21st Century Fleet Maintenance

StepVANSIn  a recent article, titled “How Telematics Has Completely Revolutionized the Management of Fleet Vehicles” published in Entrepreneur (Click HERE), the case is made on how UPS managed to increase maintenance intervals (reduce total number of inspections and PMs) while increasing fleet reliability:

That’s right: UPS went from 240,000 preventative maintenance inspections per year to 120,000. 

Director of automotive engineering Dale Spencer, who oversees the UPS fleet, explains that…For decades, UPS used the same maintenance schedule: changing the oil, fluids and brakes at prescribed intervals, no matter what…[now] UPS has learned to trust the [telematic] data–to monitor every truck remotely, from a high-temperature warning to signals as to whether a driver is wearing a seat belt. “We have the driver data; we know how fast they’re driving, how hard they’re stopping,” Spencer says. “That driver will change bad habits before it costs us money.”

With Telematics, it is easy to spot problems before they’d typically surface in normal PM inspections.  Some fleets are using the GeoTab program to spot failing alternators up to two weeks prior to the anticipated failure — giving them the luxury of pulling the vehicle when it is most convenient for their shop instead of dealing with a roadside failure later on.

It’s more than just cutting PM frequency to save money — it can be a powerful predictor of future recalls and warranty issues:

The software also allows the company to spot wear trends. “We could see certain parts wearing out on the same vehicles too quickly,” Spencer says. That enabled UPS to go back to the vehicle manufacturer and argue for a warranty claim because it was possible to document a pattern. Even a small-business owner with a 10-vehicle fleet might have such an advantage, he says, “as long as they had the data to prove it.”

ntdc truck lineupTelematics can also identify aggressive drivers who wear out vehicles faster than the norm within your fleet.  Drivers who accelerate, brake and swerve in harsh ways tend to kill the lifespan of brakes, burn fuel efficiency and damage steering and control systems. Often, these are the same drivers who top the list of “most crashes” before being asked to drive someplace else.

At the end of the day, the hardware and software your team purchases is important, but even more important will be the customer service support, the hand holding, the networking/benchmarking with other clients and the ability to integrate data into existing systems — all hallmarks of the GeoTab system offered by SafetyFirst (Click Here)

With SafetyFirst, we can integrate:

  • Scored MVRs (using your scoring system)
  • Aggregated Driver Risk Scoring (using crash data, HMD reports, MVRs and telematics)
  • Safety hotline reports (aka How’s My Driving – third generation)
  • Online Training Modules (5-7 minutes, newly produced, tailored to specific issues including speed alerts from telematics)
  • DOT DQ File Maintenance (online)

Further, these are all 100% in-house built systems — not merely a patch work assembly of multiple, third-party products that have been stitched together.

Connected Cars

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Merging at Ramps

junction13Accessing a highway can present several challenges to drivers – whether novice or experienced: poor weather, low light levels, road design and the discourtesy of other drivers can each contribute factors that increase our risk of a crash while merging at ramps.

In a perfect driving world, we’d be the only operator and vehicle on the road; however, that’s just not possible.  We face congestion, road work, and delays each day as we go from site to site.  Merging adds stress since we have to cope with limited visibility areas (aka “blind spots”) and finding that gap in traffic flow where we can “squeeze in” to our spot with all the other vehicles.

SafetyZone-Safety GoalJuly’s Ten-Minute Training Topic provides drivers and their supervisors with insights and discussion about merging at ramps.  The driver handout refreshes operators on common problems encountered, and offers reminders about traffic, ramp metering and even wrong-way crashes that happen when a confused (or impaired) motorist manages to take the wrong ramp and rushes head-long into oncoming traffic.  The slideshows also help to illustrate these issues and aids for drivers.

Automotive Fleet Magazine recently posted a nice article and video to promote safe merging at on ramps.  To view these click HERE.

ramp collisions

Profiling Driver Event History

All motor fleet operations generate or collect various data on their driver’s performance:

  • Violations/Tickets
  • How’s My Driving Alerts
  • Crashes (at-fault, preventable, etc.)
  • Telematics (GPS, EOBR)
  • Driver Logs
  • Toll Receipts (EZ Pass, etc.)
  • Automated enforcement violations (which come direct, not through MVR data)

Additionally, fleets track information about other types of driver “events”:

  • Completion of training classes (online, classroom, tailgate talks, etc.)
  • Completion of year or years with no crashes (ie. Awards)
  • Internal Company Violations
  • Customer Complaints
  • Supervisory Observation Reports

Historically, each of these data sources have been in their own “silo” or “compartment” — but what if we could get all of this data together in one spot?  We could:

  • Another example of a blended scoresegment all drivers by relative risk taking behaviors
  • segment all drivers by crash risk
  • segment all drivers by age, tenure, training completed and then compare their crash histories to build a profile
  • determine which factors precede a collision (i.e. how many incidents, which types of incidents, etc.)
  • assign a predictability score to each driver based on actual data trends and schedule them for additional coaching or training to modify their habits and risk taking.

