cases remain undiagnosed. what's really encouraging is the development recently of portable sleep studies and there is no eeg monitor and we use the chest and abdominal effort bells and airflow snoring and oxygen sensors. there variations to this model. the beautiful advantage of this type of device is that a patient can assemble it themselves in their own home. they are much more convenient for those who shift away from home a lot. once it is diagnosed, can we treat it? i my patients think of your airway like a tire. when you were a kid and you had a flat tire, you blow it up with air. we had this device called a continuous positive airway pressure machine that we don't need to bring patients back in and to repeat the sleep study to repeat the pressure level. they have automatic sensors that

determine it for you directly in the home. there so many dozens of different masks and full face masks for mouth breathers and let you sleep on your side or back. it's a flow generator and with an open airway it's possible to have a continuous flow of oxygen and with oxygen the patients can sleep and get a break from all that adrenaline. we know with randomized trials, they show c pap lowers crash risk and creates alertness and a driving simulator can improve in as little as two to seven days. people feel better. their blood pressure is lower and heard disease and stroke risk and even mortality all improve and we know that they spend less monohealth care. there other therapies including

oral appliances and surgeries. the body of evidence that supports the use is so enormous that that tends to be the first line therapy. we also recommend that the patients lose weight and they limit alcohol and sleeping pills and narcotics to the lowest amount they can get away with. avoid tobacco smoke that can increase the swelling and make the airway more collapsible. and also to keep the nasal passages open by controlling nasal congestion.'n if they need surgery, we will advise to correct the deviated septum. we can monitor those using the c pap. not only the ds cards, but they have modems that snap on to the back of the machine that allows us to track tonight how many hours they use it. what was the pressure level and is there still apnea going on and was the mask leaking?

we can address the issues as we go. this is an example of such a download and the green color indicate that is the person use it for at least four nights. night after night and on the fifth night they skipped it and it was blank. in summary, i would say that the sleep apnea is common. it's definitely been linked to sleepiness and crashes as well as major economic health outcomes and importantly it can be diagnosed in the home. the treatment is inexpensive and inaccessible and shown to lower trash risk and improves many conditions and can be tracked in realtime. thank you. >> thank you very much. >> our final panelist is from the food and drug administration. >> i'm a clin dal team leader in the center for drug evaluation and research at the food and drug administration. i would like to thank the ntsb

for inviting them here to talk and i'm going to start with a slide that said the views i am going to express are mine and not necessarily of the fda. one of the discussion questions that will come up soon is what the fda is saying to patients to help them understand the risks from drugs as with regard to drowsiness and driving. in this presentation there, it's hard to see, but there is yellow. on my screen it's hard to see. yellow highlights around text and that text is from web pages that the fda has that help patients to understand risk from drugs and also the picture on the right is from a pamphlet available to patients who would like to learn more about the effects of drugs on driving. so the fda is trying to

communicate clearly the risks that can occur from over-the-counter drugs and to use clear language and make clear recommendations like you see here fda and actually working with the ntsb and other sister agencies that warns patients that both prescription and over t kount-the-counter medications can make it to drive. one important way that the fda judges the acceptability of risk of drugs, all drugs have risks but what's an acceptable risk? we looked to examples like drowsy driving or examples like drunk driving. driving under the influence of alcohol. to try to understand society's tolerance for risks from drugs and one of the things we look at

is the legal definition. not to give legal advice but to warn patients about if you take this particular drug, would you be impaired to the same degree that you might be from alcohol at the legal limit for driving? i think too that normally when you think of adverse events from drugs, you think about injury to your liver or skin reactions. that kind of thing. certainly crashes are a serious adverse event and even the whole -- even if it's not illegal, being stopped by the police is something that patients would be interested in avoiding. so the car crashes are right in the middle of frequent events and rare events. so that if you give somebody a drug and they get into a car crash, they are frequent enough

so you can't say necessarily that the drug caused the car crash and rare enough that if you do a normal sized trial of an experimental drug, you only see a few car crashes and not the power to determine if the drug increased the risk of the car crash. the studies could be designed and designed to investigate the increased risk of the car crash from the drug, but they have to be large and most of the time that's not practical. if you have suspicion that they would cause car crashes, it would be problematic to expose them to that risk. looking to examples from alcohol and from drowsy driving one approach that we have been

looking@the fda is the effect that drugs have on driving skills. this is very helpful. drugs are certainly complicated, but drugs are extremely complicated, a drug for insomnia when the blood level is high, it's dangerous to drive. how many hours after taking the drug would it be to drive again? some of these kinds of detailed questions about drug levels that are individual patient variability is much easier in a controlled trial and laughboratory with a simulated car. so this again is an image from the fda website and stressing that knowing how your

medications and any combination of them affect your ability to drive is a safety measure that involves the patient and their passengers and others on the road. in fact, the sign here, the traffic sign shows the whole list of problems that could be caused by drugs that could affect your title drive in addition sleepiness. some of the others are more straight forward. in terms of the patient perceiving the problem like fainting. one of the things that has been talked about are patients are unaware of the drowsiness and other affects on their thinking. so that it's less reliable to judge the ability to drive after you have taken the medicine based on if you feel awake and

alert. there is a tremendous complexity to trying to understand the effects of drugs that are mixed together. it's difficult to understand the effects of drugs in different people who have different blood levels after taking the same dose who eliminate at different rates. one thing the patients need to be aware of is the combinations of drugs like two drugs have caused sleepiness can have a far greater effect than taking one drug alone. there is a very large number of drugs that cause sleepiness and they increase that risk in controlled trials and we often see things like 10% of patients who take the drug are sleepy during the day versus 3% of the people on placebo. it's a randomized sample and they have the same disease. we know about that increased

risk and this is represented in the label for drugs. the website for the fda gives kind of a long list of categories and we would recommend people check with their health care provider and with the pharmacist can read the drug labels and information that comes with the drugs. this list shows how a very large variety of drugs can cause anxiety and anti-depressants and drugs containing codeine and narcotics. cold remedies and allergy products and sleeping pills. at the bottom it lists diet pills. one thing we are concerned about is there is the possibility of the increased risk of crashes from sleepiness but drugs might affect a person's judgment.

even if they are awake that could lead to problems with decision making or aggressive driving, if you will. that's one character in stimulants that we are interested in evaluating. when thinking about what should be assessed, this line here said safety concerns could differ based on the drug and safety population. really to say it most clearly that is that the drugs have different effects on different people. right now i think doctors and the fda are struggling with how to identify patients from a particular drug. that's the ideal place to look. a lot of patients can take a drug safely and some are at risk

and the goal to be to try to identify the patients who are sleepy from the drug. we have taken a lot of guidance from work done by ntsb and meetings and expert panels and i apologize that this is small but it's kind of a graeme work for the fda that we have been using to evaluate drugs. up in the left hand corner the basic pharmocology of drugs and what receptor are they binding to and what neurotransmitter are they affecting and they give a strong indication if a drug will be appearing. we have a drug often used for sleep or anxiety. they those generally cause a great deal of sleepiness. then off to the right there is epidemiological evidence. there is evidence that drugs that can make people sleepy do

increase the risk of traffic accidents. and then down at the bottom is this focus on standardized studies. taking a look at neuropsychological tests and measuring alertness and arousal and going through actually all of the important brain functions. that brain functions are important for driving. arousal and sleepiness is important, but it would go on to things like executive function. in the setting of studies for drugs, again we can ask drug developers to enroll patients or healthy volunteers and do randomized trials and have positive controls and have a really good idea of skills important for driving like being able to stay within the lane of

the highway. so at this point i think we are changing to a more sophisticated drug. we were collecting a lot of data about patients complaining of sleepiness and representing that and the label. now more recently we have labels here where they go into some detail about the kinds of driving studies that were done and the results. we make recommendations about the dose and as the dose increases in some of these drugs, these are involving sleep. at the highest dose we will say essentially that unless the physician and patient know that the patient is not impaired, not just that they don't feel

