Article

The Silent Killer

Two fleet drivers shared their experiences with obstructive sleep apnea testing and treatment programs sponsored by their carriers.

July 2008, TruckingInfo.com - Feature

by Bette Garber, Contributing Editor

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Two fleet drivers shared their experiences with obstructive sleep apnea testing and treatment programs sponsored by their carriers. Both are enthusiastic about the results and thankful to their employers for putting them on the highway to a healthier life and lifestyle.

Tim Ucciferri, Matthews, N.C., drives for Schneider National. The 37-year-old is one of thousands of drivers in the fleet to participate in the first comprehensive in-house program to diagnose and treat OSA.

He describes himself as a large man, 300 pounds and 6 feet tall. His weight is a primary indicator for the sleeping disorder. As part of Schneider National's sleep apnea screening program, he was asked to fill out a questionnaire, checking off symptoms.

"I had suspicions that I might have [OSA]," he admits. Until a few months ago, he felt tired and run down pretty much all the time, but he was accustomed to it, working around the symptoms with the help of naps, coffee and snacking.

Like vast numbers of drivers who suspect the same and fear getting diagnosed, he admits, "I was afraid it would cost me my job and put restrictions on me. I was reassured [by Schneider National] and told, 'Absolutely not. We will give you the help you need.'"

The test was not what he expected. "Schneider routed me with a load to Indianapolis, where I had the test done. I didn't have any downtime, which was great. The room was really nice, a private room with private shower."

He was wired with sensors on his legs, chest, head and on/around his face.

Throughout the night he thought he slept well and woke up thinking, "There's no way I have [OSA]."

He was wrong. Tests proved Ucciferri was one sleepy truck driver with severe obstructive sleep apnea.

Immediately outfitted with a new CPAP machine, he was directed to drive to a company garage where an inverter was installed in his truck to power the device. Then he was on his way again. "That machine is my new best friend," he says.

He wears a mask, connected to the CPAP by a hose, while sleeping. It covers the nose and provides a gentle flow of air that keeps the upper airway open, stops the sleep interruptions, and allows him to reach the deepest levels of recuperative sleep. His appearance has changed. His family and friends comment on his weight loss, healthy color and high energy level. 

"It's such a dramatic change, better for the company and me as driver. I'm more productive. No more multiple naps and I'm still refreshed at end of the shift. Getting a good night's sleep has changed my life." 

Ucciferri talks to a lot of drivers now, eager to share his life-transforming experience. "Schneider makes everything so easy, kind of like your mom walking you through something scary."

Another success story comes from senior driver/mentor Kenneth Armstrong, 54, a fleet driver for Swift Transportation. He is a big man and got bigger when he stopped smoking in 1993. 

Armstrong had previously undergone surgery to correct OSA in 1998; it only partially corrected the problem. He asked to be part of the fleet's aggressive screening/treatment program for OSA. He was routed to a sleep lab, given a CPAP in his truck after diagnosis, and was immediately sold on the machine.

"When I went on the CPAP, it made a huge difference. I am more productive, more focused, and possess more energy," Armstrong says. "I can drive a full shift with no hint of fatigue. Before, I needed a nap every three to four hours. It is absolutely night and day. I believe I'm a much better and safer driver because I was treated." 

Sleep Apnea Checklist

Understanding the cause and effects of obstructive sleep apnea.

Following are the top 15 Indicators For Obstructive Sleep Apnea (OSA)

1. Loud snoring

2. Gasping or interrupted breathing while sleeping 

3. Daytime sleepiness 

4. Obesity

5. Thick neck and stomach

6. Dry throat upon awakening

7. Morning headaches

8. Inability to concentrate

9. Nighttime heartburn

10. Frequent night awakening.

11. Lack of exercise

12. Middle-aged males, typically over 35,
are most at risk for OSA, outnumbering 
women 2-to-1, but the disorder can 
strike anyone, at any age.

13. Adult-onset diabetes

14. Hypertension

15. Heart disease

Who Is At Risk

It has been estimated that as many as 20 million American adults have sleep apnea and more than half of these are overweight. The typical OSA candidate is a middle-aged man. The disorder becomes more common with aging, particularly among post-menopausal women. 

What Is Sleep Apnea?

Obstructive sleep apnea (OSA) is a sleep disorder in which a sleeper's breathing is repeatedly interrupted, from a few seconds to minutes per episode. These interruptions occur throughout the sleep period, as frequently as several hundred times per night, moving the sleeper out of deep restorative sleep and into light sleep with every episode. 

The frequent interruptions of deep sleep leave the sleeper tired upon awakening and excessively sleepy during the day. 

Left untreated, OSA can lead to life-threatening health problems, including stroke, heart attack, and coronary artery disease as well as high blood pressure, Worse, it will affect job performance, increasing the risk for motor vehicle accidents.. 

Causes

Blockage in the upper airway is the basic cause. Apnea can occur when the throat muscles and tongue relax during sleep and partially block the airway opening. Airways also can have an excess amount of tissue, narrowing the airway. The blockage prevents air from reaching the lungs, eventually causing a decrease in the oxygen content of the blood. On sensing the decrease in oxygen, the brain arouses the body from sleep, and the person awakes gasping for breath (but frequently does not remember waking). These frequent awakenings result in highly disrupted sleep and chronic exhaustion during waking hours.

Diagnosis and Treatment

Spouses are typically the first to notice the heavy snoring and breathing irregularities. Coworkers may notice that the individual falls asleep at inappropriate times during the day. 