More simply put, we’re trying to leverage data to build awareness and reduce crash likelihood.

Fantasy?  Millions of dollars needed?  Nope. It’s real, and it’s happening right now among some of the nations largest fleet operators.

Imagine searching through 6500 driver records to find the “at-risk” needles in the haystack. Now imagine doing that with the push of one button.

One of several SafetyFirst clients implemented our E-DriverFile system three years ago on a pilot basis, but then rolled it out to their entire corporation.  This enabled them to cut the number of “at-risk” drivers in half within the first year simply by targeting their current training and supervisory resources on those people at greatest risk of becoming involved in a collision?

Pyramid 2011 for blog

Further, our new, online safety training modules are laser cut to fit specific issues surfaced by our How’s My Driving Hotline and our E-DriverFile profiling system.  These modules zero in on those risk taking habits, and remind drivers that there are serious consequences to the choices they make when behind the wheel.

At five to seven minutes each, they represent the next generation of online learning — focused, sharp, brief, emotive and able to convince drivers to “internalize” the need and desire to driver more safely — to make wiser choices — to take fewer risks.

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To learn more, call us toll free at 1-888-603-6987

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Safety Policy Expiration Date

EdiscoveryWhen did you last review and revise your company’s driver/vehicle safety policy?  What is it’s “expiration date”?

Creating an effective, enforceable safety policy to govern how drivers drive, how vehicles get maintained, what to do in the case of a crash and so on is vitally important for a host of reasons:

  1. Education:  you need to communicate your expectations as a management team so that the drivers know what to do and how to do it.
  2. Compliance:  your standard provides a benchmark for enforcement of minimum acceptable performance
  3. Anticipates contingencies:  well crafted and communicated policies enable managers to deal with the vast majority of situations that may arise during a day, week or month without having to seek guidance from above while providing an escalation path for true exceptions

One thing that the best policy can’t become is “timeless” — the world changes around us continually and as new technologies are introduced and case law is established our policies need to be reviewed to determine whether these changes warrant a revision to the policy.

Setting an artificial “expiration date” on driver/fleet safety policies would be one way to assure that the review is scheduled, budgeted and completed on a periodic basis.  Assuming that policies will be reviewed and revised “on the fly” as changes occur may be fruitless as the demands of the moment may rob even the most dedicated manager of the time needed to complete the review/revisions in a timely fashion.  By scheduling the review in advance, the manager can take a deliberate approach to the review.

ANSI Z15 2012 coverSelf Audit Against an Industry Standard

One way to assure that any policy review is comprehensive would be to conduct a self-audit of the existing policy against a published industry standard or benchmark.  The ANSI Z15.1 “sets forth practices for the safe operation of motor vehicles owned or operated by organizations” and was most recently revised in 2012.  The standard covers seven key areas including “Definitions, Management, Leadership and administration, Operational environment, Driver considerations, Vehicle considerations, Incident reporting and analysis.

While the standard may not cover all details of a specialty operation with unique exposures to loss, it does provide a baseline for comparison.  For the vast majority of fleets, it will cover those critical areas that are found in most driver/fleet safety policies.

Fleets who discover gaps in their current policy can document why the gap exists and whether the gap should be filled or ignored (i.e. the fleet doesn’t engage in that type of operation or the scenario will not present itself in the context of the fleet’s current or anticipated operations, etc.)

Realignment of Policies with Priorities

Many progressive fleet managers and safety managers take time during these reviews to realign safety goals and tactics to assure seamless compliance from both managers and Motivating Drivers to be saferdrivers — in the past, policies were often mis-aligned where drivers were expected to do X while managers told them to do Y. Recrafting the policy to make it work saves frustration, restores confidence in safety leadership and enables people to actually perform properly instead of ‘deceptively’ (either the manager or driver breaks the rules when goals are misaligned with policy).

