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

Severe Obesity as a form of Impaired 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.

A recent study searched for links between a driver’s Body Mass Index (BMI – a key measure to determine clinical obesity in people) and their crash rate.  The findings were preliminarily published in “ScienceNOW” (Link) on October 26th of this year.

The study focused on commercial drivers who typically deal with long hours, a sedentary lifestyle punctuated with brief intervals of physical activity and a lot of stressful situations over scheduling and traffic.  Also linked to these drivers are very irregular sleep patterns and typically a deficient amount of quality sleep.

Due to the amount of miles driven, commercial operators are predisposed to crashes and many of these are already linked to fatigue, drowsiness and medical issues.

Two years ago, the research team focused on driver height and weight as factors in crash occurrence.  The height and weight can be used to derive BMI:  BMI greater than 25 is considered “overweight”; greater than 30 is considered “obese”; and greater than 35 has been labeled “severely obese” by the study.

During their first 2 years on the road, drivers in the study group with a BMI higher than 35 (“severely obese”) were 43% to 55% more likely to crash than were drivers with a normal BMI, the team reports in the November issue of Accident Analysis & Prevention (Link).

The specific causal reasons have not been clearly documented and speculation is focused on obstructive sleep apnea (OSA), limited agility and fatigue associated with other medical factors other than OSA.

There are a range of medical issues that can cause a driver to become disqualified as a “Commercial Motor Vehicle Operator” under the Federal Motor Carrier Safety Regulations (FMCSRs).   Presently, a person with severe obesity might be at elevated risk of developing some of the conditions that could lead to disqualification, but the simple weight or BMI of a person has no direct connection to qualification as expressed in Part 391.41. 

Additionally, the link between crashes and supposed causes (in this case BMI over 35) does not constitute grounds for disqualification; however, it may be a warning sign that drivers, their employers, health providers and EAP program administrators should be working in concert to manage a BMI greater than 35 downward to a lower number where feasible (if not for crash reductions, then for the many well documented health benefits of maintaining a lower BMI). 

Driving a commercial vehicle for a living presents special challenges, but comes with added responsibilities, too.  It’s a difficult challenge for many drivers to get the help and relief they need to make consistent lifestyle changes.  If they could, they’d benefit directly and if the study mentioned above is representative of all drivers, then we’d see potentially lower crash rates, too.

Stay tuned for more articles examining the issue of “impaired driving” in its many forms.

SafetyFirst provides a range of driver safety programs to more than 3,800 active fleet clients and through a network of more than 75 insurance providers. 

Our programs range from MVRs to hotline reports — all designed to identify specific drivers with specific habits that should be “brought to the front of the line” to get help from their supervisors immediately.  This compassionate intervention in a timely fashion has been documented to reduce crash rates by 20 to 30% without expensive telematics devices that cost 100 times more per vehicle per month than our proprietary program.

However, we also embrace technology and have helped our clients better leverage their telematics investments.  In one case, we worked with a client to design and implement an enhanced coaching program that reduced the actual behavior that triggers telematic speed alertsThey dropped the alerts by 600% in the first year.

Impaired Driving in its many forms…

Until very recently, “Impaired Driving” was often interpreted as “Drunk Driving” or “driving under the influence of alcohol”.  I think it means a lot more than that and the National Institutes of Health (NIH) agrees. According to their website, they state:

“Impaired driving is dangerous and is the cause of more than half of all car crashes. It means operating a motor vehicle while: affected by alcohol; affected by illegal or legal drugs; too sleepy; distracted, such as using a cell phone or texting; having a medical condition which affects your driving.”

Where I disagree is their inclusion of “distracted driving.”  I think they chose to include it since the driver could be suffering from “inattention blindness” where their mind is so hopelessly preoccupied that they don’t recognize traffic signals and conditions properly.

I feel that there is a fundamental difference between distracted driving and impaired driving:

  • Distracted drivers are fully capable of driving well, but choose to ignore their duty to drive properly
  • Truly impaired drivers incapable of driving well because they’re tired, drugged, drunk or ill, but choose to drive anyway

In reality, neither should get behind the wheel, and both choose to endanger themselves and other drivers. 

