The Enemy Within!

With the declaration of the State of Alarm due to the COVID-19 pandemic, sleep problems in Spain have increased by 30%. Driving without having slept well, either for this reason or for others, such as suffering from sleep apnoea, increases the risk.

Young woman sleeping in car on wheel

Before quarantine began, almost 60% of Spanish residents reported trouble sleeping. That percentage could have reached up to 90% during the State of Alarm, according to the calculations of Dr. Elia Gómez Merino, a pulmonologist and expert doctor in Sleep Medicine at the HLA Vistahermosa Sleep Unit. Increased levels of anxiety and depression, due to lack of control of the situation, can cause insomnia or problems falling asleep.

Risk factor

According to Dr. Gómez, not sleeping correctly generates metabolic, cardiovascular, cognitive, gastrointestinal, and emotional problems. Establishing routines, avoiding exciting substances such as alcohol or caffeine, doing some physical exercise and avoiding long naps are some of the tips for better sleep.

Not having a restful sleep at night negatively influences road safety. Fatigue or daytime sleepiness are behind 30% of traffic incidents, according to the article signed by the late doctor Joaquín Terán (then head of the Sleep Unit of the Burgos Assistance Complex) and other experts in “Archives of Broncho pneumology”. This article indicates that these road accidents have high mortality rates. In general, these are accidents on main roads, which take place in the middle of the afternoon or around midnight and with a single vehicle that goes off the road.

Chronic sleep

This group of experts emphasises that drowsiness is “an important risk factor for traffic accidents”. And they add that those most likely to suffer it are professional drivers (more time behind the wheel), those who work very long shifts, people who sleep less than 6 hours, those who consume alcohol, hypnotics or other medications, and “people who have symptoms related to the presence of undiagnosed sleep apnoea or other sleep disorders.”

Dr. Fernando Masa, head of Pneumology at the San Pedro Alcántara de Cáceres Hospital and a member of SEPAR (Spanish Society of Pneumology and Thoracic Surgery), highlights that a study carried out in the year 2000 of 4,002 drivers, showed that on 3, 6% of Spanish drivers suffered from chronic sleep during the day (about 500,000 people, since that year there were about 12 million people with driving licences in Spain). Of that percentage, 81% acknowledged falling asleep at the wheel at some time, while 25% did so regularly.

Spain, pioneer against apnoea

In 2016, Spain incorporated the European Directive that regulates psychophysical skills to obtain or extend a driving licence; one of them refers to sleep apnoea. However, the country had already included it years before in the General Regulations for Drivers (Annex IV).

From the DGT, a protocol is promoted for the Driver Recognition Centres (CRC) to carry out an individualized assessment. People diagnosed with apnoea must submit a report from the Sleep Unit that treats them, which specifies whether the disease is controlled, especially drowsiness and the type, compliance and efficacy of treatment (CPAP, mandibular advancement device), weight loss, etc.). If everything turns out positive, their driving licence is renewed for one year if they are professional drivers and for three the rest.

However, specialists recommend “carrying out a screening to detect the presence of SAHS” and assess sleepiness by combining the Epworth Scale (a short questionnaire that asks about everyday situations in which a person falls asleep) with the STOP-Bang questionnaire (which includes a series of objective data, such as hypertension, body mass index greater than 35 kg / m2, age, neck circumference, etc.).