Sleep Apnea & The Truck Driver

Sleep Apnea

 &

The Truck Driver

By: Roy Poteete, Certified Driver Trainer, Retired Firefighter, EMTI

Biography:

Retired Firefighter I & II,   State of Missouri & St. Charles County Fire Academy Certified Firefighter,  State of Missouri Licensed EMTI . American Red Cross First Aid & CPR Instructor, DAT Team Member.  Independent Fire &  Safety Consultant.  Certified Driver Trainer, 1.3 Million Safe Miles No chargeable Accident Miles.  Freelance Writer.

Do you really know what Sleep Apnea is and why it is being addressed?

Sleep Apnea is a very serious medical respiratory dysfunction that not only attacks the OVERWEIGHT Men but it can also happen to sizes of humans. Just because you are not overweight do not think that you are not at risk for Sleep Apnea.  Do we really know why this happens?  The medical reason is still being diagnosed but some feel that it has to do to the weight size and the size of the neck constricting the trachea (wind pipe). The TRECHEA is the wind pipe that carries oxygen to the lungs and in the lungs it is exchanged with CO2, as well as other gases then it is expelled from the body. This is a brief description of what happens in the lungs.

Sleep Apnea is a VERY SERIOUS MEDICALLY CONDITIONS. As a commercial driver you are charged with a responsibility to maintain a safe operations of your motor vehicle at all times. As well as maintaining a safe work condition and not being tired or a fatigued driving.  With more drivers on the roads; the driver’s medical conditions declining due to not getting enough exercise, eating right, the pounds add up. 

How many of you actually get out of your truck and take about a 60 minute walk to get some exercise? Or do you go from driving to eating a big supper/meal then to bed? As a driver I see many more drivers that are OBESE now more than ever before.  If you eat and go to bed or back to driving you are at risk to packing on more pounds of unwanted weight.  I see drivers at the BUFFET BAR go back for a 3^rd, 4^th and even a 5^th time for food.

With the Truck Stops turning into  TRAVEL CENTERS and taking out the actual restaurant and replacing them with McDonalds, Taco Bell, Hardees, Carl Juniors, Long John Silver, Subway,  Pizza Hut, etc. These are a quick bite of food for the driver but just how healthy are they? Many have excessive SALT and other additives to preserve the foods.  These are BAD for YOUR body.  These places are not that healthy. So as a driver you need to learn to eat right, get more exercise and loose weight. These are easy to do on the road.

So why is the FMSC so worried about Sleep Apnea?

With the FMCSA and the USA DOT mandating NEW SAFETY STANDARDS we all need to be made aware of these standards. We know these safety standards are now called CSA 2010. With the implantation being implemented in steps you need to know and be familiar with these standards.

They are worried because they do not want a driver to be behind the wheel of an 80,000 pound vehicle with a trailer packed full of Explosive 1.1 or Radio Active and have the driver to fall asleep.

So here are the MILLION DOLLAR QUESTIONS for you drivers:

Q:  How many CDL holders have went thru the Sleep Apnea Test?

Q:  Do you know what Sleep Apnea is and the many forms of Sleep Apnea there are?

Q:  Why the BMI is a part of the process for Sleep Apnea Study?

Q:  Why is the NECK SIZE a factor in testing?

Q: Why is the Medical Examiner telling you that you are not being medically cleared until you do the following?

Ø  Lose Weight

Ø  Get the blood pressure under control

Ø  When was you Sleep Apnea Study and who was the doctor

                      
Why is the BMI so important?

The BMI stands for Body Mass Index. This is a measure of amount of fat in the body.

Here is the web address to the United States of America Health and Human Services:

http://www.nhlbisupport.com/bmi/

Assessment of weight and health risk involves using three key measures:

1. Body mass index (BMI)
2. Waist circumference
3. Risk factors for diseases and conditions associated with obesity

Body Mass Index (BMI)

BMI is a useful measure of overweight and obesity. It is calculated from your height and weight. BMI is an estimate of body fat and a good gauge of your risk for diseases that can occur with more body fat. The higher you’re BMI, the higher your risk for certain diseases such as heart disease, high blood pressure, type 2 diabetes, gallstones, breathing problems, and certain cancers.

Although BMI can be used for most men and women, it does have some limits:

·         It may overestimate body fat in athletes and others who have a muscular build.

·         It may underestimate body fat in older persons and others who have lost muscle.

