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 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 interest 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.

• The intent behind the AHI threshold is to prioritize those drivers with OSA that need immediate treatment.
  • Drivers with mild OSA (AHI levels as low as 5) may benefit from OSA treatment, and should be encouraged to explore treatment options.
  • Drivers with an AHI between 5 and 20 should be encouraged to seek treatment, if they have a history involving a fatigue-related crash or a DOT-defined single vehicle crash [footnote reference: crash involving a CMV that results in a fatality or injury treatable away from the scene or disabling damage requiring tow away], or if they report sleepiness while operating a motor vehicle.
• Why set the AHI threshold at 20?
  • Crash risk in the moderate-to-severe OSA range is statistically higher than for drivers with mild OSA.

From a practical perspective, setting the AHI limit at 15 or above makes it more difficult to get a patient under treatment to that AHI level. Although AHI of 15 is likely a safer threshold, there is not data to show this.

RECOMMENDATION 2 — Drivers with any of the following should be disqualified immediately or denied certification: 

• Report excessive sleepiness during the major wake period while driving, OR
• Experienced a crash associated with falling asleep, OR
• Have been found non-compliant in treatment per Recommendation 1.

RECOMMENDATION 3 — Drivers with any of the following may be granted conditional certification per Recommendation 4:

• Have AHI > 20 until compliant with PAP, OR
• Have undergone surgery and are pending post-op findings per Recommendations 10-12, OR
• Have a BMI > or equal to 35 kg/m² (pending sleep study).

Notes:

• BMI cutoff of 33 is supported by studies (MRB).
• BMI cutoff should be objectively related to crash risk (Conway).

RECOMMENDATION 4 — Conditional certification

• Driver with BMI > or equal to 35 kg/m² may be certified for 60 days pending sleep study and treatment (if diagnosed with OSA).
• Within 60 days, if a driver being treated with OSA is compliant with treatment (per Recommendations 8-12), the driver may receive additional 90 day conditional certification.
• After 90 days, if the driver is still compliant with treatment, the driver may be certified for no more than 1 year.  Future certification dependent on continued compliance.

Refer to Recommendation 1 for definition of minimal compliance. [Insert clinical evaluation educational footnote]

[CLINICAL EVALUATION EDUCATION FOOTNOTE]

• Medical examiners should screen all drivers for OSA.
• The driver is judged at-risk for OSA based on:
• The driver’s answers to a validated questionnaire (e.g., Berlin), OR *Some other validated screening tool.
• Symptoms:  loud snoring, witnessed apneas, sleepiness during major wake period.
• Risk factors may include the following. A single risk factor alone may not infer risk. Need to look at multiple factors.
• Factors contributing to high risk

1. Small or recessed jaw
2. Neck size > 17” male, 15.5” female (strongly correlated with obesity, which is associated with sleep apnea)

• Other factors

1. Age 42 and aove
2. BMI > 28 kg/m²
3. Small airway (Mallampati Scale score of Class 3 or 4)
4. Family history
5. Male or post-menopausal female
6. Experienced a single-vehicle crash

• Conditions associated with high risk:

1. Hypertension (treated or untreated)
2. Type 2 diabetes (treated or untreated)
3. Hypothyroidism (untreated)

RECOMMENDATION 5 — Method of diagnosis and severity

• Methods of diagnosis include in-laboratory polysomnography, at-home polysomnography OR a FDA-approved limited channel ambulatory testing device which ensures chain of custody.
• In-laboratory polysomnography, which is more comprehensive, should be considered when the clinician suspects a sleep disorder in addition to sleep apnea.
• Note that new technologies will likely emerge that will be able to screen for OSA.
• Driver should be tested while on usual chronic medications.

• Note that the joint medical committee did not consider AHI levels from unattended studies, but only in-lab sleep studies, which detect the arousal component of hypopneas (not just saturation).
• An in-home sleep study may underestimate AHI when compared to an in-lab sleep study.
• An AHI detected on an in-home sleep study may be less than an in-lab study because the in-home study likely does not consider total sleep time.
• Therefore, the medical examiner should use clinical judgment when interpreting results of an unattended sleep study.

