their perspectives and considerable expertise today. we are calling this forum awake, alert, alive because every driver must be awake and alert to operate a vehicle safely. sufficient, good-quality sleep to alertness and human performance, and yet so many americans are on the road lack ofsly impaired by sleep. we know this is a serious problem. yet current estimates may only point to the tip of the iceberg. numbers tell us that driver fatigue may directly 100,000te to over roadway crashes annually but these are only police reported crashes. there's some estimates that put the number of drowsing driver crashes at over a million a year. conservative estimates suggest a thousand people are killed annually in these crashes while other data indicate that the as 7500 livesany are lost each year due to drowsy driving. experts agree that the number of fatalities

officialed attributed to fatigue underestimated. there is no roadway test. fatiguedness. we do not have a fatigue-alyzer as we do a breathalyzer. state reporting practices are inconsistent and there's little or no police training in identifying drowsiness as a crash factor. self reporting is unreliable. do know. we any resulting loss of life is tragic, needless and preventible. a drowsy driver can be a deadly driver. even one night losing two hours of sleep is sufficient to significantly impair our a little bit -- attention, reaction time, decision making can all be significantly reduced by 20% to 50%, and driving in this condition, that could mean not brake lights in front of us or not seeing the traffic light turning red. fatigue alone can be deadly. it also multiplies the adverse effects of other forms of

pairment that lead to crashes such as drugs, alcohol and distraction. every other form of impairment may be exacerbated when the basic requirement for sleep is disrupted. we've identified sleep as contributory in crashes across all safety modes. the agency has issued more than 200 safety recommendations in such diverse areas as research, vehicle technologies, the treatment of sleep disorders and hours of scheduling policies for commercial and bus drivers. but most people drive cars. they operate personal vehicles. for most of us, there are no hours of service or rest rules. we have to rely on our own experience for knowledge of fatigue and its effects. unfortunately, our personal experience especially as it relates to self-diagnosing

fatigue is typically inaccurate. in january 2013, the ntsb investigated a collision involving three passenger vehicles. the collision happened at about morning.he a nurse at a local hospital was driving home after more than 18 duty.on she departed her lane, crossed median and entered a nosh lane traveling against the flow of traffic. her car then struck another vehicle, pushing it into one lane over. this vehicle was struck again from behind by another car. one driver was fatally injured and the nurse was transported to a hospital where she was treated for her injuries. she had fallen asleep. shifts nineed night years and was familiar with the challenges of her schedule. and yet her inverted work schedule, along her extended time since waking, and in this hours,early 16 contributed to her falling asleep at the wheel. forum offers us an opportunity to focus on the

dangers of drowsy driving and countermeasures that could mitigate the dangers of fatigue. we will identify what we know we don't, only the most on drowsy driving can lead to the most effective counter-measures. we will examine medical continues that can lead to fatigue. we will hear about the challenges faced by young, novice drivers. discuss irregular work schedules and how the same 24/7e we depend on for our modern lifestyle and life-saving services are vulnerable to taking to the road in a fatigued state. will hear of a variety of strategies to reduce the risks driving crashes and perhaps just as importantly, we will provide a public setting to of drowsye dangers driving. for wake and alert driving to norm, the expected awareness and education must

prominent, preventive role. this forum is for all of us. doctors, lawses, enforcement officers and security guards, driving home after their night shift. workerr the utility driving into the night to fix the power lines after a storm. student, startled startled ato alertness by the blare of home as he drives home from an exam. it is for any of us who have driven with too little sleep. happen literally in the blink of an eye. it is our hope that this forum a national toward the safetybout issues involving drowsy driving. dr. janet price who organized this forum. >> thank you. for safety purposes, please note the nearest emergency exit. youcan use the rear doors came through. to enter the conference centers,

emergency doors on either side of the stage up front. so,ou've not already done please silence your electronic devices. today's forum has been designed get to the heart of several topics relevant to drowsy driving. we will begin with an destruction -- introduction and theussion of the scope of problem. we will have panels discussing workplace factors, concerns of novice drivers and a group of advocatesway safety will join us during the panel. have panels we will discussions health issues and roadway factors. the final panel of the day will counter measures. each panel will open with panelists.y our staff and panelist bios, as

agenda, are available on the forum website, ntsb.gov/drowsydriving. attendees or others who wish to forit written comments inclusion in the forum's archived materials may do so until november 7. submissions to directly address topic areasof the and should be submitted an attachedly as document. for those of you joining us in our conference center, there are of lunch options in the plaza. up one floorlators and walk straight ahead. agenda are the available in the lobby and on the forum website. your cooperation in helping us keep on schedule

and breaks.s we will have panel photos in the morning, for the morning panels morning break, and for the afternoon panels during the break.on i'll now turn to our first technical chair, mr. dennis collins, to introduce the first panel. mr. collins. >> thank you, dr. price. presenters, when speaking, please push the button on the microphone. light indicates the microphone is on. microphoneg your close and press the button to turn it off when you are done speaking. the first panel covers an introduction and the scope of the problem. our panelists is the director of unit for experimental psychiatry at the university of pennsylvania's pearlman school medicine, and brian teft,

