A reader had some excellent points (see May 15-31 Letters to the Editor) a couple of issues ago regarding sleep apnea and how it is barely the tip of the iceberg when it comes to the problem of driver fatigue.
Then at a sleep apnea conference May 11-12 in Baltimore the Owner-Operator Independent Drivers Association (OOIDA) and others also brought up some good points about a broader view of fatigue.
The reader whose letter we published, Dante Staciokas, listed irregular pick-up and delivery schedules; unrealistic broker and shipper demands; noise on the truck stop lots; the lack of safe parking; prostitutes knocking on the door at all hours and anti-idling rules as just some of the things in a driver’s lifestyle that cause fatigue.
OOIDA noted that the inability to take naps under Hours of Service, the lack of safe parking and the high cost of sleep apnea testing and treatment need to be taken into consideration in any fatigue discussion.
Let’s take the cost of sleep apnea equipment. We got a call from a lady trucker who said she was diagnosed with sleep apnea back in 2007 but because insurance didn’t cover the equipment, she and her husband had to shell out $750 for the CPAP (continuous positive airway pressure) machine plus another $150 for a special mask that fit over her nose and mouth.
She used it about five months but then the mask started leaking. However, since they paid cash, no one was willing to send her a new mask for free, so she quit using it, and her company never followed up.
Meanwhile this lady said she has done everything her doctor asked her to d she’s lost 31 pounds, changed her diet and has no diabetes or high blood pressure.
She recently went to a new carrier and now they’ve sidelined her until she gets re-tested, even though her doctor said she doesn’t need to be re-tested. She owns her own truck but can’t drive it.
She was stressed because the new tests will cost an estimated $1,500 but we directed her to a seasoned driver with sleep apnea who gave her contact information for an at-home testing kit which is considerably cheaper.
So, although a trucker’s doctor is supposed to have the final say over whether a driver is at-risk and needs to be side-lined until tested, carriers apparently are taking the matter into their own hands.
I’m guessing that’s because they’re scared to death about CSA 2010 and also because they don’t want to be on the losing side of a lawsuit.
John Hill, the former FMCSA chief, told us that if a driver who becomes involved in a serious crash has a body mass index in excess of the standard recommended by most sleep doctors the carrier would be disadvantaged in a lawsuit unless they can show they have taken steps to test and treat that driver.
Many in the industry don’t believe there is hard-and-fast evidence connecting sleep apnea and truck crashes.
OOIDA Executive Vice President Todd Spencer maintains that the correlation between sleep apnea and actual crashes is “largely fictional.”
Bob Stanton, a driver for Schneider National, which has mandatory sleep apnea testing, said research correlating sleep apnea and truck crashes is “questionable.” Stanton, himself, is a sleep apnea sufferer and spoke with us on his own, not as a Schneider representative.
A “Sleep Disordered Breathing Study” by Dr. Alex Sassani was provided to us by the American Sleep Apnea Association.
According to a disclosure statement it was supported by a $2,000 grant from the ResMed Corp., a company that develops, manufactures and markets medical products “with a focus on sleep-disordered breathing.”
The money was issued to Sassani as a “summer education stipend” while he was in medical school.
The methodology for the study was a search of MEDLINE-PubMed, an online database of biomedical journal citations and abstracts created by the U.S. National Library of Medicine.
An analysis was performed of studies investigating the relationship between collisions and OSA with
National Safety Council data used to estimate economic losses incurred from vehicle crashes.
There was no direct reference to CMV drivers. The study overview stated that there were “more than 800,000 drivers involved in OSAS-related (Obstructive Sleep Apnea Syndrome) motor-vehicle collisions in the year 2000” and were estimated to “cost $15.9 billion and 1,400 lives. …”
An FMCSA study, on the other hand, stated that their research didn’t support the hypothesis that a driver diagnosed with sleep apnea is more likely to be involved in a motor vehicle crash than a driver with no history or symptoms of sleep apnea.
However, it also said a significant relationship was found between severe sleep apnea and severe crashes (those which include multiple injuries and vehicle towed from accident scene).
“Drivers with severe sleep apnea were 4.6 times more likely to be involved in a severe crash in the seven-year period than drivers with no sleep apnea.
“However, it was also found that drivers with severe sleep apnea were no more likely to be involved in moderate/minor crashes than those without sleep apnea.”
It further stated that “With the exception of a significant positive relationship between severe sleep apnea and severe crashes, results from this study showed that the presence and severity of sleep apnea in commercial truck drivers are not good predictors of motor vehicle crash involvement.” I found that to be double-speak.
The study was derived from data collected by the University of Pennsylvania Center for Sleep and Respiratory Neurobiology between 1996 and 1998 and involved the overnight laboratory testing of 406 subjects. They were chosen after UPenn sent a questionnaire to a random sample of 4,826 CDL holders in Pennsylvania.
Drivers in the FMCSA study, however, were short-haul drivers who have to be more alert than long-haul truckers since they navigate heavily populated urban areas, while long-haulers “drive long stretches on interstate highways under monotonous driving conditions” and are “more susceptible to fatigue and daytime sleepiness,” according to the study.
To me, both studies are flawed and the subject requires a more thorough approach.
Dorothy Cox of The Trucker staff can be reached for comment at firstname.lastname@example.org.
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