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Todd Dills

Language of MCSAC / Medical Review Board recommended apnea guidelines — more from D.C.

| February 06, 2012

Contrasting viewpoints coming together — or not — made for an interesting day today at the first of four days’ worth of meetings of the FMCSA’s Motor Carrier Safety Advisory Committee. Today’s agenda was dedicated to drafting language toward formal recommendation to the agency of potential guidance to adopt in future rulemaking relating to sleep apnea and drivers’ medical qualifications. For a roundup of what’s in the recommendations as issued and some of the debate that went on today between industry participants, medical reps and law enforcement, check out the news brief now live at OverdriveOnline.com.

Below you’ll find the language of the 10 recommendations, and I thought I’d also share here some statistics that the Owner-Operator Independent Drivers Association has put together relative to the potential total cost of treatment of drivers under the 35 BMI testing mandate proposed. These costs are estimated at a $180 million total annual cost to the industry. That’s the testing alone. Granted, it assumes an average $2,500-$3,000 figure for an in-lab sleep test, which sleep specialists note has fallen somewhat in recent years. (However, in public comment near the end of the meeting yesterday, former small fleet owner — and current school bus fleet owner — Donald Fowler, of Richmond, Mo., referenced an October sleep study he himself had that was billed, all told, at just shy of $2,000.)

Furthermore, in a member survey OOIDA conducted, 72 percent of operators said their medical policies would not cover sleep apnea expenses. An argument OOIDA’s Todd Spencer and others made today, too, demonstrated something of a safety net loss if a large number of experienced operators are in fact forced out of the industry by the regulation (the OOIDA stats estimate 12 percent of the 3.5 million or more CDL drivers have BMI above or equal to 35) and are replaced by a less-experienced group, naturally more prone to making on-highway mistakes.

That’s all of course not counting the time and miles lost to downtime during testing, which for some operators could be significant if their apnea problems turn out to be significant themselves — some operators concluded to have apnea would be disqualified until treated. See below for specifics.

Another interesting part of the proceedings was the fact the final recommendations from the subcommittee on acceptable areas of treatment put the most confidence in continuous positive airway pressure (CPAP) machines, not least due to the ease of monitoring that is in place in current devices. This came in spite of dental practices in existence today that specialize in sleep medicine, as some of you I know are already well aware of. Midwest Dental Sleep Center’s Scott Craig, of Woodridge, Ill., characterized the exclusion of dental treatment of apnea in the recommendations as a mistake that is the result of the lack of a dental specialist on the FMCSA’s Medical Review Board. “Currently there are commercially available products to monitor compliance,” he said, showing me the Smart Retainer device by Scientific Compliance as an example.

The manufacturer inserts electronic temperature sensors into dental retainers in order to allow doctors to scan the device to retrieve information about use and other data.

MRB members effectively dismissed much of the literature on studies relating to dental appliances as non-objective, borderline “commercials,” one said.

MCSAC member and Texas-based Clark Freight Lines’ Danny Schnautz put in his objection to the exclusion of the devices. Schnautz could well see such devices’ potential attraction to drivers who might otherwise need to idle their trucks to ensure power to a CPAP machine and truck starting power overnight. “I think we might be shutting the door tighter than we should have,” he said, making reference to language in the MCSAC recommendations that state dental devices’ “long-term efficacy” cannot “be demonstrated currently, so these technologies are unapproved alternatives at this time.”

Full language of the recommendations as I best followed their drafting/revision follows. (Note: there may be further revision as yet before they are sent formally to FMCSA, though their intention as outlined here should largely remain. Italics represent committee annotations about intentions.)

RECOMMENDATION LANGUAGE:
Recommendation 1 — General

  • Obstructive sleep apnea (OSA) diagnosis precludes unconditional certification.
  • A driver with OSA diagnosis can be certified if:
    • The driver has untreated OSA with apnea-hypopnea index (AHI) < 20 (i.e., mild-to-moderate OSA) AND
    • The driver does not admit to experiencing sleepiness during the major wake period OR
    • OSA is being effectively treated.

A driver with an OSA diagnosis may be recertified annually, based on demonstrating compliance with therapy.

  • Minimally acceptable compliance with PAP means at least 4 hours/day of use 70 percent of days.
    • § Drivers should be encouraged that more hours of PAP use is preferable.
    • § Optimal treatment efficacy occurs with 7 hours or more of daily use during sleep.
  • David Imschweiler

    I have been using a cpap machine for about eight years and love it. I get a great nights sleep and in the interest of safety this is a bug on a bumper to do. Plus those drivers who have it once treated will feel fantastic it is great not being tired during the day!

