Archives for March 17, 2007

Driving while sleeping

Via the Fort Worth Star Telegram:

FDA says pills can cause ‘sleep-driving’


AP Medical Writer

All prescription sleeping pills may sometimes cause sleep-driving, federal health officials warned Wednesday, almost a year after the bizarre side effect first made headlines when Rep. Patrick Kennedy crashed his car after taking Ambien.

It’s a more complicated version of sleepwalking, but behind the wheel: getting up in the middle of the night and going for a drive – with no memory of doing so.

The Food and Drug Administration wouldn’t say exactly how many cases of sleep-driving it had linked to insomnia drugs, but neurology chief Dr. Russell Katz said the agency uncovered more than a dozen reports – and is worried that more are going uncounted.

Given the millions of prescriptions for insomnia drugs, Katz called the problem rare, and said he was unaware of any deaths…

I had a sleep-driving case, within the last six months or so (some details are changed).  The actual patient care was ho-hum, but the story is interesting.

An adult male patient came to the attention of firemen when he fell asleep on the horn in front of their fire station.  At about 3AM.  The firefighters found a patient who would arouse but then go directly back to sleep.  He’d answer his name, but that was about it.  No smell of alcohol, no drug paraphernalia present.

Notable was his car: the left front wheel had no tire, but no other major or even minor damage to the car.  There was a groove in the pavement made by the wheel and the PD, thinking maybe they could find his origin, followed the groove.  They returned after a bit stating it went for miles, and had no idea how long he’d been driving on the one rim.  They surmised he’d hit something while driving, blew out the left front, then drove on the shredded tire until it fell off, then a while longer, fortuitously stopping at a fire station.

EMS reported normal vitals on arrival to the hospital and we had to go through the story several times, as usually an altered patient from a vehicle with virtually any damage gets a big trauma workup, but there was no evidence of damage (except the missing tire).

The physical exam clinched the ‘tox’ thing for me, though at the time we had no idea what.  Normal vitals, pulse-ox, blood sugar.  Normal exam except when asked questions you’d get the right answer, then a volunteered answer you didn’t expect: “I’m Jim Jones,…my service number is xxxxxx…..and my Sergeant is…” followed by sleep.  As he was well beyond military service age, this kind of answer seemed odd.  As time progressed, the arousable periods got slowly longer, and we got a phone number.

A number which clinched the diagnosis, as it produced a spouse with a new pill bottle for the patient.  She hadn’t been aware he was missing, and was more than a little startled at the events.  Yes, the (sleeping pill*) was fairly new, no he’d never had a sleepwalking history she knew of, etc.  Several hours he awakened with no ill effects and went home.  Not an exciting case, but after a few years in EM you enjoy the cases where patients don’t die and it’s a little interesting.


So, my recommendation is to have somebody hide your keys when you take the sleeping pills, but that’s just me*.


*Not actual medical or legal advice, no actual product is mentioned or implied.  Your mileage may vary, void where prohibited, and thank a lawyer if you read crap like little tiny asterisked text.