This is also the time to address the effectiveness of the current policy as measured by past enforcement efforts — if the policy is unenforceable, or very difficult to monitor compliance, then a fresh discussion about compliance monitoring is appropriate.  A policy that is not followed, nor enforced isn’t much of a policy when called to testify on a witness stand following a tragic, and arguably preventable, collision.

All the News Fit To Print…

Another way to address periodic reviews/revisions is to keep a file of news articles announcing changes to regulations or laws that may affect your fleet operation.  Additionally, if any guidance is published about these changes by memorandum, keep a copy of each memo handy to incorporate into the review/revision at the scheduled date.

As the changes are incorporated into the new policy, keep a list of changes made to this edition so that it’s easier to communicate a short list of changes along with the final, revised policy.  This can boost your education efforts since most people would not want to have to re-read the entire policy solely to determine what has been updated.

Summary

Our company helps fleets to re-engineer their existing programs to get stronger results from the vendors they already use. Sometimes they’ve invested millions into programs that worked well for the pilot and then fell flat. Refreshing their approach and assigning Some parallels worth examininganalysts to “work the data mountain” into “urgently actionable” conclusions instead of frustrating “background noise” can rescue ROI from the gutter. Most of this comes from management teams who “wrote policies and bought silver-bullet systems” then stuck the notebook (policy) on a shelf and turned their attention back to their “day to day” after the vendor sales team leaves the building. Building discipline to deal with the mundane and tedious separates the winners from the whiners.

When was the last time your team reviewed your policy from start to finish?  Maybe you can leverage a standard like Z15 to help complete the review quickly, and focus on communicating the policy changes to your drivers and managers as a way to increase safety awareness and shake off complacency before any further collisions take place.

If you need help in conducting a review, call on us, we’re here to help.

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Providing Coaching Feedback for Enhanced Performance

Driver safety programs start with what managers need to do to locate, recruit, screen and train/educate candidates to become qualified operators.  Most of these programs then skip to dealing with crashes and evaluating operator turnover.  The costs associated with letting crashes push the turnover cycle are huge; however, by adopting an assertive and fair coaching mechanism, “at-risk” behaviors can be detected early in the timeline.

Additionally, those drivers who repeatedly appear in front of supervisors for coaching feedback (positive directions on how to avoid repeating the negative performance) could be cycled back through refresher education — a far more beneficial outcome and less costly than having to replace an operator.

Driver Safety Cycles

An often overlooked, but critical management task is monitoring the performance of existing operators and providing timely, relevant feedback to help them eliminate bad habits and replace them with better habits.

Many driver safety experts place a great value on feedback mechanisms for two reasons — when done well they produce great results, and not all driver safety issues can be fixed by more traditional training programs (i.e. 42 minute, online course delivered in three modules, etc.)

Look at this quote from a recent FMCSA document (link):

Additionally, experiences from the insurance industry as reported in trade sources supplement the literature on driver behaviors, suggesting that risky drivers are more than simply those with a lack of skill or inadequate training. In an interview with Peter Van Dyne, technical director for Liberty Mutual, he explains that “many crashes are caused by drivers’ habits and practice, not by their lack of technical knowledge. For example, a driver may be careless about making lane changes, or the use of cruise control, even though he or she knows the proper procedures” (as cited in Leavitt, 2005). This reinforces the notion that safety cannot simply be improved with more training. Often drivers possess the skill and knowledge needed to drive safely, but a bad habit or outside factors, such as a weak safety climate or lack of communication within an organization, will intervene and result in unsafe driving behaviors.

In that same article, it was interesting to read about feedback delivered from technology versus a personal approach:

As in the focus groups, the survey results suggested that, even though drivers may find feedback from technology helpful, they would still like feedback from a real person in addition to the technology. The majority of drivers reported that when it comes to receiving feedback from a person, they would most like feedback from a safety director or their direct supervisor…

The problem facing managers is twofold:

  1. Figuring a time-efficient way to spot and document meaningful (urgently actionable) issues without being overwhelmed by “background noise” data.
  2. Developing coaching skills to deliver feedback in a way that avoids needless confrontation and focuses on improving results without spiraling into a blame-game.

