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

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<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). 33
<strong>Effects</strong> <strong>of</strong> <strong>Sleep</strong> <strong>Deprivation</strong> on Fire Fighters and EMS Responders 2.11 Documentation <strong>of</strong> CMV Operator Hours Each trucker who drives in interstate commerce is required to keep accurate records <strong>of</strong> his/her duty status. Current rules allow truckers to use a log on an approved grid (Figure 2.2) or an automatic onboard recording device. As with other essentially voluntary enforcement schemes (such as the tax code), cheating is believed to occur. In the case <strong>of</strong> an accident, records can be checked against the expense receipts and other paperwork. Figure 2.1. <strong>Sleep</strong> Laboratory Assessment 2.12 Countermeasures and Driving The obvious countermeasure to drowsy driving is getting more restorative sleep. Countermeasures like cold air or a loud radio are not routinely effective (Reyner & Horne, 1998), and as described, drivers are poor judges <strong>of</strong> their fatigue levels. If they feel fatigued, they are, but those not feeling tired also may be significantly impaired. Caffeine and naps are discussed in Section 5. Efforts are underway to develop devices for monitoring sleepiness in real-life conditions, but so far none have been proven effective (see text box next page). Driver monitoring systems that reliably wake up drowsy drivers, without providing too many false alarms, are not available, and even if they worked as expected from a technical point <strong>of</strong> view, there is concern that such systems may result in reliance on those devices at the expense <strong>of</strong> appropriate rest (Dinges & Mallis, 1998). The American Transportation Research Institute (ATRI) encourages commercial drivers to adopt a personal lifestyle <strong>of</strong> wellness, health and fitness as a precursor to driver alertness and managing fatigue. ATRI’s approach advocates that carriers encourage drivers to personalize their own wellness, health and fitness program and to obtain sufficient sleep. The ATRI endorses educating drivers on the effects <strong>of</strong> fatigue, the need for eight hours <strong>of</strong> uninterrupted sleep to decrease fatigue, using short planned naps to restore a fatigued individual’s alertness and minimizing repeated sleep loss to prevent a chronic sleep debt which can negatively affect performance. More recently, safety practices have focused on the higherrisk driver, based on findings that a relatively small percentage <strong>of</strong> individuals are responsible for an inordinate crash risk (Knipling et al., 2004). Surveys <strong>of</strong> fleet safety managers were used to identify those higher-risk individuals, and methods to avoid their hiring and means to monitor and modify their behavior have been published (http://www.fmcsa.dot.gov/facts-research/researchtechnology/tech/high-risk-commercial-driver.pdf). The Transportation Research Board <strong>of</strong> the National Academies prepared the report, Commercial Truck and Bus Safety Synthesis Program (CTBSSP) Synthesis 4: Individual 34
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