FMCSA medical board to review sleep apnea sentiment

FMCSA medical board to review sleep apnea sentiment

In the 1970's Arnold Schwarzenegger was 6'0" tall and 305 pounds (BMI 41.4) when he competed in and won the Mr Universe competition. By your standards he was morbidly obese and because his neck was larger than 20" in circumference at that time you would require a mandatory sleep study. Does it bother any of you that this is the case? —Jim Townsend

The public comments are in, but before moving forward with a rule to address obstructive sleep apnea (OSA) in truck drivers, the Federal Motor Carrier Safety Administration wants to hear from its panel of medical experts.

In an announcement published Tuesday, FMCSA has called a meeting of its Medical Review Board for later this month, during which the five medical professionals will make recommendations to the agency as to the public’s views on the Advance Notice of Proposed Rulemaking regarding sleep apnea, published in March.

Nearly 600 comments were filed with the docket, and the agency held three listening sessions around the country to hear from truck drivers, medical practitioners, trade groups, and fleets on opportunities and challenges for determining the extent of OSA in “safety sensitive” transportation positions, and for possible screening and treatment solutions.

“As with any regulation, any future rule to require OSA screening and treatment for commercial truck drivers should be based on sound data and analysis, including the potential costs and benefits,” American Trucking Assns. says to open its formal comment. “It is also vital that FMCSA have a firm understanding of the actual crash risk that OSA poses, of which there has been minimal data to date.”

Along with posing numerous issues with regard to current crash data and sleep science, ATA emphasizes the need for any rule to “minimize cost and operational burdens,” such as allowing medical examiners (MEs) to grant drivers “conditional qualification status” so they that can continue to work through the OSA evaluation process. The agency should also avoid requiring a driver who has previously undergone a sleep test to submit to a follow-up test when seeking to renew the medical certification, ATA suggests.

ATA also argues that, “far too often,” drivers are designated for screening because they exhibit a single risk factor, and that MEs should be directed “to be cautious” when using the potentially misleading body-mass index (BMI) when assessing overall health.

In its filing, the Owner-Operator Independent Drivers Assn. notes the “substantial” impact an OSA regulation could have on small business truckers—90 percent of DOT authorized carriers. OOIDA notes that the cost of screening and treatment is a “very significant concern” for its members.

“OOIDA opposes any regulations requiring OSA screening until FMCSA identifies OSA as the cause of a not-insignificant number of truck crashes,” OOIDA states. “FMCSA should then be able to demonstrate that there are valid, reliable methods of screening and treatment for OSA that evaluate every driver under uniform procedures that can be followed by all medical examiners. Finally, that screening and those treatments should be amenable to clear and coherent regulations.”

The organization also argues that the rulemaking “exposes the unconstitutional vagueness” of the FMCSA’s current medical certification rule, which now lists sleep apnea in the updated medical certification form. The agency added this criterion to the form without the deliberation and analysis that is required of the rulemaking process, according to OOIDA.

“The comments to the rulemaking clearly illustrate that until the Agency decides upon well-defined, concrete rules (or decides that no such rules are possible), drivers will continue to be subjected to dramatically different, or no certain, standards for OSA referral, diagnosis and treatment, and incur dramatically different burdens and costs,” OOIDA says, before concluding that flexibility in the hours of service rule would provide “a greater and immediate impact on driver safety” than an OSA rulemaking.

Comments from drivers ranged from the political to the personal, with many suggesting the government should not mandate medical treatments and others detailing bad experiences with screening and with CPAP machines. A few, however, reported the diagnosis and treatment had led to much better sleep and job performance. A sampling is here.

The complete set of comments filed with FMCSA is available here.

The MRB meeting will be held on Monday and Tuesday, August 22-23, from 9 a.m. to 4:30 p.m., EDT, at the FMCSA National Training Center, 1310 N. Courthouse Road, Arlington, VA, 6th floor. It is open to the public and oral comments from the public will be heard during the meeting, subject to the discretion of the chairman, according to the FMCSA notice.

Drivers speak up

In the 1970's Arnold Schwarzenegger was 6'0" tall and 305 pounds (BMI 41.4) when he competed in and won the Mr Universe competition. By your standards he was morbidly obese and because his neck was larger than 20" in circumference at that time you would require a mandatory sleep study. Does it bother any of you that this is the case? —Jim Townsend

I just want to say if this sleep apnea is such a safety hazard then everyone should be tested. This whole issue is money driven by the doctors and cpap company's. sleep studies are very expensive even with issuance mine was $813.00 x 2 nights another $350 for a cpap and $108.00X5 visits to a pulmonary doctor to get mine renewed. I don't feel any better sleeping with a cpap than before. I have 30 years driving over 2 and a half million miles and no accidents but this isn't even considered! —William Peters

The government needs to rethink its stand on sleep apnea. People have suffered from it since time began. Why not simplify life and relax the 14-hour rule so we can sleep when we need to instead of on a shippers clock.

