Research in Action South African Journal of Science 98, July/August 2002 319

follows hours of continuous work,19,21 the

Sleep, work schedules and accident time of day at which the work is per-
formed affects the rate of decline in
risk in South African long-haul truck vigilance22 and driving performance.23
The highest incidence of sleep-related
drivers vehicle accidents occurs between mid-
night and 06:00, coinciding with the
a* a a a,b circadian nadir in alertness and a high
C.C. Maldonado , D. Mitchell , S.R. Taylor and H.S. Driver propensity for sleep. 9,24 Most sleepy
drivers are aware that they could be
falling asleep at the wheel, but they have

F
ALLING ASLEEP AT THE WHEEL HAS BEEN increasing evidence that truck drivers do only a modest ability to appreciate the
implicated in 24% of heavy-vehicle road not get sufficient sleep to maintain alert- magnitude of their impairment25 and fail
accidents in South Africa. We compiled a ness.5,6 About 13% of Australian truck to appreciate the imminence of actually
questionnaire relating driving, sleep, and
drivers obtain less than four hours of dropping off to sleep.26
social habits with accident reports. In total,
102 male truck drivers aged 43 ± 8 years sleep per day.7 The risks associated with According to the South African Labour
(mean ± s.d.) with 16 ± 8 years of professional sleep deprivation and fatigue are difficult Relations Act, amended in 1996 and cur-
driving experience participated in the study. to quantify, but it is generally accepted rently under review, truck drivers are
Three-quarters of the drivers reported being that these are major contributors to truck required to take at least half an hour ’s rest
tired at work because of working long hours accidents and impaired performance. after five hours of driving, and must have
(93 ± 30 hours/week) and half reported insuf- Drivers who complain about fatigue also a minimum of nine consecutive hours off
ficient sleep (5.4 ± 2.3 hours/day) as a reason report being involved in dangerous per day. The Act also restricts working to
for their tiredness. While sleeping in their
events on the road.8 Police records on 71 hours per week including overtime.
truck berth, almost eight out of 10 drivers
reported that their sleep was interrupted, accidents involving heavy vehicles, taken However, this restriction is not enforced.
mostly due to noise. Sixty-two per cent of from two roads in South Africa (N1 and Truck drivers are under pressure to drive
truck drivers admitted to nodding off at the N3, Tolcon) between 1992 and 1997, excessively in order to supplement their
wheel, which was associated with interrupted attribute 24% of the accidents to the income,4 and to meet company expecta-
sleep. Drivers who reported signs of sleep- driver having fallen asleep at the wheel. tions. The problem is not unique to South
disordered breathing or other sleep com- These figures, although comparable to Africa: an Australian survey reported that
plaints had an increased likelihood of having those reported in the United Kingdom 38% of truck drivers exceed 14 hours of
a sleep-related accident. These drivers also
and Australia,7,9,10 probably underestimate driving per day on one or more days and
were more likely to have a body mass index
greater than 25 kg/m2, and have a collar size the problem, since there are no patho- close to one third work in excess of 72
larger than 40 cm. In common with drivers gnomic features of a sleep-related acci- hours a week.7 About 17% of Scandina-
elsewhere, many South African long-haul dent, and drivers do not readily admit to vian truck drivers exceed the maximum
drivers work illegally long hours, often to having fallen asleep at the wheel.11,12 daily driving limit of 9 hours per day, as
supplement their income and meet company Sleeping as a co-driver in a moving stipulated by the European regulation.27
deadlines; thus their sleep is restricted and truck, or in a stationary truck at truck Thus, lack of time-off, and consequently
they feel sleepy while driving, all factors asso-
stops, where there is excessive outside less time for sleep, is a large-scale problem
ciated with increased accident risk. Driving
deprived of sleep poses a danger to all on the activity and noise, is not conducive to in the trucking industry.
road; responsible trucking companies should good sleep. Drivers can improve their Poor sleep hygiene and long work
ensure that drivers have adequate rest times sleep efficiency by sleeping in quiet hours are compounded by sleep disor-
in conditions conducive to sleep. Regulation rooms near their travel routes,5 or in a ders, such as sleep apnoea and snoring,
of infringements at the company level would comfortable truck berth. 13 However, which have an unusually high prevalence
contribute substantially to an improvement neither special accommodation nor com- in long-haul truck drivers.28,29 Sleep-disor-
of working conditions, as well as driver fortable berths are available to the aver- dered breathing and the associated sleepi-
performance and well being.
