Train drivers’ inattention, including fatigue and distraction, impairs their ability to drive and is the major risk factor for human-caused train accidents. Many experts have undertaken numerous studies on train driver exhaustion and distraction, but a systematic study is still missing. Through a systematic review, this work aims to outline the types, risk factors, consequences, and detection methods of train driver fatigue and distraction. The effects of central nervous fatigue and cognitive distraction in train drivers during driving are caused by rest and sleep schedules, workload, automation levels, and mobile phones. Furthermore, train drivers’ fatigue and distraction can cause loss of concentration and slow reaction, resulting in dangerous driving behaviour such as speeding and SPAD. Researchers have combined subjective reporting, physiological parameters, and physical factors to construct detection algorithms with good results to detect train driver fatigue and distraction. This review offers recommendations for researchers looking into train driver fatigue and distraction. And it can also make valuable recommendations for future studies about railway traffic safety.