Efficacy of a 'functional energy drink' in counteracting driver sleepiness

Driver sleepiness is a major cause of serious road crashes. Coffee is often used as an effective countermeasure to driver sleepiness. However, the caffeine levels in coffee are variable, whereas certain proprietary "functional energy drinks" (FEDs) contain known levels of caffeine (and other ingredients). We investigated the effectiveness of a well-known FED in reducing sleepiness in drivers. Twelve healthy young adults drove an instrumented car simulator between 14:00 and 17:00 h. Their sleepiness was enhanced by sleep restriction to 5 h the night before. Following a pretreatment 30-min drive and at the beginning of a 30-min break, participants were given double-blind 250-ml FED (containing sucrose, glucose, 80-mg caffeine, taurine, glucuronolactone and vitamins) vs. a control drink with the same volume and same taste but without caffeine, taurine and glucuronolactone. Two hours of continuous driving ensued. Lane drifting, subjective sleepiness and the electroencephalogram (EEG) were monitored throughout. Compared with the control, the FED significantly reduced sleep-related driving incidents and subjective sleepiness for the first 90 min of the drive. There was a trend for the EEG to reflect less sleepiness during this period. It was concluded that the FED is beneficial in reducing sleepiness and sleep-related driving incidents under conditions of afternoon monotonous driving following sleep restriction the night before.     

'Post-lunch' sleepiness during prolonged, monotonous driving - effects of meal size

The 'post-lunch' dip is a bi-circadian phenomenon, largely unrelated to lunch, and worsened by a disturbed prior night's sleep. Despite anecdotal claims of adverse effects of larger lunches on afternoon driving ability, there is little actual driving data to support this belief. Although there have been various (non-driving) laboratory studies assessing meal size and micronutrient effects on psychological performance tests, findings are mixed. Moreover, most have not utilised heightened afternoon sleepiness after a shortened night's sleep, and few tested beyond 20 min. Using a real car interactive simulator having full size screen projection, we compared the effects on a 2h monotonous afternoon drive, of two very similar, palatable lunches ('light': 305 cal vs 'heavy': 922 cal [having 3× fat and 2× carbohydrate contents]), given double blind in a repeated measures counterbalanced design, to 12 young male drivers whose prior night's sleep had been restricted to 5h. Sleepiness-related lane drifting ('incidents'), subjective sleepiness and EEG (4-11 Hz power - indicative of sleepiness) were logged throughout. The heavy lunch caused significant increases to both incidents and EEG power, and a trend for greater subjective sleepiness. All three indices showed a significant worsening of sleepiness over the drive under both lunch conditions. Whilst there were no significant condition×time interactions, there was no difference between lunches for at least the first 30 min of the drive when, thereafter, the differences appeared. Ours was a realistic driving study, utilising typical lunches, following an unexceptional level of prior sleep loss, and where a heavy lunch exacerbated inherent sleepiness, to further impair monotonous driving.     

Counteracting driver sleepiness: Effects of napping, caffeine, and placebo

Sleepy drivers should “take a break,” but the efficacy of feasible additional countermeasures that can be used during the break is unknown. We examined a shorter than 15 min nap, 150 mg of caffeine in coffee, and a coffee plalcebo, each given randomly across test sessions to 10 sleepy subjects during a 30-min rest period between two 1-hr monotonous early afternoon drives in a car simulator. Caffeine and nap significantly reduced driving impairments, subjective sleepiness, and electroencephalographic (EEG) activity indicating drowsiness. Blink rate was unaffected. Sleep during naps varied, whereas caffeine produced more consistent effects. Subjects acknowledged sleepiness when the EEG indicated drowsiness, and driving impairments were preceded by self-knowledge of sleepiness. Taking just a break proved ineffective.     

