highwaySTAR Magazine

This contraption is a CPAP machine, worn by severe-sleep-apnea sufferers during sleep. But there isn't a DC-powered version on the market right now that will run off a standard truck battery for the eight to 10 hours required for full restorative sleep. That means you'd need an AC inverter; and with all the anti-idling laws in North America, possibly an APU system too.

For a very long time Marc Paquin knew something was wrong. He just didn't know what.

After shutting down his rig and bunking down at the end of the day, disjointed interludes of feather-light sleep would often get interrupted by nightmares, bouts of cold-sweat panic, and shortness of breath.

Whenever the 10-year trucking veteran awoke, his clock would show he'd slept for eight or nine hours, but his wobbly knees and continued exhaustion told him that it couldn't be.

"I would drive two or three hours and had to go back to bed for a couple of hours." he says. "The fatigue never left me."

Then, while on a run through Toronto in 2001, Paquin had a rude awakening. As he describes it, "Without knowing how or why, I found myself in my truck, overturned on the highway."

He'd just blacked out. Soon afterwards he was diagnosed with obstructive sleep apnea (OSA), which, as the trucking community is now coming to realize, is a sleep disorder that causes the closing of the airway passage at the back of the throat, leading to cessation of breathing during sleep. You're usually not conscious of this inability to draw a breath, which can occur dozens of times an hour for periods that can be as long as a minute each.

It was discovered that Paquin, severely affected, stopped breathing 36 times for every hour he slept. Effectively, he was getting just over an hour's sleep in an eight-hour period. Hours-of-service downtime meant nothing in his world.

"I felt like my working days were endless," he recalls. "I needed 15 hours to drive 600 miles. And I often stopped to nap. If I had to wait five minutes at a customer, I leaned within the framework of the door and I slept."

Although the troubling symptoms persisted for years, Paquin, like most truck drivers afflicted with the disorder, knew little, if anything, about sleep apnea until he was diagnosed with it.

With treatment, he can breathe easier now. But the same can't be said for the hundreds of thousands of other unsuspecting North American drivers who suffer the same way.

According to Dr. Allan Pack, director of the Sleep Center at the University of Pennsylvania, roughly 28% of commercial drivers are likely afflicted with some degree of sleep apnea. It's most common in overweight males with a body mass index (BMI) of 25 or larger and a collar size more than 17 in. Loud snoring, frequent night wakings, shortness of breath, and of course, unexplainable daytime fatigue are all telltale signs.

More recently, studies have drawn clear lines between OSA-related fatigue and vehicle crashes. A Cambridge University study concluded that car and truck drivers who suffer from sleep apnea are as much as seven times more likely to be involved in an accident.

That number, says Don Osterberg of Wisconsin's Schneider National, would likely be even higher if the study focused specifically on commercial drivers since they're generally more obese and lead less healthy lifestyles than the average citizen.

Schneider's Answer
As VP of safety and training, Osterberg runs one of the few fleet-managed sleepapnea screening and treatment programs for truck drivers in North America. He says fatigue is the primary causal factor in 36% of high-severity accidents.

And much of that, his experience tells him, has to do with undiagnosed sleep apnea.

Osterberg says a handful of drivers are embarrassed to admit they may have a disorder, but overall the majority are thankful Schneider took notice of problems that many couldn't even explain.

The first phase of the elaborate, award-winning program is screening, involving a patented questionnaire that targets information related to drivers' health and wellness, BMI, and overall lifestyle. That data is analyzed to determine the likelihood of OSA. If the risk is high enough, drivers undergo overnight evaluation at a sleep clinic to confirm a diagnosis.

Treatment options vary depending on the severity. Many times it can be as simple as dieting and exercise. But serious cases usually involve the use of a Continuous Positive Airway Pressure (CPAP) device and even surgery, although success on the latter approach is hit and miss.

Schneider's existing program was borne out of two pilot studies. The first tracked 339 OSA-diagnosed drivers 12 months before treatment and 12 months after.

The conclusion: preventable crashes were reduced by 30%; median cost of crashes dropped by 48%; retention improved by 60%; and health-care savings averaged $539 per driver.

An expanded study in 2006 involved 788 drivers, and the results were similar, though there was only a 12% reduction in accident frequency - "still good," says Osterberg. But the median cost of crashes dropped by a staggering 63%.

Once the company decided to turn the program into policy, the next step was to remove barriers for drivers to be tested, such as the cost to drivers for evaluation and treatment; and reassuring them that there would be no dismissals or loss of earnings due to time off the road.

For one thing, there isn't a DC-powered CPAP machine on the market right now that will run off a standard truck battery for the eight to 10 hours required for full restorative sleep. That means you'd need an AC inverter; and with all the anti-idling laws in North America, probably an APU system too.

"It's not perfect," says Osterberg. "But to people who say 'it's not worth doing it until it's perfect,' that's not a reasonable expectation considering the risks."

New Rules Coming
The OSA problem among truck drivers has arguably reached epidemic-like levels, and that hasn't gone unnoticed. This past summer the U.S. Federal Motor Carrier Safety Administration began working to toughen the current physical qualification rules for drivers. And all signs point to mandatory sleep-apnea screening as part of that mandate. TheNotice of Proposed Rulemaking is slated for publication this month.

It's unclear what the final standard will look like, but there are strong indications that new drivers seeking a CDL would have to undergo screening for sleep apnea at the medical exam level.

All drivers could eventually be monitored by their carrier companies for screening and ongoing treatment much like existing drug-testing.

Depending on the severity, drivers with OSA could still be permitted to work if they're in a treatment program.

The issue is also top of mind in Canada, where government and industry officials are watching the proceedings in the U.S. very closely.

Stephen Laskowski of the Ontario Trucking Association doesn't know if there's genuine appetite to put forth similar Canadian legislation but he says, "We'll still have to deal with it one way or another."

"The question is how? Whether we mandate it or not, what we need is reciprocity [with the U.S.]," he says. "We need the government of Canada and the provinces to at least get behind a made-in-Canada [screening] program that can be recognized."

For Canadian U.S.-bound companies and drivers - as anyone required to test for drugs knows all too well - things could get complicated if mandatory OSA testing gets on the books in either country.

Not least because, the way the U.S. rules look now, if a driver fails a sleep test he'll have to get treatment and be retested within 30 days. What happens if the treatment takes longer? As well, there are very few sleep clinics in Canada, unlike the U.S., making the problem worse again.

And in the worst case, a driver might need surgery. Try getting that accomplished within 30 days up here in the frozen north. He'd likely be barred from driving in the meantime.

Given that about a quarter of all truck drivers apparently have some degree of sleep apnea - we know a Canadian fleet that tested its drivers and actually found 39% of them with the problem - all of this could mean serious disruptions to the industry at large as well as to individual drivers. The driver pool is already shrinking, after all.

Montreal's Marc Paquin is one trucker who's glad his sleep problems, though they sure did spill out on the highway, didn't lead to any serious injuries or land him in court before he could get medical treatment and overcome his "enemy."

Sounding a bit like an infomercial, Paquin says, very genuinely: "The results are fantastic. I am alert and energetic all day long.

"If you have several of the symptoms of sleep apnea, you should not hesitate," he says. "The examination lasts one night and your life will be completely changed."

Time Bomb