sleep apnea

[BoomerD]

So...is this test mandated by your company?

The current Oregon DOT and FMCSA don't require such a test...unless you have a diagnosed history of it...

http://www.landlinemag.com/Magazine/2014/May/News/sleep-apnea-testing.aspx

http://www.trucking.org/Safety/Obst...ercial Driver Medical Qualification_FINAL.pdf

http://www.oregon.gov/ODOT/DMV/pages/faqs/cdlmedcert.aspx

https://www.fmcsa.dot.gov/regulations/title49/section/391.43


It's NOT impossible for the medical examiner to be a bit...enthusiastic...in recommending testing that exceeds the required tests...that's one thing the medical profession has been very good at in recent years...
BUT, it could also be a requirement mandated by your company...in which case, you have to take the test...like it or not, and IF you're diagnosed with some form of sleep apnea, you COULD end up with some licensing difficulties.

(from the first link)

The Federal Motor Carrier Safety Administration is silent on sleep apnea testing. Many truckers who have been told that the testing is mandatory are probably either very puzzled or very upset right now.

The Federal Motor Carrier Safety Regulations state:

391.41(b) A person is physically qualified to drive a commercial motor vehicle if that person (5) has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his/her ability to control and drive a commercial motor vehicle safely.

Not a word in there about testing. In order to get the full scoop on what FMCSA expects from the regulations, you must look at the “guidance” the agency issues on various regulations. The agency has established guidance for chronic sleep disorders, including sleep apnea.

In that guidance, the agency lays out the minimum waiting period for certification or recertification of an individual with a chronic sleep condition after starting treatment. There is a minimum one-month waiting period after starting a continuous positive airway pressure device (called a CPAP). Individuals with surgical treatment are to wait a minimum of three months before certification or recertification. Medical examiners are directed by the agency to certify the driver for only one year.

Here is where the “mandated testing” comes in. After someone is diagnosed, the agency’s guidance directs the medical examiner to certify or recertify someone who has started nonsurgical treatment and has had “multiple sleep latency testing values within the normal range.” The guidance does not directly address sleep latency testing for drivers who sought surgical treatment. The guidance merely directs doctors to monitor the resolution of symptoms.

Nowhere in any of that did you read neck size, body mass index or anything of the sort? The sleep industry has come up with those types of criteria. Not FMCSA.


So why am I being told that it’s mandatory?
That’s where we go from concrete to somewhat speculative. Explanations vary when talking to medical examiners and motor carriers who insist on the testing, but one common theme is liability.

What got us to this point is twofold. First FMCSA published, very briefly, proposed guidance that would have expanded on sleep apnea testing in April 2012. The proposed guidance was pulled down days later, but that bell wasn’t completely unrung. The cat was out of the sleep apnea bag: FMCSA was looking to regulate it further.

Follow that up with the fact that the agency is in the process of implementing the National Registry of Certified Medical Examiners. This is a registry – basically a database – of medical examiners who have paid a fee and gone through FMCSA’s testing. Drivers will only be able to get DOT medical certification from individuals listed on the registry after May 21. (See related article Page 38.)

FMCSA has been forthcoming about the medical examiners’ responsibilities under the regulations and what the penalties could be if they circumvent those regs and incorrectly certify a driver as medically qualified when the driver actually is not medically qualified. Those fines are pretty steep: $10,000 in one instance, $250,000 – a quarter of a million dollars – in another. We won’t get into the likelihood of such fines being levied; the mere threat seems to be enough.

Toss in an added threat of litigation if a driver with a disqualifying medical condition is in a wreck, and the medical examiner who certified him could be facing some liability issues there as well.

All of that amounts to motor carriers and medical examiners looking to cover their assets – so to speak – and ordering more tests to prove they did all they could.

BUT...

What can you do?
Last year at the urging of large numbers of angry truck drivers, Congress passed (in what seemed like record time) a bill that prevents FMCSA from proceeding with any regulation of sleep apnea without going through a rulemaking process. That involves public comment periods, legitimate research, cost-benefit analysis, etc.

Soon thereafter, President Obama signed the measure into law.

Without the agency going through that rulemaking process, the current regulations along with the guidance is all there is on the books to regulate, if you will, sleep apnea.

OOIDA Executive Vice President Todd Spencer pointed out that while the issue was being considered in Congress, FMCSA maintained they planned to do the rulemaking all along.