Temporal profile of prolonged, night-time driving performance: breaks from driving temporarily reduce time-on-task fatigue but not sleepiness

Breaks are often used by drivers to counteract sleepiness and time-on-task fatigue during prolonged driving. We examined the temporal profile of changes in driving performance, electroencephalogram (EEG) activity and subjective measures of sleepiness and fatigue during prolonged nocturnal driving in a car simulator. In addition, the study examined the impact of regular breaks from driving on performance, sleepiness and fatigue. Healthy volunteers (n=12, 23-45 years) maintained a regular sleep-wake pattern for 14 days and were then in a laboratory from 21:00 to 08:30 hours. The driving simulator scene was designed to simulate monotonous night-time rural driving. Participants drove 4 × 2-h test sessions, with a break from driving of 1 h between each session. During the break participants performed tests assessing sleepiness and fatigue, and psychomotor performance (~30 mins), and then were permitted to sit quietly. They were monitored for wakefulness, and not permitted to nap or ingest caffeine. EEG was recorded during the driving task, and subjective assessments of sleepiness and fatigue were obtained at the start and completion of each session. We found that driving performance deteriorated (2.5-fold), EEG delta, theta and alpha activity increased, and subjective sleepiness and fatigue ratings increased across the testing period. Driving performance and fatigue ratings improved following the scheduled breaks from driving, while the breaks did not affect EEG activity and subjective sleepiness. Time-on-task effects increased through the testing period, indicating that these effects are exacerbated by increasing sleepiness. Breaks from driving without sleep temporarily ameliorate time-on-task fatigue, but provide little benefit to the sleepy driver.     

Corticotropin-releasing factor (CRF) receptor type 1-dependent modulation of synaptic plasticity

Mobile phones signals are pulse-modulated microwaves, and EEG studies suggest that the extremely low-frequency (ELF) pulse modulation has sleep effects. However, 'talk', 'listen' and 'standby' modes differ in the ELF (2, 8, and 217Hz) spectral components and specific absorption rates, but no sleep study has differentiated these modes. We used a GSM900 mobile phone controlled by a base-station simulator and a test SIM card to simulate these three specific modes, transmitted at 12.5% (23dBm) of maximum power. At weekly intervals, 10 healthy young adults, sleep restricted to 6h, were randomly and single-blind exposed to one of: talk, listen, standby and sham (nil signal) modes, for 30 min, at 13:30 h, whilst lying in a sound-proof, lit bedroom, with a thermally insulated silent phone beside the right ear. Bipolar EEGs were recorded continuously, and subjective ratings of sleepiness obtained every 3 min (before, during and after exposure). After exposure the phone and base-station were switched off, the bedroom darkened, and a 90 min sleep opportunity followed. We report on sleep onset using: (i) visually scored latency to onset of stage 2 sleep, (ii) EEG power spectral analysis. There was no condition effect for subjective sleepiness. Post-exposure, sleep latency after talk mode was markedly and significantly delayed beyond listen and sham modes. This condition effect over time was also quite evident in 1-4Hz EEG frontal power, which is a frequency range particularly sensitive to sleep onset. It is possible that 2, 8, 217Hz modulation may differentially affect sleep onset.     

Sleep extension versus nap or coffee,within the context of ‘sleep debt’

Though extended night‐time sleep mostly reduces the ‘afternoon dip’, little is known about evening benefits to alertness, or about comparisons with an afternoon nap or caffeine. Twenty healthy carefully screened adults, normal waking alertness levels, underwent four counterbalanced conditions: usual night sleep; night sleep extended<90 min (usual bed‐time); up to 20 min afternoon nap; and 150 mg afternoon caffeine (versus decaffeinated coffee). Sleepiness was measured by afternoon and evening multiple sleep latency test (MSLTs), longer psychomotor vigilance test (PVT) sessions and a subjective sleepiness scale. Sleep was extended by average of 74 min, and all participants could nap 15–20 min. Sleep extension had little effect on PVT determined modest levels of morning sleepiness. Afternoon and evening MSLTs showed all active treatments significantly reduced the ‘dip’, with nap most effective until mid‐evening; next effective was caffeine, then extension. Late evening sleepiness and subsequent sleep did not differ between conditions. Arguably, participants may have experienced some ‘sleep debt’, given they extended sleep and reflected some sleepiness within settings sensitive to sleepiness. Nevertheless, extended sleep seemed largely superfluous and inefficient in reducing modest levels of sleepiness when compared with a timely nap, and even caffeine. Sleep, such as food and fluid intakes, can be taken to excess of real biological needs, and for many healthy adults, there is a level of modest daytime sleepiness, only unmasked by very sensitive laboratory measures. It may reflect a requirement for more sleep or simply be within the bounds of normal acceptability.     

