Sleep apnea mandate a needless burden

By Mark Schremmer, staff writer

The Owner-Operator Independent Drivers Association delivered a heavy dose of reality to the Federal Motor Carrier Safety Administration’s and Federal Railroad Administration during public listening sessions regarding a potential sleep apnea regulation.

Members, as well as employees of OOIDA, shared their personal stories, questioned the number of crashes that have been caused by the condition and explained the burden of the costs that would be associated with an obstructive sleep apnea testing mandate during listening sessions in Washington, D.C., Chicago and Los Angeles.

The May listening sessions were held in connection with an advanced notice of proposed rulemaking published on March 10 and were aimed at receiving feedback about potential obstructive sleep apnea regulations. The comment period was originally scheduled to end June 8, but was recently extended until July 8.

OOIDA has repeatedly cited reports that show no link between sleep apnea and an increase in crashes.

According to research on sleep apnea published by FMCSA and authored by Dr. Allan Pack of the University of Pennsylvania, “there is no statistical evidence in these data to suggest that the presence of sleep apnea significantly increases the likelihood or the risk of motor vehicle crashes.”

“You can’t determine if there is a link between sleep apnea and the risk of crashing,” said OOIDA Life Member Dick Pingel, who is from Plover, Wis., and has been trucking for more than 35 years. “A driver can be tired for many reasons. They may be physically tired after securing a load or mentally tired after having a rough day that was emotionally draining.”

A study released in March by University of Minnesota Morris professor Stephen Burks claimed that truck drivers with untreated sleep apnea are much more likely to crash. However, Andrew King, a research analyst with the OOIDA Foundation, cited a paragraph in the study that was contradictory to those claims.

“However, if the ‘No Adherence’ drivers – those who weren’t compliant – have a higher crash risk than their controls, it is not possible to conclude that this difference was caused by the effect of untreated obstructive sleep apnea,” King read to the panel.

Without causation, King said there is no justification for creating such a large financial burden on the trucking industry and its drivers.

Meanwhile, many truckers say the search for drivers with sleep apnea has been a witch hunt of sorts.

Tilden Curl, an OOIDA life member with nearly 2.5 million miles, sent an email to the panel at the Los Angeles session. In the email he recalled how much more simplistic the health care process was before the days of the certified medical examiner registry and guidance from the FMCSA.

During his 2003 medical certification physical, Curl said he told the doctor he was tired all the time.

“He then ordered lab tests and found that my thyroid wasn’t working properly,” Curl wrote. “He prescribed the proper medicine and referred me to see a family doctor for continued care. My fatigue problem was alleviated. It is a condition that I continue to have monitored regularly. The testing and treating were relatively inexpensive with no lost work.

“If the same circumstances occurred today, the results would be very different. I would be immediately referred to a costly sleep study based on pressures applied on medical personnel by the FMCSA. This pressure could cause doctors to focus on the wrong conditions based on guidance rather than using their medical training to identify the real problem their patient might have. Today, treatment of my real problem might not even happen until much later and include treatments or tests that are unnecessary.”

Curl said the FMCSA is complicating an issue that should be up to a driver and his or her doctor.

“FMCSA should get out of the medical field and leave that to the doctors,” Curl said. “Qualified doctors should be the only ones responsible for determining whether a person is fit to drive. A person’s medical care should only be between the patient and doctor. To focus on a single condition that causes fatigue is extremely shortsighted and irresponsible.”

Johanne Couture, an OOIDA senior member from Ontario, Canada, also questioned why the FMCSA would feel the need to monitor the use of a CPAP or other sleep apnea treatments.

“A point of contention I have is with the insistence of monitoring usage of obstructive sleep apnea treatment,” Couture said. “American CPAP and oral appliance manufacturers have included a usage monitoring chip in their products. Why? If the patient is aware of the benefits of treatment for the condition, the patient realizes it’s in their best health interest to use it.

“I compare this to the use of my glasses. If I don’t wear them, I don’t see the road signs and traffic conditions so well. But no one monitors how much I use my glasses. There’s a noted condition on my license that says I need to be wearing them while driving, period.”

King with the OOIDA Foundation said at the Chicago listening session that studies and equipment can cost thousands of dollars. He also said the time off the road could cost an owner-operator $3,500 a week and $15,000 a month.

OOIDA Director of Regulatory Affairs Scott Grenerth wrote that members have reported out-of-pocket costs for sleep apnea testing, treatment and equipment of up to $12,000. At the Los Angeles session, Kevin Walgenbach of the National Ready Mixed Concrete Association said his members have had to pay up to $15,000. Time off the road can cost the driver even more money.

“When you factor in the unnecessary financial impact on drivers and their families, any rulemaking may actually reduce needed care and run safe drivers out of the industry,” Curl wrote. “While your intentions may be in the right place, I think the unintended consequences of this rulemaking may override the benefits and ultimately make our highways less safe. Don’t underestimate the adverse impact on the industry.” LL