“However, a time frame has yet to be mentioned and the issue doesn’t appear to be an agency priority,” he said. “So who knows when the appropriate level of scrutiny might take place to determine whether the billions in new costs to drivers are justified.”

In the meantime, drivers shouldn’t set themselves up to be victims. While apnea may not play a real role in any crashes, it is a medical condition that should be discussed and evaluated with a trusted and qualified physician, Spencer said.

He said that drivers should take care of this before their current medical certifications expire and the “proverbial gun is at your head.”

“That way you have options for testing and appropriate treatment that won’t break the bank,” Spencer said.

 

[The Stigenator]

I call BS on Sportage's comment.

There were other issues in there, CPAP didnt cause the heart attack.

1. If you are getting repeated sinus infections, you arent using the humidifer or not cleaning your device. Maintain it, you wont have problem. Make sure you use distilled water! Or you will see more sinus infections, its healthier to use distilled water. Also regularly clean mask and change filters.

2. the increased pressure (unless it was badly calculated) would not affect or cause the cold. If anything it will keep for OSD like me, keep the airway open. If you have an AutoPAP it will automatically adjust the pressures, so you dont have to worry so much. Mine is a not an AutoPAP but I know how to adjust the pressures (like when i went camping at 9000 feet and the device is certified to 7500). I was like at 20+ mm of h20 on it.

3. These days sleep studies are much easier than before. I've had 2 sleep studies done in 10 years. First when I was 24, next when I was 34. It was detected at 24, but they decided to operate on me. That did not help, after a few years the OSD was back. Thats when I got on CPAP. The second test was at my home (Kaiser is my provider). They sent me home with a box that I wire up and fall asleep in my own bed. It was comfy and worked great. After that one night, they sent me home with an Autopap that I used for a night and then they gave me my own unit. The autoPAP was my calibration unit.


4. For the CDL requirement. It seems its a safety thing. I am seeing it more in CA where if you got a sleep disorder you may require it to keep your CDL.

 

[The Stigenator]

I was diagnosed with severe sleep apnea and use a cpap machine. been using it since august or september or so I think. trying to get used to it is a bitch.

They are saying it's working and my sleep test showed I woke up 34 times an hour and my oxygen went down to 74%. the machine last month says my average was 2.2 times an hour. I have yet to feel any difference from using it. it's more a pain in the ass then any benefit I can feel.\

i never felt any of the symptoms they claim it causes it before i had the test done.

Pontifex, adjust your pressures up a tad bit, or they will do it for you. But 2.2 an hour is actually better than having like 40 an hour (which is what I had) and my O2 was around yours 70%

If you arent feeling the difference, try one or two nights without it. You will realize it. Message me I am here to help.

 

[MidasKnight]

Not mandated by my company but the medical clinic that certifies us for the medical card is sending us CDL holders for sleep test if the neck measurement is 17" or over. So ... if your overweight ... the clinic will not give you your medical card without first having the test. Then instead of renewal at 2 years it goes to 1 year certification.

Great info on those links BTW ... thanks.

So...is this test mandated by your company?

The current Oregon DOT and FMCSA don't require such a test...unless you have a diagnosed history of it...

http://www.landlinemag.com/Magazine/2014/May/News/sleep-apnea-testing.aspx

http://www.trucking.org/Safety/Obst...ercial Driver Medical Qualification_FINAL.pdf

http://www.oregon.gov/ODOT/DMV/pages/faqs/cdlmedcert.aspx

https://www.fmcsa.dot.gov/regulations/title49/section/391.43


It's NOT impossible for the medical examiner to be a bit...enthusiastic...in recommending testing that exceeds the required tests...that's one thing the medical profession has been very good at in recent years...
BUT, it could also be a requirement mandated by your company...in which case, you have to take the test...like it or not, and IF you're diagnosed with some form of sleep apnea, you COULD end up with some licensing difficulties.

(from the first link)



BUT...

 

[MidasKnight]

Why do you need a sleep study for a CDL? Are you a truck driver?

Yes. Over the road truck driver here.

 

[GRIFFIN1]

I bought a machine on Craigslist about 3 months ago because I would sometimes wake myself up snoring. It took about 3 nights before I made it through the whole night without taking the mask off. Three months later, I don't even know it's there most of the time.

I seem to remember truck driver mentioned that he had to submit the memory card from his cpap machine to prove that he was using the machine.

