Although British truck drivers are regarded to be amongst the safest on the road there have been several fatal accidents involving HGVs that have been attributed to drivers falling asleep at the wheel.
When writer Bob Bluffield was finding it difficult staying awake during daylight hours he was referred by his GP to a sleep clinic. After discovering he had a common, yet potentially dangerous, sleep disorder, a simple treatment has provided a miraculous cure.
Although British truck drivers are regarded to be amongst the safest on the road there have been several fatal accidents involving heavy goods vehicles that have been attributed to drivers falling asleep at the wheel. In July 2006 a family of four were killed on the A34 near Bicester when a 30-tonne truck ran into a line of stationary traffic during the afternoon rush hour. The driver of the truck had been awake since 0430 and had started driving at 0700. He was found guilty of four counts of causing death by dangerous driving and sent to prison for three years and nine months. During his trial he told the court "something catastrophic" had occurred but he did not know what. Without knowing it, this driver had momentarily fallen asleep.
A few months later, a young car driver was killed on the M62 near Liverpool caused by another HGV driver who had fallen asleep. The victim's family discovered a year later that there had been four other similar accidents in a period of four months from October 2007 involving HGV drivers that had resulted in the deaths of nine people. After coming to terms with the dreadful events that had left the young man dead, during August 2008 the driver responsible, Colin Wrighton, began campaigning to raise awareness of the condition that had caused him to fall asleep.
The causes of these two major accidents could easily have been avoided had they been diagnosed correctly and were attributed to a condition known as obstructive sleep apnoea. This is a significant disorder that affects more than one in 50 adults, but is more prevalent in middle-aged men who are obese. In 2005 the BBC Real Story programme suggested that 41 per cent of HGV drivers have a sleep disorder of some form with one in six of them requiring urgent treatment for sleep apnoea, although most are unaware that they are sufferers. The condition is characterised by heavy snoring that leads to acute sleep disturbances that causes fatigue and sleepiness during the day. The British Sleep Foundation (BSF) considers lorry drivers to be particularly at risk because they are often overweight because of their sedentary working conditions, have unhealthy high-fat diets and work unsocial hours. One survey showed that 38 per cent of lorry drivers had a body mass index of between 25 and 30 and more than 50 per cent were regarded as obese with a body mass index over 30. Experts estimated that 80,000 of a workforce of half a million truck drivers may be suffering from sleep apnoea without knowing it. This is a frightening thought but HGV drivers are not alone and sleep apnoea also affects train drivers, airline pilots and motorists who are equally putting their lives and the lives of others at serious risk.
It is believed that one in five motorway and trunk road accidents have been caused by drivers falling asleep. Any driver who feels sleepy during the day obviously poses an extreme risk and drivers should seek urgent medical attention if they suspect they may have sleep apnoea before it leads to an accident. Research suggests that up to 20 per cent of UK road accidents have been caused as a result of sleepiness. But many drivers who may already be aware that they have a sleeping disorder are often deterred from seeking help because obstructive sleep apnoea is a condition that they are required by law to declare to the DVLA. Although this does not necessarily lead to a temporary ban until the authority is satisfied that the condition is being treated satisfactorily, there is a risk of this happening. Professional drivers are naturally worried that their jobs will be put at risk, although once treatment is being received it is normally successful within a week or so and driving can resume. Nevertheless a temporary ban is a better option than running the risk of a prison sentence for killing someone and employers need to be sympathetic if they suspect any of their drivers have the condition.
One of the more obvious symptoms of sleep apnoea is heavy snoring caused when the muscles in the throat relax during sleep causing insufficient air to pass through the airway. This wakes the sufferer for up to ten seconds while they gasp for air. If this occurs more than five times an hour the patient is considered to have sleep apnoea but in many cases air deprivation can happen 50 or more times an hour. In more serious cases breathing can stop up to 400 times a night and if left untreated can increase the risk of a stroke or heart attack and will aggravate existing health conditions such as high blood pressure, type 2 diabetes, heart and brain diseases. Some with the condition have also reported morning headaches, irritability and memory and concentration problems, but the condition is more commonly associated with falling asleep during the daytime. In its worst form some sufferers are even falling asleep while talking or eating.
