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To Sleep – Perchance to Drive (8/26/13)

August 26, 2013

Safe to Drive?

The FDA has recently requested sleeping pill manufacturers conduct more “morning after” driving tests.  Getting sleep is important, but remaining sleepy while operating a vehicle is another story.

They should have spoken to the police in New Zealand.

Recently police in Hamilton received an odd call.  A woman called about her friend.  She thought the woman might be driving while asleep.

The call was provoked by an incident ten months before, where the same woman drove for  a long time while “unconscious”. This time the police duly tracked her driving from her home in Hamilton to a beach house in Mount Maunganui where she had previously lived.  She frequently texted during the 190 miles.  When officers arrived at the beach house she was so deeply asleep she could not be aroused.

When she awoke she remembered nothing of the drive.

Her texts were “incomprehensible.”  The night of the drive she’d taken sleeping pills.

New Zealand police have requested an “urgent order” that she not be allowed to drive, and that “medical advice” be sought regarding retaining her license.

For a moment, let’s imagine what American authorities might do.

Next, let’s ask a few questions:

Is It Possible To Drive and Text While Asleep?

People sleep and drive.  People sleep and text.  They do both actions far more often under the influence of sleeping pills, which often produce something closer to “pre-coma” than normal sleep.

It remains to be seen if the woman in New Zealand did indeed sleep, text, and drive 190 miles “safely.”

What Has the FDA Done About Sleeping and Driving?

It has withheld approval of sleeping pill suvorexant because some of the people on the drug fell asleep during driver simulation tests.  The lower dose they might approve – 10 mg – may not be high enough for the drug’s manufacturer to consider putting it on the market.

And the FDA recently cut the allowable dose of zolpidem (ambien) to 5 mg – in women only.  It also requested the dose of intermezzo, lower dose zolpidem aimed at people waking in the middle of the night, should also be cut by half in women (I’ve written about intermezzo problems in this space.)

Besides Weird Driving, Do Sleeping Pills Increase Accidents?

It’s been known for many years people who use sleeping pills have much higher rates of accidents and fatalities.  If the data from Dan Kripke’s group is to be believed, they also die more often of heart disease and cancer.

Researchers and drug companies also point out – correctly – that lack of sleep itself also leads to increased fatalities and accidents.

Is It Possible to Be Asleep and Awake at the Same Time?

Popular views of sleep as a “light switch” that gets turned on and off are sadly wrong:

1. People often can’t tell the difference between being awake and being asleep.

A study in Detroit had people slumber into stage 1 sleep for ten minutes.  When awoken, half said they were awake – the whole time.  Even when shown videotapes and EEG monitoring, many continued to say they had been asleep.

2. People often fall asleep and don’t know it.  Microsleeps of less than three seconds happen frequently through the workday.  That includes while driving.  Torbjorn Akerstedt showed many Swedish train drivers falling asleep while piloting their trains – including with their eyes wide open.

3.  A large part of sleep medicine – parasomnias – involve wake-like behaviors in sleeping people.  For many of them, no memory traces are left.

Isn’t Insomnia a Major Risk for People’s Health?

Absolutely.  Lack of sleep can lead to heart disease, stroke, depression, anxiety, poor performance – and accidents.

Yet it’s problematic to think of insomnia as an “illness” rather than a symptom.  Insomnia is a symptom with literally hundreds of causes. Some common ones are social and environmental conditions (like noisy nights and hot summer weather) and drugs (even sleeping pills can cause insomnia – especially when people become addicted to them.)

By portraying insomnia as a singular “condition” or “disorder”, drug companies have obscured the many causes and effects  of insomnia. Instead many market their sleeping pills as the “simple treatment” that can cure what is usually a complicated malaise (with the usual “ask your doctor” cop out at the end of the advertisement.)  Sleeping pills can cause death. Much of the time, “simple” insomnia is best treated without any drug at all.

What Can the FDA Do in the Future?

Ask two really important questions of all new drugs:

1. Is the new stuff better than drugs already on the market?  The FDA usually only considers the “letter of the law” – is the new compound better than placebo? If older drugs exist that are already off patent, cheap, and twice as effective as the new compound, why give blanket approval to new stuff only slightly better than placebo? Under present procedures, the FDA must do just that.

2. Recognize “effects” and “side effects” are  co-equal and should be considered before new drugs are approved.

In this example, if a drug helps people sleep, fine.  If it causes them to sleepdrive or pull vodka out of the freezer, that’s another story (the latter argument was used by a Calgary driver to explain a recent DUI. He claimed zolpidem had made him pick up a bottle of vodka from the freezer and down it all.)  You usually need to look at a larger context. Does the overall symptom reduction compare favorably with the sleepiness, accidents and illnesses provoked by the new compound?

Bottom Line

Sleep and Wake are two sides of the same coin.  Human consciousness is rarely “totally” awake or asleep.  Our alertness and awareness exist on a long, meandering continuum that changes minute by minute.

To consolidate wakefulness you need effective sleep.  To sleep well you generally need lots of physical and mental activity in the daytime.

Good sleep usually occurs with much functional physical and mental daytime activity.  Effectiveness and productivity require good sleep.

It’s really hard to get one without the other.
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration,healthy without health insurance, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news

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