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Asleep at the wheel... how tiredness was targeted as a killer on the road
Sleep expert Professor Jim Horne and his team were the first in the UK to recognise the real problem of falling asleep at the wheel. Sheena Hastings meets him.
BACK in the early 1990s, accident report forms filled in by police didn't even have a question or box to be ticked concerning the sleepiness of a driver at the time of an incident.
At around that time, sleep researchers at Loughborough University began working with Leicestershire and Cornwall police forces, analysing the circumstances of road crashes, and found that a fair chunk of them happened on mostly straight, boring roads in good weather conditions, where the driver was healthy and had not taken avoiding action before going over a white line and into a head-on collision.
These sorts of accident tended to happen between midnight and 6am and 2-4pm – times when the body experiences a natural "circadian dip", and is likely to be sluggish and sleepy.
As a result of research into driver sleepiness by Jim Horne and his team at Loughborough's Sleep Research Centre, the accident report form for all police forces changed to include a box querying whether officers "suspect sleepiness". If the box is ticked, the force can call in the experts like Prof Horne to pinpoint whether the accident does indeed fit the criteria for SRVA (Sleep-Related Vehicle Accident).
It's now reckoned that sleepy drivers cause one in five motorway crashes and one in 10 of all road accidents in the UK.
An SRVA is two-to-three times more likely to be fatal than other types of road crash, and it is likely to involve either a driver who is a shift worker travelling home in the early hours, a truck driver working nights, or a young man under 30, who is driving around with friends and won't take a break.
"I don't think the public were aware of the problem until about 10 years ago," says Jim Horne, who is involved in at least two court cases of multiple deaths due to alleged driver sleepiness at any one time. He was called as an expert witness in the case of Gary Hart, the driver jailed over the Selby rail crash disaster in 2001.
"Police are much more attuned to the signs (of driver sleepiness) than ever before, but Gary Hart never confessed to falling asleep. What made the evidence incontrovertible was that the accident was found to have nothing to do with his vehicle or trailer, or the weather, and all medical reasons could be excluded. He had the opportunity to avoid what he did, but he didn't because he was asleep.
"People are generally aware that they are sleepy but deny they've fallen asleep at the wheel. Once they've had a crash, they deny that they were feeling sleepy.
"Asking a driver several days after a crash if they were sleepy, they have no idea, but we do know that if you fall asleep at the wheel, you do go through a period of sleepiness beforehand, and if you were driving at a time of day when you would normally be tucked up in bed, it's self-evident that you would be sleepy. To deny it is nonsense, and a jury won't believe it."
Prof Horne has been studying sleep for 30-odd years, and his colleague Dr Louise Rayner, who is from Bingley, has been researching alongside him for many of her 18 years in the same field, which brings together biology, physiology and psychology.
Dr Rayner shows me the Sleep Research Centre's sleep lab, where hundreds of drivers each year get into a Ford Fiesta simulator and are monitored in six different ways while they undertake a two-hour virtual drive along a monotonous road with few bends, much like the typical motorway or major road.
After only a few minutes in the simulator, I can feel my own eyelids drooping slightly, following a bad night's sleep and very early morning start. Keeping the car away from the white lines is difficult, I'm far too relaxed, and before I know it I am very close to the rear of another car, just taking avoiding action at the last second.
Dr Rayner tells a few horrifying stories, like the one of the long-haul air stewardess who gets into her car and drives home along motorways while jet-lagged, trapping her ponytail in the sun-roof to stop her had from nodding.
I am then shown a video of a young male driver who spends long hours in his car and often drives late at night. Under instruction to sleep only five hours from 2am-7am the preceding night, the sleepy driver comes to the lab and does his two-hour stint at the wheel.
Six minutes into the drive, the man is nodding off. His eyes are closed for an alarmingly long time before his head nods. The car wanders over the white line, and after eight seconds he has crashed into the barrier on a bend.