at the aaasociate safety.or traffic >> good morning. thank you for inviting me to speak at this important meeting. i'm going to begin by setting the stage for the biological that make drowsiness it so terrifically dangerous when we drive. next slide, please. remind thoseng to listening and looking at these slides are that, as near as we now, all animals need to sleep. and humans are no exception. sleep is an essential part of our health and survival. have to do it on a daily basis and we have to achieve sleepy sleep and we need that is of adequate duration to ensure we don't have andntrolled drowsiness sleepiness during the daytime. next slide, please. remindere is just a that when we don't receive

fallate sleep, we tend to asleep very rapidly. going down on the left shows that the longer we're awake, the more rapidly we will and the more rapidly we will transition into a stage of sleep where we cannot recover even if we're alerted. remindsh on the right us that the depth and intensity an inherrenp is part of the sleep system attempting to recover the brain terrific need for sleep and to give it the sleep that is essential. speakers will talk about what happens to drowsiness and waking functions when you depth ofeive that sleep. next slide. why don't people obtain enough sleep? we now know in our modern lifestyle is that substantial portions of the population, shown in the yellow bars on the

achieve even seven hours sleep a night. the bulk of the evidence in the sleep field points to the fact that once large segments of the are sleeping less than seven hours, we get an excessiven sleepiness, accident-related sleepiness, as well as obesity, diabetes, cardiovascular problems. so there are significant safety consequences to chronically undersleeping, and segments oflarge the population undersleeping. us graph on right reminds that a major part of why people sleep ist adequate work and travel. work,pend extra time at extra time getting up early to get to work, and while those may seem like normal, routine activities, they've become so problematic that they're eating the time that one should

spend sleeping and they force us compress our sleep down into a shorter and shorter period work week, and then people make a great effort to try to recover on the weekend but that recovery is usually inadequate. two days of extra sleep usually not reverse repeated cycles of five days of inadequate sleep. so chronic sleep restriction is an inherent part of modern jobs for many people and that is where one of the sources of problems are. you'll hear other speakers talk about sleep disorders, et cetera. slide, please. we know this is occurring in the brain. many people think it's all right because it's a willful event, that somehow it got anything to do with biology and you can will yourself to overcome it and people get away with it without crashing so they that it doesn't matter if you're tired, it's ok to drive, you'll be safe, you'll

because you have a good intention. but intentions, as we know, won't really prevent this biology from turning on. this is just a brain scan showing that major areas of the the frontal part of the brain, the associative the brain and the upper back part of the brain, the areral core of the brain, all showing changes in activity metabolically in the brain that consistent with the brain falling asleep while we try to awake and drive so there's a terrific change going to that we cannot easily control and yourself in the face or turning the radio up or chewing will not prevent this from occurring and if it does prevent it, it's no more than a second or two. it won't actually have a lasting benefit. it is not the same as sleep. sleep.in needs obviously you can't sleep and drive at the same time. please.de, would you just click on this video.

hallmark features of sleep -- falling asleep lids wills that the eye close. we all know this. eyelids muscles of the losing tone due to the pressure for sleep. in other words, sleepiness and drowsiness when we're driving our brain blink on and off and not pay attention but it also causes muscle relaxation, including the muscles of the eyelids. so the muscles will come down. truck simulator, not a real driving experience. this virginia in tech film that she's falling and the head dips back and eyelids close because of loss of muscle tone. eyelids open, the eyeballs roll back and reorient in the head. happen in a second. you can see she almost ran off the road in the simulator.

know drowsy we driving is. so many people have done it in --ir lives that we dent have don't have any trouble recognizing that's what's occurring but we don't appreciate how staggeringly dangerous this is. example in the laboratory. all we need to do is click on this. in yellow, this young lady is working on a beenance task but she's sleep deprived, and on the right side, she's working on the vigilance task and isn't sleep deprived. over time, the graph on the left shows initially she walks ok but we sleep deprive her, halfway along the graph, up go in attention and up go the increase in eyelids drooping. we're measuring these by analysis. on the right-hand side, she may be bored but she can work for falling end without asleep. so people who think that drowsy

driving's due to just being drive or badu scenery are wrong. it's due to you not sleeping enough. you're is driving when not interested in what you're looking at, but you're able to awake. sleepiness and drowsiness is the pressure of the brain trying to whileyou to go to sleep you're doing a vigilance task called driving. testsw that among all the looked at on the effects of sleep loss, attention, in particular, and alertness, are number one effects of sleep loss. by far they occur more profoundlyand more than effects on memory and reasoning and many other areas. please.de, and that's best illustrated by complicated slide. heart beats.se these are reaction times of pressing ay alert button. each quick beat is a fast reaction time.