sleepy, it may not be a good idea to drive or maybe there is another drug for that patient. thank you. blap . >> risk mitigation, patients are not aware they are sleep fre a drug or it has effects on the judgment. if they do feel sleepy or do feel impaired they shouldn't drive. that could be paired with from the fda website, learning to know how your body reacts to the medicine. a lot of this gets back to the pharmocology. to the dose. it's effective for the condition and to making sure that for some

drugs like drugs for insomnia, they take them at the beginning of the night and have a full night of sleep before you drive again so that the drug levels are low and shouldn't affect you by the time you drive in the morning. it's trying to combine how they feel with kind of a wise doping strategy to decrease the risk of car accidents from drugs. that's the end. thanks. >> thank you very much, doctor fark as. this is a pretty complex issue, how to deal with the health issues related to sleepiness and driving. and so this is really a question that i would like to hear from each of you. the information that is currently available to patients directly to patients related to over the counter or prescription medications. are they getting enough

information to make knowledgeable decisions? >> well, we're increasing the amount of information available to patients and for example in prescription insomnia drugs, there is medication guides that go to patients and describe risks like impaired driving and describe how the medicine should be taken and very straight forward language. we also have information available to the patients that are very much saying that some drugs even over-the-counter drugs can impair driving. saying very clearly if you are going to drive you should try to select the medicine that doesn't cause sleepiness. or trying to direct people

towards safer drugs. >> i can tell you that in some of the patients i see, particularly at the va, they are not just taking one drug once in a while to help fall asleep. a lot are on multiple medications, all of which has sedation as a side effect and all too often they appear unaware of which cause sedation and which don't. i think that it really speaks to how fragmented the health care system has become with specialists doing their own thing and not necessarily being aware of the whole picture and what else is the patient dealing with and what meds are they on and the patients seem unaware too often. there is definitely room for improvement. . >> i think in the general population, the people are knowing the major effect of the drug -- >> i'm sorry, can you speak into

the microphone. >> yeah. they are knowing the pills that are responsible for sleepiness. the usual medications that they take for medical conditions and the conditions, they know it they drive, they must diminish or stop the medication. for the people that are taking otc, for example it is show s that often they don't read the indications that are there on the medication. also the fact that for example you can take a pill because have the fruit and inside this one is responsible for sleepiness. this is the damage. >> so again, i think we are

highlighting the complexity of this. is there enough -- have we done enough to educate and provide the correct information to patients regarding these side effects or is that in some cases still difficult for health care providers to interpret? >> i think that there many sources of information to health care providers in particular. they are tuned in to the health safety communications out of the fda and a lot of news over the past few years about the dangers of drugs that impair your brain function for driving. and they are really i think equipped with the information they need to advise patients

about drugs that impair driving. the paint is taken that there drugs available over the counter to patients that cause sleepiness and the fda is studying patients understanding of the labeling. it is trying to figure out the best ways to communicate to patients the things we have on the website. if you are going to be driving, you should select an over-the-counter medication that is less likely the cause of sleepiness. >> one thing that made a big difference for us as providers is having e prescribing available. the sedation is cross checked and getting the medication from the same source. similarly these systems can also cross check for conditions that requires lower dosing and things

like that. those have helped and the question is, are we doing enough to educate our patients? i can tell you as a busy practitioner, time is of the essence. i think that we need to make more avenues available for patients to get the information. it is critically important. pharmacists would be another great venue. i know they give an insert when patients pick up the prescriptions and i don't know who is stopping to read those inserts. if sleepiness is one of a long list of side effects with lots of percentages mixed i'm not sure they can be getting that they could be the that has that side effect. we have a lot of people underlining the fact that we

must do more. >> thank you. the next question is for the doctor. one of the interesting things that you mentioned was the relationship between psychiatric disease, sleepiness and accident risk. do we have convincing evidence that treating that disease changes that level of sleepiness for the crash risk? we know that they can be at risk from accident. the sleepiness project out for the diseases. i think that the depression by itself is giving to the people and they are more important and

responsible for a lot of accidents. >> thank you. one of the things we run into in commercial transportation is a pretty big reluctance on the part of operators to even explore the possibility of whether or not it might have a sleep disorder like sleep apnea. in my personal life, i have a couple of friend who is have sleep apnea and they don't want to know. can you talk about the folk who is may be more or less likely to be willing to be tested and treated? >> i will jump in there. that has been the area of my research and there certain aspects to care delivery that seem to help people come forward. education is really important, but even if they are aware there is a condition called sleep apnea, they don't come forward

because of fear of employment repercussions. it's important that it's nguyen punitive. we have recommendations for how to screen from the bodies now. the society task force and we have a number of guidelines and we all agree that you have to find a way to diagnose and treat people while keeping them in service. they don't feel their employment is threatened. affordable of diagnosis and treatment and we have come a long way in recent years. with home sleep testing the cost has come down considerably and automatically adjusting positive airway pressure. in more patients, they have health insurance. i think that we can continue to improve accessibility, but that made a big dent. the third place is providing ongoing support for c pap that

they don't stru as a thing that gathered dust in their closet. that has them feel better. less so on ongoing support. that is something undergoing major transformation right now. that's all good news for patients. >> you mentioned a couple of times that recently working very hard to try to increase the amount of information that is available to patients and care givers. can you talk about where people may be able to find that information. >> particularly for the over-the-counter medications. we tried to have simple drug facts on the over the-the-counter medication s that contain simple and straight forward easy to understand warnings that the drugs can cause drowsiness.

i think the goal is to still direct patients towards drugs that don't cause drowsiness. if they are going to be driving. they have drugs that they have used for many years and to give the option for drugs that can be and effective and are not ideal to use while driving and while directing them to safer drugs if they are going to be driving or safer if you are driving. >> thank you. doctor price? >> excellent presentations so far. we have one additional question to dr. fark as. you talked about the challenges in addressing and studying driving risk through naturalistic and epidemiologic

approaches. you alluded to studies as one promising approach that is being employed. you can talk about if drug testers are using the testing and what would be the role of the fda and the drugmaker in doing that type of testing? >> to what degree those drugs might impair the driving. the drug developers are coming in with new drugs. we are taking a look at the kinds of characteristics that i showed that came out as this white paper that was organized by the ntsb or that the other federal agencies had. the fda can ask drug developers

to provide all reasonable safety data. that's to do all reasonable studies that provide that data. and studies of impairment and driving simulators or that falls under theing it of things we can ask for. we have been asking for that information from drugs like for insomnia where the potential for the drugs to cause sleepiness and impaired driving if the doses were wrong or if the time of day that they are taken is wrong. it extends beyond just drugs for insomnia insomnia. we have been asking to provide increased detail, but one of the examples that i showed was for a

sleep disorder but not insomnia. >> other drugs necessary development right now that are completely unrelated to sleep where we asked for information about things like vigilance and reaction time and we will take a look at that and see if studies and driving simulators are needed to get a better idea of the real life risks. >> thank you very much. doctor? >> thank you for great presentations. doctor -- i think we know who you are talking about. >> thank you. have we seen any changes across the medical field or any programs that have been effective in educating the public about the need to treat?

