Earlier school start time can mean more car crashes

Start changing your child's sleep schedule back to school time. - JR

Teens with an earlier school start time get into more car crashes which can indicate these teens are sleep deprived due to the earlier school start time.

A new study suggests that teen drivers who start class earlier in the morning are involved in significantly more motor vehicle accidents than peers with a later high school start time. The results underscore the importance of the "Awake at the Wheel" campaign of the National Healthy Sleep Awareness Project.

Results show that the weekday crash rate for teen drivers during the 2009 to 2010 school year was about 29 percent higher in Chesterfield County, Va., where high school classes began at 7:20 a.m., than in adjacent Henrico County, Va., where classes started at 8:45 a.m. Similar results were found for the 2010 to 2011 school year, when the weekday crash rate for 16-17 year old teens in Chesterfield County was about 27 percent higher than for those in Henrico County. In contrast, there was no difference in adult crash rates in the two counties for either year. A secondary analysis evaluating the causes and types of crashes found that Chesterfield County adolescents had a significantly higher rate of run-off-road crashes, which is a common feature of drowsy driving accidents.

"There are more and more data suggesting that insufficient sleep is common in our teens and that early high school start times are a contributor to teens' reduced sleep," said principal investigator and lead author Dr. Robert Vorona, associate professor in the Division of Sleep Medicine at Eastern Virginia Medical School in Norfolk, Va. "Insufficient sleep appears to have deleterious consequences such as decrements in mood and increased risk taking, impaired academics and increased crash rates."

The results corroborate the findings of a previous study by Vorona's team that evaluated teen crash rates from 2007 to 2008. Results of the current study are published in the November issue of the Journal of Clinical Sleep Medicine.

"When high school classes begin early in the morning, we ask teens to shine when their biological clock tells them to sleep," said American Academy of Sleep Medicine President Dr. Timothy Morgenthaler, a national spokesperson for the Healthy Sleep Project. "Many do not get adequate sleep as a result. Smarter school start times, that are more consistent with sleep needs, will improve students' safety, overall health, mood and academic performance."

Recently the Healthy Sleep Project launched the "Awake at the Wheel" campaign to increase public awareness of the risks of drowsy driving. More details are available athttp://www.projecthealthysleep.org.

The study involved an analysis of data provided by the Virginia Department of Motor Vehicles. During both school years there were more than 520 motor vehicle accidents involving teen drivers in Chesterfield County and more than 320 teen crashes in Henrico County.

The American Academy of Sleep Medicine recommends that adolescents get a little more than nine hours of nightly sleep for optimal health and daytime alertness during the critical transition from childhood to adulthood. The AASM advises parents and local school boards to work together to implement high school start times that allow teens to get the healthy sleep they need to meet their full potential.

A new report from the AAA Foundation for Traffic Safety estimates that drowsy driving may cause 328,000 motor vehicle accidents and 6,400 fatal crashes on U.S. roads each year. Previous data analysis by AAA also shows that the prevalence of drowsy driving crashes is highest among drivers between the ages of 16 and 24 years.

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Insomnia raises risk of fatal injury

Having insomnia can raise a person's risk of death by motor vehicle and other fatal injuries.

New research suggests that insomnia is a major contributor to deaths caused by motor vehicle crashes and other unintentional fatal injuries. The results underscore the importance of the "Sleep Well, Be Well" campaign of the National Healthy Sleep Awareness Project.

Results show that the risk of unintentional fatal injury increased in a dose-dependent manner with the number of insomnia symptoms present. People with all three symptoms of insomnia were 2.8 times more likely to die from a fatal injury than those with no insomnia symptoms, even after adjusting for potential confounders such as alcohol consumption and daily use of sleep medication.

Among the three insomnia symptoms, difficulty falling asleep appeared to have the strongest and most robust association with fatal injuries. People who almost always had difficulty falling asleep were more than two times more likely to die from a motor vehicle injury (hazard ratio = 2.40) and more than 1.5 times more likely to die from any fatal injury (HR = 1.66) than people who never had trouble initiating sleep. Further analysis found that self-reported difficulty falling asleep contributed to 34 percent of motor vehicle deaths and eight percent of all unintentional fatal injuries, which could have been prevented in the absence of insomnia.