First, multiple mechanisms exist to gather performance issue indicators –

  1. How’s My Driving actually works very well despite the myths and misconceptions about crank calls and wasted time.  Most safety managers who actually use the program have documented that 99 out of 100 call reports are valid and worth the time to investigate and use as a coaching tool.  This is a great statistic since most fleets only get two reports per 100 vehicles per month – that’s one “bad” report every three to five years for smaller fleets.  Best of all, the program is designed to provide helpful feedback to benefit the driver, not penalize them. (80% of the drivers NEVER get a report, but 10% get multiple calls despite having the same sticker as all of their peers in their fleet!)
  2. Periodic MVR review or profiling — pulling the history of police reported crashes and moving violations for each driver enables a fleet safety team to develop a baseline of expected performance and use that as an objective measuring stick.  If drivers are accruing violations for speeding, they should receive feedback before their license is suspended for too many infractions.  Additionally, by combining additional data points such as preventable crashes (reported internally), “automated enforcement violations” from red-light cameras and radar-speed-cameras, andBlended Risk Score how’s my driving events, et.al. the fleet can get a clearer picture of which drivers are taking excessive risks while behind the wheel.  In an article that appeared in Construction Executive driver safety expert Peter Van Dyne states “Annually monitor driver performance to compare each driver’s actual performance against established safe driving expectations. However, such monitoring provides limited insight if the company has not established the right expectations. The company should review the individual’s driving record, crashes and compliance with company fleet safety expectations using a combination of observation, technology and manager feedback.”
  3. Telematics or GPS systems provide alerts on harsh braking, excessive speed, heavy acceleration and excessive sway/swerve.  Some even provide speed limit alerts based on mapping of speed limits throughout the territory.  The issue is that the pile of alerts generated in a given day or week can become excessive, requiring a filter to separate the “urgently actionable” from the “background noise”.  Additionally, it can become tedious to keep repeating “Slow Down” to your drivers if they continue to speed.  Clearly, enhanced feedback strategies are needed to translate “DATA” into “Behavior Safety Results”
  4. Camera in Cabin systems capture video of crashes so that you can tell drivers what they did wrong and why they violated your safety policies.  Typically this leads to hurt feelings, animosity, bruised egos and fear among other drivers that their own mistakes might be documented for posterity (or court).  Still, these programs could be tailored to provide a more positive coaching experience and in those circumstances may be able to provide a long-term, sustainable solution via coaching programs instead of playing “gotcha!” games with drivers.

Other programs could include supervisory ride alongs, road trailing (following behind company vehicles to make discreet observations) or incorporating feedback from customers.

Secondly, once a data gathering program is in place, supervisors need to develop practical skills on how to provide feedback on a regular basis.  This is best characterized as delivering material coaching on critical performance issues (i.e. complacency, failure to adhere to policy, excessive risk taking, et.al.) to an operator with the intent of helping them enhance their performance before a truly negative outcome occurs (i.e. crash, injury, etc.)

CoachingWhen it’s time to talk to the driver, it’s important to have a strategy.  Many supervisors don’t know where to start and quickly end up putting the driver on the defensive – unwilling to consider whether they could change their own habits to prevent injuries or crashes.  Drivers who fear coaching sessions because they’re perceived to be unhelpful, masked punishment will push back through defensive arguing and negotiating over the details of the incident regardless of how the data was developed (i.e. how’s my driving versus telematics — the driver will argue that the system failed in some manner and that the driver is blameless).  The key is to avoid blame setting by either the supervisor or driver, and focus on getting both parties to agree on what the expected level of performance must be and how to establish a goal to keep performance within those boundaries.

Coaching Tips TitleSafetyFirst has produced an online, interactive training module, a stand alone video and numerous power points and word documents to help supervisors prepare for coaching sessions.  In addition to these proprietary resources, we often recommend articles on providing feedback such as the recent one featured in Forbes (click HERE for the full article).

In summary, the Forbes article, titled “Are You Making Any Of These Common Feedback Mistakes?” covers five key mistakes folks make when providing feedback.

