#26 - Is It Safe To Drive During Insomnia Treatment?

The next time you go to work (or have a Zoom staff meeting), have a look around.

1 out of every 5 people you see is likely experiencing insomnia.

But not everyone will seek treatment for it. Many will try different ‘sleep tips’ that they’ve heard about (eg, limit caffeine, limit alcohol, avoid using technology in the hour before bed).

For some this may work. For others it does not. And that’s possibly because research shows:

• it’s not necessarily the caffeine you have during the day, but the caffeine you have in the evening that affects your sleep (Bartel et al., 2015). So if you’ve already cut back on your evening caffeine, then cutting back on your daily caffeine may not work.

• Most people hear ‘moderate your alcohol intake’. Eventually this will help, but as many people use alcohol as a sleep aid, then they may experience acute withdrawal symptoms - one of them being insomnia.

• Broadly speaking, technology use in the hour before bed does not affect everyone the same. And not all technology before bed is harmful. In fact, the definition of ‘the hour before bed’ has changed - because we use to go to bed and either read a printed book, or just turn the light off and attempt sleep. Now - people go to bed and use technology.

A study many years ago showed that 99% of people seeking help for their insomnia will visit their family doctor. Because doctors are primarily trained in the medical model, the most common treatment offered is sleep medications (eg, z-drugs like Ambien/Stillnox, or benzodiazepines). These medications have shown to be effective in the short-term for treating insomnia - yet they can have side effects (see below). Yet science shows us that when one stops using these medications, their insomnia is highly likely to return.

The remaining 1% seek help in a variety of places, the most common are the shelves at their local pharmacy.

I guess by now you can see that people seek a ‘quick fix’ for their insomnia.

And within that 1% lie experts who can effectively deliver what’s called the ‘gold standard’ treatment for insomnia - cognitive behaviour therapy for insomnia (or CBT-I).

CBT-I has primarily been delivered by psychologists. It has mainly been evaluated by psychologists using scientific methods. CBT-I consists of a bunch of behavioural and cognitive techniques.

One of these is Sleep Restriction Therapy (yep, you heard right!).

But technically speaking, Sleep Restriction Therapy does not restrict sleep. If anything, it reduces the amount of time people spend in bed so that they do not lie awake in bed so much. And it does this without restricting the person’s sleep.

Usually this technique takes a couple of weeks to perform, as people can see improvements this fast (we psychologists say fast because - relatively speaking - there are other psychological treatments that take months to perform).

But - Sleep Restriction Therapy can also increase a person’s level of sleepiness during the day.

I’m sure I’m not the only one who has suggested this technique to a client, and then had a thought race through one’s mind like “what about if they have a car accident?”

So one year - we deiced to do something about this.

We performed a study where we got people in a driving simulator before undertaking Sleep Restriction Therapy. Two weeks later, we got them to do the driving simulator again. You can read more about this study by downloading it for free here.

What did we find?

I seem to say the next phrase a fair bit with my studies - “not alot”. Well, they all slept better (ie, spent less time awake in bed), didn’t alter the amount of sleep they got, and in this case their daytime sleepiness did not change. In addition, their reaction times didn’t really change, and neither did their performance on the driving simulator.

This sounds like welcome news to many clinicians who use Sleep Restriction Therapy with their patients. But like most research studies, it’s important that this study is replicated. And one reason for that is that the insomnia group’s averaged driving scores did not change.

But there was 1 out of the 17 participants who crashed during the driving simulator after undergoing Sleep Restriction Therapy (fortunately, she got home safely).

So - is it safe to drive during insomnia treatment?

Well, let me say it this way. The risk of having an accident is lower if you are treated with CBT-I compared to sleep medications - as this study showed that driving was worse after taking a z-drug (Zopiclone).

Before you start to look for someone who can help you with your insomnia in your country, you may wish to do a bit more reading to best prepare yourself. Read our sleep expert blog here.

And if you get stuck finding someone in your local area, then know that we can help via Zoom - no matter where you are in the world.