Dealing with sleep apnea; Asleep at the wheel

by David Gee

TORONTO, Ont. – “Climb back in the cab, cross your fingers for luck, we gotta keep movin’ if we’re going to make a buck. Let it roll…down the highway…let it roll…roll…roll!”

Those immortal words from Bachman-Turner Overdrive were penned back in 1974, but as we all know, the economic pressures to keep the wheels turning are even greater today.

While you certainly wouldn’t succumb to that pressure by climbing behind the wheel of a 60-plus tonne rig with a bunch of alcohol in your system, a bunch of research says a lot of you are rolling down the highway while drowsy. And some of that research even suggests the two are just about the same thing, because like alcohol, fatigue also impairs your decision-making abilities. That even includes the ability to determine when you are too drowsy to drive.

“One of the first things to go is your level of judgment,” says Dr. Alistair MacLean, the incoming dean of Arts and Science at Queen’s University in Kingston and the former head of the psychology department there. “You’re trying to reach a decision about how sleepy you are and actually being sleepy to begin with inhibits the accuracy of that judgment.”

Dr. MacLean’s long-time research interest is the understanding of sleep: what factors affect sleep; how sleep affects your behaviour and physiology; and what mechanisms underlie sleep.

“The principal focus of this research has been the understanding of how sleep loss and sleepiness affects skilled performance such as driving. Our investigations used a small driving simulator in a lab and assessments of sleepiness to gain a greater understanding of the relationship between sleepiness and performance. We hope that will lead to improvements in our capacity to predict and detect deterioration under real-life conditions.”

Fatigue research finds that driving deterioration is greatest between the hours of midnight and 6 a.m. That’s because your body is designed to be active in the day and recover and recuperate at night. So the poorest performances will be in the early morning hours.

Dr. MacLean’s study backs that up as he took a look at the driving performances of both men and women who were considered to be “normal sleepers.” They drove at various hours of the night and day. At 2:30 a.m., their driving performance could be compared to someone with a blood-alcohol concentration of 0.05%, or the equivalent of an average-sized man who had three cocktails in an hour.

By 5 a.m., their motor skills compared to a driver with a blood-alcohol concentration of 0.08%, enough to be legally drunk in Canada.

“Fatigue is a more common cause of traffic accidents than alcohol or prescription drugs,” states W. Ward Flemons, M.D., Clinical Professor, Department of Medicine, University of Calgary. “Between 30 to 40% of the population receives insufficient sleep.”

A report by Statistics Canada goes further, saying almost 50% of Canadians go about their daily lives deprived of sleep. That means half the 18 million vehicles or so on the road are in the hands of drivers who may not be as alert as they should be. According to Mission Possible, a safe-driving initiative by the Alberta Motor Association, an estimated 15% of all drivers have reported actually falling asleep at the wheel, though in actuality that number might even be far higher.

It’s not merely a case though of truckers cheating Hours-of-Service rules, or some four-wheeler anxious to get home driving all night.

No, many of these incidents can be traced to a true sleep disorder like chronic insomnia, narcolepsy, and sleep apnea, which all lead to excessive sleepiness, and which all exponentially increase your chances of being involved in a highway crash.

In fact, people with obstructive sleep apnea (OSA) as it is called, have a three to seven times greater risk of getting in a crash than the general population.

A study published in Sleep magazine a few years back determined that more than 800,000 drivers were involved in OSA-related car accidents in 2000, costing US$15.9 billion in damage and claiming 1,400 lives.

The study also estimated that if all drivers suffering from obstructive sleep apnea were treated, over US$11 billion in damages could be saved each year, along with 980 lives.

So you probably get the point about the driving drowsy part and all that, but now we’re slinging around acronyms and names and conditions and heading down the road more frequently travelled by medical magazines, not Truck News.

Here’s the deal though. Unfortunately, about 28% of you are at risk for obstructive sleep apnea according to the Federal Motor Carrier Safety Administration, as well as scientific and anecdotal research carried out by some trucking companies.