you can see there's nothing wrong. displaying them as heart beats to give you the point that go brain is steady as you here. click on the top one and shut it off and click on the bottom one. here's the drowsy driver equivalent. they start off driving. they're just fine. but as they go along, they start to the have long lapses and minute.ear that in a there's one. that's your eyelids down. you're not responding. you're not responding. you're not monitoring. now you're back again. now you're going to go again. this is the hallmark feature of sleep loss. on that and look on the right. we know where in the brain that seeut on the right you can the instability of these response times in the sleepy driver, whereas the alert driver above on the right is steady as you go. and this is that fighting peopleess that experience driving down the road. by the time you're doing that, you are at grave risk. really shouldn't be behind the wheel. you should pull off.

you should get some sleep, get rest. you should have slept adequately heare you drive and you'll others say that. but this is the grave risk of driving. just because you get away with a mile or two doesn't mean you won't have an thentrolled sleep attack in next minute or half hour and they'll come more and more -- repeated more and more and more severe. this illustrates, the lower you have hadws plenty of sleep and you don't have the lapses. and movee sleep away you to six hours or four hours sleep a night, you see many more lapses and they're getting longer. completely unpredictable. if you could predict the moment you're going to fall asleep, you ok, i'll do something to correct that. but you cannot do that. against yours this will at a time when you suddenly justze, oh, my god, i was

awake and i realize i just slept this last period of time. operate a motor vehicle when that happens. you're begging for a crash. next slide. in fact, it takes no morning a two-second lapse of attention at 60 miles an hour with a drift,gree angle of that's just enough loss of steering control. just let your muscles relax on closing yourwheel, eyes for two seconds, you can be completely out of lane in two seconds, off and the road in four seconds. takesn easily see how it very little of this lapse tendency, these microsleeps, to in grave danger. not to mention if you're in close traffic trying to stop in time. of my messages will be, this isn't just highway phenomenon. drowsy driving, slowed reaction times, are occurring in people adequate sleep in the city. they're occurring in density

traffic. by the federale government have shown that within the washington, d.c. instrument cars, they find drowsiness occurring all over the metropolitan area we know these are high-risk events occurring even in crowded traffic. next slide. this is just an illustration of the dynamics of this drowsiness what you see in the upper graph is that you don't have any from drowsiness when you're getting normal sleep at night, on the left. without sleep,ht those lapses increase. secondwent actually a night without sleep, they go even higher. the same thing happens if you're getting, say, four or five hours sleep a night. they get progressively worse day after day. you can see the segment of the flight midnight 8:00 a.m. to 9:00 a.m., and you the high rate of motor

vehicle crashes related to falling asleep at that time. you can see they ramp up at that time. mean you're safe in the middle of the day if you haven't slept the night before. you can absolutely have a drowsy driving crash at any time of day but this just shows the dynamic in northstudy done carolina of people falling aleep and you're at particularly high danger risk through the night and especially after thening, often sun is up. people think they're safe because the sun is up. you.won't protect light is not powerful enough to override the pressure for sleep at night. awake and shift workers have a very high rate of these crashes but by no means the only group in society that have these crashes. males do at a high rate. the elderly can have them in the middle of the afternoon which is they will fall asleep crashing. next slide, please. done in the laboratory shown in the left and

right. left shows the less sleep you get every night, the more lapsing you have every day. going up. on the right are how people felt about their sleepiness. see, clicku should on that, please. what you should see in the middle graph here is at the istom graph, is performance lapsing, is getting worse linearly across time, but our sense of how we're doing is not changing. means you cannot tell how dangerous you are driving. you need to pay attention to your behavior. are actually suddenly discovering your head's falling closingur eyes are uncontrollably, you just almost drifted out of lane, you need to road.f the slap isn't a, you need to yourself or turn the radio on, to get off the road. one challenge is how to do that

but then the highway best way to go is prevention. don't get on the road sleep deprived. get adequate sleep before you get on the road and plan your trip effectively to make sure adequate breaks, et cetera. this slide makes the point that and when we work at night are awake in the daytime, even when we're trying to sleep eight and staythe daytime awake at night, we're at a greater risk for lapses of because we're awake at biological night and that puts enormous pressure on the brain go to sleep. we're programmed to sleep then. so there's no safety on what time of day you work or sleep. at risk whenever you don't get adequate sleep and whenever you're awake at night. next slide, please. and the vigilance functions are important to recall. three graphs show up is good performance, down is bad. the lines show you time on task. over 10 minutes, how your performance is deteriorating. what you can can see is whether

sleep deprived in red on the left or you have sleep apnea untreated in the middle or the red in the middle, you're an pilot flying at light, you have a lower level of performance and deteriorate more rapidly. adequate sleep, if you're treated for apnea, if you fly in the daytime, you can perform better. decrementigilant functions that are so dangerous. on task wheretime you are rapidly declining. people often can't understand that is. it's the brain cannot do a vigilance task when it hasn't had adequate sleep. that to younstrate immediately. are very dangerous with a lethality rate nearly veryof alcohol with serious injuries because the driver doesn't correct action.