One of the main advantages of cpap is that I can sleep with the blankets over my head. No more cold face for me.

 

[pontifex]

I bought a machine on Craigslist about 3 months ago because I would sometimes wake myself up snoring. It took about 3 nights before I made it through the whole night without taking the mask off. Three months later, I don't even know it's there most of the time.

I seem to remember truck driver mentioned that he had to submit the memory card from his cpap machine to prove that he was using the machine.

One of the main advantages of cpap is that I can sleep with the blankets over my head. No more cold face for me.

My machine has a memory card but it submits the data to the doctor via cell signal.

 

[lk2500]

I had the test done and I have no sleep apnea at all; so not everybody is diagnosed as positive.

I know a few people who love their CPAP machines.

If you're diagnosed positive and are having trouble sleeping try the machine to see if it helps. If it doesn't help or you don't want to, then don't. Pretty simple stuff.

 

[BoomerD]

Not mandated by my company but the medical clinic that certifies us for the medical card is sending us CDL holders for sleep test if the neck measurement is 17" or over. So ... if your overweight ... the clinic will not give you your medical card without first having the test. Then instead of renewal at 2 years it goes to 1 year certification.

Great info on those links BTW ... thanks.

I'd fight that shit. They're just revenue hunting...not making the roads safer.

I hate doctors' offices who are like that.

Personally, I'd fight it as hard as possible. Do you have a union? If so, they may be able to help.

I maintained my Class A (by a variety of names) for more than 30 years. (finally gave it up a few years back when I could no longer pass the physical because of my knees and back.)
I've seen quite a few changes in the medical test over the years...but that's ridiculous.

 

[shortylickens]

Basically anyone who is moderately obese, bmi>30, fails a sleep apnea test

I'm a chubby bastard.
Would a machine help me sleep better?

 

[Craig234]

I'm a chubby bastard.
Would a machine help me sleep better?

Get the test. If it increases your oxygen levels and decreases the interruptions, it helps you.

Some notice the difference, some don't.

 

[keird]

First, glad to see you displaying your medical degree.

Second, there are 3 specific types of sleep apnea, including obstructive, which is the most common, but there are also central apnea and complex, a combination of obstructive and central. But with your medical experience and degree, I'm sure you already knew that.


And your friend.....really sounds like he was suffering from CHF prior to his MI and most likely had pulm. edema cropping up.

This.

I'm a respiratory therapist but am not working in the sleep lab. Just the ER and medical floors. I used to score the sleep studies in the early 2000's with our old 4-channel machine. Since then, the miniaturization of technology has allowed that level of diagnostic capability to be worn at home. I frequently instruct outpatients to apply the device and they go home to sleep. They return the device the next day and the data is uploaded to a workstation. It's neither the quality nor quantity of data that the new in-house sleep lab can provide. Still, the take-home module is a cheap and easy screening device.

Even on the old 4-channel it was pretty obvious that an event occurred. You see snoring stop and then note chest wall movement also stops. 20 seconds later the oxygen level is desaturating towards 80%. That's OSA. When this occurs 40 times an hour, that's pretty severe. Aside from sleep apnea there is also hypopnea (low breathing) that can reduce oxygen levels, as well.

yields

vs.

yields

 

[Blanky]

I think it's exceedingly common. In my immediate family I know of at least three people who have it, two of which use CPAP machines. One is obese and too stubborn to use one, the other two are only mildly overweight.

Personally I find that even a 10-20 lb difference in my weight can make a huge impact to my snoring. Certainly a huge correlation between sleep apnea and weight exists.

 

[TheVrolok]

I'd fight that shit. They're just revenue hunting...not making the roads safer.

Or they're using the common risk factors to screen for an incredibly common disease (especially in the truck driving population) that causes excessive day time sleepiness and makes driving long distances far more dangerous. If one wants to sit at home with unmanaged sleep apnea and succumb to the sequela thereof, great, but don't do it while operating something that weighs up to 80,000 lbs and moves at ~70 mph.

 

[BoomerD]

Or they're using the common risk factors to screen for an incredibly common disease (especially in the truck driving population) that causes excessive day time sleepiness and makes driving long distances far more dangerous. If one wants to sit at home with unmanaged sleep apnea and succumb to the sequela thereof, great, but don't do it while operating something that weighs up to 80,000 lbs and moves at ~70 mph.