>> i can tell you that more people now know about sleep apnea than they did when i was a fellow. when i talk about it they all know somebody who has it or has used c pap. the efforts we made in the community have worked. is there more to do and there is a lot work to do. in terms of what have we done? we worked with a couple of companies to educate about sleep apnea. these were in the transportation industry. they either knew or when they heart the detail, they seemed surprised or shocked or worried.

many of them said they were on treatment. we were working with the employer and they didn't want to come forward. the efforts had limited yield in terms of the people going to get help or not. it has to be done in a non-threatening environment. the other thing is when you give them a chance to tell you about their symptoms, that's what our research knows. she did an online survey, asking truck drivers, are you snoring and gasping and falling asleep at stoplights. a huge percentage admitted they were. because it was anonymous, it couldn't be traced. we found that it works well combined with indeces like body

mass intext decks. not every driver is obese. the thinner people are helpful. getting them to talk is important and we need to get down the barriers that cause fear and that needs to be part of the endeavor we make. giving people access to self screening in a save way. >> with regard to medicines that cause potential fatigue what is the role of the pharmacist as they are thes to give thes in to inform for drowsiness. certainly the pharmacists get a lot of information from the fda about the risks of drugs that cause drowsiness.

the information that they give to patients and sheets explaining the effects of the drugs that comes from the pharmacies and sometimes from the state and that is not regulated. the fda does have for drugs that have risks that patients know about, that can explain the risks and the lesser risks of drugs that go to patients too. you think that the point has been made many times can more be done? increasing the awareness of pharmacist about the awareness of drugs is something that the fda is interested in doing and increasing the awareness of

patients about the risks of drugs for driving. trying to figure out the strategies to reach patients about the risks.y >> thank you. >> thank you. i'm going to start with you. we often talk about crashes being at the top of the pyramid especially in human performance issues cashed about the near misses. 400,000 crashes and 5,000 fatalities every year. 13.4 million is a big number. give us a comparison so we have a look at the issues that you look at. tell us where the 13.4 million

compares. as far as risk it's small, big, medium and how we can compare that to other issues we face. >> it's a very big number. compared to what we have compared to the pref lengs of insomnia insomnia, it's three times the number. probably the reason so that people are not taking care of this is because it is a variation of the sleep in the general population. it's a sign of productivity. you have more people wrongly doing medication between efficiency and efficacy of people. and if you have a lot of things

that are pushing people inside of that and probably a lot at night, the fact that you have a lot of flight the influence of the light on the people starting from the evening in the street a lot of flight inside of the home and the tv being on during the night. some people sleeping with the tv on. all of that is pruzing a disrupted sleep that could be responsible for sleepiness. they are sure that the medical conditions are going and when you look at the general population that you are looking at a big number, you see that

the environment of the people is not adequate to push them to go to sleep and have an idea about the sleep. you cannot do the economy of that. you cannot convince the enterprise that it could cost a lot in terms of life and also in terms of money. >> there has been a lot of talk about the complexity related. one of the themes is we are living in a sleep-deprived society. what interaction do we have clean sleep loss and the medications medications? >> there is certain conditions that lead to sleep loss that the

fda knows about. ideally a sleep medication would increase the ability of people to get sleep. the argument has been made that minutes of extra sleep at night every night if you can get that, that will help you over the long-term get the sleep that you need. the thing that needs to be done is to be able to accomplish treating the disease without having side effects that are unacceptable. certainly the -- there is only increased risks. there is only increased risks if the patient is taking the drug who is already with obstructed sleep apnea for an allergy what

needs to be dwn particular patients who are at risk of sleepiness and driving is to direct them to drugs that are going to be less at risk. >> just a follow-up question. if somebody has sleep apnea and taking a cold medicine, can we quantify that? the potential sleepiness is two-fold. do we have a sense of that? >> i think there is a lot that can be fantified with the percentage of patients who report sleepiness and with the studies are, you can see the ability to go within the driving lane. not a completely clear coration between these tasks and the risk of traffic accidents.

but again going to what seems to be a better corerelation for alcohol and the risk of traffic accidents, you can draw the logical connection and say that the patient is not able to stay within the driving lane and to a certain degree, it looks like the impairment from alcohol or obstructed sleep apnea. there is an ex-trapilation and it seems like the cause of similar increase risks of traffic accidents. >> 85% undiagnosed, take it from a percentage to a number. how many americans are out there with sleep apnea that are not diagnosed? >> the old estimate is 18 million, but i venture it's more than that. the number of people who are

obese compared to 20 years ago, we have 34% of people adults that are obese. the numbers are higher in african-americans. the number of people morbidly obese is on the rise. >> 18 million is the conservative and we are looking much higher. three questions for you. beyond osa which have information about trash risk? there is data looking at diabetes. >> i'm in sleep disorders. >> in sleep disrts, i'm not aware of any. >> i'm curious. there is a lot of focus because we understand that one, but

that's mind or so. when we get to insomnia and restless legs and narc lepsy may be rare, but what do we have? >> with sleep disorders we know. we have a look several times with restless legs syndrome and the prevalence of all of the disorders is around. that's at 10%. you have variation between the studies and some are finding higher. it's always there and you have to wogs with the general population, you have 28% sleepiness that is there probably they are responsible for a lot of sleepiness and more

over if probably they have disruptive sleep that's of use for sleep apnea. for older insomnia for sure. they speak about a diagnosis of which you have daytime sleepiness and you find a big risk for the people. again, if they have an accident that's not always fatal or a physical accident where the police is involved. very often it's mistakes when they are driving. doing these studies can be tricky because a lot of times sleep disorders don't happen in isolation. we found that the people were

sleeping on average only hours a night and the same people are drinking a lot of caffeine and may be depressed the. the caffeine makes them anxious and they have alcohol to take the edge off. it's never as clean and straight forward as you think. it's what you want to get an assessment of. >> that's what the doctor emphasizes. the sleepiness has multiple factors. it's one of the purest we have data about. it's a lot that we have no data. two other quick ones. one is when i get talking with folks, there is a question about who and what do i report to the motor vehicle administrations? is there a national standard or requirement or is it by state? what the sleep clinicians doing

as far as who they are supposed to report? >> a lot of confusion about who to report and who not to report. i can tell you federal law trumps anything that state societies have in place, but having said that, the federal regulations are sparse. we don't really have much in the way of when to report. it's a real problem area. if they don't know they will lose their license, you have two minutes because for the remainder remainder, you may not want the job, but you only got it for two minutes. what would you change to

increase the diagnosis and treatment of medical conditions that create drowsy driving and risk for drowsy driving. what would the changes be across the health care system that you think would give us the most effect at saving the most lives. >> we start with education and this is an important first step and get the word out that sleep is not something you do on the side, but an essential foundational part of healthy living. we have to get the message out that everyone needs to prioritize sleep. >> let me push you a little bit. if you were in charge would there be a requirement for medical students and residents and attendees and put you in charge of the system. how far would you go?

>> i would go down to kindergarten to teach them to prioritize sleep. you will pay one way or the other. as a medical student i didn't know there was a field called sleep medicine and i didn't graduate that long ago. there needs to be more of a solid curriculum in medical school and as a health care system we need more. when a patient comes in, we don't know their past. it's difficult to know what medicines they have taken. did they just have a carb crash? we need a system that is easier to track. and i think we need to make everything more affordable for

everyone. and we have some of the greatest services in the world, but they are not accessible to the people who need them the accessible, and the services, we have some of the greatest services in the world, but they're not accessible to the people who need them the most. >> so we thank you for your service for that two minutes for the entire health care system, that was very informative. great panel. i just got to tell you, i think this panel with all these medical things, everyone could have been sitting there saying what did they say, but it was quite understandable and i think really put the context of a lot of different issues we've been talking about of how so many different things affect drowsy driving. thanks to dr. mckay as well. we'll switch out to our fifth panel and talk about in-vehicle and on-road strategies. here are some of our featured programs. saturday night at 10:00 on book tv's afterwards, the pitfalls of group decision making and what to do to avoed them. and sunday afternoon at 1:00, part of book tv's college

series. we talk with recently published professor professors on the influence of hip hop on politics and the government's efforts to cure malaria during world war ii. "american history tv" saturday and anderson university professor uses abraham lincoln's life to understand the views of white americans on race and slavery both before and during the civil war. and sunday afternoon at 4:30, a discussion on birth control with margaret, the impact politic hs on the birth control movement. find our complete schedule at c-span.org and let us know what you think about the programs you're watching. join the conversation like us on facebook, follow us on twitter. more now from the national

transportation safety administration's october smumt on the dangers of driving drowsy. representatives from aaa and vehicle safety advocates look at the prevalence of drowsing driving and what can be done to address the issue. the panel coming up is on technology and a wrapup discussion. >> this is fifth panel is road crashes so doctor, whenever you are ready. >> as a reminder to our panelists, please push the button on the microphone when speaking, and again, to turn it

