Private Trucking Fleet Safety
Starting a sleep program in a private fleet may put your company far ahead of other companies in the transportation industry with regards to the to the FMSCA guidelines about sleep apnea. Implementing an OSA program can help fleet companies and the public combat the number of accidents that were caused by fatigue associated with a sleep apnea. A key driving factor of an OSA program is the reduced healthcare costs and may help in driver recruitment and retention. Up to 28% of commercial drivers have some level of sleep apnea. The largest contributing factor of sleep apnea is having a body mass index (BMI) of 35 or greater. DOT examiners are looking for the following risk indicators as well: High Blood Pressure, Neck Size – 17 inches (male), Neck Size – 16 inches (female), and Tobacco and Alcohol Use
The Federal Motor Carrier Safety Administration (FMCSA) continues to review the following guideline – The medical examiner may, but is not required to, accept the recommendations. Section 390.3(d) of the FMCSRs allows employers to have more stringent medical requirements.
Respiratory Dysfunction 391.41(b)(5)
A person is physically qualified to drive a commercial motor vehicle if that person:
Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with the ability to control and drive a commercial motor vehicle safely.
Since a driver must be alert at all times, any change in his or her mental state is in direct conflict with highway safety. Even the slightest impairment in respiratory function under emergency conditions (when greater oxygen supply is necessary for performance) may be detrimental to safe driving.
There are many conditions that interfere with oxygen exchange and may result in incapacitation, including emphysema, chronic asthma, carcinoma, tuberculosis, chronic bronchitis and sleep apnea. If the medical examiner detects a respiratory dysfunction, that in any way is likely to interfere with the driver’s ability to safely control and drive a commercial motor vehicle, the driver must be referred to a specialist for further evaluation and therapy.
Lawyers are using this type of information against truck drivers who have an untreated sleep disorder and are involved accidents that have resulted in a fatality. It’s documented that there have been lawsuits that resulted with multi-million dollar settlements against the trucking companies that employed the truck driver with the untreated sleep disorder. Implementing an OSA program can reduce your exposure to litigation and improve your existing fleet safety program. AllTrans Fleet Services offers state-of-the-art remote testing and treatment technology to the transportation industry with the convenience of full program implementation and support, DOT compliance reporting with little if any down time.
Ways to address the condition that adds to Fatigue
In the transportation industry, many risk managers and commercial drivers have to deal with the problem of sleep apnea, a condition that is directly related to daytime drowsiness, as they look for ideas to improve road safety. According to the Federal Motor Carrier Safety Administration (FMSCA) estimates that up to 26% of licensed commercial drivers have some level of sleep apnea. Per a FMSCA study, 17% of commercial drivers have mild sleep apnea, 5% have moderate, and 4% have severe prevalence of sleep apnea.
It has been shown in several studies that sleep apnea can directly impact driving performance by increasing fatigue therefore the direct relation of increasing the risk of crashes. The trucking industry is well aware of the awareness and prevalence of sleep apnea among drivers, however there are ways that the condition can be diagnosed, treated, and monitored.
Obstructive Sleep Apnea (OSA) is when the airway in the back of the throat is constricted due to the muscular relaxation when sleeping thus causing interruptions of a person breathing lasting several seconds at a time. Loud snoring is followed as the person gasps for air and resulting in a night of no restful sleep. Individuals considered at risk for sleep apnea are those with a body mass index of 35 or greater and a neck size of 17 inches or more for men and 16 inches for women. Many medical experts have stated that these types of individuals quite often suffer from other medical conditions such as diabetes and heart problems related to obesity.
Researchers say that there are a countless number of people that are not aware that they even have sleep apnea. Sleep apnea quite often contributes to daytime sleepiness, which impacts reflexes and motor skills. Even if the vast numbers of commercial drivers have some type of sleep apnea, many drivers are not willing to talk about it or admit that they may have the medical condition. There needs to be a way to educate the drivers about sleepiness and the dangers it can cause.
Currently the Federal Motor Carrier Safety Administration (FMSCA) has given guidelines on sleep apnea to the DOT Examiners for medical examination report on commercial driver’s physicals. It states the following for Respiratory Dysfunction 391.41(b)(5): A person is physically qualified to drive a commercial motor vehicle if that person:
Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with the ability to control and drive a commercial motor vehicle safely.
Since a driver must be alert at all times, any change in his or her mental state is in direct conflict with highway safety. Even the slightest impairment in respiratory function under emergency conditions (when greater oxygen supply is necessary for performance) may be detrimental to safe driving.
