Rest assured

| December 12, 2008

The SleepStyle 200 series assisted-breathing machine includes a mask, hose and monitor for sleep apnea treatment.

Seven years ago, Reggie Barnes headed to a hospital emergency room to seek relief from chronic fatigue, shortness of breath and high blood pressure.

“Anything I did that required any exertion made me really fatigued,” says Barnes, a 47-year-old resident of Grand Prairie, Texas, who at the time was a Schneider National driver.
After ruling out cardiac arrest, doctors diagnosed him with obstructive sleep apnea. The disorder, caused by blockage in the airways, deprives sleepers of oxygen.

Doctors referred him to a sleep lab. His company insurance paid for testing and treatment, which entailed mechanically assisted breathing.

“The day after they adjusted me to the machine, I was so full of energy,” says Barnes of the apparatus he has used for now seven years. “I finally had a good night’s rest in I don’t know how many years.”

The trucking industry has become increasingly aware that commercial drivers have an above-average incidence of sleep apnea. There have been calls for more regulatory action, and in January a panel sponsored by the Federal Motor Carrier Safety Administration presented guidelines to the FMCSA’s Medical Review Board for the industry to cope with the condition.

Dr. Kirsty Kerin of Sleep HealthCenter, who treats drivers at a sleep lab operated in conjunction with the National Private Truck Council, says that truckers are especially prone to sleep apnea because of their long hours and irregular schedules. Those who are obese, sedentary and 40 or older are even more vulnerable.

Six years ago, FMCSA concluded that 28 percent of truckers suffer from the condition, higher than the general population’s 20 percent rate estimated by the National Institutes of Heath. In this and subsequent studies, truckers who suffer from sleep apnea have been shown to have lower job performance and higher accident rates, say industry groups, federal agencies and medical foundations that have investigated the disorder.

Two of the nation’s largest carriers, Schneider National and Swift Transportation, are among those taking action to help their drivers and improve their safety records by more actively addressing sleep apnea.

Swift recently partnered with Precision Pulmonary Diagnostics to test and treat drivers for sleep apnea. PPD, in conjunction with Schneider and Definity Health Corp., conducted a study that found treating drivers with sleep apnea increased driver retention and reduced preventable accidents and health care costs.

For the uninsured patient, though, testing and treatment can be costly. A driver seeking testing through a sleep lab and treatment through a doctor of sleep medicine can end up paying more than $5,000, says David Johnson director of Sleep Pointe, a clinic that diagnoses and treats sleep disorder for truckers. Comparatively, he says, Sleep Pointe provides the same solutions for about $2,000 because it bundles all the services. Sleep Pointe recently announced a partnership with Circadian, a company that helps clients manage workforce fatigue risk.

The testing alone can run up to $3,000 for an in-lab polysomnogram, where the patient’s sleep patterns are measured, says Dr. John McElligott, chief medical officer of Professional Drivers Medical Depots, based in Knoxville, Tenn. Thirteen PDMD clinics conduct free in-cab tests in which the driver hooks up to a portable testing machine overnight and returns it to the clinic for results.

While the thought of wearing a mask at night deters some, other drivers who have suffered without getting enough sleep for years are relieved when they finally get help.

Frank Dimperio, company driver and resident of Erie, Pa., took “with a grain of salt” his wife’s concern that he might have sleep apnea. “I didn’t think I could stop breathing in my sleep. But I was progressively getting fewer miles and getting tired a lot faster.” He also feared that he’d be asked to quit driving if he were tested and treated for a sleep disorder.

But his wife, Tera Dimperio, encouraged him to get treatment by going herself, having had symptoms of an enlarged neck and snoring associated with sleep apnea.

When Frank, too, was diagnosed with the condition, his fears were allayed. The couple’s insurance paid 80 percent of the costs. “Our portion was moderate – not too expensive, but not cheap,” Tara says. “Despite how much it cost, I would do it all again.”

The most widely used treatment for obstructed sleep apnea is controlled breathing using a continuous positive airway pressure machine. CPAPs come in a variety of sizes, power options and masks. Smaller devices or battery-powered ones are more suitable for use in the cab. Barnes can run his CPAP from the truck battery through the cigarette lighter without idling or killing the batteries, he says.

Kerin says that while treatment is relatively simple for drivers, check-ups and long-term care can be challenging: “It’s more difficult to find a center where they can be treated because they may be in Florida one day and Washington, D.C., the next.” McElligott mitigates that problem by prescribing a CPAP with a wireless tracker that reports data to the clinic for months after diagnosis.

However much trouble is involved with treatment, the Dimperios say it’s worth it. Tera says she and Frank are “a lot less crabby.” Frank noticed that his blood pressure dropped and that he requires less sleep. “They say the treatment can take months to adjust to, but that wasn’t the case for me,” he says. “I went from being tired all the time to being awake and alert. I’ve even started trying to learn the guitar while I’m on my breaks.”


The CDL and sleep apnea
The Federal Motor Carrier Safety Regulations say sleep apnea is a “dysfunction likely to interfere” with safe driving.

However, the condition does not necessarily disqualify someone from having a commercial driver’s license. No screening for sleep apnea is required for the CDL health certificate, but the medical examination may reveal symptoms of sleep apnea that lead to testing and treatment.

In that case, Federal Motor Carrier Safety Administration regs say a driver should be temporarily disqualified until the diagnosis of sleep apnea is ruled out or the disorder is treated successfully. As a condition of continuing qualification, drivers with sleep apnea must be compliant with uninterrupted therapy, such as use of a CPAP device.

The regulatory approach to sleep apnea detection and treatment would get tougher under recommendations made by a panel to FMCSA’s Medical Review Board in January. One proposal is that drivers who have not used their assisted-breathing machines should be immediately disqualified or denied certification.

The panel also urged mandatory screening and testing for drivers above a certain body mass index, a weight-to-height ratio that measures obesity. The proposed screening would include recording a driver’s medical history, body type and possible risks.

FMCSA did not respond to Overdrive’s requests for information about the status of the proposals.


Comfort zone
Wearing a continuous positive airway pressure mask can be a daunting transition for sleep apnea patients. The type mask depends largely on the method of breathing during sleep and the patient’s sensitivity to enclosed spaces.

NASAL. Over-the-nose masks are small and cover just the nasal area. Masks with direct nasal delivery cover just the nostrils instead of the whole nose, making them a better option for patients who feel claustrophobic with masks that cover the face.

ORAL. The mouth-only masks are the best option for mouth-breathing patients prone to claustrophobia. Full-face masks cover both the nose and mouth, providing a mix of therapy for patients who don’t mind the extensive coverage.


Common symptoms
Before getting an appointment for testing, some patients first do their own preliminary online screening. One version can be found at www.sleep-tests.co.uk.

The most common symptoms are:

  • Loud snoring
  • Restless tossing and turning during sleep
  • Gasping or choking while sleeping
  • Headaches
  • Frequent nighttime urination
  • Irritability
  • Excessive daytime sleepiness
  • Memory loss and problems concentrating
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