age South African truck driver, where ness have been correlated with a high
sleep also may be compromised by ex- accident frequency in long-haul truck
Long work hours, night work and irregu-
treme ambient conditions, poor timing of drivers30,31 and automobile drivers.19,32,33
lar schedules lead to frequent complaints
trips and unsafe social circumstances. Furthermore, snoring, resulting in exces-
of sleepiness and fatigue by long-haul
The deleterious effects of fragmented sive daytime sleepiness and often related
truck drivers.1–3 In South Africa, the major-
sleep combined with prolonged wakeful- to obesity, also has been correlated with a
ity of goods are transported by road, but
ness interact and accumulate,14 and im- higher subjective sleepiness34 and acci-
research on the status of drivers is scant.
pact negatively on alertness, 6 mood, dent liability.10,35,36
Marcus4 reported that truck drivers in
cognition, motor performance,14–16 and Finally, unlike their colleagues in Europe,
the KwaZulu-Natal Midlands work on
driving efficiency.17 When sleep duration North America, or Australia, South Afri-
average 16 hours per day, and that ap-
is reduced to about five hours or less, the can truck drivers routinely have to con-
proximately 70% spend 2½ days or less at
negative effects on alertness and vigi- tend with hijacking, diesel or cargo theft,
home per month. Internationally, there is
lance, 14,18 and cognitive function and and sex workers who frequent truck
a
Brain Function Research Unit, School of Physiology,
mood15 become evident. Drivers need a stops. Also, inadequate facilities at truck
University of the Witwatersrand, Medical School, 7 York consolidated bout of sleep before begin- stops and inferior truck berths are not
Road, Parktown 2193, South Africa.
b
Department of Medicine, Queen’s University, Sleep
ning a journey,19 particularly since fatigue conducive to sleeping. Given the prob-
Disorders Laboratory, Kingston General Hospital, onset is largely determined by the level of lems that confront all long-haul truck
Kingston, Ontario, Canada.
*Author for correspondence.
fatigue before starting a trip.20 Besides the drivers, the lack of data regarding driving
E-mail: maldonadocc@physiology.wits.ac.za inevitable decline in alertness which schedules, sleep, accident risks and the
320 South African Journal of Science 98, July/August 2002 Research in Action

additional circumstances faced by truck Diet and health. We asked drivers about Fisher ’s Exact tests: r values or P2 values
drivers in South Africa, we developed a tobacco and alcohol use, and whether (with degrees of freedom in brackets) are
questionnaire aimed at identifying prob- they were taking prescribed medication, reported. A 2-tailed P < 0.05 was consid-
lems related to sleep in a sample of recreational drugs, stimulants and/or ered significant. We used a commercially
long-haul truck drivers. We believe that sleeping tablets. They were asked if they available statistical package (Graph-Pad
our study will be the forerunner of further drank coffee, tea or cola drinks to stay Instat). Incomplete responses, or altered
research on sleep-related attributes of awake, or if they ate sweets, potato crisps questions from the pilot study, were omit-
truck drivers in South Africa; other stud- or chocolates often. ted from any analyses. Sample sizes (n)
ies on driver sleepiness have been con- Sleep habits. Quality of sleep during time are indicated in each case.
fined to more affluent societies. off work was rated on a faces-scale using
five elements, depicting someone looking Results
Methods very sleepy to wide-awake. The faces Fifteen of the 33 depot managers con-
We randomly selected 33 out of 218 on the extremities were assigned word tacted thought that sleepiness or fatigue
long-haul trucking companies in and anchors, from no sleep to excellent sleep. was a problem in the trucking industry in
around Johannesburg and discussed the The same scale was used to assess the general. Three managers said that fatigue
aims of this project with depot managers. level of sleepiness at the start and at the was not a problem at all in their company.
Nine companies agreed to allow us access end of a shift — the anchors used were In total, 102 male truck drivers from nine
to drivers in their employ who were avail- from not tired to extremely tired. Drivers companies participated, 47% of them
able at the time of the interviews, which were asked if they were aware of having were between 40 and 49 years old. Demo-
took place between December 1996 and any sleep problems or if their bed part- graphic and work data are given in
May 1997. ner/s complained about their sleep, in- Table 1.
