Sleep Apnea and Driving
Sleepiness is a key symptom of obstructive sleep apnea and is often the reason that a sufferer first seeks medical help. We know from research that sleepiness behind the wheel increases the chance of traffic accidents. Once the link between alcohol and road accidents was demonstrated, new tighter laws were introduced (and enforced) to deter drink-driving. Is sleepy-driving next?
It is already a requirement of many Australian states that all medical conditions which are likely to impact upon driving ability must be reported to licensing authorities. But, recent moves to identify sleep apnea in professional drivers in the US are being closely monitored and may be followed by road traffic authorities in Australia.
Truck drivers and other professional drivers in the US may soon be required to participate in a sleep study to screen for obstructive sleep apnea before they receive their certification.
Maggi Gunnels, director of medical programs for the US Federal Motor Carrier Safety Administration, recently confirmed that the Administration’s medical review board is expected to recommend that a sleep study be required for professional drivers who are of a predetermined level of obesity. Those who test positive for OSA would be required to treat the condition with surgery or CPAP before being certified.
Professional drivers associations are expected to oppose this recommendation based on weight, unless a “direct causal relationship” between a truck driver’s obesity and OSA is clear.
But further research just published in the Journal of Occupational and Environmental Medicine reiterates the findings and demonstrates a link between obesity in truck drivers, untreated OSA and an increased incidence of accidents. There is also a strong body of research which directly links obesity to OSA, with an estimated 80% likelihood.
This whole issue must seem like a Pandora’s box to traffic authorities. If professional drivers are screened to make sure OSA is treated, would the police or traffic authorities then have to monitor CPAP compliance? How would this be done? Would there be random tests of some type, CPAP machine data reviews at the road-side or some form of on-line monitoring?
As so often happens, professional drivers are in the spotlight not because they are the biggest cause of problems, but because they are relatively easy to reach. They need a special license for their job and their livelihoods depend upon complying with the terms of the license. But professional drivers account for only a small percentage of road accidents.
What about the vast majority of road users who are not professional drivers? They are as likely to be obese, as likely to have sleep apnea and may be more likely to drive while sleepy How would they be policed?
The issue will probably filter down through tightening laws and through the denial of insurance claims – when someone is shown not to have exercised their duty of care to others by recklessly ignoring a medical condition that results in an accident, they will foot the bill.
The fact is that if you have OSA, or if you are sleepy during the day or if you drift off or fall asleep while driving, you must find a way to treat it. Surgery can work. And CPAP, with a comfortable and effective mask, is a simple and life-sustaining option.
What is clear is that sleepiness, whether caused by a medical condition or simply by not being alert, is a major and preventable cause of road accidents. While the authorities are increasingly aware of this as a potential means of addressing the road toll, it is individual responsibility that is the key to solving the problem, just as it was with drink-driving. A drink-driving charge is not cool, funny or socially acceptable in any sense.
Falling asleep behind the wheel should not evoke sadness or sympathy. Any driver, whether professional or not, who puts themselves, their passengers and other road users in danger is quite simply the same as a drink-driver. Do it and you’re “a bloody idiot”.