"Our results suggest that a large proportion of unintentional fatal injuries and fatal motor vehicle injuries could have been prevented in the absence of insomnia," said lead author Lars Laugsand, MD, PhD, postdoctoral fellow in the department of public health at the Norwegian University of Science in Technology in Trondheim, Norway. "Increasing public health awareness about insomnia and identifying and treating people with insomnia may be important in preventing unintentional fatal injuries."

The study results are published in the November issue of the journal Sleep.

"Healthy sleep is essential for physical health, mental well-being, and personal and public safety," said American Academy of Sleep Medicine President Dr. Timothy Morgenthaler, a national spokesperson for the Healthy Sleep Project. "Sleep is a necessity, not a luxury, and the promotion of healthy sleep should be a fundamental public health priority."

Earlier this year the Healthy Sleep Project launched the "Sleep Well, Be Well" campaign to increase awareness of the importance of sleep as one of the three pillars of a healthy lifestyle. More details are available at http://www.projecthealthysleep.org.

The study involved that analysis of population-based survey data from 54,399 men and women between 20 and 89 years of age. Cause of death was identified using a national registry. During the 13-year follow-up period there were 277 unintentional fatal injuries, including 169 deaths from falls and 57 deaths from motor vehicle crashes.

According to the Centers for Disease Control and Prevention, there are more than 126,000 unintentional injury deaths in the U.S. each year, making it the fifth leading cause of death. There are more than 33,000 motor vehicle traffic fatalities and more than 27,000 unintentional fall deaths annually, as well as 29.3 million emergency department visits related to unintentional injuries.

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Social skills could suffer after head injuries in children

A study shows that after children have a head injury, their social skills could suffer.

Serious head injuries may be linked to children's lack of ability to interact with others, a new study indicates.

Researchers looked at a group of children who had suffered a traumatic brain injury three years earlier, most often in car crashes.

Those with lingering damage in the brain's frontal lobes had lower-quality social lives, according to the Brigham Young University (BYU) study in the April 10 issue of the Journal of Head Trauma Rehabilitation. The study did not determine a cause-and-effect relationship, only an association.

"The thing that's hardest about brain injury is that someone can have significant difficulties but they still look OK," neuropsychologist and study author Shawn Gale said in a university news release.

"But they have a harder time remembering things and focusing on things as well, and that affects the way they interact with other people. Since they look fine, people don't cut them as much slack as they ought to," Gale explained.

The researchers found that the problem may be something called cognitive proficiency, a combination of short-term memory and brain-processing speed.

"In social interactions we need to process the content of what a person is saying in addition to simultaneously processing nonverbal cues," study co-author Ashley Levan, a doctoral student at BYU, said in the news release. "We then have to hold that information in our working memory to be able to respond appropriately. If you disrupt working memory or processing speed, it can result in difficulty with social interactions."

Attention-deficit/hyperactivity disorder also affects the frontal lobes, and previous research has shown that therapy can improve working memory in children with ADHD.

"This is a preliminary study, but we want to go into more of the details about why working memory and processing speed are associated with social functioning and how specific brain structures might be related to improve outcome," Gale said.

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Study: Drivers with ADHD are at a greater risk for crashes

A study shows that drivers who have ADHD are significantly more likely to be in a serious car crash.

Drivers with attention-deficit/hyperactivity disorder (ADHD) are nearly 50 percent more likely to be in a serious car crash, a new study suggests.

Further, men with ADHD can dramatically decrease their risk of traffic accidents if they take medication for their condition, the Swedish researchers said.

"This study confirms the importance of treatment and medication for adults with ADHD as well as teens," said Ruth Hughes, CEO of Children and Adults With Attention-Deficit/Hyperactivity Disorder, a patient advocacy group.

"The core symptoms of ADHD include problems with sustained attention and impulsivity, which can have an adverse effect on driving safely," said Hughes, who was not involved in the new study. "All drivers with ADHD need to responsibly manage their treatment to reduce driving risks."

The new findings come from a review of more than 17,000 people in Sweden with ADHD, aged 18 to 46. Researcher Henrik Larsson and colleagues at the Karolinska Institute used databases to track whether the patients had been in a car accident between 2006 and 2009, and if they had a prescription for ADHD medication at the time.

