Restless Legs Syndrome Foundation Blog

Drowsy Driving Prevention: Sleep First. Drive Alert.

Founded in 1990, the National Sleep Foundation is an independent nonprofit dedicated to improving health and well-being through sleep education and advocacy. Additional information on the National Sleep Foundation’s Drowsy Driving Prevention Week® can be found at www.theNSF.org.

Vehicles today are equipped with all types of safety features – from lane assistance to backup cameras to automatic braking systems. But the most important safety feature of the car is you – the driver. Each time you get behind the wheel of a vehicle, you commit to being a responsible and safe motorist for yourself and everyone else on the road.

November 3–9 marks Drowsy Driving Prevention Week. This annual campaign, led by National Sleep Foundation (NSF), raises awareness by educating the public on the dangers of drowsy driving and how to prevent it. Drowsy driving is impaired driving, just like drunk, drugged and distracted driving. While common, drowsy driving is also preventable.

According to data from NSF, drowsy driving is dangerously common. Six in 10 drivers (62%) reported getting behind the wheel while so tired that they had a hard time keeping their eyes open – that’s about 150 million US motorists. According to the National Highway Traffic Safety Administration, motor vehicle crashes related to drowsy driving account for roughly 20% of all accidents and an estimated 100,000 crashes each year.^1,2 Some people at an increased risk for drowsy driving include young adults ages 21–34 and men.²

NSF assembled an expert panel to establish consensus guidelines that provide a clear definition of when an individual is categorically too sleep deprived to operate a motor vehicle. This consensus statement indicates that drivers who have slept for two hours or less in the preceding 24 hours are not fit to operate a motor vehicle.^1,3 The guidelines further note that most healthy drivers would likely be impaired if they’ve had only three to five hours of sleep during the prior 24 hours.^1,3

Additionally, teenagers are an at-risk group for drowsy driving. “Recent NSF data showed many teens, early in their driving experience, say they’ve already driven while drowsy. Overall, teens know the risks of drowsy driving but don’t think it’s as risky as other forms of impaired driving,” said Joseph Dzierzewski, PhD, senior vice president of research and scientific affairs at the National Sleep Foundation. “There’s a lot we can teach our young drivers about the importance of getting the sleep they need before they get behind the wheel.”

One study compared the effects of sleep deprivation and alcohol on performance.⁴ Results found that being awake for 17–19 hours is comparable to having a blood alcohol content of 0.05%. People were also found to have decreased reaction time and hand-eye coordination. After longer periods without sleep, performance reached levels equivalent to a blood alcohol content of 0.1%, suggesting that lack of sleep can severely impair a person’s ability to safely operate a vehicle.⁴

Drowsy driving can impact anyone, and it may present increased challenges for those with sleep-related conditions. Some medications can cause drowsiness, so talk to your doctor if you have this side effect from your medications. Watch for signs of excessive sleepiness, such as yawning repeatedly or difficulties focusing. To prevent accidents related to drowsy driving, try the following:⁵

• Get sufficient sleep on a daily basis. NSF recommends 7–9 hours for most adults and 8–10 hours for teenagers.
• Monitor yourself for common signs of drowsy driving, including heavy eyelids, frequent yawning, trouble maintaining lanes or distance, missed turns, and quick irritation with common occurrences (such as traffic).
• Use a rideshare service or ask a friend or family member to drive if you are concerned about your ability to safely operate your car.
• Stop driving and take a short nap if you are feeling tired.
• If possible, avoid driving between midnight and 6 am or 1–4 pm. Accidents related to drowsy driving are more likely to occur during these hours, as people experience a natural dip in their circadian rhythm.
• Avoid alcohol consumption before getting into a vehicle. Alcohol can increase sleepiness and impairment.

“At NSF, we’re dedicated to helping everyone prioritize their sleep for health and safety. Getting enough quality sleep to be your Best Slept Self is a critical factor in our ability to drive safely,” adds Dzierzewski.

As you navigate your busy life, don’t let the dangers of drowsy driving take a back seat. The NSF’s Drowsy Driving Prevention Week campaign slogan is “Sleep First. Drive Alert.TM” The best way to honor this motto is to prioritize the safety and well-being of yourself and everyone else on the road. Don’t hesitate to call a family member or friend or to use a ride-sharing service if you are questioning your ability to drive responsibly.

