Will Sleep Apnea Screening Become Mandatory for Truckers?

Sleep disorders in commercial truck drivers has been an issue of interest by the Federal Motor Carrier Safety Administration for many years, and it's becoming increasingly apparent that FMCSA will make some move to require truck drivers to be screened for sleep apnea in the not too distant future.

While the disorder occurs in all population groups, truck drivers seem to be especially prone to the disorder. A 2002 study conducted by the University of Pennsylvania and sponsored by FMCSA and the American Transportation Research Institute of the American Trucking Associations showed that as many as 28% of truckers may suffer from sleep apnea.

There are certain factors may put people at higher risk of developing the disorder, including: a family history; being overweight (with a body mass index over 35); a large neck size (17 inches or greater for men; 16 inches or greater for women); smoking and alcohol use; and being over age 40.

Sleep apnea is considered an important trucking safety issue because it can affect the alertness of drivers. Those affected with sleep apnea often suffer from restless, fitful, oft interrupted sleep that can lead to fatigue during waking hours making the drowsy driver a potential hazard on the highway.

FMCSA has studied the issue of sleep apnea for several years and related advisory committees have issues various opinions and statements about the need for some sort of screening. While FMCSA has not yet issued formal rules on the subject, there are a number of initiatives in place that suggest it won't be long in coming, according to Rose McMurray. chief transportation advisor for FDRsafety and former Assistant Administrator and Chief Safety Officer of the Federal Motor Carrier Safety Administration in the U.S. Department of Transportation.

Earlier this year, FMCSA placed a notice in the federal register seeking public comments on mandatory screenings. It was withdrawn a few days later; the agency said that the notice had been placed prematurely.

But the adoption of federal standards for medical examiners - who certify that an individual is fit to drive - is certainly a step in that direction, McMurray notes. FMCSA adopted that requirement earlier this year; medical examiners have until mid-2014 to register. "This will ensure that those who perform medical testing are properly trained on a number of issues, including recognizing the risks of sleep apnea," McMurray said in an paper she wrote on the issue for the Courthouse News Service. "The training instructs examiners to withhold issuance of a medical certificate to those who fit the profile until sleep screening has ruled out a sleep disorder for those who exhibit symptoms."

"Already, the administration's Medical Review Board and the Motor Carrier Safety Advisory Committee - an industry group - have issued their recommendations to FMCSA." She adds. "Though the two come at the topic from different angles - one representing the medical community and the other the industry - both have recommended that FMCSA issue some sort of regulations related to sleep apnea.

McMurray notes that even without regulations in place, the sleep apnea issue has entered the courts. In December, a Canadian trucking company paid $3.25 million to a Texas woman whose husband was killed after their car was rear-ended by a truck. The driver had been diagnosed with sleep apnea, which had not been treated.

"With a body of scientific evidence on the risks of sleep apnea and now, case law, this likely will not be the last of these large damage awards," McMurray says.

It is important to note that sleep apnea is treatable, she says. "While the trucker in the lawsuit was fired from his previous trucking job for failing to submit to a sleep study, treatment is extremely successful for those with the disorder."

A typical remedy for sleep apnea is the use of a Continuous Positive Airway Pressure (CPAP) sleeping device, an over the mouth mask which allows for better, uninterrupted sleep.

Some machines are able to record date, length and time of use so that motor carriers and enforcement officers can verify that the driver is, indeed, using the CPAP device.

And private sector suppliers are also jump on the sleep apnea bandwagon. In early June, CareTouch Communications, Inc. announced a compliance service designed specifically for commercial motor carriers to monitors drivers diagnosed with sleep apnea to ensure they are on therapy.

"Proposed Federal Motor Carrier Safety Administration guidelines state that drivers should be disqualified immediately or denied certification if they have been found to be non-compliant with their CPAP treatment at any point," the managers of the CareTouch program said.

"The Harvard Medical School reports that the crash risk for a person with sleep apnea is 242% greater than a person without the disorder, so diagnosing sleep apnea in commercial truck drivers is just the first step in solving this problem," said Matthew Dolph, vice president of CareTouch Communications. "Once diagnosed, a driver's best chance of achieving compliance to therapy is through regular contact. CareTouch uses automated technology and a knowledgeable team of sleep therapy specialists to engage and communicate with drivers. Our goal is to ensure drivers are compliant which we know helps keep them safe on the road."

McMurray notes that even without regulations in place, the sleep apnea issue has entered the courts. In December, a Canadian trucking company paid $3.25 million to a Texas woman whose husband was killed after their car was rear-ended by a truck. The driver had been diagnosed with sleep apnea, which had not been treated.

"With a body of scientific evidence on the risks of sleep apnea and now, case law, this likely will not be the last of these large damage awards," McMurray says.

Plaintiffs' attorneys have been known to cite the failure of motor carriers to recognize fatigue by citing the rule that "a motor carrier may not require or permit a driver to operate a commercial motor vehicle if the driver has a medical condition (including sleep apnea) that would affect the driver's ability to safely operate the vehicle," McMurray says.

Sleep apnea is really just another manifestation of driver fatigue and there are steps that trucking companies must take to ensure that when a driver is behind the wheel, he or she is rested, she adds. Here of some tips she has for motor carriers:

• Recognize that drivers need to be alert when they report for duty and drive.
• Establish an overall Fatigue Management Program aimed at establishing a competent way to assist drivers to receive adequate sleep, including being aware of apnea signs and directing a sleep screening test, particularly for drivers displaying fatigue patterns. As with most safety oversight programs, a fatigue management program can yield cost-effective results.
• Ensure company scheduling and dispatching practices do not compromise the opportunity for drivers to gain restorative sleep.

McMurray consults with clients on motor carrier safety issues. Contact her at 1-888-755-8010 or rmcmurrary@fdrsafety.com

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