Specifically, older, overweight men with large abdominal girth and a large neck or collar size seem to be at the highest risk, though as many as 40% of people with obstructive sleep apnea are not obese, and it can also affect women and children of different sizes as well.

So what is obstructive sleep apnea, what are the risks associated with it, and what can you do about it? says sleep apnea is a condition in which your breathing is repeatedly interrupted for short periods while you sleep.

It is most frequently caused when your tongue relaxes and blocks the passage of air in your airway during sleep, causing paused breathing.

As a result, impulses from your brain wake you up so you can start breathing again.

For some people this cycle can repeat hundreds of times during sleep, resulting in sleep deprivation.

People with sleep apnea will partially awaken as they struggle to breathe, but in the morning they will not be aware of the disturbances in their sleep, other than the fact they will feel tired. Other sleep apnea symptoms may include:

* Waking up several times a night for no apparent reason;

* Excessive daytime fatigue;

* Snoring with pauses in breathing;

* Gasping or choking during sleep;

* Problem with mental function;

* Quick to anger;

* High blood pressure;

* Nighttime chest pain;

* Depression;

* Problem with excess weight;

* Morning headaches;

* Frequent trips to the bathroom at night.

So you’re tired and feel a little foggy in the cab sometimes. What’s the big deal?

It is far more serious than that. Apnea causes the oxygen levels in the blood to drop to a dangerous low while carbon dioxide levels rise. This causes heart rhythm disturbances, elevates blood pressure and can lead to fatal heart attacks and strokes.

A study at the Mayo Clinic Sleep Disorder Center shows that patients with OSA are at much higher risk of cardiac death during sleep, a statistic that might keep you awake at night.

The bad news doesn’t stop there though. People who suffer from apnea, which owes its name to a Greek word meaning “want of breath,” may also experience depression, morning headaches, memory lapses, intellectual deterioration, hypertension, and impotence.

The best way to determine if you have sleep apnea is to get tested at a sleep centre. Your primary physician can refer you. Based on your test results your doctor may suggest lifestyle changes to help you with mild sleep apnea or treatment for moderate to severe sleep apnea.

Those lifestyle changes include avoiding alcohol and medications that relax the central nervous system (for example, sedatives and muscle relaxants), losing weight, and quitting smoking.

Some people are helped by special pillows or devices that keep them from sleeping on their back, or oral appliances to keep the airway open during sleep.

If these methods aren’t effective, there are some surgical procedures that can be used to remove tissue and widen the airway.

However, on
e of the most common recommendations for people diagnosed with OSA is CPAP therapy, or continuous positive airway pressure.

CPAP involves the use of an adjustable blower unit, headgear and a mask to deliver the appropriate amount of pressurized air through the nose in order to prevent collapse of the upper airway.

Most CPAP users of course put the unit bedside, next to the lamp and the alarm clock and their favourite reading material or the TV remote.

But last time you checked you probably didn’t see a nightstand in the cab, so you can forget the CPAP solution, right?

Wrong. Plenty of truckers are going flatline (okay, given that apnea can be deadly that might not be the best bit of trucker lingo to use there) with their CPAP, including several hundred drivers for one company alone.

Schneider National of Green Bay, Wis., is way out in front of the industry on this one as it has had a team of occupational nurses dedicated to both applicants and company drivers for eight years, with the last three or so of those spent looking more closely at sleep disorders.

“When we began tracking the medical records and ailments of drivers who had become ill while working for us, we started seeing some trends,” explains Wendy Sullivan, Schneider’s occupational health manager.

“There has been a lot of research done that shows people who suffer from hypertension, diabetes and cardiovascular disease – conditions that represent three of the most costly health care expenditures among commercial drivers – may be at risk for sleep apnea. In fact, in many cases it may be the apnea that is causing those conditions.”