Use the BMI Calculator or BMI Tables to estimate your body fat. The BMI score means the following:

	BMI
Underweight	Below 18.5
Normal	18.5–24.9
Overweight	25.0–29.9
Obesity	30.0 and Above

So if you have a height of 5’8” and weight 260 your BMI is 39.5. You are OBESE and you need to lose a few pounds and get in shape. Yes, we know that there is no time on the road RIGHT? Wrong! There is time for a walk every day. When you get up, prior to going to bed, at the shipper and or the receiver if you’re waiting there is time to get some exercise. You have time to get in some exercise. Use your own body weight for resistance. We will look at some exercise that you can do that is Free and uses your body for the resistance.

So why is the NECK SIZE so important?

By measuring the neck size the medical review officer will make a determination on if the TRECHEA is COMPERMISED when laying flat causing a constriction on the TRECHEA (Wind Pipe). By the compromised trachea the less air is moved into and out of the lungs. This can assist with the LOUD SNORING. The trachea is being blocked and not allowing the air to move freely. Some doctors or medical review officers will have a range from 16 inches and over for a sleep study. Some will give you a 90 temporary medical card. When in reality they do not have to give you any leeway in this. It is there option.

The Medical Officer has to attain that you are in good health and they cannot find a problem with your health. If they certify that you are in good health and you go out and drive fall asleep behind the wheel and kill someone; they too can be held accountable for not mandating you have a sleep study or correct other medical conditions.

Here is what the Federal Motor Carriers Safety Administration says about sleep apnea.

49 CFR 391.41(b)(5) "A person is physically qualified to drive a commercial motor vehicle if that person — Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his/her ability to control and drive a commercial motor vehicle safely." Regulations Versus Medical Guidelines (Guidance)

Relevance to Driving

The commercial driver spends more time driving than the average individual. Driving is a repetitive and monotonous activity that demands the driver be alert at all times. Symptoms of respiratory dysfunction or disease can be debilitating and can interfere with the ability to remain attentive to driving conditions and to perform heavy exertion. Even the slightest impairment in respiratory function under emergency conditions (when greater oxygen supply may be necessary for performance) can be detrimental to safe driving. There are many primary and secondary respiratory conditions that interfere with oxygen exchange and may result in gradual or sudden incapacitation, for example: Asthma. Carcinoma. Chronic bronchitis. Emphysema. Obstructive sleep apnea. Tuberculosis. In addition, medications used to treat respiratory conditions, both prescription and those available without a prescription, may cause cognitive difficulties, compound the risk for excessive daytime sleepiness (EDS), or cause other forms of incapacitation. This was taken directly from their website. http://nrcme.fmcsa.dot.gov/mehandbook/respiratory4_ep.htm

Here is what FMCSA Says taken directly from their website regarding Medical Review Officer.

Respiratory — 49 CFR 391.41(b)(5)

Federal Motor Carrier Safety Regulation (FMCSR)

49 CFR 391.41(b)(5) "A person is physically qualified to drive a commercial motor vehicle if that person — Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his/her ability to control and drive a commercial motor vehicle safely." Regulations Versus Medical Guidelines (Guidance)

Relevance to Driving

The commercial driver spends more time driving than the average individual. Driving is a repetitive and monotonous activity that demands the driver be alert at all times. Symptoms of respiratory dysfunction or disease can be debilitating and can interfere with the ability to remain attentive to driving conditions and to perform heavy exertion. Even the slightest impairment in respiratory function under emergency conditions (when greater oxygen supply may be necessary for performance) can be detrimental to safe driving. There are many primary and secondary respiratory conditions that interfere with oxygen exchange and may result in gradual or sudden incapacitation, for example: Asthma. Carcinoma. Chronic bronchitis. Emphysema. Obstructive sleep apnea. Tuberculosis. In addition, medications used to treat respiratory conditions, both prescription and those available without a prescription, may cause cognitive difficulties, compound the risk for excessive daytime sleepiness (EDS), or cause other forms of incapacitation.

