The Sleep That Can Kill

June 17, 2013

Sleep Apnea can be a silent killer and is a disease that is prevalent among over-the-road truck drivers. And although the sleep disorder is easily treated many truck drivers avoid diagnosis and treatment for fear of losing their job.

However, truck drivers who may suffer from the disorder may need to address the issue sooner than later since the feds are seriously considering monitoring truckers for sleep apnea (see earlier blog post). One proposal is to require all overweight truckers to be tested to determine if they have sleep apnea.

There is good reason for concern about the issue. A 1995 study of commercial drivers found that 78% had sleep apnea – the highest number from any study of the illness. However, researchers studied only some drivers at only one company. Clearly, a more representative study of the trucking industry was needed.

Consequently, the Federal Motor Carrier Safety Administration (FMCSA) and the American Transportation Research Institute of the American Trucking Associations sponsored a more extensive study of the issue. While the results of that study were less alarming, still researchers found that almost one-third (28%) of commercial truck drivers have mild to severe sleep apnea.

The ATRI study had 400 randomly chosen commercial truck drivers within a 50-mile radius of Philadelphia stay in a sleep laboratory. The next day the drivers performed alertness tests, including assessment of reaction times, performance lapses and lane tracking ability.

What ATRI discovered:

- Though far fewer than the 1995 study found, 4.7% of commercial drivers in the study were found to have severe sleep apnea. Another 5.8% had moderate sleep apnea and 17.6% has mild sleep apnea.

- Prevalence of moderate to severe sleep apnea is twice as high among CDL holders no longer currently employed as drivers, suggesting that the industry may be losing valuable drivers because of undiagnosed sleep apnea.

- Drivers with severe sleep apnea exhibited impaired performance on alertness tests.

Shorter average sleep duration makes sleep apnea more likely. In fact, short sleep duration itself degrades performance on alertness tests.

What is Sleep Apnea?

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. Sleep apnea is a serious, potentially life-threatening condition that often goes unrecognized and undiagnosed.

Sleep apnea occurs in all age groups and both sexes, but according to FMCSA there are a number of factors that may put you at higher risk:

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

Ethnicity

Following are some of the symptoms that could indicate you suffer from 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

Consistent with other research, the ATRI found that age, gender (male) and obesity are major risk factors for sleep apnea among commercial sleep habits as well as diet and exercise.

Because sleep apnea affects a driver's sleep, it also affects their daytime alertness and performance. Untreated sleep apnea can make it difficult for a driver to stay awake, focus their eyes, 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.

FMCSA says many sleep apnea patients say they never fall asleep while driving. 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," the agency warns.

While FMCSA regulations do not specifically address sleep apnea, they do prescribe 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 in interstate commerce.

The disqualifying level of sleep apnea is moderate to severe, which interferes with safe driving. The medical examiner must qualify and determine a driver's medical fitness for duty.

However, once successfully treated, a driver may regain their "medically-qualified-to-drive" status, FMCSA stresses. "It is important to note that most cases of sleep apnea can be treated successfully."

Drivers should understand that sleep apnea is treatable, ATRI stresses, and that those diagnosed with it need not leave their occupation. The most common treatment is use of a CPAP (Continuous Positive Airway Pressure) machine.

Small and portable, CPAPs are easily taken along by anyone who must spend nights away from home. The use of this machine can restore restful sleep, hence increasing daytime energy and alertness.

Key for drivers who suspect they might suffer from the disorder to seek diagnosis from a qualified doctor.

There are also obligations for trucking companies to ensure their drivers are fit to drive, FMCSA says. "A motor carrier may not require or permit a driver to operate a CMV if the driver has a condition — including sleep apnea — that would affect his or her ability to safely operate the vehicle," FMCSA states. "It is critical that persons with sleep apnea fully use the treatment provided by their doctor. They should not drive if they are not being treated. Being effectively treated, and complying with that treatment, offers the best hope of a commercial driver with sleep apnea to secure the ability to do his or her job safely and be fully alert."

ATRI says the key to helping drivers deal with the disorder is education. "Sleep apnea is often undiagnosed and thus untreated," ATRI points out. The institute offers simple, easy to understand educational materials to benefit drivers and trucking companies.

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