Articles Tagged ‘tiredness - Brake the road safety charity’

Brake's parliamentary reception on sleep apnoea

Julie Townsend speech – parliamentary reception on sleep apnoea, 20 July 2010

I’d like to start by telling you the story of Toby Tweddell.

Toby was driving to work in Liverpool on the 8th August, four years ago in 2006. It was about 8.30 in the morning when he pulled up on the M62 behind a queue of traffic.

Out of nowhere, a large truck hit Toby’s car from behind, shunting him forward and into the pick up truck in front. Toby’s car was so badly crushed that it took emergency services an hour to cut him free from the wreckage.

He was rushed to hospital, but after five hours in the operating theatre, he was pronounced dead.

He was just 25.

It was found that the truck driver, 54 year old Colin Wrighton, had fallen asleep at the wheel. He was later diagnosed with the common sleep disorder obstructive sleep apnoea – as this was undiagnosed at the time of the death a charge of causing death by dangerous driving was dropped, and a year later the coroner returned a verdict of accidental death.

Just two weeks before the crash that killed Toby, Colin Wrighton had been to his doctor for the second time to complain about excessive tiredness. The doctor had failed to spot the signs of sleep apnoea, so the condition went untreated.

In the case of Toby Tweddell, there is an obvious link between sleep apnoea and Toby’s tragic death. In many other cases that link is not so clear. We simply don’t know exactly how many needless deaths and injuries are caused each year as a result of sleep apnoea.

However, research suggests that this is a huge problem on our roads, and one that must be addressed without delay.

An estimated 265 deaths are caused each year by tired drivers – that’s five every week. But we suspect this is just the tip of the iceberg. Recent independent research indicates that a horrifying one in six drivers have fallen asleep at the wheel.

It’s also estimated that as many as 700,000 people in the UK suffer from sleep apnoea, which disrupts sleep and causes acute tiredness. Sleep apnoea is treatable. Yet many, perhaps most people, seem to be ignorant of what it is, and how to spot the symptoms.

Those most likely to suffer from sleep apnoea are middle aged men who are overweight – a profile that a large proportion of truck drivers fit in to. It’s thought that up to one in six truck drivers could be suffering from severe sleep apnoea and requiring immediate treatment – that’s about 80,000 truck drivers who are ticking timebombs, with the potential to cause catastrophe on our roads. In simulated driving tests, sleep apnoea sufferers score worse in terms of hazard awareness and reaction times than people who are drunk.

Brake is urging policy makers to take urgent action, to prevent these ticking timebombs going off. To help those thousands of people suffering from sleep apnoea to understand their condition, to get treated, and to put an end to it. To stop more people like Toby having their lives needlessly cut short, causing unimaginable grief and trauma to family and friends.

We want to see Government investment in awareness campaigns, especially aimed at professional drivers, so they understand the tell-tale signs of sleep apnoea. We want a requirement for the National Institute for Clinical Excellence to publish clinical guidelines on the management of sleep apnoea and similar disorders. And we want drivers to be screened before they get their licence, and regular medical screening of professional drivers.

These measures require investment, but it seems obvious that sleep apnoea must be a huge economic drain, affecting the productivity of thousands of workers, as well as leading to costly and tragic deaths and injuries on our roads.

We are making these calls to action in memory of Toby Tweddell – and we hope that we have your support in making them happen.  

To the parliamentarians in the room, we’re urging you to sign an EDM calling for action on sleep apnoea (we’re collecting signatures at this reception) and we’re also urging you to push this issue within parliament – we need to see further debates to maintain pressure on the Government to act. And please do consider how you can raise awareness in your constituency as well, such as by working directly with local employers.

To the supportive organisations attending this event, please do come and talk to us about how you can help. It’s vital that we work together to secure decisive action on this important issue. Thank you.

Driver advice: fatigue

Sharpthumb

Drivers can pledge to – take regular breaks and never drive tired.

Everyone can pledge to – look out for friends and loved ones by ensuring they only drive if they're fit for it.

WakeUp-TirednessKillsDriving tired is lethal. Research found that a quarter of all crashes on British roads involving death or serious injury were sleep-related [1]. Nodding off at the wheel, even for a few seconds, can result in catastrophic crashes, because you don’t brake before impact. And you don’t have to actually fall asleep to put yourself and others at risk: tiredness increases reaction times and affects your ability to pay attention. But there are some simple steps all drivers can take to avoid fatigue.

Plan ahead

tired1Consider whether you need to drive. Public transport is often a better option for long journeys, and is likely to mean you arrive feeling more rested and refreshed than if you’ve been driving for hours – see our advice page and factsheets on sustainable travel.

If you have to drive, plan ahead so you are well-rested beforehand and never embark on a journey when you’re already feeling tired. If you know you have to drive the next day, especially a longer journey, make sure you get a good night’s sleep. The less sleep you get, the less chance you have of staying awake. When planning a long journey, allow time for regular breaks – at least 15 minutes at least every two hours – although you need to stop as soon as possible if you start to feel tired (see below).

If you’re driving somewhere relatively far away and coming back again, book an overnight stay in the middle if you can and ensure you’re well rested before heading home.

Avoid driving at times of day when you’re most susceptible to tiredness, like at night, in the evening after a long day, or in the mid-afternoon, when most people experience a ‘dip’.

If you drive for work

Insist on having time in your schedule for regular break periods to rest – 15 minutes every two hours is safest – and look at whether there are alternatives to driving, such as video conferencing or taking public transport to appointments.

If you drive a truck or bus, be aware of legislation covering the hours you are allowed to drive, and make sure you take the required rest breaks. Even if you fall behind schedule or get caught in traffic, always take your breaks. Safety comes before deadlines. Your employer should have a policy on driver tiredness that complies with health and safety laws and makes clear that safety is the priority. When you’re driving on company time, you and your employer have responsibility for making sure you’re not endangering yourself and others.

Brake advises companies on preventing fatigue and other issues to do with at-work road safety. Find out more at www.brakepro.org.    

If you feel tired

If you’re feeling tired at the wheel, you need to listen to the warning signs straight away and pull over somewhere safe as soon as you possibly can. Do not fool yourself that you can fight off sleep – it ensues much faster than you might think. Winding down the window or turning up your music does not help you to stay awake. If you ever head nod, you have already been asleep briefly, although you may not remember it, and these ‘microsleeps’ are enough to cause a devastating crash.

tired2Hence if you feel tired while driving, it’s vital to pull up somewhere safe and have a nap. Having a caffeinated drink (an energy drink is better than coffee as it’s a more reliable source of a reasonable dose of caffeine) followed by a 15 minute nap can help to temporarily stave off tiredness, but bear in mind this is only a temporary aid.

If you are still feeling tired after your nap, or you still have a long way to go, you need to stop and get a proper night’s sleep, which is the only solution to tiredness. Whatever you do, only continue your journey when you’re feeling fully refreshed.

Sleep apnoea

Sleep apnoea is a relatively common, but often undiagnosed condition that puts sufferers at great risk of tiredness crashes. Sufferers briefly stop breathing repeatedly while they are asleep. While the sleeper may not realise it, this interrupts their sleep and results in daytime sleepiness, which can result in falling asleep at the wheel. Signs of sleep apnoea include loud snoring, disturbed sleep, regularly waking up coughing, fighting for breath during sleep, and falling asleep in the daytime. The highest-risk group for sleep apnoea are overweight middle-aged men, although it can affect other groups too.

See our fact page on sleep apnoea. If you think there is a chance you have sleep apnoea, seek medical advice. Sleep apnoea is treatable, and if left untreated can increase the risk of high blood pressure, stroke and heart attacks, as well as driver fatigue crashes. The sooner you see a doctor, the better

[1] Sleep-Related Crashes on Sections of Different Road Types in the UK (1995–2001), Department for Transport, 2004

Page updated June 2015

Driver fatigue

Key facts

  • One study found one in six crashes resulting in death or injury on major roads are fatigue-related [1];
  • Peak times for fatigue-related crashes are within the hours of 02.00-06.00 and 14.00-16.00 when drivers are naturally more sleepy; [2]
  • Drivers at 6am are 20 times more likely to fall asleep at the wheel than at 10am; [3]
  • About 40% of fatigue-related crashes involve commercial vehicle drivers, often in the largest vehicles on our roads that can cause the most harm in a crash. [4].  

Introduction

Fatigue is a major contributory factor in crashes in the UK, with too little sleep radically affecting driver attention, awareness, reaction time and ability to control the vehicle. [5]

In 2015, government figures recorded fatigue as a contributory factor in just 4% of road fatalities and 2% of all road casualties [6]. However, these figures are believed to be a very significant under-estimation because fatigue is hard to spot; unlike alcohol and drugs, police can’t test for tiredness. Research, commissioned by the Department for Transport in 2004, found one in six crashes resulting in death and injury on motorways and A roads were fatigue related [7].

Research has shown motorways and dual carriageways are the most common roads for sleep-related crashes, due to the monotonous road environment and lack of interruptions or driver stimulation [8].

Crashes caused by drivers falling asleep typically involve vehicles running off the road or into the back of another vehicle. They tend to be high-speed crashes, because drivers do not brake before crashing, so the risk of death or serious injury is high [9]. Even if tired drivers don’t fall asleep, they still pose a danger. Research suggests driving tired can be as dangerous as drink-driving [10], and is a significant factor in many rear end crashes [11]

Influences

Many factors can contribute to driver tiredness and increase the risk of being involved in a fatigue related crash. These include:

Lack of sleep or disturbed sleep: This could be due to disruptions in life such as a new baby, busy schedules or stress, or could be due to sleep disorders such as narcolepsy, insomnia or sleep apnoea.

