Truck Drivers and OSA
Trucking Related News
Interview with Former Truck Driver Regarding Rules and Regulations Click Here
Should Sleep Apnea Testing Be Required for Commercial Drivers?
The prevalence of obstructive sleep apnea (OSA) amongst commercial truck drivers has been a hot button issue for recent debate among drivers and non-drivers alike.
What’s the issue? (The relationship between Truck Drivers and OSA)
The central focus of the debate has been over whether or not the Department of Transportation’s commercial driving branch, the Federal Motor Carrier Safety Administration (FMCSA), should implement extensive regulations that would enforce the testing of truck drivers for the possibility of OSA. From a safety perspective, the logical answer to this question seemingly would be, yes. Why wouldn’t the FMCSA want to keep both their drivers and the general public safe on the roads? Yet there has been a surge of opposition from both truckers and their employers concerning the cost of testing for OSA, and the possibility of losing employment following a positive diagnosis.
The role of the FMCSA is to develop standards to test and subsequently issue licenses to commercial drivers. They are also charged with collecting and disseminating data about motor carrier safety, and improving regulations. In a study co-sponsored by the FMCSA entitled, “A Study of Prevalence of Sleep Apnea among Commercial Drivers, authors uncovered alarming information regarding OSA and commercial trucking. Specifically, they reported that 17.6 percent of commercial drivers had mild sleep apnea, 5.8 percent had moderate sleep apnea, and 4.7 percent had severe sleep apnea. Additionally, the study concluded that susceptibility to a sleep apnea diagnosis directly correlates to both age and degree of obesity.
Typically, truckers are compensated based upon a mile to dollar conversion rate. Because of this, many try to record as many miles as possible in a given day. This takes a toll on their personal sleep habits and overall health. Consequently, many truckers report problems with weight gain and overall daytime sleepiness. In alignment with this hypothesis, this study reported similar findings, highlighting that more than 35 percent of truckers reported terminating their sleep cycle early to get back on the road, leading to significantly shorter sleep durations and negative effects on driving performance. The correlation between sleep apnea and self-reported daytime sleepiness is unclear, however almost all tracking performance tests illustrated a relationship between poor level of driving and severity of OSA.
With a combined 28 percent of commercial drivers reporting some form of sleep apnea, and 35 percent reporting daytime sleepiness, America’s drivers are presented with an obvious safety issue. In fact, in a separate study FMCSA reported that commercial drivers are involved in 4,000 fatal crashes a year, and 13 percent of these crashes result from symptoms of fatigue or other physical issues. Truckers are required to pass a medical evaluation every two years, and are warned of the dangers of sleep apnea, yet no specific sleep apnea testing is required unless the driver reports symptoms of the disorder.
During a commercial driver’s medical card certification evaluation, if sleep apnea or Excessive Daytime Somnolence (EDS), is suspected they can be temporarily disqualified until testing has been completed and the necessary treatment options have been administered. This presents a serious issue for many drivers, tempting them to hide their sleep disorder symptoms. A trucker is given the right to receive evaluation from any doctor, promoting doctor shopping for the best assessment. To further complicate the issue, many commercial driving companies are independently owned, and a high number of drivers do not have health insurance. As a result, sleep evaluations are proving to be both time consuming and expensive for individuals in the trucking industry.
Upon being asked if truckers would be accepting of sleep evaluations, former commercial trucker Heather Davie responded, We are already encouraged to be evaluated, but most put it off until a problem develops. There is a money and time concern that most people cannot get past. I wouldn’t mind having to be evaluated as long as hiring companies pick up the bill. They already do for the medical cards and it would be nice if they would for a sleep evaluation. Read the full interview with Davie.
A single fatal commercial vehicle accident in the US costs approximately 3.6 million dollars. With the adoption of mandatory sleep assessments, it is suspected that this cost will be lowered, and more lives will be saved. The FMSCA has been considering the prospect of implementing regulation for some time and is ready to get the ball rolling. InsideFMCSA reports that, Elaine Papp, chief of Medical Programs Divisions of the FMSCA told attendees of the Mid-America Trucking Show that new guidance has been proposed. The prospective rules include:
- FMCSA recommends the issue of new guidance for medical examiners mandating that drivers with a body mass index (BMI) of greater than 35 be evaluated for obstructive sleep apnea (OSA) using an objective test.
- The driver may be given a 60 day conditional certification during the evaluation and treatment process.
- A driver diagnosed with OSA may maintain certification with evidence of appropriate treatment (if any) and effective compliance and if the examiner determines that the condition does not affect the driver’s ability to safely operate a commercial motor vehicle (CMV).
- Subsequent certification should be no longer than one year term.
- Future certification should depend on proof of continued compliance with treatment
Immediate Disqualification from Medical Expert Panel/Medical Review Board recommendations.
- Drivers who should be immediately disqualified:
- Individuals who report that they have experienced excessive sleepiness while driving.
- Individuals who have experienced a crash associated with falling asleep.
- Individuals with an apnea-hypopnea index (AHI) measurement > 20, until such an individual has been adherent to CPAP. They can be conditionally certified based on the criteria for CPAP compliance.
- Individuals who have undergone surgery and who are pending the findings of postoperative evaluation.
- Individuals who have been found to be effectively non-compliant with their CPAP treatment.
Proposal for new guidance does not constitute an immediate change in protocol. The next step will be to publish the proposal in the Federal Register, opening the forum for public opinion on the amendments. It is absolutely imperative that you participate in this rule-making, Papp said. If you don’t like something in there, or do like it, you better tell us.
Learn about the risk factors of OSA.
Learn about the symptoms of OSA.
Learn about treatments for OSA.