Officialed attributed to fatigue underestimated. There is no roadway test. Fatiguedness. We do not have a fatiguealyzer as we do a breathalyzer. State reporting practices are inconsistent and theres little or no Police Training in identifying drowsiness as a crash factor. Self reporting is unreliable. Do know. We any resulting loss of life is tragic, needless and preventible. A drowsy driver can be a deadly driver. Even one night losing two hours of sleep is sufficient to significantly impair our a little bit attention, reaction time, Decision Making can all be significantly reduced by 20 to 50 , and driving in this condition, that could mean not brake lights in front of us or not seeing the traffic light turning red. Fatigue alone can be deadly. It also multiplies the adverse effects of other forms of pairment that lead to crashes such as drugs, alcohol and distraction. Every other form of impairment may be exacerbated when the basic requirement for sleep is disrupted. Weve identified sleep as contributory in crashes across all safety modes. The agency has issued more than 200 safety recommendations in such diverse areas as research, vehicle technologies, the treatment of sleep disorders and hours of scheduling policies for commercial and bus drivers. But 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 effects. 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 morning. He a nurse at a local hospital was driving home after more than 18 duty. On she departed her lane, crossed median and entered a nosh 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 nurse was transported to a hospital where she was treated for her injuries. She had fallen asleep. Shifts nineed night years and was familiar with the challenges of her schedule. And yet her inverted work schedule, along her extended time since waking, and in this hours,early 16 contributed to her falling asleep at the wheel. Forum offers us an opportunity to focus on the dangers of Drowsy Driving and countermeasures that could mitigate the dangers of fatigue. We will identify what we know we dont, only the most on Drowsy Driving can lead to the most effective countermeasures. We will examine medical continues that can lead to fatigue. We will hear about the challenges faced by young, novice drivers. Discuss irregular Work Schedules and how the same 24 7e we depend on for our modern lifestyle and lifesaving services are vulnerable to taking to the road in a fatigued state. Will hear of a variety of strategies to reduce the risks driving crashes and perhaps just as importantly, we will provide a public setting to of drowsye dangers driving. For wake and alert driving to norm, the expected awareness and education must prominent, preventive role. This forum is for all of us. Doctors, lawses, enforcement officers and security guards, driving home after their night shift. Workerr the utility driving into the night to fix the power lines after a storm. Student, startled startled ato alertness by the blare of home as he drives home from an exam. It is for any of us who have driven with too little sleep. Happen literally in the blink of an eye. It is our hope that this forum a national toward the safetybout issues involving Drowsy Driving. Dr. Janet price who organized this forum. Thank you. For safety purposes, please note the nearest emergency exit. Youcan use the rear doors came through. To enter the conference centers, emergency doors on either side of the stage up front. So,ouve not already done please silence your electronic devices. Todays forum has been designed get to the heart of several topics relevant to Drowsy Driving. We will begin with an destruction introduction and theussion of the scope of problem. We will have panels discussing workplace factors, concerns of novice drivers and a group of advocatesway safety will join us during the panel. Have panels we will discussions Health Issues and roadway factors. The final panel of the day will Counter Measures. Each panel will open with panelists. Y our staff and panelist bios, as agenda, are available on the forum website, ntsb. Gov drowsydriving. Attendees or others who wish to forit written comments inclusion in the forums archived materials may do so until november 7. Submissions to directly address topic areasof the and should be submitted an attachedly as document. For those of you joining us in our conference center, there are of lunch options in the plaza. Up one floorlators and walk straight ahead. Agenda are the available in the lobby and on the forum website. Your cooperation in helping us keep on schedule and breaks. S we will have panel photos in the morning, for the morning panels morning break, and for the afternoon panels during the break. On ill 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. Light indicates the microphone is on. Microphoneg your close and press the button to turn it off when you are done speaking. The first panel covers an introduction and the scope of the problem. Our panelists is the director of unit for experimental psychiatry at the university of pennsylvanias pearlman school medicine, and brian teft, at the aaasociate safety. Or traffic good morning. Thank you for inviting me to speak at this important meeting. Im going to begin by setting the stage for the biological that make drowsiness it so terrifically dangerous when we drive. Next slide, please. Remind thoseng to listening and looking at these slides are that, as near as we now, all animals need to sleep. And humans are no exception. Sleep is an essential part of our health and survival. Have to do it on a daily basis and we have to achieve sleepy sleep and we need that is of adequate duration to ensure we dont have andntrolled drowsiness sleepiness during the daytime. Next slide, please. Remindere is just a that when we dont receive fallate sleep, we tend to asleep very rapidly. Going down on the left shows that the longer were awake, the more rapidly we will and the more