Ethics. All the drivers and depot manag- cluding snoring and signs indicative of Driving experience and schedules. Most
ers who were interviewed gave their in- sleep apnoea, such as witnessed apnoeas drivers (46%) reported that they had be-
formed verbal consent and were assured or waking up gasping for breath. Other tween 10 and 20 years of professional
of total anonymity. Each interview was questions relating to sleep habits included driving experience. Older drivers were
conducted privately without interference the amount of time slept each night more experienced than younger drivers
from management or other drivers. during a long-haul, where they slept and (r = 0.74, P<0.0001, n = 100). P-square
Pilot study. A pilot survey of 22 drivers whether their sleep was interrupted. If statistics showed that 48% of drivers who
from two companies was conducted to their sleep was interrupted, drivers were reported not having experienced a near
assess the feasibility of the study and de- asked to identify what adversely affected accident in the past six months were at
velop the questionnaire. Many of the their sleep, and which disturbance they least 45 years old, while 60% of drivers
truck drivers interviewed were not fully regarded as the biggest problem. If driv- who reported having one or more near
literate in English. To improve the accu- ers were sleepy during their working accident were 39 years old or less (P2(2)
racy of the responses, we reformatted time, possible causes were listed. They 12.19, P = 0.002, n = 94). Of the drivers
some of the questions, made translators also were asked to list practices that they with more than 16 years’ driving experi-
available at interviews, and personally employed to alleviate sleepiness, and ence, only 5% reported having experi-
assisted drivers to complete the question- how often they felt that they were about enced near accidents, and 41% of the
naire, where necessary. to fall asleep when driving. drivers who had less than 10 years’ driv-
Procedure. Drivers were met at their Accident risk. We asked the drivers if ing experience reported a near accident in
company depot before they went on a trip they had been involved in accidents or the past six months (P2(2)7.70, P = 0.02,
or after they had returned. The interview had experienced any potentially danger- n = 95).
included measures of collar size, body ous events on the road because of sleepi- Most of the drivers (63%) drove alone
mass and height. We handed question- ness, and how often they had had a ‘near but 28% drove with a co-driver who
naires to the drivers, which they subse- accident’ as a result of sleepiness in the shared the driving (2-up), and 9% had an
quently completed, either alone, in a past six months. assistant who did not drive. Drivers who
driver training class organized by the Analysis. Data are presented as mean ± drove alone or with an assistant reported
company, or with our assistance. standard deviation, or range or percent- about 2.5 hours more driving per day
Questionnaire. The final questionnaire age, where appropriate. We performed than the 2-up drivers did (P2(3)17.00, P =
contained 41 questions, subdivided into non-parametric analyses using the 0.0007, n = 98). We found that drivers who
four categories, as outlined below. De- Spearman rank correlation, P-square and drove alone were more at risk of experi-
scriptive questions were structured such
Table 1. Demographic and work data.
that the driver had to select answers from
a list. More than one answer was possible
Mean ± s.d. Range n
and drivers were given the opportunity to
include unlisted answers, where appro- Age (yr) 43 ± 8 28–63 100
priate. Body mass (kg) 81.8 ± 18.1 45–143 98
Driving habits. Drivers were asked how Height (m)
2
1.8 ± 0.1 1.6–2.0 94
Body mass index (kg/m ) 26.8 ± 5.2 17–42 91
long they had been driving profession- Collar size (cm) 39.6 ± 3.2 33–48 75
ally. They also gave details of their weekly Professional driving experience (yr) 16 ± 8 2–40 102
work duties and schedules, including Distance driven per day (km/day) 670 ± 300 100–1900 100
average daily distances driven, number of Hours driven per day 11.9 ± 4.1 4–24 102
Hours worked per week* 93 ± 30 30–146 101
days off work in a typical month, and Hours of sleep per working day 5.4 ± 2.3 0–10 100
whether they drove alone or with a co-
driver. *Includes driving, loading or unloading, waiting at border posts and waiting for a load.
Research in Action South African Journal of Science 98, July/August 2002 321

encing a potentially dangerous event Table 2. Reasons given by drivers for disrupted sleep mostly while sleeping in their truck berth en route.
(38%) than those who drove 2-up (14%)
Variable Drivers reporting each problem Drivers who rated the disturance
(P = 0.027, Fisher ’s Exact test, n = 86). (% of total respondents) as the biggest problem
In their descriptions of a typical work- (% of total respondents)
ing day, drivers reported irregular sched-
Noise 64 24
ules, with 72% of drivers starting their Excessive heat/cold 40 8
shift between 04:00 and 08:00, 21% Outside activity 35 7
between 01:00 and 04:00, and 7% between Uncomfortable cab 34 5
Sunlight/outside lights 18 0
18:00 and 01:00. Just over half the drivers Restlessness 16 2
(54%) finished their shifts between 20:00 Stress/worry 15 4
and 01:00 and 44% finished work be- Sex workers 14 <3
tween 12:00 and 20:00. All the drivers said
Other factors cited included vibration of the truck or of passing trucks, breaking and accelerating, worries about hijacking and
that they worked schedules besides their safety, work pressure and uneven road surfaces.
routine times, with 49% working over-
time or with varying schedules, 42% P < 0.001, n = 78). The bigger drivers also sleep also felt that they were not com-
working night shifts in addition to their reported reduced alertness at the start of pletely alert at the start of subsequent
daylight work hours, and 9% were on the trip compared to their slimmer col- trips (P2(2)13.86, P = 0.001, n = 84).
