In recent years, organizations like the National Sleep Foundation have been working hard to raise awareness about the dangers of many sleep related topics.  One area of focus has been to increase the public’s understanding about the dangers of drowsy driving through it’s website and the Stay Alert, Arrive Alive campaign.  Another key area has been to increase awareness about Sleep Apnea, one of the most common sleep disorders that can have very serious health consequences but that often remains undiagnosed.  Although these two problems are both related to sleep, they have, before now, had little cross-over in terms of awareness and education.

Last month, the American Thoracic Society published new guidelines related to sleep apnea and driving in the American Journal of Respiratory and Critical Care Medicine.  The updated guidelines seek to provide medical practitioners with a more comprehensive way of assessing and managing the dangers of drowsy driving in their patients with sleep apnea.

Drowsy driving statistics are scary.  According to the National Sleep Foundation, over 100,000 accidents and more than 1500 deaths each year result from drowsy driving.  While drowsy driving can be caused by anything that keeps someone from getting enough sleep, people with sleep apnea may be at a higher risk because they routinely do not get enough sleep and as many have not been diagnosed, they may not even realize how often their sleep is disrupted.  This is why raising awareness about both problems and establishing the kind of link between the two that is provided by these guidelines is so important.

The new guidelines include the following recommendations:

  • Any patient who is suspected of having sleep apnea, being evaluated for sleep apnea, or who has been diagnosed with sleep apnea should be questioned about daytime sleepiness and how their sleepiness has or is impacting their ability to drive.
  • Doctors should specifically ask about recent accidents and near misses that involved sleepiness, fatigue, or lack of attention.
  • Anyone in the categories above should be considered a high-risk driver and the dangers of drowsy driving should be outlined for them.
  • All patients in these groups should be advised to take extra caution when driving until a diagnosis is made and a treatment program is in place that will alleviate any excessive daytime sleepiness.
  • In addition, the medical professional must consider the patients past ability and willingness to participate in treatment as part of the overall drowsy driving risk assessment.  Patients who struggle to adhere to sleep apnea management programs may have a higher risk of being involved in a drowsy driving accident.
  • Because of the risk posed by drowsy driving, the guidelines recommend that polysomnography should be done and treatment should be initiated as quickly as possible to minimize the driving risk in any patient who is very likely to have sleep apnea who has also been designated a high risk driver.
  • However, the guidelines specifically state that empiric continuous positive airway (CPAP) treatment and the use of stimulant medications should not be used unless medically warranted, i.e. it should not be used just to lower driving risk.