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Volume 14 No. 04
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The Risk of Fatigue and Sleepiness in the Ridesharing Industry: An American Academy of Sleep Medicine Position Statement

Michael Berneking, MD1; Ilene M. Rosen, MD, MS2; Douglas B. Kirsch, MD3; Ronald D. Chervin, MD, MS4; Kelly A. Carden, MD5; Kannan Ramar, MD6; R. Nisha Aurora, MD7; David A. Kristo, MD8; Raman K. Malhotra, MD9; Jennifer L. Martin, PhD10,11; Eric J. Olson, MD6; Carol L. Rosen, MD12; James A. Rowley, MD13; Indira Gurubhagavatula, MD, MPH2,14
1Concentra, Inc., Grand Rapids, Michigan; 2Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; 3Carolinas Healthcare Medical Group Sleep Services, Charlotte, North Carolina; 4University of Michigan Sleep Disorders Center, Ann Arbor, Michigan; 5Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee; 6Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota; 7School of Medicine, Johns Hopkins University, Baltimore, Maryland; 8University of Pittsburgh, Pittsburgh, Pennsylvania; 9Washington University Sleep Center, St. Louis, Missouri; 10Veterans Affairs Greater Los Angeles Healthcare System, North Hills, California; 11David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California; 12Department of Pediatrics, Case Western Reserve University, University Hospitals - Cleveland Medical Center, Cleveland, Ohio; 13Wayne State University, Detroit, Michigan; 14Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania

ABSTRACT

The ridesharing—or ride-hailing—industry has grown exponentially in recent years, transforming quickly into a fee-for-service, unregulated taxi industry. While riders are experiencing the benefits of convenience and affordability, two key regulatory and safety issues deserve consideration. First, individuals who work as drivers in the ridesharing industry are often employed in a primary job, and they work as drivers during their “off” time. Such a schedule may lead to driving after extended periods of wakefulness or during nights, both of which are factors that increase the risk of drowsy driving accidents. Second, these drivers are often employed as “independent contractors,” and therefore they are not screened for medical problems that can reduce alertness, such as obstructive sleep apnea. Some ridesharing companies now require a rest period after an extended driving shift. This measure is encouraging, but it is insufficient to impact driving safety appreciably, particularly since many of these drivers are already working extended hours and tend to drive at non-traditional times when sleepiness may peak. Therefore, it is the position of the American Academy of Sleep Medicine (AASM) that fatigue and sleepiness are inherent safety risks in the ridesharing industry. The AASM calls on ridesharing companies, government officials, medical professionals, and law enforcement officers to work together to address this public safety risk. A collaborative effort is necessary to understand and track the scope of the problem, provide relevant education, and mitigate the risk through thoughtful regulation and effective fatigue risk management systems.

Citation:

Berneking M, Rosen IM, Kirsch DB, Chervin RD, Carden KA, Ramar K, Aurora RN, Kristo DA, Malhotra RK, Martin JL, Olson EJ, Rosen CL, Rowley JA, Gurubhagavatula I, American Academy of Sleep Medicine Board of Directors. The risk of fatigue and sleepiness in the ridesharing industry: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2018;14(4):683–685.


INTRODUCTION

The American Academy of Sleep Medicine (AASM) is the leading professional society dedicated to promotion of sleep health. The AASM improves sleep health and fosters high-quality, patient-centered care through advocacy, education, strategic research, and practice standards. The AASM endeavors to advance sleep health policy that improves the health and well-being of the general public.

Sparked by the mobile phone revolution, the ridesharing— or ride-hailing—industry has grown exponentially in recent years, transforming quickly into a fee-for-service, unregulated taxi industry. Many individuals rely on these drivers when they themselves are tired or impaired from alcohol or other substances. While riders are experiencing the benefits of convenience and affordability, some key regulatory and safety issues deserve consideration.

