Truck drivers who fall asleep at the wheel will report “don’t know what happened” or “I never saw him.” And in many cases they are telling the truth, because they were asleep and the crash woke them up. The culprit is sleep apnea.
Sleep apnea causes severe fatigue during waking hours, dulls alertness, and falling asleep during the day, even while driving or sitting at a traffic light.
Apnea means “without breath.” People with obstructive sleep apnea stop breathing in their sleep and their oxygen level drops, denying life-refreshing sleep.
Anyone who drives, knowing that they suffer from sleep apnea, is acting recklessly and in conscious disregard for the safety of others. Any trucking company that employs drivers without screening them for sleep apnea is equally reckless. Both should be liable for punitive damages for their contempt for public safety, in addition to being responsible for the deaths, injuries and destruction caused by an 80,000 pounds of tractor and trailer.
Twenty-five percent of men, many overweight, have obstructive sleep apnea. Although airline pilots are screened for sleep apnea, the trucking industry does not do the same for truck drivers and like the general population, many with obstructive sleep apnea are undiagnosed and untreated until it is too late.
For decades, trucking companies and the trucking industry lobbied for rules that only allowed drivers 8 hours off in every 24 hours, so that many drove long hours to meet schedules.
Under current Department of Transportation regulations, a driver may not drive without first taking 10 consecutive hours off duty and then can drive a total of 11 hours during the next 14 hours. AT the end of 14 hours, another compulsory 10 hours off duty is required.
Trucking companies are not required to screen drivers for sleep apnea and there is no requirement under the Federal Motor Carrier Safety Administration for drivers to complete a sleep apnea test during the biennial DOT physical examination. At that exam a medical examiner has the discretion to test for respiratory disorders as a requirement of certification. A sleep test may be ordered after evaluating the hallmarks of sleep apnea: high body mass index, hypertension, age, receding chin, large neck circumferences, diabetes and smoking.
Obstructive sleep apnea is treatable. It occurs when the body’s muscles naturally relax during sleep. Once the throat muscles relax, a person’s airway narrows or collapses, air does not get to the lungs and breathing stops. Tissue in the back of the throat, large tonsils, nasal obstructions and being overweight are the precipitating causes, which result in snoring, cessation of breathing, and then gasping for air, a key sign of the condition.
Deprivation of restful sleep caluses severe fatigue, grogginess, loss of concentration, memory loss, depression, sexual dysfunction, and morning headaches. Long-term sleep disorders increase the risk of high blood pressure, heart attacks, strokes, and profound fatigue that causes collisions and work place injuries.
Sleep apnea for men with high blood pressure result in heart attacks early in the morning, after the heart has been deprived of oxygen through most of the night.
Anyone who is not getting restful sleep, snores heavily, gasps for air while asleep, or who suffers heavy fatigue on a routine basis, should obtain a full sleep evaluation from a sleep clinic.
After an initial screening, patients sleep overnight in a testing facility under the care of a sleep doctor. Throughout the night an EKG, EEG, and other monitors record the patient’s breathing, blood pressure, heart rate, oxygen level, muscle activity, rate of respiration and periods of REM sleep. It is all done under the observation of nursing staff trained in this specialty.
If obstructive sleep apnea is diagnosed, the most common treatment is continuous positive airway pressure or CPAP, a small quiet pump which provides a positive flow of air through a mask to keep air pushed through the airway throughout the sleeping hours. Positive pressure keeps the airway open and eliminates obstructive apneas.
A CPAP creates regular breathing patterns that stops snoring, maintains appropriate oxygen levels, and assures restful sleep. It works best when combined with weight loss, exercise and avoidance of alcohol and provides substantial improvement when used on a continuous basis. That requires working with a licensed respiratory care sleep therapist to assure the equipment is being used reliably and effectively and making return visits to the sleep physician to assure proper CPAP settings to maximize restful sleep. CPAPs are available with humidifiers, bi-level pressures, and auto adjustments for inhalation and exhalation to maximize effectiveness. New compact models easily fit into a suitcase for trips away from home.
Understanding sleep apnea and being alert to its warning signs is essential. The consequences for public safety and public health cannot be ignored. But that is what the trucking industry has been doing for years. The industry and government regulators will need to aggressive address this important safety issue and incorporate both driver education and mandatee screening for obstructive sleep apnea into every trucker’s medical examination and certification to safely drive heavy equipment, just as the FAA has required for airline pilots.
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