There are many conditions that interfere with oxygen exchange and may result in incapacitation, including emphysema, chronic asthma, carcinoma, tuberculosis, chronic bronchitis and sleep apnea. If the medical examiner detects a respiratory dysfunction, that in any way is likely to interfere with the driver’s ability to safely control and drive a commercial motor vehicle, the driver must be referred to a specialist for further evaluation and therapy.
The guidelines are currently under review but are not yet regulation. Many DOT examiners and trucking companies are taking the guidelines seriously and have implemented screening policies. The National Registry for Medical Examiners will be keying in on sleep apnea and only physicians that are in National Registry for Medical Examiners will be allowed to conduct DOT exams.
Effective Sleep Apnea Treatments
There are many different types of sleep apnea treatments available. The most appropriate way to decide which treatment is right for you would be to see what type of sleep apnea you have. To determine what type of sleep apnea you have, you must take a sleep study, whether it is a home sleep test or in lab test. Treatment for sleep apnea allows you to effectively control the condition.
The most common type of sleep apnea is Obstructive Sleep Apnea (OSA). This occurs when there is an obstruction in your airway, preventing oxygen from getting to your lungs. Essentially, when this obstruction occurs, usually due to the relaxation of the muscles and soft tissues around the throat, you stop breathing momentarily. Central Sleep Apnea (CSA) is a type of apnea in which their is a disconnect between the part of your brain which sends signals to breath and the diaphragm muscles, also causing you to stop breathing momentarily.
Undergoing Continuous Positive Airway Pressure Therapy (CPAP) is the most common type of treatment for sleep apnea. With this type of treatment, the patient wears a mask that is attached to a machine. This machine blows air at a certain constant pressure while sleeping. This pressure effectively keeps the airway open throughout the night. A BIPAP is another treatment option in which there are 2 different pressures, that are automatically adjusted while exhaling and inhaling providing for a more comfortable sleep for those who require it. An APAP is another variation in which the pressure adjusts according to need based on the patient’s breathing levels. The APAP units are set within a range that the pressure is constantly readjusting between.
A secondary method of treatment is the use of oral appliances. These appliances are placed in your mouth each evening. While you are sleeping, it works to maintain tongue and jaw alignment to prevent any obstructions of your airway from occurring. Although these are an accepted form of treatment for sleep apnea, the use of a CPAP, APAP, or BIPAP is definitely more effective.
Other treatments consist of lifestyle changes in which you would alter the position that you sleep in, weight loss, or cessation of smoking. These changes, paired with a treatment mentioned above, would best suit you for treating and controlling your sleep apnea.
Different Types of Sleep Apnea Treatments
If you have recently been diagnosed with Obstructive Sleep Apnea, you should know that there are a variety of different treatments based on the severity of your condition. Mild sleep apnea can be treated with simple lifestyle changes.
For example, following an exercise regimen to lose weight and thus decrease your BMI, quitting smoking to better your health in general, or changing your sleeping style by sleeping on your side or on your back.
When you have moderate to severe sleep apnea, these lifestyle changes will more than likely not suffice for adequate sleep apnea treatment.
An alternative type of treatment that is most commonly used is using a Continuous Positive Airway Pressure machine (CPAP). These machines deliver air pressure through a mask placed over your nose and/or mouth while you are asleep. This air pressure keeps your airway open throughout the night, preventing any obstructions from occurring. Different types of this treatment are available: the CPAP is set at one static pressure, the BiPAP is set at two pressure that alternate as you inhale and exhale, and the APAP is set at a range of pressures that adjust according to breath pressure and severity of the obstructions.
Another type of treatment is wearing an oral appliance. These appliances are designed to maintain your jaw and tongue positioning throughout the night to prevent obstructions from occurring. Although patients due find this treatment to be useful, the most effect treatment is the positive airway pressure machines.
Finally, there are surgical options to treat your sleep apnea, which consists of the partial removal of the tissue in your throat to prevent the obstructions from occurring.
About Sleep Apnea
One of the most essential habits in order to maintain a healthy lifestyle is having a good night’s sleep. Sleeping well is just as important as exercising and eating all your nutrients. People with undiagnosed or untreated sleep apnea leaves them with high health risks for a variety of disorders and diseases. These health risks include hypertension, heart disease, stroke, anxiety, erectile dysfunction, loss of memory, diabetes, and obesity. All of these potential dangers are easily avoidable with the diagnosis and treatment of sleep apnea.
