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America toughens up on drivers with sleep apnoea

May 16, 2012
The inherent dangers of sleep deprivation among drivers was highlighted in my article in The Mover (April 2011) and now, according to reports appearing in mainstream publications and online, there is a move by the US authorities to get much tougher with those who either do not seek treatment for the condition or find that treatment is ineffective. By Bob Bluffield.

The inherent dangers of sleep deprivation among drivers was highlighted in my article in The Mover (April 2011) and now, according to reports appearing in mainstream publications and online, there is a move by the US authorities to get much tougher with those who either do not seek treatment for the condition or find that treatment is ineffective.


Sleep apnoea is (or apnea in the US) is a common yet serious condition characterised by abnormal breaks in breathing patterns during sleep that can last from a few second to several minutes and can occur up to 50 times or more every hour. This results in daytime drowsiness that can cause sufferers to fall asleep without warning. The disorder is typically common amongst people that are obese and those that have sedentary lifestyles. Sleep apnoea, once identified, is normally easy to treat.

Writer Todd Dills reported in the American trucking magazine Overdrive (January 2012) that the Federal Motor Carrier Safety Administration (FMCSA) panel is in favour of screening drivers that do not meet specific body mass index (BMI) requirements. The FMCSA's Motor Carrier Safety Advisory Committee and the Medical Review Board support a move to evaluate any interstate commercial driver with a BMI of 35 or higher. According to the report, this is likely to be any driver who is 6-foot tall, weighs 258-pounds (18.42 stone) and has a BMI of 35. This move follows other recommendations in recent years that could result in drivers with BMIs of 30-35 being required to be mandatorily screened. Further, drivers who have failed to meet the following criteria would be subjected to immediate disqualification:

  • Having reported excessive daytime sleepiness
  • Having had a sleep related accident
  • Exhibiting apnoea-hypopnoea index (AHI) scores of 20 or greater, until they've had effective treatment
  • Having had surgery to correct sleep apnoea and are awaiting operative evaluation
  • Those that have been found to be effectively noncompliant with their treatment

The above criteria, issued by the FMCSA and the Medical Review Board, were regarded as short-term guidance until sleep disorders can be officially codified and be included in regulations. A draft for such new regulations was issued by the authorities during February but could take several years to implement. Another US based publication, Today's Trucking, reported that if the proposals raised by the FMCSA were accepted, provision would be made to allow a driver suffering from sleep apnoea to get a 60-day conditional card during evaluation and treatment for the condition. It was not made clear however whether this would allow an individual to continue driving while evaluation was taking place.

Concern over the risks of sleep related accidents were criticised by Todd Spencer, Vice President of the US Owner-Operator Independent Drivers' Association who posed the question: "If these staggering numbers have some real live applications, why don't highways all over America look like war zones today?" Mr Spencer was also quoted in the Huffington Post (20 December, 2011) to have said: "It is more likely that sleep-deprivation accidents occur among truckers more often because of just pure exhaustion than sleep apnoea."  He continued by stating: "Does apnoea result in very many crashes? Real accident analysis suggests it doesn't. It's going to be far more likely that somebody just didn't have the opportunity to get restorative sleep because that's not an easy thing for truck drivers to do". These comments appear contradictory considering that any form of sleep deprivation can be a contributing factor in accidents. Spencer's comments have been countered by Charles A Czeisler of Harvard Medical's Division of Sleep Medicine quoted in Overdrive by saying: "It is actually a war zone out there ... 20 per cent of all crashes (not just truck related) are related to drowsy driving, and  two million drivers a week in the US nod off at the wheel. With fatalities related to drowsy driving occurring once every 70 minutes on average, that's equivalent to two 9/11 events every year."

Wanda Lindsay, a resident of Texas has been a widow since an 18-wheeler truck driven by a driver who had previously been diagnosed as suffering from severe sleep apnoea crashed into their car.  Mrs Lindsay had no doubts about the dangers of sleep apnoea when she told the Austin American-Statesman "If you could have seen the scene that killed my husband ... or any other scenes that have been tied to sleep apnoea ... it does look like a war zone". She asked: "How many other families are going to be torn apart before we do something?" The FMCSA has stated that as many as three in ten truck drivers in America suffer from mild to severe sleep apnoea. Anne Ferro, Administrator of the FMCSA, quoted in the March issue of Overdrive said there had been 3,675 truck-involved accidents during 2010; about 500 involved a fatigued truck driver. She added, "Trucking cannot ignore a health condition whose primary symptom is chronic fatigue."

One trucker who had been required to be assessed because his body mass index and weight were in the category that put him at risk called it an "apnoea witch hunt" after he claimed he had been pigeon-holed purely because of his weight. He told Overdrive that he had not had any sleep problems but is still required to have monthly checks and had been told to use a CPAP machine despite not having sleep apnoea. The driver claimed that this is just  "raking in dough for the sleep clinics".

On a positive note, many truckers had been surprised, when they did receive treatment, just how quickly results were achieved. Many had been sceptical but found the treatment, usually from using a continuous positive airway pressure machine (CPAP) to be extremely effective.

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