Module 7 of the North American Fatigue Management Program (NAFMP) discusses corporate motor carrier responsibilities for identifying, treating and managing sleep disorders. To avoid legal risk, carriers should develop policies and procedures, educate managers about fatigue, document implementation of a Fatigue Management Plan (FMP) and communicate with drivers with sleep disorders.
Schneider National Inc. implemented and Obstructive Sleep Apnea (OSA) program in 2006. Initial reports showed a positive return on investment, including a 73% reduction in preventable crashes for drivers treated for OSA.
Crashes by a driver with OSA could lead to claims that 1) the carrier should have known the driver had OSA; 2) the carrier di not monitor or follow up with an OSA-diagnosed driver prescribed CPAP treatment; or 3) the carrier’s FMP was inappropriate, incomplete or not implemented. Under federal regulations, a driver with a condition likely to interfere with their ability to driver safely are not qualified to operate a commercial motor vehicle. Moderate or severe OSA may disqualify the driver until treated properly.
The motor carrier should educate executives, management, staff and drivers about OSA and sleep disorders through newsletters, videos, programs and publicizing company success stories. Since OSA is largely related to being overweight, health education should be provided along with sleep disorder treatment education.
The Medical Expert Panel (MEP) of the Federal Motor Carrier Safety Administration has given recommendations on medical standards and certification of commercial motor vehicle drivers, including educating drivers with OSA about:
- The importance of adequate sleep
- Life changes (weight loss, exercise)
- Consequences of OSA
- Effects of respiratory and central nervous system depressants on OSA
Carriers can screen drivers with a variety of questionnaires, including the Epworth Sleepiness Scale, Berlin Questionnaire, Functional Outcomes of Sleep Questionnaire and the Pittsburgh Sleep Quality Index. Physical objective signs that may indicate sleep disorders include BMI>30kg/m2, neck size> 17”, waist >40” and high blood pressure.
Once a person is screened as high risk for OSA, it is recommended they undergo immediate testing for diagnosis. Laboratory polysomnography, or PSG, is considered the gold standard for diagnosing sleep disorders. PSG requires an overnight stay at a sleep center and it is expensive.
Portable monitoring is more affordable and can be done in the sleeper berth. MEP recommends PSG in an overnight lab, but accepts PM as an alternative if there is a minimum 5 hours recording time, the device is validate against PSG and device records oxygen saturation, nasal pressure, sleep time and wake time.
OSA is usually treated with a PAP (CPAP, BiPAP, APAP) or positive airway pressure machine. A 2008 study showed 83% of adults on PAP do not comply with PAP treatment. Drivers must comply adequately to permit them to continue to legally drive a commercial motor vehicle. Carriers can monitor PAP usage by reviewing data cards and web-based monitoring.
Carriers should take action with non-compliant drivers, including giving warning, identifying reason for non-compliance, restricting driving, coaching and supporting and ultimately joy termination. Carriers can help drivers by installing inverters in the cab to power PAP machines and organizing PAP-user groups.
The transportation industry has a responsibility to address sleep disorders in employees as a matter of health, safety, and legal consequence.