Carriers wake up to Obstructive Sleep Apnea

Momentum for broader fatigue management is building without government mandates

By John Hill

Since the Federal Motor Carrier Safety Administration (FMCSA) came into existence in 2000, the agency has imposed myriad regulatory challenges and new requirements for commercial carriers in the trucking and motorcoach industries to navigate.

Significantly, one issue — driver fatigue — is being tackled from three different angles.

In response to congressional mandates, there have been two instances of hours-of-service regulations issued since 2003 and a third regulation is under way, due for release in July.

The National Transportation Safety Board has issued a series of recommendations to FMCSA for changes to existing rules touching on driver fatigue while calling for new regulations. One example has been to screen drivers for Obstructive Sleep Apnea (OSA) as part of an overall fatigue-management program. So pervasive is the OSA problem that the NTSB has issued similar warnings to the aviation, maritime and rail industries for their employees.

Most significantly, FMCSA’s new Compliance, Safety, Accountability program, or CSA, attempts to expand the scope of regulatory oversight of motor carriers and drivers. The program will add tools to the conscientious safety manager’s toolbox and identify trends in driver behavior — including fatigue — before they cause crashes.

Yet, while drivers and motor carriers await the new hours-of-service rule and adjust to CSA, momentum for broader fatigue management among the most safety-conscious motor carriers is building without government mandates.
I believe this self-imposed leadership by a few carriers holds more promise than any regulations or laws. Much debate surrounds the hours-of-service rule and its effect on driver health, but reducing the hours a driver can work or drive will not remedy the health problems caused by obstructive sleep apnea.

In fact, the effort expended on HOS changes is likely to produce fewer safety benefits than the industry could capture simply by aggressively addressing the health of today’s commercial drivers through targeted treatment of OSA.

Studies show that people with untreated sleep apnea face a long list of increased health risks, including hypertension, Type 2 diabetes, memory loss, chronic fatigue, obesity and a doubling in the chance of heart attack and stroke.

OSA deprives a driver of deep sleep by obstructing the airway in the back of the throat for 10 seconds or longer. Reduced oxygen wakes the sleeper just enough to start breathing again but not enough to remember the action. This can happen more than 50 times per hour. The result is a driver who is almost as fatigued in the morning as when he retired for the night — and doesn’t know why.

Estimates vary, but information from one study in 2006 that the FMCSA Medical Review Board drew on to provide recommendations regarding medical requirements for commercial vehicle drivers, suggested between 24 percent and 41.9 percent of all commercial drivers could qualify for OSA screening.

The MRB recommended in January 2008 that FMCSA make substantial changes to the current guidelines pertaining to OSA. In retrospect, I regret not issuing updated guidelines to medical examiners when I was FMCSA administrator. Though the Administration does make them part of a regulation, such guidelines would increase the medical examiner’s attention and focus on improving health and reducing fatigue. This group of chronically sleep-deprived drivers is weary not because of long hours of driving but rather by losing sleep to OSA.

I commend companies such as Schneider National and J.B. Hunt for proactively addressing this issue among their drivers. Interestingly, they not only have had significant safety benefits from their self-initiated OSA treatment programs, but they also have saved considerable company money in the form of reduced medical and insurance payments.

OSA testing and treatment options are varied. Traditional testing can require two or more overnight stays in a sleep clinic to test for OSA and determine if the patient will benefit from sleeping with a special mask that keeps the airway open with a continuous flow of air.

As fleet owners require healthy and treated drivers for daily duty, commercial drivers must undergo a diagnosis and receive treatment expeditiously. Ambulatory testing of drivers, which can be done while a driver sleeps at home, in a hotel or even in a sleeper berth, holds tremendous promise for companies that take this task on voluntarily.

Savvy industry executives who realize how essential their drivers are to business view the treatment of OSA as an investment in their drivers, their families and the company’s viability. The data clearly shows that through effective management of OSA, individuals experience improved quality of life and fewer catastrophic illnesses and diseases.

Alerted to the dangers posed by overweight and related OSA, a driver for the J.B. Hunt trucking company responded by losing 110 pounds. He then went on record to say his company had essentially saved his life by investing in OSA treatment driver. Such actions by carriers throughout the commercial transportation industries have resulted in improved driver retention.

Motor carriers have a unique opportunity to address potential safety liabilities within their companies by establishing OSA programs. Once they accomplish this, their reward will be healthier, happier and more productive employees with fewer health claims, as well as reduced crash numbers and workplace injuries.

Get ahead of the regulatory machine and avoid complicated, costly and restrictive regulations. Self-imposed changes are likely to yield the most resilient motor carrier industry.  BR

John Hill, principal for The Hill Group, Greenwood, IN, serves as Industry Adviser for SleepSafe Drivers Inc, Laguna Niguel, CA, which provides programs to reduce sleep apnea risk for drivers of commercial vehicles drivers. Hill also is the former Administrator of the Federal Motor Carrier Safety Administration (FMCSA).