24-hour call. More than half (58%) the leagues (P2(2)7.00, P = 0.03, n = 75). Regu- The main factors that drivers said con-
drivers reported driving at least 10.5 lar snoring was reported by 23% of tributed to a disturbed sleep en route are
hours per day. Those who drove for drivers and another 6% reported snoring listed in Table 2, noise was the biggest and
longer hours (>13.5 hours/day) were less sometimes. Drivers over 40 years were most common disturbance.
alert at the end of their trip than drivers more likely to report snoring or com- Of the drivers who reported never
who drove less than 8.5 hours (P2(3 )11.51, plaints of snoring from a bed partner having interrupted sleep en route, 65%
P = 0.009, n = 85). (P2(3)12.97, P = 0.005, n = 85). Symptoms also said that they did not nod off at
Half the drivers reported that they associated with sleep apnoea were re- the wheel, whereas 57% of drivers who
drove between 500 and 700 km/day and ported by 9% of drivers; they said that always had interrupted sleep felt that
26% reported driving between 700 and they stop breathing or wake gasping for they regularly nodded off at the wheel
1100 km/day. Forty-two per cent of drivers breath at least sometimes. (P2(4)20.33, P = 0.0004, n = 97). Forty-two
reported working within the legal limit Sleep hygiene. Almost all the drivers re- per cent of drivers who always, and 30%
(71 h/week) for this type of work, 22% of ported that they slept less than 8 hours who sometimes, had interrupted sleep
drivers worked between 70 and 100 hours on a typical working day: 61% slept on felt that they had been involved in a
per week, and 36% reported working in average 6 hours or less, including 32% potentially dangerous driving incident
excess of 100 hours per week. Of the driv- who slept an average of 4 hours or less. (P2(2)6.21, P = 0.045, n = 96). Most of the
ers who worked 70 hours or less per week, The majority of drivers said that they drivers with no symptoms of sleep apnoea
the majority (92%) drove alone or with a slept in their truck, at a truck stop or com- (89%) denied having any accidents. Of
non-driving assistant, whereas 32% of mercial area, 3% slept in their cab at the the drivers who reported signs of sleep
drivers who worked more than 100 hours depot or a police station, and 3% slept at apnoea, 44% had been involved in at least
per week drove 2-up (P2(2)7.20, P = 0.03, home. Very few said that they slept at the one sleep-related road accident (Fisher ’s
n = 97). Drivers had between zero and 3 road-side. Of the drivers who drove 2-up, Exact test, P = 0.024, n = 89), and 78%
days off work per week, with an average 34% reported that they slept in the cab reported being less than completely alert
of 4 days off per month. while a co-driver drove. at the start of a trip. By contrast, 68% of the
Over-the-counter stimulants were re- About two-thirds (63%) of drivers re- drivers who reported no signs of sleep
portedly used by 5% of drivers. Almost ported being completely alert at the start apnoea, felt completely alert at the start of
half (43%) said that they smoked ciga- of trips, but 6% who said that they were a drive (Fisher ’s Exact test, P = 0.022, n =
rettes, from 2 to 60 a day (median = 20), sleepy even at the start of trips were more 74). Approximately half (52%) the drivers
and 19% reported smoking cigarettes likely to report having been involved in a who reported snoring admitted to nod-
specifically to help them keep awake potentially dangerous event (Fisher ’s ding off regularly at the wheel, while 22%
while driving. One driver reported smok- Exact test, P = 0.028, n = 82). Drivers who reported that they sometimes nodded off
ing cannabis to alleviate sleepiness, 54% said that when they were not completely (P2(2)7.19, P = 0.028, n = 86). By contrast,
of drivers said that they drank tea, coffee alert at the start of a trip, felt the same at 91% of the drivers who did not snore had
and/or cola drinks to help them stay the end of the trip (P2(2)16.46, P = 0.0003, never had a sleep-related accident (Fig. 1).
awake, and 55% declared that they ate n = 84). When sleeping at home between Other sleep problems reported by 14% of
snacks often to stay awake behind the trips, 86% of drivers said that they ob- drivers included back pain, restlessness,
wheel. tained relatively good sleep. Three driv- insomnia and frequent nocturnal awak-
Physical characteristics and sleep disorders. ers commented that they slept poorly on enings.
Fifty-eight per cent of the drivers were the first night after a drive but that their Sleep-related accidents. The majority of
overweight (body mass index (BMI) sleep improved with subsequent nights drivers said that they had not experi-
>25 kg/m2). Collar size correlated with off. enced a sleep-related accident or a recent
BMI (Spearman rank r = 0.87, P < 0.0001, Nearly eight out of 10 drivers said that near accident (Table 3). The majority
n = 73), and this was greater than 40 cm they had interrupted sleep when they (88%) of those drivers who said that they
in 43% of drivers. The bigger drivers stopped to sleep during a trip; it was did not nod off at the wheel (71% of all
(BMI > 30 kg/m2) were more likely to sometimes a problem for 51% of drivers drivers) also said that they had never ex-
report that they snored than the slimmer and always a problem for another 25% of perienced a potentially dangerous event,
ones (BMI < 25 kg/m 2 ) (P 2 (2)13.53, drivers. Those who reported disturbed while 46% who regularly nodded off on
322 South African Journal of Science 98, July/August 2002 Research in Action

nearly three-quarters cited long working

hours as a reason for their sleepiness;
other reasons for feeling sleepy are given
in Table 5.

