According to the National Sleep Foundation (NSF), its 2012 Sleep in America poll is the first to ask transportation professionals-- including pilots, train operators and truck, bus, taxi and limo drivers-- about their sleep habits and work performance. NSF said the poll found a significant number of these workers say that sleepiness has caused safety problems on the job—including 14% of truck drivers who report they have had a "near miss" due to sleepiness.
Among all the workers surveyed, train operators and pilots report the most work day sleep dissatisfaction. Almost two-thirds of train operators (57%) and one-half of pilots (50%) say they rarely or never get a good night's sleep on work nights, compared to 44% of truck drivers and 42% of non-transportation workers. Bus, taxi, and limo drivers report the best work day sleep satisfaction, with about one-third (29%) saying they rarely or never get a good night's sleep on work nights.
"The margin of error in these professions is extremely small,” noted David Cloud, NSF’s CEO. “ Transportation professionals need to manage sleep to perform at their best. As individuals and employers, we need to know more about how sleep improves performance."
The poll results in fact point to sleepiness being common for all workers, according to NSF, which pointed out that roughly one in ten Americans say they are likely to fall asleep at an inappropriate time and place, such as during a meeting or while driving.
The poll included a validated assessment tool used by doctors to determine whether a person is "sleepy." Anyone who suffers from excessive sleepiness should seek professional help to identify underlying conditions, stressed NSF. The study finds that 11% of pilots, train operators, bus, taxi, and limo drivers and 8% of truck drivers as well as 7% of non-transportation workers are "sleepy."
NSF contended that a sleepy transportation worker is far more prone to mistakes—noting that sleepy transportation workers report job performance problems about three times more often and report averaging about 45 minutes less sleep per night than their non-sleepy peers.
Many transportation workers polled by NSF cite their schedule as a major contributor to sleep problems. Almost one-half of train operators (44%) and more than one-third of pilots (37%) report that their current work schedule does not allow adequate time for sleep, compared to about one-fourth of non-transportation workers and truck drivers (27% each) and one-fifth of bus, taxi and limo drivers (20%).
In general, transportation professionals work more varied shifts than other workers, which may play a role in their sleep problems, NSF pointed out, as well as time off between shifts. Non-transportation workers report having an average of 14.2 hours off between shifts, compared to 12.9 hours for pilots; 12.5 for train operators; 12.1 for truck drivers; and 11.2 hours for bus, taxi, and limo drivers.
"Transportation workers experience considerable variability in the days they work, the times they work, and the amount of time off between shifts,” said Patrick Sherry, Ph.D., a sleep researcher and professor from theUniversity of Denver Intermodal Transportation Institute. “This makes it difficult for such workers to maintain regular sleep/wake schedules, which can, in turn, make it difficult for these workers to maintain alertness on the job. Employers should put more effort into designing work/rest schedules that facilitate sleep and minimize workers exposure to irregular, variable schedule changes.”
The poll shows that transportation professionals are taking more naps than other workers. About one in five pilots (20%), bus, taxi and limo drivers (20%), truck drivers (16%) and train operators (16%) say they take 3-5 naps during the work week. Among those who report napping on work days, one-half of pilots (50%), almost one-half of truck drivers (42%), one-third of train operators (33%) and nearly one-fourth of bus, taxi and limo drivers (24%) say they actually napped during work hours in the past two weeks, compared to about one in five non-transportation workers (19%).
"Transportation workers have challenging schedules that compete with the natural need for sleep,” said Thomas Balkin, Ph.D., a sleep researcher from the Walter Reed Army Institute of Research. “While I'm impressed that transportation professionals nap when they are off duty, we need to better understand how to use naps to reduce sleep deprivation and overcome scheduling issues.”
In related news, while sleep-medicine professionals do not generally endorse the long-term use of sleeping pills, a new study casts a darker pall over these medications.
According to a news story by Daniel J. DeNoon posted on WebMD.com, a “provocative new study finds that people who take prescription sleeping pills -- even once in a while -- have a higher death risk than non-users.” The study found that the top third of sleeping-pill users had a 5.3-fold higher death risk as well as 35% higher risk of cancer.
"We are not certain,” study leader Daniel F. Kripke, MD, told WebMD. ‘But it looks like sleeping pills could be as risky as smoking cigarettes. It looks much more dangerous to take these pills than to treat insomnia another way.
The sleeping pills in the study are known as hypnotics. They include newer drugs such as zolpidem (the best known brand name is Ambien) as well as older drugs such as temazepam (the best known brand name is Restoril).
According to the WebMD report, hypnotic sleeping pills actually cause a person to fall asleep. This sets them apart from other sleeping aids, such as the supplement melatonin, which promote sleep through relaxation. Other sleep drugs described as hypnotics by Kripke and colleagues include eszopiclone (Lunesta), zaleplon (Sonata), triazolam (Halcion), flurazepam (Dalmane), barbiturates, and older antihistamines such as diphenhydramine.
Kripke, emeritus professor of psychiatry at the University of California, San Diego, began looking at a possible link between sleeping pills and death risk in 1975. Since then, he and others have published 18 studies that found a link, noted the report.
In their latest study, Kripke's team analyzed 2002-2007 data from a large Pennsylvania health system. They obtained medical records for 10,529 people who were prescribed hypnotic sleeping pills and for 23,676matched patients who were never prescribed sleeping pills. Over an average of 2.5 years, the death rate for those who did not use sleeping pills was 1.2%. It was 6.1% for people with sleeping pill prescriptions. Even those prescribed 18 or fewer sleeping pills a year had a 3.6-fold higher death risk.
Based on these findings, Kripke and colleagues estimate that sleeping pills are linked to 320,000 to 507,000 U.S. deaths each year. "We think these sleeping pills are very dangerous,” he told WebMD. “We think they cause death. We think they cause cancers. It is possible but not proven that reducing the use of these pills would lower the U.S. death rate."
In 2010, as many as 1 in 10 Americans used one of the sleeping pills in the Kripke study, said WebMD. As to whether they can be “that deadly,” WebMD said it consulted experts who noted that Kripke study “certainly raises a red flag.” But they all said that the study -- a look-back study based on patients for whom there is incomplete information -- is not proof that sleeping pills kill.
This "very provocative and interesting study raises a lot of questions," said Nancy Collop, MD, president of the American Academy of Sleep Medicine and director of the Sleep Center at Emory University School of Medicine. "You cannot assume, just because you find this kind of association, that hypnotics are killing people," Collop told WebMD. "People who go on sleeping pills are a sicker population. I know they tried to control for that, but these people simply are not as healthy."
Bryan Bruno, MD, chair of psychiatry at New York's Lenox Hill Hospital, noted that the actual number of people who died in the study is small. "This does not establish any direct cause-and-effect relationship between hypnotic use and death," Bruno told WebMD. "But it does remind us that these drugs have risks, and even mortality, associated with them."
And Michael Yurcheshen, MD, head of the sleep fellowship program and assistant professor of neurology at the University of Rochester, N.Y., told WebMD that much can be missed in a study that looks back at medical records rather than at the patients themselves. "It is implausible to think that so many of these medications, spread across several different drug classes, could have the same biological effects," Yurcheshen said.
It may sound surprising, but sleeping pills are not the best way to treat insomnia, noted DeNoon in his news report. “The drugs clearly help people with short-term trouble getting to sleep. But for most insomnia sufferers, they are not the answer. “ He noted that Kripke and all of the other experts agree that a form of short-term psychotherapy -- cognitive behavioral therapy or CBT -- is surprisingly effective for people with chronic insomnia.