Sleep Apnea and the Trucking Industry

September 2016 train crash in Hoboken, NJ.

The Trump administration has recently ordered the Department of Transportation to withdraw a proposal put forth by former President Barack Obama that would require truck drivers and other heavy equipment operators in the transportation industry to undergo mandatory sleep apnea testing. Obama’s proposal was made shortly after the September 2016 train crash in Hoboken, New Jersey that killed one individual and injured over one hundred others. It was found after an in-depth investigation into the accident that the driver had an undiagnosed condition known as Obstructive Sleep Apnea. The Trump administration has stated that their revocation of this suggested safety precaution is part of a larger attempt to roll back trade and commerce regulations across the board in order to expand the economy and create jobs. However, the National Transportation Safety Board and senators such a Chuck Schumer (D-N.Y.) and Cory Booker (D-N.J.) vehemently oppose the Trump administration’s decision, stating that public safety is being put at risk. Schumer and Booker have introduced a Bill that would make sleep apnea testing for certain populations in the transportation industry mandatory. There are larger trucking companies that already require their drivers to get tested.

What is Sleep Apnea?

While there are different forms of sleep apnea, Obstructive Sleep Apnea (OSA) is the most common. OSA is a condition that is triggered when an individual’s airway collapses during sleep. A person with this disorder stops breathing at different intervals of the night, disrupting their deep sleep pattern at a frequency that can reach 400 times a night. Essentially, when someone that suffers from OSA stops breathing, the body responds by waking that individual from the deep sleep we all need to feel truly rested and remain alert throughout the day. While some cases of OSA are relatively mild, more serious cases mirror narcolepsy, a condition in which those inflicted by the disorder will spontaneously fall asleep.

Why are Truck Drivers at Risk?

There are many underlying causes for OSA including high blood pressure, type 2 diabetes, age, high BMI, and having an irregular rest schedule. All of these health concerns are common in the trucking industry. Many drivers live a largely sedentary lifestyle, healthy food choices are not easily accessible on the road, and HOS (Hours of Service) regulations can create erratic sleep schedules.  The FMCSA estimates that 28% of all truck drivers have mild to severe sleep apnea.

How big of a problem is Obstructive Sleep Apnea?

While leaders in the transportation industry have long recognized that OSA is a major safety concern, there have been few studies that provide statistical data to back those trepidations until recently. In 2016, researchers from the T.H. Chan School of Public Health at Harvard University made an in-depth inquiry into OSA in the trucking industry by observing thousands of drivers who suffered from OSA and creating a control group of drivers who did not. They also split the study further making note of the driving records of those drivers who sought OSA treatment and those who chose to forgo treatment. The study found that drivers who received treatment had safety ratings nearly identical to drivers who do not have the condition. However, drivers who have OSA and did not seek treatment were five times more likely to be involved in preventable accidents. Senior author of the study, Stefanos Kales, argues that “Up to 20% of all large truck crashes are due to drowsy or fatigued driving, which would account for almost 9,000 fatalities and up 220,000 serious injuries.” The researchers concluded that OSA was pervasive enough that regulatory agencies owed it to both truck drivers and the general motoring public to require testing.

What does this mean for drivers?

The primary argument against OSA testing for commercial drivers is the expense. Payments for sleep testing are occasionally paid for by larger trucking companies, but many drivers are uninsured or have very high deductibles. There are at home sleep tests that range from $150-$500, but sleep-center studies can be as expensive as $4,000. Sleep centers studies also require drivers to take a significant amount of time off of work – time that many drivers cannot afford. That is only the cost to receive a diagnosis. Approved treatments for OSA are limited and the most common treatment is the use of a pressurized breathing machine or CPAP machine. This machine can cost $1,500 to $3,500 and is not covered under all insurance plans. Drivers are required to pass a “medically-qualified-to-drive,” exam in order to continue driving (frequency varies by state). If regulations were passed without provisions to help drivers mitigate the monetary cost of having OSA, many drivers could not pass their medical examinations and lose their means of livelihood.

CPAP diagram

Final Remarks

OSA is a hefty concern for those in charge of public safety and individuals in the trucking industry, particularly truck drivers. While Congress and other regulatory agencies debate on how to best address the safety concerns raised by OSA, there are a few things truck drivers can do. OSA can be reversible with some lifestyle and habit changes! For some, weight loss through exercise and diet can significantly improve and even eradicate OSA symptoms. Some corporations are taking their own action including instituting corporate wellness programs such as the one implemented by Celadon Trucking called “Highway to Health.” With others it may be as simple as making healthier food choices while on the road, which can make a huge difference.




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