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PAPERS: Jennie Connor, Robyn Norton, Shanthi Ameratunga, Elizabeth Robinson, Ian Civil, Roger Dunn, John Bailey, and Rod Jackson Driver sleepiness and risk of serious injury to car occupants: population based case control study BMJ 2002; 324: 1125 [Abstract] [Full text]

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Rapid Responses published:

Driving after a " night on call"

Avanish P Saklani, Shafi M, Nagabhushan J, Delicata RJ   (14 May 2002)

Failure of basic Cognitive Mechanisms associated with sleepiness

Michael J. Hogan, Professor Ian Robertson, Trinity College, Dublin.   (15 May 2002)

A way to cope which works

Leopold Reinecke   (10 June 2002)

Driving after a " night on call" 14 May 2002
Avanish P Saklani, Senior SHO surgery Nevill Hall Hospital, Brecon Road, Abergavenny, NP7 7EG, Shafi M, Nagabhushan J, Delicata RJ Send response to journal: Re: Driving after a " night on call"	sir, A survey regarding driving after a " night on call" was carried out amongst doctors in a District General Hospital . 55 of 69 doctors responded( 76%).36 of these 55 (64%) doctors drove home after a night on call. 24 of 36 doctors drove more than 30 miles after a "night on call". 31% ( 11/36) doctors admitted that they came close to falling asleep on the wheel. However statistical analysis revealed that the chances of falling asleep while driving was irrespective of the distance travelled. we safegaurd the interest of the patients by giving the doctors a day off, however allowing such doctors to drive home may pose a public hazard. No wonder,a recent report by one insurance company cited doctors to make the highest motoring insurance claims 1. Reference: churchill Insurance. Doctors make the most motoring claims. Daily Express. 27th Feb 2002; 961,754:46
Failure of basic Cognitive Mechanisms associated with sleepiness 15 May 2002
Michael J. Hogan, Lecturer in Psychology, NUI, Galway, Ireland Ireland, Professor Ian Robertson, Trinity College, Dublin. Send response to journal: Re: Failure of basic Cognitive Mechanisms associated with sleepiness	Cognitive psychologists, Industrial Psychologists and Human Factors specialists have long been interested in the role of arousal on performance. Arousal centers in the midbrain regions operate to maintain activation in regions of the right prefrontal cortex that are critical for sustained attention (see Robertson & Murre, 1999 for a review). Sustained attention operates at a very basic level to support active mental reprenentations, inhibit distractors, and maintain goals and intentions. In the absence of sustained input from these midbrain regions, the frontal lobes are forced to increase their monitoring of arousal, sending feedback signals to the midbrain to re-activate the system. This increased frontal monitoring is like an increased workload. Clearly, acute sleepiness acts to reduce arousal (see e.g., Stadling et al., 2000), distupting sustained attention networks, increasing the liklihood of distractor processing and a breakdown of goal monitoring. Furthermore, disruption of this delicate cortical balance results in a failure to inhibit dominant responses that may be inappropriate in a specific situation (Manly et al., 1999). Conor and colleagues have clearly demonstrated the devastating consequences of acute sleepiness as a risk factor for accidents. The changing nature of the working world means that longer working days with longer commute times are commonplace. Many people now begin their commute earlier in the morning and do not finish their working day until late into the evening. These behaviour patterns, along with the consequent reduction in daylight exposure and in the available time for physical activity may disrupt sleep patterns and circadian arousal rhythms. Is there any solution to these problems? One solution comes from an awareness that part of the problem lies in the impact of sleepiness on basic cognitive mechanisms outlined above. There are two types of alerting mechanisms that operate to increase arousal and sustain attention; Endogenous and Exogenous. Endogenous arousal operates to sustained attention either through feedforward and feedback loops operating between midbrain and right pre-frontal areas, while exogenous arousal derives from an environmental source. Robertson et al. (1998) have clearly demonstrated that when endogenous sources of sustained attention are disrupted, exogenous alerting can significantly improve performance. It may be possible to apply neuroscience findings and principles of cognitive rehabilitation to ergonomic design of vehicles. Exogenous altering to drivers when objective indices of arousal reach sub- optimal levels is a possibility. Thus, while it is important for drivers to monitor subjective awareness of sleepiness, simple biofeedback devices (e.g., in the form of wristwatch devices that measures pulse, blood pressure, galvanic skin response) could be integrated into the design of modern vehicles and offered as additional safety features. References: Robertson IH, Murre JMJ Rehabilitation of brain damage: Brain plasticity and principles of guided recovery PSYCHOL BULL 125 (5): 544-575 SEP 1999 Stradling JR, Barbour C, Glennon J, et al. Prevalence of sleepiness and its relation to autonomic evidence of arousals and increased inspiratory effort in a community based population of men and women J SLEEP RES 9 (4): 381-388 DEC 2000 Manly T, Robertson IH, Galloway M, et al. The absent mind: further investigations of sustained attention to response NEUROPSYCHOLOGIA 37 (6): 661-670 JUN 1999 Robertson IH, Mattingley JB, Rorden C, et al. Phasic alerting of neglect patients overcomes their spatial deficit in visual awareness NATURE 395 (6698): 169-172 SEP 10 1998
A way to cope which works 10 June 2002
Leopold Reinecke, Radiation oncologist Rand Clinic Send response to journal: Re: A way to cope which works	I drive from Johannesburg a distance 350 kilometers one way to do a clinic near the Kruger National Park 3 weeks out of every 4...and return the next day on one of the busiest routes in South Africa - where the road is only partially a double carriage road. The South African Government has lifted the ban on the very large trucks - which used to be a feature of the "apartheid" government - and so the roads are full of these behemoths...in addition to the traffic which is oncoming from Johannesburg to the Eastern Transvaal on the Friday afternoon and evening - the weekend holiday trippers....Hence, a high level of stress and danger accompanies this trip. Initially I could not cope without a co-driver. When the patient load lessened - without the need for the co-driver who also helped me with the administration of chemotherapy - I needed to change my schedule in order to prevent the diabolic "hypnotizing" effect of the road. Now, I sleep for at least an hour directly before driving (be it in the morning or late afternoon), and if I do that I find that the dreaded "sleepiness" which used to afflict me - seems to not be a problem. Perhaps there is some neurophysiological reason for that - I cannot tell - But it works.