Driver sleepiness-comparisons between young and older men during a monotonous afternoon simulated drive

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.     

Suppression of sleepiness in drivers: Combination of caffeine with a short nap

Previous research has shown that caffeine and a<15-min nap effectively and separately reduce sleepiness in drivers for I hr. In the present study, we examined in 12 sleepy individuals the treatments combined, taken during a 30-min break, prior to a longer (2 hr) continuous monotonous afternoon drive in a car simulator. Nonnap comparisons were 200 mg caffeine only and placebo. For placebo, driving incidents. Subjective and electroencephalographic measures of sleepiness all reflected a mid-afternoon peak'. This peak was significantly reduced by caffeine and eliminated by the combined treatment, which reduced incidents to 9% of placebo levels versus 34% of placebo levels for caffeine alone. Naps comprising “nonsleep dozing” were still effective.     

The circadian and homeostatic modulation of sleep pressure during wakefulness differs between morning and evening chronotypes

The purpose of this study was to evaluate homeostatic and circadian sleep process in 'larks' and 'owls' under daily life conditions. Core body temperature, subjective sleepiness and waking electroencephalogram (EEG) theta-alpha activity (6.25-9 Hz) were assessed in 18 healthy men (nine morning and nine evening chronotypes, 21.4 +/- 1.9 years) during a 36-h constant routine that followed a week of a normal 'working' sleep-wake schedule (bedtime: 23.30 h, wake time: 07.30 h). The phase of the circadian rhythm of temperature and sleepiness occurred respectively, 1.5 h (P = 0.01) and 2 h (P = 0.009) later in evening- than in morning-type subjects. Only morning-type subjects showed a bimodal rhythm of sleep-wake propensity. The buildup of subjective sleepiness, as quantified by linear regression, was slower in evening than in morning types (P = 0.04). The time course of EEG theta-alpha activity of both chronotypes could be closely fitted by an exponential curve. The time constant of evening types was longer than that of morning types (P = 0.03), indicating a slower increase in sleep pressure during extended wakefulness. These results suggest that both the circadian signal and the kinetics of sleep pressure buildup differ between the two chronotypes even under prior naturalistic conditions mimicking the usual working day.     

Daytime sleepiness, performance, mood, nocturnal sleep: the effect of benzodiazepine and caffeine on their relationship

The present study was part of a larger 3-day, 2-night double-blind parallel group design in which 80 young adult men were divided into eight treatment groups to examine the effects of benzodiazepines and caffeine on nocturnal sleep and daytime sleepiness, performance, and mood. The present study was done to examine further the relationship among daytime sleepiness, performance, mood, and nocturnal sleep and to determine if and how these relationships were affected by the nighttime use of benzodiazepine and the ingestion of caffeine in the morning. Subjects received 15 or 30 mg of flurazepam, 0.25 or 0.50 mg of triazolam, or placebo at bedtime and 250 mg of caffeine or placebo in the morning for two treatment days. Two objective (Multiple Sleep Latency Test and lapses) and two subjective (Stanford Sleepiness Scale and Visual Analog Scale) measures of sleepiness, five performance tests, and two mood measures (Profile of Mood Scale and Visual Analog Scale) were administered repeatedly on both days. Electroencephalogram sleep was recorded on both nights. Objective sleep measures of daytime sleepiness were not significantly related to either performance or mood, but subjects with greater daytime sleepiness had significantly longer and more efficient nocturnal sleep. Neither benzodiazepine or caffeine influenced these relationships. In contrast, higher estimates of subjective sleepiness were significantly associated with poorer mood and tended to be related to poorer performance. Caffeine significantly reduced these relationships. Nocturnal sleep measures were not related to subjective estimates of daytime sleepiness.     

Stop and revive? The effectiveness of nap and active rest breaks for reducing driver sleepiness

The purpose of this study was to compare the effects of two commonly utilized sleepiness countermeasures: a nap break and an active rest break. The effects of the countermeasures were evaluated by physiological (EEG), subjective, and driving performance measures. Participants completed 2 h of simulated driving, followed by a 15‐min nap break or a 15‐min active rest break, then completed the final hour of simulated driving. The nap break reduced EEG and subjective sleepiness. The active rest break did not reduce EEG sleepiness, with sleepiness levels eventually increasing, and resulted in an immediate reduction of subjective sleepiness. No difference was found between the two breaks for the driving performance measure. The immediate reduction of subjective sleepiness after the active rest break could leave drivers with erroneous perceptions of their sleepiness, particularly with increases of physiological sleepiness after the break.     