Overall, having ADHD increased a man's risk of a traffic crash by 47 percent and a woman's risk by 45 percent, the researchers found.

They then investigated the role of medication in preventing crashes by determining whether people involved in a wreck had filled a prescription for ADHD medicine within the previous six months.

Dr. Lenard Adler, a professor of psychiatry at NYU Langone Medical Center in New York City, said despite a broad definition of taking medication, "men [who were] treated substantially lowered their risk for accidents."

Access to ADHD medication reduced men's risk of a car wreck by 58 percent compared to men who did not take medication, according to the study. Women with ADHD, however, did not receive any significant benefit from medication in terms of car crashes.

The study, published online Jan. 29 in the journal JAMA Psychiatry, did not receive any funding from drug companies.

Breaking down the numbers further, the researchers estimated that between 41 percent and 49 percent of the car accidents involving men with ADHD could have been avoided if they had been taking their medication as prescribed.

About three out of five children with ADHD carry the disorder with them into adulthood, according to the Anxiety and Depression Association of America. That amounts to about 8 million adults living with ADHD.

Previous research with ADHD patients in virtual-reality driving simulators found that they are more likely to speed, drive erratically, tap the breaks and accelerate into potential accidents, said Adler, who did not take part in the Swedish research.

"These sorts of things are more likely in individuals with ADHD than in people without ADHD," he said. "This is an important study that follows up on ... some of the shorter-term studies that have shown that people with untreated ADHD have more accidents."

Although the study found an association between having ADHD and greater risk of serious car crashes, it did not establish a cause-and-effect relationship.

Adler said, however, that you don't necessarily have to fear getting into a car with a driver who has ADHD.

"With ADHD, there tend to be two groups: a group that is distracted and impulsive, and a group that drives fine. Not everyone with ADHD has this problem, but a substantial percentage does," he said. "This study highlights another reason why getting an appropriate diagnosis for adult ADHD is important, and why it is important to get the ADHD treated."

People with ADHD also should to take extra precautions that will help them keep their mind on the road, Hughes said.

"In addition to medication, this can mean limiting distractions like texting or cell phones, fewer passengers, breaking up monotonous drives with frequent breaks and being more vigilant about driving defensively," she said.

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Insufficient sleep epidemic

Insufficient sleep is a huge public health issue and is becoming an epidemic leading to negative health outcomes. This article tells you the possible negative health outcomes from insufficient sleep, how much sleep you should be getting, and general sleep hygiene tips.

Sleep is increasingly recognized as important to public health, with sleep insufficiency linked to motor vehicle crashes, industrial disasters and medical and other occupational errors. Unintentionally falling asleep, nodding off while driving, and having difficulty performing daily tasks because of sleepiness all may contribute to these hazardous outcomes. People experiencing sleep insufficiency also are more likely to suffer from chronic diseases such as hypertension, diabetes, depression and obesity, as well as from cancer, increased mortality and reduced quality of life and productivity. Sleep insufficiency may be caused by broad scale societal factors such as round-the-clock access to technology and work schedules, but sleep disorders such as insomnia or obstructive sleep apnea also play an important role. An estimated 50 to 70 million U.S. adults have sleep or wakefulness disorder. Notably, snoring is a major indicator of obstructive sleep apnea.

In recognition of the importance of sleep to the nation's health, Centers for Disease Control and Prevention surveillance of sleep-related behaviors has increased in recent years. Additionally, the Institute of Medicine encouraged collaboration between the CDC and the National Center on Sleep Disorders Research to support development and expansion of adequate surveillance of the U.S. population's sleep patterns and associated outcomes. Two new reports on the prevalence of unhealthy sleep behaviors and self-reported sleep-related difficulties among U.S. adults provide further evidence that insufficient sleep is an important public health concern.

