Occupational Sleep Education
The National Institutes of Health have stated that there are 50 to 70 million Americans that are affected by sleep disorders that are chronic, or intermittent which can result in compromised safety in the workplace. 18 million of the above mentioned Americans have sleep apnea. If you are a part of this statistic, it is extremely important to be educated on occupational sleep and the importance of these sleep related conditions.
Sleep apnea can occur in all age groups and both genders, however there are certain factors that increase your risk in being diagnosed, including large neck size, small upper airway or large tongue, overweight or obesity, small jaw, recessed chin, smoking and alcohol, age, and ethnicity. OSA has also shown signs to run in some families, providing speculation to the to idea of the disorder to have some genetic indications as well. Lifestyle is also an indicator of sleep apnea. People who work the second or third shift in the day may also be at an increased risk of developing sleep apnea. These workers should insist on becoming educated about occupational sleep and should consider getting screened or tested for sleep apnea. AllTrans Medical is a great source for any sleep apnea disorder information and solutions. By providing screening, testing, diagnosing, treatment, and monitoring, AllTrans is a full-service solution to your potential sleep apnea problems.
Lack of Sleep Has Negative Effects on Your Work
A shocking 40% of Americans do not get a sufficient amount of sleep at night. Knowing that a percentage of this 40% probably drive a motor operated vehicle daily, and some of them even work for Trucking Fleets as a profession, this alarming statistic would definitely cause alarm. Within the transportation industry alone, undiagnosed sleep apnea is a major cause of lack of sleep. Drivers are reported to feel fatigued and tired during the middle of the work day to the point where their job performance is affected. The Federal Motor Carrier Safety Administration has worked to decrease these reports by not only acknowledging the importance of sleep apnea screening, but also recommending more thorough screening for truck driver sleep apnea based on a selected criteria.
Obstructive sleep apnea is a sleep-breathing disorder. An apnea event occurs throughout the night when the individual’s airway to the lungs becomes obstructed due to relaxation of muscles, resulting in snoring, or the individual to stop breathing temporarily. This event causes the individual to awake from their deep sleep to be able to breath again. If many of these events occur during the night, the individual will not feel well rested and refreshed.
Trucking companies are all looking for the overall safety of their drivers and the civilians on the road, and thus are looking to be extra careful when hiring new drivers by being sure to rule out sleep apnea and ensuring a sufficient amount of rest time before the driver is on the road.
The National Transportation Safety Board (NTSB) says that a Fatal Bus Crash Underscores the Need for Fatigue Management Programs.
The National Transportation Safety Board has urged the Federal Motor Carrier Safety Administration to be more aggressive in monitoring fatigue management programs due to a fatal bus crash in last year.
On May 31, 2011 at 4:55am an incident occurred because the driver fell asleep, the Board found. A Sky Express bus that was headed northbound on I-95 in Virginia flipped over after it drifted across the roadway and struck a cable barrier. Unfortunately, four passengers were killed and fourteen others were seriously injured.
After the investigation was completed, the Board found that the bus driver had been suffering from sleep loss, poor sleep quality and interruption of his heart rhythm.
“Sky Express’s failure to exercise even minimal oversight of its drivers’ rest and sleep activities enabled the drivers to drive while dangerously fatigued,” the Board said.
The Board would like for the FMSCA to implement a program to monitor and improve the safety management programs to address fatigue. This is a direct follow up on a previous recommendation that all carriers have a fatigue management program.
The Board also wants new-entrant safety audits to include a review of a structured safety management process so the new carriers will know how to identify safety risks and maintain a safety assurance program.
Sky Express passed the Federal Motor Carrier Safety Administration new entrant safety assurance audit despite safety shortcomings in its operation, which indicates the new entrant audit process is not always keeping unsafe carriers from entering the motor carrier industry,” the Board said.
Fatigue Management Program for North American
The Board has urged the agency to incorporate fatigue management strategies, in addition to the hours of service rules for bus drivers who work at night.
The Board has also recommended a joint FMCSA-Transport Canada project to develop a fatigue management program.
The North American Fatigue Management Program, as it is called, aims to provide carriers with a manual that would have a best-practices reference for implementing a fatigue management program in their operations.
Rebecca Brewster, president and COO of the American Transportation Research Institute stated that It has been in the works for several years and now is nearing completion. The American Trucking Associations is on the project’s steering committee.
Brewster said the project expects to launch a website by November that will provide program materials at no charge. Training and materials for drivers, dispatchers, and management, have been developed and tested by carriers in the U.S. and Canada.
Ways to address the condition that adds to Fatigue
In the transportation industry, many risk managers and commercial drivers have to deal with the problem of sleep apnea, a condition that is directly related to daytime drowsiness, as they look for ideas to improve road safety. According to the Federal Motor Carrier Safety Administration (FMSCA) estimates that up to 26% of licensed commercial drivers have some level of sleep apnea. Per a FMSCA study, 17% of commercial drivers have mild sleep apnea, 5% have moderate, and 4% have severe prevalence of sleep apnea.
It has been shown in several studies that sleep apnea can directly impact driving performance by increasing fatigue therefore the direct relation of increasing the risk of crashes. The trucking industry is well aware of the awareness and prevalence of sleep apnea among drivers, however there are ways that the condition can be diagnosed, treated, and monitored.