off when finished. in this panel we will discuss in-vehicle and roadway factors. our panelists are mr. frank scambardi, director of marketing, product planning and innovation management for the chassis systems control gigs at bosch, dr. vonk, engineering gigs division at the national highway traffic safety administration and mr. peter, associate professor of civil construction and environmental engineering at iowa state university. mr. scambati? >> sorry about that, thank you for that. i'd like to thank the ntsb, member rosekind and also dr. bessik for the opportunity to speak to you today. i'm going to be bringing a little bit of a different perspective i'm going to talk to you about some of the technologies that are available in the market to be able to detect drowsy driver, focus on

some of the areas that are specific to bosch, but in general i'll give you an insight/overview what we're doing in the industry. so of course, i'll talk a little bit about the motivation behind that, but there was many, many panels that have already covered most of the motivation of why we've addressed this topic with technology. i'll give you a little bit about the market trends and what's regard to where driver monitoring is going, talk about the scope of some of the bosch activities related to this technology in this area and in this field, principles of our, what we call our steering-based -- steering-angle based system which detects drowsiness for driver and then i'll have a short summary. not to beleaguer what was discussed in the panels earlier but there are lots of different studies out there that prove there is a problem or issue with

regard to drowsiness and driving. so one of the focus areas for us, we truly appreciate an industry all the research because this helps us to drive our innovation. internally this helps us to focus our inventive efforts in finding what are the right solutions through technology within the vehicle. so i just wanted to commend all of those that have done studies that we wish from an industry perspective that you continue doing this because it helps us to understand where we can focus our innovative efforts. so a little bit about what we're doing at bosch. we have a long history, we do actually do our own accident research. we work closely with consortiums, we work closely with academia to understand where the areas of concern are. specifically, one of the things that we've been focusing on is that we've done some research on inattentive detection of driver drowsiness. this research started in 2001. it was a video-based eyelid research, basically where we

were focused on trying to understand the attentiveness of the driver. we've done research also with the consortium known as a.c.t.i.v.e., which we did on 2006 to 2010, focused on the algorithm development for inattentiveness. we conducted a bosch predevelopment project where we were looking at occupant detection, this system was a video-based occupant classification, and we did this in 2001 to 2006. finally, the bosch driver drowsiness detection system, which we brought to the market in 2010. this system is an algorithm based solution. i'll give more detail later in the presentation. so i guess just in summary, there has been some long research and development efforts by bosch. i'll focus on drowsiness and inattentive driver. so what i'd like to do now is talk a little bit about some of the detection systems or variants that are in the market today. there are a couple that i will foccus on here i have here highlighted in red. it's not very clear. i'm sorry.

i apologize for that. we have some technical difficulties. oe we're approaching that 3:00 in the afternoon spot and we've just hit our first technical difficulty, which is actually pretty good for a day's forum. but we'll get that brought up for you. is there anything you want to continue until you get your slides? >> yeah. the focus we've been working on is what we call a steering-based angle -- a steering-based solution. the solution is actually evaluating the driver's behavior. some of the basic requirements or inputs are a steering wheel stent, the two inputs we base our technology on. another technology that is out

in the market is called a lane monitoring solution. this solution actually monitoring the lane-keeping behavior of the driver. what technology is utilized is actually -- here we go -- is actually what we call a multipurpose camera. this camera solution is actually located at the wind screen of the vehicle and forward-looking in vehicle. what the technology does is it will actually look and evaluate the lane markings of forward in vehicle. some other areas i've highlighted here that i won't go into too much detail, variants in the market is what we call an eye-face monitoring system or the physiological measurements. some variants are not yet quite mature but solutions for future opportunity. what i'd like to do is compare the two i had mentioned in the previous slide. some of the pros and cons. these systems are not perfect. the technology, though, sometimes can be complementary,

i should say, cooperative. the steering wheel measuring device we are utilizing, a couple pros is that it has a high sensor availability in vehicles. what i mean here is that the steering angle sensor or even electric power steering as we go forward based on the monday date for electronic stability -- sensors. it has the ability to detect very small motions by the driver. some of the cons of the system is actually dependency on the vehicle parameters. i'll talk in detail later about the technology but it requires several different inputs in order to determine the proper drowsiness level. then, of course, there is the influence of driving style. this does play a role. with the lane-based measuring,

the driver's guidance. the simple -- one of the pros is it's a simple vision-based system. it also has minimal influence of the driving style. as i mentioned earlier, the vision-based system, again, is a camera located in the vehicle. some of the cons, though, the dependency -- these forward-looking cameras do get negatively influenced by the environmental conditions, so heavy snow, heavy rain. even actually blinding sunlight can negatively impact the performance of these technologies. of course, the constraints in availability. there are multiple -- there are large numbers of vehicles that do have these cameras, but the penetration rated is nowhere near 100%. again, what i just wanted to highlight is with these systems, pros and cons, can you combine

the principles of each and improve the overall performance. now, taking a little bit of a look into the future, the future state of driver monitoring, so driver safety awareness will still play a significant role in the future with regard to both distraction and drowsiness. one of the key drivers is automated driving. as the need to monitor the monday tort driver becomes much more presay lent to ensure this proper handoff between the driver and the vehicle. in the consumer electronics world there's influence between gesture and gaze technologies. these will come into the vehicle going forward. so the interior design will be influenced by that. personalization based on identification or conditions may be offered also as part of the influence from the consumer electronics world. of course, there is this growing mobile, medical and health care market that integrates mobile devices as part of the health services. final advanced automatic

collision notification will play a significant role going forward. you'll see going into the future a convergence of all these three areas that will influence driver monitoring. and just to highlight the flexibility of the system we've developed, it is a steering angle input and it can come from the steering angle sensor, which you'll find today in your steering column of your vehicle or in future steering systems, the electric power steering allows the inputs to come from there. one of the key aspects is the precision of these sensors that allow the ability to do a software algorithm-based solution. now i'd like to talk to you about the operating principle of the bosch system. during any journey, drivers provide many steering inputs to guide their vehicle.

we've seen in some of the panel discussions earlier this morning, that showed some of these, the algorithm-based solution. this information is supplemented by the situational parameters such as duration of journey, time of day and vehicle speed. in fact, to assess the driver's level of drowsiness as early as possible, the algorithm will evaluate approximately 70 different parameters known as c.a.n. once a certain driver's level is exceeded, the system will trigger a warning and the warning can be either an audible or visual warning. in the case of some oems they implemented this coffee cup to indicate time to be alert for a case of drowsiness. the systems can also be supplemented by information that's also provided via navigation system to indicate it's the proper time to pull over and take a rest.

i mentioned this drowsiness value. the principle of detecting the drowsiness of the bosch algorithm-based system is that the need for sleep most often -- which we heard earlier in the discussions today. the algorithm from bosch analyzing the steering behavior to detect the so-called dead band events. these dead bands are phases in which the drivers stop steer, abruptly correct their behavior, which is a sign of fading concentration. i think we saw slides this morning which showed that. as these events become more frequent, the drowsiness increases and once we reach a defined value, a warning is then given to the driver.

this value is developed collectively or collaboratively with our oem partners. so in summary, as we all know and we learned today in many of the discussions, drowsiness is one major reason for serious accidents. the bosch system operates by analyzing the driver's steering behavior. it identifies the steering patterns where the driver does not steer for a brief period and then makes an abrupt steering correction. the system combines the frequency and strength of these reactions with other data, such as the vehicle speed, duration of travel and to calculate a drowsiness index. the bosch driver detection system identifies when a driver is at risk of falling asleep and sends a warning. thank you. >> thank you. our next presenter is chris monk of the national highway traffic safety administration. dr. monk. >> thank you very much.