"A typical profile is that a driver will feel sleepy after about 20 minutes," says Dr Rayner. "In this case, he fell asleep around 40 times in two hours. When we showed him the video he was appalled, and has certainly adjusted his driving habits and lifestyle since then. All he recalled was having blinked a lot; there was no memory of falling asleep."
In the scientifically-based opinion of both Horne and Rayner, it simply is not safe to drink in the middle of the day and drive afterwards. The body's natural circadian dip in the afternoon means that the effects of even two units of alcohol are much more intense and potentially destructive than drinking the same amount in the evening.
They also say that strategies such as playing loud music and opening a window to keep yourself awake are "a waste of time", as are wearable devices which buzz or beep when the head nods. They recommend a couple of cans of a caffeine-containing energy drink like Red Bull, followed by a short sleep while you wait for the caffeine to kick in. The boost from the caffeine should enable you to drive safely for another hour
or two.
You don't spend decades studying the way sleep contributes to chaos on the road without coming up with a few solid proposals for change.
The Loughborough team's work has brought about changes in Highway Code recommendations on sleepiness and the use of "Tiredness Kills – make time for a break" signs above motorways.
Further measures Jim Horne would like to see considered include an embargo on insurance for newly qualified drivers, so that they are not covered to drive between midnight and 6am for their first year on the road.
He thinks there should be compulsory screening of truck drivers for the sleep disorder sleep apnoea (the sufferer disturbs their own sleep very badly due to heavy "gagging" snoring that wakes them up briefly but frequently during the night, leading to daytime tiredness at the wheel), which Prof Horne says is likely in obese drivers, with large belly and neck due to poor diet and little exercise.
"Such drivers are often in denial about it, because even
if they think there's a problem, they fear losing their licence if they go to the doctor. The irony is that the treatment is very simple and quick, and they can be back on the road in a couple of weeks."
One of his other bugbears is how ordinary drivers are recommended to take a break after two hours, yet truck drivers are allowed to drive continuously for four hours at night, and when they do take a break that "rest" need not include sleep.
"Are truck drivers supposed to be superhuman that they can go for that long without a break, when half the crashes on our motorways at night are sleep-related?"
Sleepfaring – A Journey Through the Science of Sleep by Jim Horne is published by Oxford University Press, 7.99. To order a copy from the Yorkshire Post Bookshop, call 0800 0153232 or go to www.yorkshirepostbookshop. co.uk. Postage and packing cost 2.75.
TRAGEDY ON THE RAILWAY LINE
In the early hours of February 28, 2001, a GNER Newcastle to London King's Cross passenger train hit Gary Hart's Land Rover at 117 mph at Great Heck, near Selby.
He had scrambled to safety after his car and trailer careered off the M62, down the embankment and on to the railway track.
The derailed train met, head on, a freight train coming the other way at 47mph and laden with 1,000 tons of imported coal. Chaos and 10 deaths ensued.
Gary Hart, then 37, insisted to police that he had heard a bang, before the car swerved to the left and veered off the motorway. Police officers found all but one of the 700 parts of the car. They were pieced together, and experts agreed there had been nothing wrong with the vehicle.
With mechanical malfunction ruled out, some other explanation had to be found for why the car had left the motorway at a bend and travelled down the embankment with such catastrophic consequences.
Accident investigation specialists found that tyre marks left by the car and trailer on the embankment showed that no braking had been used as evasive action. The wheels had been rolling freely throughout.
Hart had been screened for drugs and drink and his eyes were tested; nothing was physically wrong with him other than slight injuries. Lead investigator Det Chief Supt Peter Mackay called in Prof Jim Horne.
The professor's conclusion was simple and clear: Hart was a classic case of someone who had fallen asleep at the wheel. To corroborate this, the police team began to build a picture of what Hart had been up to in the hours preceding the crash.
Having at first told officers that he had had three-and-a-half hours' sleep before setting out on the fateful journey from his home at Strubby in Lincolnshire to a job in Manchester, Hart later admitted he had had no sleep in the 24 hours before the crash, except a 30-40-minute nap the afternoon before.
