Not All Drivers Should Be Behind the Wheel
When you think about the irregular schedules of commercial drivers, it’s no wonder that the majority of them suffer from some kind of sleep disorder. The question is – How severe is it? The Federal Motor Carrier Safety Administration (FMCSA) reported, in 2010, that 35% of drivers sleep less than 6 hours per night on average. Ideally, they should be getting 7-8 hours, meaning that the drivers on our roads could be getting 50% of the rest that they need to function properly. Over an extended period of time, or the length of time they are employed as a commercial driver, this sleep deprivation significantly increases sleep-disordered breathing.
Commercial vehicle crashes related to drowsiness are 7 times more likely to be fatal than other drivers on the road. The size of the vehicles, the speed, and the inability to perform quick maneuvers can result in catastrophic accidents. Not to mention the cost factor when it comes to injuries, hospital care, time off work, property damage, insurance claims, etc. Driving and sleeping are clearly not a good mix.
An estimated 14 million people in the US are holders of a CDL (commercial drivers license), of which 7 million are employed as active interstate drivers. These drivers experience 341,000 crashes per year, which result in approximately 4,000 deaths. Fatigue is the largest cause (31%) of fatal-to-driver accidents. Afflicting between 28% and 80% of commercial truck drivers, OSA causes daytime sleepiness and increases fall-asleep-crash risk. -FMCSA Website
Drowsiness/Fatigue has been recognized all over the US as a main contributor to fatal crashes. This sleepiness while driving could be the result of:
- Long work hours (most drivers work a shift lasting 10-13 hours)
- Driving during periods of circadian misalignment (night work)
- Poor sleeping environments (the truck cab)
- OSA – whether it is diagnosed or undiagnosed
This high prevalence of OSA in commercial drivers may be unsurprising, as they fall under 3 major categories for risk factors – male, obese, and middle-aged. In addition, many of them are smokers, drink a lot of caffeine, or use other stimulant products to stay awake behind the wheel, ultimately affecting their ability to get quality sleep when it is time for them to have a day off. It is also very possible that sleep-related problems, including sleep-disordered breathing, play a significant role in the high turnover rate among commercial drivers.
The National Transportation Safety Board (NTSB) has been urging the FMCSA to formulate specific rules regarding the screening of commercial drivers for OSA. Currently, there is only rule 49 CFR 391.41, which states that the commercial driver:
“(5) Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his/her ability to control and drive a commercial motor vehicle safely”
This rule unfortunately does not provide specific criteria for evaluation and treatment, nor does it specify OSA or other sleep breathing disorder. Therefore, companies become more hesitant to enforce screening because of the lack of specifications. If only everyone could agree that treating sleep disorders such as OSA among commercial drivers improves their work safety as well as the safety of other drivers on the road.
Employers have concerns about liability, staffing and scheduling, and screening may result in many drivers being removed from service. Our economy also relies heavily on trucking, so screening can impact the economy as a whole. An effective screening program would require careful consideration of work schedules and routes. While this may seem costly up front, data shows that health care costs and disability claim rates actually decline with proper screening and treatment.
Administration of sleepiness questionnaires (like the Epworth Sleepiness Scale) coupled with an objective assessment of sleep test (either take-home or in a lab) can undoubtedly improve safety on the roads. Sleep/wake cycles (along with prolonged sleep deprivation) are rarely taken into consideration when drivers are evaluated for the risks of developing disorders like OSA. It would be beneficial to evaluate drivers and their habits during time off, in addition to their driving periods.
Evidenced by multiple studies, CPAP treatment for OSA is associated with a significantly reduced crash risk for motor vehicle drivers following treatment, compared with untreated OSA (65% to 78% reduction in risk).
In 1981, the invention of the CPAP machine was an effective step in treating OSA. In 1995, the American Academy of Sleep Medicine (AASM) accepted the CPAP as the gold standard of treatment for OSA. In 2007, oral appliances (OAs) were considered acceptable treatment for those patients with mild to moderate OSA unable or unwilling to utilize or comply with CPAP. Patients diagnosed with severe OSA are still advised to initially use the CPAP.
There are over 100 different types of oral appliances that are made for the treatment of OSA. Dr. Klein works with each patient to provide the best options for their specific treatment.
At Michigan Head & Neck Institute, Dr. Klein offers exclusive treatment for OSA with a custom-fit oral appliance (OA), which is comfortable and can be adjusted to meet the requirements of each patient. Follow-up sleep studies will ensure that the OA is positioned properly. Please call our office at (586) 573-0438 for further information.
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US Government Publishing Office – Electronic Code of Federal Regulations
Available from: https://www.ecfr.gov/cgi-bin/retrieve – se49.5.391_141
National Sleep Foundation. Missing a Night of Sleep Renders Drivers Unfit to Operate a Motor Vehicle. Sleep Review – The Journal for Sleep Specialists; May 17, 2016. Available from: http://www.sleepreviewmag.com/2016/05/nsf-missing-night-sleep-renders-drivers-unfit-operate-motor-vehicle/