rapidly we will transition into a stage of sleep where we cannot recover even if were alerted. Remindsh on the right us that the depth and intensity an inherrenp is part of the sleep system attempting to recover the brain terrific need for sleep and to give it the sleep that is essential. Speakers will talk about what happens to drowsiness and waking functions when you depth ofeive that sleep. Next slide. Why dont people obtain enough sleep . We now know in our modern lifestyle is that substantial portions of the population, shown in the yellow bars on the 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 are sleeping less than seven hours, we get an excessiven sleepiness, accidentrelated sleepiness, as well as obesity, diabetes, cardiovascular problems. So there are significant safety consequences to chronically undersleeping, and segments oflarge the population undersleeping. Us graph on right reminds that a major part of why people sleep ist adequate work and travel. Work,pend extra time at 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 the time that one should spend sleeping and they force us compress our sleep down into a shorter and shorter period work week, and then people make a great effort to try to recover on the weekend but that recovery is usually inadequate. Two days of extra sleep usually not reverse repeated cycles of five days of inadequate sleep. So chronic sleep restriction is an inherent part of modern jobs for many people and that is where one of the sources of problems are. Youll hear other speakers talk about sleep disorders, et cetera. Slide, please. We know this is occurring in the brain. Many people think its all right because its a willful event, that somehow it got anything to do with biology and you can will yourself to overcome it and people get away with it without crashing so they that it doesnt matter if youre tired, its ok to drive, youll be safe, youll because you have a good intention. But intentions, as we know, wont really prevent this biology from turning on. This is just a brain scan showing that major areas of the the frontal part of the brain, the associative the brain and the upper back part of the brain, the areral core of the brain, all showing changes in activity metabolically in the brain that consistent with the brain falling asleep while we try to awake and drive so theres a terrific change going to that we cannot easily control and yourself in the face or turning the radio up or chewing will not prevent this from occurring and if it does prevent it, its no more than a second or two. It wont actually have a lasting benefit. It is not the same as sleep. Sleep. In needs obviously you cant sleep and drive at the same time. Please. De, would you just click on this video. Hallmark features of sleep falling asleep lids wills that the eye close. We all know this. Eyelids muscles of the losing tone due to the pressure for sleep. In other words, sleepiness and drowsiness when were driving our brain blink on and off and not Pay Attention but it also causes muscle relaxation, including the muscles of the eyelids. So the muscles will come down. Truck simulator, not a real driving experience. This virginia in tech film that shes falling and the head dips back and eyelids close because of loss of muscle tone. Eyelids open, the eyeballs roll back and reorient in the head. Happen in a second. You can see she almost ran off the road in the simulator. Know drowsy we driving is. So many people have done it in ir lives that we dent have dont have any trouble recognizing thats whats occurring but we dont appreciate how staggeringly dangerous this is. Example in the laboratory. All we need to do is click on this. In yellow, this young lady is working on a beenance task but shes sleep deprived, and on the right side, shes working on the Vigilance Task and isnt sleep deprived. Over time, the graph on the left shows initially she walks ok but we sleep deprive her, halfway along the graph, up go in attention and up go the increase in eyelids drooping. Were measuring these by analysis. On the righthand side, she may be bored but she can work for falling end without asleep. So people who think that Drowsy Drivings due to just being drive or badu scenery are wrong. Its due to you not sleeping enough. Youre is driving when not interested in what youre looking at, but youre able to awake. Sleepiness and drowsiness is the pressure of the brain trying to whileyou to go to sleep youre doing a Vigilance Task called driving. Testsw that among all the looked at on the effects of sleep loss, attention, in particular, and alertness, are number one effects of sleep loss. By far they occur more profoundlyand more than effects on memory and reasoning and many other areas. Please. De, and thats best illustrated by complicated slide. Heart beats. Se these are reaction times of pressing ay alert button. Each quick beat is a Fast Reaction time. You can see theres nothing wrong. Displaying them as heart beats to give you the point that go brain is steady as you here. Click on the top one and shut it off and click on the bottom one. Heres the drowsy driver equivalent. They start off driving. Theyre just fine. But as they go along, they start to the have long lapses and minute. Ear that in a theres one. Thats your eyelids down. Youre not responding. Youre not responding. Youre not monitoring. Now youre back again. Now youre going to go again. This is the hallmark feature of sleep loss. On that and look on the right. We know where in the brain that seeut on the right you can the instability of these response times in the sleepy driver, whereas the alert driver above on the right is steady as you go. And this is that fighting peopleess that experience driving down the road. By the time youre doing that, you are at grave risk. Really shouldnt be behind the wheel. You should pull off. You should get some sleep, get rest. You should have slept adequately heare you drive and youll