There are different types of sleep apnea, the most common being “Obstructive Sleep Apnea” (OSA). OSA most commonly occurs when the airway to the lungs collapse in people during sleep due to their relaxation of muscles. This limits your ability to breath for an elongated amount of time (~10 seconds). This is called an apnea. If additionally your airflow decreases by 30-50% during the apnea, you are considered to have a hypopnea. The Apnea and Hypopnea combined are known as an AHI event. The more AHI events you have, the less amount of oxygen is reaching your bloodstream, causing you to be oxygen deprived. When you reach this state, your body starts pumping your heart faster, causing you to jump out of your deep sleep, or maybe even jolt awake. These events are known as micro-arousal. Each time an untreated person reaches deep sleep, an event may occur, preventing them from ever obtaining a good night’s deep, refreshing sleep.
Sleep apnea is known to affect almost 12% of the adult male population. Women are less likely to have the disorder, however it is possible. In truck drivers specifically, 28-30% of truck drivers have sleep apnea. In parallel, the trucking industry carries the highest rate of obesity, which is a risk-factor that leads to OSA. Additionally, the majority of these truck drivers are not diagnosed with sleep apnea, yielding nearly 28-30% of drivers to be operating vehicles with inadequate sleep, experiencing compromised health, and elevating risk for accidents, liability, and medical expenses. Symptoms or markers of sleep apnea include: neck circumference greater than 17”, a body mass index greater than 30. snoring, drowsiness during the daytime, hypertension, diabetes, history of stroke, heart disease, or frequent nighttime urination. Up to 90% of people who have sleep apnea are unaware of the symptoms and thus don’t even know they have this sleep-breathing disorder. Those who have some or all of the symptoms listed above are encouraged to get tested for sleep apnea in order to prevent any further detrimental health consequences.
On a positive note, there are very effective treatment solutions for those diagnosed with sleep apnea. CPAP machines (continuous positive airway pressure) treats sleep apnea by providing continuous air pressure through a mask in order to prevent the airway from collapsing and an apnea event from occurring. Doctors can prescribe one set pressure for the air to be constantly flowing at using a CPAP, however taking into account that many people have various depths of sleep, an APAP might be a superior option. An auto-setting positive airway pressure device adjusts accordingly throughout the night to the pressure that would give the most comfort to the patient. This increases compliance and provides a more comfortable and peaceful sleep for the patient. Other treatments are available for treatment such as surgery and dental devices, however a positive airway pressure device is an easy, convenient and tolerable option for all patients to be able to have a deep and restful sleep.
Treatment for sleep apnea is important in any situation, however for drivers specifically, untreated sleep apnea can result in 7 times more likely chance to get into a serious accident. This is because the disturbances caused by sleep apnea throughout the night results in a loss of concentration and alertness for the driver while on the road. The driver will also be at risk of a variety of health issues, causing a greater liability for the fleet and fleet owners. If these health issues surface, the cost of medical care will increase immensely as well. Using our Turn-Key program, you we will not only ensure that your drivers are diagnosed accurately, we will commit to monitoring their treatment usage to be certain that their health or lack of sleep is no longer an issue due to sleep apnea. We will provide unsurpassable support and reliability to your entire fleet to make this testing and treatment process smooth.
Currently, it is advised by the DOT/FMCSA’s Medical Advisory Board to verify all Medical Examiners providing a physical exam to renew a driver’s CDL to check the all risk factors for sleep apnea. Although this has not been declared by the board to be a requirement, there is talk of an implementation of this recommendation soon. AllTrans Fleet is providing Fleet owners a cost efficient opportunity to get ahead of the curve and complete testing and treatment for all of their drivers before the official mandate is set. All in all, signing up for the AllTrans Fleet program will be beneficial to both you and your drivers for a variety of reasons: (1) Financially, you will save costs on medical expenses, accident fees, employee turnover, and insurance rates.(2) It is an inevitable reality that you will be mandated to do complete it regardless of if you join the program now or later…why wait? (3) You reduce the risk of danger and accidents on the road for your drivers and all motor vehicle operators in your region. (4) Our method of home sleep testing is affordable and fast, preventing your drivers from having to spend a night and double the cost in a sleep lab. (5) Our management team will be with you the whole way to maintain your drivers’ compliance (6) Become an icon in the Trucking Industry as a steward of public safety, caring for the health of your drivers and all drivers in your region.