Sleepiness is a signal to go to bed: data and model simulations

Study ObjectivesAssess the validity of a subjective measure of sleepiness as an indicator of sleep drive by quantifying associations between intraindividual variation in evening sleepiness and bedtime, sleep duration, and next morning and subsequent evening sleepiness, in young adults.MethodsSleep timing and sleepiness were assessed in 19 students in late autumn and late spring on a total of 771 days. Karolinska Sleepiness Scales (KSS) were completed at half-hourly intervals at fixed clock times starting 4 h prior to participants’ habitual bedtime, and in the morning. Associations between sleepiness and sleep timing were evaluated by mixed model and nonparametric approaches and simulated with a mathematical model for the homeostatic and circadian regulation of sleepiness.ResultsIntraindividual variation in evening sleepiness was very large, covering four or five points on the 9-point KSS scale, and was significantly associated with subsequent sleep timing. On average, a one point higher KSS value was followed by 20 min earlier bedtime, which led to 11 min longer sleep, which correlated with lower sleepiness next morning and the following evening. Associations between sleepiness and sleep timing were stronger in early compared to late sleepers. Model simulations indicated that the directions of associations between sleepiness and sleep timing are in accordance with their homeostatic and circadian regulation, even though much of the variance in evening sleepiness and details of its time course remain unexplained by the model.ConclusionSubjective sleepiness is a valid indicator of the drive for sleep which, if acted upon, can reduce insufficient sleep.     

Driver sleepiness and individual differences in preferences for countermeasures

The aim of the present national questionnaire study was to relate the use of sleepiness countermeasures among drivers to possible explanatory factors such as age, sex, education, professional driving, being a shift worker, having experience of sleepy driving, sleep-related crashes, problems with sleep and sleepiness in general and sleep length during working days. Also the attitude to countermeasures related to information or driver support system was studied. A random sample of 3041 persons was drawn from the national register of vehicle owners. The response rate was 62%. The most common countermeasures were to stop to take a walk (54%), turn on the radio/stereo (52%), open a window (47%), drink coffee (45%) and to ask passengers to engage in conversation (35%). Logistic regression analysis showed that counteracting sleepiness with a nap (a presumably efficient method) was practiced by those with experience of sleep-related crashes or of driving during severe sleepiness, as well as by professional drivers, males and drivers aged 46-64 years. The most endorsed means of information to the driver about sleepiness was in-car monitoring of driving performance providing drivers with information on bad or unsafe driving. This preference was related to experience of sleepy driving, not being a professional driver and male gender. Four clusters of behaviours were identified: alertness-enhancing activity while driving (A), stopping the car (S), taking a nap (N) and ingesting coffee or other sources of caffeine (C) (energy drinks, caffeine tablets). The participants were grouped according to their use of any of the four categories of countermeasures. The most common cluster was those who used activity, as well as stopping and drinking caffeine.     

Daytime sleepiness during Ramadan intermittent fasting: polysomnographic and quantitative waking EEG study