Schneider began working with sleep specialist Dr. Mark Berger and Precision Pulmonary Diagnostics out of Houston, Texas. They are an experienced group of sleep physicians and health professionals whose focus is on health and safety issues specific to drivers and their employers. Partnering with Precision, Sullivan and Schneider diagnosed 339 drivers with sleep apnea for an OSA study that will soon be published.

“We tried to approach this diagnosis cautiously, and in the scope of what it means to their health, safety and career,” Sullivan said. “We recognize the problem and we are paying it the due diligence it merits. Sleep apnea never goes away. If you have it, you have it. While you can’t cure it, you sure can mitigate its impact on someone who drives a 60-tonne rig for a living.”

In Schneider’s case, that meant equipping several hundred drivers with CPAP machines to take on the road with them. And that has not only helped the drivers, but has brought benefits to the company as well, as Sullivan talks about.

“The health care costs of our driver group who successfully use a CPAP have been reduced by 50%. In today’s vein of consumer-driven health care, that’s huge. We saw improvement in some of those medical conditions we mentioned our drivers were suffering from such as hypertension, diabetes and cardiovascular disease. And not coincidentally, the retention rates in this successfully treated group improved significantly as well.”

Right now there are Schneider drivers on the road using machines from a variety of companies such as ResMed, Respironics, and DeVilbiss. Some of the units in use by commercial truckers are being wired directly into the truck’s electrical system, some use inverters, and some, like the AEIOMed Everest system, use a proprietary battery that can power the CPAP and humidifier for hours, depending on pressure and heat settings. The batteries can also be recharged the next day through the truck’s cigarette lighter.

“Our CPAP units are really ideal for commercial truckers, not only because of the battery option, but because the small footprint and lighter weight (1.3 kg) make it less cumbersome in your cab than other CPAP’s,” says Holly Larkin of AEIOMed, who is a graduate of the Stanford School of Sleep Medicine and a registered polysomnographic technologist.

“We also know that comfortable CPAP users are more compliant and successful users, which is why our headgear and sleep masks don’t have any facial straps or pads to irritate soft tissue, and the entire system anchors securely without any tension on the nose.”

Schneider also knows this sleep disorder problem is going to become even more nightmarish in the future, which is why on Apr. 1 it sent out a sleep apnea screening survey to all its drivers.

The company wants to make sure its drivers know that sleep apnea is a treatable condition, it does not disqualify them from operating a commercial vehicle, and that the company will in fact pay for the CPAP unit if a driver is diagnosed with OSA.

The third largest trucking company in the US by revenue is also enlisting the help of some CPAP-using champion drivers to talk the talk to their co-workers.

They’ve been saying things like “I had no idea I could feel this good” … “my ability to concentrate and retain information has increased”…”for the first time in my life I have been able to come home from a trip and stay awake to watch a movie with my son” … “my doctor says he saw great improvement in my cardiac condition” … and so on.

“This is a significant way to help the driver and have some impact in improving his lifestyle,” says Schneider’s Sullivan.

“We not only value the health and safety of our employees, but those with whom they share the road as well. It’s our mission.”

And whether it’s Bachman-Turner Overdrive, or a more contemporary group, that kind of sentiment should be music to the industry’s ears.

Sleep factoids

75% of adults report frequently having a sleep problem.

69% of American adults fail to recognize sleep as a critical factor in maintaining health.

62% of American adults believe that proper diet or exercise is more important than sleep in maintaining a happy and healthy life.

One in six adults indicated that they or their partner often have difficulty staying awake while driving during the daytime.

58% of employed adults indicated they experience daytime sleepiness.

39% of sexually active adults indicated they decline sex due to tiredness.

16% of adults sleep less than six hours a night during the week.

Sleep related issues are the most common reasons people are late for work.

Problem sleepers cause their employers an average of $3,349 more in annual health care costs than a non-problem sleeper.

Source: National Sleep Foundation

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