Discussion
Many of South Africa’s long-haul truck
drivers are at risk of being involved in
traffic accidents because of their dis-
turbed sleep. Restricted and disturbed
sleep during a trip contributed signifi-
cantly to the drivers not being completely
alert at the start of trips, and therefore
more likely to nod off behind the wheel.
Fig. 1. Percentage of drivers who reported snoring sometimes and always, and those who reported no snoring, Those drivers who reported nodding off
as a function of the number of accidents experienced in the past. Prevalence of snoring correlated directly with
having experienced a sleep-related accident (Fisher’s Exact test, P = 0.014, n = 82).
at the wheel also tended to have been
involved in a recent near accident. Other
factors cited as contributing to sleepiness
Table 3. Percentage of drivers who reported driving incidents.
included the heat, which was cited by half
None (% of total One (% of total More than one (% of
the drivers, just under half blamed the
respondents) respondents) total respondents) monotony of the road and work, and a
minority found that loading or assisting
Road accident*
#
85.2 11.9 2.9 with a load made them sleepy when they
Recently experienced near accident* 84.2 7.4 8.4
next drove. Similar causes of sleepiness
*Refers to a sleep-related accident or near accident. have been cited during long-distance
#
Refers to a near accident experienced in the past six months. driving elsewhere.7,10,21
About three-quarters of the drivers in
the road (29% of all drivers) said that they few minutes and 7 hours, 49% continued our survey reported that the long hours
had experienced a potentially dangerous driving and opened a window, 16% con- contributed to their sleepiness, over half
event (P2(2)9.28, P = 0.0096, n = 95). The tinued driving and increased auditory of them claimed to work more than 70
frequency of nodding off at the wheel was stimuli (they turned on the radio or made hours per week — the upper legal limit in
positively related with having had a re- it louder, or talked or sang), 11% said that South Africa. Drivers who drove with a
cent near accident (Fisher ’s Exact test, P = they moved their body in the seat or co-driver tended to work more hours per
0.042, n = 93). turned on the air conditioner. Apart from week than drivers who drove alone, and
Sleepy drivers. General factors that driv- sleeping when they stopped, 48% said were not able to sleep properly in a
ers considered made them feel tired at that they stopped for tea or coffee, 35% to moving truck. These extended work
work are given in Table 4. When asked exercise or stretch their legs (from 2 to 45 hours are comparable to those that truck
what they did to cope with sleepiness minutes), 28% to change drivers, and 29% drivers work in other countries. 7,8,27
while driving, 55% of drivers said that stopped (from 20 to 60 minutes) to rest Working long hours leaves little time for
they stopped for periods of between a without sleeping. Of all the drivers, relaxation and sleep; the average amount
of sleep our drivers obtained was too
Table 4. Proportion of drivers who indicated the source (and incidence) for their tiredness at work.
short for optimal alertness,6,37 especially
Variable Never/seldom a problem Sometimes a problem Often/always a problem
for the third who slept for 4 hours or less
(% of total respondents) (% of total respondents) (% of total respondents) per day while on duty. These sleep
durations are comparable to those of
Disturbed sleep 46 16 38 long-haul drivers studied in other coun-
Not enough sleep 25 28 47
Stress/worry 65 18 17
tries.5,7,8 Automobile drivers who reported
Poor health 75 17 8 reduced sleep before a long-distance
vacation trip scored higher subjective
Other factors cited included financial worries, domestic problems or bad working conditions. sleepiness ratings than those who slept
adequately before their trip.19 Sleep depri-
Table 5. Reasons given by drivers for sleepiness while driving. vation strongly impairs cognitive func-
tion and, to a lesser extent, motor tasks,
Variable Drivers reporting each problem (% of total respondents) with mood being affected the most.15 With
regard to driving performance, speed and
Long work hours 74
Hot stuffy cabs 49 position on the road also are impaired by
Monotonous work/roads* 46 sleep deprivation.17,25
#
Poor sleep quality in the truck berth 29 The irregular hours reported by our
Time of day – particularly night driving 19
Loading or assisting loading between trips 11
drivers also may have contributed to their
Other factors† 6 reduced alertness. Other studies show
that drivers who work irregular sched-
*The recommended speed limit of 80 km/h was considered tiring, as well as always taking the same route.
