The AAA Foundation for Public Safety’s long-awaited report on the effects of drowsy driving concluded that as much as 21% of crashes (from 2009-2013) in which a person was killed, likely involved a drowsy driver.
“If these proportions are applied to all reported crashes nationwide, results suggest that an average of 328,000 crashes annually, including 109,000 crashes that result in injuries and 6,400 fatal crashes, involve a drowsy driver,” wrote AAA analysts in a report released this week.
According to the National Highway Traffic Safety Administration (NHTSA), approximately 1.4% of all motor vehicle crashes in the United States, 2.2% of those that resulted in injuries, and 2.5% of all fatal crashes in years 2005-2009, involved a drowsy driver, and those crashes resulted in a total of 5,021 deaths over those years.
“However, the official government statistics are widely regarded as a substantial underestimates of the true magnitude of the problem,” writes AAA. “This study estimates that as many as 6% of all crashes in which a passenger vehicle is towed from the scene, 7% of crashes that result in any injuries, 13% of crashes that result in sever injuries requiring hospitalization, and 21% of fatal crashes involve a drowsy driver.”
In the wake of last year’s Bronx commuter train derailment that killed four passengers, Metro-North officials have issued a directive that would require the 350 engineers who work for the railway to be evaluated in the coming months for sleep apnea.
The report from ABC News reiterates that the engineer on the ill-fated train suffered from “severe” sleep apnea. According to reporter N.J. Burkett, the rail union has no objections. Mike Doyle, general chairman of the Officials with the Association of Commuter Rail Employees union, told ABC Eyewitness News in a statement that, “recognizing that an undiagnosed sleep disorder likely was a major contributing factor to the tragic accident…our organization is working with Metro-North to establish a program to help identify engineers who may suffer from the same medical condition.”
MTA chief spokesman Adam Lisberg said there are still a lot of questions about the screening and that it will be extended to all safety-sensitive personnel. “We haven’t agreed on what to do in the program,” he told Burkett. “We’re working on plans for addressing sleep apnea for critical safety personnel, but have no final plans yet for what we’ll do.”
Dr. Steven Feinsilver, of Mount Sinai, applauded the move, but warned that screening for sleep apnea is easier said than done. “Feinsilver said the best testing is an overnight sleep study which can be a ‘relatively complicated thing to do,’” wrote Burkett.
Reprinted with update from an article in Health and Wellness Magazine Nov, 2013
Every year in America there are nearly 500,000 commercial truck accidents, and, according to the Federal Motor Carrier’s Safety Administration, driver fatigue accounts for nearly 40% of these accidents. Obstructive sleep apnea is an incredibly frequent and treatable cause of the truckers’ fatigue, yet most truck drivers have not been tested for sleep apnea and, due to the inconvenience of common sleep apnea treatments, even fewer are being treated for their fatigue. For years this problem has remain unaddressed. However as Executive Director of the Dental Division of the American Sleep and Breathing Academy, I think our team can make our highways safer.
Also as founder and President of Pro Player Health Alliance, an organization which teams up with retired professional sports players to promote sleep apnea awareness, I have had the opportunity to help numerous former NFL players achieve a better night’s sleep. I noticed that, like NFL players, truckers endure long periods of travel and are frequently overweight, which places them at a higher risk of having obstructive sleep apnea. In fact, according to a recent study by the Federal Motor Carrier Safety Administration, a third of American truck drivers have medium to severe sleep apnea.
Thus, On July 11th 2013 I, as well as Dr. Elliott Alpher and Dr. Richard Klein, met with the Department of Transportation to present ways to treat truck drivers for obstructive sleep apnea. The conventional treatment method for obstructive sleep apnea involves using a Controlled Positive Airway Pressure (CPAP) device. However these machines are bulky and require electricity, usually from large batteries, in order to function. Therefore most truck drivers, due to their frequent traveling, find CPAP devices to be very inconvenient. Furthermore, according to the American Thoracic Society, even in the general patient population, between 46% and 83% of CPAP patients will not adhere to CPAP therapy. Instead, we recommended for truck drivers the same treatment already been using for NFL players: oral appliance therapy.