Sleep-related unhealthy behaviors

The Behavioral Risk Factor Surveillance System survey included a core question regarding perceived insufficient rest or sleep in 2008 (included since 1995 on the Health Related Quality of Life module) and an optional module of four questions on sleep behavior in 2009. Data from the 2009 survey's Sleep module were used to assess the prevalence of unhealthy sleep behaviors by selected sociodemographic factors and geographic variations in 12 states. The analysis determined that among 74,571 adult respondents in 12 states, 35.3 percent reported fewer than seven hours of sleep during a typical 24-hour period, 48.0 percent reported snoring, 37.9 percent reported unintentionally falling asleep during the day at least once in the preceding month, and 4.7 percent reported nodding off or falling asleep while driving at least once in the preceding month. This is the first CDC surveillance report to include estimates of drowsy driving and unintentionally falling asleep during the day. The National Department of Transportation estimates drowsy driving to be responsible for 1,550 fatalities and 40,000 nonfatal injuries annually in the United States.

Self-reported sleep-related difficulties among adults

The National Health and Nutrition Examination Survey introduced the Sleep Disorders Questionnaire in 2005 for participants 16 years of age and older. This analysis was conducted using data from the last two survey cycles (2005 to 2006 and 2007 to 2008) to include 10,896 respondents aged older than or equal to 20 years. A short sleep duration was found to be more common among adults ages 20 to 39 years (37.0 percent) or 40 to 59 years (40.3 percent) than among adults aged older than or equal to 60 years (32.0 percent), and among non-Hispanic blacks (53.0 percent) compared to non-Hispanic whites (34.5 percent), Mexican-Americans (35.2 percent) or those of other race/ethnicity (41.7 percent). Adults who reported sleeping less than the recommended seven to nine hours per night were more likely to have difficulty performing many daily tasks.

How much sleep do we need? And how much sleep are we getting?

How much sleep we need varies among individuals but generally changes as we age. The National Institutes of Health suggests that school-age children need at least 10 hours of sleep daily, teens need nine to 10 hours, and adults need seven to eight hours. According to data from the National Health Interview Survey, nearly 30 percent of adults reported an average of less than or equal to six hours of sleep per day from 2005 to 2007. In 2009, only 31 percent of high school students reported getting at least eight hours of sleep on an average school night.

Sleep hygiene tips

The promotion of good sleep habits and regular sleep is known as sleep hygiene. The following sleep hygiene tips can be used to improve sleep:

* Go to bed at the same time each night and rise at the same time each morning.

* Avoid large meals before bedtime.

* Avoid caffeine and alcohol close to bedtime.

* Avoid nicotine.

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Sleepy teenagers are at greater risk of pedestrian accident

Pedestrian teenagers who are sleepy due to sleep deprivation are more likely to be hit by a car.

Sleep-deprived teens are at increased risk of getting hit by a vehicle while crossing the street, researchers warn.

The new study included 55 teens, aged 14 and 15, whose ability to cross a street safely was tested in a virtual-reality setting in the Youth Safety Lab at the University of Alabama at Birmingham.

Teens whose sleep was restricted to four hours the night before the test took more time to begin crossing a street, crossed with less time before contact with vehicles and had more close calls than those who slept for eight and a half hours. Four hours of sleep is half the amount considered adequate for 14- and 15-year-olds.

The sleep-deprived teens averaged 2.2 close calls or hits by vehicles on 25 of the simulated street crossings, compared with 1.42 close calls or hits for those who had an adequate amount of sleep, according to the study, which was published Sept. 3 in the Journal of Adolescent Health.

The findings suggest that teens' ability to cross the street safely can be compromised after only one night of too little sleep, said study author Aaron Davis, a psychology post-doctoral fellow in the Leadership Education in Adolescent Health program at the university.

"It is easy to discount the idea that this loss of sleep could have a significant impact if it occurs rarely, but this study demonstrates that adolescents' safety could be put at risk after just one night of inadequate sleep," Davis said in a university news release.

An estimated 8,000 teens aged 14 and 15 require medical attention for pedestrian-related injuries each year in the United States, according to background information in the news release.

Study co-author David Schwebel, director of the Youth Safety Lab, said the study "demonstrates the importance of sleep for human functioning. Our results show clearly that insufficient sleep influences adolescent safety; without sufficient sleep, they are inattentive, distractible and poor decision-makers."

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The Dangers of Sleep Apnea

This article discusses what exactly sleep apnea is and why it is a dangerous condition.

If you suffer from sleep apnea, you may be unaware of the fact. Sleep apnea is a sleep disorder whereby a person suffers from repeated interruptions to their sleep because of breathing difficulties. The patient typically stops breathing for around 10 seconds before the brain is forced to wake up and kick start the breathing process again. Most people with sleep apnea also snore heavily.

