Fit for the Road
Trucking Wakes Up to Problem
Industry coming to grips with long-term health consequences of sleep apnea
Tony Guzman, an owner-operator leased to Prime Inc., was having a hard time making it through most driving shifts without a nap, despite often sleeping through and beyond the end of the required 10-hour rest.
“I was always exhausted,” Guzman says. “I couldn’t get through the day. I would sleep 10 or 12 hours, and it wouldn’t be enough. I would have to pull over 200 or 300 miles down the road and sleep some more and keep going that way.”
Fellow Prime driver James Stitt of Charlotte, N.C., has a similar story. He would wake up feeling tired, moody and suffering from headaches. “I would wake up aching and just didn’t feel good at all,” Stitt says.
Last year Prime screened both drivers and set them up for a sleep study at the Springfield, Mo., company’s offsite sleep lab. Neither driver was happy about it.
“The drivers sometimes get angry when we tell them they have to be tested,” says John Hancock, director of driver training at Prime. “We get them to talk to other drivers who have been diagnosed and are being treated.”
“Some guys quit,” adds Don Lacy, Prime safety director, who also suffers from sleep apnea. “What makes up for it is when a driver comes to you and says, ‘You saved my life.’”
The attitude changes almost immediately when a driver with sleep apnea begins treatment using a continuous positive airway pressure (CPAP) device.
“Every time I use the machine, I wake up with a lot more energy,” Guzman says. “It just makes it a better day. Now I get my job done quicker without all the quirks of having to stop to sleep for four or five hours during the day.”
What is sleep apnea?
Apnea is a Greek word that means “without breath.” There are three kinds of sleep apnea: obstructive, central and mixed.
Obstructive sleep apnea (OSA), the most common form, is caused by a blockage of the airway that usually occurs when the soft tissue in the rear of the throat collapses and closes during sleep. Symptoms often include loud snoring, restless sleep and sleepiness during the day.
Central sleep apnea (CSA) is not caused by a blocked airway but when the brain temporarily fails to signal the muscles to breathe.
You’ve heard the rumors. The Federal Motor Carrier Safety Administration is soon going to require testing for sleep apnea if your body mass index (BMI) and/or neck size is [fill in the blank].
From all indications, it does appear that FMCSA plans to address sleep apnea sometime and will require some kind of action to screen/test for and treat those drivers who are diagnosed. Many medical experts and trucking company officials think FMSCA may initiate a process that deals with sleep apnea later this year.
Sleep apnea is a combination of the two.
With each apnea event, which can happen hundreds of times in a single night in severe cases, the brain finally arouses you to breathe again. This means the restorative sleep your body needs to function properly is fragmented and of poor quality.
“For a person who has moderate to severe sleep apnea, it is very much like someone poking you every 30 to 45 seconds to wake you,” says Duke Naipohn, president and CEO of Sleep Pointe, which partnered with Prime to run its sleep lab.
Untreated sleep apnea can have serious and deadly consequences. According to the American Sleep Apnea Association, sleep apnea can contribute to high blood pressure and other cardiovascular disease, diabetes, memory problems and weight gain. People with untreated sleep apnea also may complain of headaches, depression, reflux, nocturia (the need to go to the bathroom frequently in the night) and impotency.
Studies have shown sleep apnea can lead to job impairment and motor vehicle crashes.
How big is the problem?
According to Dr. Mark Berger, president and chief medical officer for Precision Pulmonary Diagnostics, approximately 20 million Americans have OSA. Of those, 17 million are undiagnosed. The risks for sleep apnea increase with age and weight gain.
Among truckers, a 2002 study commissioned by the Federal Motor Carrier Safety Administration found that approximately 28 percent of drivers on the road suffer from sleep apnea. Some medical experts think the actual number is higher and is growing due to the upward trend in average age of the driver population, coupled with contributing health factors.