i would like to thank the ntsb and member rosekind for inviting nhtsa to be part of this important forum. i'm going to talk today a little about nhtsa's work in the area of in-vehicle detection of drowsiness but we would like to start out, first and foremost, putting it in the context of larger set of impairment and attention in which we do work. certainly we have an active area in driver distraction topic and also in alcohol impairment. we have various programs and technological developments and research areas with those but that's where drowsiness fits in along with those. and before i move too much further, i know that this was presented earlier in terms of data. i don't want to go into this too much to repeat it but this is 2012 data, which we have not

previously published. can you see 2.4% of fatal crashes between 2008 and 2012 were reported as involving drowsy driver, which a number of areas similar to what we heard earlier for the period of 2005 through 2009. 29 lives were lost in crashes that were reported to involve drowsy driving in 2012. so this is certainly an important issue. these data are the most recent data we have. so, going onto detection and the technology, this is a particularly challenging problem. as we just heard, there's a lot of pros and cons for each of the different approaches. can you start with the most direct measurement and physiological measurement, but these have their own drawbacks. in particular, when thinking about ways in which this technology can be implemented in the vehicle is very obtrusive, still.

perhaps that will change in the future. moving on then forward to the camera-based type systems, they measure fatal information. those algorithms are quite mature and have been shown to be effective in lab settings. however in research, in field test we did with heavy details and looking at the eyelid close measurement using camera system, in the real world that's a bit of a challenge. the algorithm works well but the data that comes to the algorithm is a bit challenged by the conditions in which they need to operate. so, that also has not borne out to be the most effective approach at this time. as we just heard with bosch, the validation in what we're seeing as well, that the vehicle-based measures are really where we see some substantial promise. that is where our current active

area of research is. so we have a research program going on right now that is looking at developing algorithm to detect different types of impairment, not just drowsiness. using this vehicle-based data, again, steering and lane departure type data, that can predict not only drowsy driver states but also distracted drivers and alcohol impaired drivers. certainly looking at the relationship between those different algorithms and how they might be optimized to work together or independently. and really the goal is to produce data that validates this approach and to see that we can actually show the potential for accurately and quickly detecting different states of impairment. if we can then -- using just that vehicle-based data. that's the important part there. so, the study we actually completed on this and we have a series of research study and data collections going on in part of the different impairment areas. for drowsiness, we actually published a report earlier this year.

can you see the report there. can you find that on nhtsa's website. and it really shows that using vehicle-based measures again that the real time algorithm. this is important. this is not post-processing. this is not a system that can be examined later and then determine whether a driver is drowsy or not, but in real time was able to successfully predict lane departures six seconds before those departures. this is an important point. now we have empirical data to support that a predictive algorithm is possible and now we can start to look at, what do you do with that information? so, again, just to reiterate that point, the goal here was to demonstrate the possibly for using vehicle-based data to produce a predictive algorithm for detecting drowsiness. we also have successful and predicting distracted states and

alcohol-impaired states as well. and returning to those other measurement and sensor types, we don't want to leigh leave those fully behind. we recognize there's potential in some areas, be it the eyelid closure and, perhaps, the new area of facial expression tracking, might be more feasible in the future. those we certainly recognize, but at this point, what has been proven and a built more feasible for the immediate future is the vehicle-based measures. so, now that you've -- we've been able to move down the road here of detection and making a predictive detection assessment, what do we do with that? this is the important piece of the puzzle that has not been fully addressed. and what kind of feedback can you give to the driver in real time? that would illicit some sort of change in behavior?

that's a big open question. that really feeds into our next phase of the research we're conducting where we will be looking at some early versions of countermeasure. again, real time feedback to the driver in the vehicle. whether that be a simple icon type of feedback system or other types of feedbacks that we're currently developing in the research plan so we're investigate what might be the best types of feedback to give in real time. we'll be moving forward to see if there's any sort of change in behavior. what those changes might be, ultimately, of course, as we heard earlier, the solution is

to get enough sleep. given the context of a drowsy driver is detected, what kind of feedback can be given to the driver to illicit some behavior change. or if any behavior change can be illicited from this type of feedback in this context. i do want to tie in an important piece of the puzzle and approaching all crashes is crash avoid technology. not only with drowsy drivers, but drivers of all types and all contexts and, in particular those that are impaired, be it from drowsiness or distraction, otherwise, inattentive. the whole notion of a warning system is to draw the driver's attention and get them to respond or react. and so this is an important area.

nhtsa certainly has invested quite a bit of research and effort in moving forward with this. we have already incorporated crash warnings into the new car assessment program and that is nhtsa's five-star safety rating, which you can find at safercar.gov. just in august of this year we put out -- technology, a dedicated short-range communication technology where vehicles essentially talk to one another. this technology ol % enable a great range of safety applications that could be implemented in vehicles. and so that's an active area for us as well. and lastly i want to mention the agency decision on automatic emergency braking systems, this is the larger set of not only warning systems but also active safety systems as well. for light vehicles due in the coming months. so, certainly nhtsa sees that crash avoidance technologies are an important piece of the solution. not only for drowsy drivers but, of course, roadway safety in general. thank you very much. >> thank you, dr. monk. our final panelist will be peter from iowa state university.

>> thanks to member rosekind for inviting me here this afternoon. i'm going to follow up on the colleagues you heard here recently. on the vehicle side there's been a lot of discussion today about how the impetus really falls on the driver to help drive down these numbers for drowsy driver and related crashes and fatalities. looking to the future, i think the inner operatability between vehicle-to-vehicle communication shows a promising road map. unfortunately, at this point we're so far out from drew market penetration there that we're still relying on some of the old school civil engineering, which i'm going to talk about right here, to help prevent these type of crashes or mitigate their severity should they occur. i'm going to talk about two specific countermeasures today which we're probably all familiar with in this room. one is roadside rest areas or rest stop which is have been around for 50, 60 years. providing opportunities for motorists who are drowsy to do what we want them to do and get off the road. or the more recently, not that novel, rumble strips that which have been on the interstate and edge line and center line of

two-lane highways. these resulted from research projects sponsored by michigan department of transportation. i recently moved from iowa state here in knowledge. so i would like to acknowledge my colleagues at wayne state university. roadside rest areas initially one of the primary intents, obviously, was to get tired drivers off the road to provide them a chance to take a nap, to recharge and then to go back about their business. it's become a hot button issue. just a few years ago here in virginia there was a decision to close a lot of those rest areas. then that was reversed after there was large public outcry and opposition to that. in michigan we faced similar issues where mdot was getting confess, what actual value are they deriving to the traveling public?

we looked at a variety of factors but one of the primary foci be looking at what the effect is on fatigue-related crashes. we talked about how it's difficult to define those types of crashes using the limitation of our current crash data. for the purpose of our analyses we focused on crashes that occurred between 10 p.m. and 6 a.m., which involved one vehicle departing the road and neither alcohol involvement or deer involvement. we conducted spatial analyses within a 20-mile radius within rest areas of the state of michigan. we looked on each one-mile segment as we approached the rest area and we continued downstream past the rest area, what do those crash rates look like ultimately. if we look at the next diagram

here, this is just the plot of the average number of crashes over our five-year analysis period. so, the middle of that diagram is where the rest area is located. there's a bit of noise because we're dealing with crash data and these tend to be rare and random events but we see a trend that as you move past the rest area, we see the crash rates increase significantly. upstream, prior to the rest area, we also see those rates are relatively high. they tended to be lowest at the rest area. it looks like they are providing some benefit. we see a dip in crash rates immediately prior and we're not sure if those are drivers anticipating the rest area coming up, focusing, knowing that rest area is up ahead based on advanced signing, things of that nature. we looked separately at frees and two-lane highways. what you'll notice up here, what the mean result shows is for every one mile away from the rest area, those road segments tended to experience 1.8% more crashes in the freeway environment. much more pronounced 7.5% increase on two-lane highways. we suspect part of that is that these two-lane highways are in much more isolated environments

where you don't have as many comparable service facilities like gas stations, hotels, fast food restaurants, so forth and so on. whereas in the freeway environment, we have more of these facilities. we had done some supplemental work here that actually showed on those freeways a lot of motorists and truck drivers were tending to use some of those alternate facilities. we wouldn't see quite the same yield there. it's pretty compelling evidence here. our u-shaped trend has been shown by prior research that's been conducted in california as well. looks like drivers, some subset of drivers, is cognizant and able to make the determination that, hey, maybe i should take some time and get off the road and take a break here. so that was very promising to see.

