The Co-development of a comprehensive sleep management programme in commercial drivers

Road freight is a key economic sector, transporting about 77% of all UK goods delivered, and employing over half a million (HGV and van) drivers. The occupational demands associated with commercial driving, like long working hours, abrupt changes in work schedules, prolonged lone working with little social contact, night and early morning shift work, and lengthy periods of sitting, foster unhealthy lifestyles. Commercial drivers consistently report short, disrupted and inadequate sleep. This, in turn, leads to increased feelings of sleepiness and fatigue when driving. As a result of this, a very high proportion of fatigue-related traffic accidents on UK motorways involve large goods vehicles. While representing only 12% of motorway traffic, for example, heavy goods vehicles (lorries) are associated with 41% of all motorway fatalities. Commercial drivers also tend to eat a less healthy diet, and have low levels of physical activity. These behaviours, coupled with insufficient and disrupted sleep, directly influence health, with drivers being more likely to be overweight/obese, which in turn increases their risk of developing heart disease, diabetes and other chronic diseases, and likely explains in-part their shorter life expectancies, compared with other occupational groups.
The aim of this project is to co-develop (with drivers and employers) a practical and effective intervention to improve the sleep quality of commercial drivers. The intervention would make an important contribution to public safety and it would also improve the general health of commercial drivers. Research shows that inadequate sleep is, by itself, a risk factor for obesity, diabetes, and heart problems. Part of the reason for this is that sleep affects the hormones which regulate our hunger, with shorter sleepers eating more. Inadequate sleepers are also less likely to exercise, since they feel tired during the day. These risks can be reversed by increasing the duration of sleep.
The NHS recommends cognitive behavioural therapy (CBT) as the main treatment for insomnia symptoms. The evidence also shows that the principles of this therapy, along with sleep management strategies like napping, and increased levels of exercise, can be used to improve and extend sleep even in people who do not have insomnia. Sleep improvement programmes based on these principles have been successfully delivered to non-transport workers (using classroom-based methods and printed handouts). Reaching a driver workforce which is mobile and dispersed, however, presents a special challenge.
To meet this challenge our aim is to develop a sleep improvement programme which can be delivered as a phone/tablet app. The app will be developed in collaboration with commercial drivers, transport managers, and health and safety managers, will offer advice and strategies specific to the commercial driver's work environment, and will be designed to engage the user and encourage the adoption of the advice offered. The intervention will be based on our extensive research into CBT techniques for improving sleep, and reflect the team's expertise in developing digital sleep-management programmes. The project will be in four parts. Part 1 will consult representatives from the transport industry and individual drivers, in order to better understand how legislation, employer policies, and the 24-hour schedules of drivers should be reflected in the app. Part 2 will develop the separate components of the app. Part 3 will ask the drivers to test and suggest modifications to the app components. And Part 4 will field-test the app with drivers under real-life conditions; this part will include detailed assessments of the driver's views on whether the app was practical, easy to use and useful. We then plan to conduct a future study in commercial drivers, testing whether the sleep intervention app increases sleep duration, improves sleep quality, and improves daytime alertness in this at-risk group.

Optimising daytime vigilance among workers in safety-critical industries can deliver benefits to public health, productivity, and personal wellbeing. Commercial drivers are exposed to occupational and lifestyle challenges which degrade sleep quality and increase daytime fatigue. For most drivers, chronic symptoms fall below the threshold of DVLA notifiable excessive daytime sleepiness. Survey data indicates that > 30% of HGV drivers admit falling asleep whilst driving, and falling asleep at the wheel accounts for 20% of serious collisions. Our own research showed that commercial drivers reported high levels of sleep deprivation and poor sleep quality. Benefits of improved sleep in this at-risk occupational group would be direct (immediately reducing daytime fatigue and improving vigilance) and indirect (through improved cardiometabolic health and daytime stamina). The driving safety of those meeting diagnostic criteria for sleep disorders (e.g. Obstructive Sleep Apnoea) is addressed by current protocols, but no such procedures exist which address the impact of irregular sleep patterns, insufficient sleep duration, and poor sleep hygiene practices. The design and development of our proposed intervention involves collaboration from different layers within the complex system of change: drivers and their immediate environment; employers; and the legal framework governing the work environment. The aim of our proposed study is to co-develop, and provide, an app-based sleep management intervention. The intervention will be grounded in cognitive behavioural therapy principles, accompanied by additional motivational techniques. The study will involve obtaining expert evidence on the interface of sleep and work safety, focus groups with drivers and industry stakeholders addressing sleep, wellbeing and safety, development of the prototype app and usability testing, and app feasibility testing.