ABSTRACT
Bus driver sleepiness is commonplace but often goes unreported within the industry. Whilst past research has begun to shed a light on the prevalence, potential causes, and consequences of bus driver sleepiness, this is often done using self-report methods. This is the first study to investigate sleepiness amongst city bus drivers on-road using a live bus route with drivers' regular schedules. A total of 16 participants completed two drives of their regular bus route once during an early morning shift and once during a daytime shift whilst physiological and self-report measures of sleep and stress were taken. Prior to these drives, drivers recorded their sleep in a diary and wore an actigraph to obtain objective sleep measures. Results showed that most drivers did not obtain sufficient sleep prior to early morning shifts, and often did not obtain as much sleep as they would need in order to feel rested before work. Sleepiness and stress were observed in both shifts. During early morning shifts sleepiness was likely a result of working during circadian lows and not obtaining enough sleep prior to the shift. In contrast, sleepiness during the daytime shift was likely a result of completing a highly demanding task in complex traffic which not only contributed to fatigue, but also led to increased levels of stress. As well as demonstrating the prevalence of sleepiness amongst bus drivers, these findings show that the causes of sleepiness can be multifaceted and often come about due to a combination of work and personal factors. In addition, the experience of sleepiness is not the same for all drivers, with individual differences in the experience of sleepiness playing a large role. These differences highlight the need for individualised interventions which should be considered by policymakers alongside the combination of causal factors within a larger systems approach.
ABSTRACT
Despite improvements to road safety, accidents involving pedestrians are still numerous, for example in the UK there were over 20,000 pedestrian casualties on public roads in 2019. One of the potential causal factors is pedestrian distraction. Therefore, this study aimed to predict pedestrian intention to cross the road under conditions of distraction (using phone maps, talking to another pedestrian, listening to music through headphones), by applying the Theory of Planned Behaviour (TPB) using an online survey. This also involved investigation of the impact of selected traffic characteristics (traffic density, vehicle speed) and crossing type (pelican, zebra, unmarked). The survey consisted of 72 questions and took approximately 15 min to complete. The results (N = 81) revealed that the TPB construct of perceived behavioural control (PBC) was a significant predictor of intention to cross the road while distracted across all scenarios. Furthermore, crossing type was a significant predictor of PBC across all scenarios, with marked crossings facilitating feelings of PBC. Findings suggest that high feelings of PBC, as measured through ease and confidence, are linked with stronger intention to cross the road while distracted. This understanding of pedestrian motivation can be used to help design interventions (such as auditory and visual pedestrian warnings) that prevent conflict between distracted pedestrians and vehicles. These interventions should target marked crossing types, whereby pedestrians are more likely to cross while distracted.
Subject(s)
Music , Pedestrians , Accidents, Traffic/prevention & control , Humans , Intention , Safety , WalkingABSTRACT
OBJECTIVE: The objective of this study was to understand the relationship between some of the most common diseases that are known to contribute to excessive daytime sleepiness (EDS) and traffic injury crashes. Specific focus was on the relationship between disease and crash type (single-vehicle or multiple-vehicle crash) and between disease and injury severity. METHODS: This registry-based study considered all passenger car drivers involved in a crash in Sweden between 2011 and 2016 who were 40 years or older at the time of the crash (n = 54,090). For each crash-involved driver, selected medical diagnoses registered from 1997 until the day before the crash were extracted from the National Patient Register. The drivers were assigned to 1 of 4 groups, depending on prior diseases: sleep apnea (SA; group 1, n = 2,165), sleep disorders (group 2, n = 724), Parkinson's or epilepsy (group 3, n = 645) and a reference group (group 4, n = 50,556). Logistic regression analysis compared single-vehicle crashes with multiple-vehicle crashes and moderately/severely injured drivers with slightly/uninjured drivers. RESULTS: Drivers with EDS-related diseases (groups 1-3) had higher probability of a single-vehicle crash than a multiple-vehicle crash compared to the reference group. The most sizeable effect was found for Parkinson's/epilepsy with an odds ratio (OR) of 2.5 (confidence interval [CI], 2.1-3.0). For multiple-vehicle crashes, the probability of a moderate/severe injury was higher for drivers with other sleep disorders (OR = 1.5; CI, 1.0-2.2) and Parkinson's/epilepsy (OR = 1.6; CI, 1.1-2.3) compared to the reference group. CONCLUSIONS: This study has made first steps toward understanding the relationship between some of the most common diseases that are known to contribute to EDS and crashes. Having Parkinson's/epilepsy, in particular, elevated the probability of a single-vehicle crash compared to a multiple-vehicle crash. A single-vehicle crash was seen as indicative of causing a crash; thus, having Parkinson's/epilepsy could be interpreted as a risk factor for crash involvement. Having Parkinson's/epilepsy, as well as other sleep disorders, was also related to more severe outcomes in multiple-vehicle crashes, given that a crash occurred. This was not identified in single-vehicle crashes.