Diagnosis is based on medical and family history, physical exam and results from a sleep study, which is typically done at a sleep center/lab. Here the patient is wired with sensors and sent to bed. Technicians monitor the sleeper's brain activity, eye movement, breathing, heart rate, air movement in lungs, oxygen levels in the blood, and other muscular activity. 

New technology, now permitted by Medicare, allows self-testing in one's own bed/bunk. 

The most common treatment for moderate or severe OSA is Continuous Positive Airway Pressure (CPAP). This is a machine which uses a mask placed over the nose (sometimes mouth as well) to deliver a gentle air flow into the throat to keep the airway open throughout the sleep period. Other treatments include dental appliances, surgery, and lifestyle changes.

Apnea Testing Available at Travel Centers

On a delivery in California, Iowa long hauler Linwood Hunt scratched his shin bone on a pallet. By the time he got to Idaho, the scratch had turned red and grown considerably. As he continued east, he began experiencing chills alternating with feverish episodes, nausea, and headaches. 

"I was sicker than a poisoned pup," he recalls. 

The question of stopping to have the wound looked at was out of the question, he says. "I was afraid I'd get stuck in a hospital and I had a load to deliver." Besides, there was no convenient place to seek help - not for someone driving an 18-wheeler.

Like Hunt, millions of hard-working Americans have been isolated from even the most rudimentary health care while performing their job on the nation's highways.

Bringing medical clinics into travel centers is an idea whose time has finally come. Within the last year, eight of these conveniently accessible medical clinics have opened at travel centers, with about 100 slated to be open within the next three years. No appointment is necessary, and hours of operation are lengthier than at a standard doctor's office. Services are networked, meaning an over-the-road driver's information is available in all clinics coast-to-coast. Serious medical conditions are referred to a local affiliated hospital.

Typical medical services at these clinics include:

DOT-related medical testing

(physicals, drug screening, 

breath alcohol testing) 

Sleep disorder screening

First aid and minor trauma care

General health care

Vaccinations and flu shots

Prescriptions and antibiotics

Wellness management

Weight loss and quitting smoking

Dentistry and chiropractic care at some locations

In 2007, Professional Drivers Medical Depots opened its first four facilities in Tennessee, Georgia, Illinois and Arkansas and has plans to have 15 opened by the end of 2008. The clinics are located in Petro Stopping Centers, Travel Centers of America, and Sapp Bros. PDMD's service is provided solely to professional truck drivers and truck-related professionals.

Another company, Roadside Medical Labs and Clinics, partnered with Pilot Travel Centers, recently launched its national network of medical clinics with three facilities located in Pilot Travel Centers locations in Cartersville, Ga., Knoxville, Tenn., and West Memphis, Ark. A clinic in Amarillo, Texas, is slated to open this month. Roadside plans to deliver 16 additional locations in 2008 and 20 more in 2009. 

Testing for OSA

Both PDMD and Roadside Medical are helping to diagnose and treat sleep apnea for the thousands of drivers who suspect they have sleep apnea, and cannot, or are unwilling to, schedule an overnight visit to a traditional sleep lab. Now they can be tested in the comfort of their own truck bunk.

New diagnostic technology makes it possible for truckers to pick up a small sleep-screening device at one of these clinics, take it back to their truck, sleep in their own bunk, and return the device (which now holds a record of their sleep activity), to the clinic. The information is downloaded from the device, sent to an expert sleep center, and diagnosed. Another sleep period is required with a CPAP machine. The results of that test provide an appropriate CPAP pressure number. The clinic can then either provide a CPAP or write a prescription for one, on the spot. 

Each clinic uses a different detection device. Roadside Medical is teamed with Braebon Medical, using its MediByte Screener and is affiliated with Apnea Management Services for diagnosis. Professional Drivers Medical Depots uses ResMed's next generation ApneaLink screener. Both of these devices are palm-sized, easy to use and light-years away from the old sleep tests that required an hour or two of wiring the patient with sensors.

A study used by the FMCSA's Medical Research Board provided an analysis of a variety of these portable devices. Results showed that while none of the instruments are as thorough as a sleep lab test, "they are potentially a good alternative and a less expensive option."

Why Truckstop Clinics

PDMD researched its target audience before opening, and the results showed that 56 percent of truckers had difficulty utilizing healthcare services at home, that 47 percent of those surveyed lacked a regular healthcare provider, and 20 percent frequented emergency rooms and urgent care centers. 

Roadside Medical's early research showed long, stressful hours behind a steering wheel and little, if any, exercise leading to excessive weight gain in drivers, elevated cholesterol levels, and high blood pressure. It showed that many truckers delay seeking the help they need when sickness strikes. 

To address the lifestyle issue and bring truckers closer to a healthier lifestyle, Roadside Medical also offers a $9.95 per month Wellness Program. It provides an exercise program, nutrition guidance, help quitting smoking, ongoing physical reviews, and phone access to professional wellness coaches.

For drivers who do not carry insurance, PDMD also offers a Professional Driver Insurance Program, which includes customary insurance coverage and benefits such as medical, dental, vision, accident, and a 24-hour medical hotline. 

"Research shows there are more than 3.2 million professional drivers in the United States, and at least one million of those drivers are not currently covered by medical insurance," said John McElligott, chairman and chief medical officer of PDMD. 

The Professional Driver Insurance Program is available in four categories: single members, member and spouse, member and children, and family coverage.

More information about PDMD and PDIP can be found at the company's website, www.pd-md.com. Roadside Medical's website is www.roadsidemed.com.

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