1. Breaking Report from the National Sleep Foundation Update on Drowsy Driving; 2022. https://www.thensf.org/wp-content/uploads/2022/11/National-Sleep-Foundation-Breaking-Report_Drowsy-Driving.pdf

2. Tefft, B.C. (2024). Drowsy Driving in Fatal Crashes, United States, 2017–2021 (Research Brief). Washington, D.C.: AAA Foundation for Traffic Safety.

3. Czeisler CA, Wickwire EM, Barger LK, et al. Sleep-deprived motor vehicle operators are unfit to drive: a multidisciplinary expert consensus statement on drowsy driving. Sleep Health. 2016;2(2):94-99. doi:10.1016/j.sleh.2016.04.003

4. Williamson AM, Feyer AM. Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occupational and Environmental Medicine. 2000;57(10):649-655. doi:10.1136/oem.57.10.649

5. Andrew Currin. NHTSA. NHTSA. Published September 8, 2016. https://www.nhtsa.gov/risky-driving/drowsy-driving

RLS Foundation 2024 Research Grant Program Awardees

Each December, the RLS Foundation announces the opening of preapplications for research grant proposals through its Research Grant Program. Since its inception in 1997, this program has focused on supporting efforts to develop better treatments for RLS and ultimately find a cure. Researchers can apply for grant proposals of a 1 year-duration, with funding levels of up to $50,000.

This year marks a significant milestone: for the first time, the RLS Foundation is funding four RLS research studies in the same year! This historic level of support is made possible by our dedicated members and a collaboration with the American Academy of Sleep Medicine Foundation (AASMF), which co-funded one of the grant awards. Each project aims to deepen our understanding of the genetic, biochemical, and cellular mechanisms of RLS.

We are excited to introduce the innovative researchers leading these groundbreaking studies:

Shawn Hochman, PhD

Emory University School of Medicine, Atlanta, Georgia

RLS Foundation and AASMF Co-Funded Grant

Grant Title: Sensory dysfunction in a diet-induced iron-de¬ficiency mouse model of RLS: Characterization and control by dopamine-sensitive spinal gating circuitry

Objective: This study aims to use electrophysiological and genetic approaches in mice to study whether an iron-deficient diet leads to; (1) increased excitability in select ‘pain-like’ pe-ripheral sensory signals arising in calf muscles, (2) whose activa¬tion of central circuits is abnormally amplified due to deficient capacity for dopamine-sensitive inhibitory gating signals in the spinal cord. As an individual with RLS, I fully appreciate the suf¬fering associated with abnormal limb sensations and the imme¬diate relief provided by leg movements.

Imad Ghorayeb, MD, PhD

Hospital Center University De Bordeaux, France

Grant Title: Functional connectivity of the interoceptive network in RLS: An anatomo-clinical prospective study

Objective: This project will precisely characterize the intero¬ception awareness in RLS patients together with the time vari¬ance of the symptoms and their sleep/wake cycle impairment using ambulatory assessment. This assessment of the symp¬toms will be correlated to time-of-day intrinsic connectivity of the insula, based on both static and dynamic connectivity frameworks. Such a survey may confirm the hypothesis that interoceptive dysfunction in patients with RLS would link the sensorimotor and non-motor symptoms of the disorder into a common pathophysiological process.

Brian Koo, MD

Yale Center for Sleep Medicine, New Haven, Connecticut

Grant Title: Cerebrospinal Fluid Melanocortin and Endor¬phin in Restless Legs Syndrome Related Augmentation

Objective: This proposal aims to study melanocortin biol¬ogy among RLS patients suffering dopamine agonist-induced augmentation and in the post-augmentation stabilized state, having been taken off the dopamine drug and treated with a non-dopamine medication. This proposal focuses on the neurobiological interaction between dopamine and MC biol¬ogy, first assessing cerebrospinal fluid MCs (α-MSH, β-MSH, β-EDP) in the chronic dopamine agonist setting, and then in the post-dopamine agonist setting.

Mauro Manconi, MD, PhD

Sleep and Epilepsy Center, Civic Hospital Neurocenter of Southern Switzerland

Grant Title: Epidural Spinal Cord Stimulation in Refractory or Augmented Restless Legs Syndrome

Objective: This research consists of a pilot interventional study with the general aim to test the efficacy and safety of epidural spinal cord stimulation (SCS) in patients with moderate to very severe RLS that is refractory, or intolerant to standard treatments. This is a proof-of-concept, open-label clinical trial.

Congratulations to the 2024 grant awardees! An in-depth review of each study will be published in the Fall edition of the RLS Foundation's quarterly magazine, NightWalkers. If you are not yet a member of the RLS Foundation and would like to receive a subscription to NightWalkers, visit our website at www.rls.org.