Subject(s)
Accidental Injuries/epidemiology , Accidents, Traffic/statistics & numerical data , Automobile Driving/standards , Disorders of Excessive Somnolence/epidemiology , Sleep Deprivation/epidemiology , Accidental Injuries/diagnosis , Adult , Disorders of Excessive Somnolence/diagnosis , Humans , Male , Middle Aged , Odds Ratio , Risk Factors , Safety/statistics & numerical data , Sleep Deprivation/diagnosis , Sweden/epidemiologyABSTRACT
The so-called 'fatal five' behaviours (drink and drug driving, distraction and inattention, speeding, fatigue, and failure to wear a seat belt) are known to be the major behavioural contributory factors to road trauma. However, little is known about the factors that lead to drivers engaging in each behaviour. This article presents the findings from a study which collected and analysed data on the factors that lead to drivers engaging in each behaviour. The study involved a survey of drivers' perceptions of the causes of each behaviour and a subject matter expert workshop to gain the views of road safety experts. The results were mapped onto a systems ergonomics model of the road transport system in Queensland, Australia, to show where in the system the factors reside. In addition to well-known factors relating to drivers' knowledge, experience and personality, additional factors at the higher levels of the road transport system related to road safety policy, transport system design, road rules and regulations, and societal issues were identified. It is concluded that the fatal five behaviours have a web of interacting contributory factors underpinning them and are systems problems rather than driver-centric problems. The implications for road safety interventions are discussed.
Subject(s)
Accidents, Traffic/psychology , Automobile Driving/psychology , Ergonomics/statistics & numerical data , Risk-Taking , Stakeholder Participation/psychology , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Perception , Queensland , Safety Management , Seat Belts , Social Conditions , Surveys and Questionnaires , Young AdultABSTRACT
Operators of highly automated driving systems may exhibit behaviour characteristic for overtrust issues due to an insufficient awareness of automation fallibility. Consequently, situation awareness in critical situations is reduced and safe driving performance following emergency takeovers is impeded. A driving simulator study was used to assess the impact of dynamically communicating system uncertainties on monitoring, trust, workload, takeovers, and physiological responses. The uncertainty information was conveyed visually using a stylised heart beat combined with a numerical display and users were engaged in a visual search task. Multilevel analysis results suggest that uncertainty communication helps operators calibrate their trust and gain situation awareness prior to critical situations, resulting in safer takeovers. In addition, eye tracking data indicate that operators can adjust their gaze behaviour in correspondence with the level of uncertainty. However, conveying uncertainties using a visual display significantly increases operator workload and impedes users in the execution of non-driving related tasks. Practitioner Summary: This article illustrates how the communication of system uncertainty information helps operators calibrate their trust in automation and, consequently, gain situation awareness. Multilevel analysis results of a driving simulator study affirm the benefits for trust calibration and highlight that operators adjust their behaviour according to multiple uncertainty levels.
Subject(s)
Attention , Automobile Driving , Reaction Time/physiology , Uncertainty , Adult , Attention/physiology , Communication , Computer Simulation , Eye Movements , Female , Heart Rate/physiology , Humans , Male , Man-Machine Systems , Middle Aged , Multilevel Analysis , Task Performance and Analysis , Trust , User-Computer Interface , WorkloadABSTRACT
Many rail level crossings (RLXs) have only passive protection, such as static signs instructing road users to stop, yield, or look for trains. Stop signs have been suggested as a low-cost option to improve safety at passive RLXs, as requiring drivers to stop should encourage safe behaviour. However, field observations have noted high rates of non-compliance at stop-controlled RLXs. To explore this further, we conducted an on-road study to identify factors that influence compliance at stop-controlled RLXs. Twenty-two drivers drove a 30.5km route in rural Australia, encompassing three stop-controlled RLXs. In over half of all cases (59%) drivers stopped completely at the RLX; on 27% of crossings drivers executed a rolling stop, and on 14% of crossings drivers violated the stop controls. Rolling stops were defined as a continuous deceleration to <10km/h, but remaining above 0km/h, before accelerating to >10km/h. Behavioural patterns, including visual checks and decision-making, were similar when comparing drivers who made complete versus rolling stops. Non-compliant drivers did not differ from compliant drivers in approach speeds, but spent less time visually checking for trains. Post-drive interviews revealed some drivers wilfully disregarded the stop sign, whereas others did not notice the stop sign. Those who intentionally violated noted trains were infrequent and suggested sight distance was good enough (even though all crossings had been formally assessed as having inadequate sight distance). Overall the results suggest most drivers exhibit safe behaviour at passive RLXs, but a notable minority disregard or fail to notice signs. Potential avenues for redesigning passive RLXs to improve safety are discussed.
