Awakening up from Denial: Acknowledging the Crisis of Sleep Apnea

For decades, multiple sources cited the commonly-accepted statistic that only an estimated four percent of all individuals possessed a medical condition known as Obstructive Sleep Apnea (OSA). OSA is largely the result of certain physical characteristics and lifestyle habits that reduce the flow of oxygen into one’s lungs while asleep. These characteristics result in lowered blood oxygen levels throughout one’s normal night’s sleep, and lower the quality of that sleep such that the individual is fatigued through much of the day. For purposes of motorcoach transit, and long-haul trucking, recently studies have increasingly acknowledged an almost astonishing percentage of professional drivers with Sleep Apnea compared to the general population.

Of those physical and lifestyle conditions that contribute to this problem are obesity (including an abnormally thick neck and even a short mandible) and other structural characteristics of one’s neck and throat and their sub-elements These problems are further compounded by lifestyle choices like alcohol and caffeine consumption, and many prescription and non-prescription drugs — not to mention our obscene intake of sugar and high fructose corn syrup which, directly or indirectly, further impede the body’s ability to maintain a consistent level and quality of sleep. During the night, individuals with Sleep Apnea commonly snore, and their sleep is often considerably more restless than normal. The point is, the incidence of Sleep Apnea is not dramatically higher among drivers than the general population simply as a coincidence. Interestingly, even apart from Sleep Apnea, fatigue levels among professional drivers compared to the general population are dramatically higher, much of it related to the irregularity of drivers’ shifts’ start and end times from day to day, and the “disassociation” from their normal circadian rhythms this inversion in sleep-wakefulness cycles creates.

But the deteriorated quality of one’s sleep is hardly the major problem with Sleep Apnea victims. The real problem – and why I consider the glacial pace of our addressing it to comprise a crisis — is that, during their wakeful hours, individuals with this affliction, and who experience periods of fatigue in general, are not only less alert, but prone to irregular, intermittent bouts of “microsleeps” – effectively “black-outs” lasting only a few seconds, but during which time these victims are effectively fast asleep. This problem is not likely to manifest itself during one’s involvement in intense activity – such as combat, sports competition or even exercise. Instead, it rears its ugly head during periods of quiet and monotony – a common environment in which long-haul truckers and motorcoach drivers not only find themselves, but find themselves for extended periods of time, much less during those hours when their bodies would normally be asleep even without any sleep disorders. The efforts of our industry’s lobbying organizations, nearly a decade ago, to exempt motorcoaches from changes to the Hours-of-Service regulations that would have minimized such problems – changes enthusiastically endorsed by the U.S. trucking industry – helped cement this precarious phenomenon into place.

For even one out of every 25 motorcoach driver – never mind every motorist – to possess this problem – known for years but which triggered virtually no institutional or regulatory responses – is nothing short of inexcusable, especially in the context where major institutions such as the National Transportation Safety Board and Federal Motor Carrier Safety Administration have for years voiced their belief that roughly half of all catastrophic motorcoach accidents were fatigue-related. Of course, the inertia of our response to these beliefs is hardly surprising in a society where it took decades of frenetic advocacy to require the installation of seatbelts in common automobiles. However, some shocking new discoveries have suddenly drawn attention to the magnitude of risks involved by our failure to address this issue – particularly the dramatically-exaggerated understatement of the problem’s depth, statistically.

Before exploring the new data, and certain organizations’ recent responses to it, it must be pointed out that, for years, Sleep Apnea has been not only diagnosable, but treatable. Unfortunately, while losing weight, exercising and making other lifestyle modifications can often alleviate this condition, the medical industry’s alternative has been to sleep with a somewhat grotesque mask that simply opens the throat’s airway passages during sleep. One can imagine one’s reluctance to wear such a device to bed, especially with a spouse or girlfriend, as this paraphernalia is not exactly a romantic or sexual turn-on.

Better Data and Mixed Reactions

While concern about Sleep Apnea has been growing significantly this past year, interest exploded when the results of a recent Australian study was released. That study of 480 truck drivers [535 candidates are considered a scientifically “random sample” and the legitimate foundation for drawing scientific conclusions] found that close to half of them possessed this disorder. I do not have a stereotype of “Aussies” as a continent full of fatties with thick necks. If any nations are close to this, they are Britain and the United States, where one half and one third of their entire populations, respectively, are classified as having some degree of obesity. Regardless, Sleep Apnea is far less likely to be a problem in Africa or the Orient, where obesity is rare (Sumo Wrestlers excepted). But it a whopping problem here.

Other studies “closer to home” have mirrored the Australian study’s findings. Most interesting, recently studies have found that 28% of truck drivers suffer from “Obstructed Sleep Apnea” (OSA) compared to only about six percent of the general population. Clearly, driving large vehicles is the poster boy for dangerous sedentary jobs. Unfortunately, driving a large vehicle is not only mentally and physically exhausting, and filled with stress (which further contributes to fatigue), but often compounded by bad diets, and where fatigued drivers are among the least likely members of the population to engage in physical exercise. Yet OSA is only one of 70 different sleep disorders noted by Mary Parrish, Vice President of Transportation Safety of the sleep discovery management firm Fusion Sleep.

Expounding further on these dangers, Ms. Parrish noted that the real issue is not so much the failure to diagnose and treat sleep disorders in their early stages, but that the failure to diagnose and correct this condition leads to not only an increase in overall fatigue, but to a host of other medical problems, such as type II diabetes and high blood pressure. Yet despite these extraordinary revelations, and an outburst of rhetoric about its importance (including a genuine expression of concern from Anne Ferro, the FMCSA Administrator), not only does the FTA (the FMCSA’s USDOT sister organization) have no formal medical standards for transit operators (many transit operators drive either split shifts, but often “night” and “owl” period shifts), but even the FAA does not provide any guidance regarding these risk factors to its pilots. Historically, only the freight rail industry has been deeply involved in programs to screen out OSA-vulnerable motormen and other railroad personnel, and otherwise engage in what is known in other modes as “bio-sensitive driver assignment” (matching one’s shift to his or her natural sleep-wakefulness cycle). Otherwise, the other sectors have effectively been “asleep at the switch” – and, as noted, at least one industry, our own, has fought against efforts to address these problems at the institutional levels – while they were applied universally to the nation’s trucking industry, which encompasses roughly 99 percent of the commercial vehicles regulated by the FMCSA. At least the revised Hours-of-Service regulations help keep our packages safe.

This past May, 2012, at a two-day Sleep Apnea and Trucking Conference sponsored jointly by the American Trucking Association and Federal Motor Carrier Safety Administration, the NTSB recommended that all modes begin identifying their drivers possessing high risks for sleep disorders and guiding them to medical treatment, effectively renewing its campaign to broaden the use of sleep disorder screening across all modes of transportation as part of a long-term effort to reduce the obvious risks.

In response, regulatory responses have been, in my opinion, relatively impotent. The FMCSA’s Ferro acknowledged that “the challenge is to develop- screening and treatment options that are affordable and accepted by operators,” yet claims that among operators, sleep apnea is a highly sensitive issue. What can she be talking about? Other than the suggestion that a percentage of Sleep Apnea victims live largely on a diet of soda pop and Nachos — perhaps a mild embarrassment likely to be obvious to many casual observers anyway — I find it puzzling how this issue could be remotely sensitive. If anything, the failure to address it aggressively is the height of insensitivity.

Publications: National Bus Trader.