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ASLEEP
at the wheel
FMCSA can lead truck drivers
to CPAP therapy, but it can’t make them sleep
By Kris Rutherford
Rusty Traxler insisted he never felt sleepy when operating a vehicle.
“I never knew I had a big problem other than I’d stop [breathing]
for slight moments, and I snore — at least according to my wife,” said
Pennsylvania-based truck driver Traxler.
After a sleep study confirmed he had obstructive sleep apnea
(OSA), Traxler became a statistic. He was one of the 28% of truck drivers
diagnosed with OSA. His career soon became complicated.
“The issue has had me angry since they hit me with it,” said Traxler
of his experience with Federal Motor Carrier Safety Administration’s
sleep apnea guidelines. “I’ve been fighting to keep my CDL ever since.”
According to the National Sleep Foundation (NSF), OSA is “a disorder
in which breathing is repeatedly interrupted during sleep.” Conditions
and symptoms of people with untreated OSA include anxiety,
high blood pressure, and depression, all of which are known to
increase the severity of OSA. The impact of a severe case of untreated
OSA on a driver is the equivalent of operating a vehicle at twice
the blood alcohol level considered legal in most states. Still, OSA is
treatable. In most cases, those with the condition use a continuous
positive airway pressure (CPAP) device to ensure productive sleep.
Following his sleep study, with CPAP in hand, Traxler visited
his physician, and he expected to receive clearance to drive. He
was wrong.
Traxler visited two physicians to obtain CPAP certification. The first
told him to provide evidence of CPAP compliance for 30 days. The
second asked for 60 days. Traxler eventually gained clearance, but
that was not the end of his ordeal. When he needed recertification, a
physician told him he needed a 90-day compliance record.
Traxler says the FMCSA guidelines related to OSA are subjective,
and different physicians can read the data and come to different
conclusions. He believes the guidelines force physicians to take a
cautious route for fear of being held liable in the event of an OSArelated
incident.
“I‘ve never slept more than five or six hours, with or without a
CPAP,” shared Traxler. “I didn’t need a $700 study to tell me that.”
AN INDUSTRY VETERAN’S VIEW
Cliff Abbott is a trucking industry veteran who has worked as a truck
driver, recruiting manager, and director of driver developments; he
has studied industry trends as a trucking-media veteran. Abbott has
had his fair share of experience with what he calls “arbitrary” DOT guidance
on OSA. He too believes the FMCSA guidance places too much of
a burden on physicians’ analysis of subjective data.
“The problem stems from the requirement that the physician not
only recognizes sleep apnea but is satisfied with its treatment and
control,” said Abbott. “Unfortunately, FMCSA guidance does not
define what ‘treated and controlled’ means.” Examiners often look
to physical characteristics such as neck size, body weight, and age
when estimating whether a driver has potential for OSA.
“While these may be indicators, they don’t prove anything,” said
Abbott, noting that plenty of drivers have all the indicators, but they
sleep fine without mechanical help. “There’s an overabundance of
caution,” he said.
FMCSA, DRIVERS, PHYSICIANS RECEIVE CRITICISM
“Examiners often ask for the latest printout from the driver’s CPAP
machine,” said Abbott. “Other times, they’ll request a report from the
driver’s primary physician based on the CPAP data.” FMCSA does not
stipulate a timeline for when a report should be deemed invalid.
Abbott has seen enough CPAP printouts to understand how 10
different doctors might interpret identical data in 10 different ways.
Opinions of abnormalities based on the number of incidents of waking,
gasping, and mask leakage differ among physicians, he said.
“Too many drivers are delayed or even denied medical certifications
based on a subjective process,” continued Abbott. Ultimately, drivers
are often required to pay for testing while unemployed and uninsured.
Abbott has concerns about FMCSA’s OSA guidelines, but he
says drivers share the blame. While all drivers are not cut from
the same cloth, “the driver population is notorious for noncompliance,”
he said. Lack of compliance requires physicians to be cautious,
he said. Compliant drivers are then unfairly subjected to
increased scrutiny.
FMCSA Spokesman Duane DeBruyne explained the federal-state
partnership in ensuring all drivers are medically sound to operate
a truck safely. “A CDL is a state-issued license,” he said. “The state is
certifying that the individual possesses the knowledge and skills to
operate a large commercial motor vehicle on public roadways.”
14 TRUCKLOAD AUTHORITY | www.Truckload.org TCA 2020