• If the clinician believes the level of apnea is greater than the level reported by the in-home study, the clinician should consider recommending an in-laboratory sleep study.

RECOMMENDATION 6 — Treatment, PAP

• All individuals with OSA should be referred to a clinician with relevant expertise.
• PAP is the preferred OSA therapy.
• Adequate PAP pressure should be established through one of the following:
  • Titration study with polysomnography
  • Auto-titration system

A driver who has been disqualified may be conditionally certified (per Recommendation 4) if successfully treated for 1 week AND

• The driver can demonstrate at least minimal compliance (4 hrs/use 70% of nights) AND
• The driver does not report excessive sleepiness during major wake period.

RECOMMENDATION 7 — Treatment alternatives

There are limited data regarding compliance with and the long-term efficacy of dental appliances cannot be demonstrated currently, so these technologies are unapproved alternatives at this time.

Surgical treatment is acceptable (see Recommendations 10, 11 and 12).

RECOMMENDATION 8 — Bariatric surgery

After bariatric surgery, a driver may be certified if:

• Compliant with PAP, OR 6 months have passed since surgery (for weight loss), AND
• Cleared by treating physician, AND
• No reported excessive sleepiness during major wake period.
• After six months have passed since surgery, a repeat sleep study may be considered to evaluate for the presence of ongoing sleep apnea.

Annual recertification

• Maintain stable weight

If clinically indicated, repeat sleep study.

RECOMMENDATION 9 — Oropharyngeal surgery, facial bone surgery

After oropharyngeal or facial bone surgery, a driver may be certified if:

• 1 month has passed since surgery, AND
• Cleared by treating physician, AND
• No reported excessive sleepiness during major wake period.

After 1 month has passed since surgery, if the apnea appears to have resolved, a repeat sleep study should be considered to test for the presence of ongoing sleep apnea.

Annual recertification

• If clinically indicated, repeat sleep study.

RECOMMENDATION 10 — Tracheostomy

After tracheostomy, a driver may be certified if:

• 1 month has passed since surgery, AND
• Cleared by treating physician, AND
• No reported excessive sleepiness during major wake period.

After 1 month has passed since surgery, if the apnea appears to have resolved, a repeat sleep study should be considered to test for the presence of ongoing sleep apnea.

Annual recertification

• If clinically indicated, repeat sleep study.

If you were listening to Morning Edition on NPR today you may have heard this interview with Sowder by host Steve Innskeep about the accomplishment. Among Sowder’s observations about how the work of driving has changed over the years is one those of you who’ve been on the roads for decades will no doubt see no small measure of truth in, I’d imagine: “The old saying used to be courtesy is contagious — not so much any more. You let people in, and that’s that. Only about one out of 50 can bring themselves to throw their hand up, thanks….” Read or listen to more from him here.

All the same, here’s congrats to Sowder on the milestone. Keep on trucking’.

Photos courtesy of UPS.

The 51-year-old operator, here pictured, now begins a journey toward losing weight and getting fit enough to compete as part of CNN’s team, alongside Dr. Sanjay Gupta and six teammates, at the 2012 Nautica Malibu Triathlon. Keller estimates he could lose up to 100 pounds or more to get his weight to an ideal state. You can watch his winning video via this link, or check it out embedded below. Read more about the Fit Nation program.

Keller’s not the only driver working this year toward getting fit. Check out the debut of Truckers News’ “Go for the Goal” feature series and health program in the January issue here.

[There is a video that cannot be displayed in this feed. Visit the site entry to see the video.]

