It’s well known that obstructive sleep apnea or “OSA” is considered a major health risk for truck drivers. Indeed, a recent survey of 800 commercial vehicle operators by the American Transportation Research Institute (ATRI) revealed almost one-third of them (28%) suffer from mild to severe sleep apnea – a number that could actually be higher, the group stressed, since sleep apnea is often unrecognized and undiagnosed.
One of the bigger questions OSA poses for motor carriers, however, is whether it impacts the driving hiring process and – ultimately – the safety and liability risks for the fleet.
Fleet Owner talked with Michael Nischan, vice president of transportation & logistics risk control, for EPIC Insurance Brokers and Consultants, working out of the Southeast Region in Atlanta, and Ayana Collins, a 10-year veteran wellness consultant working for EPIC, to get their take on how motor carriers should deal with OSA-related issues not only to protect the health and well-being of drivers suffering from it but also to ensure that it does not pose a safety risk for the fleet as a whole.
Why does sleep apnea pose a threat not just to truck driver health, but to trucking companies overall? Is it a safety risk?
Nischan: OSA is a serious sleep disorder that causes interruptions of breathing during sleep. It is a potentially life-threatening condition because 1) the condition can reduce the flow of oxygen to organs and cause irregular heart rhythms and 2) the sleep disruption affects daytime alertness and performance. Untreated sleep apnea can make it difficult to stay awake, focus, and react quickly while driving.
Sleep apnea is more likely if a person is overweight, has a large neck, or has smaller airways. There may be other causes for sleep apnea and risk factors include smoking, diabetes, and high blood pressure. Most people with sleep apnea don't know they have it because it occurs while sleeping. Consider these sobering statistics in the trucking industry: roughly 70% of drivers are morbidly obese, more than 50% smoke, and nearly a third suffer from sleep apnea.
A fatigued driver may have as much as a 50% decrease in judgment and decision-making skills, along with a 75% decrease in the ability to pay attention – and these are important skills needed to be safe while driving.
Should trucking companies institute mandatory screening and treatment for sleep apnea? How can they go about this and get employee ‘buy-in’ to the process?
Nischan: The FMCSA (Federal Motor Carrier Safety Administration) is very clear about its stance on sleep apnea – a motor carrier may not require or permit a driver to operate a commercial motor vehicle (CMV) if the driver has a condition, including sleep apnea, which would affect his or her ability to safely operate the vehicle. It is critical that drivers with sleep apnea follow the treatment recommended by their physician, and they should not drive if they are not being treated.
Motor carriers are required to use the National Registry of Certified Medical Examiners (NRCME) to ensure that Department of Transportation (DOT) physicals are conducted by trained professionals to established standards. Revised driver examination forms must be used effective April 20 this year to enable the examiner to obtain a more comprehensive medical history than in the past.
For example, if a driver has a blood pressure (BP) greater than 180/110 (Stage 3 hypertension), he or she will be disqualified. Any driver with BP of 160-179/100-109 (Stage 2 hypertension) will receive a one-time three-month certification.
Requirements under FMCSR Part 391 also includes testing for: hypertension; diabetes; hyperlipidemia; arthritis; tobacco use; poor nutrition; lack of exercise; and unmanaged stress and depression.
Remember, too, that drivers can still visit any health professional – including a chiropractor, physician assistant or osteopathic physician – as long as the examiner is in the NRCME. As you can imagine, this means many previously “certified” drivers may no longer be fit to drive. That’s why employers should take an active role in promoting good health to keep from losing drivers.
Armed with more information about the driver’s health history, any concerns that warrant more attention – such as a sleep study – can be addressed when justified, thereby increasing the chance that a fatigue risk can be identified and treated.
In addition to following the driver qualification requirements set forth by the FMCSA, companies can invest in simple wellness education to improve driver health. Regular communication to the driver’s family about smoking cessation, diet, alcohol and exercise can bring about improved wellness not only with the driver, but with the driver’s family. When the entire family is practicing healthy habits, it’s easier for the driver to be successful over the long term.
Finally, it’s worthwhile to consider the addition of a simple incentive plan to provide rewards for reaching attainable wellness goals.
How does treating sleep apnea fit into a trucking company’s overall ‘wellness program’ for its drivers? What other ‘wellness’ best practices can help improve the overall health of truck drivers, thus making them safer and more alert on the road?