you fall asleep, you exit the roadway, you don't engage in a to avoid thetion pole or hitting the truck or and or rolling the vehicle as a result they have a high degree of bodily injury or lethality, almost that of high levels of alcohol. -- the good news. -- study from qualitier qualitier reed. one group got seven hours time bed at night, one group got 10 hours. the more you sleep ahead of you tolerateter the effects of any restriction on your sleep period being the middleet up in of the night to care for a baby or to get up early to drive to work. your sleep ist the bottom line and you have to treat sleep as a high priority your life every day to cumulative sleep debts

pose the danger of drowsy driving. of brain is the organ behavior and the brain needs healthy sleep of adequate daily duration to prevent drowsy driving. there's no question about it. thousands of studies support statement. it is unequivocal. we know it in medicine and science and we have to penetrate this message to the public and drives whethero professionally or just trying to whatever.ildren or when sleep is inadequate, the andn has a slower response unpredictably lapse into microsleeps that result in the waxing and waning of attention, slowed reaction times, and these pose a very serious crash risk. lapsespiness increase, get more frequent and longer in duration and there's increasing the of muscle tone in hands, the eyelids, that contribute to an ever greater

driving risk. you start having the attack driving, it's not going to get any better unless you get off sleep or takesome some other kind of counter measure which will be discussed today. next please. as sleepiness related lapses of of only two seconds is enough to result in you being ofpletely off the road, out lane. so it takes very little here to have a catastrophe. next slide. such crashes often involve very severey that's or fatality because there's very action in active timely manner by the sleepy driver. next. times, eveneaction without frequent lapses of attention, can cause problems in congested traffic so even if you're not frankly falling asleep, if you're sleepy in the morning and you drive, you can have slowed reaction times in that will get you in trouble. finally, since people are

theirntly unable to judge vulnerability to drowsy driving even when they're lapsing repeatedly, they think they're ok, it is essential that people have notive when they slept efficiently. what this means is you plan your who has slepton the most and is most fit and if you absolutely must drive overnight, having someone else with you to watch you. have someone watching you and don't let everybody going to sleep because the driver will go to sleep. that's my final message. next slide. i think that's it. thank you very much. you.ank our next speaker for this panel mr. teft of the aaa foundation for traffic safety. >> thank you, mr. collins. talke been asked today to about the prevalence and impact

the road driving on and in traffic crashes. next slide, please. so, in this presentation, i'll recent research into the prevalence of drowsy drivers on the road both in drivers actually falling asleep while they're whoing, as well as drivers are highly if fatigued yet not asleep. and i'll also be talking about studies of actual motor vehicle the numbert estimate and proportion of crashes involving if fatigue and drowsiness. next slide, please. that havel surveys centers for the disease control and aaa foundation for traffic safety, the motoring public has been whether they have fallen asleep or nodded off while they

were driving and consistently of these studies find that about two out of five americans having fallen asleep while they were driving at some andt in their life consistently across any study that's looked at this, about 11% report having done so within the 4%t year and approximately of american drivers report having fallen asleep at the wheel within the past 30 days. and these statistics even are underreported because studies have shown that has to be asleep for, on average, two to four minutes, before they're more likely than not to realize, yes, i was just asleep. so these are likely underestimates of the frequency which people actually fall asleep at the wheel. aaain addition to that, the foundation every year in a

do of driving behaviors and drivers' people, in thesk past 30 days, how often have you driven when you were so tired that you had a hard time keeping your eyes open and in response to that question more than a quarter of american drivers consistently report having done that at least once in the past month, and 2% report having done regularly. often or next slide please. of the toll of drowsiness in motor vehicle recent, the most official statistics published by the national highway traffic administration show that of fatal crashes, 2% of crashes resulting in and 1.3% of all driver,involve a drowsy based on data from 2009.

next slide, please. thater, the statistics these are based on are wrought of limitations there likelyn being substantial underestimates scope of the problem. first, it's very difficult for police to ascertain after the when they arrive at the scene of a crash whether a driver was drowsy or not. a driver who's alert and awake able to talkand about what happened may not be willing to admit to the police drowsy and that that contributed to the crash. again, they might not realize or remember that they were asleep. one has to be out for two to four minutes before they're more likely than not to realize, yes, they were sleeping. the case of the more crashesrashes and resulting in fatalities, the

be unconscious or verysed and of course it's difficult for the police to ascertain what happened. another more subtle and insidious limitation of these in many states, the forms that police officers to indicate what happened in simple, they contain a series of check boxes to indicate whether a driver was perhaps drowsy, impaired by alcohol, whether they were emotional, distracted, et cetera, et cetera. an officer would indicate that a driver is drowsy, of course, is by checking the box. if the driver was not drowsy and simplyow that, they would not check the drowsy box. unfortunately, this creates a problem in interpreting the data after the fact because the way