#
ules report greater subjective fatigue,
Either because the mattress was too thin or it got too hot because of the proximity of the engine to the mattress.
†
Other factors cited included poor daytime sleep, being at work constantly, working overtime, sitting and driving, and oncoming
physiological stress and performance
lights. decrements than those on a regular
Research in Action South African Journal of Science 98, July/August 2002 323

schedule. 1 Regularizing sleep–wake who reported being less than completely same situation in more affluent and
schedules improves alertness.38 Most of alert at the start of a trip had a higher BMI better-regulated countries. An additional
our drivers reported starting work before than those who did not. So other drivers challenge in the South African context is
08:00 and almost a quarter said that they who participated in our study who had a the higher risk of crime, which was not
started before 04:00. These early starting high BMI and collar size may have had specifically addressed in this study, but
times exacerbate sleepiness and reduce sleep apnoea without being aware of their may contribute to drivers being unwilling
performance, physiological activation, condition or its consequences for driving. to take a break at the road-side or a rest-
subjective alertness and behavioural From our sample, age and driving expe- stop if they become sleepy. Improved
efficiency.19,39,40 Driving is not as proficient rience showed an inverse relationship, as contact and monitoring by cell phone and
in the early hours of the morning as it is expected. The younger drivers, with less electronic devices may provide better
later in the day.23 Being able to sleep driving experience, were more likely to security.
during the night hours improves calm- have had a near accident in the past six Interventions that might attenuate the
ness of sleep, ease of falling asleep, being months. Our findings confirm previous risk of long-haul driving accidents in
able to sleep through, and reduces the reports which show that accident fre- South Africa, according to our data, in-
number of awakenings. 41 Feyer and quency decreased with increased age clude reducing the working week and
Williamson22 showed that drivers who (and driving experience),10,35,36,44 and par- increasing the time available for relax-
take rest times when the propensity to ticularly that sleep-related accidents were ation and sleep, air conditioning of cabs,
sleep is higher manage fatigue better. more frequent in younger drivers.9,45 The the provision of quiet sleeping accommo-
Our results confirm those of others and driving experience acquired with age ap- dation near safe truck stops,5 reschedul-
emphasize the importance of being alert pears to equip the driver with better skills ing driving trips towards more regular
at the start of a trip.20 to avoid potential accident situations.1,17 hours of work with later starts to trips,
Most of the drivers’ sleep was inter- Although just about two-thirds of our and treatment of sleep-disordered breath-
rupted and for a variety of reasons. The drivers were aware of falling asleep be- ing and obesity where they occur. Regula-
most common causes were noise (the hind the wheel at least sometimes, only tion of infringements at the company
biggest problem for just under a third of about half reported stopping driving, level would contribute substantially to an
drivers), followed by extremes of temper- even for a few minutes, when they felt improvement of working conditions, as
ature, outside activity, uncomfortable sleepy. Reyner and Horne26 reported that well as driver performance and well
cabs, light, restlessness, stress or worries. drivers making serious sleep-related being. Driving while deprived of sleep
The presence of a sleep disorder was errors were aware of being sleepy well poses a danger to all road users.
likely to have exacerbated sleepiness in a beforehand. Even experienced drivers We are indebted to the trucking companies and the
substantial subgroup of drivers. One commit more errors as subjective sleepi- drivers who participated in this study. Thanks to
quarter of our sample was clinically ness worsens.26 Techniques employed Fiona Baker for valuable technical assistance and
obese, almost a third of our drivers re- by our drivers to alleviate sleepiness advice, and to her and to David Makoa, Jackie
Mahlaba, Muzi Maseko, Lennox Nqobo and Simone
ported that they snored, and approxi- included caffeine consumption, increas-
Glassom for assisting with interviews.
mately one in 10 had apnoeas or woke ing ventilation in the truck, and listening
Received 21 November 2001. Accepted July 2002.
gasping for breath. to the radio. Although these techniques
Sleep disorders such as habitual snoring provide some relief, the improvement in 1. Brown I.D. (1994). Driver fatigue. Hum. Factors 36,
and sleep apnoea mar sleep,35 increase alertness is only transient, and the effects 298–314.