others say that. But this is the grave risk of driving. Just because you get away with a mile or two doesnt mean you wont have an thentrolled sleep attack in next minute or half hour and theyll come more and more repeated more and more and more severe. This illustrates, the lower you have hadws plenty of sleep and you dont have the lapses. And movee sleep away you to six hours or four hours sleep a night, you see many more lapses and theyre getting longer. Completely unpredictable. If you could predict the moment youre going to fall asleep, you ok, ill do something to correct that. But you cannot do that. Against yours this will at a time when you suddenly justze, oh, my god, i was awake and i realize i just slept this last period of time. Operate a Motor Vehicle when that happens. Youre begging for a crash. Next slide. In fact, it takes no morning a twosecond lapse of attention at 60 miles an hour with a drift,gree angle of thats just enough loss of steering control. Just let your muscles relax on closing yourwheel, eyes for two seconds, you can be completely out of lane in two seconds, off and the road in four seconds. Takesn easily see how it very little of this lapse tendency, these microsleeps, to in grave danger. Not to mention if youre in close traffic trying to stop in time. Of my messages will be, this isnt just highway phenomenon. Drowsy driving, slowed reaction times, are occurring in people adequate sleep in the city. Theyre occurring in density traffic. By the federale government have shown that within the washington, d. C. Instrument cars, they find drowsiness occurring all over the metropolitan area we know these are highrisk events occurring even in crowded traffic. Next slide. This is just an illustration of the dynamics of this drowsiness what you see in the upper graph is that you dont have any from drowsiness when youre getting normal sleep at night, on the left. Without sleep,ht those lapses increase. Secondwent actually a night without sleep, they go even higher. The same thing happens if youre getting, say, four or five hours sleep a night. They get progressively worse day after day. You can see the segment of the flight midnight 8 00 a. M. To 9 00 a. M. , and you the high rate of Motor Vehicle crashes related to falling asleep at that time. You can see they ramp up at that time. 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 just shows the dynamic in northstudy done carolina of people falling aleep and youre at particularly high danger risk through the night and especially after thening, often sun is up. People think theyre safe because the sun is up. You. Wont protect light is not powerful enough to override the pressure for sleep at night. Awake and shift workers have a very high rate of these crashes but by no means the only group in society that have these crashes. Males do at a high rate. The elderly can have them in the middle of the afternoon which is they will fall asleep crashing. Next slide, please. Done in the laboratory shown in the left and right. Left shows the less sleep you get every night, the more lapsing you have every day. Going up. On the right are how people felt about their sleepiness. See, clicku should on that, please. What you should see in the middle graph here is at the istom graph, is performance lapsing, is getting worse linearly across time, but our sense of how were doing is not changing. Means you cannot tell how dangerous you are driving. You need to Pay Attention to your behavior. Are actually suddenly discovering your heads falling closingur eyes are uncontrollably, you just almost drifted out of lane, you need to road. F the slap isnt a, you need to yourself or turn the radio on, to get off the road. One challenge is how to do that but then the highway best way to go is prevention. Dont get on the road sleep deprived. Get adequate sleep before you get on the road and plan your trip effectively to make sure adequate breaks, et cetera. This slide makes the point that and when we work at night are awake in the daytime, even when were trying to sleep eight and staythe daytime awake at night, were at a greater risk for lapses of because were awake at biological night and that puts enormous pressure on the brain go to sleep. Were programmed to sleep then. So theres no safety on what time of day you work or sleep. At risk whenever you dont get adequate sleep and whenever youre awake at night. Next slide, please. And the vigilance functions are important to recall. Three graphs show up is good performance, down is bad. The lines show you time on task. Over 10 minutes, how your performance is deteriorating. What you can can see is whether sleep deprived in red on the left or you have sleep apnea untreated in the middle or the red in the middle, youre an pilot flying at light, you have a lower level of performance and deteriorate more rapidly. Adequate sleep, if youre treated for apnea, if you fly in the daytime, you can perform better. Decrementigilant functions that are so dangerous. On task wheretime you are rapidly declining. People often cant understand that is. Its the brain cannot do a Vigilance Task when it hasnt had adequate sleep. That to younstrate immediately. Are very dangerous with a lethality rate nearly veryof alcohol with serious injuries because the driver doesnt correct action. You fall asleep, you exit the roadway, you dont engage in a to avoid thetion pole or hitting the truck or and or rolling the vehicle as a result they have a high degree of Bodily Injury or lethality, almost that of high levels of alcohol. The good news. Study from qualitier qualitier reed. One group got seven hours time bed at night, one group got 10 hours. The more you sleep ahead of you tolerateter the effects of any restriction on your sleep period being the middleet up in of the night to care for a baby or to get up early to drive to work. Your sleep ist the bottom line and you have to treat sleep as a high priority your life every day