Wake up call
Don’t be caught napping when the feds finalize stringent health regs for sleep apnea and other disorders, many of them common among truckers. Your CDL could hang in the balance.
The Federal Motor Carrier Safety Administration is expected soon to issue guidelines and later initiate rulemaking that would significantly raise the bar on screening and treatment for obstructive sleep apnea and other health conditions believed to affect driver safety.
Regulation of obstructive sleep apnea, which prevents sleepers from getting enough oxygen and rest, has become an especially contentious issue for FMCSA.
Some drivers worry that the agency will place too much emphasis on screening by single factors, such as obesity or neck size, or that mandated testing will be too costly to drivers in terms of money or downtime.
An estimated 28 percent of drivers suffer from mild to severe sleep apnea, but less than half of those with the disorder are being treated for it, experts say. Nearly 42 percent of drivers are overweight and considered prone to having the disorder.
Fleet safety directors and health specialists say that stricter oversight and required guidelines for screening, diagnosis, testing and monitoring of sleep apnea can’t come soon enough. Some large carriers have been working with specialists to develop their own testing and treatment programs.
Don Lacy, Prime’s safety director, says his company started screening for the condition in 2001 to help at-risk drivers reduce daytime drowsiness. “It’s rampant,” says Lacy, adding that micro-naps cause many truck-related accidents. “People can suffer from obstructive sleep apnea and not know they have it.”
Currently, the medical certification required for commercial driver license holders includes only one question regarding sleep apnea. Examiners are not required to screen for the condition if drivers respond that they are symptom-free.
Under current CDL restrictions, drivers with moderate to severe sleep apnea that interferes with safe driving can be disqualified if a state-licensed medical examiner determines they should not drive. No medicines can treat the disorder, but devices known as continuous positive airway pressure (CPAP) or auto-titrating positive airway pressure (APAP) machines open the airways with use of a face mask, allowing the user to get sound sleep. Many drivers are treated for sleep apnea with such machines and maintain their CDLs successfully.
Progress on regulating the condition has been complicated because not all parties agree on the relationship between sleep apnea and safety. FMCSA wants to verify that sleep apnea affects trucking safety before announcing a notice of proposed rulemaking and getting public comments, says FMCSA spokesman Duane DeBruyne. It may be as long as two years before a formal rulemaking process begins, says Mary Gunnels of the FMCSA’s Office of Medical Programs.
Knowing the factors that put drivers at risk for sleep apnea isn’t enough, explains Dr. Ellison Wittels, a CDL medical examiner, an FMCSA consultant for more than 20 years and a founding member of FMCSA’s Medical Review Board.
“What we don’t know is which drivers with sleep apnea will crash. You have to look at the impact of all the negative risk factors,” says Wittels, a senior physician at Concentra Medical Centers in Houston. “It’s pretty hard to come out against safe driving, but if you are too restrictive, you drive drivers underground. You have to be reasonable.”