Driving presents a unique challenge each time we get behind the wheel.  To be ready to handle the dynamic situations we’ll encounter when driving, we ought to be in top condition. 

Our bodies and minds can be affected by a wide range of factors: being tired; being physically ill; suffering from allergies; coping with chronic physical conditions; taking over the counter medications; drinking alcohol; smoking marijuana; taking prescription medications or abusing illicit drugs.

These factors most commonly contribute to collisions by impairing the driver’s judgment and/or reaction times. 

The universal precaution for impaired driving is to avoid becoming impaired in the first place.  This may translate into getting enough sleep and eating a proper diet to avoid fatigue, getting a flu shot annually to lessen the impact of symptoms, avoiding the intake of alcohol or other “recreational” drugs such as marijuana, or asking extra questions of the doctor and pharmacist when dealing with prescribed medications for illnesses or chronic conditions. 

For regulated drivers (i.e. those subject to FMCSRs), physical or medical qualification is an important aspect of becoming and remaining qualified to drive.  For most regulated drivers, this translates to visiting the doctor for a physical once every two years (or more frequently depending on your condition and the doctor’s findings).  In some cases, a failure to meet the minimum requirements (or any discovered fraud surrounding these issues) could lead to disqualification.  On November 30, 2012, the FMCSA issued a press release (Link) stating that it had ordered a driver to cease driving “due to his failure to exercise an appropriate duty of care to the motoring public regarding his medical conditions.”

The FMCSA placed the driver out of service “…after agency investigators found serious safety concerns surrounding his medical condition and qualifications under his commercial driver’s license (CDL) issued by the State of Georgia.” 

Specifically, “…Investigators discovered that Felton failed to disclose to a medical examiner his disqualifying medical conditions, including his medications prescribed in treating those conditions.”

The news release concludes with this message;

“This case sends a clear message that we will use every tool at our disposal to identify and remove from our roads unsafe operators,” said FMCSA Administrator Anne S. Ferro. “Our agency is committed to raising the bar for commercial vehicle and driver safety.”

This month’s Ten-Minute Training Topic is on Impaired Driving and includes a driver handout, manager’s supplemental report, and a pair of slideshows to facilitate educational opportunities with drivers.  This is distributed to all of the supervisors who receive monthly summary reporting through our Safety Hotline program — in place at more than 3,800 active clients and covering about a quarter million commercial vehicles.

We’ll also be looking at individual forms of impairment more closely through our blog site over the next several weeks.

Sustainability – not just a buzz word in transportation

Today, I found an article titled “Sixty feet of controversy” about a new tractor-trailer design that helps retailers conserve fuel, make fewer trips by carrying more cargo per trailer, and yet it generates controversy among experts.

For many retail store distribution operations (e.g. snack foods; general merchandise for retail department stores; food products, etc.) the current trailer designs are maximized for structural strength and their ability to carry a large weight of goods.  These retailers often stuff the current style of trailer full, but it’s nowhere near maximum weight.  This requires additional trailers running additional trips which is wasteful for several reasons:

  • Each outbound load also generates a return “empty” trip that only burns fuel and generates no productive revenue for the company
  • Because the trailer is designed to carry extra weight, there’s extra emphasis on structural support beyond what is needed to make the trailer “safe” to operate — the added (but un-needed) support beams add dead weight that burns fuel on both the outbound and return trips.
  • If there had been a way to stuff more light-weight cargo into the trailer, more product would arrive efficiently.

What would help these operators is a trailer designed to provide an emphasis on cubic volume rather than a focus on weight of cargo.

This new “supercube” design (link to image) is being tested on a very limited basis in Canada.  It is only seven and a half feet longer than most trailers on the road, but can carry 28% more cargo by volume.  It includes several interesting design changes to manage this feat.  According to the article; “A lowered floor and 126-inch interior increases trailer capacity by 28%, offering 5,100 cu.-ft. of storage, and a drome box mounted to the back of the cab adds another 521 cu.-ft. of carrying capacity.

By placing an emphasis on a custom design, the shipper can move more cargo efficiently.

While other proposals for LCV (Longer Combination Vehicles) focused on double trailers or even triple trailers pulled by a larger tractor with greater horsepower, there has been a concern expressed for the safety of a string of trailers being driven in mixed traffic (i.e. next to smaller cars and light duty trucks) on existing highways.

