Driver Lifestyles

Sleep Apnea: Got it? Get it treated.

Some estimates place driver fatigue as the responsible factor in approximately 100,000 motor vehicle accidents and in about 1,500 deaths each year in the United States. If you transfer those numbers into dollar figures, you’re looking at more than $12 billion dollars per year, which is what the NHTSA estimates that “drowsy driving,” commonly associated with sleep apnea, costs on a yearly basis. Also along these lines, it’s estimated that over 70% of a trucking company’s costs associated with fatal and injury-related crashes can be attributed to some variety of sleep apnea.

There are three primary forms of sleep apnea: obstructive, central, and complex. Central sleep apnea is the less common of the two and is associated with brain activity. In cases of central sleep apnea, the brain repeatedly fails to send signals to the muscles controlling respiratory function during sleep. The symptoms, both primary and secondary, are similar, but the root cause is significantly different than that of the most common form of sleep apnea, which is known as obstructive sleep apnea.

Obstructive sleep apnea (OSA) happens when the muscles which keep airways open during sleep are not strong enough to do so, or because there’s excess soft tissue in those areas critical to breathing during sleep. As obesity is also a major problem the United States faces, it’s easy to see why obstructive sleep apnea happens to be the most common form of the condition.

The third type of sleep apnea is actually a hybrid of the two--this is why it’s referred to as “complex” sleep apnea. There are numerous ways that an individual can develop complex sleep apnea, but the most common is that central sleep apnea develops in conjunction with a longstanding or persistent case of obstructive sleep apnea. Complex sleep apnea is often discovered when an individual’s OSA is being treated.

There are numerous significant risk factors for sleep apnea, including being overweight, smoking and alcohol use, certain physiological issues such as hav- ing a small jaw or large overbite, having a large tongue or a recessed chin, a large neck size, and being over the age of 40. There are also certain ethnicities where sleep apnea seems to be more prevalent (African-American, Hispanics, and Pacif- ic Islanders, specifically), and sleep apnea also appears to run in families as well, which suggests possible ties to genetics.

WHAT KIND OF TREATMENTS ARE THERE & WHAT’S EFFECTIVE?

A broad variety of treatments for sleep apnea are available; the great majority of those treatments tend to be aimed at treating OSA as opposed to central sleep apnea, which speaks primarily to the disparity in commonality between the two types.

Too, the great majority of treatments for sleep apnea treat only the symptoms of the ailment and do not correct the source of the problem.  For example, the most popular--and generally most effective treatment for OSA is the continuous positive airway pressure (CPAP) device, which essentially is designed to ensure that the patient’s airway stays open during sleep. The patient wears a mask that’s attached to a bedside machine, which regulates the air pressure in his or her air- ways, keeping the obstructive parts from, well, obstructing.

Another popular non-surgical option is oral appliance therapy (OAT), which is a device prescribed by dentists that specialize in sleep disorders that shifts the lower jaw forward, thereby opening the obstructed airway. These treatments aren’t without their limitations, however; both the CPAP and OAT tend to be designed toward more serious cases of OSA and are as helpful for central sleep apnea, which is most commonly treated with both other types of mechanical means and drugs.
When CPAP and OAT doesn’t help, surgery may be an option for the patient; there are numerous surgical solutions to OSA, many of which involve reshaping the air passages. This reshaping tends to depend upon what passages (e.g., nasal passages, the throat, etc.) are obstructed when the patient is sleeping and upon what areas the OSA is most severely affecting.

In cases of mild to minor sleep apneas, there are scads of solutions available to help keep one’s airways open, including certain types of pillows and shirts that keep the patient sleeping on their sides or in reclining positions, among count- less other devices. As to whether or not a particular device will work--it’s difficult to say, because OSA is a condition that can depend from patient to patient and in the end, it’s likely just best to consult with your physician about what solution is best for you.

FMCSA GUIDELINES FOR OSA

A fairly recent modification to the FMCSA safety guidelines included a rule directed primarily at OSA which can disqualify drivers who are leaving their condition untreated. The guideline reads, “A person is physically qualified to drive a commercial motor vehicle (CMV) if that person has no established medical history or clinical diagnosis of a respirato- ry dysfunction likely to interfere with his/ her ability to control and drive a commer- cial motor vehicle safely. If the medical examiner detects a respiratory dysfunc- tion that in any way is likely to interfere with the driver’s ability to safely control and drive a commercial motor vehicle, the driver must be referred to a specialist for further evaluation and therapy.”

A 2008 Medical Expert Panel offered a number of suggestions relating to OSA, including that drivers should be screened and tested for OSA, how to best treat the condition, how to actually best define the diagnosis of OSA, and when a driver should be disqualified or denied certification based on a rather lengthy series of criteria. In order to be certified, however, if you have OSA, you must meet the following criteria:
A score less than or equal to 20 on the AHI scale, which measures the severity of sleep apnea No sleepiness during the day One must be currently receiving ongoing effective treatment. Essentially, it comes down to this: if you’ve got sleep apnea, it’s in your best interest to ensure that you’re treating it, because there’s a possibility that if you’re not, it could cost your license--and nobody needs that.

TALK TO YOUR DOCTOR - GET TESTED

In the Atlanta, GA area, there’s a practitioner of Sleep Medicine who has a special focus on the trucking industry. Fusion Sleep, the practice of Dr. Jeffrey Durmer, also known as Dr. Sleep, maintains a website focused on the sleep health of the trucking and aviation industries at http://www.sleep4safety.com , where you’ll find a wealth of information about not only sleep apnea, but numerous sleep ailments and disorders and how they relate to both your job and your every day life.
In the end, the most important note to make is that if you’re finding yourself driving in a drowsy state more often than not, it might be a good time to talk to your doctor about the matter. It may not be an issue with sleep apnea, but if it is, getting the diagnosis can not only save you the trouble of just being tired all the time. It may keep you from getting heart disease, hypertension, or any number of other associated ailments. Pile that on top of the possibility of getting in to a crash while expediting, and you’re looking at a situation that’s definitely worth looking further into.

SOURCE MATERIAL AND ADDITIONAL READING:

www.sleepfoundation.org/
www.fmcsa.dot.gov/facts-research/briefs/SleepApneaCrash-RiskStudy-Tech-Brief.htm
www.satc2010.org/
www.fusionsleep.com/
www.sleep4safety.com
www.sleepapnea.org/
emedicine.medscape.com/article/304967-treatment
www.trucking.respironics.com/FMCSA_summary.aspx