Nischan: One of the biggest challenges for a trucking company is selecting and hiring drivers. Once hired, the next most important challenge is retaining drivers. The average cost to hire and train a driver has increased dramatically during the past decade, and today’s cost is nearly $9,000 [per driver]. One good investment to reducing turnover costs is to make driver qualification a number one priority – and you can’t achieve driver qualification without an emphasis on wellness.
For example, ATRI’s sleep apnea survey this past May found that among drivers who had been referred to a sleep study, 53% paid some or all of the test costs, with an average of $1,220 in out-of-pocket expenses, representing just over 1.5 weeks of median driver pay at $805 per week. Additionally, 61% of truck drivers [in the survey] said their sleep study was not covered by health insurance.
Among drivers who have had sleep studies and those who have not, there was concern about the use of neck circumference and Body Mass Index (BMI) as measures to refer drivers to sleep studies. Most drivers believe that the guidelines for referring drivers for sleep studies are too broad and that medical examiners do not follow the guidelines for referrals to sleep studies.
Collins: Those survey results, though, also present a great opportunity for motor carriers, especially in terms of investing in a good wellness program to educate drivers. This is an important process and can determine how well employees respond and engage in a company sponsored wellness program.
First, a company must make wellness a part of the company culture. Employees are more engaged when they think their company cares about their health more so than a “bottom line.”
Second, Effective and consistent promotion of the resources and tools available for drivers is the key to any successful wellness program. The overall goal of any well-being program should be to improve employees’ self-efficacy to adopt and maintain healthy behaviors.
Why is encouraging ‘self-efficacy’ among truck drivers about their health so important?
Collins: We know that long haul drivers have an 11 times higher death rate [compared to the general population] and are often plagued with low back pain, hypertension, heart attack and digestive programs.
We can attribute this increased [health] risk to negative healthy behaviors; however, we also must consider other external factors like depression and financial strain.
Therefore, when developing a fleet wellness program we encourage employers to provide resources towards financial support and education, stress management, and mental health awareness.
Thus, research should be done to understand what intrinsic and extrinsic factors will motivate drivers to change; there has to be a balance of reward and punishment. It has been shown that rewarding positive behaviors along with promoting consequences is important to the success of a wellness program.
Use a reputable medical firm that will guide you in properly identifying candidates for sleep studies. Many examiners believe that drivers exhibiting just two risk factors alone (BMI and neck size) must undergo a sleep study for sleep apnea before they can be certified, but this is not true. Many examiners have been misled into thinking that sleep testing of all drivers is a regulatory requirement, but this is also not true.
What types of things should fleets include in a ‘wellness program’ for it to be effective?
Collins: An effectively-planned wellness program should include:
- Quantifiable goals that are integrated into the overall benefits program;
- An incentive structure that encourages participation, which can include health insurance premium differentials, employer contributions to a flexible spending account (FSA), gym membership discounts, etc.;
- A comprehensive communication strategy that includes wellness messaging and support from the leadership team;
- Biometric screening data that is fed to the carrier’s system for aggregate employer reports;
- Tobacco cessation programs;
- Education about fatigue along with referral to medical specialists practicing fatigue;
- Non-discrimination testing for adherence to federal regulations related to wellness.
Nischan: The FMCSA would like to reduce fatigue-related crashes by implementing a combination of science-based regulations, comprehensive fatigue management programs, and individual responsibility. This means that eventually we’ll have a sleep apnea rule, but until then, there are no regulations or advisory criteria on sleep apnea.
Thus it’s important to partner with a reputable fatigue management clinic and to do it in a way that allows you to build long-term relationships between physicians and drivers. You’ll have better results with a clinic that not only conducts sleep studies and provides effective treatment plans, but offers wellness counseling as well.
You also need to determine if your insurance firm has the expertise in their risk management and employee benefits divisions to assist you. They can help you assemble affordable health insurance programs that won’t scare drivers away, and they can combine safety and compliance training with effective wellness education to bring about improved driver health.
Those investments not only enhance safety on our highways, but show drivers that you care. You can expect improved morale and productivity, and drivers will feel you are genuinely dedicated to their professional success and overall health. That means drivers are more likely to stay in your employment, and they are more likely to do their very best in getting our nation’s goods get to their destinations safely.