“Doc, I’m glad you made me have that test. Now I feel better than ever. I just didn’t realize how tired I really was!”
A truck driver had come in for his Department of Transportation (DOT) required certification exam. That was his parting comment to his provider as they exchanged a hearty handshake, and he left with his certificate, satisfied.
Although they were seeing eye-to-eye by then, things didn’t start that way. The driver was surprised a month earlier when his provider required him to have a sleep study to screen for sleep apnea.
His doctor had explained how this very common condition causes people to momentarily but repeatedly stop breathing while asleep, disrupting normal sleep cycles. He understood that, and admitted his wife once mentioned she noticed pauses in his snoring pattern while he slept.
Then his provider covered the connection between untreated sleep apnea and health conditions, including how it can lead to high blood pressure, heart failure, and even sudden death. He said he’d heard that, too, and knew his own blood pressure had been borderline.
Because sleep apnea sufferers never reach deeper levels of sleep, they are prone to excessive daytime drowsiness, which could lead to falling asleep at the wheel. That’s where the driver stopped agreeing with his doctor and clammed up.
His test confirmed severe sleep apnea. He started nightly use of a CPAP machine, and noticed results right away. “I should have done this years ago!” he said.
Sleep apnea isn’t new. But requiring tests for it, in people who don’t feel they have it, is new. This has created no small amount of controversy, particularly among truck drivers, who are under scrutiny because of the obvious public safety implications of their job.
Sleep apnea is a killer
There are more than 5,000 deaths due to large truck crashes in the U.S. annually. Somewhere between 7 percent and 20 percent of these crashes are due to truck drivers falling asleep behind the wheel. Their job is very demanding and would be stressful for anyone. But it’s a killer for someone with untreated sleep apnea, which may increase crash risk by two to seven times. And it is estimated that 17 percent to 28 percent of truck drivers have that condition. (Reference: Parks, 2009)
Still, those same statistics mean most truck drivers don’t have sleep apnea. And, most truck drivers finish long careers without ever being in any accident. So, how can doctors decide which drivers need to go through this inconvenient and expensive process, simply to remain eligible to drive a truck?
The answer is by using a tape measure, a scale, and a blood pressure cuff.
How to identify possible sleep apnea
In 2006, a joint task force of three major professional groups was formed: The American College of Occupational and Environmental Medicine, the American College of Chest Physicians, and the National Sleep Foundation.
One of their tasks was to decide how doctors could identify drivers who ought to have sleep apnea screening, even among drivers who didn’t think they were drowsy. Their consensus was to require the screening test if two out of the following three criteria were met:
- Body mass index of 35 or greater
- Neck circumference of 17″ or greater in male drivers and 16″ in females
- High blood pressure that was either new, uncontrolled, or requiring two or more medicines to control
(Source: Hartenbaum et al, 2006)
Should you be tested for sleep apnea?
If you are a truck driver, staying alive requires that you can stay awake. Discuss sleep apnea with your doctor and have the test if they or your DOT medical examiner recommends it.
If your work is not as safety-sensitive as that, talk to your doctor if you are concerned about feeling tired or sleepy. Also, the following increase your risk of sleep apnea:
- If your body mass index is over 25.
- If your neck measures 17 or more inches around (16 inches if you are female)
- If your blood pressure is a problem