Time of day: The most common times for drivers with normal sleep patterns to fall asleep at the wheel are early morning (2am-6am) and early afternoon (2pm-4pm). These times are when the body clock reaches a natural dip, causing drowsiness and reduced concentration [12].

Stress: Tiredness and difficulty concentrating are typical symptoms of stress [13].

Irregular sleep patterns: This can be a problem caused by irregular work shifts and switching from day to night shifts without having sufficient time off in between for your body clock to adjust. Research has found shift workers are particularly high risk for sleep-related crashes [14].

Driving for long periods: Research has found driving deteriorates after two hours of continuous driving, as you become less able to concentrate, and slower to react to hazards. The longer you drive, the more rest you need to recover driving performance [15]. Breaks are therefore recommended every two hours.

Vehicle engineering: Modern vehicles are usually quiet and comfortable for the driver, meaning a more relaxed drive. This can lull drivers, particularly in vehicles fitted with comfort-enhancing features such as cruise control [16].

Medication: Some prescription and over-the-counter drugs can cause drowsiness and impaired alertness. Medications may carry warnings that are not clear they impair driving, for example small print that only advises not to operate heavy machinery. Learn more about drug driving.

Signs of fatigue

Research shows normal sleep does not occur without warning, and most people recognise symptoms but underestimate the dangers of continuing to drive [17]. Warning signs include: increased difficulty concentrating; yawning; heavy eyelids; eyes starting to ‘roll’; and neck muscles relaxing, making the head droop.

A ‘microsleep’ occurs when someone nods off for between two and 30 seconds without realising or remembering it [18], often known as head-nodding. This occurs when people are tired but trying to stay awake, most common in monotonous situations, like motorway driving at night. A Brake and Direct Line survey found one in three (31%) UK drivers surveyed admit having experienced a microsleep at the wheel [19].

After a microsleep the driver may feel like they’ve just briefly nodded their head, but they have actually been asleep. During this time they will have been completely unaware. In six seconds, a vehicle being driven at 70mph travels about 200 metres, which is enough time to veer across three lanes of traffic or into the central reservation. Simulator studies have shown a clear relationship between microsleeps and crashes [20].

At-work drivers are particularly at risk from tiredness, because they typically spend longer hours at the wheel, with four in ten tiredness-related crashes involved someone driving a commercial vehicle [21].

Male drivers are more involved in sleep-related crashes than females. Drivers under 30 are at higher risk than older drivers [22], and are most likely to crash due to tiredness in the early morning after little or no sleep [23]. 

Many drivers continue to take the risk of driving while tired, probably linked to lack of awareness of the risks. A Brake and Direct Line survey in 2014 found almost half (49%) of UK drivers surveyed admit driving after less than five hours’ sleep; this is not enough sleep to prevent fatigue [24].

Legislation on fatigue

Police investigations and penalties for killing someone due to fatigue-related driving

It can be difficult to prove a crash was caused by driver tiredness. A driver who was tired and crashed may not admit to drowsy driving or may die in the crash. It is not possible to test drivers for tiredness. However, if police suspect tiredness they can investigate length of driving, lifestyle (did the driver sleep for an adequate time before driving) and the type of impact (many tiredness crashes are high speed and do not involve braking because the driver is asleep). Lack of skid marks from braking, information from event data recorders and tachographs (see below) and eye witness statements can all help point the finger at fatigue.

A tired driver who kills someone can be charged with death by dangerous driving (if the nature of their driving was perceived to be dangerous) or death by careless driving (a lesser charge for less dangerous driving). The maximum penalty for death by dangerous driving is 14 years imprisonment [25] and the maximum penalty for death by careless driving is five years. The difference between 'careless' and 'dangerous' driving in the eyes of the law is slight and subjective: it's the difference between someone's driving falling below or well below what is expected of a careful and competent driver.  

Learn more about Brake’s Roads to Justice Campaign calling for appropriate sentencing for drivers whose driving causes death and injury.

Commercial vehicle legislation

In the UK companies operating fleets of vehicles have a legal duty of care to “ensure, so far as is reasonably practicable, the health and safety of all employees while at work” and are responsible for what might happen if this is not done. This “applies to all on-the-road work activities as to all work activities”. [26]

Under the Management of Health and Safety at Work Regulations (1999) employers must assess the risks involved in staff use of the road for work and put in place all reasonably practical measures to manage driver fatigue. Employers need to assess which drivers and journeys are at risk and set schedules that do not require drivers to exceed recommended working limits and driver hours. [27]

Professional drivers of goods and passenger road vehicles must comply with the UK and EU Drivers’ Hours Rules, maintain log books, record hours of work and rest and ensure medical assessments are up-to-date as required. [28] Many commercial vehicles (trucks and coaches) have a device in their vehicle called a tachograph, which records how long they had been driving and breaks taken; this information, along with any available telematics information from event data recorders, can be studied by police if the vehicle is involved in a crash.

Rules for some commercial vehicle drivers are much stricter than others. In most cases, lorry and coach drivers are bound by European Union driver hours regulations (Directive 2012/15/EC); these regulations are complex but include limiting time at the wheel to nine hours a day or 56 hours a week on routes where all or part of the journey is in more than one EU country. Drivers must legally take a break for at least 45 minutes after 4.5 hours of driving. They must have unbroken rest periods of 45 hours every week, which can be reduced to 24 hours every other week. [29]

However, other commercially-operated vehicles, notably vans (commercial vehicles weighing 7.5 tonnes or under) and minibuses with 10-17 seats operated for reasons that aren’t commercial (for example for community transport), are exempt from EU regulations. These vehicles are only bound by much less rigorous GB domestic hours rules. These rules restrict a driving day to ten hours. However, they only stipulate a 30 minute break after 5.5 hours’ driving, or 45 minutes taken at times within an 8.5 hour driving shift.

UK figures show vans are the fastest growing users of the strategic road network (SRN), rising an estimated 4.2% between 2014 and 2015 alone. [31]

Medical restrictions

For some conditions associated with fatigue, such as sleep apnoea (for which effective treatment is available), drivers should inform the DVLA of their condition but can continue driving. For other fatigue-related conditions, like narcolepsy (for which there is no cure), drivers must contact the DVLA on diagnosis to relinquish their licence and it is a legal requirement for medical practitioners to tell them to do this. If a doctor discovers that their patient is continuing to drive, they are required to inform the DVLA. A driver who fails to notify the DVLA can be fined £1,000, or prosecuted for failing to do so. [32]

Mitigating fatigue: driver behaviour

The best way to avoid driving tired is to get plenty of rest beforehand, particularly if setting off early in the morning: at least seven to eight hours is recommended [33]. Research shows that driving on less than five hours sleep results in a one in ten chance of staying awake on a lengthy journey [34]. If driving late in the day, especially after a busy day, having a nap before setting off can help alertness.

Drivers are advised to plan long journeys to include rest breaks of at least 15 minutes at least every two hours [35] and if tiredness kicks in before then it is important to stop and rest as soon as possible. Trying alternate measures such as winding down the window, listening to music and talking to a passenger do not help [36].

When taking a break, the only cure for tiredness is sleep. Having a nap for 15 minutes is more effective in reducing driver sleepiness than an active break such as getting out of the vehicle and walking around [37].

Drinking a caffeinated drink such as coffee or an energy drink is effective in reducing driver tiredness over short periods, and has been found to reduce crash risk among long-distance truck drivers by 63% [38]. Energy drinks are a more reliable source of caffeine, as levels in coffee vary. Drinking caffeine before taking a 15 minute nap, giving the caffeine time to kick in while you rest, can therefore be helpful in addressing tiredness temporarily. However this is only a short-term solution, and cannot replace regular breaks and sufficient sleep. Therefore drivers who still feel tired or still have a long way to go should stay put and, if possible, check into a hotel to get some proper rest.

Read: Brake’s advice for drivers on avoiding tired driving.

Mitigating fatigue: road and vehicle design

There are ways to lessen the risk of fatigued drivers on the road, and, in the unfortunate event of a crash, reduce the consequences. Research shows that effective vehicle design and careful infrastructure management can prevent road crashes due to fatigue or mitigate the impact of a crash, should it occur [39]

In-vehicle technology

Driver distraction and drowsiness recognition (DDDR) is an in-vehicle system designed to detect symptoms of fatigue and alert the driver, warning them to take a break. The system monitors eye movement, including slow eyelid closure and rate of blinks, and wider head movements, such as a nodding head. Upon detecting physical indicators of fatigue the system will send a warning to the driver, indicating that they should take a break. DDDR systems can also be designed to monitor levels of heart rate and brain function; or steering and braking patterns indicative of inattention.

These systems (particularly those that track eye movement) are often available as an aftermarket product, marketed to fleet operators. TRL (the UK’s Transport Research Laboratory) recommend DDDR designed to monitor eye movement as these have the ‘strongest evidence base for real-time detection’ of fatigue. [40]

Improvements to the road environment

Should a road crash occur due to fatigue the design of the road can significantly affect the severity of the outcome. Infrastructure interventions that can mitigate the impact of sleep-related crashes include crash barriers (particularly median barriers on motorways and trunk roads). Barriers absorb kinetic energy and protect drivers from hitting other hazards (particularly the danger of hitting oncoming traffic in opposing lanes which increases the risk of death and injury due to the combined speed of a head-on crash) [41].

Infrastructure interventions such as barriers support the ‘safe systems approach’ that accepts some drivers will continue to make mistakes and works to improve the environment and vehicles to mitigate outcomes of crashes. The safe systems principles are supported in Britain’s Road Safety Statement launched in 2015 [42].

Highways England is responsible for the maintenance of England’s SRN, England’s motorways and most of its trunk roads. It is currently developing a system to rate accurately the safety standards of roads it is responsible for, based on the International Road Assessment Programme (iRAP) standards [43].

