As a society we have made significant progress in the battle against those who drink and drive, the use of seatbelts and child safety seats and we are starting to clarify the issues on the use of cell phones (to be covered in a future column). A topic that is far more insidious and receiving much less attention is the subject of this column - Driving While Drowsy (DWD).

What is it? Simply put, it is the driving while over-tired and falling asleep at the wheel and is one of the most under-recognized public health problems in our society and with more and more people working longer hours and days, it is more likely to become a still greater menace. Sadly, this serious public health issue is seen as an acceptable risk, rather than a danger akin to drunk driving. Let's put the problem in perspective. I want to warn you, though, that the figures you are about to read are monstrous. The National Highway Traffic Safety Administration conservatively estimates that 100,000 police-reported crashes are the direct result of driver fatigue each year. These crashes cause over 1,550 deaths and 71,000 injuries as well as $12.5 billion in loss due to diminished productivity and property loss (these are 1995 figures).

According to the National Sleep Foundation (NSF), an independent, science-based, nonprofit, voluntary health organization dedicated to promoting awareness regarding the importance of good sleep and sleep disorders and the public consequences of sleep deprivation, a 2001Sleep in America poll , found that more than one-fourth of the respondents (27 percent) said they have driven drowsy to or from work at least a few days a month, 12 percent drove drowsy a few days a week, and 4 percent said they drove drowsy every day or almost every day! In a 1999 NSF poll, 60 percent of parents with children who drive living in the household, said they have not discussed the dangers of falling asleep at the wheel. In a 2002 poll, nearly all respondents (96 percent) agreed that information about driving while drowsy should be included in tests for a driver's license.

On the New York State level, 40 percent of fatal crashes over the last several years were attributed to drowsy and fatigued drivers drifting off the road on the New York State Thruway. Startling as these figures are, most researchers and traffic safety officials believe that these statistics under-report the problem for several reasons. State reporting practices are inconsistent - six states still do not have a proper or any code for "sleepiness" on their crash report forms. Additionally, practices for reporting vary from state-to-state. There is no test to determine sleepiness such as there is for intoxication, e.g., "Breathalyzers." Drowsiness may play a role in crashes attributed to other causes such as alcohol (a study of researchers in Australia found that being awake 18 hours produced impairment equal to a blood alcohol concentration of .05 and .10 after 24 hours; .08 is generally deemed legally drunk. There is little or no police training to identify drowsiness as a factor contributing to a crash. Clinical studies indicate that people are notoriously inaccurate in recognizing when they have nodded-off for a short period of time, so-called microsleeps (if at 60-mph you close your eyes for only one second, you have traveled 88 feet). Finally, there are many over-the-counter medications that cause impaired driving ability and cause drowsiness and these are often overlooked in the reporting of statistics related to sleepy drivers.

Part two of Driving While Drowsy will be covered in the next issue. The recognition and possible areas of remediation as well as a brief driving drowsy quiz you can take will be part of this column.