Since 1981, Gergen’s Orthodontic Lab has been designing the highest quality oral appliances. Based on my experience, I feel that an oral appliance is
safe, affordable, easily transported, and non-electric, which makes it ideal for a trucker’s lifestyle. In the past, CPAP has been favored because of its ability to measure compliance and usage. However, with the addition of a new panel of sensors invented by Dr. Bonato, CEO of Braebon, who was also at the meeting, any of the oral appliances made with the sensor by Gergen’s can be used to measure compliance and usage. Appliances include the Sleep Herbst, EMA, Respire, TAPs and the newest addition invented by Steven Harkins, the Twilite Appliance which has successfully treated over 300 patients.
Furthermore even the sleep apnea screening process can be made simpler and more portable by using new technology which could record data from off-site locations such as a hotel room or even the cab of a truck. With the availability of this new portable technology, I believe that truckers deserve the same treatment that we have been delivering to NFL players for years.
The Department of Transportation agreed with our presentation and the government responded. On October 15th 2013 a major step was taken toward making America’s highways safer when President Obama signed into law H.R. 3095, which requires screening all commercial truck drivers for sleep apnea. Screening for sleep apnea will make thousands of drivers aware of the cause for their drowsiness and will encourage them to pursue treatment.
Still, there are more workers in the transportation sector who could be helped by sleep apnea screening and oral appliance treatment, including train operators and pilots. For example, a most recent event in Brooklyn unfortunately involved a train engineer falling asleep at a turn, derailing and flipping the train. Sleep apnea was later to be believed as the cause of this accident, although sleep test results have not been confirmed to date. However, Dr. Klein best captures the importance of October’s decision by saying, “Last year over 200,000 people on the roadways in this nation lost their lives due to sleepy drivers and now American roads will be safer and drivers can feel more confident in their safety.”
Since he received the award for The Finest Orthodontic Technician in the country given by Columbus Dental in 1986, he has worked for some of the pioneers in the orthodontic and sleep dentistry fields. He was the personal technician for the likes of Dr. Harold Gelb, Dr. Robert Ricketts, Dr. Ronald Roth, Dr. A. Paul Serrano, Dr. Clark Jones, Dr. Arthur Gaus, Dr. Joseph R. Cohen and Dr. Edward Spiegel. He has also taught orthodontic technicians at Arizona Institute of Technology for dental and medical careers. David has also been active on the Arizona State University Sports and Medicine team since 1991. He also received in 2012 a lifetime achievement award by the Gelb Academy as America’s greatest Orthodontic technician of all time. David can be reached at www.Gergensortho.com
David Gergen, CDT and President of Pro Player Health Alliance, has been a nationally respected dental lab technician for over 25 years. He received the award for “The Finest Orthodontic Technician in the Country” given by Columbus Dental in 1986. He also has been appointed Executive Director of the American Sleep and Breathing Academy Dental Division, a national interdisciplinary academy dedicated to sleep training and education with over 60,000 members. David rolled out of bed on December 4, 1982 and had his career “ah ha” moment. He knew he was going to be an orthodontic technician and he knew he was going to help people all over the country to help treat their sleep disorders in partnership with their dentists. He has worked for some of the pioneers in the orthodontic and sleep dentistry fields. He was the personal technician for the likes of Dr. Robert Ricketts, Dr. Ronald Roth, Dr. A. Paul Serrano, Dr. Clark Jones, Dr. Harold Gelb, Dr. Joseph R. Cohen, Dr. Rodney Willey, Dr. Allan Bernstein, and Dr. Thien Pham. One of his proudest achievements is receiving The National Leadership award for Arizona Small Businessman of the Year in 2004.
