How Not to Lose Sleep over Apnea

January 2016, - Department

by David Cullen, Executive Editor - Also by this author

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A common therapy for obstructive sleep apnea is continuous positive airway pressure, known as CPAP. Photos: Safety First Sleep Solutions
A common therapy for obstructive sleep apnea is continuous positive airway pressure, known as CPAP. Photos: Safety First Sleep Solutions

There’s no federal rule in place to govern the testing and treatment of sleep apnea for truck drivers. Yet mounting evidence of the costly impact of not treating this medical condition can have on highway safety and on driver quality of life should keep fleet managers awake at night.

Thunderous snoring is the punchline of many a joke, but when the hallmark of an apnea sufferer, it’s no laughing matter. The National Institutes of Health says sleep apnea is a common, and usually chronic, disorder that causes a person to take one or more pauses in breathing or to breathe shallowly while asleep. “When you try to breathe [during sleep with apnea], any air that squeezes past the blockage can cause loud snoring,” NIH says.

The pauses can last a few seconds or extend for minutes and may occur 30 times or more an hour. The condition disrupts sleep in such a way that the sufferer moves in and out of deep and light sleep. That results in poor-quality sleep, leading to chronic sleep deprivation. And that brings on fatigue, revealed as excessive daytime sleepiness.

The most common type is obstructive sleep apnea, in which the airway collapses or becomes blocked during sleep. Studies have found that OSA affects 2 to 4% of middle-aged adults and that drivers with OSA have an increased crash risk that can be 2 to 4 times that of the general population.

A University of Iowa study looked at what happened when individuals with an OSA diagnosis entered into “microsleeps” while on an hour-long drive in a high-tech simulator. As explained by risk-management firm Circadian, a microsleep is a “brief sleep episode that lasts up to 30 seconds, during which a person temporarily loses consciousness and external stimuli aren’t perceived.”

That’s more than enough time for things to go horribly wrong on the road. The UI study authors reported that the OSA-afflicted drivers “showed significant deterioration in vehicle control during the microsleep episodes… The degree of performance decrement correlated with microsleep duration, particularly on curved roads.”

As if substantially upping the risk of a driving or a work-related accident weren’t reason enough to seek treatment, per NIH, untreated sleep apnea can also:

  • Increase the risk of high blood pressure, stroke, diabetes and obesity
  • Increase or worsen the risk of heart failure
  • Make arrhythmias (irregular heartbeats) more likely

The Virginia Tech Transportation Institute points out that beyond negatively affecting any apnea sufferer’s health, untreated OSA can be especially dangerous for truck drivers. “Excessive daytime sleepiness may negatively influence behavior, and can result in poor judgment and impairments in concentration, memory, and cognitive function.”

VTTI Research Associate Erin Mabry, who co-authored a case study on the impact of apnea treatment offered by motor carriers, says such programs significantly cut accident and medical costs — and help trim driver turnover.

That was demonstrated in the study’s review of a pilot program to screen for and treat drivers for OSA set up by Schneider National. “The fleet said it wanted to address sleep apnea before any regulation came about,” Mabry explains.

While being studied, the carrier’s screening led to OSA treatment for 348 drivers. The fleet saw a 48% cut in medical costs and a 73% drop in preventable accidents, Mabry says. “And they saw the retention rate for those drivers climb to two to three times that of their overall driver population. I think that shows the drivers really appreciated that Schneider offered the program to them free of charge.”

Todd Simo, chief medical officer of Charlotte-based HireRight, says that while truck drivers above all should be concerned about OSA as it affects their ability to work, the condition should also “concern every employer who cares about their employees. On top of that, the 20 to 60% higher accident risk of those with untreated OSA can increase the cost of accidents and litigation to the point of shutting down smaller companies.”

Apnea is a condition that can lead instantly to a fatal crash but also can cause a lifetime of daily suffering while piling on long-term health risks. Screening for OSA and then providing treatment if needed is the most direct way a fleet can help drivers gain relief from the condition and go on to be safer and healthier employees.