Symptoms of Sleep Apnea

Unless your partner has told you that you snore and stop breathing on a regular basis, look out for the following signs of sleep apnea:

• Sore throat in the morning
• Feeling very tired when you wake up
• Waking up repeatedly during the night gasping for air
• Anxiety and depression
• Men may suffer from impotence

Snoring is No Joke

Snoring is often considered to be a bit of a joke, but the reality is that excessive snoring and associated sleep apneais no joke whatsoever. It is bad for your health and extremely bad for your close relationships—most people find it very taxing to sleep with a partner who snores heavily and wakes up multiple times per night snorting and gasping for oxygen. Even if you felt romantic when you first went to bed with them, after a few nights of snoring and snorting, the passion will soon be long gone.

Health Problems Caused by Sleep Apnea

Sleep apnea is linked to a number of serious health problems, including:

• Weight gain –   Gaining weight can lead to snoring, which in turn can exacerbate sleep apnea. Unfortunately, poor sleep affects the endocrine system and the body is more likely to crave sugary and starchy foods, which leads to weight gain. So it all becomes a vicious circle.
• Heart disease – People with sleep apnea are much more likely to suffer from heart attacks. This could be as a result of low oxygen levels, but research has also found that some sleep apnea patients have irregular heart rhythms.
• Strokes – Having sleep apnea puts you at greater risk of suffering from a stroke because oxygen deprivation has an effect on blood flow through the arteries and brain.
• High blood pressure – Frequent patterns of interrupted sleep can play havoc with the endocrine system, which affects blood pressure. Oxygen deprivation can also cause spikes in blood pressure.
• Type 2 diabetes – There is no definite link betweensleep apnea and type 2 diabetes, but at least 80% of diabetic patients suffer from sleep apnea.

Other Complications of Sleep Apnea

Aside from the serious health problems listed above, sleep apnea can be hazardous to your wellbeing in a number of other ways. As we have already mentioned, sleep apnea can lead to impotence in men, which is unlikely to be great for your long-term relationships. Excessive tiredness can also contribute to problems at work, or in extreme circumstances, directly cause car accidents if you end up falling asleep whilst driving.

If you suspect you may be suffering from sleep apnea, it is a good idea to make an appointment for a full medical check-up. Ignoring the problem is not likely to make it go away, whereas if you seek treatment, you could be on the way towards obtaining a CPAP breathing machine and seeing a significant improvement in your sleep patterns.

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Driving Recommendations for People with Obstructive Sleep Apnea

Driving risks associated with obstructive sleep apnea are discussed as well as recommendations to make for safer driving.

Obstructive sleep apnea is a sleeping disorder linked to various other health problems. It can also cause daytime sleepiness that makes driving risky.

A series of guidelines and recommendations were just released by the American Thoracic Society about sleep apnea and driving risks.

The committee said patients with sleep apnea should follow their treatment plan, which usually means sleeping with a continuous positive airway pressure (CPAP) machine.

The committee said stimulant medications were not recommended for patients with sleep apnea to reduce driving risks.

The guidelines, written by a committee of American Thoracic Society doctors led by Kingman P. Strohl, MD, director of the Center for Sleep Disorders Research at Case Western Reserve University, updated the guidelines that had been published in 1994.

The primary recommendation of the committee was that patients diagnosed with obstructive sleep apnea be treated with CPAP to reduce driving risk.

CPAP involves wearing a mask to bed. The mask includes tubes that force air into the patient's lungs to ensure they always are receiving oxygenated air continuously.

"Treatment of obstructive sleep apnea improves performance on driving simulators and might reduce the risk of drowsy driving and drowsy driving crashes," the authors wrote.

The committee reviewed the most up-to-date research on sleep apnea and driving risk and then wrote a series of conclusions and recommendations.

They concluded that the risk of a car accident was two to three times higher for individuals with obstructive sleep apnea compared to those without sleep apnea.

However, this risk varies by the person, by the severity of their illness and by whether they are receiving treatment.

"Up to 20 percent of crashes that occur on monotonous roads can be attributed to sleepiness, and the most common medical cause of excessive daytime sleepiness is obstructive sleep apnea (OSA)," Dr. Strohl said in a prepared statement.