unfortunately, not all drivers, as we've learned today, are able to make that connection. that brings us to the second countermeasure here. center line rumble strips and shoulder rumble strips. these as opposed to serving as a bed like the rest area, these are more like the alarm clock, ultimately. what we're providing here is an audible and tactile warning to drivers. they not only hear the rumble strips, they feel them as they cross over. hopefully are then able to take corrective action to avoid an impending lane departure. either a run off the road or -- i'm sure. us are familiar with these. we may have driven over them at times. there's been a lot of research recently that has looked into the effectiveness of rumble strips reducing crashes and the most recent number suggests they stop road crashes of which drowsy driving crashes are a subset by 30% to 35% on average. looking although fatales and serious injuries, those are more

pronounced reductions on the neighborhood of 40% to 55%. and one thing that hadn't been tied down, what are the actual behavioral changes facilitating these reductions? we know drivers appeared to be correcting, but are there fundamental differences in their underlying driving differences. we investigated that and looking into the combination of shoulder and center lines introduced any sort of incremental benefit beyond just the use of center lines. and so what we did to assess that, michigan had the most aggressive installation program in the country. more than 5,000 miles. essentially entire high-speed two-lane highway network across the state. you see indicated on the map here where those various installations were. so, to assess changes in driver behavior, we conducted a series of before and after field studies to see what happened preand post installation on five highways throughout the state. you'll notice those are geographically representative of areas across the rural regions of michigan. we set up high-definition video cameras along both tangent sections of roadway and curve roadway and tracked the positioning of drivers as they traversed those roadways. on the next slide there, if you

could help me with the video there, this is just a sample. we set up high-definition video cameras covertly 20 feet above the roadway and we tracked drivers as they went across the curves and tangent sections. we coordinated where they were within the lane and how frequently they would encroach either onto the center line or edge of the roadway. the next slide, we observed more than 50,000 vehicles. i've got give my thanks to my students who watched enough video to come up with 50,000 observations. and you'll notice in this table right here, we've got the before period data, which is representing the percentage of all vehicles who were in a center lane position. roughly a third of drivers were tending toward the center of the lane. a lot of drivers would tend to move to the right side of the lane. they are further from oncoming traffic. it's human factor, driver comfort there.

at the locations where only center line rumble strips were, that was consistent for tangent sections, for curve it is to left and curves to the right as well. whoa went to our additional locations where center line and shoulder rumble strips were installed and surprised to see even more pronounced improvements in driver lateral positioning at those locations. roughly 70% on average. those results were significant and consistent across tangents, left curves and right curves. focusing on some of the more extreme events, we look at how frequently they encroached on the edge line or center line. you'll see here, we also saw marked improvements here. if we look at the straight tangent sectionses, edge line encroachments reduced by roughly 40%. center line encroachments were cut by 60%. while that 1.5 to 1.6% may not

seem like a big number, if we think of the millions of miles, that amounts to a significant number of collisions that could averted by the use of these rumble strips. we also saw on left and right curves in the absence of these rumble strips, vehicles would tend to cut these curves or tend to drift outside of the lane lines. we saw significant reductions as a result of this as well. ultimately it seems this is helping to explain those significant crash reductions that have been experienced recently. drivers are actually making the determination to change their driving pattern, consciously or subconsciously, but we're seeing very clear and compelling evidence that this is a great countermeasure but it's not a silver bullet. ultimately we're returning back to some of the advances that have been talked about earlier today and trying to integrate

the driver of the vehicle and the roadway into one cohesive unit that's able to diagnose a drowsy driving problem and ultimately react to that. so just wrapping things up -- that 20-mile radius. i apologize. i should have noticed that previously roughly at 40-mill increments. center line rumble strips improve lateral positioning. the two in concert introduced an additional increment. we've also completed some recent work looking at cable median barriers. in cases where we're not able to prevent drivers from departing the roadway, the installation of high-tension cable barrier is a relatively low cost installation which was shown to reduce fatal

crashes by 30% to 40% at our michigan location. it's looking at a combination of these practical solutions while we wait for the technology to kind of catch up and give us that additional thrust. so, with that, i would like to, again, acknowledge my colleagues at wayne state and my students who moved with me to iowa state. i believe we'll turn it over to the panel for questions. thank you. >> thank you, doctor. thank you for a very informative presentation. the reduction numbers in encroachment with rumble strips center and shoulder line look substantial, very considerable. in which areas of roads, highways, different types of highways, would they be the most and the least effective? >> that's a great question. we're actually working on a phase two project right now where we're developing

guidelines for installation of rumble strips. michigan is very proactive and said, we're going to put them on the entire state wide system. there are some limitations in terms of where we can install shoulder rumble strips. the reason for that is oftentimes shoulders will be used for bicycle traffic. on shoulders narrower than four feet, for example, that may not be the best place to install those shoulders. center line, as long as you have a minimum of 20 feet of pavement is a working rule. anything narrow her than that and you would have a lot of incidental strikes. you're looking at higher volume roadways and roads where you've got sharper horizontal, which would be your first target locations you'd want to hit as a

part of that. our data suggests they can and have been successful in virtually any type of road environment. >> thank you. dr. monk, you mentioned nhtsa's research pertains to the feedback. what do you think if even for a moment you could consider yourself not part of nhtsa, what should be the role of in-vehicle drowsiness detection system? currently these systems only alert a driver they may drowsy. however, should the systems go further, perhaps, encourage driver to take a break or perhaps be even more proactive, something akin to alcohol and ignition locks? >> ultimately, i think to maximize safety, really, what the role of these systems should be is to whatever feedback or

whatever manifestation these systems works the best to prevent crashes. and that, i think, is the important part. that's the big open question we have to answer is what kind of feedback might be effective. that's why we're pursuing that research, initiating it now. but ultimately i think keeping our eye on whatever -- we know no system is perfect. we heard earlier in the early sessions that we are pretty poor at detecting on-site drowsiness. the question is, should overreliance become a problem? >> this is a question that's asked often of any of these, what we would call driver assistant technologies. so even crash technologies that dr. monk presented. in our opinion, we have not seen any evidence that shows there's overreliance on technology. in fact, what we see f you look

at electronic stability control, for example, these systems, it's now become more and more mandated throughout the world. we also see global reduction in fatalities and injuries that are contributed to an assisting system, such as electronic stability control. we don't see any evidence there will be overreliance on the technology. >> glad to hear that. this is for either dr. monk. considering that for general collision avoidance systems, the primary focus on determining the status of the outside environments. for the drowsiness technology. does it make sense to view and develop these technologies in isolation or should we consider them as part of a more global, more fully aware vehicle? >> i guess i'll start out. from an industry perspective, we

clearly see the future of these systems become more fused. we see sensor data fusion. as we take inputs from various external sensors and couple them with various sensors such as driver state detection systems, whether it's interior cameras, i would say even physiological inputs, it's a natural evolution of the technology that they will come together and they will converge going forward from our perspective. there is a work of work to try and enhance. as i showed in my presentation, each of these systems have pros and cons. but by fusing a lot of the systems and the sensors, we hope to improve the detectability and performance of the technology. i would just add that where the -- it's important to the crash avoidance technology

outside of the vehicle, if you will, and the driver monitoring inside the vehicle, each of those technology areas develop -- there may be really great opportunities to fuse them later, quite simply. for example, for a crash avoidance system, parameters for that warning system could be adjusted based on the state of the driver. now, of course, that would have to be borne out with research and how to adjust those parameters, but can you see how, perhaps, if the system detects a drowsy or otherwise impaired driver that a warning system then might be signaling to the driver earlier or in a different way. that would be one way in the future they could be brought together. >> excellent. thank you very much. one quick question. can design of vehicle interior promote alertness? do features such as backlight of

