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Transportation risk managers and commercial drivers are grappling with the problem of sleep apnea, a condition that contributes to daytime drowsiness, as they try to find ways to improve safety on the road.
According to a 2002 Federal Motor Carrier Safety Administration commissioned study, out of 3.4 million licensed commercial drivers, approximately 26% of drivers suffering from some form of sleep apnea. Studies have shown that sleep apnea can severely impact driving performance by greatly increasing fatigue, boosting the risk of crashes.
Though the commercial trucking industry is aware of the prevalence of sleep apnea among drivers, there still is much to be learned in the way the condition is diagnosed, treated and monitored, experts say.
Sleep apnea is a condition in which the airway is constricted due to muscular relaxation while sleeping, with interruptions in breathing lasting several seconds at a time, often accompanied by loud snoring and resulting in nonrestful sleep.
Individuals considered at risk for sleep apnea are those with a body mass index of 30 or greater and a neck circumference of 17 inches or more, experts say, adding that such people often suffer from additional health problems related to obesity, such as diabetes and heart problems.
Many people with sleep apnea don't even know they have it, researchers say, adding that the sleep disorder often results in daytime sleepiness, which has severe effects on reflexes and cognitive and motor skills.
“I promise you there are thousands of commercial drivers out there that have some form of sleep apnea,” said Don Osterberg, vp of safety and driver training for Green Bay, Wis.-based Schneider National Inc. “Many drivers don't want to talk about it, or are in denial that they have a medical condition, or don't even know they have it. They are not educated on sleepiness, and they might think that daytime sleepiness is normal to them and they don't realize it is abnormal.”
Mr. Osterberg said at least 17% of drivers at Schneider are afflicted with severe sleep apnea. To deal with the issue, Mr. Osterberg said Schneider recently funded an initiative to help diagnose and treat their drivers as a way to help mitigate health care costs and reduce the crash risk on the road.
As a result, Mr. Osterberg said Schneider has seen a “significant reduction” in the frequency and severity of crashes.
“Making this a safety priority has paid back dividends,” he said.
Drivers who are diagnosed with sleep apnea are required by the FMCSA to be “disqualified until diagnosis of sleep apnea is ruled out or has been treated successfully.”
According to Christina Cullinan, director of workplace and fleet safety with the American Trucking Assn., a FMCSA certified medical examiner must ultimately determine whether a driver can continue driving.
If an examiner decides a driver likely suffers from sleep apnea, a sleep study will be advised, including the use of a continuous positive airway pressure—or CPAP—machine. Treatment can last anywhere between one and four weeks, depending on the condition's severity.
It should be noted the FMCSA provides no guidance on how to identify commercial drivers at risk for sleep apnea. The administration includes a question on its commercial driver medical certification form that asks specifically about sleep disorders, but it's up to medical examiners if they want the driver to go through a sleep study, or screening.
The FMCSA's medical review board made a recommendation in January 2008 that the FMCSA should require screening for sleep apnea in all drivers with a BMI more than 30, however there has been no action on that recommendation to date.
Gary Hull, who has worked for eight years as a long-haul trucker and is a member of Kansas City, Kan.-based chapter of AWAKE Truckers with a Cause, a support group for truckers with sleep apnea, said he thinks testing and treatment for sleep apnea has improved over the years, though he said putting jobs at risk because of the condition is not fair.
Mr. Hull said drivers are not always honest about health problems out of concern that they will lose their jobs. He added that there needs to be more research on the effects of sleep apnea on truck drivers and its relationship to crashes.
“We can have millions of accident-free miles, but unfortunately if it's found that you have sleep apnea or signs of it, you are shut down,” said Mr. Hull. “If they were safe to drive yesterday, why should they be disqualified today because of sleep apnea? They most likely have been living with it for years.”
Mr. Hull said there needs to be some form of standardized testing for drivers at the federal level, but said drivers want the testing—and any restrictions placed on drivers—to be “based on good science.”
Deborah Luthi, director of enterprise risk management solutions for Matheson Inc., a trucking company based in Sacramento, Calif., said motor carriers are concerned about this issue, but said Matheson does not specifically test drivers for sleep apnea outside of its driver medical screening process.
Ms. Luthi said Matheson has taken an active approach in promoting health and safety with its drivers, including fatigue abatement training to drivers and supervisors. She also said Matheson is working with its broker, Marsh & McLennan Cos. Inc., in the development of a training module linking driver fatigue with sleep apnea.
Sleep apnea first was classified as a sleep condition in 1965 but only recently has gotten significant attention, said Ed Grandi, executive director of Washington-based American Sleep Apnea Assn.
In May, the ASAA, FMCSA and ATA will co-host a sleep apnea and trucking conference in Baltimore. The hope, Mr. Grandi said, is to bring all parties to the table to discuss how best to address the problem.
“A loss exposure exists, and trucking companies and drivers need to recognize this,” Mr. Grandi said.