One of the concerns expressed over the supercube design is that it might be used to haul heavy goods and become a safety threat if improperly employed in the future.

While the supercube may be a perfect fit for some shippers, it is not hard to imagine that a truck fleet, already operating on thin profit margins and dynamic fuel costs, might try to use supercubes improperly.  This brings up controversy from safety professionals, and transportation industry insiders.

Regardless of controversy, shippers will not stop looking for their holy grail of trailers.

What do you think about supercube designs versus LCV combinations?  Are they coming to a road near you soon?  Is there a legitimate safety concern associated with these monster trucks?  How do we deal with any real safety issues — more regulations?  Specialized Training?

Let us know at our discussion group on LinkedIn.com!

 

FMCSA Seeks 183% Budget Hike to Increase CSA Enforcement – Market Trends – Automotive Fleet

As reported by Automotive Fleet magazine (see link — FMCSA Seeks 183% Budget Hike to Increase CSA Enforcement – Market Trends – Automotive Fleet.) “the Federal Motor Carrier Safety Administration (FMCSA) can only audit about 2 percent of the nation’s truck fleets due to its finite resources”.

The article asserts that these few audits are focused on “high-risk fleets“, but many would counter that the program designed to spotlight those operators (CSA) is flawed and has never been fully validated (the use of all crash data, not only “at-fault” data to establish scores as one example).

To now propose a radical increase in budget to spike enforcements (and levy fines) using this unproven and critically attacked system is either genius or heinous.

On one hand, the Federal Motor Carrier Safety Regulations (FMCSRs) attempt to define the bare minimum safety standards that should universally apply to medium and heavy duty vehicles engaged in interstate commerce.  There are flagrant violators and there are also “gold medal” companies who go far above and far beyond these minimums. 

Unfortunately, the stellar performers get underbid on cargo shipments by the flagrant violators.  This vicious circle works against the promotion of safe driving at reasonable speeds — the motor carrier with the fastest transit times and most blatant disregard for “hours of service” rules (and lower than realistic bids) often edge out the carriers who do it right and bid it appropriately.

Regardless of all the bystander’s rantings about CSA, one thing is clear — FMCSA is signalling it’s intent to ramp up enforcement. 

Curbing unsafe driving, inspecting and repairing equipment, documenting driver qualifications and handling all recordkeeping consistently are more important than ever before.  And that’s not a bad thing, is it?

UPDATE: Drowsy Driving

Our recent posting about Drowsy Driving got a lot of attention.  We wanted to circle back and provide a few updates.

A federal jury awarded a $7 million judgment in the case of a fatigue (or driving while drowsy) case.  Here’s a link to the report:  http://www.insurancejournal.com/news/southcentral/2011/11/14/223977.htm

Several interesting news articles have appeared over the last week or two and we wanted to share them with you.

November 17, 2011  http://www.digitaljournal.com/pr/494110 (it starts with “For any motorist, driving under the influence of alcohol or drugs or without sufficient sleep can have disastrous results. However, drowsy or intoxicated truckers and other drivers of large commercial vehicles pose a unique safety threat, as serious consequences of accidents caused by these types of vehicles are far more likely to gravely impact passengers in other autos: only about ten percent of those killed annually in truck accidents are drivers or passengers in the truck.”)

November 9, 2011 — “Driving drowsy as dangerous as driving drunk, studies showhttp://thechart.blogs.cnn.com/2011/11/09/driving-drowsy-as-dangerous-as-driving-drunk-studies-show/  “I know what it feels like and looks like and so do you. So why do many surveys show that most of us have driven while drowsy and many of us do so on a regular basis? Well, for one thing, we are not a culture that takes sleep seriously.”

November 15, 2011 – “Not Enough Drivers Realize Dangers of Drowsy Driving, Insurer Says”  http://www.insurancejournal.com/news/east/2011/11/15/224095.htm “According to the National Sleep Foundation, the AAA Foundation for Traffic Safety estimates that about one in six deadly crashes involve a drowsy driver.”

November 14, 2011 – “Is the driver in the next lane falling asleep at the wheel?”  http://fredericksburg.com/News/FLS/2011/112011/11142011/664324 – “BE CAREFUL next time you’re out on the road–the driver next to you might be asleep. Or at least pretty tired. Neither, obviously, is a good thing.”