More and more customers are going to hard to work hours making quality rest harder to obtain. Relaxing the 14 hour rule to allow a one-time 2 or 3 hour sleeper berth to stop the clock would immensely aide in the health and safety of any driver needing to use the nap. This would also increase productivity along with aiding safety by allowing us to sleep while sitting at a dock for 6 hours and it not killing our 14 or worse yet violating the 14 hour rule. —Andrew Sumrall

I have been driving for forty years and have never had an accident or fallen asleep at the wheel. A year and six months ago I was told that I have sleep apnea. Since that time I have used my cpap machine every night. I was told it would take two months to get use to it.

I have not gotten use to it and it causes me to wake up and adjust the mask, or hose, or machine,all night long. I can't get a good or restful nights sleep. It is only after I take the mask off can I sleep uninterrupted.

I always slept great till I was told I had sleep apnea and started using the machine. This is just not a natural way to breath. It makes my chest hurt, sometimes I feel like I'm suffocating, can't get enough air and other times too much air like the mask is blowing off my face. I have tried two different machines and four styles of face masks.

I'm sure it helps some people and that is a good thing. It is not a one size fits all. It should be left up to the individual. —James Howard

Less than a month ago I had to update my 2 year medical card. I am a 35 year old female with no medical issues. I do not snore. I have never had any issues with sleep - my head hits the pillow and I am out and wake feeling well rested. I do not have high blood pressure. My neck circumference is 13 inches - 4 inches less than the 17 inch "guideline" requirement for a sleep study. I do have a BMI of 35 and apparently a tongue that is high in my mouth (according to the DOT medical examiner)? I am home nightly and never drive more than 150 miles in a day. I went to the recommended DOT medical examiner that my employer provided. I was not asked any questions about my sleep habits, driving habits or health by this DOT medical examiner. She decided to require a sleep study test be done before renewing my medical card solely based on my BMI and tongue placement. The medical examiner even stated that the likelihood of the sleep test finding that I have sleep apnea is highly unlikely. This required me to return to my primary physician to request the test be ordered, as she stated that she could not order the test herself. My primary physician, who I have been seeing for years, does not agree that a sleep study is needed, as I have no symptoms other than BMI. What does one do when this test is not required for medical necessity, but only to satisfy guidelines places upon medical examiners, I assume to limit their own liability? What happens for folks like myself caught in the middle of the bureaucracy? I am required now to spend the funds to have this sleep study completed or I will lose my job. For someone such as myself with no sleep concerns I was blindsided by this issue. And, there is nothing for me to do other than proceed with the expensive, unnecessary testing. I have spent hours researching this topic now and have found hundreds of others in the same boat that I am in. Medical examiner requires the test, but primary physician does not agree. Something seems very wrong here when medical doctors are not in agreement over treatment of a patient after a new regulation is in put into place. DOT doctors are being "guided" to require these sleep studies when in their own medical judgment, they are not necessary. —Elizabeth Kenning

I work in a Sleep Center providing direct patient care to many CMV operators. Many brag how either they themselves or a buddy of theirs was able dodge or "work" the system in some way, shape or form. I had a patient tell me directly that he was going to take his home sleep study unit home and not sleep while it was recording. That was his way of making sure he got a negative diagnosis and would not lose his license.

This is a perfect example of what is going on out there. Some regulation needs to be put in place! The regulations cannot be what benefit the trucking industry or what benefits physicians or what benefits the Sleep Centers more. It must be what is in the best interest of the patient themselves as well as the public they serve in their jobs every day.

Doing home sleep studies on CMV drivers opens the door for fraud and misdiagnosis (as in the case above). Then something happens a few months or years later and there are lawsuits trying to hold the physician responsible when it's not the physician's fault. But insurance companies and the government are more worried about saving money and preserving the trucking industry versus doing the right thing and requiring in-lab sleep testing on all CMV drivers. —Stephanie Betz

My dad was killed on Interstate 85, by a truck driver who told the officer he was sorry, he was sleeping. There had been a prior crash, closing the right lane. Traffic was slowed due the prior crash, emergency vehicles, and the lane closure. Dad was merging into the left lane in front of another passenger vehicle. I suppose that passenger vehicle saw the semi-truck in their rear-view mirror and realized the semi wouldn't be able to stop, That passenger vehicle pulled into the median. Emergency personal, who were working the prior crash, were running for safety because they recognized that the semi would be unable to stop. Dad's airbag data showed his vehicle went from 14 m/h to 65 m/h in seconds. The emergency personal already on site could not save my dad. He died of blunt force trauma. belted in his crushed car. 

I don't know why the semi driver was sleeping. But to those of you complaining about the cost, I would like to know what you would be willing to pay, to save a loved one's life.

I thank the FMCSA for looking into this matter. Many comments made sense (about being sensible) about this issue. But to just complain about the cost is short sighted and painful. —Beth Badger

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