Subject(s)
Accidents, Traffic/prevention & control , Automobile Driving/psychology , Railroads , Rural Population , Adult , Australia , Automobile Driving/statistics & numerical data , Decision Making , Female , Humans , Male , Middle AgedABSTRACT
OBJECTIVE: The ability to detect changing visual information is a vital component of safe driving. In addition to detecting changing visual information, drivers must also interpret its relevance to safety. Environmental changes considered to have high safety relevance will likely demand greater attention and more timely responses than those considered to have lower safety relevance. The aim of this study was to explore factors that are likely to influence perceptions of risk and safety regarding changing visual information in the driving environment. Factors explored were the environment in which the change occurs (i.e., urban vs. rural), the type of object that changes, and the driver's age, experience, and risk sensitivity. METHODS: Sixty-three licensed drivers aged 18-70 years completed a hazard rating task, which required them to rate the perceived hazardousness of changing specific elements within urban and rural driving environments. Three attributes of potential hazards were systematically manipulated: the environment (urban, rural); the type of object changed (road sign, car, motorcycle, pedestrian, traffic light, animal, tree); and its inherent safety risk (low risk, high risk). Inherent safety risk was manipulated by either varying the object's placement, on/near or away from the road, or altering an infrastructure element that would require a change to driver behavior. Participants also completed two driving-related risk perception tasks, rating their relative crash risk and perceived risk of aberrant driving behaviors. RESULTS: Driver age was not significantly associated with hazard ratings, but individual differences in perceived risk of aberrant driving behaviors predicted hazard ratings, suggesting that general driving-related risk sensitivity plays a strong role in safety perception. In both urban and rural scenes, there were significant associations between hazard ratings and inherent safety risk, with low-risk changes perceived as consistently less hazardous than high-risk impact changes; however, the effect was larger for urban environments. There were also effects of object type, with certain objects rated as consistently more safety relevant. In urban scenes, changes involving pedestrians were rated significantly more hazardous than all other objects, and in rural scenes, changes involving animals were rated as significantly more hazardous. Notably, hazard ratings were found to be higher in urban compared with rural driving environments, even when changes were matched between environments. CONCLUSION: This study demonstrates that drivers perceive rural roads as less risky than urban roads, even when similar scenarios occur in both environments. Age did not affect hazard ratings. Instead, the findings suggest that the assessment of risk posed by hazards is influenced more by individual differences in risk sensitivity. This highlights the need for driver education to account for appraisal of hazards' risk and relevance, in addition to hazard detection, when considering factors that promote road safety.
Subject(s)
Automobile Driving/psychology , Environment Design/statistics & numerical data , Safety , Adolescent , Adult , Age Factors , Aged , Automobile Driving/statistics & numerical data , Female , Humans , Male , Middle Aged , Risk Assessment , Young AdultABSTRACT
The ability to detect changes is crucial for safe driving. Previous research has demonstrated that drivers often experience change blindness, which refers to failed or delayed change detection. The current study explored how susceptibility to change blindness varies as a function of the driving environment, type of object changed, and safety relevance of the change. Twenty-six fully-licenced drivers completed a driving-related change detection task. Changes occurred to seven target objects (road signs, cars, motorcycles, traffic lights, pedestrians, animals, or roadside trees) across two environments (urban or rural). The contextual safety relevance of the change was systematically manipulated within each object category, ranging from high safety relevance (i.e., requiring a response by the driver) to low safety relevance (i.e., requiring no response). When viewing rural scenes, compared with urban scenes, participants were significantly faster and more accurate at detecting changes, and were less susceptible to "looked-but-failed-to-see" errors. Interestingly, safety relevance of the change differentially affected performance in urban and rural environments. In urban scenes, participants were more efficient at detecting changes with higher safety relevance, whereas in rural scenes the effect of safety relevance has marginal to no effect on change detection. Finally, even after accounting for safety relevance, change blindness varied significantly between target types. Overall the results suggest that drivers are less susceptible to change blindness for objects that are likely to change or move (e.g., traffic lights vs. road signs), and for moving objects that pose greater danger (e.g., wild animals vs. pedestrians).