A preliminary study [44] of standards of road safety on the SRN in 2010 starred roads out of five (five being best) and found:

  • 50% of the motorway network was at 3 star and 50% at 4 star;
  • 78% of dual carriageways were at 3 star, with 20% at 4 star, and 2% at 2 star;
  • 62% of single carriageways were at 2 star, with nearly all the remainder at 3 star (only 1% being 1 star).

In light of these standards, Highways England is using a ring-fenced road safety fund (part of the Road Investment Strategy 2015-2020) and is currently making upgrades to roads with lower star ratings, as well as building in safety measures such as barriers as part of its general road improvement and development programmes (such as SMART motorways). 


End notes

[1] Jim Horne and Louise Reyner, Sleep Related Vehicle Accidents, Loughborough University, 2000
[2] Horne, J. and Reyner L., Sleep related vehicle accidents, 1995
[3] PACTS, Staying awake, staying alive: the problem of fatigue in the transport sector, 2014
[4] Flatley, D. & Rayner, L. et al, Sleep-Related Crashes on Sections of Different Road Types in the UK (1995–2001), 2004
[5] Road Safety Observatory, Driver fatigue: an overview, 2013
[6] DfT, Reported road casualties Great Britain: Annual Report 2014, 2016, RAS50001
[7] Road Safety Research Report No. 52 Sleep-Related Crashes on Sections of Different Road Types in the UK (1995–2001), Sleep research centre, Loughborough,2004
[8] Ibid
[9] PACTS, Staying awake, staying alive: the problem of fatigue in the transport sector, 2014
[10] Long nightly driving comparable to drunk driving, Utrecht University, 2011
[11] Hui Zhang et. al, The effect of fatigue driving on car following behaviour, 2016
[12] Horne, J. and Reyner L., Sleep related vehicle accidents, 1995
[13] NHS Choices, Struggling with stress?, 2014
[14] RSSB, Driving for work: managing fatigue risks, 2013
[15] The impact of continuous driving time and rest time on commercial drivers' driving performance and recovery, Harbin Institute of Technology, 2014
[16] VINCI Autoroutes Foundation, Cruise control may cause drivers to be less attentive and more susceptible to fatigue, 2013
[17] Are drivers aware of sleepiness and increasing crash risk while driving? University of New South Wales, 2014
[18] PACTS, Staying awake, staying alive: the problem of fatigue in the transport sector, 2014
[19] Brake and Direct Line, Fit to drive: driver tiredness, 2014
[20] Microsleep Episodes and Related Crashes During Overnight Driving Simulations, University of Applied Sciences Schmalkalden, Germany, 2011
[21] Flatley, D. & Rayner, L. et al, Sleep-Related Crashes on Sections of Different Road Types in the UK (1995–2001), 2004
[22] Driver sleepiness—Comparisons between young and older men during a monotonous afternoon simulated drive, Biological Psychology, 2012
[23] Misperceptions about Unforewarned “Sleep Attacks” When Driving, British Medical Journal, 2011
[24] Brake and Direct Line, Fit to drive: driver tiredness, 2014
[25] Road Traffic Act (1988), Gov.uk, 1988
[26] Health and Safety at Work etc. Act (1974), Gov.uk, 1974
[27] Management of Health and Safety at Work Regulations (1999), Gov.uk, 1999
[28] RSSB, Driving for work: managing fatigue risks, a guide for road vehicle drivers and their managers, 2013
[29] Directive 2002/15/EC on the organisation of the working time of persons performing mobile road transport activities, European Parliament and of the Council, 2002
[30] Drivers’ hours – Great Britain domestic rules, Gov.uk, 2016
[31] Road traffic estimates: Great Britain 2015, Department for Transport, 2016,
[32] General Medical Council Guidelines reproduced by General information: assessing fitness to drive, Driver and Vehicle Licencing Agency, 2016
[33] BUPA, The science of sleep, 2015
[34] Sleep research centre, Loughborough, Road Safety Research Report No. 52 Sleep-Related Crashes on Sections of Different Road Types in the UK (1995–2001),  2004
[35] Department for Transport, The Highway Code: rule 90
[36] In-car countermeasures hardly effective against driver sleepiness, Swedish Road and Transport Research Institute, 2012
[37] The effectiveness of nap and active rest breaks for reducing driver sleepiness, Queensland University of Technology, 2014
[38] Caffeine reduces crash risk for long-distance truck drivers but can't replace sleep, George Institute for Global Health, 2013
[39] Merat, N. and Jamson, A., The effect of three low-cost engineering treatments on fatigue: a driving simulator study, 2012
[40] Benefit and Feasibility of a Range of New Technologies and Unregulated Measures in the fields of Vehicle Occupant Safety and Protection of Vulnerable Road Users, TRL, 2015[41] Zero road deaths and serious injuries: leading a paradigm shift to a safe system, International Transport Forum, 2016
[42] Working Together to Build a Safer Road System British Road Safety Statement, Department for Transport, 2015
[43] Road Safety Toolkit, International road assessment programme (iRAP), undated
[44] As presented by iRAP to road safety stakeholder meeting convened by Office Of Rail and Road, September 2016


Page last updated: November 2016

 

Driver tips: Sleep apnoea

Sleep apnoea is a killer condition causing you to fall asleep at the wheel and crash. Some research has found sleep apnoea sufferers are seven times more likely to crash. Yet you might not know you have it. Read this page to find out if there's a chance you do, and if there is, then go to your doctor to find out. Treatment is possible.

What is sleep apnoea?
Sleep apnoea is relaxation of muscles around the upper airway (in the throat behind the tongue and palate) causing snoring and obstruction to airflow during sleep. When this happens the brain responds by waking up and re-starting breathing. A few such interruptions in sleep may have little effect but frequent interruptions and waking cause tiredness upon waking, daytime sleepiness, lack of concentration, poor memory and, most dangerously of all, falling asleep while driving or operating dangerous machinery.

What causes it?
The shape of the throat and position of the lower jaw; the presence of swellings in the airway; fluid and fat in the tissue beside the airway, swollen tonsils and the ‘strength’ of muscle around the airway (it may be ‘weak’ in one in four people with diabetes) can all make sleep apnoea more likely.

Being overweight or obese can be a factor in some people. Having excess fat in the body as a whole resets the body’s metabolism making the muscle around the airway ‘weaker’, and is associated with more fat around the airway, compressing and narrowing it. The actual amount of fat beside the airway may be very small but can cause serious narrowing.

Even some people who are not seriously obese (BMI more than 30, see table) may have enough extra fat beside the airway to cause sleep apnoea.

How will I know that I might have it?
Sleep apnoea should be suspected if you have:
• Disturbed sleep
• Wake up coughing or fighting for breath during sleep
• Snore excessively
• Are tired on waking
• Fall asleep after meals (even without alcohol)
• Fall asleep in front of the TV
• Fall asleep during meetings
• Have a collar size of 17 or over (men only)
• Are obese (BMI more than 30, see table)
• You have fallen asleep or felt sleepy while driving in the past year or so
• Frequently have to use coffee or other caffeine containing bever ages to try to keep alert

How will I know if I am obese? 
This is a guide only, but you will probably have a BMI (Body Mass Index – weight in kg divided by height in metres squared) of 30 or over if your weight exceeds the value given for your height.

1.6m/ 5ft 3in = 76.8kg/ 12st 1lb
1.65m/ 5ft 5in = 81.7kg/ 12st 12lb
1.7m/ 5ft 7in = 86.7kg/ 13st 9lb
1.75m/ 5ft 9in = 91.8kg/ 14st 6lb
1.8m/ 5ft 11in = 97.2kg/ 15st 4lb
1.85m/ 6ft 1in = 102.7kg/ 16st 2lb
1.9m/ 6ft 3in = 108.3kg/ 17st 1lb

Do not drive with uncontrolled sleep apnoea
If you are suffering from sleepiness at the wheel, have well-founded suspicion that you have sleep apnoea, or have been diagnosed with sleep apnoea and the symptoms are not yet controlled (see below), or cannot be controlled, it is not safe to drive. Do not drive.

What do do if you suspect you have sleep apnoea
If you suspect that you may have sleep apnoea or believe that your body weight may be putting your driving career at risk speak to your fleet manager and talk to your GP. Ask for a referral to a sleep clinic or a department of respiratory medicine for a sleep study and emphasise that your driving career may depend on a rapid referral and prompt treatment. If you are overweight or obese there are some options for losing weight available through your GP practice – ask for a prompt referral.

The latest research from Sweden shows that a majority of men with moderate and severe sleep apnoea can lose enough weight to improve their sleep apnoea symptoms in just 9 weeks [1] – a formula diet programme of this kind is available in the UK, although not yet through the NHS. If a diagnosis of sleep apnoea is made it is readily treated with the use of a face mask and air-pump which raises the air pressure going into your airway helping to keep it open. This form of treatment, known as CPAP (Continuous positive airway pressure) has been proved scientifically to greatly improve the symptoms and the bad effects of sleep apnoea in most users.

[1] Johansson K, Neovius M, Lagerros YT, Harlid R, Rossner S, Granath F, Hemmingsson E. Effect of a very low-energy diet on moderate and severe obstructive sleep apnoea in obese men: a randomised controlled trial. BMJ 2009; 339: b4609 doi 10.1136/bmj.b4609 .

Driving for Zero

Campaigning for zero tolerance of impaired driving

Driving for Zero is Brake's campaign for zero tolerance of impaired driving. It tackles issues relating to alcohol and drugs calling for "none for the road". It also tackles driver tiredness, poor vision and other impairments relating to health. 

One in eight deaths on British roads still involves a driver over the alcohol limit [1], and in 2015 arrests for drug driving soared after a new law enabled police to arrest people who tested positive to illegal and some legal drugs. Many more drivers are impaired by tiredness, poor vision and ill health.

