Behavioral and Environmental Countermeasures

Henry Ford Hospital, Sleep Disorders and Research Center, 

Population-based surveys typically have found that a substantial percentage of people report that they do not get sufficient sleep (1). While the exact prevalence may be disputed, it is an accepted fact that many people get insufficient sleep. In addition to those recognizing their insufficient sleep are other individuals who show objective evidence of excessive sleepiness, deny difficulty with sleepiness, and yet show normalization of their alertness with extended time in bed (TIB) (2). Consciously or subconsciously, people employ various stratagems to counteract the disruptive effects of their sleep loss. While the functionally disruptive effects and health risks associated with sleep loss and its consequent daytime sleepiness are generally recognized, questions remain regarding what behavioral and environment factors act as countermeasures to sleep loss and daytime sleepiness, as well as to their effectiveness and duration of effect. 

This chapter will review all of the behavioral and environmental interventions that may act as countermeasures to the disruptive effects of sleep loss on waking function. The literature addressing this question is very limited, not well organized, and quite diverse. Many questions remain unanswered. Before reviewing the evidence regarding countermeasures, we will provide a conceptual analysis of the issues surrounding them. 

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The last part. Crash Causation and Countermeasures, focuses on what we have learned over the past one hundred years - and especially over the past few decades - about the causes of traffic accidents, their relative frequencies, and the means that have proven successfiil in combating accidents. The crash causation chapter also has a methodology component, because often the relative frequency of various causes of traffic accidents is methodology-bound meaning that different methods of analyses yield different conclusions. The countermeasures chapter is divided into first domains in which countermeasures can and have been applied organizational actions (such as "Vision Zero" mentioned above), behavioral changes in drivers and other road users, environmental treatments of the roadway and its furniture, and vehicular changes in both crash prevention and injury reduction. 

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