Failure to test truck drivers for sleep apnea 'indefensible'

BUS DEPARTMENT NEWS

Failure to test truck drivers for sleep apnea 'indefensible'

A nationally known sleep expert says it is "absolutely indefensible" that federal highway safety officials do not have commercial truck and bus drivers screened for sleep disorders.
"This is a major public safety issue. There is no reason not to enact" guidelines to check drivers, said Dr. Mark Mahowald, director of the Minnesota Regional Sleep Disorders Center and past president of the American Academy of Sleep Medicine.
Mahowald made his remarks yesterday following a National Sleep Foundation press conference in Washington, D.C., that was meant to draw attention to the hazards of sleepy drivers at the wheel of 80,000-pound rigs. The nonprofit foundation is involved in promoting public understanding of sleep and sleep disorders.
A two-part Pittsburgh Post-Gazette series last month looked at weaknesses in federal oversight for ensuring that truck and bus drivers are medically fit to drive commercial vehicles.
One problem is that the required Department of Transportation physical done every two years does not specifically screen truck and bus drivers for sleep disorders such as obstructive sleep apnea -- even though some sleep experts believe the condition may affect up to 15 percent of the 9 million commercial drivers.
Federal highway officials have proposed including questions during the physicals that might reveal sleep problems. Those questions were even published in the Federal Register in August 1998.
Since then, following a brief public comment period, the proposal has remained with the Federal Highway Administration, now called the Federal Motor Carrier Safety Administration, where it has been reviewed, analyzed and modified.
The methodical approach is necessary, said safety administration spokesman David Longo, to make sure that the rules are really needed and that they don't contradict already existing rules or regulations.
"The other part of the problem is, there are some other regulations that Congress asks us to issue" which then delays the work. Longo said he anticipates the new medical examination form that includes questions about sleep problems will come out by summer.
For Mahowald, however, there is no good reason for the delay when a few simple questions during a driver's physical exam could signal a medical condition that poses a life-threatening danger to anyone on the highway.
"Once this became known publicly [through the Federal Register], this should have been enacted immediately," said Mahowald. "There is no defensible reason not to. It would be very easy to identify the individuals, to get them diagnosed, and get them treated." Once treated, he added, the drivers can safely resume driving.
Much of the public debate regarding truck driver fatigue has centered on federal highway officials' review of commercial drivers' "hours of service," the maximum number of hours they can drive and the minimum amount of rest they must get each day and each week.
Current regulations allow drivers to spend up to 10 hours a day behind the wheel and another five loading or unloading before taking at least eight hours off. National Sleep Foundation officials yesterday said they favor a proposal for driving up to 12 hours, then taking 12 hours off, because it more closely follows the body's natural sleep-wake cycle.
But for some drivers, it doesn't matter if they drive 12 hours or 12 minutes. They're sleepy all the time, yet they may not see the danger they pose to themselves and others.
"I didn't realize what was wrong with me until after I had the accident," said Tim Douglas, 37, a former truck driver from Florida, who also spoke at yesterday's press conference.
In July 1995, Douglas was driving south on Interstate 75 in Georgia when he fell asleep at the wheel. His semi plowed into the back of a pickup truck carrying 14 people on their way to a family reunion. Seven people in the pickup were killed, including two children about the same age as Douglas' own children.
"I look at my kids," said Douglas, "and the memories [of the crash] don't go away."
Police charged Douglas with vehicular homicide because, they said, he was following too closely and the truck's brakes were out of adjustment. Under the terms of a plea agreement, Douglas spent nearly two years in prison.
While Douglas was awaiting his trial, his girlfriend convinced him to see a sleep specialist because she'd noticed he sometimes stopped breathing during the night. Barely two hours into his overnight study at an Orlando sleep clinic, Douglas said, they woke him because of his erratic breathing.
"The nurse said, 'We can't let you go any further. You might die on us.' "
Douglas has obstructive sleep apnea, a condition in which his airway becomes blocked at night and prevents him from sleeping well. People with the condition become so tired they may fall asleep during the day, sometimes without warning.
Sleep experts believe truck and bus drivers may be especially vulnerable to sleep disorders because of the many hours they spend sitting behind the wheel. Poor diet and obesity also contribute, as does a work schedule that already leaves many drivers without adequate sleep.
Drivers with sleep apnea like Douglas, who fall asleep and cause a fatal crash, can then get blamed for the consequences of their medical condition.
An exception was Raymond G. Holsopple.
The same year Douglas collided with the pickup in Georgia, Holsopple of Somerset County fell asleep at the wheel of his truck and crashed into a car on a Maryland highway, killing four people.
But, months later, prosecutors dropped all criminal charges after sleep specialists determined that Holsopple had sleep apnea. Because Holsopple didn't know he had the disorder, Maryland prosecutors decided they couldn't prove a crime was committed.
Douglas said he considered getting a sleep expert for his trial, too, but "it was going to cost me thousands of dollars I didn't have. So, instead, I spent two years in suspended animation."
Douglas now works in construction six days a week. At night, he wears a special mask that uses pressurized air to keep his airway open and help him sleep. He's no longer sleepy during the day and he's decided to go public with his story in the hope others may be spared a similar tragedy.
"At least if everybody had to be checked, it would be one less thing we would have to worry about," Douglas said. "It would save lives."