What you can do

Fortunately, concerned fleets are finding that employment-related service providers are offering programs aimed at making OSA screening and treatment cost-effective and simple to implement.

“It just makes tremendous financial sense for companies to be proactive,” says Robin Ivany, general manager of one such provider, Safety First Sleep Solutions, Girard, Ohio. “This health condition creates a tremendous liability for companies, mostly because most people that have sleep apnea do not even know it.” 

SFSS has come up with affordable testing and treatment solutions for sleep apnea geared toward truck drivers. “We use a convenient, low-cost testing system that enables patients to be screened in the comfort of their homes,” Ivany explains, “and there are sleep-therapy experts available 24/7 to assist with any questions or problems.”

She says the company also offers “a cost-effective CPAP and power supply combination to provide effective FMCSA-compliant apnea treatment for use in a sleeper berth equipped truck.” Ivany adds that a big part of SFSS’ effort is to educate drivers and the industry about sleep apnea.

HireRight’s Steven Spencer, managing director of transportation and health care, says a new sleep-apnea study service launched as part of the firm’s driver- health screening offering makes tacking OSA “easy and convenient for drivers and helps motor carriers maintain compliance, mitigate risks, reduce costs, and improve retention.”

He explains that HireRight provides a portable testing device that can be used at home or in a sleeper berth, so a driver need not stay overnight at a sleep-study lab. The program includes “concierge-level service for both the driver and motor carrier throughout the process.”

“Effective treatment can show marked change right away,” says HireRight’s Simo. “And epiphanies often result. After sleeping well, those treated realize ‘fatigue stinks.’”

Safety aside, he adds, “Who wants to be tired all the time?”


  1. 1. John Smith [ January 22, 2016 @ 03:53AM ]

    Sound like an article written by and for the sleep industry. The problem is the government regulating a health issue. We had sleep apnea program. 35% of our drivers were flagged for needing a sleep study and of those, we could count on 90% coming back with a positive diagnosis for sleep apnea. Of those, well over half couldn't adjust to their machine, and now here we are 3 years later, and for the drivers still with us, most 'use' their machines 30 days before a physical so they can get enough compliance data to get past a dot physical. I don't doubt the effects of sleep apnea, but I do doubt that 35% of truck drivers have the condition. Not only that, there is debate within the medical community on the efficacy of CPAP machines. There are alternatives to it, but you can't get compliance data from breathe right strips or mouth inserts. Longitudinal studies are dismal when it comes to CPAP. The majority of folks put on CPAP no longer use it 3 years later because there is no perceived benefit. I'm sorry, I think if a driver seeks treatment find, but to go looking for a condition in 35% of a particular demographic is a money grab and a witch hunt. The first line says all that needs to be said, "There is no federal rule" and it should stay that way.

  2. 2. Randy Gehrke [ January 22, 2016 @ 04:46AM ]

    God blessed me with a big neck, even as a Marine, I had a big neck. Add some weight later in life and I still have a big neck. Add weight, big neck and 50th birthday and I must have Sleep Apnea when renewing my medical card. A sham of a sleep study designed to sell CPAP machines. I sleep worse with it and only do for the months before renewing card. In fact, I am more of a danger when using the machine. I get for some this is life changing. My best friend has battery packs for his CPAP when we camp with no power. There is a valid situation for some people. But this crusade has went way over the top. We put the fox in charge of the hen house and of course they are going to say it is worse than it is to sell more studies and machines. Glad I am at a point I can drop my CDL. I feel sad for those coming into the industry and get why they don't. It is not fair to say there is no federal rule on sleep apnea, clinics say they have to screen for it to be certified.