What are we calling for?

Driving for Zero aims to save lives through evidence-led, legislative interventions, including:

  • a lowering of the drink drive limit to an effective zero tolerance level across the UK
  • an extension, to Scotland and N. Ireland, of the England and Wales law prohibiting drug driving
  • compulsory eyesight tests for drivers
  • rigorous enforcement of laws relating to impairment, including driving hours, and tough penalties for offenders

We are also working to

  • Tackle impairment within commercial fleets, including driver health checks and technology that prevents and warns of impaired driving.
  • Educate law-abiding drivers about how to avoid low-level driver impairment, which can also cause crashes

 Take action

Visit our Driving for Zero campaign pages

 

Driving for Zero: facts and campaign updates

Key facts

Vision and ill health – I don’t really have a specific ‘ill-health fact’ bar one for sleep apnoea:

  • Road crashes involving a driver with poor vision are estimated to cause 2,900 casualties and cost £33 million in the UK per year [1].
  • Eyesight can decline gradually and unnoticed, with people losing up to 40% of their visual acuity without being aware of deterioration [2].

Fatigue:

  • Drivers at 6am are 20 times more likely to fall asleep at the wheel than at 10am [3].
  • About 40% of fatigue-related crashes involve commercial vehicle drivers, often in the largest vehicles on our roads that can cause the most harm in a crash [4].  

Alcohol/Drugs:

  • In 2014, 240 people in Great Britain were killed in crashes where at least one driver was over the drink-drive limit, largely unchanged since 2011 [5].
  • Impairment by illegal or medical drugs was officially recorded as a contributory factor in 62 fatal road crashes and 259 crashes resulting in serious injuries in 2015 in Britain [6].

Driver distraction:

  • Drivers who use phones, either hands-free and hand-held, have been found by researchers to be four times more likely to be in a crash resulting in injuries than drivers not distracted [7].
  • A recent survey by Brake and Direct Line revealed a third of drivers admit to eating at the wheel and one in 10 suffered a near-miss because they were distracted by food while driving [8].

Campaign Updates

Charity welcomes tougher penalties for mobile phone use behind the wheel, 1/3/2017

 

Return to our driving for zero campaign page or visit our Driving for Zero campaign pages on these themes and more

Alcohol & Drugs 

Phones and devices

Tiredness

Vision and ill health    

End Notes.

[1] Fit to Drive: a cost benefit analysis of more frequent eyesight testing for UK drivers, RSA Insurance Group plc, overview available on the Road Safety Observatory, 2012

[2] Assessment of fitness to drive: a guide for medical professionals, DVLA, 2016

[3] PACTS, Staying awake, staying alive: the problem of fatigue in the transport sector, 2014

[4] Flatley, D. & Rayner, L. et al, Sleep-Related Crashes on Sections of Different Road Types in the UK (1995–2001), 2004

[5] DfT,Reported road casualties in Great Britain: Estimates for accidents involving illegal alcohol levels: 2014 (final) and 2015 (provisional),  2016

[6] Department for Transport, 2016, Reported road casualties in Great Britain 2015, table RAS50001

[7] Role of mobile phones in motor vehicle crashes resulting in hospital attendance: a case-crossover study, University of Western Australia, 2005

[8] Eating at the Wheel, Brake and Direct Line Survey, 2016

Driving for zero: fatigue

wake upTired driving is lethal.

Crashes caused by drivers who have nodded off typically involve vehicles running off the road or into another vehicle at high speed, because sleeping drivers do not brake; so the risk of death or serious injury is high. Even if tired drivers don’t fall asleep, they still pose a danger. Too little sleep affects ability to drive safely, increasing reaction times, reducing attention, and reducing ability to control the vehicle. Research suggests driving tired can be as dangerous as drink-driving, and only sleep is a proven method for preventing it.

Tired driving is a significant cause of casualties. A study of crashes on Britain's most monotonous roads (motorways and A roads) found one in four fatal or serious injury crashes was due to tired driving. Causes are lack of sleep, irregular sleep, lack of breaks and driving in the early hours. Fatigue can be exacerbated by lack of stimulation on monotonous roads. There are also health-related causes, such as sleep apnoea (which causes day-time sleepiness and is treatable but can go undiagnosed) and some medications cause drowsiness.

Tired driving is common and many drivers still don't take it seriously enough. A Brake and Direct Line survey found a third of drivers (35%) admit to feeling tired and "pushing on", engaging in useless measures to combat fatigue. Winding down the window, listening to music and talking to a passenger do not help. Caffeine may be of only limited, short term value, but using it on its own to combat driver tiredness is not recommended. Only sleep is effective.

At-work drivers are at risk of tired driving, because they typically spend longer hours at the wheel, often on monotonous roads: four in 10 tiredness-related crashes are estimated to involve an at-work tired driver. EC regulations limit driving hours and stipulate rest breaks for large vehicles, but drivers of vans weighing under 3.5 tonnes are not required to take rest periods or record their driving hours. 

Drivers under 30 may also be at higher risk of sleep-related crashes than older drivers due to propensity to stay up late.

There are several reasons why driver tiredness is a particular concern today. There is growth in:

  • traffic on our monotonous motorway and A road network.Miles travelled by vehicles on the Strategic Road Network (motorways and many of our A roads, as managed by Highways England) rose from under 85bn in 2012/13 to nearly 90bn in 2015/16 and traffic is expected to grow up to a further 60% by 2040 compared with 2010.
  • vehicles being driven for work, with vans the fastest growing type of any vehicle on the Strategic Road Network.
  • cruise control systemsas Advanced Driver Assistance Systems. Research has shown these can reduce alertness.
There is also concern about road infrastructure not being of the highest quality, contributing to worse outcomes when tired drivers crash. Highways England is working to improve the safety standards of motorways and A roads, including barriers.
 
Read more facts on driving tired and sleep apnoea.

What are we calling for?

Brake is calling on government to:

  • Launch a review of GB domestic rules regarding drivers' hours, which do not require at-work van or car drivers to take rest breaks.
  • Ensure Brexit does not result in EU goods and passenger vehicle regulations relating to drivers' hours, being slackened.
  • Ensure prioritisation of the upgrading of central barriers on the Strategic Road Network through implementation of the Road Investment Strategy (as managed by Highways England). 
  • Review eye-lid detection DDDR systems. and consider after-market fitment in our largest vehicles (mandating, or enabling through subsidy) in line with recommendations about the efficacy of these systems by TRL (the UK's Transport Research Laboratory) to the EU. Research has found significant correlation between drooping eyelids (including "microsleeps" lasting seconds) and crashes.
  • Require the National Institute for Clinical Excellence to publish clinical guidelines on the management of sleep apnoea and similar disorders to aid medical practitioners in diagnosing and treating such disorders.
  • Review labelling of medication that causes drowsiness, to ensure it warns about driving as well as machinery operation.
  • Ensure DVSA officers and police officers are adequately staffed and trained to enforce driver hours' compliance.
  • Prioritise engagement with the fleet industry regarding screening of fleet drivers for sleep apnoea and other medical conditions that make falling asleep at the wheel much more likely.

Take action

Campaign news

Bolton MP wins national road safety award for campaign to raise awareness of sleep apnoea, 08/10/2014
Wake up to dangers of tired driving, male drivers urged: half have nodded off at wheel, 09/01/2014
Half of drivers ignore basic advice to prevent deadly tiredness at the wheel, 25/07/2013
One in eight drivers nodded off at wheel in past year, 13/07/2011
Brake's campaigns director speech at Wake Up! parliamentary reception, 13/07/2011
Driver tiredness on the rise ten years on from Selby rail crash, 28/02/2011
British Lung Foundation launches campaign raising awareness of sleep apnoea, 13/06/2011
Millions risking lives through confusion over tired driving, reveal Brake and Direct Line, 13/08/2010

End notes

[1] Transport Research Laboratory, The relationship between driver fatigue and rules limiting hours of driving and work, 2009

[2] Accident Analysis and Prevention, Exploratory study of fatigue in light and short haul transport drivers in NSW, Australia, 2008

[3] Utrecht University, Long nightly driving comparable to drunk driving, 2011

[4] Sleep research centre, Loughborough, Road Safety Research Report No. 52 Sleep-Related Crashes on Sections of Different Road Types in the UK (1995–2001),2004

[5] The impact of continuous driving time and rest time on commercial drivers' driving performance and recovery, Harbin Institute of Technology, 2014

[6] Brake and Direct Line, Fit to drive, Tiredness and long journeys, Report 2, Section 4, 2014

[7] In-car countermeasures hardly effective against driver sleepiness, Swedish Road and Transport Research Institute, 2012

[8] Department for Transport, THINK! Don’t drive tired, (undated)

[9] Biological Psychology, Driver sleepiness—Comparisons between young and older men during a monotonous afternoon simulated drive, 2012

[10] British Medical Journal, Misperceptions about Unforewarned “Sleep Attacks” When Driving, 2011

[11] ORR, Annual assessment of Highways England performance, April 2015-Mar 2016, 2016

[12] Cruise control may cause drivers to be less attentive and more susceptible to fatigue, VINCI Autoroutes Foundation, 2013

[13] Highways England, National Incident and Casualty Reduction Plan,  2016

[14] gov.uk, Drivers' hours, GB domestic rules

[15] gov.uk, Drivers' hours, EU rules

[16] TRL, Benefit and Feasibility of a Range of New Technologies and Unregulated Measures in the fields of Vehicle Occupant Safety and Protection of Vulnerable Road Users, 2015

[17] University of Applied Sciences Schmalkalden, Microsleep Episodes and Related Crashes During Overnight Driving Simulations,  2011

 

Male drivers urged to wake up to dangers of tired driving; survey finds half have nodded off at wheel

9 January 2014

Brake, the road safety charity
news@brake.org.uk

Male drivers are being urged to get plenty of sleep and take regular breaks, as research from Brake and Direct Line reveals a horrifying 45% admit ‘head-nodding’ at the wheel – meaning they have been asleep briefly, risking appalling crashes.

