The Apnea Hurdle
Owner-operators have many of sleep apnea’s risk factors, which include being male, overweight and older than 50. Nearly 30 percent of truckers are obese, and many of them also are at risk for or have cardiovascular disease, hypertension and diabetes. all of which are exacerbated by sleep apnea makes worse and can impede driver certification.
Drivers often are reluctant to be tested for sleep apnea. They fear a carrier won’t hire them, that they will be taken out of service or that treatment will be too time-consuming and costly. The Owner-Operator Independent Drivers Association questions what may be “unneeded expenses,” making it “harder for drivers with the condition to have the freedom of choice of employers,” says OOIDA spokeswoman Norita Taylor. She notes anyone with symptoms of the disorder should seek medical advice.
Drivers with moderate to severe sleep apnea that interferes with safe driving can be disqualified if a state-licensed medical examiner decides they should not drive. While medicines cannot treat the disorder, continuous positive airway pressure (CPAP) machines keep users’ airways open during sleep with use of a face mask.
Some trucking advocates say no hard evidence shows sleep apnea causes crashes, but others point to crashes caused by fatigue, a major symptom of sleep apnea. In 2010, 3,675 fatalities involved trucks, including Class 8 rigs and smaller, according to the U.S. Department of Transportation. An estimated 500 of those deaths involved a fatigued trucker, FMCSA head Anne Ferro says.
Charles Czeisler, chief of Harvard Medical School’s sleep medicine division, says 20 percent of all highway crashes are related to fatigue. He served on the Medical Review Board panel that developed proposed sleep apnea guidelines in 2008. He says drivers with a BMI of 30 or higher – not 35 or higher – should be screened for the disorder.
Czeisler is weary of FMCSA’s decades of indecision on a rule that would regulate the disorder and the screening for it, though he notes that the National Registry will be “a key in making the roads safer.”
Experts familiar with driver health regulation say one of the surest ways for truckers to stay on the road is to take responsibility for their health. Regarding sleep apnea, “The no-cost solution is weight loss,” says Ben Hoffman, Medical Review Board chair. “Changing lifestyle is the solution.”
Anne-Marie Puricelli, a veteran CDL medical examiner and trainer with Concentra Medical Center, in Maryland Heights, Mo., agrees. Truckers “need to focus on improving their health in terms of losing weight, exercising and getting conditions tested,” she says. “Right now there is a big focus on improving the health of the drivers who have sleep apnea, and they might as well do it themselves before they’re told they have to do it.”
Truckers who’ve sought sleep apnea treatment have found that CPAP machines produce quick results. “Most of them come back to us and thank us for treating them,” she says.
One of the smartest changes for smokers is to stop smoking. Its associated health care costs are high and it exacerbates sleep apnea, as well as other conditions, says Bob Rose of J.J. Keller & Associates. “Owner-operators concentrate on their business, but they also have to concentrate on their health. Their return on the investment will prove itself.”
Registry will raise the standard on medical exams
Even apart from expected tighter standards regarding sleep apnea, the National Registry of Certified Medical Examiners could curtail the driving force. This would happen both by requiring tougher nationwide minimum standards for medical exams and by screening out medical professionals who now take a lax approach in approving medical certificates.
Announcement of a final rule creating the registry is expected soon. Carriers with 50 drivers or more will be required to use certified medical examiners two years after the final rule becomes effective. All other drivers and carriers will have three years.