Subject(s)
Accidents, Traffic/prevention & control , Attention/physiology , Automobile Driving/psychology , Visual Perception/physiology , Adult , Female , Humans , Male , Rural Population , Safety , Urban Population , Young AdultABSTRACT
OBJECTIVES: Shift workers are prone to obesity and associated co-morbidities such as diabetes and cardiovascular disease. Sleep restriction associated with shift work results in dramatic endocrine and metabolic effects that predispose shift workers to these adverse health consequences. While sleep restriction has been associated with increased caloric intake, food preference may also play a key role in weight gain associated with shift work. This study examined the impact of an overnight simulated night shift on food preference. METHODS: Sixteen participants [mean 20.1, standard deviation (SD) 1.4 years; 8 women] underwent a simulated night shift and control condition in a counterbalanced order. On the following morning, participants were provided an opportunity for breakfast that included high- and low-fat food options (mean 64.8% and 6.4% fat, respectively). RESULTS: Participants ate significantly more high-fat breakfast items after the simulated night shift than after the control condition [167.3, standard error of the mean (SEM 28.7) g versus 211.4 (SEM 35.6) g; P=0.012]. The preference for high-fat food was apparent among the majority of individuals following the simulated night shift (81%), but not for the control condition (31%). Shift work and control conditions did not differ, however, in the total amount of food or calories consumed. CONCLUSIONS: A simulated night shift leads to preference for high-fat food during a subsequent breakfast opportunity. These results suggest that food choice may contribute to weight-related chronic health problems commonly seen among night shift workers.
Subject(s)
Diet, High-Fat , Food Preferences , Work Schedule Tolerance , Adult , Energy Intake , Female , Humans , Male , Sleep Deprivation , Young AdultABSTRACT
BACKGROUND: Hot air ballooning incidents are relatively rare; however, when they do occur they are likely to result in a fatality or serious injury. Human error is commonly attributed as the cause of hot air ballooning incidents; however, error in itself is not an explanation for safety failures. This research aims to identify and establish the relative importance of factors contributing toward hot air ballooning incidents. METHODS: Twenty-two Australian Ballooning Federation (ABF) incident reports were thematically coded using a bottom-up approach to identify causal factors. Subsequently, 69 balloonists (mean 19.51 yr experience) participated in a survey to identify additional causal factors and rate (out of 7) the perceived frequency and potential impact to ballooning operations of each of the previously identified causal factors. Perceived associated risk was calculated by multiplying mean perceived frequency and impact ratings. RESULTS: Incident report coding identified 54 causal factors within 9 higher level areas: Attributes, Crew Resource Management, Equipment, Errors, Instructors, Organizational, Physical Environment, Regulatory Body, and Violations. Overall, 'weather', 'inexperience,' and 'poor/inappropriate decisions' were rated as having greatest perceived associated risk. DISCUSSION: Although errors were nominated as a prominent cause of hot air ballooning incidents, physical environment and personal attributes are also particularly important for safe hot air ballooning operations. In identifying a range of causal factors, the areas of weakness surrounding ballooning operations have been defined; it is hoped that targeted safety and training strategies can now be put into place to remove these contributing factors and reduce the chance of pilot error.