indicated thate the driver was not drowsy and the way that it would be indicated that we don't know whether the driver was drowsy or same, anactly the empty box. next slide, please. about a fewalking special studies that have looked depth at data on specific samples of motor vehicle crashes to estimate the proportion and the number that drowsiness.er the first study i'll talk about dr. dinges alluded to. naturalistic00 car driving study by the virginia tech institute. dataput cameras and collection equipment into 100

monitored the drivers. with researchers manually reviewing video from crashes and crashes that occurred, looking at the signatures of that dr. dinges noted musclevideo, the slack the in the face, researchersping, snated -- estimated that 22% to 24% of crashes or near crashes in the study involved mod drivere to severe drowsiness. this is done in the washington, area. aother study that took totally different approach to this problem was a study by dr. james stuts and colleagues at the university of north

carolina. study thes researchers gathered a sample of police reported crashes from the of north carolina where the researchers believed there reasonable ascertain amount of whether the driver was drowsy drowsy and they developed a statistical model to predict driver wasood that a drowsy based on the characteristics of the driver includedrash that were in the police reports. then the researchers applied to data from fatal crashes that occurred nationwide years 2001 to 2003. and when they did so, they that as many as 15% of drivers in fatal crashes were drowsy and in the author's own words, they called this a estimate.ve again, the national statistics

of fatalhat about 2% crashes involve a drowsy driver. the authors of this study 15%, and labeled that a conservative estimate. next slide, please. and another study that gives us more insight into the prevalence of drowsiness in crashes is the national motor vehicle crash causation survey done by the national highway traffic safety administration. study that used crashisciplinary teams of investigators to look at the factorsnd contributing of a sample of 5,470 crashes the years 2005 to 2007 that were severe enough to emergency medical services were dispatched to the scene. study had a fairly in-depth assessment of driver fatigue.

this involved not only police of drowsy driving but interviews by the investigators the the drivers as well as drivers' families, their and others about whether they were if fatigued at the crash, their recent and long-term habits, medicationschedule, they were taking, et cetera. and aside from the video-based is probably some ascertainmentst driving indrowsy traffic accidents. this study only looked at betweenthat occurred 6:00 a.m. and midnight. this study did not investigate crashes that occurred between midnight and 6:00 a.m. when, as you might assume, drowsy driving significantly more prevalent. next slide, please. this study, again, excluding the hours when drowsy

crashes are known tour most likely to occur, the ofearchers found that 2% drivers involved in these asleep atre actually the time of the crash and an were,onal 5% of them despite not being asleep, they fatigued.d to be and in nearly a third of 29%, they were unable to assess whether a driver was fatigued or not so aggregating this driver level data to crashes, this would as 3% ofhat as many all crashes involved a driver actually asleep and an additional 10% involved a driver was not actually asleep but fatigued. and this is only out of the 60% of crash where researchers could ascertain that for all drivers. next slide, please. and the last study that i'll

study that --a that i did for my employer, the foundation, in 2012. usedhis was a study that the national highway traffic nationalministration's automotive sampling system, crash worthiness data system, which i looked at data 1999-2008. over 47,000 crashes involved over 80,000 vehicle driver's in total. data on drivers attentiveness was assessed not just from police reports, but nterviews. 2% of drivers were drowsy.

researchers reported 45% of cases they were not able to assess whether the driver was drowsy or not. the distinction between the driver not in drowsy and the investigators not being able to make a determination is important. i was able to use a statistical method of multiple -- to estimate the proportion were investigators couldn't make that determination. t is a method in which you build a model using data that is related to the probability a driver will be rousing or the operability -- will be drowsy or the probability. using this model identify other cases in the data where drivers

drowsiness is actually known that are the most similar to the cases you are looking at and ake a random draw from the istribution of the data were drowsiness is known to estimate he drowsiness in cases where investigators were not able to ssess. next slide. that is a message the national highway traffic safety administration has used since 2001 to estimate the proportion of fatal crashes. in 45% of cases, driver drowsiness was unknown.

i estimate that 4% of drivers in all crashes were drowsy. 7% of the crashes involved at least one drowsy driver. among the more severe crashes those in which an occupant was hospitalized as a result of injuries sustained, i estimate as many as a percent of the drivers were drowsy. - 8% of the drivers were rowsy. 12% of drivers involved in fatal crashes were drowsy. 17% of fatal crashes involved at least one drowsy driver. based on the number of people killed in crashes each year, that would imply over 5000 people each year are killed in crashes involving a drowsy driver. next slide please. a couple of comments and observations on these studies collectively. no single study can provide the answer. there is reasonable convergence across multiple studies that the proportion of crashes involving a drowsy driver a much higher

than is reflected in the official statistics. couple of trends are although the studies with the best ascertainment are also based on some of the less representative samples of drivers in crashes, we see the study with the best ascertainment of drowsiness goes with in-depth interviews, those with video data of crashes estimates the highest proportion of crashes involving drowsiness. probably unrealistic to expect solid ascertainment or drowsiness in data that is collected by officers who arrived at the scene of the crash.

