The sandman cometh

Treating drivers with sleep disorders can cut medical costs, improve safety

In November 2010, the Federal Motor Carrier Safety Administration announced plans to revise the physical qualification regulations for commercial motor vehicle drivers. These changes – which almost surely will include new screening standards for sleep disorders – will be based on new guidance from FMCSA’s Medical Review Board and will impact the standards for the U.S. Department of Transportation physical exam that is required every two years.

Drivers using Sleep Pointe’s APAP machines use a “SmartSticks” USB drive to upload sleep data through the ACS sleep apnea reporting service.

Obstructive sleep apnea, the most common sleep disorder among drivers, is caused by the airway being blocked during sleep. The body wakes up a minimum of 15 to 20 times an hour to restore breathing. Besides causing daytime drowsiness, OSA can lead to serious health issues such as hypertension, diabetes and cardiovascular disease.

According to an oft-cited research project by Dr. Allan Pack of the University of Pennsylvania, up to 28 percent of commercial drivers have a severe form of OSA. Other studies found that drivers with untreated sleep disorders are up to seven times more likely to be involved in a crash, a risk equal to that of drunk driving with a Blood Alcohol Content of 0.08.

With a highly mobile and decentralized work force, most commercial and private fleets traditionally have not been able to easily address the problem of sleep apnea within their driver ranks. But during the past few years, many companies have started using new services and technology to solve this challenge.

Outsourcing treatment

Scheduling drivers for sleep tests is the first challenge. In 2000, Prime Inc. contracted with a medical provider to open an onsite family practice. The Springfield, Mo.-based company’s 5,700 driver associates, both employees and independent contractors, also use its medical facility for DOT physical exams.

Prime also contracted with Sleep Pointe, an OSA diagnosis and treatment provider. Sleep Pointe, which operates a sleep lab on the fleet’s property, conducts full polysonogram testing if Prime’s doctor believes the associate may have a sleep disorder.

Associates pay for the doctor’s visits and sleep testing themselves. Through Sleep Pointe, Prime is able to offer full diagnostics, treatment and compliance services to drivers for at least 50 percent less than what it would cost elsewhere, says John Hancock, director of recruiting.

Since most fleets lack the volume to contract with an onsite vendor, companies that specialize in treating sleep disorders for the transportation industry have created national networks to make it convenient for drivers to be diagnosed and treated.

SleepSafe Drivers now has a national network of more than 55 locations, and the company plans to expand to more than 200 sites by yearend. SleepSafe uses an ambulatory testing program where drivers are given a small device to monitor their sleep in a natural location, such as in their cab, hotel or home.

Testing and diagnosing drivers may be easy compared to getting them to comply with their treatment plans. Generally, the treatment involves using a continuous or automatic positive airway pressure (CPAP or APAP) device when sleeping.

As part of the overall service, vendors provide the systems and staff to monitor drivers’ compliance with the treatment plan. They will follow up with drivers personally if needed.