Health History and Physical Examination

General Purpose of Health History and Physical Examination The general purpose of the history and physical examination is to detect the presence of physical, mental, or organic conditions of such character and extent as to affect the ability of the driver to operate a commercial motor vehicle (CMV) safely. This examination is for public safety determination and is considered by the Federal Motor Carrier Safety Administration (FMCSA) to be a “medical fitness for duty" examination. As the medical examiner, your fundamental obligation during the respiratory assessment is to establish whether a driver has a respiratory disease or disorder that increases the risk for sudden death or incapacitation, thus endangering public safety. The examination is based on information provided by the driver (history), objective data (physical examination), and additional testing requested by the medical examiner. Your assessment should reflect physical, psychological, and environmental factors. Medical certification depends on a comprehensive medical assessment of overall health and informed medical judgment about the impact of single or multiple conditions on the whole person. Key Points for Respiratory Examination During the physical examination, you should ask the same questions as you would for any individual who is being assessed for respiratory diseases or disorders. The FMCSA Medical Examination Report form includes health history questions and physical examination checklists. Additional questions about symptoms of respiratory disease should be asked to supplement information requested on the form. Regulations — You must review and discuss with the driver any "yes" answers Does the driver have: Shortness of breath? Lung disease? Emphysema? Asthma? Chronic bronchitis? Sleep disorder? Pauses in breathing while asleep? Daytime sleepiness? Loud snoring? Recommendations — Questions that you may ask include Does the driver: Smoke? If yes, how much and for how long? Feel short of breath while driving? Cough frequently? If yes, is the cough productive of sputum? Experience tightness of the chest while resting or exercising? Wheeze during the day or night? Use respiratory agents? Use oxygen therapy? Self-report sleepiness that may indicate increased risk for EDS? Regulations — You must evaluate On examination, does the driver have: Impaired respiratory function? Cyanosis? Abnormal: Chest wall expansion? Respiratory rate? Breath sounds, including wheezes or alveolar rales? Findings that may require further testing such as pulmonary tests and/or X-ray of chest? Recommendations — You may request A detailed pulmonary function evaluation or consultation with a pulmonologist when the physical examination reveals: Clubbing of the fingers. Cyanosis. Prolonged expiration. Tachypnea at rest. Pulmonary wheezes and rhonchi, pulmonary rales. Absent or decreased breath sounds. Pleural friction rub. Unequal inflation-deflation contours of the right and left thorax. Significant kyphosis or scoliosis of the thoracic spine. Use of accessory muscles of ventilation at rest. NOTE: When requesting additional evaluation from a specialist, the specialist must understand the role and function of a driver; therefore, it is helpful if you include a copy of the description of the driver role found in the Medical Examination Report form and a copy of the applicable medical standard and guidelines with the request. Record Regulations — You must document discussion with the driver about Any affirmative respiratory history, including if available: Onset date, diagnosis. Medication(s), dose, and frequency. Any current limitation(s). Potential negative effects of medication use, including over-the-counter medications, while driving. Any abnormal finding(s), noting: Effect on driver ability to operate a CMV safely. Necessary steps to correct the condition as soon as possible, particularly if the untreated condition could result in more serious illness that might affect driving. Any additional respiratory tests and evaluation. Remember Medical fitness for duty includes the ability to perform strenuous labor. Overall requirements for commercial drivers as well as the specific requirements in the job description of the driver should be deciding factors in the certification process.

Respiratory System — Guidance/Advisory Criteria

The following link to select respiratory guidance/advisory criteria key points: Respiratory System Topics Allergies and Asthma-related Diseases Chronic Obstructive Pulmonary Disease Chronic Sleep Disorders Infectious Respiratory Diseases Non-infectious Respiratory Diseases Pulmonary Function Tests Secondary Respiratory Conditions and Underlying Disorders The complete text of the medical conference reports can be accessed from FMCSA Medical Reports.

So why are so many drivers stating that they DO NOT MEET THE REQUIRMENTS?

Ø  Fear

Ø  Knowing that they might have a medical condition

Many different answers on this, but the Medical Review Officer has the ultimate decision to mandate you to have a Sleep Apnea Study. If more drivers will stop listening to talk radio shows that the HOST(S) DOES NOT HAVE A CDL,NOR HAVE ANY EXPERIENCE BEHIND THE WHEEL AS A DRIVER AND CONTACT THE FMCSA DIRECTLY REGARDING THE NEW MEDICAL MANDATES. THEN AND ONLY THEN WILL THEY LEARN THE TRUTH.

The Federal Motor Carrier Safety Administration DOES HAVE THE RIGHT TO MANDATE TOO YOU THE DRIVER TO HAVE A MEDICAL CONDITION CORRECTED PRIOR TO YOU BEING MEDICALLY CLEARED TO DRIVE.