Later, in the trial, Hart described to the court how he could skip meals and go 36 hours without rest. He was convicted of causing death by dangerous driving and given a five-year prison sentence. He was released after two-and-a-half years.
DOZE AND DON'Ts: THE PROFESSOR'S SECRETS OF SUCCESSFUL SLUMBER
Prof Horne does not run a clinic for sleep problems; his department is purely a research centre. However, he is probably one of the most popular men at a party because of his professional expertise. Here he answers frequently-asked questions (many more queries about sleep are answered in his very readable book Sleepfaring – A Journey Through the Science of Sleep):
What is sleep?
It's an altered state of consciousness, as opposed to an unconscious state. It allows the brain to undergo a complex recovery process; as you wind down into sleep, you physically become less aware of your surroundings. Sleep is a regular state of natural rest observed in all mammals, birds and fish, and is characterised by a reduction in voluntary body movement. The circadian rhythms governing the body clock and hormonal and environmental factors all affect your ability
to sleep.
What is a good night's sleep?
Uninterrupted sleep to the point where you wake up refreshed, and are alert for most of the day. Most people probably get more decent quality sleep than they think, averaging seven hours a night. If you are alert and don't suffer from sleepiness during the day, then you are getting enough sleep.
Any tips for the fitful sleeper?
Find out why you feel disturbed – is the source some stress related to work or family, or your bed partner? Work out what it is, do something about it, and leave worries outside the bedroom. Half of the people who think they are insomniacs sleep more than they realise.
What to do to improve a new baby's fitful sleep?
New parents don't appreciate what can be done to improve things. One recipe for disaster is putting baby down for a nap in a darkened room. Put the baby to sleep in daylight – by a window or in the garden, even, and with plenty of normal noise. The baby will have a shorter nap but sleep longer
at night.
Does the much bandied-about notion of "sleep debt" really exist?
No, it's nonsense. In lots of ways we've never had it so good. 100 years ago, people were working long hours in fields and factories, sharing the bed with several other people and maybe bed bugs and lice. We have lovely comfy beds, duvets and central heating. There's no evidence that we get any less sleep than our ancestors.
If we are sleepy during the day, how long is the ideal nap?
No more than 20-30 minutes. Any longer than this and you wake up feeling groggy and hung over. Drink a cup of coffee and settle down for a short snooze straight away. After around 20 minutes the coffee will kick in and wake
you up.
Do we grow in our sleep?
Yes and no. If you measure your height before going to bed and again in the morning, there is usually an extra centimetre or more. Soon after getting up and walking around, it has disappeared again. This is because lying down for a few hours allows the cartilaginous discs between our vertebrae to absorb water, expand a little and lengthen the backbone. Standing up means that our body weight and gravity make the discs compress once more.
Do all animals sleep?
Not only can ducks sleep with one eye shut, the same happens with their brains. Much of what a bird sees in one eye goes to the other side of its brain, which allows it to sleep with the side of the brain connected to the closed eye, while the other side of the brain stays awake.
Dolphins and some other whales have developed this "half-asleep" technique to even more sophisticated degree, so that they can continue swimming, surfacing and breathing. After an hour or so like this the roles reverse, the sleeping side waking up and the other side going to sleep. Like ducks, dolphins sleep with one eye open.
Migrating birds and albatrosses at sea fly for days at a time; it's not yet known whether they sleep on the wing or simply deprive themselves of sleep.
The record for the longest sleeper goes to the South American two-toed sloth, which spends around 20 hours a day asleep, up in the highest branches of the rainforest. Antelopes are fitful sleepers, sleeping in herds, with only those at the centre of the herd able to sleep safely. Being on the perimeter means either no sleep or becoming someone's dinner.
There are no permanent non-sleepers in the animal kingdom, which points towards sleep having essential life-preserving purpose
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