This article examines the policies related to truck driver hours of service regulations that affect occupational and public health and safety. The interaction of the nature of truck driving, labor practices and deregulation of the trucking industry, and the evolution of the current regulations are presented. The work of advocacy coalitions and legal action related to this issue is described. Possible policy alternatives and recommendations are presented. The article supports the position that although federal government regulators attempt to promulgate regulations based on current circadian science, the regulations are ineffective as stand-alone measures. Labor policies and practices must foster a work environment that facilitates sleep and safe driving performance. Advocacy by nurses on this issue continue the rich tradition of public health nursing. Nurses may benefit from the study of truck driver hours of service regulation as recommendations limiting their own hours of service are being considered and legislated. © 2005, Sage Publications. All rights reserved.