Effects of Sleep Deprivation on Fire Fighters and EMS ... - NAEMT

<strong>Effects</strong> <strong>of</strong> <strong>Sleep</strong> <strong>Deprivation</strong> on Fire Fighters and EMS Responders
back <strong>of</strong> the throat. Due to this, the brain awakens, though the
person might not be aware <strong>of</strong> their disturbed sleep. Mild to
moderate sleep apnea is when these brief sleep interruptions
occur 5 to 30 times an hour, while severe sleep apnea is when
these interruptions occur more than 30 times an hour.
A recent study <strong>of</strong> CMV drivers found that sleep apnea is more
common among them (18 percent mild , 6 percent moderate and
5 percent severe sleep apnea) than the general population where
approximately 3 percent are believed to have severe sleep apnea.
The increased prevalence among truckers may result from that
pr<strong>of</strong>ession’s concentration <strong>of</strong> the risk factors for OSA including
being male and overweight/obese, smoking and drinking alcohol.
The researchers also identified that for certain individuals, sleep
apnea may have a multiplying effect on driver fatigue. They
observed that the prevalence <strong>of</strong> sleep apnea depended on the
average duration <strong>of</strong> sleep prior to the study. Short sleep duration,
six hours or less per night, resulted in more sleep apnea. In addition,
there was more sleep apnea when individuals awoke early in the
morning, and since more than a third <strong>of</strong> CMV operators start their
drives before 6:00 AM, that also could increase apnea and its
associated risks. Although drivers generally were poor judges <strong>of</strong>
their fatigue level, almost all objective tests <strong>of</strong> performance showed
a clear relationship with the severity <strong>of</strong> sleep apnea and driver
impairment.
Because the frequency <strong>of</strong> sleep disorders is increased among CMV
operators and the consequences <strong>of</strong> increased fatigue potentially
so catastrophic, there are regulations in place for screening CMV
operators for sleep apnea and monitoring their adherence to
therapy when it is detected (see page 58). Effective treatment <strong>of</strong>
OSA reduces its daytime fatigue and significantly improves
cognitive performance (McMahon et al., 2003). When treated,
crash risk <strong>of</strong> apneic drivers is not different from normal
individuals (George, 2001).
OSA has health consequences other than fatigue-associated
crashes, such as an increased risk <strong>of</strong> hypertension, weight gain,
sexual dysfunction, heart disease and sudden death. Although
Obstructive sleep apnea (OSA)
probably contributed to the
untimely death <strong>of</strong> Reggie White,
one <strong>of</strong> the greatest players in
NFL history, who died at age 43.
When severe, OSA can cause
cardiac arrhythmias and sudden
death. Mild sleep apnea may be
as common as diabetes and
asthma, and severe problems
occur in two to five percent <strong>of</strong>
adults, most <strong>of</strong> whom do not
know that they have the
disorder. Symptoms <strong>of</strong> OSA
include loud snoring, choking
during sleep, excessive daytime
sleepiness and morning
headaches. It can only be
diagnosed in a sleep
laboratory. More information is
at www.sleepapneainfo.com/.
reduction in crashes is critical, treating OSA also is cost effective by other indices. Between
January 2003 and December 2005, researchers from Texas, Wisconsin, and Minnesota analyzed
339 commercial truck drivers with newly diagnosed sleep apnea. All received a continuous
positive airway pressure (CPAP) machine for treatment. Researchers found that after CPAP
intervention, there was an average savings <strong>of</strong> $538 per member per month or a 58 percent
reduction in total health care costs. In addition, inpatient hospital admissions showed a reduction
<strong>of</strong> 91 percent after CPAP was used. Researchers conclude that companies can reduce health
care costs by identifying and treating employees with sleep apnea (Berger et al., 2006).
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