  3. 3. Vee [ January 22, 2016 @ 05:46AM ]

    This B.S. of the one size fits all in the medical field has to go...I'm a big girl and always have been a big girl (all my life) and they just looked at me and started asking the questions about sleep apnea. I got nasty with the dude and asked him if he was going to pay my bills, run my business and drive my truck, things changed real fast on how the exam went after that....not saying it will happen with every DOT exam, but NO one knows your body better than YOU!!! They have become bullies in the md's office all behind the dollar...DO NOT let them tell you what is what!! If you're reading this, then you also have access to a computer, look it up and go in there knowing a little sumin sumin

  4. 4. Joe [ January 22, 2016 @ 10:33AM ]

    My doctor confirmed CPAP machines have a 50% success rate (read that 50% failure rate). I know I had sleep apnea but couldn't stand the machine. My wife said the machine made more noise than my snoring. I started sleeping in a different room and found that before long my symptoms were gone. My wife also said my snoring stopped. I am convinced a change of mattress was the key. I mentioned it to my doctor but he didn't want to hear any of this. Maybe he doesn't get a kickback on mattresses.

  5. 5. Steven Scott Duff [ January 22, 2016 @ 03:08PM ]

    This is nothing more than a way to rip truck drivers off they say you have sleep apnea and you cant drive unless you buy their expensive equipment this equipment is sold by buddies of the FMCSA YOU HAVE NO CHOICE this practice should be illegal sleep apnea is bullsht its not even a real thing no other careers do this to their employees FMCSA you can GO FCK YOURSELF WE WILL TAKE OUR COUNTRY BACK AND YOU WILL BE OUT OF YOUR JOB.

  6. 6. Frank Thompson [ January 23, 2016 @ 12:34PM ]

    Many of you commenting, all say that you don't need a CPAP machine, well I'll be the one that says that the machine saved my life. I've had mine since 1994 and I would literally kill you if you tried to take it away. Before I got it though I was in denial like many, saying that I didn't need it until I took the sleep study, and got the best sleep in my life after they put me on the machine. In those days you went to the hospital and did the study. The techs told me they could have jack hammered the floor because I went into such a deep sleep. Even today, I have to rely on my wife to wake me up because when my head hits the pillow and I turn on the machine I'm out for the night until I wake in the morning. I'm glad I work from the house and I don't have to be at work by any certain time, because it would be bad. I don't even hear the alarm clock, when it goes off for my wife. I started driving a truck in 2006, and I've always have had my machine, and now when they tell me, I need to produce my data, Its right there for them. To answer the questions to some above, sleep apnea is real and it's deadly if not treated. Keep denying that you don't need it until you run over someone, then what are you going to do, say that it wasn't your fault, when it was.

  7. 7. Keith [ January 24, 2016 @ 02:52PM ]

    Frank you are in the minority and we are thankful that this device has saved your life and means so much to you. However, this does not support the fact that it does not work for far more than it supposedly works for. I agree with the other writers that this is a typical "Good Ole Boy" backdoor money in their pockets program that is being jammed down truck driver's throats. What's next to be jammed down our throats? A special high priced shoe to stop hang nails. A special pair of ultra expensive glasses to prevent headlight glare from idiot four wheelers that don't know how to dim their headlights? What everyone is saying is that sooner or later this mass jam it down the truckers throat for profit has got to stop. We already experience enough extortion at the scale houses and roadside with DOT inspections. Is it going to come to a point that we have to pay the carrier to work? Government intervention into our lives has gotten way out of control and most people are too blind to see it because those doing the governing, rule making and manufacturing of expensive toys are only looking at profits and big gains into their pockets. If you think it is all about safety then why do cops, fire-fighters, emergency room doctors not have all this crap jammed down their throats? Everything is about money and it is disguised a safety benefit. A big BS to all that. I have lived 62 years without all this crap and when God decides it is my time to go I will go. And He doesn't need an sleep study or a CPAP machine to tell him when my number is up. So, like so many others; I will turn in my CDL before I use one of these machines. And believe me I have tried using them and they are worthless, annoying and I too got little to no rest with one. So, if it helps you; more power to you. But make it my decision not some bureaucrat that is trying to justify his/her cushy government do nothing job.