The Aircraft Owners and Pilots Association (AOPA) is asking the Federal Aviation Administration to indefinitely suspend a new policy that would require some pilots to be screened and, if necessary, treated for obstructive sleep apnea before receiving a medical certificate.
An article posted on the AOPA Web site reports that at first, the screening would apply to pilots with a body mass index (BMI) over 40. Over time, the FAA would lower the BMI requirement, compelling more pilots to be screened by a board-certified sleep specialist. The policy is the result of NTSB recommendations, but AOPA argues that there is no evidence to support the need for such screenings among general aviation pilots.
A look at the comment section following the article shows widespread support for suspending the policy. “[The FAA] admits to no data on the effects of sleep apnea on pilot performance, and they target the entire pilot database anyway,” writes one commenter. “These are not decisions based on aviation safety. They are a nanny style directive.”
“This policy seems to be based on one incident involving an airline flight,” said Rob Hackman, AOPA vice president of Regulatory Affairs. “In that case, the crew fell asleep and missed their destination but woke up and landed safely. Analysis of a decade of fatal general aviation accidents by the General Aviation Joint Steering Committee didn’t identify obstructive sleep apnea as a contributing or causal factor in any of the accidents studied.”
AOPA is composing a formal letter to FAA Federal Flight Surgeon Dr. Fred Tilton asking him not to implement the new policy and noting that there was no public comment period before the policy was announced. The new requirements could potentially affect thousands of pilots, adding to what AOPA calls the already significant backlog for processing special issuance medicals.
In 2011, the FAA identified 124,973 airmen who are considered obese, making them potential candidates for screening. According to reporter Elizabeth Tennyson, the new policy grew out of a 2009 NTSB recommendation that the FAA change the airman medical application to include questions about any previous diagnosis of obstructive sleep apnea as well as the presence of risk factors for the disorder.
The recommendation also asked the FAA to implement a program to require pilots at high risk for obstructive sleep apnea to be evaluated and, if needed, treated before being granted medical certification.
The trucking industry does not want the Federal Motor Carrier Safety Administration (FMCSA) to use “informal guidance” to address sleep apnea. The House Transportation and Infrastructure Committee agreed, quickly approving a bill that would instead require “rulemaking.”
“ATA [American Trucking Association] believes that testing alone for obstructive sleep apnea of truck drivers could cost the industry nearly $1 billion,” said ATA president and CEO Bill Graves. “If our industry is to be burdened with such a cost, then the FMCSA owes it to trucking to conduct a full and thorough rulemaking, including collection of scientific data and a cost-benefit analysis.”
The bill, introduced by Reps Larry Bucshon (R-Ind) and Dan Lipinski (D – Ill) reportedly has broad bipartisan support, already garnering nearly 50 cosponsors. “While FMCSA has said they are receptive to a rulemaking process in lieu of sleep apnea guidance, we urge the House and Senate to follow through with swift approval of HR 3095,” said Graves.
“FMCSA will issue a notice to address obstructive sleep apnea through the formal rulemaking process after collecting and analyzing the necessary data and research,” the agency said in a statement. The statement does not address the broader issue of sleep disorders.
According to a report in TruckingInfo.com, the FMCSA proposed tougher standards for sleep apnea evaluation last year. The proposed guidance in 2012 mandated that drivers with a body mass index of 35 or more must be evaluated for sleep apnea. The advisory committees supported the “guidance” approach but saw it as an interim step toward a comprehensive rule.
“Trucking interests have registered deep concern about the use of a guidance, and have been pushing for the rulemaking approach,” writes Oliver Patton in TruckingInfo. “They worry that the guidance will not give employers a clear enough statement of their legal responsibilities.”
Don Osterberg, senior vice president of Safety, Security and Driver Training for Schneider National, reportedly told Deputy Transportation Secretary John Porcari that a guidance has the effect of putting trucking companies in a tight legal spot. “It puts motor carriers in a situation where we can pick our lawsuit,” he said.
The ATA, America’s largest trucking industry association, is on record in support of the new Bucschon/Lipinski Bill.