The National Highway Traffic Safety Administration reports that drowsy driving claimed 846 lives in 2014.1 However, because drivers may be reluctant to admit to sleepiness while driving, and because we do not have a test that is equivalent to a Breathalyzer to detect drowsiness, actual prevalence is likely to be higher than estimated rates. Survey data from the Centers for Disease Control and Prevention (CDC) indicate that drowsy driving is common, as 4.2% of drivers reported having fallen asleep while driving at least one time during the previous 30 days.2 Furthermore, the AAA Foundation for Traffic Safety estimates that an average of 328,000 annual crashes involve a drowsy driver, including 109,000 crashes that result in injuries and 6,400 fatal crashes.3 These crashes tend to be severe, given that the driver does not undertake the usual maneuvers to avoid the accident or reduce its severity, including swerving away or applying brakes.4 Risky behaviors, such as excessive speed or texting, may accompany drowsy driving, due to frontal lobe dysfunction that occurs when a driver is drowsy.5

POSITION

It is the position of the AASM that fatigue and sleepiness are inherent safety risks in the ridesharing industry. The AASM calls on ridesharing companies, government officials, medical professionals, and law enforcement officers to work together to address this public safety risk. A collaborative effort is necessary to understand and track the scope of the problem, provide relevant education, and mitigate the risk through regulations and fatigue risk management systems.

DISCUSSION

Two major safety issues associated with the ridesharing industry deserve attention. First, we know that the largest impediment to achieving sufficient sleep is the number of hours worked, both on weekdays and weekends.6 Experience also indicates that many individuals who work as drivers in the ride-sharing industry view this type of work as an additional source of income. As such, these individuals are often employed in a primary job, working as drivers during their “off” time. Such a schedule may lead to driving after extended periods of wakefulness or during nights, both of which are factors that increase the risk of drowsy driving accidents. The AAA Foundation reports that drivers who usually sleep for less than 5 hours daily, have slept for less than 7 hours in the past 24 hours, or have slept for 1 or more hours less than their usual amount of sleep in the past 24 hours have significantly elevated crash rates.7 Data also show that drowsy driving accidents are much more likely to occur between 11:00 pm and 7:00 am.8 Therefore, both sleep deprivation and circadian influences leave ridesharing drivers at risk for drowsy driving.

Second, these drivers are often employed as “independent contractors,” and therefore they are not screened for medical problems that can reduce alertness, such as obstructive sleep apnea (OSA). The National Transportation Safety Board (NTSB), in its Most Wanted List of Transportation Safety Improvements, urges federal regulators to require medical fitness for safety-critical transportation personnel through implementation of a comprehensive medical certification system.9 The NTSB also continues to advocate for policies to reduce fatigue-related accidents, including hours-of-service regulations and appropriate work-rest schedules.10 However, work hours and rest opportunities are not monitored for ridesharing drivers, who are subject to little or no regulatory oversight.

While we are encouraged that some ridesharing companies are requiring a 6-hour rest period after a work shift of 12 hours11 or 14 hours,12 we feel that this limit is insufficient to impact driving safety appreciably, particularly since many of these drivers are already working extended hours and tend to drive at non-traditional times when sleepiness may peak.

The AASM recommends that the following steps be taken to address the risks of fatigue and sleepiness in the ridesharing industry.

  1. Industry, in collaboration with academic sleep facilities and sleep researchers, should:

    1. Assess the profession

      1. How many drivers work multiple jobs?

      2. How much sleep are they getting?

      3. When are they sleeping?

      4. Which shifts do they typically work?

    2. Track the problem

      1. How often do drivers experience drowsiness while driving?

      2. What is the frequency of drowsy driving accidents?

    3. Provide education

      1. Equip drivers, and potential drivers, with the resources that they need to understand the importance of sleep, the risks of driving while drowsy, and effective management strategies.

      2. Educate law enforcement officers at all levels to recognize the tell-tale signs of a crash related to drowsy driving.

  2. Government agencies should:

    1. Mitigate the risk

      1. Introduce regulations that mandate rest and limit hours of service (as has been done with other professional drivers, such as bus, truck, rail and airline operators).

