About Sleep Apnea

Good sleep is as absolute a requirement for maintaining good health as nutrition and exercise. Studies show that people with untreated sleep apnea face a long list of increased health risks, including hypertension, diabetes, erectile dysfunction, memory loss, chronic fatigue, obesity, and a doubling in the chance of heart attack and stroke. The good news is that sleep apnea has become easy to diagnose and treat, which normalizes these health risks.

What is sleep apnea?

"Obstructive Sleep Apnea" (OSA) is the most common type of "Sleep Disordered Breathing" (SDB). Obstructive Sleep Apnea most commonly occurs when the airway in the back of the throat is obstructed, limiting your ability to breath. Any time your obstruction interrupts breathing for 10 seconds or more, it is considered an apnea. If the flow is decreased by 30-50%, it is called an Hypopnea.

Some apnea patients have more than 50 "apnea + hypopneas" per hour (AHI index), which causes the oxygen level in their blood to severely decrease and triggers the body to release bursts of adrenaline and race the heart. These reactions cause the person's level of sleep to decrease slightly (micro-arousal), allowing them to get a gasp of air. The sleep level deepens again, and the pattern is repeated throughout the night, resulting in greatly disrupted sleep.

Who has a tendency to have sleep apnea?

Sleep apnea affects about 6-12% of the overall adult male population (less for women), but a remarkable 28-30% of truck drivers. This high prevalence rate is a clear result of the fact that as a job category, trucking has the highest rate of obesity, and obesity leads to OSA. As the great majority of people with sleep apnea are undiagnosed, this means that on average, 28% - 30% of the drivers in a fleet are needlessly experiencing compromised health and elevated accident, liability, and medical expenses. While most fleets are treating a small number of drivers, studies show that 90% of people who have sleep apnea don't even know it.

Typical symptoms or conditions that increase the odds of sleep apnea includes:

  • Neck size greater than 17" (16" for women)
  • Body Mass Index greater than 30
  • Snoring/troubled sleep patterns
  • Daytime drowsiness
  • Frequent night urination
  • Hypertension
  • Diabetes
  • Stroke
  • Cardiovascular problems

Sleep apnea is a serious medical issue that requires immediate treatment to avoid the inevitable consequences of the disease.

What is the treatment for sleep apnea?

Treatment solutions include CPAP (Continuous positive airway pressure), which gives a patient continuous air pressure through a mask placed over the nose while you sleep. This keeps the upper airway passages open, preventing sleep apnea.

If a lab test determines that the highest pressure you needed during the entire night was 13cm, then your CPAP will always run at 13cm. A far more comfortable and successful option in terms of compliance is the APAP, (Autosetting Positive Airway Pressure), which continually measures the patient's pressure needs and adjusts to that, acting as a thermostat for pressure. By lowering the average pressure, the APAP makes it more likely a patient will stay comfortable and therefore compliant over the long haul. The APAP has been shown to be the most effective treatment with the majority of people who have sleep apnea.

Other options include surgery and dental devices. Surgery and dental devices have a much lower rate of success, but in some cases (especially mild apnea) do allow the patient to deal with their apnea without having to use APAP or to make their APAP / CPAP easier to tolerate.

Why is sleep apnea important for fleet vehicle operators and others in safety-sensitive positions?

Studies have shown that untreated drivers with sleep apnea are up to 7 times more likely to have a serious vehicular accident. And, their ability to respond to risky traffic situations equals that of a drunk driver. Why? Sleep apnea disturbs sleep so severely that the person is chronically fatigued and more likely to fall asleep or lose alertness while behind the wheel. Untreated sleep apnea doubles the chance of heart attack and stroke, Type II diabetes, and various cardiovascular problems. In general, sleep apnea will make the individual less healthy, more of a liability in the work function, and a more expensive employee in terms of medical care costs.

Statistics show that 50% of sleep apnea patients fail therapy within the first month. With risk sensitive job categories, it is critical to use a program like SleepSafe™ Driver's Sure-Compliance™ to help ensure employees get optimal coaching and support toward achieving great long term compliance.

The "Regulation" of Sleep Apnea: Expected DOT Guideline revision requiring testing and treatment

The DOT/FMCSA's Medical Advisory Board has reviewed all the data in this field and concluded that untreated sleep apnea is such a serious issue that the CDL exam process should be amended to include screening, testing, and treatment (if needed) for sleep apnea. Their recommendation includes testing for any drivers who have any two of the following 'symptoms' typical of sleep apnea: neck => 17, Body Mass Index => 33, Hypertension, Diabetes, Cardiovascular Disease, Snoring or fatigue, etc. The current Guidelines are over 17 years old and woefully out of date, with 90% of drivers being undiagnosed. The expected Guideline revisions are estimated to require about half of all CDL holders to be tested for sleep apnea.

While the FMCSA has not yet set a date for implementation or officially adopted the recommendations, there are a lot of good reasons for fleets to "get ahead of the curve" vs. waiting for a mandate:

  • Financial: Early programs have documented that they more than pay for themselves in reduced accidents, medical expenses, and employee turnover.
  • Safety / Risk: Evidence is clear that untreated drivers are 3-7 times more likely to crash, and as impaired as drunk drivers. Ignoring this dramatic risk factor for 28% of drivers is problematic.
  • Practicality: It is now a relatively simple matter to profile a cross section of employees and determine a target population of employees to be further tested (Web-Questionnaire).
  • Logistics: Ambulatory testing has proven itself to be an effective, viable, cost-effective method to test for OSA, which eliminates the need for the driver to travel to a sleep lab.
  • Success of treatment: Once identified as having sleep apnea, treatment methods are well understood and high-compliance treatment can be achieved for 90% of employees.
  • Liability: Many legal experts now say that as awareness of the issue continues to grow, the option of claiming "plausible deniability" of ignorance of the issue has passed. Failure to start a good faith effort at a program could lead to lawsuits for gross negligence.
  • "Stewards of public safety": As stated by one of the most respected VPs of Safety for a top ten fleet, "Safety Managers hold the responsibility of being sure our employees are fit for the responsibility of their duties, and as stewards of public safety, it is imperative that we ensure that these employees are not impacted by the negative effects of sleep apnea."

For more in depth information on sleep apnea, go to the following sites: