swaminathan Subramaniam is a physician, pharmacologist, neuroscientist, corporate R&D executive and most recently an entrepreneur. His book, Mastering Sleep (Pan Macmillan) is to be launched in January 2019. Email: swami2m@gmail.com)

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