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FMCSA’s sleep apnea safety recommendations but each state sets its own laws!

Driving requires many simultaneous skills, mainly eye-hand coordination with accurate speed and direction calculations. This requires full concentration, as evidenced by the higher accident rates in those who use mobile phones while driving.
There is good evidence that sleepiness and fatigue are responsible for about 20% of driving accidents. Many of these sleep-related accidents are due to lifestyle issues, such as driving without adequate sleep, and often happen at times when levels of concentration are naturally low; such as in the afternoon and at night. However some are due to medical conditions. Federal Motor Carrier Safety Administration’s Medical Review Board recommended guidelines for when a driver should be tested for obstructive sleep apnea, the minimum amount of treatment for compliance, and when a driver should be retested.

The recommendations came during the Medical Review Board’s meetings on Aug. 22-23 in Washington, D.C., The FMCSA and FRA are expected to consider the recommendations when and if they decide to move forward with the rulemaking process. In October 2013, President Barack Obama signed a law that required the FMCSA to go through its regulatory process before making any sleep apnea testing requirements.   So are your drivers suffering from obstructive sleep apnoea syndrome (OSAS)?

Among the board’s recommendations for when a truck driver should be required to have a sleep test. The board suggested mandatory screening for any truck driver with a body mass index 40 or above, with admitted fatigue or sleeping during wakeful periods, or for any drivers who have been involved in a sleep-related motor vehicle accident. Screening could also be mandatory for drivers who possess a BMI of 33 and have at least three of the following risk factors:

  • Untreated hypertension
  • Type 2 diabetes
  • Loud snoring
  • Witness apneas
  • Small airway/Mallampati score
  • A neck size of 17 inches or more for males and 15.5 or more for females
  • Age 42 or older
  • Male or post-menopausal female
  • Untreated hypothyroidism
  • Stroke, coronary or artery disease

There are three physical attributes on the list – age, sex and neck size – shouldn’t be enough to require a sleep test.

FMCSA states:

What is Sleep Apnea?

Sleep apnea is a breathing-related sleep disorder that causes brief interruptions of breathing during sleep. These pauses in breathing can last at least 10 seconds or more and can occur up to 400 times a night. Sleep apnea is a serious, potentially life-threatening condition that often goes unrecognized and undiagnosed.

Risk Factors for Sleep Apnea

Sleep apnea occurs in all age groups and both sexes, but there are a number of factors that may put you at higher risk:

  • A family history of sleep apnea
  • Having a small upper airway
  • Being overweight
  • Having a recessed chin, small jaw, or a large overbite
  • A large neck size (17 inches or greater for men, 16 inches or greater for women)
  • Smoking and alcohol use
  • Being age 40 or older
  • Ethnicity

Symptoms of Sleep Apnea

  • Loud snoring
  • Morning headaches and nausea
  • Gasping or choking while sleeping
  • Loss of sex drive/impotence
  • Excessive daytime sleepiness
  • Irritability and/or feelings of depression
  • Disturbed sleep
  • Concentration and memory problems
  • Frequent nighttime urination

Diagnosing Sleep Apnea

In order to diagnose sleep apnea, your doctor may send you to a sleep center for testing. You may be asked to spend a night at the center, where experts will monitor your sleep.

How Can Sleep Apnea Affect Your Driving?

Because sleep apnea affects your sleep, it also affects your daytime alertness and performance. Untreated sleep apnea can make it difficult for you to stay awake, focus your eyes, and react quickly while driving. In general, studies show that people with untreated sleep apnea have an increased risk of being involved in a fatigue-related motor vehicle crash.

Many sleep apnea patients say they never fall asleep while driving. That may be true. But remember, you don’t have to fall asleep to have a crash. You simply have to be inattentive or less alert — and with untreated sleep apnea; you are not as sharp as you should be.

Can You Still Drive if You Have Sleep Apnea?

Yes! While FMCSA regulations do not specifically address sleep apnea, they do prescribe that a person with a medical history or clinical diagnosis of any condition likely to interfere with their ability to drive safely cannot be medically qualified to operate a commercial motor vehicle (CMV) in interstate commerce.