  • Don Lanier

    David,
    But what about drivers who dont have the symptoms, show no drowsiness or have no issues with sleep, and are forced to use the machine and have more issues sleeping with it. Thats the class I fall in, It may help some people but I tried to use the machine for a full 2 months, and after that I had red eyes, poor sleep, and it kept me constantly worried about compliance. I think someones not leaving an out for drivers who have no symptoms, but the sleep centers say Oh you do have this ??? Ive been trying to comply and losing sleep with a vacuum blower strapped to my face. There needs to be alternative treatment besides Bariatric Surgery, and Surgery that costs thousands when I have no Health Insurance.
    Drivers are gonna be run out of trucking by this STATISTIC and Testing that no one understands but the Sleep scientist and his Algorythms…

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  • oilman29

    Why cant we have just one rule, be careful and drive as safely as possible. Done.

  • MercenaryMan

    Frankly this LANGUAGE will elimante more then half of the older fatter and well paid drivers once its made into law, anybody who thinks its about DRIVER SAFETY is a fool. Notice that youll be FORCED to pay for numerous sleep studys and you can be sure the INHOME or reasonable cost testing will soon be not good enough, youll pay and pay and pay, and once your on it, you wont use it for a few months it will be part of your life FOREVER with the ongoing costs paid by YOU THE DRIVER.

    This has got PROFITS AND its easy to see whose going to profit, the sleep industry suddenly is the all knowing caring safety industry, why is it for nearly 70 years weve had millions of drivers behind the wheel in trucks, and a very small percentage suffered from really being tired, most of these men and women did this job perfectly and kept there truck and freight safe.

    So when do they start testing all shift workers, you can bet soon that will start and on and on, once these Do gooders get there hands in the pocket book and you can bet the see a GOLDMINE COMING….

    Brothers and Sisters if you dont stand up and tell these folks what you think of this , anyone 42 and above can expect to be out of a job, if your belts an XLarge your gone too, and if you have that BMI of 35 and over youll be wearing and using a blow dryer on your face to sleep as long as you hold a CDL….

    I was about to buy a brand new truck, I wanted to drive ten years and retire, thats not gonna happen now, I see the writing on the wall and it doesnt look good for me, my driving record is spotless, CSA score is Perfect, never had an accident and that should be what Im judged on not my Belt size….Stigmatizing anyone whose what they deem overweight, unhealthy and dangerous…..HOGWASH

  • MercenaryMan

    If clinically indicated, repeat sleep study. 2000.00 dollars paid by YOU, and after 1 year, If clinically indicated repeat sleep study, 2000.00 dollars paid by you, Machine rentals, Doctors visits, If clinically indicated repeat sleep study…2000.00, money you cant spend on a car, home, college or kids..BUT WHOSE GETTING RICH !!!!

  • guest

    That is the crazyest thing I have ever seen….that crazy “Mask”….out of a Horror Movie……Frankensteins Lab…I wont be attending THAT B.S. I can assure you…..a “sleep lab”..way too weird…..this crap is for astonauts…..be sensible..Bus Drivers are next??? Maybe Cabbies??

  • guest

    Totally INSANE..the whole thing…

  • guest

    Sure…come into the Lab…Do as the “sleep Scientist” tells you to do…..now disrobe for us…….ahahahaha lol
    Not Me Weidos……..I aint goin anywhere near your
    Weirdo “LAB”………what a sick joke.

  • guest

    While you are asleep they install a Monitoring Chip up your Butt…..what an insane bunch of crap….boy that Singer was RIGHT…..If You Dont Make A Stand..you will fall for anything..the old time truckers would be laughing their heads off at all this CRAP!!!!

  • HywayHero

    Read an artical about this some time ago. The author hinted that the makers the cpap machines and the doctors who do the testing are the ones pushing to impliment this rule. Bet you last dollar its not so much abourt safety as it is about them making more money.

  • johnny dark

    i just hope that they don’t find out that one of my legs is shorter than the other two. while not debilitating it may make me unfit for service

  • shane

    Drivers shouldn’t be screened as at-risk for obstructive sleep apnea (OSA) by belt size (BMI)! My BMI is considered well within the healthy range. I’m 6 ft, 190 lbs, 33-in waist … but … I have SEVERE OSA! Using BMI would not have flagged me for OSA …

  • shane

    Drivers shouldn’t be screened as at-risk for obstructive sleep apnea (OSA) by belt size (BMI)! My BMI is considered well within the healthy range. I’m 6 ft, 190 lbs, 33-in waist … but … I have SEVERE OSA! The BMI criteria would not flag me …