Opinion: Sleep Apnea and the Regulatory Agenda
By John Hill
Industry Adviser
SleepSafe Drivers Inc.
This Opinion piece appears in the March 21 print edition of Transport Topics. Click here to subscribe today.
The trucking industry long has been resilient to change and transition. The country’s recent economic climate certainly illustrates how essential and strong the transportation component is to our way of life, but trucking has needed to navigate regulatory challenges as well.
Since the Federal Motor Carrier Safety Administration came into existence in 2000, there have been considerable changes and requirements imposed on trucking, with Congress providing the agency with a long list of regulations to implement.
Significantly, one issue — driver fatigue — is being tackled from three different angles:
• In response to congressional mandates, there have been two instances of hours-of-service regulations issued since 2003 and a third regulation is under way, due for release in July.
• The National Transportation Safety Board has issued a series of recommendations to FMCSA for changes to existing rules touching on driver fatigue while calling for new regulations. One example has been to screen truck drivers for obstructive sleep apnea (OSA) as part of an overall fatigue-management program. So pervasive is the OSA problem that the NTSB has issued similar warnings to the aviation, maritime and rail industries for their employees.
• Most significantly, FMCSA’s new Compliance, Safety, Accountability program, or CSA, attempts to expand the scope of regulatory oversight of motor carriers and drivers. The program will add tools to the conscientious safety manager’s toolbox and identify trends in driver behavior — including fatigue — before they cause crashes.
And yet, while drivers and motor carriers await the new hours-of-service rule and adjust to CSA, momentum for broader fatigue management among the most safety-conscious motor carriers is building without government mandates.
I believe this self-imposed leadership by a few carriers holds more promise than any regulations or laws.
Much debate surrounds the hours-of-service rule and its effect on driver health, but reducing the hours a driver can work or drive will not remedy the health problems caused by obstructive sleep apnea. In fact, the effort expended on HOS changes is likely to produce fewer safety benefits than the industry could capture simply by aggressively addressing the health of today’s commercial drivers through targeted treatment of OSA.
Studies show that people with untreated sleep apnea face a long list of increased health risks, including hypertension, Type 2 diabetes, memory loss, chronic fatigue, obesity and a doubling in the chance of heart attack and stroke.
OSA deprives a driver of deep sleep because the airway in the back of his throat is obstructed for 10 seconds or more. Reduced oxygen wakes the sleeper just enough to start breathing again but not enough to remember the action. And this can happen more than 50 times per hour. The result is a driver who is almost as fatigued in the morning as when he retired for the night — and doesn’t know why.
Estimates vary, but based on one 2006 study used by the FMCSA Medical Review Board, which provides the agency with recommendations regarding medical requirements for commercial vehicle drivers, suggests that between 24% and 41.9% of all commercial drivers could qualify for OSA screening.
The MRB recommended in January 2008 that FMCSA make substantial changes to the current guidelines pertaining to OSA.
In retrospect, I regret not issuing updated guidelines to medical examiners when I was FMCSA administrator. Such guidelines, though not required by regulation, would increase the medical examiner’s attention and focus on improving health and reducing fatigue among a group of chronically sleep-deprived drivers whose weariness is caused not by hours of driving but rather by losing sleep to OSA.
I commend companies such as Schneider National and J.B. Hunt for proactively addressing this issue among their drivers. Interestingly, they not only have had significant safety benefits from their self-initiated OSA treatment programs, but they also have saved considerable company money in the form of reduced medical and insurance payments.
OSA testing and treatment options are varied. Traditional testing can require two or more overnight stays in a sleep clinic to test for OSA and determine if the patient will benefit from sleeping with a special mask that keeps the airway open with a continuous flow of air.
Truck drivers, however, need to be diagnosed and treated expeditiously because fleet owners require healthy and treated drivers available for daily duty. For these companies, ambulatory testing of drivers holds tremendous promise because it can be done while a driver sleeps at home, in a hotel or even in his cab’s sleeper berth.
Savvy industry executives realize that drivers are essential to their business and treating OSA where needed is an investment in those drivers, their families and the company’s viability. Data clearly show that with effective management of OSA, individuals experience improved quality of life and fewer catastrophic illnesses and diseases.
A J.B. Hunt driver alerted by his company to the dangers posed by overweight and related OSA lost 110 pounds. He then went on record to say his life had been saved by Hunt’s investment in treating driver OSA. Such actions by carriers have resulted in improved driver retention.
Motor carriers have a unique opportunity to address potential safety liabilities within their companies by establishing OSA programs. When this has been accomplished, they will be rewarded with healthier, happier and more productive employees with fewer health claims as well as reduced crash numbers and workplace injuries.
Get ahead of the regulatory machine and avoid complicated, costly and restrictive regulations. Self-imposed changes are likely to yield the most resilient motor carrier industry.
SleepSafe Drivers Inc., Laguna Niguel, Calif., provides programs to reduce sleep apnea risk for truck drivers. The author, a former administrator of the Federal Motor Carrier Safety Administration, also is principal for The Hill Group, Greenwood, Ind.
