Objective: This study examines specific hypotheses that both sleep loss and behavioral changes occurring with the time shifts for Daylight Savings Time (DST) significantly effect the number of fatal traffic accidents in the United States of America.Background: It has been reported that there is a significant increase in the number of automobile accidents in the spring shift to DST due to the loss of 1 h of sleep. But the extra hour gained at night with the shift from DST in the fall has been variably reported to be associated with increases and decreases in the number of automobile accidents which may reflect either behavioral anticipation with an extended late night prior to the change or the benefit of extra sleep after the change.Methods: Data from 21 years of United States' fatal automobile accidents were gathered. The mean number of accidents on the days at the time of the shifts (Saturday, Sunday and Monday) was compared to the average of the corresponding mean number of accidents on the matching day of the weeks preceding and following the shift. This was repeated for each DST shift. The number of accidents for a particular shift was also correlated with the year of the accidents.Results: There was a significant increase in accidents for the Monday immediately following the spring shift to DST (t=1.92, P=0.034). There was also a significant increase in number of accidents on the Sunday of the fall shift from DST (P<0.002). No significant changes were observed for the other days. A significant negative correlation with the year was found between the number of accidents on the Saturdays and Sundays but not Mondays.Conclusions: The sleep deprivation on the Monday following shift to DST in the spring results in a small increase in fatal accidents. The behavioral adaptation anticipating the longer day on Sunday of the shift from DST in the fall leads to an increased number of accidents suggesting an increase in late night (early Sunday morning) driving when traffic related fatalities are high possibly related to alcohol consumption and driving while sleepy. Public health educators should probably consider issuing warnings both about the effects of sleep loss in the spring shift and possible behaviors such as staying out later, particularly when consuming alcohol in the fall shift. Sleep clinicians should be aware that health consequences from forced changes in the circadian patterns resulting from DST come not only from physiological adjustments but also from behavioral responses to forced circadian changes.