Driver safety regulators in Washington, D.C. are spending the upcoming summer days asking for industry input on new regulations for sleep apnea screening, testing, treatment and guidelines for determining medical safety. A study conducted by the University of Pennsylvania and sponsored by the Federal Motor Carrier Safety Administration (FMCSA) and the American Transportation Research Institute of the American Trucking Associations found that almost one-third (28%) of commercial truck drivers have mild to severe sleep apnea.
Although there are varying degrees of severity, sleep apnea is a breathing-related sleep disorder that causes brief interruptions of breathing during sleep. These pauses in breathing can last at least 10 seconds or more and can occur up to 400 times a night. According to sleep specialists action the nation, it is a serious, potentially life-threatening condition that often goes unrecognized and undiagnosed by primary care providers and pulmonologists (respiratory physicians)
The National Institute of Health reports that sleep apnea occurs in all age groups and both sexes, but there are a number of known risk factors and symptoms drivers and their care providers should pay attention to:
Risk Factors of Sleep Apnea
- A family history of sleep apnea
- Having a small upper airway
- Being overweight
- Having a recessed chin, small jaw, or a large overbite
- A large neck size (17 inches or greater for men, 16 inches or greater for women)
- Smoking and alcohol use
- Being age 40 or older
Symptoms of Sleep Apnea
- Loud snoring
- Morning headaches and nausea
- Gasping or choking while sleeping
- Loss of sex drive/impotence
- Excessive daytime sleepiness
- Irritability and/or feelings of depression
- Disturbed sleep
- Concentration and memory problems
- Frequent nighttime urination
Because sleep apnea affects a driver’s sleep, it also affects daytime alertness and performance. Untreated sleep apnea can make it difficult to stay awake, maintain eye focus, and react quickly while driving. In general, studies show that people with untreated sleep apnea have an increased risk of being involved in a fatigue-related motor vehicle crash.
Sleep specialist Dr. Michaelson works with truck drivers who have sleep issues and many of his patients say they never fall asleep while driving. He reminds them, “That may be true. But remember, you don’t have to fall asleep to have a crash. You simply have to be inattentive or less alert — and with untreated sleep apnea; you are not as sharp as you should be.”
Regulations In The Making
While FMCSA regulations do not specifically address sleep apnea, they do state that a person with a medical history or clinical diagnosis of any condition likely to interfere with their ability to drive safely cannot be medically qualified to operate a commercial motor vehicle (CMV) in interstate commerce. Currently, a driver’s care provider and/or his company’s health programs (if applicable) are open to interpret what this vague guideline means for each individual’s circumstance. If a governing establishes that the driver’s medical condition is unsafe, they may take away their CDL temporarily. After successful treatment, drivers can get back on the road.
Dr. Michaelson, MD, points out that the current and even proposed solutions to sleep issues within commercial transport are both impractical and controversial.
Many truck drivers feel unjustly targeted when required to do extensive sleep screening tests which often cost hundreds of dollars out of pocket for self-insured drivers and drivers with high-deductible health insurance plans. Companies with large fleets have better resources to support their drivers through organized programs that monitor screening, testing and treatment. Overall, these programs have lowered company costs by decreasing liability (lower insurance costs) and increasing driver productivity with happier, well-rested employees.
If a driver is diagnosed with obstructive sleep apnea, commonly referred to as OSA in the industry, there are several treatment options but all include significant lifestyle changes from wearing a sleep mask every night to prescribed weight loss including exercise and nutrition requirements.
Currently the regulations and guidelines for sleep apnea screening are vague and have little enforcement. Public Law #113-45, aka the “sleep apnea bill,” was signed into law and effective October 15, 2014. This law requires that the formal rule-making process be followed regarding sleep apnea screening, testing, and treatment of truckers and other commercial motor vehicle operators and forbids the issuing of any informal guidance on this subject.
Some drivers and doctors are happy with Public Law #113-45, but others warn of negative consequences. Many in the trucking industry applaud the new law, which allows medical experts, drivers, and other stakeholders the opportunity to provide input via a public forum for the FMCSA to consider as regulations are developed. Formal rule-making will require an analysis of the benefits and costs of regulating sleep apnea, which is not required for issuing the guidelines that current exist.
The costs of mandated testing and treatment may turn out to be an excessive burden on the industry. A reoccurring fear on the input board for the law is that complying with policy may increase health costs for all employees in the commercial transport industry, forcing many to leave the profession and making it even more difficult to recruit and retain drivers (an industrial issue unto itself).
Challenges lay ahead as rules and regulations are developed, but the path to answers may be found with the people who will be impacted the most: truck drivers themselves. Drivers today have a unique and powerful opportunity to shape laws that will impact the trucking industry long term in significant ways. Through co-creating safety regulations, the Sleep Apnea Bill may foster a new, more collaborative regulatory process.
To be heard by the FMCSA about your own experiences with driver safety, industry regulations and health issues, visit www.regulations.gov and search for “sleep apnea.” Regulators will review input during the upcoming legislative session in fall 2016. All comments submitted by June 8, 2016 will be included in the review.
What Do Real Drivers Have To Say?
“It makes being on the road harder for me because I have to watch my hours so I can shut down to use the machine at least four hours every night. It’s improved my sleep, yes, but it’s a pain to keep filling it with water and I’ve about strangled my fiancé more then once with the hose. “
“I have a machine for sleep apnea. I can tell a difference. It is a pain in the butt. The hose about strangled the boyfriend in his sleep a few times with it… I swear accidentally! Somehow he gets caught up in it…”
“I’ve got a friend who said it has improved rest 10 fold. Hadn’t realized how bad sleep was till he got a CPAP.”
“I use Inspire Sleep. I have a remote that I turn on at night and turn off in the morning and no mask, but I still get to keep my CDL.”
“I’ve had issues keeping my mask and hose clean. You have to really wash it out each week at least or you can get sick. I do sleep better though.”
“I am a team driver and my partner just got a machine. No real changes.”