A LOT of Truckers may fall in these early recommendations for a Sleep Apnea Test

[Luke Kibby]

Last week FMCSA’s Medical Review Board outlined recommendations they hope to require truckers to be screened for sleep apnea. Based on these preliminary recommendations, which FMCSA has no legal requirement to adopt any of the suggestions but likely lean on them when developing a sleep apnea rule, many truckers fall into the categories needed to be recommended for sleep apnea test.

The board based its recommendations on multiple public meetings held this year, in which board members heard testimony from truckers and industry advocacy groups, along with expert testimony from doctors.

The meetings and the formal questionnaire were not only initiated to determine what a sleep apnea rule may look like, but to determine if a rule was needed at all.

Recommendations encourages FMCSA to require a trucker screened for sleep apnea if:

• (1) has a body mass index greater than 40, OR
• (2) has a body mass index greater than 33 and meets (three) of the following:

o age > 42,
o is male,
o is a postmenopausal female,
o has diabetes,
o has high blood pressure,
o has neck size > 17in(males) or 15.5in(females),
o has history of heart disease,
o snores loudly,
o has witnessed apneas,
o has small airway,
o has untreated hypothyroidism or has micrognathia or retrognathia.​

Based on BMI charts, 6’ person needs to weigh (1) 300lbs or (2) 250lbs, a 5’9” person needs to weigh (1) 270lbs or (2) 230lbs. Do you fall into these categories?

Among other preliminary recommendations outlined by the board this week is a provision to limit truckers who’ve received a sleep apnea diagnosis to a yearly medical certification, even if the diagnosis was for mild apnea.

This means truckers with any type of apnea diagnosis would need to be re-certified at least annually, if not more often, rather than the standard every-other-year certification.

Discussed treatment options in the board’s preliminary report include (1) use of PAP machine or other oral appliance, (2) bariatric surgery, (3) oropharyngeal surgery or facial bone surgery and (4) tracheostomy.

 

[Turtle]

This started several years ago when all five members of the FMCSA's Medical Review Board were doctors heavily and directly involved in the sleep industry in one way or another. Three of them ran sleep clinics, even. They change out the membership regularly, but over the years there has always been at least two members of the Board who are sleep specialists. Currently, 4 of the 5 board members are involved in the sleep industry. It should come as no surprise that they want to set the criteria for testing so as to get as many people as possible into the program with annual testing and on CPAP machines.

 

[xiggi]

Based on multiple public meetings, that's a hoot.

 

[Turtle]

Based on multiple public meetings, that's a hoot.

Exactly. It's all theater. The FMCSA and the medical board tried to sneak sleep apnea into the regs when Congress said they at least have to go through the motions. The recommendations manual that medical examiners are given had everything regarding sleep apnea worded as if it were already a regulation, instead of merely a suggestion, including a strongly worded warning about liability if the recommendations were not followed. Congress made them issue a full retraction and add a disclaimer on that one, too. It's going to happen, they're just going through the required motions, much like the EOBRs.

 

[acvox24]

Surprised smoking is not in there too.

 

[xiggi]

I'm surprised drive a truck isn't in there.

 

[beachbum]

it looks like they want to want just about everyone doing the test. Then again, when it becomes a rule, I'll be retired anyway.

 

[brokcanadian]

Ok besides the fact that I meet most of the criteria does anybody know what #4 treatment option is? Who's ok with a hole in the throat, anyone?

 

[JohnWC]

I just don't get it.
Why not rest everyone who works a job in this country and see what % have sleep problems.
I sleep between 3 to 5 hours.

 

[hossman2011]

This started several years ago when all five members of the FMCSA's Medical Review Board were doctors heavily and directly involved in the sleep industry in one way or another. Three of them ran sleep clinics, even. They change out the membership regularly, but over the years there has always been at least two members of the Board who are sleep specialists. Currently, 4 of the 5 board members are involved in the sleep industry. It should come as no surprise that they want to set the criteria for testing so as to get as many people as possible into the program with annual testing and on CPAP machines.

once tested, annual is not needed. the testing company will monitor compliance. data uploaded monthly.

 

[hossman2011]

My only contention is that if this makes sense for truckers and other large vehicle operators, it should apply to anyone that drives a vehicle. Those four wheelers have just as much of a chance of falling asleep behind the wheel because of ineffficient sleep and causing a trucker to have to avoid there drowsy ass, and get into an accident. That is where the agencies fighting this should go with the argument.. I have been using a machine since february, and it has been a good thing. Much better sleep. and not as prone to afternoon drowsiness.

 

[Turtle]

once tested, annual is not needed. the testing company will monitor compliance. data uploaded monthly.