However, once successfully treated, a driver may regain their “medically-qualified-to-drive” status. It is important to note that most cases of sleep apnea can be treated successfully.

Because each State sets its own medical standards for driving a CMV in intrastate commerce, check with your local Department of Motor Vehicles for regulations in your State.

What Should You Do Once You Learn You Have Sleep Apnea?

You and/or your doctor should contact the medical qualifying examiner to determine your fitness to operate a commercial motor vehicle and to get help with treatment.

What Level of Sleep Apnea (mild, moderate, severe) Disqualifies a CMV Driver?

The disqualifying level of sleep apnea is moderate to severe, which interferes with safe driving. The medical examiner must qualify and determine a driver’s medical fitness for duty.

What are the Obligations of a Motor Carrier Regarding Employees with Sleep Apnea?

A motor carrier may not require or permit a driver to operate a CMV if the driver has a condition — including sleep apnea — that would affect his or her ability to safely operate the vehicle.

It is critical that persons with sleep apnea fully use the treatment provided by their doctor. They should not drive if they are not being treated. Being effectively treated, and complying with that treatment, offers the best hope of a commercial driver with sleep apnea to secure the ability to do his or her job safely and be fully alert.

Risk Factors for Sleep Apnea Sleep apnea occurs in all age groups and both sexes, but there are a number of factors that may put you at higher risk: • A family history of sleep apnea • Having a small upper airway • Being overweight • Having a recessed chin, small jaw, or a large overbite • A large neck size (17 inches or greater for men, 16 inches or greater for women) • Smoking and alcohol use • Being age 40 or older • Ethnicity Symptoms of Sleep Apnea • Loud snoring • Morning headaches and nausea • Gasping or choking while sleeping • Loss of sex drive/impotence • Excessive daytime sleepiness • Irritability and/or feelings of depression • Disturbed sleep • Concentration and memory problems •

Frequent nighttime urination Diagnosing Sleep Apnea In order to diagnose sleep apnea, your doctor may send you to a sleep center for testing. You may be asked to spend a night at the center, where experts will monitor your sleep. How Can Sleep Apnea Affect Your Driving? Because sleep apnea affects your sleep, it also affects your daytime alertness and performance. Untreated sleep apnea can make it difficult for you to stay awake, focus your eyes, and react quickly while driving. In general, studies show that people with untreated sleep apnea have an increased risk of being involved in a fatigue-related motor vehicle crash.

Many sleep apnea patients say they never fall asleep while driving. That may be true. But remember, you don’t have to fall asleep to have a crash. You simply have to be inattentive or less alert — and with untreated sleep apnea; you are not as sharp as you should be.

Can You Still Drive if You Have Sleep Apnea? Yes! While FMCSA regulations do not specifically address sleep apnea, they do prescribe that a person with a medical history or clinical diagnosis of any condition likely to interfere with their ability to drive safely cannot be medically qualified to operate a commercial motor vehicle (CMV) in interstate commerce. However, once successfully treated, a driver may regain their “medically-qualified-to-drive” status. It is important to note that most cases of sleep apnea can be treated successfully.

Because each State sets its own medical standards for driving a CMV in intrastate commerce, check with your local Department of Motor Vehicles for regulations in your State. What Should You Do Once You Learn You Have Sleep Apnea? You and/or your doctor should contact the medical qualifying examiner to determine your fitness to operate a commercial motor vehicle and to get help with treatment. What Level of Sleep Apnea (mild, moderate, severe) Disqualifies a CMV Driver? The disqualifying level of sleep apnea is moderate to severe, which interferes with safe driving. The medical examiner must qualify and determine a driver’s medical fitness for duty. What are the Obligations of a Motor Carrier Regarding Employees with Sleep Apnea? A motor carrier may not require or permit a driver to operate a CMV if the driver has a condition — including sleep apnea — that would affect his or her ability to safely operate the vehicle. It is critical that persons with sleep apnea fully use the treatment provided by their doctor. They should not drive if they are not being treated. Being effectively treated, and complying with that treatment, offers the best hope of a commercial driver with sleep apnea to secure the ability to do his or her job safely and be fully alert.

Terry Penney

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