2. Williamson A.M., Feyer A-M., Coumarelos C. and
sleepiness,19,36 and reduce attention.31 There on driving performance negligible.1,46,47 Jenkins T. (1992). Strategies to Combat Fatigue in the
is a strong direct association between Taking stimulants is apparently less of a Long Distance Road Transport Industry. CR 108.
sleep apnoea in drivers, and the risk of problem in South African truck drivers Federal Office of Road Safety, Canberra.
than in Australian drivers.7 3. Rosa R.R. (1995). Extended workshifts and exces-
traffic accidents.31–33 A previous study on
sive fatigue. J. Sleep Res. 4, 51–56.
long-haul truck drivers showed that Although subjective data have limita- 4. Marcus T. (1996). AIDS: Interpreting the Risks — A
drivers with sleep-disordered breathing tions, the best information drivers have Case Study of Long Distance Truck Drivers. Commu-
had a twofold higher accident rate than about sleepiness comes from their own nity Agency for Social Enquiry, University of
Natal, Pietermaritzburg.
those without sleep-disordered breath- self-knowledge12 and it is their personal 5. Mitler M.M., Miller J.C., Lipsitz J.J., Walsh J.K. and
ing.30 Also, obese drivers reported unin- experience of sleepiness and fatigue that Wylie C.D. (1997). The sleep of long-haul truck
tentionally falling asleep more often and ultimately will determine whether they drivers. N. Engl. J. Med. 337, 755–761.
6. Gillberg M. (1995). Sleepiness and its relation to
presented a twofold higher accident rate adopt good sleep hygiene and fatigue the length, content, and continuity of sleep.
than non-obese drivers.29 Most relevant to reduction strategies.1,21 Since our drivers J. Sleep Res. 4, 37–40.
us, drivers of heavy goods vehicles who were unlikely to obtain any immediate 7. Hartley L.R., Arnold P.K., Penna F., Hochstadt D.,
benefit from misrepresenting informa- Corry A. and Feyer A-M. (1997). Fatigue in the West-
snore every night are more sleepy,34,36 and
ern Australian Transport Industry. Part One: The
have a higher accident liability than those tion, there was no incentive for them to principle and Comparative Findings. Institute for
who do not.35 In previous studies, neck provide false information. Clear trends Research in Safety and Transport RN 117. Western
circumference ranked highest as an inde- emerged from the subjects, each of whom Australia Department of Transport.
8. Arnold P.K., Hartley L.R., Corry A., Hochstadt D.,
pendent predictor of snoring,42 and corre- was unaware of any other driver ’s re- Penna F. and Feyer A-M. (1997). Hours of work
lated well with the apnoea/hypopnoea sponses. and perceptions of fatigue among truck drivers.
index.43 Our results confirm that drivers In conclusion, we have found that Accid. Anal. Prev. 29, 471–477.
9. Horne J.A. and Reyner L.A. (1995). Sleep related
who snore tend to be older, more likely to long-haul truck drivers in South Africa vehicle accidents. Br. Med. J. 310, 565–567.
have a larger collar size, and a higher BMI are at significant risk of having a sleep- 10. Maycock G. (1996). Sleepiness and driving: the
and are more likely to report signs of sleep related road accident. The factors that put experience of UK car drivers. J. Sleep Res. 5,
apnoea. These drivers are more likely to 229–237.
all drivers at risk, and those that distin-
11. Leger D. (1994). The cost of sleep-related acci-
have experienced an accident, and to guish the driver with exaggerated risk, dents: a report for the National Commission on
nod off behind the wheel. The drivers are similar to the factors that induce the Sleep Disorders Research. Sleep 17, 84–93.
324 South African Journal of Science 98, July/August 2002 Research in Action

12. Horne J.A. and Reyner L.A. (1995). Driver sleepi- 24. Folkard S. (1997). Black times: temporal determi- 35. Maycock G. (1995). Driver Sleepiness as a Factor in
ness. J. Sleep Res. 4 (suppl. 2), 23–29. nants of transport safety. Accid. Anal. Prev. 29, Car and HGV Accidents. Transport Research Labo-
13. Kecklund G. and Åkerstedt T. (1997). Sleep in a 417–430. ratories 169. Crowthorne, Berks.
truck berth. Sleep 20, 614–619. 25. Arnedt J.T., Wilde G.J.S., Munt P.W. and MacLean 36. Mycock G. (1997). Sleepiness and driving: the
14. Dinges D.F., Pack F., Williams K., Gillen K.A., A.W. (2000). Simulated driving performance experience of heavy goods vehicle drivers in the
Powell J.W., Ott G.E., Aptowicz C. and Pack A.I. following prolonged wakefulness and alcohol UK. J. Sleep Res. 6, 238–244.
(1997). Cumulative sleepiness, mood disturbance consumption: separate and combined contribu- 37. Benoit O. (1984). Homeostatic and adaptive roles
and psychomotor vigilance performance decre- tors to impairment. J. Sleep Res. 9, 233–241. of human sleep. Experientia 40, 437–440.
ments during a week restricted to 4–5 hours per 26. Reyner L.A. and Horne J.A. (1998). Falling asleep 38. Manber R., Bootzin R.R., Acebo C. and Carskadon
night. Sleep 20, 267–277. whilst driving: are drivers aware of prior sleepi- M.A. (1996). The effects of regularizing
15. Pilcher J.J. and Huffcutt A.I. (1996). Effects of sleep ness? Int. J. Legal Med. 111, 120–123. sleep–wake schedules on daytime sleepiness.
deprivation on performance: a meta-analysis. 27. Häkkänen H. and Summala H. (2000). Sleepiness Sleep 19, 432–441.