Brake and Direct Line’s survey [1] reveals:

  • One in three drivers overall (31%) admit ‘head-nodding’ at the wheel – nearly half (45%) of male drivers and one in five (22%) female drivers.
  • One in 14 drivers overall (7%) admit actually ‘falling asleep’ at the wheel – 14% of male drivers and 2% of female drivers.
  • Almost half (49%) of drivers admit driving after less than five hours’ sleep – not nearly enough for safe driving. Again, this is more common among men (55%) than women (45%).

Many drivers aren’t aware that if you ‘head nod’ (also called ‘micro-sleeps’) you have already nodded off, putting yourself and others in a huge amount of danger. Micro-sleeps can last from two to 30 seconds, meaning that a frighteningly large number of drivers have been temporarily out of control of their vehicles.

Tired driving kills at least 300 people on UK roads every year [2], with a devastating impact on families across the country– although the actual figure could be much higher as driver tiredness can be hard to prove as a cause of crashes. More facts below.

Brake urges all drivers to help stamp out devastating crashes by making a pledge to always getting a good night’s sleep before driving, taking two-hourly breaks, and pulling over somewhere safe as soon as safe to do so, if feeling tired.

Brake also calls on the government to run more campaigns to raise awareness about the dangers of driving when tired and how to avoid it, as well as calling on them to conduct a review of safe stopping places on motorways, ensuring there are enough to enable drivers to take regular breaks.

Julie Townsend, deputy chief executive, Brake, said:“The fact that so many drivers – especially men – have head-nodded at the wheel is horrifying, even more so that many don’t recognise this means they have fallen asleep briefly. This survey suggests this is down to many people failing to ensure they always get sufficient sleep before embarking on journeys. We need all drivers to wake up to the fact that ‘head nodding’ is falling asleep, and can easily lead to catastrophe, but it can, of course be prevented. Brake urges all drivers to pledge to get a good night’s sleep before driving, take breaks every two hours, and never try to ‘plough on’ when they’re tired, because sleep can ensue so quickly. Ultimately, getting home to your loved ones a bit later is better than never getting there at all.” 

Rob Miles, director of Motor at Direct Line, commented: “Tiredness and driving are a deadly combination. Not only is there a risk of falling asleep at the wheel, but when we are tired our reactions and awareness of our surroundings are not as sharp as they would normally be. Regular breaks, at least every two hours, are essential for staying alert and awake, as is getting plenty of sleep the night before.”

Read about Brake’s ‘Wake up!’ campaign. Read thesurvey report.

Facts
At least 300 people are killed each year as a result of drivers falling asleep at the wheel [3] and tiredness is estimated to cause one in five deaths on UK trunk roads [4]. These crashes typically involve vehicles running off the road or into the back of another vehicle, and are often serious, high speed collisions because the driver does not brake [5].

Too little sleep radically affects your ability to drive safely: on just five hours’ sleep you only have a one in ten chance of staying awake on a lengthy journey [6]. When sleep comes it is not without warning; drivers know when they are getting sleepy [7]. Warning signs include: difficulty concentrating; yawning; heavy eyelids; eyes starting to ‘roll’; neck muscles relaxing, making your head droop.

Drivers trying to fight off sleep often experience ‘micro-sleeps’, nodding off for two to 30 seconds, often without realising or remembering it. This is more than enough to cause a fatal crash: a driver experiencing a six-second micro-sleep at 70mph on a motorway would travel 200m in that time. Simulator studies have shown a clear relationship between ‘micro-sleeps’ and crashes [8].

At-work drivers are particularly at risk from tiredness, because they typically spend much longer hours at the wheel. Nearly half (about four in ten) tiredness-related crashes involve someone driving a commercial vehicle [9].

If you cause a death while proven to be driving tired, you can be charged with causing death by dangerous driving. The maximum penalty is 14 years in prison.

Brake's advice
Brake urges all drivers to have a good night’s sleep before any journey. If you drive when tired, it is impossible to stop yourself eventually nodding off at the wheel [10]. Drivers should also take a break at least every two hours for at least 15 minutes, but should stop sooner if they feel tired.

Winding down the window or turning up the radio does not prevent sleep. If you feel tired you need to stop in a safe place as soon as possible. Drink coffee or ideally an energy drink with caffeine in it, then try to snooze for ten minutes in your vehicle. By the time you wake up, the caffeine will have kicked in [11]. If you feel alert again, drive on. If not, stay put. Bear in mind the effects of caffeine are temporary; the only real solution is a good night’s sleep.

If you wake up in the morning feeling exhausted, struggle to stay awake, snore or wake up struggling to breathe, you may suffer from a relatively common condition called sleep apnoea. Sufferers are at a significantly increased risk of crashing [12]. However, the condition is fully treatable, so if you experience symptoms, stop driving immediately and see a doctor.

Calls for government action
Brake calls for a national audit of rest areas and crash barriers on motorways and trunk roads to ensure that there is adequate provision for drivers to rest regularly, and to minimise the consequences of crashes caused by tired drivers.

Brake is also calling on the government to run more education campaigns warning of the dangers of driving tired, and explaining what drivers can do to prevent tired driving crashes.

Case study
Andrew Radford, 33, was a respected deputy head teacher at a primary school in Shropshire. He was a kind and gentle man with a love of music.

At about 5.30pm on 4 December 2008 Andrew was on his way back from work, and only two minutes away from home, when he veered across the central line into oncoming traffic, causing several cars to swerve out of his way before crashing head-on into a Volvo. A driver behind Andrew noted that his brake lights did not come on. Despite having emergency surgery, Andrew died in hospital in the early hours of Friday 5 December.

Andrew told a paramedic treating him at the scene that he fell asleep at the wheel after deciding not to take a break. This decision cost him his life.

His wife Vicki was left to break the news to their two children, Sam and Alice (then aged 4 and 2). Vicki says: “As a husband and father he was perfect – my best friend, soul mate and love of my life. I wish that we had known more about tired driving and taken it more seriously. Andrew was a good driver – no points, always sensible, the last person you would think this could happen to. I wish that he had stopped to rest; I would rather he came home late than not at all. If any good can come out of this, then it will be that people will hear about Andrew and think again about continuing to drive when they feel tired. The only way to stop this happening over and over is show people the consequences – it happened to us, it can happen to you.”

The coroner at Andrew’s inquest said: “The tragic death of Mr Radford is a reminder to all of us that when we do feel tired when driving, but feel we can make it to our destination, it is better to stop.”

About the report
These survey results come from section 5 of the Direct Line and Brake report on safe driving, 2012 – 2014 Fit to drive, released today (Tuesday 7 January). The survey consisted of 1,000 drivers and was conducted by Redshift Research. Read the report.

Brake
Brake is an independent road safety charity. Brake exists to stop the five deaths and 63 serious injuries that happen on UK roads every day and to care for families bereaved and seriously injured in road crashes. Brake runs awareness-raising campaigns, community education programmes, events such as Road Safety Week (18-24 November 2013), and a Fleet Safety Forum, providing advice to companies. Brake’s support division cares for road crash victims through a helpline and other services.

Road crashes are not accidents; they are devastating and preventable events, not chance mishaps. Calling them accidents undermines work to make roads safer, and can cause insult to families whose lives have been torn apart by needless casualties.

Direct Line
Started in 1985, Direct Line became the first UK insurance company to use the telephone as its main channel of communication. It provides motor, home, travel and pet insurance cover direct to customers by phone or on-line.

Direct Line general insurance policies are underwritten by UK Insurance Limited, Registered office: The Wharf, Neville Street, Leeds LS1 4AZ. Registered in England No 1179980. UK Insurance Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.

Direct Line and UK Insurance limited are both part of Direct Line Insurance Group plc. Customers can find out more about Direct Line products or get a quote by calling 0845 246 3761 or visiting www.directline.com.

End notes
[1] A survey of 1,000 drivers from across the UK conducted on behalf of Brake and Direct Line by Redshift Research. The results are contained in the Brake and Direct Line Report on Safe Driving 2012-14: Fit to Drive, section 5 – tiredness. Read the report.
[2] Loughborough University Sleep Research Centre, www.lboro.ac.uk/departments/hu/groups/sleep
[3] ibid
[4] Department for Transport, www.thinkroadsafety.gov.uk
[5] ibid
[6] Loughborough University Sleep Research Centre, www.lboro.ac.uk/departments/hu/groups/sleep
[7] ibid
[8] Golz, M. et al. 2011. ‘Microsleep Episodes and Related Crashes During Overnight Driving Simulations’, http://drivingassessment.uiowa.edu/sites/default/files/DA2011/Papers/007_GolzSommer.pdf
[9] Department for Transport, www.thinkroadsafety.gov.uk
[10] Horne, J & Reyner, L. 1995. ‘Sleep Related Vehicle Accidents’, British Medical Journal
[11] ibid
[12] Sleep Apnoea Trust, www.sleep-apnoea-trust.org

 

Meg Munn MP won Parliamentarian of the Year 2009 - National Campaigner

nationalcampaigner2009Brake and Direct Line Insurance have awarded Meg Munn, MP for Sheffield Heeley, ‘Parliamentarian of the Year – National Campaigner’ for her determination to eradicate undiagnosed sleep apnoea in commercial drivers, a major cause of road crashes, and achievement of real results to improve the safety of UK road users.