instrument panel impact the level of alertness in any way? >> i'm by no means an interior vehicle design expert but i can imagine that certain tactical design of the vehicle can definitely improve the detectability. within bosch we also have a user interface group that is actually evaluating a lot of the areas that dr. monk was mentioning because this interaction between the human and the machine is very critical area, especially when we talk about handoff. and there's still a lot of, i think, more research that needs to be done with regard to, you know, how does the human actually react to all these different inputs, whether it's the audible or the visual. i think definitely there's opportunity there. >> thank you. one last question for, doctor. we've talked about the future and upcoming in-vehicle

technologies. rumble strips and rest areas present additional solutions to drowsy drivers. are there other potential solutions under development here in the u.s. or elsewhere in the world? and what impact might connected vehicles have as potential roadway solutions? >> well,there have been a number of collision avoidance type technologies where the vehicle is able to communicate with the roadside infrastructure, whether it's looking -- the vehicle can actually monitor the lane lines to detect where the vehicle is

positioned laterally, communicating to alert the driver and vehicle of an impending departure. there are some examples there. with the type of work weaver focused on, a lot of times we're looking at things external to the vehicle. one of the upcoming projects we're really excited about, we're involved with the strategic highway research program so we'll get access to virginia tech transportation institute has naturalistic -- it's 4,000 terabytes, an enormous amount of information what drivers are actually doing during these crash or near crash events. i think that will help to inform some subsequent decisions on the infrastructure side as well the vehicle side. >> thank you. dr. price? >> thank you. thank you for your excellent presentations. i was especially fascinated by

the presentation of the drowsy driver detection algorithm that can detect six seconds ahead of a lane departure. it seems very encouraging. i know that some of these -- similar warning systems that don't have to tell drivers how to respond to this or through surveys or anything that can help us know to tell us if people are attending to as a result of these type of warnings? >> what i can say is that i know the interest in certain markets, for example, in germany, a recent study that was performed by bosch we realize that for new vehicle purchases, i think it numbers around 23% of the driver actually choosing this

technology as part of their purchasing decision. so, i think there's an awareness or interest from a driver perspective, but, unfortunately, i'm not aware of any data post-technology implementation. >> okay. i'm encouraged at least by the rumble strip research that shows that it appears that the crashes are reduced suggesting if people are getting some kind of feedback, in this case getting the rumble strip sensation, it's keeping them from reducing crashes. it will be -- if you're looking at naturalistic data, i would think with near crashes, i don't know if people looked at driver behavior after near crashes to see if they stopped driving or what is the subsequent behavior of those drivers. on another topic, we've heard about various systems. some systems which appear to try to monitor the driver, monitor

the driver directly, eye closures or in the case of, you know, other forms of impairment, looking at their behaviors. and then other systems that look at the driving performance or in-vehicle systems. are there any you think are particularly -- >> i don't know we have data on ones that are, perhaps, better than others other than aside what we've done with the vehicle-based sensor detection system. ultimately whether we see a bringing together of some of the different detection technologies to optimize that, that remains to be seen and remains to be tested in time. >> i have one final question. i don't know if you know this. i did some research a while -- a

long time ago looking at rest areas for truck driver usage. and among the things i look at, i found crowding at rest areas, limits on rest area usage, there were many kinds of obstacles beyond just having them present that were a problem. and i'm wondering if in the work that you did, if you found that those obstacles remain and if there's any effort to address that? >> we didn't address that directly as a part of our research. mdot had a complementary research project. the i-95 corridor is one of the heavily trafficked corridors in the country. moves large volumes of freight. as you get from michigan into bordering states, indiana, moving that freight west, they had a problem with rest areas,

overcapacity. they actually worked with the trucking industry to provide essentially real-time parking information to truck drivers to address that issue. because that has been an off-sighted concern. truck capacity, fitz not there, trucks may tend to park on a ramp or somewhere elsewhere it's not potentially safe to do so. so, i know there are several ongoing initiatives in that very area. thank you very much. >> you gave us a sense in germany what percentage of people desire this technology. do you have any sense in america how many -- what percentage of potential purchasers would want this technology? unfortunately, i don't have hard data. we have consumer information where we discussed safety technologies in general. what seems to have come always to the top for sure is blind spot detection. that is one of the most sought-after consumer safety technologies.

drowsy driver does come into the top ten, but i don't have any empirical data. we just performed the study in germany this year. we're quite encouraged. i will add part of the difficulties is that technology is an option in many cases. outside of a few oems that actually have it as standard. i think it's difficult to find data -- enough data to find a true ascertation of what the study is. the study in germany was based on new registration. do the oems provide guidance to drivers on what to do when it activates? >> in some cases, yes, i think it really comes down to the dealerships. >> it seems once it comes to the dealer level, there is a limited amount of information that's provided to the consumers. we have very good empirical data that shows that. what we've been doing as part of our partnership with our oems is

we will do what we call a -- train the trainers or some of the dealers will have different events where they'll invite us and we'll bring our technologies to them and be able to have them experience it and demonstrate it firsthand. what we found is co-efforts between ourselves and oems, it really helps to educate the actual dealers, not only is the dealers -- the salespeople that have the point of sale contact and what we found is the education and awareness at this point really enhances the ability to make sure that the consumer has an informed decision. >> thank you very much. >> we'll get to roadways in a second. how do you validate these

systems? are there standard protocols? i think where we're getting to here with the questions you've heard is, how do you know they work? and good for you for saying interest is not effectiveness. and so dr. farkess is still here. you can see that from a medication standpoint until they went through strict protocols where they put a lot of stuff in a car and you wonder, is it working or not? here's one. whether it's drowsiness or distraction or whatever, so i'm kind of wondering, are there validation procedures? are there protocols?

are there ways the industry and others are talking to each other to figure this out? >> first off i'd like to start,ist very, very difficult to validate these technologies. the amount of efforts and man hours and, let's call it road time, to truly be able to validate and prove out the effectiveness of these technologies is exponential. take decisions for the driver, have you this concern with false positives. and on so there's a tremendous amount of effort. hundreds of thousands of miles or kilometers of validation to ensure that the robustness of the technology is there. it's difficult but there are proceeds. i would say there are certain groups within the industry that are working towards setting up performance standards.

nhtsa is doing a good job. i will commend them. the new car assessment program is one good example for consumer awareness but also setting performance standards, being able to rate these. the institute for highway safety and safety top pick plus is another example of these rating systems based on performance standards that all of the different technologies can be put up against each other and proven out whether it's effective or not. i think to answer the question simply yes. there's a tremendous of validation. it's difficult. but i think -- in my presentation towards this world of automated driving, there's going to be a tremendous amount of work that's needed going forward. >> you want to add anything,

dr. monk? >> i would just echo it is, indeed, very difficult to do. in particular, when you get to the area of drowsy driving, because in the lab, which is where you really need to start and detect the detectionz, have you to akt accurately independently determine they are drowsy, not by lane departure in lane which is the measures you're using for your detection but you need to independently verify they are, in fact, drowsy. can you do this with the measures in the lab. once you move forward, once you have a system, and again we have a big piece that's missing and that is that feedback component. so, to determine effectiveness in the long run requires a substantial amount of work to identify what is effective, what parameters, what characteristics makes a feedback system effective. and test those repeatedly not only on the lab but on the road and so on. it's a high bar to prove that out.