After a recent court ruling that held the Tiger Truck Stop’s permit for displaying the big cat was invalid, however, another group stood up and spoke out, defending the truck stop owner. Among them was owner-operator Gordon Alkire (pictured), whom you may recall for his part in Overdrive‘s 50th-anniversary coverage on the OverdriveRetro.com website last year. Alkire offered up the following commentary, reposted here with his permission:

So you think that Tony the tiger is in bad health, in an unsafe environment and should be removed. This is no different than removing a child from its home because of a busybody neighbor that reads something from nothing and never even had a child. It is life-altering for the child. The same can be said of the tiger. But it can’t speak and tell you it is unhappy or stubbed its toe, so it is taken care of the best way it can be. This tiger gets regular vet visits, real food — not the ground stuff your pets eat — and enjoys the attention. It is not alone. Tony has fresh air, a space of his own, not like in a zoo or a carnival.

I have seen dogs in trucks that are mistreated or not properly cared for, their diets no better than Mickey D’s two times a day. This truck stop is not hiding this tiger, as many other people have done with their pets, mistreating them.

This tiger is an icon. It is healthy. If this is so bad a situation for the tiger, why has it taken more than 10 years for these critics to get involved?

The answer is simple. The situation is neither bad nor dangerous for Tony. This uproar strikes me as driven by the attraction of getting on some bandwagon for certain individuals, to be a part of something, no matter the pain or suffering or cost it causes for someone else. They are searching for their 15 minutes of fame at the expense of someone else. Namely, the owner of the truck stop. It is called mob mentality in some circles. The writers of some anti-Tony the tiger stories are only seeking attention, and feel the need to do anything to get it at other people’s expense.

Unfortunately, Tony happens to be the target now.

I have a suggestion for the anti-Tiger enthusiasts. Pay attention to your surroundings and go after the drivers and dog owners that mistreat their animals. How about the drivers that have 100-pound-plus dogs in a six-by-eight-foot cab and only take them out for short walks to do their business and rush them back into the cab again. That is mistreatment of animals, as a dog this size needs room to grow and stay active. Or what about the drivers who think using a stick to beat a dog to make it mind is OK? I’ve seen it happen.

Tony has been in this truck stop for more than 10 years, and only in the last two or three has this action to remove him surfaced.

Among all these non-experts, including some truckers, the biggest are those who begin to think they are experts in tiger care and truck stop management and demand Tony’s removal while knowing absolutely nothing about the situation, all the while refusing to listen to both sides of the problem.

It is time to give it a rest. Leave Tony alone.

“Drivers are some of the most technologically advanced people I know and many of them interact via social media each day,” said Ellen Voie, WIT’s President/CEO.  “By offering this forum we can give our members the opportunity to connect with others who share their involvement in trucking and to learn more about our organization in the process.”

The blog was created with the support of Con-way Inc. “The new blog will serve as another resource to help Women In Trucking continue its mission of encouraging women to pursue trucking as a career and supporting their growth and development in the transportation industry,” said Con-way Director of Communications Gary Frantz. “Con-way is proud to sponsor and support this worthwhile endeavor.”

Con-way Truckload, you’ll recall, has an ongoing health blog of its own, launched at the Great American Trucking Show in Dallas last year. They’ve got some great-sounding slow-cooker recipes up there now, among other info, if you’re packing a crock pot. Check it all out here.

WIT encourages all drivers, male and female, to interact with the association via the new blog. There’s not a whole lot there as yet, but keep an eye on it for future growth.

A letter writer to the Chattanoogan newspaper last week proposed to fine drivers of large trucks involved in accidents per hour of required cleanup or per mile of backed up traffic. Specifically:

$5,000 per hour of cleanup or per mile of backed up traffic, whichever is greater, to be paid by the trucking companies, and $1,000 per hour of cleanup or per mile of backup, whichever is greater, to be levied against the truck driver.

You can read his full, though quite brief, commentary here. We’ve heard stuff like this before, but what might be remarkable in this case is the not-so-brief response the idea garnered. Among the many drivers weighing in I was happy to find was Buddy Wenners, the Nabisco driver who last month famously (and quite satirically) proposed in these halls that an outright ban on truck driving ought to do the trick in impressing upon the imagination of the general public just how important are this nation’s truck drivers to its day-to-day life.