  1. The Pillow Effect – sometimes we’re so concerned with the potential emotional response (or bruising) that could happen when delivering feedback about negative performance that we go overboard in placing “pillows” of false praise to cushion the blow of the actual feedback.  Sometimes referred to as the “Sandwich” of praise, criticism and more praise, this approach more often confuses the operator because we’re sending mixed signals.  The article states “Studies have shown that this type of feedback leads to confusion, and causes a distraction from the essential problem that needs to be fixed. Just as bad, the feedback can come across as insincere and condescending. If you’re the recipient of such feedback, you’re generally just waiting to get to the real point — and preferring to be treated like an adult who can handle the truth. In fact, the only person who feels better from this approach is the one giving the feedback.”  Instead of trying to cushion the blow, be direct and honest.  Explain why this coaching session was triggered (we don’t want anyone getting hurt and we take safety seriously, etc.) and outline the ideal outcome of the session.  Perhaps the start of the conversation might sound like this:  “I’d like us to talk about and agree on a plan to do things differently to reduce the chances of a crash – part of that plan will need to include no-fault training that offers a basic refresher on key topics – not because you’re at fault, but because we need to document actions taken and because it’s never a bad time to get a refresher on safety.”  This is clear and avoids the “good news, bad news, good news” sandwich that leaves operators confused as to what’s actually happening – did I do well or poorly?  Am I in trouble and don’t really know it yet?
  2. Lack of specificity – as supervisors and managers, the more precisely we define the issue, the more constructive the conversation can be.  Saying things like “you need to be more careful” don’t help most operators very much.  Explaining why most drivers don’t realize that they’re following too closely can get them into trouble with inadequate reaction time and stopping distance is more helpful when trying to help drivers curb their tailgating habits.
  3. Wrong type of feedback feedback is not a one-size-fits-all effort.  The article states it well “When people are new at a task they need more positive feedback. As they move to a higher level of experience, they crave constructive criticism to stay sharp and increase performance.”  So a rookie driver may need more details and examples of how to do it right, but a seasoned vet may need a blunt discussion about following the rules instead of taking liberties with policies that are in place to protect them from getting hurt.  The article references a skills versus will chart to help us diagnose whether the underlying issue is one of skills (don’t know what to do or how to do it correctly) versus will (knows how to do it correctly, but isn’t willing to follow the procedure due to complacency or other issue).  http://www.primarygoals.org/general/skill-will-matrix/
  4. Wrong setting – “Where you give feedback matters greatly. The adage to praise in public and punish in private exists for a reason. Giving feedback in a collective environment, like a weekly meeting, can cause embarrassment and stress. Even if you as a manager don’t think it’s particularly harsh, that doesn’t mean the recipient feels the same. A quick, critical comment about an employee’s performance can have a disproportionate impact.”  Giving your operator a head’s up about the need to have a coaching session gives them time to prepare, but it also gives you time to prepare yourself to focus on the benefits of improved performance, elimination of sloppy habits and the reduced chances of being hurt due to a crash – even if it’s another driver’s “fault”.
  5. Over-reliance on positive or negative feedback – “Depending on our personalities, some of us find it easier to provide one kind of feedback over the other. For example, some highly analytical people tend to lean on constructive feedback, and can find positive feedback to be fluff. It’s important to know what you gravitate towards, and to shore up your weakness so you provide a balance of feedback.”  Regarding safety issues, it’s important to avoid the blame game and instead focus on working as a team to set short-term, highly achievable goals that reduce risk, comply with policy and encourage the operator to leave the session empowered to do their job in an expert manner – for the benefit of both the operator’s well being and the company’s mission.

Training Matters

Many employers are sending their operators to online training modules as refreshers.  This is a good approach, unless the training is boring, tedious or feels like punishment.  The average online training session for driver safety issues runs about 42 minutes long!  The average adult attention span is under 15 minutes, and most television ads have been cut from 30 seconds to 15 seconds in recent years.

The selection of training content could undermine all of your coaching feedback efforts in an instant.  How?  If you ask a driver to submit to a mind-numbing series of modules on why they should be using their turn signals consistently it will surely feel like punishment after the fact.

SafetyFirst has pioneered a series of HD, broadcast quality videos that combine live action, talking heads, onscreen animations, and limited text presentations which engage drivers and give them the reminder in less than 5 minutes.

The programs have been praised by safety managers as comprehensive and by drivers who feel respected as professionals by the brevity of the presentation.

The ten-question quiz must be passed with a minimum score of 80% and is unique to each driver (pulling randomly from a pool of twenty questions, and presenting the answer choices in randomized order each time).

The program has been through an extensive beta-test to increase the “user friendliness” for drivers and their managers.  For those fleets who need i-pad support, our programs are NOT flash-based and will work on any hand-held device (for those “gather around” meetings at job sites where all can group around a laptop to watch the presentation and then take paper-based quiz sheets to document their understanding of the content).  We have twelve topics in English and the five most common driving issues available in Spanish, too.

Current Safety Hotline (blue sticker program) clients can pay the upgrade fee to turn on the system, or they can purchase DVDs of individual titles if they’re not set up for online training due to firewall/IT issues.