on the data front, it is important to distinguish the driver was not drowsy verses where they can't make a determination. that is absent from most data we have. to summarize, survey show as many as two out of five drivers eport having fallen asleep while driving at some point in their lives. 11% of drivers admit doing that n the past year. 4% report doing that in the past month that is consistent across multiple studies by different organizations over the span of a decade. official statistics estimate 1-2% of crashes involve rousing driving began likely -- the

study with the best data and esearch methods consistently show a much higher prevalence of drowsy driving. on the low end. on the high-end come as many as 24% involving drowsy driving as the cause or can should bidding factor. the data tends to suggest the prevalence is on the high-end of that range. thank you. > thank you. in your presentation, you are very clear that there are severe and safety consequences. i'm wondering if you could tell

us in simple, general terms what is affect in combating fatigue. >> the primary countermeasure is adequate sleep. healthy sleep. it was your other speakers talk about what healthy and unhealthy sleep is. occur not too far before the driving episode. sleeping one night and two days later driving with inadequate sleep. the other most commonly used way of coping with drowsiness is caffeinated beverages. there is evidence that caffeine an promote alertness, but no drug is a substitute for sleep. it is not a chemical sleep.

it is forcing areas of your brain to use -- to be more alert. blocking some molecules that produce sleep in the brain. they cannot block all of it. once the pressure for sleep is very high, caffeine cannot stop rowsiness. it also doesn't last a day. you take a couple copy, it depends on how many -- how much caffeine is in the coffee and what your sensitivity is. none of it will last in your bloodstream more than 3-4 hours at most. then you are faced with the problem of what do you do now if you are still drowsy? you will have to sleep. it won't keep you going

indefinitely. it is probably the most common way people attempt to cope with sleepiness when they have to drive. it is a limited ountermeasure. alas, the options are quite limited. what are the medical mplications? >> i'm also wondering if you could speak briefly on the nature of differences with respect to fatigue and sleep. what effect and problems does a

post to you as a researcher? >> there are differences in how rapidly people will become impaired. everyone becomes impaired. take some people longer than thers. as had typically, we don't understand the basis for it. those who take longer to get impaired are the minority of the opulation. you're not even sure that there always -- it is so is the same. we don't understand what it is that makes them less of vulnerable.

once you are awake too long, everyone will become impaired. even if you don't feel it, it doesn't mean fewer not experiencing drowsiness or lapses. the only way to be safe and certain is get adequate sleep. >> you cited 2009 data. i am wondering if you had a chance to look at anything more recent and if you could comment on what it shows. >> the data from 2009 was the last data cited in official publications by the national traffic safety dministration. that data -- those statistics are based on data that is collected annually and is presently available through 012. the most recent data from 2012 shows that 1.6% of drivers involved in fatal crashes in

2012 were believed to be drowsy or fatigued at the time of the crash. >> what would you say is the general trend for the drowsy driving data? is there a trend and, if so, which direction is it heading? >> in official statistics, there does not seem to be much of a general trend. if anything, the proportions in the official statistics may have decreased slightly. as i talk about in my presentation, i believe that is a vast underestimate. i would not look to the data published in those sources for evidence of a trend or lack thereof. in the study that i conducted

that looks at eta from 1990 99 - data from 1999-2008, in that data, there was not evidence of an increasing or decreasing trend in the proportion of the crashes that involved drowsiness. i would note that, in recent years, the raw number of crashes and deaths nationwide has decreased and that is a good thing. i do not believe there is any evidence based on the best available data that the problem is increasing or decreasing as a share of all crashes. if we look or use conservative estimates that we have across any of the more solid studies of the proportion of crashes that nvolved drowsy drivers and

apply that to 2012 data, we estimate over 5000 were killed in crashes that involved a drowsy driver. >> you mentioned multiple amputation and you look at alcohol-impaired driving. i am wondering if you can use the same technique on that data to look at fatigue-related crashes. if so, or if not, what would your opinion be? >> i believe it could be done. i would only do that with a couple of the data from studies that i referred to in my

presentation. the national motor vehicle crash causation survey and automotive sampling system. in those studies, researchers, independent of the police, make the determination of whether a driver is drowsy. they distinguish between whether a driver was known to be attentive or if they were known to be drowsy. r, whether they could not make a determination. in the data published annually by the national traffic safety administration, the fatality analysis reporting system and the general estimate system, the data on driver drowsiness is based on data from reports completed in the field by police officers and, in most cases, i do not believe they make a determination between -- a distinction between whether a driver was known to be attentive or whether they simply could not tell that the driver was drowsy or not. there is an indication in the data of whether there were no