Subject(s)
Accidents, Aviation/statistics & numerical data , Adolescent , Adult , Aged , Australia/epidemiology , Decision Making , Equipment Failure , Female , Humans , Male , Middle Aged , Risk Factors , Weather , Wounds and Injuries/epidemiology , Young AdultABSTRACT
Sleep disruption strongly influences daytime functioning; resultant sleepiness is recognised as a contributing risk-factor for individuals performing critical and dangerous tasks. While the relationship between sleep and sleepiness has been heavily investigated in the vulnerable sub-populations of shift workers and patients with sleep disorders, postpartum women have been comparatively overlooked. Thirty-three healthy, postpartum women recorded every episode of sleep and wake each day during postpartum weeks 6, 12 and 18. Although repeated measures analysis revealed there was no significant difference in the amount of nocturnal sleep and frequency of night-time wakings, there was a significant reduction in sleep disruption, due to fewer minutes of wake after sleep onset. Subjective sleepiness was measured each day using the Karolinska Sleepiness Scale; at the two earlier time points this was significantly correlated with sleep quality but not to sleep quantity. Epworth Sleepiness Scores significantly reduced over time; however, during week 18 over 50% of participants were still experiencing excessive daytime sleepiness (Epworth Sleepiness Score ≥12). Results have implications for health care providers and policy makers. Health care providers designing interventions to address sleepiness in new mothers should take into account the dynamic changes to sleep and sleepiness during this initial postpartum period. Policy makers developing regulations for parental leave entitlements should take into consideration the high prevalence of excessive daytime sleepiness experienced by new mothers, ensuring enough opportunity for daytime sleepiness to diminish to a manageable level prior to reengagement in the workforce.
Subject(s)
Postpartum Period , Sleep/physiology , Female , Humans , Longitudinal StudiesABSTRACT
The majority of individuals appear to have insight into their own sleepiness, but there is some evidence that this does not hold true for all, for example treated patients with obstructive sleep apnoea. Identification of sleep-related symptoms may help drivers determine their sleepiness, eye symptoms in particular show promise. Sixteen participants completed four motorway drives on two separate occasions. Drives were completed during daytime and night-time in both a driving simulator and on the real road. Ten eye symptoms were rated at the end of each drive, and compared with driving performance and subjective and objective sleep metrics recorded during driving. 'Eye strain', 'difficulty focusing', 'heavy eyelids' and 'difficulty keeping the eyes open' were identified as the four key sleep-related eye symptoms. Drives resulting in these eye symptoms were more likely to have high subjective sleepiness and more line crossings than drives where similar eye discomfort was not reported. Furthermore, drivers having unintentional line crossings were likely to have 'heavy eyelids' and 'difficulty keeping the eyes open'. Results suggest that drivers struggling to identify sleepiness could be assisted with the advice 'stop driving if you feel sleepy and/or have heavy eyelids or difficulty keeping your eyes open'.
Subject(s)
Automobile Driving/psychology , Eye/physiopathology , Sleep Stages/physiology , Adult , Asthenopia/physiopathology , Computer Simulation , Darkness , Dry Eye Syndromes/physiopathology , Eyelids/physiopathology , Female , Fixation, Ocular/physiology , Humans , Male , Sweden , User-Computer InterfaceABSTRACT
The appropriateness of applying drink driving legislation to motorcycle riding has been questioned as there may be fundamental differences in the effects of alcohol on driving and motorcycling. It has been suggested that alcohol may redirect riders' focus from higher-order cognitive skills such as cornering, judgement and hazard perception, to more physical skills such as maintaining balance. To test this hypothesis, the effects of low doses of alcohol on balance ability were investigated in a laboratory setting. The static balance of twenty experienced and twenty novice riders was measured while they performed either no secondary task, a visual (search) task, or a cognitive (arithmetic) task following the administration of alcohol (0%, 0.02%, and 0.05% BAC). Subjective ratings of intoxication and balance impairment increased in a dose-dependent manner in both novice and experienced motorcycle riders, while a BAC of 0.05%, but not 0.02%, was associated with impairments in static balance ability. This balance impairment was exacerbated when riders performed a cognitive, but not a visual, secondary task. Likewise, 0.05% BAC was associated with impairments in novice and experienced riders' performance of a cognitive, but not a visual, secondary task, suggesting that interactive processes underlie balance and cognitive task performance. There were no observed differences between novice vs. experienced riders on static balance and secondary task performance, either alone or in combination. Implications for road safety and future 'drink riding' policy considerations are discussed.
Subject(s)
Cognition/drug effects , Ethanol/adverse effects , Motorcycles , Postural Balance/drug effects , Psychomotor Performance/drug effects , Accidents, Traffic/statistics & numerical data , Adolescent , Adult , Female , Humans , Male , Middle Aged , Task Performance and Analysis , Visual Perception/drug effectsABSTRACT
Young men figure prominently in sleep-related road crashes. Non-driving studies show them to be particularly vulnerable to sleep loss, compared with older men. We assessed the effect of a normal night's sleep vs. prior sleep restricted to 5h, in a counterbalanced design, on prolonged (2 h) afternoon simulated driving in 20 younger (av. 23 y) and 19 older (av. 67 y) healthy men. Driving was monitored for sleepiness related lane deviations, EEGs were recorded continuously and subjective ratings of sleepiness taken every 200 s. Following normal sleep there were no differences between groups for any measure. After sleep restriction younger drivers showed significantly more sleepiness-related deviations and greater 4-11 Hz EEG power, indicative of sleepiness. There was a near significant increase in subjective sleepiness. Correlations between the EEG and subjective measures were highly significant for both groups, indicating good self-insight into increasing sleepiness. We confirm the greater vulnerability of younger drivers to sleep loss under prolonged afternoon driving.