Here’s a piece of what he had to say to the letter writer: “What you see is the aftermath of an accident, never the truck driver trying to avoid killing the teenie bopper that ran a red light/stop sign because she was busy gossiping with her BFF, or the unannounced lane change by the guy that realizes his exit is next to him and three lanes to his right….”

To check out the full commentary and/or weigh in yourself, find everything at the Chattanoogan’s site.

And I’m curious — anybody out there who feels like such a punitive fine, combined with a robust determination of at-fault parties in any given accident and similar fines for four-wheelers, would be a good idea, a safety plus?

The most current action, as far as I can tell, has been that Tiger Truck Stop owner Michael Sandlin has sued the state of Louisiana and Iberville Parish over the constitutionality of their ban prohibiting “anyone from owning wild, exotic or vicious animals for display or exhibition.” It’s something of a countersuit, as a court in November ordered the tiger to be removed from the premises, revoking a state-issued permit on a technicality and prompting animal rights activists with the Animal Legal Defense Fund and other groups to claim victory in setting Tony free.

But the battle goes on.

One of the last couple times I wrote about the tiger, it was on the occasion of a group of drivers getting involved to call for the animal’s removal from the truck stop location. What do you think today?

Wilson himself was at the Motor Carrier Safety Advisory and Medical Review Board joint sleep apnea subcommittee meeting in Washington last week, where he reports committee members worked at drafting language for potential official medical guidance on the sleep apnea condition. The upshot of the subcomittee’s conclusions? “It’s not looking positive for the industry,” Wilson says. “The BMI [screening] standard is likely to be between 31 and 35. The last number I really heard talk of was 31. That was probably going to be the guideline. They tended to lean toward 33 for a while – and a size 17 neck.”

As committee members debated standards, Wilson says, the general consensus was that a sleep apnea diagnosis would be a “disqualifiable diagnosis with a stand-down,” meaning a driver diagnosed with the condition would be required to undergo treatment to be reinstated. The next meeting of the full MCSAC committee Feb. 6-9 will see further action on the issue, Wilson notes. Watch for details about it to emerge at MCSAC’s website.

More broadly, Wilson’s thinking on where the industry is today is reflected in the analysis that follows, a sort of state-of-the-industry that began as a response to another post put up for discussion on the LinkedIn business networking site. I thought I’d throw it out there for you, as it contains clear indications as to why he thinks the sleep apnea debate will be a net negative for the business of trucking. He gets into what he sees developing in the realms of safety and opportunity, given the current unsettled regulatory environment and perhaps equally unsettled economy. My question for you: Is he correct? Are we in fact headed down a path that leads ultimately to no improvement in “conditions, pay, rewards, trust and attitudes toward drivers”? His full commentary follows.

I think that the major players in our industry are taking a “sit back and see” attitude to future regulations, including estimates of how they will affect their bottom lines. With hours of service changes, potential EOBR mandates, driver medical qualifications changes and the institution of the National Registry of Certified Medical Examiners (among which I think some are good and some unnecessary), how will the bottom line be affected?

Example: The new restart provision ultimately means fewer available hours of work time, more equipment, and more support personnel and, ultimately, more drivers will be needed to deal with the same logistical tonnage. The two 1 a.m. to 5 a.m. provisions will create more heavy truck traffic during the already cluttered rush hour traffic jam, placing more trucks in the currently overburdened infrastructure, and cause increased crash rates by just adding additional trucks to the highways. Take into consideration that I did not mention any more revenue generated, just more trucks and drivers to haul the same amount of product. Some smaller carriers and owner-operators will feel the pressures, and try to adapt, but I can see a culture developing of violators just trying to survive.

Point 1: This is not a safe culture, either.