Our “Ten-Minute Training Topic” on Drowsy Driving has been one of the most popular and often downloaded topic we’ve published since 2003!  Thanks for the interest and support of our crash reduction programs.

Drowsy Driving Week – November 6-12, 2011

No, it’s not the week where we want to drive drowsy — it’s to raise awareness of the extent of the issue and the need to educate drivers of what they can do to prevent driving while drowsy.

While most people have come to recognize the dangers of “drinking and driving“, “texting while driving” or “driving without the use of a seatbelt“, many still consider “driving while drowsy” to be a relatively minor safety concern. People think that they can tell when they’re about to fall asleep and can safely get home before a problem occurs. These drowsy drivers are at much greater risk to be injured in a crash than they realize.

The National Highway Traffic Safety Administration estimates that drowsy driving results in 1,550 deaths, 71,000 injuries and more than 100,000 accidents each year.

In a recent AAA Foundation for Traffic Safety (AAAFTS) survey, nearly nine out of every ten police officers reported they had stopped a driver who they believed was drunk, but turned out to be drowsy.  The AAAFTS survey also indicated that:

  • Younger drivers age 16-24 were nearly twice as likely to be involved in a drowsy driving crash as drivers age 40-59,
  • About 57 percent of drowsy driving crashes involved the driver drifting into other lanes or even off the road.
  • More than half (55%) of those drivers who reported having fallen asleep while driving in the past year said that it occurred on a high-speed divided highway.
  • More than half (59%) of those drivers who reported having fallen asleep while driving in the past year said they had been driving for less than an hour before falling asleep; only one in five reported they had been driving for three hours or longer.

Drowsy driving is operating a motor vehicle while sleepy, fatigued or “tired/exhausted”.  Sleepiness and driving is a dangerous combination. Most people are aware of the dangers of drinking and driving but don’t realize that drowsy driving can be just as fatal. Like alcohol, sleepiness slows reaction time, decreases awareness, impairs judgment and increases your risk of crashing.

The potential to fall asleep behind the wheel can’t be judged by the operator – they simply fall asleep and typically lose control of their vehicle.

This month’s Ten-Minute Training Topic covers what drivers can do to recognize the warning signs, prevent drowsy driving and improve their health/wellness in the process. 

The Ten-Minute Training Topic series is a monthly driver training package on a specific, focused issue like Drowsy Driving, Parking Lot Dangers, Improper Passing, etc.  The program includes driver handouts, manager’s supplemental reports (with relevant news stories, links to web site resources, etc.) and links to A-V presentations for the drivers.  The program materials can be used as payroll stuffers, classroom training sessions, or tailgate talks.  Drivers can review the materials from remote locations electronically.

We encourage managers to review any existing company policies that relate to the Ten-Minute Training Topic in advance of its distribution to drivers.  This provides an opportunity to make any needed enhancements, prepare for anticipated questions and check to make sure that your policy and the Ten-Minute Training Topic are in agreement.

While some companies may have developed “policies” concerning how drivers should deal with drowsy driving and “fatigue”, others may want to consider the following questions:

  • Are your drivers aware of your specific company expectations regarding driving while tired or “drowsy”?
  • Are there any specific instructions you want them to follow regarding breaks, use of rest areas or other procedures when “at-risk” of falling asleep at the wheel?
  • Are there any circumstances where the driver should not attempt to drive while tired?
  • Has your company developed or participated in any workplace wellness programs that might help address sleep disorders, diet and other contributing factors?
  • Are there pertinent regulations affecting your drivers with regard to their alertness or ability to drive safely (ie. Federal Motor Carrier Safety Regulations; Hours of Service Rules, etc.)

This is a great time to re-acquaint them with your company’s practices and expectations regarding all aspects of driving safely at night or during extended trips where fatigue may become a safety issue.

If you’re interested in learning more about our monthly driver training package (included free in our hotline program, or available for separate purchase), please let us know.  We can even send out a sample training topic for your review as a courtesy copy. 

Our toll-free number is 1-888-603-6987 – just let us know that you’re interested in the Drowsy Driving Training Topic.