  8. 8. GC [ January 25, 2016 @ 08:05AM ]

    I have to say, Frank and I are in the same boat "No one" touches my machine. Since I got mine in 2005, I've been sleeping like a baby and my overall health has improved. Trust me folks I cried BS on this whole issue until I finally gave in and had a sleep study. The folks that struggle with their machines are folks that are still in denial and are not taking the steps to have the machine fitted for them. They instead try to fit themselves to the machine and that will always fail. My wife said my machine makes sounds that actually help her sleep. Personally I think she sleeps better knowing I'm not going to have a heart attack or swallow my tongue during the night. I don't like the bureaucrats getting into my business for any reason. However, I always amazed that whenever there is rule or guidance laid out to people there is always this same outcry. Hmmm very similar to the Seatbelt outcry a while back. The fact is SA is a problem and especially for CMV drivers therefore if you truly care about Safety then saddle up. Just Saying

  9. 9. ryan [ April 15, 2016 @ 08:40AM ]

    Ok so many of you are in denial about this condition, but this is very serious. I dont mean to sound like a broken record but sleep apnea can lead to so many other health complications like diabetes, stroke, high blood pressure. I used to drive trucks but now i work in supply chain management. I was diagnosed with sleep apnea two years ago and starting using a <a href="">CPAP</a> . Let me tell you i agree with frank because i started getting the best, deepest sleep in my life. My dreams were so much more intense than i had ever experienced, and I wake up feeling very refreshed. Using a CPAP may seem like BS at first but after 1 week of using it you will feel like superman. NO lie.

  10. 10. Julio [ July 06, 2016 @ 04:55PM ]

    I am with the minority's in this group i got my machine about 2 years ago because i was forced to after getting a physical for my medical card. I had been told by friends and family many times that i should get checked because i could sleep till 3pm on my days off and still be tired my snoring was bad and my wife would tell me she would swear i stopped breathing at night! Sometimes i am surprised i am still alive i just remember being in my truck and fighting to stay awake and i never knew why i just knew i had to work because i had to feed my family. After my test i found out that from 8 hours of sleep i was really only getting 2 if i was lucky i never entered REM sleep and had about 70% oxygen going through my lungs every night when it should be 90%. Long story short i cannot live without this machine i take it everywhere and i don't drive a rig anymore but man could i have used it. For all that say it is BS and for them to make more money well they focus on the trucking industry because we live on the road and we are not only putting ourselves in danger but also the lives of others.

  11. 11. Jeff [ April 09, 2017 @ 07:53AM ]

    Interesting because there is no final rule, no law yet the physicians push this and are misleading drivers into thinking it is the law. Problem is that there are many drivers who may meet their criteria for testing, are tested and dont have it. Under the current recommendations they can be forced into testing every 2 years. While everybody complains about truckers and the accidents why is there no outrage when those who drive their cars are falling asleep or are suffering from medical episodes? My opinion is because truckers are a class that can be controlled by regulatory means. I have gone through hell every 2 years getting medically certified because of their "criteria". Despite being evaluated by physicians who say I dont have OSA the DOT physicians like to think they know better. Even the FMCSA admits that those forced into testing is not generating the numbers of drivers with OSA that they were led to believe had it. When this all started all I did was to follow the money. Sleep clinics popped up all over the country and my phone was ringing off the hook as they offered to test my drivers. Then the clinics had their referrals for drivers. Then came the fun. As an experiment I had several drivers tested by certified physicians and they all tested negative despite having the criteria for testing. Then they were sent to the clinics that recommended their own sleep clinics.......guess what? They all tested positive. Imagine that. Nobody will ever convince me that this is not a money grabbing scheme.

  12. 12. john p [ August 12, 2017 @ 04:07AM ]

    hello i am a city bus driver for the last 15yrs and for the last 4yrs i have had a cpap machine and yes it kinda sucks but i was always told honesty is the best policy so i said i snore and stop breathing while sleeping and after watching the first sleep study on tape it scarred the crap out of me ever since then i have sleept good every nite.SO if any of you think u r having trouble sleeping go get the study done for ur own piece of mind who knows it just might amaze you


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