Obstructive Sleep Apnea (OSA) is when the airway in the back of the throat is constricted due to the muscular relaxation when sleeping thus causing interruptions of a person breathing lasting several seconds at a time. Loud snoring is followed as the person gasps for air and resulting in a night of no restful sleep. Individuals considered at risk for sleep apnea are those with a body mass index of 35 or greater and a neck size of 17 inches or more for men and 16 inches for women. Many medical experts have stated that these types of individuals quite often suffer from other medical conditions such as diabetes and heart problems related to obesity.
Researchers say that there are a countless number of people that are not aware that they even have sleep apnea. Sleep apnea quite often contributes to daytime sleepiness, which impacts reflexes and motor skills. Even if the vast numbers of commercial drivers have some type of sleep apnea, many drivers are not willing to talk about it or admit that they may have the medical condition. There needs to be a way to educate the drivers about sleepiness and the dangers it can cause.
Currently the Federal Motor Carrier Safety Administration (FMSCA) has given guidelines on sleep apnea to the DOT Examiners for medical examination report on commercial driver’s physicals. It states the following for Respiratory Dysfunction 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 the ability to control and drive a commercial motor vehicle safely.
Since a driver must be alert at all times, any change in his or her mental state is in direct conflict with highway safety. Even the slightest impairment in respiratory function under emergency conditions (when greater oxygen supply is necessary for performance) may be detrimental to safe driving.
There are many conditions that interfere with oxygen exchange and may result in incapacitation, including emphysema, chronic asthma, carcinoma, tuberculosis, chronic bronchitis and sleep apnea. If the medical examiner detects a respiratory dysfunction, that in any way is likely to interfere with the driver’s ability to safely control and drive a commercial motor vehicle, the driver must be referred to a specialist for further evaluation and therapy.
The guidelines are currently under review but are not yet regulation. Many DOT examiners and trucking companies are taking the guidelines seriously and have implemented screening policies. The National Registry for Medical Examiners will be keying in on sleep apnea and only physicians that are in National Registry for Medical Examiners will be allowed to conduct DOT exams.
Effective Sleep Apnea Treatments
There are many different types of sleep apnea treatments available. The most appropriate way to decide which treatment is right for you would be to see what type of sleep apnea you have. To determine what type of sleep apnea you have, you must take a sleep study, whether it is a home sleep test or in lab test. Treatment for sleep apnea allows you to effectively control the condition.
The most common type of sleep apnea is Obstructive Sleep Apnea (OSA). This occurs when there is an obstruction in your airway, preventing oxygen from getting to your lungs. Essentially, when this obstruction occurs, usually due to the relaxation of the muscles and soft tissues around the throat, you stop breathing momentarily. Central Sleep Apnea (CSA) is a type of apnea in which their is a disconnect between the part of your brain which sends signals to breath and the diaphragm muscles, also causing you to stop breathing momentarily.
Undergoing Continuous Positive Airway Pressure Therapy (CPAP) is the most common type of treatment for sleep apnea. With this type of treatment, the patient wears a mask that is attached to a machine. This machine blows air at a certain constant pressure while sleeping. This pressure effectively keeps the airway open throughout the night. A BIPAP is another treatment option in which there are 2 different pressures, that are automatically adjusted while exhaling and inhaling providing for a more comfortable sleep for those who require it. An APAP is another variation in which the pressure adjusts according to need based on the patient’s breathing levels. The APAP units are set within a range that the pressure is constantly readjusting between.
A secondary method of treatment is the use of oral appliances. These appliances are placed in your mouth each evening. While you are sleeping, it works to maintain tongue and jaw alignment to prevent any obstructions of your airway from occurring. Although these are an accepted form of treatment for sleep apnea, the use of a CPAP, APAP, or BIPAP is definitely more effective.
Other treatments consist of lifestyle changes in which you would alter the position that you sleep in, weight loss, or cessation of smoking. These changes, paired with a treatment mentioned above, would best suit you for treating and controlling your sleep apnea.
Different Types of Sleep Apnea Treatments
If you have recently been diagnosed with Obstructive Sleep Apnea, you should know that there are a variety of different treatments based on the severity of your condition. Mild sleep apnea can be treated with simple lifestyle changes.
For example, following an exercise regimen to lose weight and thus decrease your BMI, quitting smoking to better your health in general, or changing your sleeping style by sleeping on your side or on your back.
When you have moderate to severe sleep apnea, these lifestyle changes will more than likely not suffice for adequate sleep apnea treatment.
An alternative type of treatment that is most commonly used is using a Continuous Positive Airway Pressure machine (CPAP). These machines deliver air pressure through a mask placed over your nose and/or mouth while you are asleep. This air pressure keeps your airway open throughout the night, preventing any obstructions from occurring. Different types of this treatment are available: the CPAP is set at one static pressure, the BiPAP is set at two pressure that alternate as you inhale and exhale, and the APAP is set at a range of pressures that adjust according to breath pressure and severity of the obstructions.
Another type of treatment is wearing an oral appliance. These appliances are designed to maintain your jaw and tongue positioning throughout the night to prevent obstructions from occurring. Although patients due find this treatment to be useful, the most effect treatment is the positive airway pressure machines.
Finally, there are surgical options to treat your sleep apnea, which consists of the partial removal of the tissue in your throat to prevent the obstructions from occurring.