Restless Nights: Navigating RLS Amidst COVID Chaos

Marilyn Meier has had RLS for many years. She is a mother of two, a grandmother of four, a world traveler and a birder who loves hosting her friends and family. She recently shared her experience of having RLS and COVID-19 with RLS Foundation staff. Though there is little research studying this correlation, she is sharing her story with other members of the community who may have had a similar experience.

I had “jumpy legs” starting in my 30s, but I did not have an official diagnosis of restless legs syndrome (RLS) until I was in my 50s. I had great faith in my family doctor, but quite frankly, very little was known at that time about RLS – even for specialists like neurologists. I took no medications to manage my symptoms for years until things progressed to the need for pramipexole (Mirapex). Mirapex certainly helped … initially. However, as my symptoms grew worse, my doctor increased the dosage. Once again, it helped. The bad news, however, was that I developed a side effect known as augmentation.* Concurrently, studies were being published connecting augmentation to Mirapex and other medications known as dopamine agonists.

I began seeing a neurologist who trained at Mayo Clinic and was familiar with RLS and augmentation. She prescribed gabapentin and slowly reduced the amount of Mirapex. When the augmentation persisted, she started me on oxycodone in addition to the other medications. This was life-changing! My symptoms improved significantly. Although I still experience breakthrough symptoms, for the most part my RLS is under control.

I have been fortunate that my severe RLS symptoms do not usually occur during the night when I am asleep. More often, they intensify in the afternoon (if I try to rest and start to doze off) and after 9:00 pm before I go to bed. When I experience these episodes, often daily, I call it an “attack.” The symptoms usually subside after about one or two hours. I walk, march in place, or go to the kitchen to find something to nibble on like grapes, cereal or peanuts – anything that might distract me from the maddening sensations in my legs! There have been rare occasions over the years when the attack has lasted as long as 30-plus hours without a wink of sleep. Does this sound familiar to any of you?

I was scheduled to have my right hip replaced this January – my ninth joint surgery. I mention this so that you understand that, by now, I know the drill and did not have any overriding anxiety about the surgery. However, I was experiencing some congestion the day before the surgery and, after consulting with the pre-op nurses at the hospital, I was advised to get a COVID test at my clinic. The lab technician told me that my results would probably not be reported until later that night, but in time for my scheduled surgery. I went to bed at 11:30 pm, fully expecting to get a good night’s sleep. But within half an hour, I was driven out of bed with my jumpy legs – I could not understand! This was not the normal pattern of my RLS. I headed downstairs so as not to disturb my husband, and that was the beginning of my endless night.

I desperately tried my usual coping strategies to disrupt the attack. I walked around, turned on the TV for distraction, marched behind my desk chair, moaned and groaned, but nothing helped. At 6:00 am, I looked again at my online patient portal and there it was – a positive COVID result! My COVID test meant no surgery – I was completely bummed! Not only did I have COVID, but I had suffered a severe attack of RLS. My legs were still going crazy, and they did not let up until 2:00 pm that afternoon, 14 hours after they kicked in. As you can imagine, I was exhausted and beyond frustrated. I questioned: Did COVID play a role in my RLS attack? After all, I rarely have such a severe attack, so it was a departure from any former pattern. I have no idea if COVID triggered my restless legs attack, and I will never know for sure if the two were connected.

Because I had COVID, my surgical team followed its protocol to wait six weeks after the diagnosis to reschedule surgery. In a few days, I will finally be getting my hip replacement. And am I ever ready!

Before closing, I would like to thank the RLS Foundation for the incredible work that they do. I became familiar with them during COVID and attended some of the online support group sessions. I read the NightWalkersmagazine from cover to cover, learning more and more about this disease. I have attended their fabulous webinars, which have enabled me to have more informed conversations with my neurologist. The information that these specialists provide is excellent. Thanks to the RLS Foundation, I can live more successfully with this disease!

*Medical Editor’s Note: Augmentation is a worsening of RLS symptoms after getting initial relief (often months or even years) from medication that treats RLS. These are typically dopamine related drugs (carbidopa/levodopa, pramipexole, ropinirole or rotigotine) but the non-dopamine drug, tramadol may also cause augmentation. Increasing the dose of the drug will provide temporary relief but with time, will worsen the augmentation process. For further information, see the RLS Foundation’s handout on RLS Augmentation.