      2. Encourage drivers with symptoms of serious sleep disorders, such as OSA, to undergo screening and, if appropriate, testing and treatment.

CONCLUSIONS

Demand for services from ridesharing companies has grown tremendously and shows no signs of slowing. Given the high prevalence of drowsy driving in the general population, the vulnerability to fatigue and sleepiness of ridesharing drivers, and the virtual absence of sleep-related regulation in this industry, we urge both private and public stakeholders to promote roadway safety by addressing the threat of drowsy driving in the ridesharing industry.

DISCLOSURE STATEMENT

The authors comprise the 2017–2018 board of directors of the American Academy of Sleep Medicine, except for Dr. Berneking and Dr. Gurubhagavatula, who are on the AASM Occupational Sleep Wellness Presidential Committee. This position statement was developed by the board of directors of the AASM to help promote transportation safety. It is published by the AASM as an advisory that is to be used for educational and informational purposes only.

ACKNOWLEDGMENTS

The board of directors thanks AASM staff members who assisted with the development of this position statement.

REFERENCES

1 

National Highway Traffic Safety Administration. Drowsy driving. https://www.nhtsa.gov/risky-driving/drowsy-driving. Accessed March 20, 2018.

2 

Centers for Disease Control and Prevention (CDC). Drowsy driving - 19 states and the District of Columbia, 2009-2010. MMWR Morb Mortal Wkly Rep. 2013;61(51-52):1033–1037. [PubMed]

3 

Tefft BC. AAA Foundation for Traffic Safety. Prevalence of motor vehicle crashes involving drowsy drivers, United States, 2009 - 2013. November 2014. http://newsroom.aaa.com/wp-content/uploads/2014/11/AAAFoundation-DrowsyDriving-Nov2014.pdf. Accessed March 20, 2018

4 

Strohl KP, Blatt J, Council F, et al. Drowsy driving and automobile crashes: NCSDR/NHTSA Expert Panel on Driver Fatigue and Sleepiness. National Highway Traffic Safety Administration website. https://one.nhtsa.gov/people/injury/drowsy_driving1/Drowsy.html. Accessed March 20, 2018.

5 

Goel N, Rao H, Durmer JS, Dinges DF. Neurocognitive consequences of sleep deprivation. Semin Neurol. 2009;29(4):320–339. [PubMed Central][PubMed]

6 

Basner M, Fomberstein KM, Razavi FM, et al. American Time Use Survey: sleep time and its relationship to waking activities. Sleep. 2007;30(9):1085–1095. [PubMed Central][PubMed]

7 

Tefft BC. AAA Foundation for Traffic Safety. Acute sleep deprivation and risk of motor vehicle crash involvement. December 2016. https://aaafoundation.org/acute-sleep-deprivation-risk-motor-vehicle-crash-involvement/. Accessed March 20, 2018.

8 

Tefft BC. AAA Foundation for Traffic Safety. Prevalence of motor vehicle crashes involving drowsy drivers, United States, 1999-2008. Accid Anal Prev. 2012;45:180–186. [PubMed]

9 

National Transpiration Safety Board. NTSB 2017 - 2018 Most Wanted List of Transportation Safety Improvements. Require medical fitness. https://www.ntsb.gov/safety/mwl/Pages/mwl6-2017-18.aspx. Accessed March 20, 2018.

10 

National Transpiration Safety Board. NTSB 2017 - 2018 Most Wanted List of Transportation Safety Improvements. Reduce fatigue-related accidents.https://www.ntsb.gov/safety/mwl/Pages/mwl1-2017-18.aspx. Accessed March 20, 2018.

11 

Kansal S. Another step to prevent drowsy driving. Uber website. https://www.uber.com/newsroom/drowsydriving/. Accessed March 20, 2018.

12 

Lyft. Taking breaks and time limits in driver mode. Time limits. Lyft website. https://help.lyft.com/hc/en-us/articles/115012926787-Taking-breaks-and-time-limits-in-driver-mode. Accessed March 20, 2018.