Best Kept Secret
by Tim Barton
A decade ago, Tim Douglas was convicted of second-degree vehicular homicide for killing five people in a pickup truck after he fell asleep at the wheel. He had slept 15 hours out of the previous 24 and was running a genuinely legal log.
"One minute I was awake, passing this pickup. The next minute I was asleep," Douglas recounts. "I had had 15 hours of sleep in the last 24. My log was legal. I didn’t feel tired, and I thought I was well rested."
Back on the street after serving a two-year sentence, Douglas had two more accidents in his personal vehicle. Both times he thought he had blacked out. "I told the sheriff there must be something wrong with me," he says.
At the time Douglas was living with a nurse who told him he snored loudly and seemed to gasp for air constantly. At her insistence, he began what became a marathon of doctor visits that found nothing wrong until a neurologist suggested a sleep study. What the study discovered changed Douglas’s life. It helped him deal with the guilt he felt about the accident, and it put him back on the road again.
"I was diagnosed with sleep apnea," Douglas says. "I didn’t even know what it was. But the doctor woke me up shortly after I started the test and put me on a CPAP (continuous positive airway pressure) machine. I was told my breathing was so irregular he was afraid I was going to die. The machine still helps me breathe at night."
Douglas’s story may be uncommon for its tragic consequences, but sleep apnea may be the most under-diagnosed causes of ill health among the general population, and probably more so among the ranks of drivers. About one in 22 Canadians suffer from sleep apnea. Aside from the fact that sleep apnea can lead to high blood pressure, heart disease, diabetes, depression, and stroke, it can really compromise your ability to sleep restfully. The National Sleep Commission on Sleep Disorders in the United States estimates obstructive sleep apnea (OSA) may be involved in as many as 38,000 cardiovascular related deaths per year.
Sleep apnea is a condition in which the throat's soft tissues relax, restricting airflow and causing the sufferer to awaken in order to restore breathing. This can occur several hundred times during a typical night's sleep, which begs the question: how can you achieve restful, restorative sleep if you're constantly waking up in order to breathe?
The answer is, you can't. As a result, the exhausted brain is prone to lapsing easily into microsleeps – brief intervals of deep sleep that occur almost instantly. Like Douglas, you’re awake one instant, and asleep the next.
About 33 percent of drivers have sleep apnea, according to findings from the University of Pennsylvania in a study conducted jointly with the Department of Transportation and the U.S.-based National Sleep Foundation. For these men and women – who tend to be overweight, and who work irregular hours as a matter of course – the impact of oxygen deprivation and disrupted core sleep can have dramatic consequences.
Perhaps not surprisingly, this sleep disorder is easily disguised beneath the umbrella of fatigue. As much as fatigue is a problem in trucking, more specific sleep disorders like insomnia and apnea tend to remain unaddressed. Among a population that accepts fatigue as a normal way of life, individuals who are unaware they may have obstructive sleep apnea learn to compensate for daytime hypersomnolence (excessive daytime sleepiness) with strategies that may be partially effective in the short term but do not address the long term effects of the condition.
The Road To Recovery
Diagnosis of sleep apnea isn't complicated, but it may require a night in a sleep lab. There are several new technologies in use now to detect abnormal sleep patterns that one can use at home – or even in the truck. The Itamar Medical Watch PAT-100 is a glove of sorts that monitors, among other things, sleep/wake state, REM (rapid eye movement) sleep stage, and total sleep time.
Another device, the Remmers' recorder, records diagnostic indicators of sleep apnea, and can be used to monitor the effectiveness of CPAP therapy. The Remmers' recorder indicates the total time the sleeper did not breathe during a night of testing.
Both devices measure the level of oxygen in the blood, heart rate, pulse, respiratory airflow, and the amount of contraction and dilation of blood vessels in the fingers. In combination, these indicators allow a trained doctor to diagnose the degree of apnea from which a sleeper is suffering. The testing may also show that a sleeper does not have apnea.
These home-based diagnostic tools are considerably less intrusive and less expensive than a night in a sleep lab; however, a medically accurate diagnosis of sleep apnea can usually be made by a sleep specialist only, under laboratory conditions.
Sleep apnea is a treatable condition, and just one night of treatment often produces a remarkable improvement. Sufferers reap the benefits of a full restful night's sleep. Potential remedies include lifestyle changes, such as weight control, smoking cessation, limiting alcohol consumption, and establishing more regular sleep patterns. Surgery is an option, but it may or may not be effective.
What's needed to affect a remedy is to maintain an open breathing passage. CPAP machines literally pump air into your lungs as you sleep, solving the breathing problem. The cure, however, may be hard won. Some patients can’t tolerate the facemask and headgear that must be worn to maintain positive airflow.
Dr. Michael Gelb, a professor of clinical sleep dentistry at New York University notes, "Nearly 70 percent of apnea sufferers can be successfully treated with an oral appliance fitted by a trained dentist." Similar to a mouth guard worn by football and basketball players, these devices hold the jaw open while you sleep, preventing the soft tissue at the back of the throat from collapsing and cutting off breathing.
Education and Insurance
The education of drivers and fleets about apnea and its treatment is long overdue. Douglas recounts that some prospective employers told him they would not hire him despite the fact he is being successfully treated. But a driver getting treatment under a doctor's care should be more fit for duty than he is without treatment.
There’s a "don't know, don't tell" attitude surrounding sleep apnea. Drivers that suspect they might have OSA might be reluctant to seek treatment, fearing the fleet or a doctor might see fit to relieve them of their duties.
Dr. Martin Moore-Ede, chairman and CEO of Circadian Technologies, says negative attitudes toward OSA may be more of a liability than seeking treatment for the condition. "A driver who does not know he has apnea and has an accident, then is diagnosed, creates liability," he says.
Tim Douglas has had a succession of low paying trucking jobs over the past 11 years – the only kind he says he can get. "No big company is going to hire me," he says. "The accident has dropped off my record but if a company digs deep enough they will find it." Despite the fact Florida reinstated his licence after he began treatment with a CPAP machine, Douglas’s professional life has been squeezed into a cul de sac.
"I killed five people," Douglas admits. "I killed them because I had a medical condition I didn’t even know existed. That’s behind me now, and my condition is under control. It’s ironic that now few carriers will hire me."