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Article #68

LETTER QUOTED:

There is a new initiative by the U.S. Federal Highway Administration(FHWA) and the Trucking Research Institute (TRI) to provide exercise facilities at selected truck stops in the U.S. I think that this is a bad idea which, at best will distract attention from drivers' needs for more sleep and, at worst, will contribute to their sleep deprivation. I do understand the philosophy behind promoting exercise among truck drivers and I have no disagreement with the American Heart Association's material on the cardiovascular benefits of exercise. It is also clear from the scientific literature that increased physical fitness will increase the amount of work that can be done in a given time. Thus, exercising drivers may have a beneficial effect on the amount of physical work drivers can perform. However, there is no evidence that lack of physical fitness is a large source of driver impairment in the trucking industry. Moreover, I know of no evidence that physical fitness will improve sleep, reduce sleep need or improve driving performance under conditions of sleep deprivation. The fact that obesity is statistically related to sleep apnea is not relevant because: (1) fitness training has not been shown to be a reliable treatment for obesity and (2) fitness training has not been shown to be a reliable treatment for sleep apnea. In our sleep research literature, there is firm documentation of (1) the irrelevancy of physical fitness and exercise to sleep; (2) the negative effects exercise can have on performance during sleep deprivation; (3) the seriousness of the impairment stemming from sleep deprivation; and (4) the broad extent of sleep deprivation in long haul trucking. Most importantly, Dawson and Reid's findings presented in the highly regarded journal, Nature, show that the effects of sleep deprivation are serious and comparable to ethanol in its potential to impair ability to drive. And, the FHWA's Driver Fatigue and Alertness Study (DFAS) suggests that even among regularly employed drivers of large companies, sleep deprivation is universal. The FHWA and TRI need to acknowledge that sleep deprivation is a large source of driver impairment in the trucking industry. I recognize that we may not be able to improve this situation. That is, given the driving distances and economic realities, the levels of sleep deprivation we documented in the DFAS may already be the lowest possible. But, if this is the case, FHWA ought to commit resources to demonstrate that present levels of sleep deprivation are already an optimum balance between work and sleep. Such a demonstration would be a greater service to the public than providing mobile gyms for drivers. Promoting mobile gyms for drivers is not sound public policy. Rather, it is a policy which could actually be dangerous to drivers and backfire. As has been shown by several research groups, sleep deprivation can be as impairing to driving ability as drinking ethanol. So, important questions will be asked of the FHWA/TRI exercise program. Will the FHWA/TRI exercise program help people drive while sleep-deprived? No, not anymore than it will help people drive while drunk. I understand that FHWA is not trying to quantify or demonstrate specific crash reduction benefits from exercise. However, FHWA must consider the possibility that exercise will increase the probability of crashes by further depriving drivers of sleep with yet another activity that will compete with sleep. The DFAS suggests that virtually all drivers who have not just begun their work week are sleep-deprived. These sleep-deprived drivers are the very people to whom your mobile gyms would cater and they will be subjected to the following negative effects of exercise: (1) Drivers may be tempted to cut back on sleep time to engage in exercise; (2) Several studies have shown that aerobic exercise, itself, increases the impairment of sleep deprived subjects; (3) Exercise too near to bedtime is known to disturb sleep. Finally, promoting exercise for drivers as part of a driver wellness/lifestyle initiative, may be viewed as a policy of "blaming the driver" for the fatigue problem, i.e. "fatigue is a problem for physically unfit drivers". The public may come to view the FHWA/TRI exercise program as an attempt to distract attention from the major problem of sleep deprivation in the trucking industry. Given the results of FHWA's DFAS, sleep deprivation should be considered as a major problem. And, it is a problem that will not go away by spending public and private resources on the FHWA/TRI exercise program. Society might be better served by spending those resources on more and safer rest stops so that drivers could sleep more thereby reducing their impairment due to sleep-deprivation. In any case, promoting exercise for drivers will not answer the question of whether we can, or even whether we should, do anything to reduce sleep deprivation in the trucking industry.

COMMENTS

Dr. Mitler's letter arrested my attention even without a primary research component or a focus on sleep apnea. It exemplifies the effects of public ignorance about excess sleepiness, sleep deprivation, and sleep disorders on public policies about to be implemented right now. Truck drivers are like "point men" for all sleepy drivers. Driving the most miles, in the biggest vehicles, they seem to present the greatest danger. At the same time, their livelihoods depend critically on their ability to drive. On the other hand, a lot of people's jobs depend on driving, if only to commute. It's obvious that autos can cause fatal accidents; you don't need a truck, just a modicum of speed. > Many of us with sleep apnea have had the experience of getting sleepy while driving. How helpful would you find it to have a free gym available every 50 miles or so? The idea would be laughable if some people with control of resources weren't taking it seriously. As Dr. Mitler suggests, it might help a little to have a rest stop convenient for sleeping, at least on long trips. On the other hand, the key measure is to get at the root of the sleep deprivation, whether it be simply "voluntary" sleep restriction or an actual sleep disorder, or both. Dr. Mitler mentions ways that exercise may actually aggravate excessive daytime sleepiness. In the obscure disorder called chronic fatigue syndrome, it is typical for drastically increased fatigue to follow efforts at exercise. I don't know data on effects of exercise on sleep apnea, but I do know from my own experience that I have had a similar reaction. Also, most of us probably experience the limitations on good, alert time imposed by excessive daytime sleepiness. In this context, not only energy but time is lacking for exercise, however important to general health. One may do well to get to work, get home, and take care of one's hygiene and one's bills, without opportunity to do anything else. Many people with sleep disorders have been annoyed by recent publicity emphasizing "voluntary" sleep restriction as the greatest cause of excess sleepiness, when far more serious and treatable diseases like sleep apnea exist at very high prevalence. This perspective not only trivializes the problem as one of bad habits, but also, as Dr. Mitler remarks, works towards "blaming the victim," all too common a practice throughout medicine and public health. At this time, it is worth all our while to keep in mind the recurrent comparison between sleepiness and alcohol intoxication. Whatever one's view of alcoholism may be, one should perceive the invidiousness of the comparison. It looks possible that we may jump from trivializing to criminalizing sleep disorders! Without belaboring the many points, I note the AA advice to "just don't drink" has no parallel for the "sleep drunkenness" of someone with sleep apnea. Now that I have vented my wrath, I am truly interested in hearing some of your opinions!

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