But they're holding his license hostage with a test that is NOT required/mandated by law.
THAT'S the problem I have with this.

 

[Ns1]

But they're holding his license to make sure we don't get Tracy morgan'd.

Ftfy

 

[Brainonska511]

But they're holding his license hostage with a test that is NOT required/mandated by law.
THAT'S the problem I have with this.

It's not mandated by law, but perhaps the company wants to protect itself from liability and perhaps the law has been slow to change.

 

[OverVolt]

I'm around normal BMI. I think sleep apnea is a bit on the scam side of things. Sometimes I snore, sometimes not. No one has ever observed me cease breathing while sleeping. I sleep rather well and do not wake up several times a night. I can close my eyes and 10 hours instantly pass thank you very much. I tend to sleep on my side and I would have a hard time sleeping on my back. I'm honestly surprised they need all that additional equipment to do a sleep study. All they really need is your oxygen saturation IMO.

There are way too many obese people is the bottom line. I wouldn't be surprised if sleep apnea was the main mechanism behind the link between heart disease & obesity.

That being said, there is no way so many people need CPAP machines.

 

[TheVrolok]

All they really need is your oxygen saturation IMO.

Well, not really.

 

[OverVolt]

Well, not really.

I guess only if you have more problems than just sleep apnea. Presumably you'd know if you have CHF or COPD or whatever.

70% is shockingly low though. Just checked... someone with CHF needs to be on oxygen if their O2 saturation goes below 90%.

If you measure O2 saturation throughout the night and it drops like that, then you know its sleep apnea. Pretty cut and cry. It would be hard to mistake it for a different disease.

 

[Brainonska511]

I'm around normal BMI. I think sleep apnea is a bit on the scam side of things. Sometimes I snore, sometimes not. No one has ever observed me cease breathing while sleeping. I sleep rather well and do not wake up several times a night. I can close my eyes and 10 hours instantly pass thank you very much. I tend to sleep on my side and I would have a hard time sleeping on my back. I'm honestly surprised they need all that additional equipment to do a sleep study. All they really need is your oxygen saturation IMO.

There are way too many obese people is the bottom line. I wouldn't be surprised if sleep apnea was the main mechanism behind the link between heart disease & obesity.

That being said, there is no way so many people need CPAP machines.

And why do you think sleep apnea is a scam? It's a well documented condition with serious implications for people that leave it untreated.

 

[OverVolt]

And why do you think sleep apnea is a scam? It's a well documented condition with serious implications for people that leave it untreated.

Because it seems like a normal complication of obesity. The whole sleep study and CPAP charade game is really dancing around the issue. Lose some damn weight. Its over-medicalizing a simple problem.

 

[Ns1]

Nm reply later. Too hard on phone.

 

[OverVolt]

The management of obstructive sleep apnea was improved with the introduction of continuous positive airway pressure (CPAP), first described in 1981 by Colin Sullivan and associates in Sydney, Australia.[65] The first models were bulky and noisy, but the design was rapidly improved and by the late 1980s CPAP was widely adopted. The availability of an effective treatment stimulated an aggressive search for affected individuals and led to the establishment of hundreds of specialized clinics dedicated to the diagnosis and treatment of sleep disorders. Though many types of sleep problems are recognized, the vast majority of patients attending these centers have sleep-disordered breathing. Sleep apnea awareness day is April 18 in recognition of Colin Sullivan's.

:hmm:

 

[TheVrolok]

If you measure O2 saturation throughout the night and it drops like that, then you know its sleep apnea. Pretty cut and cry. It would be hard to mistake it for a different disease.

The point is the other measuring devices (eye monitoring, EEG leads, etc.) are to gather additional information which can suggest type of sleep apnea (obstructive, central, mixed) which can be managed differently and to better titrate therapy. It's really not as cut and dry as you may think.

Because it seems like a normal complication of obesity. The whole sleep study and CPAP charade game is really dancing around the issue. Lose some damn weight. Its over-medicalizing a simple problem.

Of course your right, and many people with obstructive sleep apnea would get better with weight loss .. but patients, generally, don't lose weight. They just don't. It's not an effective treatment modality.

:hmm:

Well, obviously. What's the point in screening for disease you can't treat? It's not tin foil hat stuff. Are you equally surprised that we've started screening for more cancers as we've developed more cancer therapies? Are you surprised that the CDC started recommending the baby boomers be screen for Hep C once far more benign oral curative therapies were developed?