contributing factors of parent or, whether the condition at the time of the crash was unknown. however, the proportion in which they indicate the condition was unknown is implausibly low among crashes in which only one vehicle was involved and there was only one occupant in the vehicle and the driver was eceased. even in those crashes, they only report the driver condition as unknown one third of the time. in 60% of the cases, they report, no contributing factors are apparent and i am not sure how one could arrive at that determination when the person involved in the crash is deceased. > i want to comment on the notion of a prevalence

changing. there is no question that the introduction of rumble strips and airbags may have made it safer or less likely to be lethal for somebody who drives drowsy. it is unclear to me that they have reduced drowsy driving. the message is, do not engage in that behavior to begin with. i think what they have done is try to other people from catastrophic running off of the road. it is not clear to me that we have the evidence to suggest that they have really prevented drowsy driving and the risk factor here is the impaired river. if we do not have a concerted effort to teach children and adolescents at risk in this area, shift workers, and average people who push themselves very hard and does not get adequate sleep, if we do not make an effort to make sleep a priority,

in addition to all of the other things we can do to protect drivers, we are, in effect, not dealing with the source of the problem, it adequate sleep and operating a motor vehicle. -- inadequate sleep and operating a motor vehicle. >> you spoke about banking sleep or recovery sleep. how much time does it take to pay back sleep? if they have enough, are they safe to perform after? >> thank you for the question. it is not as easy to answer as i would like it to be. the estimates -- we have been studying this for the national institutes of health and other agencies. it appears that the old believe

that you can make it all up in one night is not supported by he evidence. that belief came about but only allow one night of sleep and people look fine the next day so they let them go home. when you keep them and you study how they function and how safe they are, you realize that it takes more night of steady sleep to get back. it would be better to not get sleep deprived then to attempt to recover from it. that is a harsh message for the public that has gotten used to sleep deprivation. prevention is the best way to go. recovery takes longer and it can take longer, if you have other conditions that are causing the sleepiness or contributing to it. medical conditions, etc. >> i have question. -- a question.

with regards to the data and people being more drowsy in general and people reporting driving while drowsy. have the surveys look at the attitudes with the risks of driving drowsy. if so, do people make the link between drowsy driving and risk? >> it does not appear that they do. we have looked at that in surveys by the aaa oundation. in those surveys, we asked people how much of a threat they think other people who are drowsy are to their safety and whether they think it is acceptable for a person to drive when they are so tired that they

have a hard time keeping their eyes open. a large majority of people consider it a threat to personal safety. those drivers are out there and they consider it unacceptable to drive when they are tired. over a quarter of them consistently report having driven in the past 30 days when they were so tired that they could not keep their eyes open and a minority that translates to a large number of people report doing that often or regularly. > thank you. r. rosekind. >> in your understanding of the data, give me the numbers. take a year. do not say, "the data suggests --" how many drives th -- drowsy driving crashes? >> based on the estimates of the

prevalence that i consider credible and the recent statistics on the number of crashes in the united states annually, conservatively, 400,000 police reported crashes each year involve drowsy driving as a contributing factor. over 100,000, i would estimate -- approximately 115,000 crashes involving injuries involve drowsy driving and at least 5000 are killed every year in crashes involving drowsy driving. >> thank you for being direct about that. i want to talk about shortcomings in methodological approaches. if you were going to create a program that would accurately define the program in an ongoing manner, what would it look ike?

>> ideally, if -- if every vehicle on the road -- or at least a large sample on an ongoing basis -- were equipped with sophisticated collection instruments, including cameras, it would give us insight into the causes and contributing factors in crashes, including drowsiness. hat i would really like to see in the national traffic highway safety administration system, which i believe is the only ongoing data collection system that has the means to make a reasonable determination of whether a driver was drowsy or whether fatigue contributed to a crash. not at the same level as vehicle cameras. better than investigations and police reports. if the data collection system

was used up in size -- beefed up in size and more depth of investigation was added, analogous to the effort in 2005-2007. if they interviewed the driver, the families, the employers, and try to gain insight into what the driver's life was like and the state of the driver at the time of the crash. if that was done with a reasonably sized sample, at east 3000-5000 crashes annually, that would put us ahead of where we are now. >> great. thank you. why do you think we have a disconnect between the science of what we know involving sleep

and sleep loss and our societal attitudes and behaviors. what do you think the basis s? >> one of them is that we are used to being sleep deprived and drowsy. we are used to falling asleep. no one thinks that is unusual. years ago, no one thought it was odd that someone snored loudly when they slept. that seemed normal. you will hear from physicians, regarding apnea, that is not normal and poses health risks. this touches on the point of what you would do about it. we need to show people and drivers driving drowsy that the study done in northern virginia by dot and in the washington area was shocking. 60 minutes show the videos. it frightens you when you see it