Due to lifestyle and working conditions, truck drivers are much more susceptible to sleep apnoea. Sleep apnoea sufferers are often tired during the day and are more likely to fall asleep at the wheel, lose control of their vehicle and crash. Sleep-related crashes often result in death or serious injury, as they tend to occur at high speeds, with the driver is unable to take any preventative action, such as braking, before the collision. Undiagnosed sleep apnoea may affect nearly one in six lorry drivers [1] and sleep apnoea suffers are seven times more likely to crash [2]. Up to 80,000 HGV drivers in the UK may be putting their own lives and the lives of others at risk by driving while suffering from the effects of sleep apnoea [3].

Meg first came across the issue when constituent Seb Schmoller contacted her, in early 2008, following the death of his nephew Toby Tweddell. Toby, 25, was killed on 8 August 2006 when a lorry ploughed into his car. The driver, Colin Wrighton, had fallen asleep at the wheel of his lorry. Following the crash, it was found that the medical profession had previously failed to diagnose him with sleep apnoea, an easily treatable disorder. Meg quickly realised that action needed to be taken at a national level.

Meg raised the subject in a Parliamentary debate, convincingly arguing that there was an urgent need for a change in regulation. She then secured a meeting with the Road Safety Minister in October 2009. Thanks to Meg’s thorough research and careful planning, the Minister was convinced of the need to act and committed to make changes to the medical examination form that commercial drivers must complete with their doctors before they can get their licence, to include checks for the symptoms of sleep apnoea. The Minister also promised to raise awareness of the issue among the medical profession. It is hoped that these steps will make a real impact on the detection of sleep apnoea in commercial drivers.

In 2010 Meg will continue to tackle the issue by working with business to raise awareness and encourage regular screening for commercial drivers. She is already in the process of organising a trial with a major firm to begin screening and offering treatment to their drivers. She hopes this will demonstrate the value of screening to other employers, and bring about widespread screening as an industry standard.

The awards were presented at Brake’s annual reception at the Houses of Parliament on the evening of Tuesday 19 January 2010.

Cathy Keeler, deputy chief executive of Brake, said: “Meg’s substantial efforts to raise awareness of the problems of undiagnosed sleep apnoea in commercial drivers will prevent many more lives being needlessly lost, and many more families being devastated. Brake is delighted to award Meg ‘Parliamentarian of the Year – National Campaigner’ for her tireless national campaigning in Parliament and with Government. I urge everyone to support Meg in her excellent work and look forward to hearing how her campaign develops in 2010 through her work to encourage businesses to screen their drivers for sleep apnoea and offer treatment where necessary.”

Meg Munn MP said: “I am delighted to receive the award. Toby Tweddell was killed by a lorry driver with undiagnosed Obstructive Sleep Apnoea. His uncle, my constituent, Seb Schmoller; Toby’s fiancée Jenny Crisp; and other members of Toby’s family have undertaken substantial work to raise awareness and change policy. This award is a tribute to their determination to prevent other families suffering the same heartache.”

Steve Treloar, Managing Director of Motor at Direct Line Insurance said: “As the UK’s number one direct car insurer we have a very real interest in ensuring that road safety issues remain part of the public and political agenda and real action is taken at a local and national level to avoid the tragedies that are still too common on our roads. We are proud to sponsor these awards and would like to congratulate Meg who has tirelessly campaigned to make a difference.”

Members of the public can nominate their MP for a Brake award by emailing ebooth@brake.org.uk. They can also visit the Brake website (www.brake.org.uk) to find out about how to support Brake’s work with families that have been affected by a road crash by helping to raise vital funds for Brake. You could take part in a parachute jump, organise a coffee morning or take part in a sponsored walk. To find out about these and other fundraising ideas, call Lisa Kendall on 01484 683294 or email lkendall@brake.org.uk

Photos of Meg receiving her award are available from Brake.

Direct Line

Started in 1985, Direct Line became the first UK insurance company to use the telephone as its main channel of communication. It provides motor, home, travel and pet insurance cover direct to customers by phone or on-line.

Direct Line is part of RBS Insurance, the second largest general insurer in the UK1 and is wholly owned by the Royal Bank of Scotland Group. Customers can find out more about Direct Line products or get a quote by calling 0845 246 3761 or visiting www.directline.com Direct Line Insurance plc is authorised and regulated by the Financial Services Authority. Registered office: 3 Edridge Road, Croydon, Surrey CR9 1AG. Registered in England and Wales no. 01810801. The Financial Services Authority’s Register can be accessed through http://www.fsa.gov.uk

[1]: Howard, Mark E., Desai, Anup V., Grunstein, Ronald R., Hukins, Craig, Armstrong, John G., Joffe, David, Swann, Philip, Campbell, Donald A. and Pierce, Robert J. ‘Sleepiness, Sleep-disordered Breathing, and Accident Risk Factors in Commercial Vehicle Drivers’, American Journal of Respiratory and Critical Care Medicine, 2004: 170, pp. 1014-21
[2]: Sleep Apnoea Trust, Website: www.sleep-apnoea-trust.org
[3]: Based on DfT figures showing there are approximately 500,000 active HGV drivers in the UK

Meg Munn, MP for Sheffield Heeley, November 2009

nationalcampaigner2009Meg Munn, MP for Sheffield Heeley, has been named November’s ‘Parliamentarian of the Month’ for her road safety work in Parliament. She has been raising awareness of the risks of drivers falling asleep at the wheel resulting from undiagnosed sleep apnoea, a condition associated with obesity, which is a risk factor of long haul commercial driving. She has successfully brought together a team of campaigners including affected constituents and prominent researchers in the field, to lobby the Government for a change in regulations.

Meg’s constituent, Seb Schmoller, brought the issue of undiagnosed sleep apnoea to her attention early in 2008 following the death of his nephew Toby Tweddell. On 8 August 2006, Toby, 25, set off to work along the M62 near Liverpool. On the way, a lorry ploughed into his car, and as a result Toby died.

Colin Wrighton, the lorry driver who killed Toby, had fallen asleep at the wheel of his vehicle. Wrighton had seen his doctor just five months earlier complaining of tiredness. Tests to find out whether he was diabetic returned negative, and he was told he was probably suffering from stress. The medical profession failed to diagnose sleep apnoea, an easily treatable condition, which resulted in Wrighton crashing his lorry and killing Toby.

At the inquest into Toby’s death, the Coroner took the unusual step of issuing a rule 43 report to the Lord Chancellor’s Department calling for the toughening of the licensing regime for commercial drivers, who are particularly likely to develop sleep apnoea. The Department for Transport responded that current regulation was adequate and they had no intention to review regulations.

Meg began to look into the problem of undiagnosed sleep apnoea and was shocked to find that nearly one in six lorry drivers may have sleep apnoea [1].

Meg brought together key academics and doctors such as Professor Jim Horne and Dr Louise Reyner from the sleep research centre at Loughborough University; Dr John Shneerson, from Papworth hospital; Dr Dev Banerjee from Birmingham Heartlands hospital and Dr Stephen Bianchi from the Royal Hallamshire hospital in Sheffield. Together they set out to find the most effective way to tackle the issue.

The group identified three key campaign points:

  • Regular screening of commercial drivers as part of the licensing process to pick up undiagnosed cases automatically.
  • A legal requirement for commercial operators to have sleep apnoea screening processes in place.
  • Raising awareness of sleep apnoea and commercial driving in the business and medical professions.

In May 2009, Meg was able to secure an on the issue of the widespread under diagnosis of sleep apnoea in commercial drivers, and she used the opportunity to highlight both how widespread the problem was and the positive steps that the Government could take to tackle the problem. The Road Safety Minister subsequently agreed to meet with Meg and key people involved with the campaign.

Meg met with Paul Clark on 13 October. She took along Toby’s uncle Seb, his father Nic Tweddell and fiancée Jenny Crisp as well as one of the sleep disorder experts from her campaign group, Dr Stephen Bianchi.

Meg challenged the minister to implement some straightforward changes to the DVLA medical examination report form. Drivers must complete this form to show employers that they are safe to drive. Meg pointed out that the questions on the form designed to identify sleep apnoea (‘Does the applicant have sleep apnoea syndrome?’ and ‘Is there any other medical condition causing excessive daytime sleepiness?’) would not identify a driver with undiagnosed sleep apnoea as they ask about the condition and not the symptoms. The campaign group recommends that the driver’s Body Mass Index be calculated on the form with a warning that there is a higher incidence of sleep apnoea among obese people.

Meg also pointed out that the accompanying information to help complete the form is misleading. It stated, that ‘at least three in every thousand men’ have sleep apnoea, yet among commercial drivers the incidence is probably nearer to fifteen in every 100 . Later in 2009 this was amended to read ‘four in every one hundred’ have sleep apnoea.

Millions of drivers risking lives through confusion about tired driving

13 August 2010
Brake, the road safety charity

Drivers are being urged to wise up to the dangers of tired driving – as research out today by Brake and Direct Line[1] shows the vast majority admit driving while tired, and drivers don't know the difference between fact and fiction on tackling sleepiness at the wheel.

The campaign is being backed by Vicki Radford, whose husband Andrew was killed when he fell asleep at the wheel in 2008 (see case study below).

Brake and Direct Line's survey found that nearly three-quarters of drivers (74%) admit driving tired in the past 12 months – with almost one in ten (9%) saying they did so at least once a week. This is a huge increase from six years ago, when 46% of drivers owned up to getting behind the wheel while tired.

An estimated one in five fatal crashes on trunk roads are caused by tired drivers[2]– although the real figure could be higher, because it can be difficult to prove when a crash was caused by a driver falling asleep. They tend to be high-speed crashes, because drivers do not brake before crashing, so the risk of death or serious injury is greater.[3]

Despite this, most drivers simply don't know how often they should take rest breaks to help prevent tiredness, and what to do if they get sleepy behind the wheel. The Government advises breaks every two hours on long journeys, yet Brake and Direct Line's survey found that almost three-quarters (73%) fail to follow this advice by driving for three hours or more at a time.

