Can you afford not to address sleep apnea?

by James Menzies

TORONTO, Ont. – Consider the life of a sleep apnea-stricken professional truck driver: Four hours of driving followed by a two-hour nap, then another four hours of driving and another nap. Worse, home time that is literally slept away with no sense of restoration before heading back out on the road.

That was the reality for Kenneth Armstrong, a professional driver with Swift Transport, who was a guest at the Ontario Trucking Association’s annual convention where the increasingly common sleep disorder was once again discussed.

Obstructive sleep apnea (OSA), as most are by now aware, is a condition in which an individual’s airway partially closes while sleeping, preventing sufficient oxygen from reaching the brain and the sufferer from attaining any meaningful, restorative sleep. The effects are compounded over time, potentially leading to other ailments including high blood pressure, heightened risk of heart attack and stroke and a host of other life-endangering afflictions.

“Essentially, the longer your body goes without that oxygen-rich blood, it puts tremendous strain on the heart,” explained Tom DiSalvi, director of safety and loss prevention with Schneider National.

But back to Armstrong, a self-described “success story” in dealing with sleep apnea: As he has found, sleep apnea is not necessarily a sentence to lifelong fatigue. The condition is entirely treatable, usually through CPAP (Continuous Positive Airway Pressure) therapy, and the treatment can be life altering.

“It changed my life,” Armstrong said of his diagnosis and treatment. “It’s a quality of life issue for my family and a productivity issue for fleet managers and company owners…I want to encourage all of you in the audience today, that this is something you need to look at. It’s going to affect the lives of a lot of people who have it. I’m a better, safer, more focused driver. I’m more alert. My lane control is much improved over when I was not treated. There are just so many positives that come out of it.”

Those positives extend to the carrier Armstrong works for as well. Not only is he a safer, more productive driver, but his employer is also likely to see a significant reduction in health care costs as a result of his treatment. DiSalvi shared results from a pilot project Schneider National conducted, and the cost savings when implementing a sleep apnea screening and treatment program were staggering.

The pilot project compared the before and after performance of 339 Schneider drivers over a 24-month period (one year prior to and after beginning treatment). Schneider found preventable crashes among the pilot group declined 30%, the median cost of crashes dropped 48%, the driver retention rate among these drivers improved by 60% and health care savings totaled $539 per driver, per month. The findings caught the company’s attention and it expanded the study to include 788 drivers, with similar results.

The company has since rolled its sleep apnea program out to its entire fleet and estimates a payback of $15.7 million per year. DiSalvi said about 2,000 of Schneider’s 14,000 drivers suffer from sleep apnea and now, all new hires are screened.
Schneider partnered with Precision Pulmonary Diagnostics (PPD) to develop a screening and treatment program customized to the realities of the long-haul trucking lifestyle, including allowing drivers to take part in a sleep study in their own truck cabs or to stop in at strategically located sleep centres near Schneider’s own facilities. The carrier operates 26 of its own clinics and can now diagnose and begin treatment on a driver even while he or she is under load.

PPD conducts the screening and then tracks CPAP usage to ensure drivers with the condition are using the devices. Eventually, the fleet hopes it will be able to collect CPAP usage data and transmit it back to head office using its existing Qualcomm satellite communications platform.

While that type of oversight may induce fears of privacy violation and human rights lawsuits, Rhonda Shirreff of Canadian law firm Heenan Blaikie, said the risk of not implementing a sleep apnea program is far greater than doing so – especially when awareness of the condition has increased so significantly. She said there is nothing within human rights or privacy laws – or collective bargaining agreements – that can be used to derail the implementation of a sleep apnea program involving mandatory treatment.

“There are no legal barriers under human rights, privacy legislation or labour law in Canada that would prohibit you from taking a proactive approach before an accident occurs,” she said. “It’s probably the only time a lawyer will tell you ‘Yes, you can do that’.”

Not only can, but should. Shirreff said if a driver with sleep apnea causes an accident, the trucking company owner and directors can be held civilly and criminally responsible.

“Given the increase in awareness within your industry, it is entirely plausible that an employer who fails to take reasonable steps to address these safety hazards may be subject to criminal charges,” she said. “You do not want to be the poster child.”

So, where does a fleet begin to implement a sleep apnea program? That’s about to get a whole lot easier in Canada, as the Ontario Trucking Association has partnered with PPD to develop a program that mirrors those developed with Schneider National and other American fleets. There will be differences, of course. In Ontario, for instance, OHIP covers the cost of the sleep study and most of the cost of the CPAP machine and ongoing maintenance. However, PPD will help administer the program and provide compliance monitoring to ensure diagnosed drivers are carrying through with their treatment.

A PPD official speaking at the convention said the entire program will be made available for a fixed monthly fee per driver.

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