>> i would like to ask the same question to hours of service. there are changes in those areas and i like to say, how do we know they're working? we've got new ones and these are very difficult. just the fact that people have those questions in their mind, which is why i was going to go back. earlier there was a question about comparisons but it sounds like the ratings you just mentioned, in fact, there are mechanisms and venues where the systems are being compared to one another. can you say anything else about those? those comparison opportunities out there? it sounds like they're to performance criteria. >> in order to make a legitimate comparison, you have start out with a robust performance specifications. in many of the cases, the five-star rating that dr. monk mentioned, what we found in on

you research that consumers when they're searching in preparation for their vehicle purchase, one of the first things they will look at is online information. they will go to safercar.gov and look at different rating systems in order to determine -- or help support their vehicle decision process. so, performance standards, i think, are critical. i mean, not just having the technology, but have you to have a robust performance standard to be able to rate the system's performance, compare system to system. >> great. i'm curious, what's our prevalence of these road design systems? there must be some identification sort of within the united states, how many roads would benefit by the kind of countermers you were talking about. and sort of, what's our penetration of how much of that is actually on our roadways today.

>> there are a few national initiatives. aaa has the u.s. road assessment program where they've done rate ogsz a statewide basis across several roadways. we're getting a lot richer transportation database information these days. we have a better sense of what our existing infrastructure assets are. from that, a lot of states are moving towards sort of data-driven, prioritization scheme of where these certain types of countermeasures would be most effective. as i had alluded to, we're developing guidelines for placement of center line and shoulder rumble strips. we've recently developed similar guidelines for where to place the cable median barrier i had referred to previously. across -- all states are running into the same issue. we have a fine amount of funding and resources to invest in safety improvements so it's a matter of determining where that money can be best utilized

ultimately. i think that's really where we've made a huge amount of progress over just the past 10, 15 years, is with our ability to better handle data with gis databases and inventory and linking all that information together. we're on this path of current avoidance technologies up to the ultimate, which is auto ton autonomous, self-drive, whatever the label will end up being. i'm curious each of you, this is a great panel, different perspective, so each of you, two sentences each, on sort of, you know, your observation of where that path is as far as technology innovation, the timeline we may be looking at, where the biggest challenges may be. just kind of again a couple sentences of where you think we on that path. let's start here and we'll go down and -- great. >> from our perspective, it's going to be an evolutionary process. we have this thing internally within bosch. we call it a step-by-step process.

from a technological implementation, from legal and liability implementation -- it's not going to happen next year or five years. everybody is looking for the crystal ball to figure out when it's going to happen. it will happen. we are convinced it will happen. an evolutionary process -- and nontechnological perspective. >> great. >> i think i would just like to reiterate that in terms of the near part of that path, certainly crash avoidance technology, certainly in warning and upcoming active type safety systems are an important piece of the puzzle and solution for crashes of all types. but also, i think, in moving forward what we'll see is in general driver monitoring technology will become a bigger piece or more important piece. not only for drowsiness, but all types of impairment. that will be good for detecting

drowsy driver. and then still the big, big open questions about what to do once you detect those drivers -- in particular drowsy drivers. again, that -- what we've heard all day, an important message. not just about that real-time feedback, but the overall message and education in getting enough sleep. that's so important. >> i think the technology is there, frankly, at this point to move towards these fully instrumented vehicles, driverless cars, and so forth. there are a number of hurdles we need to address to get there. it's going to take time. it's going to take money. but issues like privacy and, you know, big brother driving my vehicle and those sorts of issues we really haven't got into much at this point. i think the focus has largely been on the technical side of things. i think those are just a few areas here in the short term that really are going to be addressed seriously. >> thanks for raising that issue because it's come up in some

ntsb recommendations the acceptance of the technology by consumers is going to end up being a huge part of this. it's not just acceptance, interest in buying it but their trust in the system is valuable, reliable. great panel. great leadership. thanks much. we'll take our afternoon break here until 3:45. after the break, we have our final panel of the day. consideration of countermeasures and future directions which promises to be just superb. so, we'll see you at 3:45. >> if the afternoon panelists can join us up near the stage, we would like to take a couple of pictures. thank you. the purpose of the final panel is to synthesize the material provided throughout the day and to move forward to address drowsy driving.

i will begin by inviting each of our panelists to provide a summary of what they felt were some of the key messages from all of the panelists we heard today. and then we will conclude with a dihere future research is needed. we will begin with remarks from dr. sizler. >> thank you very much, dr. price. i really appreciate the national transportation safety board having organized this very exciting and provocative forum. i must say, given that we were asked to summarize it, i've never paid more -- close attention to a meeting that i've attended. but i think that -- i mean, i was just struck by the scope of this issue. that there are 56 million people in the united states, drivers who struggle to stay awake while driving. that's 1.9 million drivers per take struggling to stay awake at the wheel. there are 8 million drivers per

month who fall asleep at the wheel. that's 280,000 per day. actually admitting to falling asleep. resulting in somewhere between 400,000 and 1.2 million crashes per year, 55,000 debilitating injuries and 5,000 to 7,000 fatalities. so, that takeaway for me in terms of the scope was really extraordinary. in terms of the contributors to this really epidemic of drowsy driving, i think that the chronic insufficient sleep that was described with 70% of americans according to the cdc reporting routinely getting insufficient sleep, we know that some of the reasons for that are related to the light exposure we get between dusk and when we go to bed at night that delays our internal clock even more so in adolescents making it tougher to go to sleep and wake up in time.

the technology, the texting, the tablets, the tvs that have invaded the bedroom. and then we have individuals driving after pulling either partial or full all-nighters, and these -- we used to think of this only taking place in the situation of night shift work, but we now know that these full and partial all-nighters are occurring not just with respect to extended duration work shifts and night shift work, which are both serious problems and contribute to the issue but also in association with travel because the roadways are less crowded at night and main people for their leisure travel will travel overnight and also play, whether video games. there was a tragedy in massachusetts where someone was killed after a kid had been awake all night playing video games and at 19 years old fell

asleep at the wheel and killed him a week before his wedding, and that has led to proposed legislation in massachusetts. and then we heard about the early school start times, and as has been pointed out, it's not just school start times but work times. the largest growing sector of the work hours in terms of when jobs are starting are between 3:30 and 6:30 in the morning. so we have early school start times, and that contributes because many students end up staying up late either doing homework or preparing for an exam or playing video games or whatever, and then they have to get up then at sometimes 6:00 in the morning in order to get to those 7:00 a.m. classes. then there are sleep disorders that we heard about today. 85% of which are undiagnosed and untreated.

the institute of medicine has estimated 70 million americans suffer from -- chronically from sleep disorders or chronic sleep deficiency, and so we see a huge medical issue of undiagnosed and untreated disorders, and then we heard from dr. farkas about drug that is increase sleepiness, anti-histamines, codeine, anti-arrhythmia drugs, cold remedies, antipsychotics, sleeping pills, pain relievers, tranquilizers, and those are all really serious issues that can independently contribute or can contribute in individuals who also have a sleep disorder and may also be sleep deficient. so what to do about this? we heard about a number of countermeasures today, and my

take on countermeasures is the first and most important one is really education about the hazards of drowsy driving, and if we think about the 11,000 individuals who are killed every year in alcohol-related crashes for which we spend in the united states justifiably $300 million a year trying to educate the public and then compare that to the 7,000 drowsy drivers who area0s.z killed every year, people who are killed in drowsy driving crashes, given that there's less than $300,000 a year spent on drowsy driving education, that means that just to bring it on par with alcohol related education, about alcohol related crashes, we need to spend 500 to 1,000 times more funding to get the message out about the importance of drowsy driving as a hazard. secondly, we heard about the

issue of work hour limits, and we still have in the united states people working, as we heard related to the police officers, working extended duration shifts. we know in the medical area they're working 24-hour shifts. we know from our work with firefighters that they're working 48, 72-hour, even 96-hour shifts in some cities in california. and many times they're able to get some sleep during those shifts, but on many occasions they can't because they're dealing with paramedic responsibilities and others, and so there's no real provision. we heard issues about could transportation be provided but most employers don't provide those transportations. whereas the person may be driving a commercial vehicle like a fire truck during their work hours, they're going to be driving their own vehicle, a noncommercial vehicle, driving