Point 2: More trucks mean more drivers, of course, and there is a discernible shortage of “qualified” drivers today. Average ages of over-the-road drivers have been getting higher and higher and in the last seven years and have increased from 47 to almost 53. Look at the numbers — it’s not older drivers entering our industry; it’s the phenomenon of the current drivers getting older and not many new drivers coming into the industry to replace them. These same 50+ drivers are slowly being shuffled out of the industry by more stringent medical standards as well. If you get rid of all your turkeys, you’ll not have any for Thanksgiving! If you get rid of all the older drivers and don’t replace them, you’re going to have a bunch of empty seats.

This brings up Point 3: Carriers have to fill the seats of the additional trucks, likewise the trucks vacated by the older drivers. Our industry, considered in total, has a weak training and mentoring system now! The so-called “CDL-mill” companies that generate more actual dollars from the company truck driver training schools than they do from freight in some cases have a 15 percent success rate putting those drivers in their trucks. At the same time, there’s in the neighborhood of a 4 percent retention rate for those same drivers that survive or stay with the carriers past the 274-day average retention period. This means they are collecting unpaid educational fees from more than 81 percent of the trainees that don’t make it. Those drivers are paying for the balance owed for the schooling, because of contractual agreements made when entering the school for another four to five years. Oh yeah, this encourages students to stay with the companies. So now we are still not filling the empty seats, or we are filling them with less-qualified or inadequately trained drivers. The larger companies will have to lower standards and place drivers behind the wheel quicker to keep the fleets moving and meet the proposed new regulations.

Point 4: These additional regulations are being implemented to lower crash and fatality rates, and, let’s be frank, to appease P.A.T.T., C.R.A.S.H., the DOT, FMCSA, NTSB and Advocates for Highway Safety we as an industry have reduced the crash and fatality rates over many years and have learned to live with the current regulations. They have shoved CSA at us, making drivers more accountable, and we have listened and adapted — and it’s working.

Regulations that will result in more traffic to move the same tonnage, less qualified and trained drivers to haul it, and fewer drivers in aggregate as CSA scores will force carriers to remove problem drivers to prevent an “intervention” is no formula for safety improvement. It will do nothing but increase crashes and fatalities and totally eradicate all the improvements we have accomplished by trying to improve the industry, as well as provide additional ammunition for the advocacy groups to further restrict our industry.

Improving conditions, pay, rewards, trust and attitudes toward drivers begins with the companies being able to afford improvements. I don’t see an atmosphere right now allowing that, or any company taking a chance with pending rules and unknowns venturing in a new direction for driver improvement. I see a recipe for disaster created by the burden of new regulations, and additional costs to the carriers to comply. One of the first cuts in an economically strapped company is resources for safety, and cutting safety will improve nothing.
–Rich Wilson, Regulatory Manager, Trans Products / Trans Services

Guidelines in full are available in the competition flyer’s image posted here or at the Truckers America website. Essentially, post your photo utilizing the form on their Facebook page by end of day Feb. 29 to enter.

Need ideas? As always, the Truckers News Photo Group on Flickr is open to all the shutterbugs out there among you, and I imagine the wintry shots from current members should be increasing shortly.

Join the group today if you’re not a member already.

Writer Peter Miller caught up with the Wolfs at the annual Twins Days Festival in Twinsburg, Ohio, last August while the two were checking out a booth testing the FBI’s facial recognition software to determine whether it could differentiate between identicals. “Like most twins who attend,” Miller wrote, the Wolfs “enjoy spending time with each other. In fact, during the past 18 years, the 53-year-old truckers … have driven more than three million miles together, hauling everything from diapers to canned soup from places like Seattle, Washington, to Camden, New Jersey….”

Find the full story via the National Geographic website this month.

Among the highlights: Dave asks one of the FBI researchers whether shaving his beard would fool the recognition software if he “went out and committed a crime.” Answer? Probably so, but don’t go committing a crime….

It’s a fascinating piece for many other reasons. Give it a read.