Sleep Apnea – Know Before You Go for Your DOT Physical

Do you snore? Do you wake up feeling tired? You may be suffering from sleep apnea.

Good sleep is critical for your health. A good night’s sleep consists of 4 to 5 sleep cycles. Each cycle includes deep sleep and rapid eye movement (REM) sleep. As the night goes on, the portion of that cycle that is in REM sleep increases. This pattern of cycling and progression is crucial for getting quality restorative sleep. If your sleep is interrupted, it can disrupt this critical cycle. Hormones released during sleep help repair cells and control the body’s use of energy. Although personal needs vary, most adults need 7 to 8 hours of sleep per night.

Drivers with untreated sleep disorders such as sleep apnea are a danger to our roads. Driver fatigue is responsible for an estimated 100,000 motor vehicle accidents each year. The driving performance of an untreated driver is similar to a person with a .06 -.08 blood alcohol content level. A driver can be imprisoned for manslaughter, for not taking a recommended sleep study that causes a fatality.

Studies show that obesity among CDL drivers is one of the major causes of OSA (obstructive sleep apnea). Drivers untreated for sleep apnea face increased risk factors including hypertension, diabetes, erectile dysfunction, memory loss, chronic fatigue, increased risk for heart attack and stroke, and obesity (untreated apnea causes hormones to trigger hunger and weight gain).

What is sleep apnea? Obstructive sleep apnea occurs when the airway in the back of the throat is obstructed, making it difficult to breathe. The word apnea means “no air or breath.” Any time you do not breathe for more than 10 seconds, it’s considered an apnea.

The severity of OSA is measured by Apnea-Hypopnea Index (AHI) discovered during a sleep study.

Minimal OSA – Less than 5 events per hour of sleep

Mild OSA – 5-15 apnea events per hour of sleep

Moderate OSA – 16-30 events per hour of sleep

Severe OSA – Over 31 events per hour of sleep

 

What increases your risk for having apnea? What are the medical examiners looking for?

–Neck size greater than 17” (16” for women) – extra weight in the neck area weighs on and collapses the airway during sleep.

–Body Mass Index greater than 30 (or greater than 28 with additional risk factors)

–Snoring/troubled sleep patterns

–Daytime drowsiness

–Frequent night urination

–Hypertension

–Diabetes

–History of stoke or cardiovascular problems

–Untreated hyperthyroidism

–Age 42 years or greater

–Small airway

–Small or retracted jaw

–Male, or post-menopausal female

Offering accessible testing to drivers may reduce the risk of accidents.

How do you treat OSA?

–Lose weight

–Avoid alcohol, muscle relaxants, and other depressants

–Quit smoking

–Increase periodic movement or mild exercise

–Sleep with your upper body elevated

–Sleep on your side, rather than your back

–Get sufficient sleep time to feel adequately rested

–Special mouthpiece from a dentist to open your upper airway during sleep

–Surgical procedure to remove tissue and widen the airway.

In most cases your doctor will recommend a Continuous Positive Airway Pressure (CPAP) machine, which assists with inhaling. In more severe cases, a BiPAP machine may be needed, which assists with inhaling and exhaling. PAP treatment reduces appetite, cuts risk for heart attack and stroke by half, improves hypertension, diabetes and daytime fatigue.

What are the requirements once you start treatment?

The Medical Expert Panel’s minimum recommended compliance is 4 hours of CPAP sleep per day, 70% or more days. The most effective treatment is 7 or more hours of CPAP use during sleep.

PAP therapy adherence should be objectively monitored by a sleep specialist addressing therapy adherence and efficacy. Printed reports or SD cards (records data on the PAP machine) must be taken to the DOT examiner before a new CDL card can be issued.

It is important to note several important factors for CDL drivers related to OSA:

  • FMCSA regulations do not specifically address sleep apnea. Rather, they prescribe that a person with a medical history or clinical diagnosis (obtained from a sleep study) of any condition likely to interfere with their ability to drive safely cannot be medically qualified to operate a commercial motor vehicle (CMV) in interstate commerce. However, once successfully treated, a driver may regain their “medically-qualified-to-drive” status.
  • Each State sets its own medical standards for driving a CMV in intrastate commerce so rules can vary from state to state.
  • FMCSA has determined that moderate to severe levels of sleep apnea (as diagnosed by a sleep study) interfere with safe driving. However, the medical examiner is the determiner of a driver’s medical fitness for duty related to being “successfully treated”.
  • Driver’s must comply with doctor recommended treatment options and should not drive if not doing so because they would no longer be considered “successfully treated”.
  • FMCSA does not require any specific treatment or equipment in its regulations so there are no CPAP usage report requirements. However, since the medical examiners are responsible for determined if someone with moderate or severe OSA is being successfully treated, they may require them as proof of treatment.
  • Lack of specific FMCSA requirements for OSA results in inconsistent qualification decisions for drivers related to medical cards.

Tips for a Restful Night’s Sleep

  • Limit electronics and their bright lights – Light from cell phones, laptops, tablets and other electronic devices such as TV, DVD etc. can disrupt sleep. Silence the devices and turn them face down to limit lighting that could disrupt sleep. Stop using them 30 minutes prior to turning in for the night to help calm the mind and prepare it for rest and to help support the body’s natural circadian rhythms.
  • Limit how much you eat – A full stomach causes the body to continue to work instead of allowing it to rest. It can also cause discomfort due to gas, bloating or acid reflux that can disrupt sleep as well. It is best not to eat within several hours of reclining for sleep.
  • Skip the evening night cap – Alcohol can help people fall asleep but unfortunately it can lead to less restful sleep. Alcohol can worsen existing sleep disorders such as obstructive sleep apnea.
  • Maintain a sleep routine – While most people find it difficult to keep a strict sleep schedule, keeping a set routine before bed regardless of the time of day can be helpful.
  • Temperature matters – The ideal room temperature for sleep is between 60 and 68 degrees so be sure the room is not too chilly or too hot to promote restful sleep.
  • Exercise timing matters – While exercise is important and can help the body be ready to rest, working out too close to bed time can make falling asleep difficult. It is best not to exercise no sooner than two hours before the anticipated bed time.
  • Sleep position matters – Finding the right position for sleep matters especially if managing sleep apnea. Avoid lying flat on the back which can cause the jaw and soft tissue to fall to the back of the throat which limits or cuts off the airway. If staying on the back at night is a problem, try sewing a pocket on the pack of pajamas to hold a tennis ball to help avoid back sleeping. Using body pillows or sleeping wedges can also help limit back sleeping as well.
  • Get the right number of hours – Although everyone needs a different amount of restful sleep, the average adult needs seven to nine hours per day. To get that many hours, be sure to allow enough time to wind down and become ready for sleep so that you can enter the deep and reparative stages of sleep quickly.