The most concerning thing is that obstructive sleep apnoea is not always recognised by the medical profession. In the case of the M62 accident, the truck driver, Colin Wrighton, had been to his GP five months earlier complaining of tiredness but his doctor had instead checked him for diabetes. The test came back clear and the doctor told the driver that he was probably suffering from stress. Had the GP been more aware of sleep apnoea and had diagnosed this as a cause of his tiredness, then Mr Wrighton could have been referred to a sleep consultant. This would normally involve spending the night in a sleep clinic where he would have been monitored and his sleep patterns would have been electronically recorded. It proves there is a symptomatic failure of the system when GPs frequently miss obvious signs and fail to associate tiredness with sleep apnoea even though it is a common condition with serious implications. This could be causing scores of needless deaths every year. One study calculated that drivers suffering from sleep apnoea are 6-15 times more likely to become involved in a road accident; a mind-numbing statistic.
Obstructive sleep apnoea is usually very simple to treat. Sometimes it may require little more than a reduction in weight, stopping smoking or a reduction in alcohol intake. Most sufferers who have been diagnosed with the condition will be prescribed a positive airway pressure machine (CPAP) that is attached to a face mask that is worn over the nose (or nose and mouth) during sleep. This quietly blows filtered room air at a slight pressure into the wearer's airway during sleep that is sufficient to widen the throat cavity to assist normal breathing. Within a very short period of using a CPAP machine normal sleep is restored and the user is able to enjoy a much improved lifestyle without the risks of dosing off during the time they would normally be awake. Their partners and families also benefit by not being kept awake by constant loud snoring. Although vanity prevents a few from considering wearing a mask while they are in bed, because they are hardly sexy, the long term benefits of using a CPAP device far outweigh the disadvantages. There are other treatments that may be suggested. Dental devices, similar to gum shields, worn during sleep are proving to be successful by reducing snoring in some sufferers, whereby throat sprays are less so. A tonsillectomy or a surgical procedure to cut away excess skin to widen the airway can be a last resort option if other treatments fail to work.
At the inquest of Toby Tweddell, the victim in the M62 crash, the Coroner issued a Rule 43 report to the Lord Chancellor's Department that called for a toughening of the licensing of commercial drivers. He called for medical screening of all lorry drivers with a view to amending the DVLA medical examinations report form to improve the identification of sleep apnoea sufferers. He also highlighted the necessity for a fast-track medical examination of commercial drivers involved in road traffic collisions, and for better education to make drivers aware that diagnosis of sleep apnoea is almost certainly not the end of a driver's career. In November 2008 the Department of Transport responded by stating that current arrangements for the control of sleep apnoea are adequate. The Department also said no changes would be made to the medical examination report form completed by doctors with applicants for vocational driving licenses and he saw no need to change the frequency with which goods vehicle drivers should undergo routine medical examinations. The DVLA document INF4D notes that accompany the medical report clearly states: 'at least three in every thousand men' have sleep apnoea, although Dr Irshaad Ebrahim, Medical Director of the London Sleep Centre, believes 6-8% of the male population over the age of 50 suffer from the condition, so why are the authorities not giving the condition more prominence? Sleep scientist Melanie Marshall has said that "untreated, undiagnosed sleep apnoea individuals are more lethal on our roads than individuals who have been drink-driving".
This leaves drivers to bear the brunt of responsibility by notifying the authorities if they feel that they have a sleep disorder, but employers should also play their part by ensuring they adopt a sensible and mature approach by being sympathetic towards any of their drivers they may suspect of having the condition.
Useful web sites:
The Sleep Apnoea Trust: www.sleep-apnoea-trust.org
NHS Choices: www.nhs.uk/conditions/sleep-apnoea
Private Healthcare UK: www.privatehealth.co.uk/diseases/sleep-disorders/obstructive-sleep-apnoea/
The British Sleep Society (regulations on sleep apnoea and driving) : www.sleeping.org.uk/dvla_advice.aspx
Most sufferers who have been diagnosed with sleep apnoea will be prescribed a positive airway pressure machine that is attached to a face mask that is worn over the nose (or nose and mouth) during sleep.