If drivers do feel tired behind the wheel, they are advised to pull over somewhere safe as soon as possible, drink caffeine, and then take a short power nap[4] – or find somewhere to stay overnight and get a good night's sleep. All other methods of staying awake and alert at the wheel are unproven.

Yet of the 800 drivers surveyed a huge proportion are risking lives by driving on when tired and using unproven methods to stay awake:

More drivers open a window while driving (70%) to starve off sleep than take regular rest breaks on long journeys (69%).More than half listen to the radio or a CD to keep them awake when driving (54%); that's more than have a nap or drink caffeine in rest breaks (21% and 43%). Nearly twice as many drivers go for a short walk during rest breaks (39%) than have a short nap (21%). Nearly one in three (29%) admit splashing water on their faces when taking a rest break in the vain hope that it will wake them up.

Ellen Booth, Brake's campaigns officer, said:

"It is terrifying how complacent drivers are about tiredness at the wheel. It only takes a couple of seconds of sleep to cause a fatal crash, yet millions of drivers are regularly getting behind the wheel while tired, and most don't know how to deal with sleepiness on a long journey.

"We all know when we're feeling sleepy – we know what the warning signs are. When we're driving we must listen to these signs without delay. Thinking that we can fight off sleep, especially using unproven methods like opening the window, is a mistake that could cost your life, or someone else's."

Andy Goldby, Director of Motor Pricing & Underwriting at Direct Line said:

"The increase in drivers admitting to driving whilst tired is a worrying trend. Tiredness and driving are a deadly combination: not only is there a risk of falling asleep at the wheel, but when we are tired our reactions and awareness of our surroundings are not what they would normally be. Drivers know when they are tired, and whilst they may think stopping for a break may increase their journey time, it's not worth the risk to themselves, their passengers or other road users. It is better to get there late than to not arrive at all."

DRIVER ADVICE

  • Get plenty of sleep before a journey, plan your journey to include time for adequate rest and don't set out if you are already tired.
  • Take rest breaks at least every two hours for a minimum of fifteen minutes.
  • If you feel tired when you are driving, listen to the warning signs and stop for a break somewhere safe as soon as you can. Sleep ensues faster than you think – trying to fight off sleep by opening the window or listening to the radio puts you at risk of 'microsleeps', when you nod off for two to 30 seconds without remembering it.  Microsleeps can be fatal: at 70mph a driver travels 200m in six seconds.
  • If you start to feel sleepy while driving:
    - Stop for a 15 minute break somewhere safe as soon as possible.
    - If you drink caffeine, drink two cups of coffee or a high-caffeine drink, such as an energy drink, then take a 10-15 minute rest or snooze.
    - By the time you wake up any caffeine will have kicked in and you may feel alert enough to continue your journey. If you still feel tired, or you still have a long way to go, you should stay put and try to find somewhere to get a good night's sleep.
    - Remember caffeine is a temporary drug and its effects do not last long. Sleep is the only long-term cure to tiredness.

ACTION FROM THE GOVERNMENT

Brake is calling on the Government to:

Run more education campaigns warning of the dangers of driving tired, and stating what drivers can do to prevent tired driving crashes.Make traffic policing a national policing priority, and ensure there are more patrols to spot and stop weaving vehicles driven by tired drivers.Introduce regular testing of drivers, particularly people who drive for work, for sleep apnoea, a medical condition that makes falling asleep at the wheel much more likely.Introduce better and longer safety barriers to minimise the consequences of crashes caused by tired drivers on motorway and trunk roads. Conduct an audit of rest areas on motorways and trunk roads, to ensure they provide adequate provision for our road network, enabling drivers to always find somewhere to stop and rest.Extend rules controlling hours that can be driven legally by large vehicle drivers

to fleet drivers in vans and cars, and encourage companies to use trains more instead of cars for long distance journeys.

The consequences – case study

Andrew Radford was a respected deputy head teacher at a primary school in Shropshire. He was a kind and gentle man with a love of music.

Andrew, 33, was only two minutes away from his house, on his way home from work, when he veered across the central line into oncoming traffic, causing several cars to swerve out of his way before he crashed head-on into a Volvo. A driver behind Andrew noted that his brake lights did not come on. It was about 5.30pm on 4 December 2008. Despite having emergency surgery, Andrew died in hospital, in the early hours of Friday 5 December.

Andrew told a paramedic treating him at the scene that he fell asleep at the wheel after deciding not to take a break. This decision cost him his life.

His wife, Vicki, was left to break the news to her two young children Sam (then aged 4) and Alice (then aged 2). The pupils and staff at his school were also devastated and tributes flowed to the man they had so much respect and admiration for.

His wife Vicki said: "As a husband and father he was perfect – my best friend, soul mate and love of my life. I wish that we had known more about tired driving and taken it more seriously. Andrew was a good driver – no points, always sensible, the last person you would think this could happen to. I wish that he had stopped to rest; I would rather he came home late than not at all. If any good can come out of this, then it will be that people will hear about Andrew and think again about continuing to drive when they feel tired. The only way to stop this happening over and over is show people the consequences – it happened to us, it can happen to you."

The coroner at Andrew's inquest said: "The tragic death of Mr Radford is a reminder to all of us that when we do feel tired when driving, but feel we can make it to our destination, it is better to stop."

[1] Direct Line Report on Safe Driving 2009-2011 PART TWO, Fit to drive?, Brake and Direct Line, 2010.

[2] Department for Transport, www.thinkroadsafety.gov.uk

[3] Department for Transport, www.thinkroadsafety.gov.uk

[4] Caffeine combined with a short nap effectively counteracts driver sleepiness, Loughborough University Sleep Research Centre, 1997.

Personal tragedies, predictable causes: case studies of cyclist deaths

cycle4life_10This page tells the stories of some deaths of cyclists on British roads and the causes of those deaths.

Case study: The Ryl Disaster

For 12 members of Rhyl Cycling Club, it should have been a leisurely Sunday ride along a favourite route. But when an oncoming car hit black ice, the day turned instantly to disaster - three men and a 14-year-old boy were killed in Britain’s worst ever bike crash. The car veered across the A547, crashing into them. Those who died were: 14 year old Thomas Harland; Maurice Broadbent, 61, the chairman of the club; Dave Horrocks, 55, who had caught the cycling bug after he and his wife were given bikes by their son; and Wayne Wilkes, 42, who was cycling with his own son. Bad driving and lack of road gritting contributed to Britain’s “worst cycling disaster,” said coroner John Hughes. “The evidence shows classic signs that Robert Harris, driving a Toyota Corolla, was driving without due care and attention and he admitted his responsibility in going too fast. I fail to understand why no proceedings were brought against him.” The Inquest’s jury ruled out accidental death and returned a narrative verdict. Hughes also pointed out a failure to grit roads after calls had been made alerting officials to the ice after another driver had skidded earlier. The cyclists had set out on a 60-mile trip between Great Orme and Llanrwst, in what they believed was fine weather, in pairs and wearing helmets. Harris was fined in separate criminal proceedings for having defective tyres.
Read the BBC report.

Case Study: Tired driver kills champion cyclist

Champion speed cyclist Zak Carr was killed in October 2005 by a motorist thought to have dozed off at the wheel who drove into the back of him. The crash happened on the A11 near Wymondham, Norfolk at 7.30am. Forty-nine year old driver, Donald Pearce, was travelling home from a holiday in Turkey, having missed a night’s sleep. He was sentenced to five years in prison.
Read the BBC report.

Case Study: Collisions with trucks

33 year old Ninian Donald was killed when the driver of a skip lorry, turning at a junction, failed to spot him. The driver was not prosecuted because he had legal mirrors. Ninian left behind his partner Kate Evenden and their 19 month old daughter Ava Rose. Kate is campaigning for wide-angled mirrors on trucks and training for large vehicle drivers about cyclists. She says: “Ava Rose asks for her father every day. I have pictures of him around and tell her all about him but our lives have been changed for ever.”
Read the Evening Standard report.

In February 2006, 32 year old Patricia McMillan was cycling to work in Kensington, London, listening to music on her iPod. She was hit by an articulated lorry and crushed to death. A spokesperson from the Royal Society for the Prevention of Accidents (RoSPA) said “If you are on a bike, you need to be aware of what is going on around you - and you can’t be if you’re listening to music.”
Read the Daily Mirror report.

Case Study: Speeding, texting car driver

Nineteen year old Jordan Wickington was killed by a speeding 25 year old who was texting her husband while driving at 45mph in a 30mph zone through a junction in Southampton. Jordan rode through a red light and was hit by the car. Kiera Coultas, found guilty of Death by Dangerous Driving, had already received three fixed penalty tickets for speeding in the same area.
Read the Daily Telegraph report.


Cycling for health >>

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Report 2 - Fit to drive?

Report 2 - Fit to drive?Published 2010

Drink and drug driving are among the most disgraceful social ills of the developed world. Although it's often claimed that drink driving is socially unacceptable, it still accounts for one in six road deaths. We don't know the exact extent of drug drive casualties, but we do know it is a growing menace. This report reveals a significant minority admit driving on drink or drugs, and examines misapprehensions that are likely to contribute to this ongoing problem.

Tired driving can also have catastrophic consequences, as illustrated in 2001, when the country woke up to the carnage caused by a driver who fell asleep and drove onto train tracks near Selby, causing 10 deaths. Years later, this survey demonstrates ongoing complacency and confusion about preventing fatigue at the wheel.

The recommendations for Government at the end of this report set out steps that must be taken to stamp out the devastation caused by people driving while impaired by drink, drugs or tiredness.

Main findings:

  • One in three (35%) admit driving after drinking alcohol (any amount) in the past year, a decrease from 51% who admitted this in 2003
  • Four in 10 (38%) admit 'morning after' drink driving, up from 28% in 2003
  • Nearly half (45%) believe they would need to consume two or more units for their driving to be affected, with one in seven (14%) believing it takes three or four units or more
  • More than half (53%) think there is a less than a one in four chance of being caught if they were to drive over the limit, while nearly a third (31%) think there is less than a one in ten chance.
  • One in 25 (4%) admit driving on drugs in the past year
  • Nearly three-quarters (74%) admit driving tired in the past 12 months, compared to 46% in 2003

Press releases from this report:

Breath-testing rate low and drivers know it, 14 April 2011
Driver tiredness on the rise 10 years on from Selby Crash, 28 February 2011
Morning after drink-driving on the rise, 14 December 2010
Millions risking lives through confusion over tired driving, 13 August 2010

Sleep apnoea

Obstructive Sleep Apnoea (OSA) is a condition that causes sufferers to briefly stop breathing while they are asleep. This interrupts sleep and causes excessive daytime sleepiness. People with OSA are prone to nodding off during the day, and are about seven times more likely to have crashes [1].

Many people that suffer from the condition do not realise it, due to lack of awareness about symptoms. In the UK, it is estimated that around 4% of middle-aged men and 2% of middle-aged women have OSA [2].

How does OSA affect sleep?

OSA is one of the most common medical causes of excessive daytime sleepiness [3]. People with OSA suffer interruptions in their breathing while they are sleeping. The interruptions can last 10 seconds or longer and occur when the muscles around the throat relax too much during sleep. The brain briefly wakes a person up to re-start their breathing, interrupting sleep. Usually the person does not remember waking up so is unaware they have the condition. Because of the repeated waking, sufferers have poor-quality sleep so will feel sleepy during the day and be prone to nodding off [4].

Some people with OSA may only wake a few times in the night, and suffer minimal daytime sleepiness. The more severe form of the condition, where sufferers may wake hundreds of times in the night and suffer severe daytime sleepiness, is known as Obstructive Sleep Apnoea Syndrome (OSAS). OSAS occurs in approximately one in four people with OSA [5].

Fatigue severely impairs your ability to drive safely. For this reason, drivers suffering from untreated sleep apnoea are considered highly dangerous. Sleep scientist Melanie Marshall says, “Untreated, undiagnosed sleep apnoea individuals are more lethal on our roads than individuals who have been drink-driving” [6].

Learn more: Read our fact page on the wider risks of driver tiredness.

Who is most likely to have OSA?

The highest-risk group for OSA are middle-aged men who are overweight, with a collar size of 17 inches or more [7]. However, not all sufferers fit this profile.

Anything that makes the throat narrower (such as enlarged tonsils or set-back lower jaw) means it is easier for the throat to close off and block the airway. Contributory factors can include smoking and drinking (especially before going to sleep) and taking sleeping pills or other sedative medications [8].

Professional drivers such as truck drivers are known to be at higher risk for sleep apnoea. Studies in the USA [9], Australia [10] and Sweden [11] have indicated that 12% to 17% of professional drivers may have OSA. Research has suggested that up to 41% of UK truck drivers have a sleep disorder of some form, with 16% suffering from severe sleep apnoea requiring immediate treatment [12].

What are the symptoms of OSA?

The main symptoms of OSA are snoring and daytime sleepiness. Even slight sleepiness will affect monotonous tasks such as reading, watching TV and driving on trunk roads. If a sufferer’s sleepiness gets worse, it can lead to them falling asleep while talking or eating [13].

Snoring does not necessarily mean a person has OSA, but frequent, very loud snoring together with daytime sleepiness is likely to indicate OSA.

Other symptoms that may indicate OSA include [14]:

  • choking episodes during sleep
  • morning headaches
  • depression
  • waking feeling unrefreshed
  • difficulty concentrating
  • irritability.

The Epworth Sleepiness Scale is a self-assessment test that can be used to determine whether someone is likely to be suffering from OSA. People who score moderate or high risk on this questionnaire should seek medical advice immediately, and may need to notify the Driver and Vehicle Licensing Agency (see below).

What is the law on OSA?

If a tired driver causes a death, they can be charged with death by dangerous driving if evidence proves they were impaired through fatigue. The maximum penalty is 14 years in prison.

If you suffer from OSAS, or OSA with excessive daytime sleepiness, you must inform the DVLA. Group 1 licence holders (car/motorcycle) diagnosed with OSAS must stop driving until the symptoms have been controlled. Group 2 licence holders (lorries and buses) diagnosed with OSAS must stop driving until the symptoms have been controlled, and must have ongoing treatment [15].

How is OSA treated?

OSA is treatable, so anyone who thinks they may be suffering should seek medical advice as soon as possible so they can start getting uninterrupted sleep again. Anyone who drives and thinks they may be suffering should stop driving while they seek diagnosis and treatment, to ensure they are not putting themselves and others at great risk.

Early diagnosis and treatment is also important because, apart from the immediate danger of causing a crash by nodding off at the wheel, untreated OSA increases the risk of high blood pressure, stroke and heart attacks, and can reduce life expectancy by 20% [16].

Referral to a sleep unit will almost always be necessary for suspected sufferers of sleep apnoea so that they can be diagnosed and offered treatment. Some simple approaches are also worth trying to reduce the causes of mild sleep apnoea:

  • losing weight
  • stopping smoking
  • sleeping on your side
  • keeping the nose clear, for example by using a nasal spray, or raising the head end of the mattress
  • reducing or stopping evening alcohol consumption [17].

A person diagnosed with OSA will usually be treated with a continuous positive airway pressure (CPAP) machine, which keeps the throat open with the use of pressurised air. The person must wear a mask, connected to a small pump beside the bed, over their nose during sleep. CPAP machines greatly improve the person’s sleep: sufferers usually notice an immediate, vast improvement in their quality of sleep [18]. Research has found that, for people with OSA, even a few hours’ sleep with a CPAP machine reduces sleepiness at the wheel more than a full nights’ sleep without CPAP [19].

For mild cases of OSA, a mandibular advancement device (MAD) may be more appropriate than a CPAP machine. This is a device like a gum shield, to be worn over your teeth when you are asleep. It is designed to hold your jaw and tongue forward to increase the space at the back of your throat. If you think a MAD may help you, it is recommended that you ask a dentist who is experienced in treating OSA fit one. Buying a ready-made MAD online or from a specialist store is not recommended, as poorly-fitted MADs can make the symptoms worse [20].

In some rare cases, surgery may be an option. However surgery is not often as successful at treating the symptoms as CPAP, and runs the risk of complications, so is usually only considered if all other treatment options have failed and the condition is seriously affecting a patient’s quality of life [21].

Take action: Support Brake’s Driving for Zero campaign to raise awareness of the risks of impaired driving, including sleep apnoea.

How can employers support drivers with OSA?

Under the Health and Safety at Work Act, UK companies and organisations have a responsibility for their employees while they are driving for work purposes. This means that they may be liable for road crashes caused by or involving employees who are suffering from excessive sleepiness.

Brake recommends that companies with staff who drive for work train their drivers and managers to look out for common symptoms. Suspected sufferers should be taken off driving duty immediately and referred for medical assessment. Annual health checks can also help to identify potential OSA sufferers. Research has indicated that medical examinations for drivers that look for common health issues among sedentary workers, such as obesity, hypertension and diabetes, can help identify OSA in drivers who may not have noticed the symptoms themselves [22].

Claire Michell, from the Sleep Apnoea Trust, advises employers to be sympathetic to drivers who may have OSA. Drivers often won’t want to admit there is a problem because they will be scared they will lose their job. Employers can help with this by educating line managers about the condition, particularly the crucial fact that it is treatable.

Learn more: Employers can access guidance from Brake on OSA and a broad range of other road safety topics to help them prevent at-work crashes at www.brakepro.org.

Sources of further information:


[1] Effect of a very low-energy diet on moderate and severe obstructive sleep apnoea in obese men: a randomised controlled trial, British Medical Journal, 2009

[2] Sleep apnoea, NHS Choices, 2014

[3] Excessive daytime sleepiness: A challenge for the practising neurologist, Brain: a journal of neurology, 2001

[4] Frequently asked questions, Sleep Apnoea Trust Association, undated

[5] Sleep apnoea and driving, Real Sleep, 2014

[6] Quoted in: Real Story: Killer in the Cab, BBC 1, 21 November 2005

[7] Frequently asked questions, Sleep Apnoea Trust Association, undated

[8] Sleep apnoea, NHS Choices, 2014

[9] Consensus Criteria for Screening Commercial Drivers for Obstructive Sleep Apnea: Evidence of Efficacy, Journal of Occupational & Environmental Medicine, 2008

[10] Sleepiness, Sleep-disordered Breathing, and Accident Risk Factors in Commercial Vehicle Drivers, American Journal of Respiratory and Critical Care Medicine, 2004

[11] Sleep debt, sleepiness and accidents among males in the general population and male professional drivers, Accident Analysis & Prevention, 2003

[12] Respironics SASA research, presented in: Real Story: Killer in the Cab, BBC 1, 21 November 2005

[13] Frequently asked questions, Sleep Apnoea Trust Association, undated

[14] Sleep apnoea and driving, Real Sleep, 2014

[15] Ibid.

[16] Ibid.

[17] Sleep apnoea, NHS Choices, 2014

[18] Treatment of sleep apnoea, Sleep Apnoea Trust Association, undated

[19] One night CPAP withdrawal impairs performance at a driving simulator task, Queensland University of Technology, 2014

[20] Obstructive sleep apnoea – treatment, NHS Choices, 2014

[21] Ibid.

[22] Factors associated with obstructive sleep apnea among commercial motor vehicle drivers, Meharry Medical College, 2011


Page last updated: October 2014