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Gambling with Sleep Apnea | Behind the scenes of DOT screening

Recently in Michigan a truck driver was sentenced to prison for criminal vehicular homicide. The driver, John Ray Carpenter, claims he "dozed off" prior to the crash that killed 31-year-old Andrew Johnson. Carpenter has a documented history of diagnosed sleep apnea and has a least six crashes related to sleep apnea, yet still stayed on the road. Reports show that Carpenter lied to his doctors, drove too many hours and hid crashes from his insurance.

How does this keep happening? How many more are out there gambling with other's lives every time they get behind the wheel? It is my opinion that doctors need to have public safety as the first priority when evaluating sleep apnea, especially with CDL drivers. There are subjective questionnaires such as the Epworth Sleepiness Scale, however, those are very easy to "pass" and patients who think that responding truthfully will hinder their vocation are now financially motivated to say the "right" answer rather than the truth. Maybe the patient believes they are telling the truth, and their coping mechanisms

(coffee, extra sleep, adderall) have made them feel better over the years. However, the signs and symptoms of sleep apnea can be evaluated objectively by a provider trained in sleep medicine or by using an objective screening tool, STOP-BANG. As an example the STOP-BANG states that if you are a male, over 50 years old with a thick neck means there is a high risk of sleep apnea present.

In some cases of occupational medicine or primary care, that is all that is asked when screening for sleep apnea and some providers are more lenient on screening for OSA. Those doctors get a reputation within the trucking industry to be the easiest to past the OSA screening and become the "go to" person when needing the correct documentation. As you can see where this is going, the motivation of all parties do not align with the real reason we need to get drivers with sleep apnea on therapy. This is happening in American, I assure you.

This isn't a cost issue, it is a priority issue.

There must be a breakdown in communication to the drivers on the importance of treating sleep apnea if you have it. I am sure all of the CDL drivers would agree that drinking and driving is not acceptable and would agree that there is a need to have licenses revoked if caught under the influence. It is a public safety hazard! I will break this down: Driving with sleep apnea is VERY similar to drunk driving! Both sleep apnea and drinking can cause slow reaction times, dozing off, and impairs coordination. Here is the kicker, sleep apnea doesn't go away like a buzz. Have undiagnosed sleep apnea is like having negative compound interest on your health. High blood pressure, diabetes, risk of stroke and heart failure can be caused by sleep apnea and can be significantly improved with therapy. It is a win-win. The driver's overall health is improved and they are no longer a danger to the public.

For some reason, sleep apnea treatment is not widely known. Patients do not know where to start, where to go afterwards, and how long it will take. There are some great sleep companies out there that focus primarily in the D.O.T. field.

Here is a high level breakdown of how the process works:

  1. They start by working with your provider by educating them on the process.

  2. The doctor will send an order to the sleep company to deliver a home sleep test.

  3. The Home Sleep Apnea Test (HSAT) will be send to the patient to be worn at home.

  4. The results must be read by a board certified sleep doctor and then forwarded to the treating provider.

  5. If moderate to severe sleep apnea is present, the driver will get a 30 day card to get on treatment and become compliant. Typically the HSAT company can deliver the CPAP unit.

  6. Then the patient will need to show to be compliant on therapy for 90 days.

  7. If compliant, the patient will be issued a 12 month card that needs to followed up annually.

  8. If the driver is not complaint on therapy, they will have their license suspended.

As a service to the public, doctors and drivers, please take this screening very seriously. While the max out of pocket cost from start to finish is around $1500 (without insurance assistance), the cost of killing someone, having a stroke or heart attack is significantly more. Keep in mind that people will pay for services they deem valuable. Treating sleep apnea early and staying complaint has more benefits than keeping a CDL license, the quality of life improves to the patient and those around the patient. This isn't a cost issue, it is a priority issue.