During the lunar month of Ramadan, Muslims abstain from eating, drinking and smoking from sunrise to sunset. We reported previously that Ramadan provokes a shortening in nocturnal total sleep time by 40 min, an increase in sleep latency, and a decrease in slow-wave sleep (SWS) and rapid eye movement (REM) sleep duration during Ramadan. During the same study, the effects of Ramadan intermittent fasting on daytime sleepiness were also investigated in eight healthy young male subjects using a quantitative waking electroencephalograph (EEG) analysis following the multiple sleep latency test (MSLT) procedure. This procedure was combined with subjective alertness and mood ratings and was conducted during four successive experimental sessions: (1) baseline (BL) 15 days before Ramadan, (2) beginning of Ramadan (R11) on the 11th day of Ramadan, (3) end of Ramadan (R25) on the 25th day of Ramadan, (4) recovery 2 weeks after Ramadan (AR). During each session, four 20-min nap opportunities (MSLTs) were given at 10:00, 12:00, 14:00 and 16:00 h and were preceded by rectal temperature readings. Nocturnal sleep was recorded before each daytime session. Subjective daytime alertness did not change in R25 but decreased in R11 at 12:00 h, and subjective mood decreased at 16:00 h, both in R11 and R25. During the MSLT, mean sleep latency decreased by an average of 2 min in R11 (especially at 10:00 and 16:00 h) and 6 min in R25 (especially at 10:00 and 12:00 h) compared with BL. There was an increase in the daily mean of waking EEG absolute power in the theta (5.5-8.5 Hz) frequency band. Significant correlations were found between sleep latency during the MSLT and the waking EEG absolute power of the fast alpha (10.5-12.5 Hz), sigma (11.5-15.5 Hz) and beta (12.5-30 Hz) frequency bands. Sleep latency was also related to rectal temperature. In conclusion, Ramadan diurnal fasting induced an increase in subjective and objective daytime sleepiness associated with changes in diurnal rectal temperature.     

Driver sleepiness--evaluation of reaction time measurement as a secondary task

The application of reaction time (RT) as a secondary task to determine sleepiness in drivers is of increasing interest, but is a problematic area. We assessed the extent to which RT reflected this sleepiness, and/or otherwise affected driving behaviour in sleep restricted, moderately sleepy people. They drove a real-car interactive simulator for two, two hour afternoon monotonous drives, with and without RT (counterbalanced). Simple auditory RT was used, with a semi-random inter-stimulus interval averaging 21/2 minutes. Lane wandering (driving "incidents"), subjective and EEG measures of sleepiness were obtained. For both conditions all three indices changed significantly during the course of the afternoon circadian "dip". However, this was not reflected in RT, which remained relatively stable. Nevertheless, RT provided more "stimulation" for the sleepy driver, and significantly reduced subjective sleepiness, with a trend for fewer incidents and a more alert EEG. Possible reasons for the disparity in sensitivity between RT and the other measures are discussed. Under this experimental protocol, RT did not provide a useful guide to driver sleepiness; it was merely a mechanism for increasing task load and reducing monotony. The drivers' own insight into their sleepiness had more validity as a tool for assessing sleepiness.     

Awareness of sleepiness when driving

The extent to which sleepy drivers are aware of sleepiness has implications for the prevention of sleep-related crashes, especially for drivers younger than 30 years old who are most at risk. Using a real car interactive simulator, we report on EEG, subjective sleepiness, and lane drifting (sleepiness-related driving impairment) from 38 sleep-restricted, healthy young adults undergoing nontreatment control conditions from three (unpublished) investigations using the same experimental protocols for assessing various drinks intended to alleviate sleepiness. Participants drove 2 h during midafternoon under monotonous conditions. For all studies, subjective sleepiness and EEG activity indicative of sleepiness were highly correlated, with both changing concomitantly, along with lane drifting. Drivers had knowledge of their physiological sleepiness. There were indications that sugar content of these drinks may additionally affect sleepiness.     

Green light attenuates melatonin output and sleepiness during sleep deprivation

Melatonin output covaries with sleepiness, with both peaking early morning. Bright white light suppresses this output, but it is not known if such treatment ameliorates nighttime sleepiness during sleep deprivation. However, sleep-deprived subjects find such light irritating. Humans are particularly sensitive to green light, and melatonin output is more readily suppressed by this hue. A pilot study using different green light regimens showed that sleep-deprived subjects well tolerated 2,000 lux green light given 10 min hourly, and that this dose reduced nighttime melatonin output. The main study gave this light treatment vs. a low intensity red/green light control, from 1900 hr for 11 hr, to two groups of subjects (n = 6 each) sleep deprived for 36 hr. Urine was collected at 6-hr intervals during sleep loss and on a baseline day. Vigilance performance, subjective sleepiness, and oral temperature were monitored during sleep loss. The experimental condition suppressed urine 6-hydroxymelatonin sulfate (aMT6s) output between 0000 hr and 0600 hr, and increased it 0600-1200 hr; but there was no change in total 24-hr values. The control condition had no such effects. The oral temperature rhythm remained unchanged. Vigilance and subjective sleepiness were improved significantly relative to control values during 0000-0600 hr; these improvements were maintained somewhat over the 0600-1200-hr period, contrary to what one might expect if the delayed melatonin surge at this time was increasing sleepiness. Although the bright green light helped counteract sleepiness, any causal link with changes in melatonin output seem tenuous.     