and i do not think we have shown people how dangerous it is. when you see it what the cameras are seeing and feet is closing on traffic, you get the message loud and clear. was in australia and they had mounted public advertisements on this, showing graphics of falling asleep crashes involving families, truck drivers, individuals alone. i brought some of them back in the response that i got was that they are too frightening for the american people. in fact, i think we need some shock and awe. we need to show the truth about drowsiness. it is not funny. it is not cute. it is not willfully overcame. driving with alcohol in your

system is dangerous to do. driving with out seatbelts is dangerous to do. we need to do the same with drowsiness and show what it is, extremely risky. it should not be normalized. it should not be permitted. >> that is a perfect ending to the panel. what do you think, briefly, regarding safety, is the biggest scientific challenge out there? > i think it is inadequate areas for people to get off the road, take a nap, or stop driving. if you drive in the northeast, ira member getting into a trip and not being able to get a hotel room, driving from new york and philadelphia. i was engaged in something risky. she was trying to keep me

awake. i was driving on a high density highway. it was foolish and i was looking for a place to get off. there was no place to get off. we have no safe place to get off the road when there is an uncontrolled sleep attack. it is repeated and due to inadequate sleep. we need to make it possible for people to get off the road safely or get some sleep. do something, rather than continue to drive. that may mean added signage or better plans for planning trips. we need to do something that allows people, if we cannot completely prevent it, that allows them to get a countermeasure. get a nap. allow yourself a chance to wake up from it and put yourself back at a better level when you get

back at the road -- on the road. >> beautifully done. we needed a great foundation. we talked about the biology and the scope of the problem. i want to thank you all for a great job. a nice job with the panel. we are going to switch out and welcome debra bruce. she will be chairing a panel on workplace issues. panelists, that is your cue, as well. >> tonight on c-span, a debate about undocumented immigrant children. a conference on crime and

incarceration and later a look at the role of the justice department >> and here are a few will be comments we have recently received from viewers. >> i must say, "washington journal," first thing in the morning, absolutely wonderful. very informative. i appreciate you letting people such as myself call in and sometimes even talk to people who are running our country and our world. >> i feel like you guys do a good job on just letting it out on the table for everybody to see and not using any preferential treatment on the information.

it gives honest americans a chance. to check everything out. i appreciate you all. keep up the good work. >> i enjoy c-span1, too, and three and i watch it off and on all day. i am at home and i like to see what is going on. i need to know what is going on. been watching c-span and probably since its inception, since the 1980's, i think. source ofst my only civil, intelligent, unbiased programming. post college education. i watch it on three different channels in west palm beach, florida. i do not know what i would do without it because the regular network programming is so biased

facto bereft of logic in -- and a and commercialism that it gets to be unbearable. doo not know what i would without c-span, i love it and it is on my tv all day long. thank you. >> continue to let us know what you think. call us, e-mail us, or you can send us a tweet. conversation.n like us on facebook and follow us on twitter. >> now a discussion about undocumented immigrants and what to do about immigrants and what lived in the united states their whole lives after being brought here illegally by their parents. local politicians and activists debated the issues and answered questions from the audience at the texas tribune festival in austin. this is an hour and 10 minutes.

>> good afternoon. thank you for being here today. i'm manny fernandez. i'm the houston bureau chief for "the new york times." and on behalf of the texas tribune, i'm very happy to welcome everyone to the fourth annual texas tribune festival and to our panel today, entitled what to do with the dreamers. our panelists are george baldor, a dallas businessman who started a website supporting the texas d.r.e.a.m. act, also known as hb 1403. the website is keephb1403.com. veronica escobar -- [applause] the county judge of el paso county. she become the top elected official in texas this sixth

-- in texas's six largest county in 2011. we also have gabby pacheco, program director of a national college scholarship fund for undocumented students called the dream.us. last april, she became the first undocumented latina to testify before congress. [applause] we also have with us jerry patterson, the texas land commissioner. he's a former state senator who helped the texas republican party adopt a more moderate position on immigration in its 2012 official party platform. we also have george rodriguez, the south texas coordinator of the tea party patriots. he cohosts a show on raging elephants. in 2011, he became the first hispanic president of a major tea party group when he headed the san antonio tea party.

we also have with us congressman mark vicci, who represents congressional district 33 in the u.s. house of representatives. the congressman has been an outspoken supporter of comprehensive immigration reform. in 2013, he invited an undocumented immigrant from texas, one of the first undocumented students to pursue a higher education in texas, right here at ut austin, to be his guest at president obama's state of the union address. our discussion today will last 60 minutes and we'll include time for 15 to 20 minutes of questions from the audience. i'd like to ask everyone to please silence your phone. in june of 2001, texas became the first state in the country to adopt a law allowing undocumented students to pay in-state tuition rates to attend public universities. there have been efforts in the legislature to repeal this law since then, but all of them