Sleep and the Fitness to Drive: A Swiss Perspective

Abstract

Medical conditions and behavioral patterns affecting sleep are a largely underestimated threat to traffic safety. Unsupervised or even illegal self-treatment of sleep issues by, for example, anti-histamines, cannabis products, or stimulants, questions safe driving and the fitness to drive as well as low compliance/adherence to treatments (CPAP, medication, etc.) of medical conditions, such as OSAS, or narcolepsy. In such cases, Swiss law calls for a medical assessment of the fitness to drive by experts in traffic medicine. With increasing complexity, this medical assessment is escalated in a four-tiered system of qualified experts, ranging from a qualified practitioner to experts in traffic medicine, at, for example, an Institute for Legal Medicine. The following overview provides insight in the Swiss framework of traffic medicine assessments that – with all caveats and potential drawbacks – helps mitigating the risk of sleep-related accidents. For this, we first introduce Swiss traffic medicine and then argue for consistent terms and measurements to assess sleepy driving. A concise summary of those sleep related conditions most relevant in traffic medicine is followed by an overview over potential issues of sleep-medication.

Towards the Validation of an Observational Tool to Detect Impaired Drivers—An Online Video Study

“…There exists a vague legal definition of when a driver is not allowed to drive a vehicle. The Swiss Road Traffic Act defines any driver as impaired who does not have the required physical or mental capacity due to the influence of alcohol, narcotics, medication, or other reasons [ 42 ]. From the point of view of traffic medicine, there are three important functions needed to maintain the required physical or mental capacity for safe driving: vision, cognition, and motor function [ 43 ].…”

“…If both the normal performance capacity and the reserve capacity are exhausted, the performance limit is reached. When this happens, drivers are not able to react to difficult and unpredictable situations, such as when an animal suddenly crosses the street [ 42 ]. The literature has additionally demonstrated the importance of reserve capacity by revealing that drivers spend approximately half of their driving time engaged in secondary tasks unrelated to driving, requiring a high level of cognitive effort.…”