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Researchers Work Tirelessly To Understand Fatigue

CUPERTINO, Cal. - A great deal of research has been undertaken on driver fatigue over the last decade in both Canada and the US, but only recently have strategies been implemented in an intensive way ...

CUPERTINO, Cal. –A great deal of research has been undertaken on driver fatigue over the last decade in both Canada and the US, but only recently have strategies been implemented in an intensive way to address this problem, according to Dr. Mark Rosekind of Alertness Solutions.

Rosekind is participating in a collaborative cross-border study between Transport Canada and the US Federal Motor Carrier Safety Administration (FMCSA) which has three companies testing the strategies: two Canadian transport companies, and one in the US, with 40 drivers at each site.

“We’re implementing education,” he says of the multi-faceted approach. “We’re trying to also educate schedulers and dispatchers at each of the companies, so that they can see how the scientific information can be incorporated into what they do. We’re also screening all of the participant drivers for sleep apnea, using devices that can actually screen them in their home. If they’re diagnosed with sleep apnea, they can see a sleep physician to be treated.”

Rosekind emphasizes that driver fatigue is a very complex topic, encompassing hours-of-service regulations, which is only part of an overall strategy to reduce fatigue and make the roadways safer. For instance: the driver has to have sufficient rest once they take time off, which could be disturbed by any number of work related issues, such as a split shift. The driver might also be suffering from personal or family-related issues during their off-time, which might be disruptive to rest, such as sickness, young and demanding children, elderly parents to care for, etc.

“In other words, just because they have off time, doesn’t mean they’re going to get the sleep they need, or the rest that’s required when they have to go back on duty again,” he says. “That’s something that the hours-of-service can’t control.”

Rosekind says there needs to be a comprehensive programmatic approach to fatigue or alertness management, due to the complexities of the problem. He says fatigue management needs to have four approaches, which are:

1. Education and greater knowledge about fatigue for everybody in the company, not just drivers, but also schedulers, and senior management: “Everybody’s got to know basic stuff about sleep need, body clocks, or circadian rhythms.”

2. Strategies to deal with fatigue: Everybody in the company needs to learn about what strategies work to help promote performance and alertness, including lifestyle choices such as naps and the effects of caffeine, or physical activity. “There’s just a series of strategies that should be known to help get good sleep,” says Rosekind. “When you’re awake, what do you do to help maintain your performance and alertness?”

3. Scheduling methods in relation to fatigue: Even with the hours-of-service regulations, companies have very distinct scheduling requirements based on their operation, according to the fatigue expert, who suggests that schedules needs to be “scientifically sound” and make “physiological sense,” to be effective. “You really need to look at the actual schedules, not just the federal rules.”

4. Healthy sleep: Rosekind recommends that sleep disorders be addressed at a corporate level, and treated with various sleep promoting strategies, which may include screening and treating drivers for sleep apnea.

In an effort to quantify driver sleep patterns during actual driving assignments, the Transport Canada/FMCSA driver fatigue study’s test subjects were given an “actigraph” or an actimetry sensor.This is a non-invasive method of monitoring human rest and activity cycles, a wrist-worn device that is about the size of a watch.

It records the driver’s movement from a 24-hour period to 30 days. With the Transport Canada/FMCSA study, the actigraph recorded the information a few days before, during, and a few days after a driving assignment.

“You can analyze the pattern of movement with software, to actually get a very solid estimate of the quantity and quality of their sleep,” explains Rosekind.

While sleep labs are valuable for evaluating clinical issues like sleep apnea and other types of sleep disorders, the driver fatigue researcher indicates that this expensive and time-consuming option is not needed for field studies where the states and stages of sleep are not required.

The actigraph can give an effective estimate of total sleep, quality, and how long it took for the driver to fall asleep, according to Rosekind.

“We just need an estimate of how much sleep they got, and what’s the quality.”

There are 88 sleep disorders, according to statistics offered by sleep medicine specialists that Rosekind refers to. One of the most prominent is sleep apnea. Sleep apnea is a disorder where sufferers can’t sleep and breathe at the same time.

Sleep apnea suffers typically wake up periodically throughout a period of rest, breathe and then go back to sleep, and then wake up again with the same procedure.

Rosekind says there are a few concerns about this particular sleep disorder, such as how long the person stops breathing and how many times the sufferer wakes during the night.

Five occurrences an hour is considered a mild form of sleep apnea. Rosekind is aware of a an extreme case where the sufferer had over 800 apneas in one night, and complains of constant fatigue.

“The good news is the guy’s alive, but the bad news is that he never sleeps well, and is tired all the time.”

There are very significant health and safety consequences related to sleep apnea, including high blood pressure, heart failure and increased risk for stroke, memory problems and other side-effects. As for safety issues, Rosekind says that drivers with sleep apnea are at risk of having a six to eight times higher chance for vehicle crashes over somebody that doesn’t have sleep apnea.

Although only 2-4% of the general population has sleep apnea, of that overall percentage, 9% are females and 24% are males, a statistic that gets even more startling when profiling the trucking industry. Rosekind cites a study by the University of Pennsylvania that revealed that 28% of truck drivers in a controlled study had sleep apnea. Further studies revealed that physical conditions like body mass, or height and weight, is a substantial factor as to whether a person, is at risk for sleep apnea, according to Rosekind.

“One thing about trucking, if they’re not in good shape and not getting exercise, that puts them at risk for sleep apnea, which has serious safety risks,” he says.

Those test drivers that were diagnosed with sleep apnea have been offered “continuous positive airway pressure devices,” or CPAP, which pushes air into the throat through a device that is attached to a face mask.

Without C-PAP, Rosekind compares the sufferer’s windpipe to a straw that has been deflated, due to a lack of air.

“It basically puts air into the straw to keep the straw – or your windpipe – open, so that you can breathe in and out,” he says of a device that many consider to be cumbersome. “That’s one of the biggest problems,” says Rosekind. “There’s barely 40-60% compliance with people who get prescribed with C-PAP, meaning only 40%-60% are using it.”

On the bright side, there is a surgical procedure, that might eliminate the problem. For others, losing weight has shown to also cure sleep apnea. Rosekind indicates that regular exercise and diet control are critical lifestyle solutions that can improve sleep quality and quantity.

The sleep expert further states that the trucking industry has been promoting a healthier lifestyle to improve not only job performance, but also operations, safety, and health costs, not to mention quality of life for the driver.

But he admits the task of changing a lifestyle mindset is not easy, especially considering the present driver shortage and the high turnover that trucking companies have to cope with. There is also a prominent economic consideration, as well.

“A lot of these drivers get
paid by the mile, and so while the hours-of-service are all based on the number of hours they can work, that’s not what they get paid by. They get paid by doing their deliveries by miles. That’s why I say a lot of these guys have a hard life. I have a lot of respect for them, because I think that it’s a tough job.”

Overall, Rosekind believes that driver fatigue has been an under-recognized problem, until recently, and he’s gratified that the trucking industry is considering strategies to address the issue.

He says the industry needs more proven solutions, which could be technological, such as in-cab sensors, or practical, with scheduling adjustments. Other solutions include better sleep apnea diagnostic methods, as well as effective fatigue management programs.

“I think it’s great that there’s a growing acknowledgement of the problem. We need proven, effective strategies – solutions that help reduce the risks and the costs.”

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