Sleep apnea a target in CSA

03 July 2012

Sleep apnea is now a concern for truck drivers.

On a basic level, it's probably true that we all understand that getting a good night's sleep is important. None of us likes to constantly feel tired and irritable, and certainly none of us wants to perform at less than our level best. What we may not understand, however, is just how important sleep is to the work we perform, especially when that work happens to be operating a commercial motor vehicle.

According to the National Sleep Foundation, there are two factors that scientists and researchers are continuing to learn about in regards to the importance of sleep: basal sleep need, and sleep debt. So, as we try to understand the importance of sleep and how it relates to our aptitude to perform our duties to the best of our abilities, it's imperative to consider these two important variables.

Basal sleep need is the amount of sleep our bodies need on a regular basis for optimal performance.] It's the magic number, so to speak, that allows us to perform at our best and feel the most energetic. The number varies from person to person; however, two research studies suggest that it ranges from seven to eight hours of sleep per night for healthy adults.

On the other side of the scale is what's known as sleep debt-the accumulated sleep that is lost to poor sleep habits, sickness, and awakenings due to environmental factors or other causes.[2] And like most other types of debt, it's not good to accumulate too much. Furthermore, it has a specific interaction with basal sleep need whereby a person can meet their basal sleep need for the night, but still feel tired because of unresolved sleep debt. Connecting this to commercial motor vehicle drivers, we begin to see just how important getting the right amount of sleep is, and, additionally, just how vital it is to identify any conditions that might be hindering our ability to get the desired amount of sleep.

Sleep apnea

The National Sleep Foundation defines obstructive sleep apnea (OSA) as "a disorder in which breathing is briefly and repeatedly interrupted during sleep."[3] There is a breathing pause that lasts at least 10 seconds and occurs when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe. Sleep apnea is considered a serious and potentially life-threatening disease that is often unrecognized and undiagnosed. It's also quite expensive. According to a research study titled "The Medical Cost of Undiagnosed Sleep Apnea," untreated sleep apnea is estimated to cost $3.4 billion in additional medical costs in the U.S.[4]

Because of its broad prevalence, potentially deadly consequences, and enormous cost, the Federal Motor Carrier Safety Administration (FMSCA) has engaged in efforts to increase driver and industry awareness, as well as study the condition's causes and treatments. A well-documented study sponsored by the FMCSA and the American Transportation Research Institute of the American Trucking Association (ATA) titled, "A Study for the Prevalence of Sleep Apnea Among Commercial Truck Drivers," was performed to address the prevalence of sleep apnea among commercial truck drivers, potential risk factors, and its impact on driving performance.[5] The study found that 17.6 percent of CDL holders in the population used in the study had mild sleep apnea, 5.8 percent had moderate sleep apnea, and 4.7 percent had severe sleep apnea.

Additionally, the study revealed an interesting correlation between two factors-age and degree of obesity. The study found that drivers with higher ages and Body Mass Index (BMI)-a tool used to measure obesity-were more prone to having severe sleep apnea. The FMCSA says that as many as 28 percent of commercial driver's license (CDL) holders have sleep apnea. To that end, the FMSCA is poised to offer new guidelines and rules regarding sleep apnea, CDL holders, and what a driver with severe sleep apnea faces in terms of CDL disqualification and denial.

Are you at risk for sleep apnea? Eight potential factors:

1. A family history of sleep apnea

2. Being overweight

3. A large neck size (17 inches or greater for men, 16 inches or greater for women)

4. Being age 40 or older

5. Having a small upper airway

6. Having a recessed chin, small jaw, or large overbite

7. Smoking and alcohol use

8. Ethnicity

Immediate disqualification or certification denial

Drivers should be disqualified immediately or denied certification if any of the following conditions are met:

1. The driver admits to experiencing excessive sleepiness during the major wake period while driving;

2. The driver experienced a crash associated with falling asleep; or Show citation box

3. The driver has been found non-compliant with treatment per Recommendation I.D.

FMCSA response

As a result of the study and a number of other considerations, the FMCSA is taking recommendations from two advisory panels-The Medical Review Board, and the Motor Carrier Safety Advisory Committee. (MCSAC) [6] The Medical Review board, a panel comprised of five physicians that advises the agency on medical issues, has been pushing for stricter regulatory standards on sleep apnea for quite some time. The other panel, the MCSAC, is charged with providing advice and recommendations to the FMCSA on safety programs and regulations, and is comprised of 19 experts from the motor carrier industry, safety advocates, and safety enforcement sectors. At the agency's request, the committees deliberated and provided their finalized recommendations to FMCSA on February 6, 2012. The agency proposes to adopt the recommendations as regulatory guidance after reviewing and evaluating comments received from the public. The public comment period ended on May 21^st, 2012.

According to the Federal Register notice posted by the FMCSA on April 20, 2012, the initial recommendations are being used as guideposts for DOT examiners, but "the agency proposes to adopt the recommendations as regulatory guidance after reviewing and evaluating comments received from the public."[7] Among the notable items included in the recommendation is the suggestion that any driver with a body mass index of 35 or greater should be examined for sleep apnea. Data has shown that the higher the BMI, the greater the likelihood the person has sleep apnea. Though it's not a sure fire system, it seems the FMCSA is leaning towards using BMI as a trigger for screening.

What if you have it?

While the likelihood of restrictions being put on drivers with sleep apnea is high, all is not lost. Sleep apnea is highly treatable. Devices like continuous positive airway pressure machines force compressed air into the nasal passage and open the airways resulting in a good night's sleep. Of course, there are other initiatives like losing weight, avoiding alcohol before bedtime, and sleeping on one's stomach that can all help, too. Although the proposed guidelines are being met with some resistance, perhaps we ought to remember why the initiative was undergone in the first place. The research study slogan the FMSCA adopted may have said it best. "Staying awake means staying alive." There's just no replacement for a good night's sleep.

[1] 6 National Sleep Foundation http://www.sleepfoundation.org/article/sleep-related-problems/obstructive-sleep-apnea-and-sleep

7 Federal Register Notice https://www.federalregister.gov/articles/2012/04/20/2012-9555/proposed-recommendations-on-obstructive-sleep-apnea#p-3

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