Sleep 19, 318–326. at work among commercial truck drivers. Sleep 23, 39. Åkerstedt T. (1984). Work schedules and sleep.
16. Gillberg M. and Åkerstedt T. (1998). Sleep loss and 49–57. Experientia 40, 417–422. .
performance: no ‘safe’ duration of a monotonous 28. Stoohs R.A., Guilleminault C. and Dement W.C. 40. Åkerstedt T. (1995). Work hours, sleepiness and
task. Physiol. Behav. 64, 599–604. (1993). Sleep apnea and hypertension in commer- the underlying mechanisms. J. Sleep Res. 4, 15–22.
17. Lenne M.G., Triggs T.J. and Redman J.R. (1998). cial truck drivers. Sleep 16, S11–S14. 41. Åkerstedt T., Hume K., Minors D. and Waterhouse
Interactive effects of sleep deprivation, time of 29. Stoohs R.A., Bingham L., Itoi C., Guilleminault C. J. (1997). Good sleep — its timing and physiologi-
day, and driving experience on a driving task. and Dement W.C. (1995). Sleep and sleep- cal sleep characteristics. J. Sleep Res. 6, 221–229.
Sleep 21, 38–44. disordered breathing in commercial long-haul 42. Stradling J.R. and Crosby J.H. (1991). Predictors
18. Kecklund G. and Åkerstedt T. (1995). Effects of truck drivers. Chest 107, 1275–1282. and prevalence of obstructive sleep apnea and
timing of shifts on sleepiness and sleep duration. 30. Stoohs R.A., Guilleminault C., Itoi A. and Dement snoring in 1001 middle aged men. Thorax 46,
J. Sleep Res. 4, 47–50. W.C. (1994). Traffic accidents in commercial 85–90.
19. Philip P., Ghorayeb I., Stoohs R., Menny J.C., long-haul truck drivers: the influence of sleep- 43. Hoffstein V. and Mateika S. (1992). Differences in
Dabadie P., Bioulac B. and Guilleminault C. (1996). disordered breathing and obesity. Sleep 17, abdominal and neck circumferences in patients
Determinants of sleepiness in automobile drivers. 619–623. with and without obstructive sleep apnoea. Eur.
J. Psychosom. Res. 41, 279–288. 31. Teran-Santos J., Jimenez-Gomez A., Cordero- Respir. J. 5, 377–381.
20. Williamson A.M., Feyer A-M. and Friswell R. Guevara J. and Cooperative Group Burgos- 44. Hamelin P. (1987). Lorry driver’s time habits in
(1996). The impact of work practices on fatigue in Santander. (1999). The association between sleep work and their involvement in traffic accidents.
long distance truck drivers. Accid. Anal. Prev. 28, apnoea and the risk of traffic accidents. N. Engl. J. Ergonomics 30, 1323–1333.
709–719. Med. 340, 847–851. 45. Summala H. and Mikkola T. (1994). Fatal accidents
21. Feyer A-M. and Williamson A.M. (1995). In Fatigue 32. Pakola S.J., Dinges D.F. and Pack A.I. (1995). among car and truck drivers: effects of fatigue,
and Driving: Driver Impairment, Driver Fatigue and Review of regulations and guidelines for com- age, and alcohol consumption. Hum. Factors 36,
Driving Simulation, ed. L. Hartley, chap. 3, pp. mercial and non-commercial drivers with sleep 315–326.
25–32. Taylor & Francis, London. apnoea and narcolepsy. Sleep 18, 787–796. 46. Reyner L.A. and Horne J.A. (1997). Suppression
22. Feyer A-M. and Williamson A.M. (1995). Work and 33. Young T., Blustein J., Finn L. and Palta M. (1997). of sleepiness in drivers: a combination of caf-
rest in the long-distance road transport industry Sleep-disordered breathing and motor vehicle feine with a short nap. Psychophysiology 34, 721–
in Australia. Work and Stress 9, 198–205. accidents in a population-based sample of 725.
23. Lenne M.G., Triggs T.J. and Redman J.R. (1997). employed adults. Sleep 20, 608–613. 47. Reyner L.A. and Horne J.A. (1998). Evaluation of
Time of day variations in driving performance. 34. Hanning C.D. and Welsh M. (1996). Sleepiness, ‘in-car’ countermeasures to sleepiness: cold air
Accid. Anal. Prev. 29, 431–437. snoring and driving habits. J. Sleep Res. 5, 51–54. and radio. Sleep 21, 46–50.