Diagnosis and treatment
The most accepted form of sleep apnea diagnosis starts with a questionnaire screening. If it is determined that a person exhibits symptoms related to a possible sleep disorder, the next step is an overnight sleep study. This is done in a controlled environment where certified sleep technicians hook monitoring sensors to the patient to record and study apnea events. Depending on the number of apnea events the patient has during each hour of sleep, the patient will be diagnosed as either not having a disorder or as having mild, moderate or severe sleep apnea.
Treatments range from lifestyle changes, including weight loss, smoking cessation, exercise and different sleeping positions, to specialized devices like a CPAP or auto-titrating positive airway pressure (APAP) systems to dental devices to surgery.
While CPAP and APAP are most commonly used to treat moderate and severe sleep apnea, oral appliances are prescribed by many dentists to reduce the number of apnea events. Some patients go this route when they find they can’t adjust to wearing the mask required to use CPAP systems.
Dr. William Adams, who specializes in sleep disorders at his Albertville, Ala., dentistry practice, advocates oral devices as the best alternative for CPAP haters. In fact, he is a member of a national campaign called I Hate CPAP to bring awareness to dental devices offered for sleep apnea sufferers.
While he admits CPAP is a more effective treatment when properly used — especially among severe sleep apnea patients — real-world evidence suggests that many people simply quit using them.
“We found that 35 to 50 percent of patients given CPAP machines quit using them after six months,” Adams says. “With oral devices, 90 percent are still using them after one year.”
But other medical experts say CPAP machines offer accountability that the device is being used with downloadable data cards. Oral appliances do not. “In the trucking industry, it’s about accountability, especially with facing stricter federal regulations,” says Berger, who provides a comprehensive sleep apnea program to fleets like Schneider National and Swift.
Several kinds of surgeries can help in some sleep apnea cases. These include trimming throat tissue, removing tonsils and adenoids, gastric bypass, restructuring the jaw, repairing a deviated septum and tracheotomy. These procedures are done in the more extreme cases and have varying degrees of success for curing sleep apnea permanently.
CPAP, oral devices and surgery are all acceptable treatments recognized by the American Academy of Sleep Medicine.
Sleep apnea rule coming soon
But at the Healthy Trucking Association of America’s February Healthy Trucking Summit in Atlanta, FMCSA Office of Medical Programs Director Dr. Maggi Gunnels was vague on the timeframe and nature of a potential rule.
While some type of sleep apnea regulation may be on the horizon, Gunnels said due to the nature of the process, it’ll likely be at least a couple of years. Even if that does happen in the future, “are we going to mandate screening and testing?” Gunnels asked. “I don’t think we know yet. I think we’re going to propose that it probably will be screened for. … But I don’t know how detailed we’ll get in terms of regulation or mandates.”
Last year, the FMCSA Medical Review Board made a recommendation that the agency require screening for obstructive sleep apnea for all drivers with a BMI greater than 30. More recently, the National Transportation Safety Board urged the FMCSA to begin a program to identify commercial drivers at high risk for obstructive sleep apnea, and if treatment is required, show that it is has been conducted.
— Misty Bell contributed to this report.
Conference and Webinar
The American Sleep Apnea Association will hold its first “Sleep Apnea & Trucking Conference” May 11-12 in Baltimore. The conference’s focus is creating greater awareness about sleep apnea and its dangers.
The conference is cosponsored by the American Trucking Associations and the Federal Motor Carrier Safety Administration.
Panel discussions include:
• Body mass index (BMI) guidelines
• Interstate medical exams and enforcement
• Affordability of diagnosis and treatment
• Future research needs on prevalence and impact
For more information, visit: www.satc2010.org.
Truckers News held a webinar titled “Sleep Apnea: A Wakeup Call” in February. The guest speaker was Dr. Mark Berger, CEO and chief medical officer of Precision Pulmonary Diagnostics. You can download and listen to the recorded webinar in the archives at www.truckerwebinars.com
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