Q: Some are asking so if the FMCSA is mandating that I the driver have a Sleep Apnea Test done at a cost of $3,000 +/- dollars then why don’t they pay for the machine.

 A: because it is not their health that is being studied, nor is it their health that may compromise other drivers.

Q: Does the insurance companies pay the expenses?

A: Yes, most will pay for the test as long as it your doctor gets medical authorization and explains that you need the test for your job.

Q: If I have a Health Care Savings Account or a Flex Spending Account can I use the money in there to offset the cost of the test?

A: Contact your Tax Advisor; but as I read the regulations you are able to use these funds to pay for Medical Expenses.

Q: Who pays the expensive equipment?

A: Most insurance companies will cover the cost for the equipment lease and related costs of new masks bi-annually, new breathing tubes bi-annually, and the downloading of the micro-chip of your sleeping and the use of the machine.

Q: Is there any medication that goes with the machine?

A: Generally No, not unless the doctor prescribes you a sleep sedative to allow your body to rest.

You can get more answers from your sleep doctor and or the sleep center that your doctor has refereed you too.

AlWAYS >Prior to losing any weight and starting a weight loss program consult your primary doctor.

Some minor tips to assist in losing weight and using your body as a resistance.

Ø  Stretching the leg muscles by placing your foot on the bottom step and lunge forward towards the truck and rock back. Do this several times on each leg. Do this several times each day; this helps stretch out the leg muscles and works the knee muscles and helps strengthen the tendons and ligaments.

Ø  Grab the hold/grab bar at the back of the cab or on the side of the cab and lower yourself towards the truck and then push yourself back up. Do this several times on each arm and do this several times each day.

Ø  Stretch your leg muscles prior to walking. Park in the middle of the parking lot and walk to the door. Not in the front row. Walking does a heart good! Do this for several weeks. Then park farther away and try to walk at least 2 times around the parking lot prior to bed and after eating.

Ø  Always go to a shoe store and get fitted for a pair of shoes to wear.

Ø  NO SODA, unless it is sugar free kind.

Ø  Walk the Shopping Centers in bad weather and when the weather is hot. Use the steps when available. Also when you are in your local Wal-Mart, Sam Club, Costco Wholesale or a big store walk the store several times prior to leaving. Park away from the store and get active.

Ø  Walk the parking lots of the shipper and receiver when you can and be safe.

Ø  Wear an ANSI DOT Rated Class III Safety Vest and wear Light Color Clothing. If you can find an ANSI SAFETY RATED LIME GREEN OR BLAZE ORANGE T-shirts wear them.

Ø  Go to your local library and get some books on staying fit and exercise.

Ø  Enroll in a local gym so when you are home you have a place to work out.

Ø  Some employers have a weight room available for the drivers.

Ø  Some Truck Stops have weight machines, tread mills and other equipment available for you to use.

Ø  By increasing your heart rate during the work out you will decrease your blood pressure. You will help shed the pounds.

Ø  Learn to eat healthy.  If you are a diabetic you already know about eating right. Teach others to do the same. You can lose weight by cutting the carbohydrates (bread, pizza, pasta) lower the intake of calories.

Ø  Eat Whole Grain Bread, Whole Grain Pasta. Instead of Ice Cream eat Frozen Yogurt. Eat Granola Bars if you are hungry and need a bit of energy. Or eat some Beef Jerky to calm the hunger pains.

Ø  Eat fresh fruits instead of potato chips and other “JUNK FOODS” like candy bars, and other forms of candy.

Ø  Consult with your doctor and health trainer to get you on a good workout program will shed pounds off you in no time.

You can get healthy and stay somewhat fit on the road. You have to put your mind to achieving the goal that you set for yourself. Consult your doctor prior to any weight loss program and get a trainer to assist you from your local gym facility.

I hope this has enlightened you on the Sleep Apnea Topic. I have had the study. I slept about at a facility for 9 hours and went home. I have a mild form of Sleep Apnea and do not go into the RELM Sleep. The machine assists me with going into a deeper sleep and allows me to breathe better while sleeping. I feel more rested much better attention span in the daytime when I am driving. Yes, I felt apprehensive about getting the test. Yes, I was made about paying these fees and co-pays. But I have to say with this test and having a potential medical hazard corrected I will continue to pursue my challenge of MORE MILLION MILES TRAVELED WITH NO CHARGEABLE ACCIDENTS.  

Best regards,

Roy Poteete,

Certified Driver Trainer, Retired Firefighter, EMTI