Subject(s)
Accidents, Traffic , Aging , Automobile Driving , Sleep Deprivation/physiopathology , Sleep Stages/physiology , User-Computer Interface , Accidents, Traffic/psychology , Adult , Aged , Analysis of Variance , Automobile Driving/psychology , Brain Waves/physiology , Electroencephalography , Electrooculography , Humans , Male , Middle Aged , Young AdultABSTRACT
PURPOSE: Obstructive sleep apnoea (OSA) patients effectively treated by and compliant with continuous positive air pressure (CPAP) occasionally miss a night's treatment. The purpose of this study was to use a real car interactive driving simulator to assess the effects of such an occurrence on the next day's driving, including the extent to which these drivers are aware of increased sleepiness. METHODS: Eleven long-term compliant CPAP-treated 50-75-year-old male OSA participants completed a 2-h afternoon, simulated, realistic monotonous drive in an instrumented car, twice, following one night: (1) normal sleep with CPAP and (2) nil CPAP. Drifting out of road lane ('incidents'), subjective sleepiness every 200 s and continuous electroencephalogram (EEG) activities indicative of sleepiness and compensatory effort were monitored. RESULTS: Withdrawal of CPAP markedly increased sleep disturbance and led to significantly more incidents, a shorter 'safe' driving duration, increased alpha and theta EEG power and greater subjective sleepiness. However, increased EEG beta activity indicated that more compensatory effort was being applied. Importantly, under both conditions, there was a highly significant correlation between subjective and EEG measures of sleepiness, to the extent that participants were well aware of the effects of nil CPAP. CONCLUSIONS: Patients should be aware that compliance with treatment every night is crucial for safe driving.
Subject(s)
Automobile Driving , Awareness , Continuous Positive Airway Pressure/adverse effects , Continuous Positive Airway Pressure/psychology , Disorders of Excessive Somnolence/psychology , Disorders of Excessive Somnolence/therapy , Patient Compliance/psychology , Sleep Apnea, Obstructive/psychology , Sleep Apnea, Obstructive/therapy , Aged , Arousal , Attention , Computer Simulation , Electroencephalography , Female , Humans , Male , Middle Aged , Signal Processing, Computer-AssistedABSTRACT
OBJECTIVES: To examine the effects on monotonous driving of normal sleep versus one night of sleep restriction in continuous positive airway pressure (CPAP) treated obstructive sleep apnoea (OSA) patients compared with age matched healthy controls. METHODS: Nineteen CPAP treated compliant male OSA patients (OSA-treated patients (OPs)), aged 50-75 years, and 20 healthy age-matched controls underwent both a normal night's sleep and sleep restriction to 5h (OPs remained on CPAP) in a counterbalanced design. All participants completed a 2h afternoon monotonous drive in a realistic car simulator. Driving was monitored for sleepiness-related minor and major lane deviations, with 'safe' driving time being total time driven prior to first major lane deviation. EEGs were recorded continuously, and subjective sleepiness ratings were taken at regular intervals throughout the drive. RESULTS: After a normal night's sleep, OPs and controls did not differ in terms of driving performance or in their ability to assess the levels of their own sleepiness, with both groups driving 'safely' for approximately 90 min. However, after sleep restriction, OPs had a significantly shorter (65 min) safe driving time and had to apply more compensatory effort to maintain their alertness compared with controls. They also underestimated the enhanced sleepiness. Nevertheless, apart from this caveat, there were generally close associations between subjective sleepiness, likelihood of a major lane deviation and EEG changes indicative of sleepiness. CONCLUSIONS: With a normal night's sleep, effectively treated older men with OSA drive as safely as healthy men of the same age. However, after restricted sleep, driving impairment is worse than that of controls. This suggests that, although successful CPAP treatment can alleviate potential detrimental effects of OSA on monotonous driving following normal sleep, these patients remain more vulnerable to sleep restriction.