Summary

Feedback is critical to assuring success in any driver safety effort.  For fleets of company cars, supervisors may want to examine MVR data (provided and profiled by our E-DriverFile program) for coaching and refresher training.  Other fleets may use telematics or How’s My Driving hotlines (like our “Blue Sticker Program”) to target drivers who may be “at-risk” of becoming involved in a collision if their behaviors are ignored.

When you invest time to help supervisors improve their feedback skills, you’ll get a much larger dividend than from safety coaching alone – they’ll be better equipped to provide feedback on all sorts of performance issues (i.e. idling, customer service, etc.)

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Sleep Apnea: One Pathway to Drowsy Driving

NOTE: This article is part of a series investigating the definition of “impaired driving” as it occurs in society, traffic safety and driver safety professional networks.

Drowsy driving, sometimes called fatigued driving, has long been suspected of a great number of crashes.  Over the past several decades, greater study into the causes and effective treatments for sleep apnea have been completed, and now there is great emphasis on diagnosing and treating sleep apnea.

At Federal Motor Carrier Safety Administration’s own website there are resources available, and a great overview of the problem:

“Sleep apnea is a major contributor to daytime drowsiness—a condition that could prove deadly for commercial truck drivers and everyone sharing the road with them. It is a condition where, during sleep, a narrowing or closure of the upper airway causes repeated sleep disturbances leading to poor sleep quality and excessive daytime sleepiness. Since excessive sleepiness can impact a driver’s ability to safely operate the commercial vehicle, it is important that drivers with sleep apnea are aware of the warning signs.”

At this site (click here) you’ll find resources tailored towards drivers, the industry at large and even tools like quizzes to test knowledge and awareness levels.

Statistics from the American Sleep Apnea Association report that sleep apnea affects 1 in 4 men and 1 in 9 women in the United States—accounting for an estimated 22 million individuals—with 80% of moderate and severe sleep apnea cases still undiagnosed.

Left untreated, sleep apnea can lead to a myriad of serious health consequences, including increased mortality and an increased incidence of hypertension, stroke, heart failure, coronary artery disease, cardiac rhythm problems, type 2 diabetes, gastroesophageal reflux disease, nocturnal angina, hypothyroidism, or neurocognitive difficulties.(1-7) In addition, individuals with untreated sleep apnea are 10 times more likely to die from a motor vehicle accident compared with the general population because of impaired driving performance.(8-9)

Whether your fleet of vehicles and drivers are regulated or not, sleep apnea is a significant wellness factor that can affect more than just motor vehicle crash rates.  Take time to learn more about this issue and consider how you might share this information with your drivers.

Web sites that provide a more thorough review of sleep apnea conditions and treatment options exist.  You may want to conduct further research at:

Notes:

  1. What is sleep apnea? National Heart Lung and Blood Institute website. http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/. Accessed May 23, 2012.
  2. George C. Sleep apnea, alertness, and motor vehicle crashes. Amer J Resp Crit Care Med. 2007;176:954-956.
  3. Obstructive sleep apnea. American Society of Anesthesiologists website. http://www.lifelinetomodernmedicine.com/Anesthesia-Topics/Obstructive-Sleep-Apnea.aspx. Accessed May 23, 2012.
  4. Yaggi HK, Concato J, Kernan, WN, et al. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034-2041.
  5. Obstructive sleep apnea. Merck Manual for Healthcare Professionals Online Edition. http://www.merckmanuals.com/professional/pulmonary_disorders/sleep_apnea/obstructive_sleep_apnea.html. Accessed May 23, 2012.
  6. Lin CM, Huang YS, Guilleminault C. Pharmacotherapy of obstructive sleep apnea. Expert Opin Pharmacother. 2012;13(6):841-857.
  7. Marin JM, Agusti A, Villar I, et al. Association between treated and untreated obstructive sleep apnea and the risk of hypertension. JAMA. 2012;307(20):2169-2176.
  8. George C. Sleep apnea, alertness, and motor vehicle crashes. Amer J Resp Crit Care Med. 2007;176:954-956.
  9. Obstructive sleep apnea. American Society of Anesthesiologists website. http://www.lifelinetomodernmedicine.com/Anesthesia-Topics/Obstructive-Sleep-Apnea.aspx. Accessed May 23, 2012.
  10. http://www.pharmacytimes.com/publications/issue/2012/December2012/Obstructive-Sleep-Apnea-An-Important-Wake-Up-Call