That's best case, though. The recommendation is to issue a medical card initially for 1 month, and if the patient complies with the program for at least 4 hours a night for 70% of the nights, it is recommended that the next medical card be issued for 3 months. If the patient sticks with compliance, then 6 months, and then one year. If at any time they feel the patient isn't complying, they recommend full retesting to get another certification... for one month again.

 

[Turtle]

My only contention is that if this makes sense for truckers and other large vehicle operators, it should apply to anyone that drives a vehicle

Not all vehicles present the same level of risk to the general public. There's a reason the federal government is even allowed to regulate heavy trucks and busses (and hazardous materials) engaged in interstate commerce and they aren't allowed to regulate vehicles not engaged in interstate commerce.

 

[rollincoal]

Ahhhh just what we need. More bogus regulations. From a bunch of corrupt government/medical establishment quacks looking to cash in, no less. Isn't it funny, or sad, how they don't even try to hide corruption any more?

 

[davekc]

Ahhhh just what we need. More bogus regulations. From a bunch of corrupt government/medical establishment quacks looking to cash in, no less. Isn't it funny, or sad, how they don't even try to hide corruption any more?

Exactly. It is all about following the money. Absolutely nothing to do with safety unless it happens by accident. This is no different than the ELD mandate or speed limiters.

 

[coalminer]

Just out of curiosity does anyone who has commented on this know someone who has severe sleep apnea?

Let me tell you that if you did you wouldn't be saying the things you do, I know 2 people who will tell you that that machine saved their lives, and that there were days they don't remember making it to work.

And as for criteria to determine if a sleep study is needed remember what dr house always said, everyone lies, not a single person is going to check the box that says they have problems breathing at night.


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[Turtle]

Let me tell you that if you did you wouldn't be saying the things you do, I know 2 people who will tell you that that machine saved their lives, and that there were days they don't remember making it to work

I know several. The problem is not those with sleep apnea who will benefit from a CPAP machine, the problem is the way the medical review board has gone about their relentless campaign since the late 90s to get this info the regulations and get as many truckers as possible into an ongoing sleep management program. They tried twice before, in early 2002 and again in 2008 to just backdoor sneak it into regs without any supporting evidence whatsoever. Then 3 years ago, all without any studies to back it up, put OSA testing into the official medical recommendations, knowing full well that many examiners would take that to mean the same as a regulation. When the FMCSA let leak a proposed ruling to go ahead and make it a regulation, Congress finally had to step in and make them at least go through the morons. There is still zero evidence to support about half the listed criteria, such as diabetes, neck size, and BMI. But just like the eobrs and hos rulings, a lack of supporting evidence is not going to stop them. They'll make it up of they have to.

 

[coalminer]

I know several. The problem is not those with sleep apnea who will benefit from a CPAP machine, the problem is the way the medical review board has gone about their relentless campaign since the late 90s to get this info the regulations and get as many truckers as possible into an ongoing sleep management program. They tried twice before, in early 2002 and again in 2008 to just backdoor sneak it into regs without any supporting evidence whatsoever. Then 3 years ago, all without any studies to back it up, put OSA testing into the official medical recommendations, knowing full well that many examiners would take that to mean the same as a regulation. When the FMCSA let leak a proposed ruling to go ahead and make it a regulation, Congress finally had to step in and make them at least go through the morons. There is still zero evidence to support about half the listed criteria, such as diabetes, neck size, and BMI. But just like the eobrs and hos rulings, a lack of supporting evidence is not going to stop them. They'll make it up of they have to.

Spend some time on the other side of the truck stop and see if you still have the same opinion. Watch the drivers that pull up to the fuel islands and watch them waddle out of the drivers seat, fuel their truck and then by the time they go inside to get their receipt, they are huffing and puffing like they just ran a marathon. Oh yeah and when they carry their carton of smokes back to the truck you think they are carrying a cinder block.

And if they are a diabetic they are excluded anyway.

But regardless, the criteria that they come up with is only going to matter to the big companies, the independent "super truckers" are going to know how to get their medical card regardless of what is wrong.


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[MikeDamone]

Just out of curiosity does anyone who has commented on this know someone who has severe sleep apnea?

Let me tell you that if you did you wouldn't be saying the things you do, I know 2 people who will tell you that that machine saved their lives, and that there were days they don't remember making it to work.

And as for criteria to determine if a sleep study is needed remember what dr house always said, everyone lies, not a single person is going to check the box that says they have problems breathing at night.


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My dad had sleep apnea for quite a while and absolutely refused to admit he had a problem. It wasn't until he damn near killed himself in a car wreck that he finally had surgery. Thank God he wasn't driving an 80,000 pound truck.

 

[Opel2010]

it looks like they want to want just about everyone doing the test. Then again, when it becomes a rule, I'll be retired anyway.

It's all about money...