Lessons Learned:
How To Manage Driver Fatigue & Sleep Apnea

What’s the best way to manage the safety, human resource and legal issues to minimize sleep apnea and fatigue in drivers? Employers should approach sleep apnea like any other medical or impaired condition, measuring the safety hazard and treating every situation in a confidential, non-discriminatory, legal and fair manner.

Ideally, a driver would use the appropriate rest and medical treatment if they experienced sleeplessness or fatigue. However, employers must manage this risk. Disqualifying impaired drivers from driving and putting in place procedures that identify the medical condition of sleep apnea are proactive ways for managing this risk. The Department of Transportation’s driver medical qualifications have enough latitude to give discretion to the examining medical professional to discover sleep disorders that would adversely affect safe driving. By implementing procedures and standardization with the company-designated medical professional, employers could address this issue. Each new hire and periodic driver physical could include this sleep disorder evaluation for safe driving.

Historically, lack of sleep has been an identified and suspected cause of industrial accidents. What have been hard to pinpoint, however, are the factors that lead to the lack of quality sleep and the resulting fatigue. Lifestyle, diet, changing work patterns, Seasonal Affected Disorder (SAD) and sleep apnea are just some of the potential causes. The following information reviews driver-related fatigue and sleep apnea.

Driver Fatigue And Alertness Studies

The Federal Highway Administration (FHWA) Office of Motor Carriers (OMC) has been researching driver fatigue and alertness since 1991. Their Driver Fatigue and Alertness Study (DFAS) is the most comprehensive over-the-road study of commercial driver alertness to date. The DFAS results are major scientific inputs to the current re-examination of the FHWA’s 60-year-old driver Hours of Service regulation (HOS). Major findings include:

• Driver alertness and performance were more consistently related to time-of-day than to time-on-task. Driver drowsiness episodes were eight times more likely between midnight and 6 a.m.
• Drivers in the study did not get enough sleep compared to their “ideal” sleep needs. Drivers obtained an average of two hours less sleep than their daily “ideal” requirements.
• Drivers were not very good at assessing their own levels of alertness.
• There were significant individual differences among drivers in levels of alertness and performance.

The University of Michigan Transportation Research Institute between 1991 and 1993 performed a local/short haul driver fatigue crash data analysis. The analysis found trip distance to have the most pronounced effect on the percentage of fatal crashes that were fatigue-related; shorter trips are associated with a much lower incidence. The risk of local/short haul trucks’ involvement in fatigue-related fatal crashes is a fraction of that of over-the-road trucks.

The Virginia Polytechnic Institute and State University Center for Transportation Research is conducting a three-year study to determine the impact of fatigue and inattention in driver errors and incidents in local/short haul truck operations. A portion of the study has been completed. The top five ranked safety issues are: problems caused by drivers and private vehicles, stress due to time pressure, inattention, problems caused by roadway/dock design and fatigue. When questioned specifically about fatigue, drivers identified 22 issues. The top five ranked fatigue-related issues were not enough sleep, hard/physical workday, heat/no air conditioning, waiting to unload and irregular meal times.

What Is Sleep Apnea?

Sleep apnea is a breathing disorder that occurs during sleep. Typically it is accompanied with loud snoring. There are two different types:
Obstructive Sleep Apnea – During loud snoring the airway in the back of the throat collapses and prevents oxygen from entering the lungs and bloodstream. If these episodes last over 10 seconds and occur more than seven times an hour, the effect reduces blood oxygen levels to the brain. This, in turn, forces the person to stay in a lighter sleep stage so that the breathing passage muscles are kept tighter. This prevents the person from obtaining maximum rest benefits during sleep and can cause the person to fall asleep during daytime hours.
Central Sleep Apnea – very rare; when the brain fails to signal the lungs to breathe.

Symptoms Of Sleep Apnea

• Daytime sleepiness
• Loud, irregular sleepiness
• Morning headaches
• Irritability or moodiness
• Lack of concentration
• Obesity — biggest demographic predictor
• Hypertension
• Frequent nocturnal urination

Consequences Of Sleep Apnea

Because sleep apnea decreases the level of oxygen in the blood it frequently leads to high blood pressure, heart attack, stroke, fluid retention and abnormal heartbeats. There are approximately 38,000 cardiovascular deaths a year attributed to sleep apnea.

American Trucking Association (ATA) Apnea Signs & Symptoms Quiz
The following are indicators of a sleep disorder. If you answer yes to any of them, you should discuss it with your physician.

Have you been told that you snore loudly?
Have you been told that you gasp and choke in your sleep?
Do you spend eight or more hours in bed, yet still feel as though you have not had enough sleep?
Do you take frequent naps?
Do you fall asleep at inappropriate times?
Do you have trouble getting to sleep, or do you wake up for a few hours during the night?
Have you been told that you have trouble breathing when you’re asleep?

Testing* For Sleep Apnea

Tests can be performed in a laboratory, or in your home. Sensors monitor your breathing, heart rate and other vital signs overnight. This information is analyzed by laboratory technicians and diagnosed by a physician.

Treatments*

Treatment depends on the type and severity of your sleep apnea. Treatments include but are not limited to the following:

• Surgery involves cutting the tissue in the neck; (weight loss surgery i.e., laparoscopic obesity surgery)
• Dental appliances
• Continuous Positive Airway Pressure (CPAP)

[CPAP is a small machine that blows air into the nose through a nasal mask and keeps the airway from collapsing. It must be worn during all sleep time.]

*Most insurance plans cover the cost of testing and treatment devices.

Know Your Body

Everyone has a biological clock. Among other things, your biological clock tells you when you’re hungry, tired, hot, cold and lively. Get to know your personal biological clock, especially the times when you tend to be most active or tired. According to the ATA, there are two times a day when your biological clock is most likely to feel tired. The first is the “afternoon lull,” from 2 to 5 p.m. The second is 2 to 6 a.m. If you must drive during your biological sleepy time, take precautionary measures. Leave time for a nap prior to the shift, talk on your CB radio, pull over every two hours to take a quick walk and make sure your cab is getting plenty of fresh air. When all else fails, pull over in a safe location and get some sleep. Caffeinated drinks may give you a boost; however, the effect lasts for a short period of time.

Getting The Word Out

To the greatest extent possible, the operational environment must support alert driving. Fleet management practices, in particular scheduling and policies regarding the taking of rest breaks while on duty, can greatly influence driver lifestyle and the priority they place on sleep.

XL Environmental • Risk Control Division • 520 Eagleview Boulevard, PO Box 636, Exton, PA 19341 • Phone: 800-327-1414 • Fax: 610-458-7285 • xlenvironmental.com

XL Environmental is a division of XL Specialty Insurance Company.