The committee regarded a "high-risk driver" as one who had "moderate to severe daytime sleepiness and a recent unintended motor vehicle crash or a near miss attributable to sleepiness, fatigue or inattention."

However, the researchers said there is not evidence to support restricting the driving privileges of patients who have sleep apnea if they have not had a car accident or near miss.

The committee also noted that patients who are evaluated, treated and educated about sleep apnea in a timely manner are less likely to become one of the statistics in car crashes related to sleepiness caused by obstructive sleep apnea.

The first recommendation made by the committee was that doctors who are screening patients suspected of having sleep apnea ask the patient about daytime sleepiness and drowsiness while driving.

Asking about drowsy driving or sleep-related car accidents allows doctors to warn potentially high-risk drivers about the dangers of driving with untreated sleep apnea.

If doctors suspect a patient has obstructive sleep apnea and is a high-risk driver, a sleep study should be done as soon as possible.

Doctors should also determine how severe the patient's sleep apnea is, if they have it, and assess how well the patient is following their treatment plan.

While CPAP is recommended for patients diagnosed with sleep apnea, the use of stimulant medications is not recommended for reducing driving risks.

Doctors should also regularly check in with their patients about driving risks, daytime sleepiness and their adherence to their treatment plan.

CPAP machines require a prescription and can cost anywhere from $150 to over $5,500, though most insurance plans will cover some or all of the expense. CPAP masks range from $30 to $200.

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Taking catch-up naps may reduce risk of crashing for young tired drivers

An Australian study shows that young drowsy drivers who take catch-up naps reduce their risk of crashing.

Young drivers who get behind the wheel while drowsy run a higher risk of getting into car crashes, but Australian researchers have found that not catching up on missed sleep on weekends puts them in even greater danger of having an accident at night.

"This is another challenge to adolescents that comes with lack of sleep," said Dr. Flaura Winston, co-scientific director and founder of the Center for Injury Research and Prevention at Children's Hospital of Philadelphia.

"You have to be ready, body and mind, to drive," she said. "If you are exhausted, you are neither ready body nor mind."

In tackling this challenge, both parents and the community have roles to play, said Winston, who was not involved with the study.

"This is a safety concern," she said. "If the teen doesn't get enough sleep, then they are at increased risk for crashes, so parents need to step in."

Parents should see their role as one that helps their teenager stay safe without being controlling, Winston explained. They can encourage their children to get more sleep, and provide rides at night to ensure that their teens are not driving exhausted.

One of the more positive things parents can do is let their teen sleep late on the weekends, Winston noted. "Teens need their catch-up sleep," she said. "They do need to sleep late on the weekends."

There are also social factors that limit teens' sleep. For example, many high schools start classes very early, cutting into students' sleep time, Winston pointed out. "Studies have shown that later school start times are better for adolescents," she said.

Not only do they start school early, but "they have long days. They have sports, after-school activities and studying, so there are things that are way beyond the family that put these teens at risk when it comes to driving," Winston said.

The report was published online May 20 in the journal JAMA Pediatrics.

To look at what role sleep plays in teen car crashes, a team led by Alexandra Martiniuk, an associate professor at the George Institute for Global Health in Sydney, collected data on more than 20,000 drivers aged 17 to 24.

The investigators found that those who said they slept six or fewer hours a night had a 21 percent higher risk of having a car accident than those who got more than six hours of sleep.

Moreover, those who got less sleep on the weekends had a 55 percent increased chance of having a single-car accident, where the car drifts or swerves off the road, they added.

Most accidents (86 percent) happened between 8 p.m. and 6 a.m., the researchers noted.

"Sleeping six hours a night is enough to put young drivers at significant risk of having a car crash. With work, study and social commitments, especially on weekends, it is easy to miss out on the extra hours of sleep we need," Martiniuk said in a statement.

More than 3,000 people die every day in car crashes around the world -- that's more than 1.3 million car-related deaths a year, with between 20 million and 50 million people injured or disabled, the researchers noted.

In the United States alone, it is estimated that 20 percent of all car crashes are the result of drowsy driving, which adds up to 1 million crashes, 50,000 injuries and 8,000 deaths a year, the study found.

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