Circadian rhythms of early morning awakening insomniacs

SUMMARY It has been suggested that two types of insomnia, sleep onset insomnia and early morning awakening insomnia, may be caused by delays and advances respectively of circadian rhythms. Evidence supports the circadian rhythm phase delay of sleep onset insomniacs. The present study investigated the phase timing of circadian rhythms of early morning awakening insomniacs compared with a group of age matched good sleepers. A 24-h bed rest laboratory session was used to evaluate the endogenous core body temperature and urinary melatonin rhythms. Objective and subjective sleepiness were also measured every 30 min across the session with 10 min multiple sleep latency tests and Stanford Sleepiness Scale. Maximum and minimum phases of each individual's rhythm were identified using two-component cosine curve fitting. Compared with the good sleepers, the insomniacs had significant phase advances of 2 4 h for the temperature and melatonin rhythms. However, the 0-4 h advances of the sleepiness rhythms were not significant. This latter unexpected result was explained on the basis of variability of sleepiness measures. It was suggested that early morning awakening insomnia arises from phase advanced circadian rhythms which evoke early arousal's from sleep.     

Aging and Nocturnal Driving: Better with Coffee or a Nap? A Randomized Study

STUDY OBJECTIVE: To test the effects of coffee and napping on nocturnal driving in young and middle-aged participants. DESIGN: A cup of coffee (200 mg of caffeine), a placebo (decaffeinated coffee, 15 mg of caffeine), or a 30-minute nap were tested. Participants drove 125 highway miles between 18:00 and 19:30 and between 02:00 and 03:30 after coffee, placebo, or a nap. SETTING: Sleep laboratory and open French highway. PARTICIPANTS: Twelve young (range, 20-25 years) and 12 middle-aged participants (range, 40-50 years). MEASUREMENTS: Inappropriate line crossings, self-perceived fatigue and sleepiness, and polysomnographic recordings were analyzed. RESULTS: Compared to daytime, after placebo the number of inappropriate line crossings was significantly increased (2 versus 73 for young participants, P < 0.01 and 0 versus 76 for the middle-aged participants, P < 0.05). Both coffee and napping reduced the risk of inappropriate line crossings, compared with placebo, in young participants (respectively, by three-quarters, incidence rate ratios [IRR] = 0.26 95% confidence interval [CI], 0.09-0.74, P < 0.05 and by two thirds, IRR = 0.34 95% CI, 0.20-0.58, P < 0.001) and in middle-aged participants (respectively by nine tenths, IRR = 0.11 95% CI, 0.05-0.21, P < 0.001 and by one fifth, IRR = 0.77 95% CI, 0.63-0.95, P < 0.05). A significant interaction between age and condition (IRR = 2.27 95% CI, 1.28-4.16 P < 0.01) showed that napping led to fewer inappropriate line crossings in younger participants than in middle-aged participants. During napping, young participants slept more (P < 0.01) and had more delta sleep (P < 0.05) than middle-aged participants. Self-perceived sleepiness and fatigue did not differ in both age groups, but coffee improved sleepiness (P < 0.05), whereas napping did not. CONCLUSIONS: Coffee significantly improves performance in young and middle-aged participants. Napping is more efficient in younger than in older participants. Countermeasures to sleepiness should be adapted according to the age of drivers.     

Impaired alertness and performance driving home from the night shift: a driving simulator study

Driving in the early morning is associated with increased accident risk affecting not only professional drivers but also those who commute to work. The present study used a driving simulator to investigate the effects of driving home from a night shift. Ten shift workers participated after a normal night shift and after a normal night sleep. The results showed that driving home from the night shift was associated with an increased number of incidents (two wheels outside the lane marking, from 2.4 to 7.6 times), decreased time to first accident, increased lateral deviation (from 18 to 43 cm), increased eye closure duration (0.102 to 0.143 s), and increased subjective sleepiness. The results indicate severe postnight shift effects on sleepiness and driving performance.