Sleep apnea has been a very “hot button” issue in the trucking industry the last several years. C-PAP (continuous positive airway pressure) machines and forced overnight sleep studies for drivers with an elevated BMI or neck circumference have become commonplace in some fleets, often at the expense of the driver, and often without a true resolution to the problem.
Obesity is an epidemic in the United States in general, but especially within the trucking industry. Drivers have had historically poor food choices, and little to no physical exercise is required for a large number of driving jobs. These factors make the industry more prone to apnea, but BMI and neck circumference aren’t the only indicators, and obese people aren’t the only ones to suffer from apnea.
Snoring is the sound of obstructed breathing during sleep and occurs when the structures in the throat muscles relax enough to cause the airway to narrow and partially obstruct the flow of air. Air passing through these structures causes vibration, the sound we know as snoring. Physiological structure and fat deposits can contribute to snoring, but snoring doesn’t always indicate apnea. Snoring in the absence of obstructive sleep apnea can still confer risk of carotid artery plaques and stroke over time if not properly treated.
Obstructive Sleep Apnea, or OSA, occurs when there is a blockage in the upper airway, obstructing air flow until it is greatly reduced or stops. Oxygen levels in the brain drop, resulting in an autonomous gasp reaction, which causes the sleeper to partially awaken. Disrupted sleep and low blood oxygen levels have been associated with cardiovascular problems, stroke, high blood pressure, depression and sexual dysfunction; decreases in cognitive function, excessive daytime sleepiness, and increased risk of motor vehicle and work-related accidents are also possible.
Mid-way between snoring and OSA lies the condition know as upper airway resistance syndrome (UARS), in which patients suffer many of the symptoms of OSA, but normal sleep testing will result in a negative diagnosis due to normal blood oxygen levels and lack of obstructive events. These patients have subtle airway disturbance, and may suffer migraines, temporomandibular joint disorders, or chronic pain conditions similar to fibromyalgia. UARS is most often recognized by co-sleepers, who report episodes infrequent enough to be considered “moderate,” but significant enough to affect function and focus during waking hours.
Causative factors for sleep apnea include obesity, but other physiological traits, from the tip of the nose to the lungs themselves, may factor in when determining a diagnosis. Most commonly, the base of the tongue isn’t supported by enough musculature in the jaw to keep it from obstructing the airway. This condition is heightened by a lack of hard or chewy foods in our modern diet. Our jaws simply don’t work as hard as they did 150 years ago, and the muscle mass we develop is sometimes lacking strength necessary to keep the base of the tongue from sliding backwards during periods of body rest. A deviated septum, nasal congestion, a large soft palate or uvula, enlarged tonsils and adenoids, and gastroesophageal reflux can also contribute to OSA.
The risk for sleep apnea is two to three times greater for men than it is for women, however, post-menopausal and pregnant women have a significantly increased risk for the condition as well.
The most commonly prescribed treatment for OSA is a C-PAP machine, in which the patient wears a mask connected to a pump that forces air into the nasal passages with sufficient-enough pressure to keep the airway unobstructed. Unfortunately, a large number of patients prescribed a C-PAP are unable to benefit fully from it, because the apparatus itself interrupts their sleep; they may remove it in the middle of the night, stop using it over time, or reject it without even trying to use it.
Dr. James Metz, of the Metz Center for Sleep Apnea in Columbus, Ohio, has developed an FDA cleared oral appliance to not only combat OSA by positioning the structure within the mouth properly, but helping increase muscle tone in the tongue and affecting an overall improvement in the condition.
Dr. Metz has a unique understanding of the trucking industry — his father was in the business. He was around trucks and truckers for most of his youth and has insight on the challenges of eating well and taking care of yourself on the road. He has consulted on the issue of sleep apnea with large fleets, and promotes a comprehensive regimen of self-care and healthy choices, along with less invasive, non-pharmaceutical treatments for OSA.
Most of the advantages of using an oral appliance versus a C-PAP machine are obvious – size, travel-ability, comfort, noise and electricity use are among a few, but Dr. Metz cautions that not all oral appliances are equal or well done. The issue of proving compliance is more difficult with a mouthpiece, and the cost of having a good one made rises exponentially when the appliance is chipped to provide access for compliance.
Cost aside, results are the true measure. Finding an appliance or machine that works for your personal condition is the most important factor in maintaining your personal health. Knowing the options and having several to choose from allows a much greater chance of success in the search.