Sleep Apnea: The 'Slow-Moving Killer' Lurking Among Long-Haul Truck Drivers

Bob Stanton has been in long-haul trucking for 20 years. During that time, what truly put his life on the line wasn't bad weather or reckless drivers, but poor breathing at night—obstructive sleep apnea. It's a frequently missed condition that robs sleepers of the rest and deep dreams they should have.

"If I hadn't been treated in 2002, I might be dead now," Stanton said. He recently transitioned to a role as a referral coordinator for Dedicated Sleep, a specialty sleep medical group.

According to the American Sleep Apnea Association, sleep apnea is the involuntary cessation of breathing that occurs during sleep. When the body detects a problem, it prompts the sleeper to wake, but not fully, and this process repeats. The association notes that some patients may experience hundreds of such interruptions in a single night.

This condition prevents the body from entering the deep sleep where dreaming and full rest occur, and it also causes abnormal blood oxygen levels, creating ripple effects on health, attacking the circulatory and cardiovascular systems. Stanton says sleep apnea can therefore become a "slow killer" and significantly increase the risk of truck accidents.

The Federal Motor Carrier Safety Administration (FMCSA) takes this condition seriously, although the agency hasn't specifically legislated on apnea. According to Stanton, the Obama administration leaned toward mandatory screening for all commercial drivers, but former President Donald Trump halted that effort to cut regulations. The industry currently operates under what Stanton calls a "rule of no rules" regarding apnea. The FMCSA groups apnea with other conditions that could impair safe driving.

The FMCSA website states: "Individuals with a history or clinical diagnosis of any condition that may affect their ability to drive safely cannot be medically certified to operate a commercial motor vehicle (CMV) in interstate commerce." But once treated, drivers can regain "medically qualified to drive" status.

"If I hadn't been treated in 2002, I might be dead now." — Bob Stanton, Referral Coordinator at Dedicated Sleep

Stanton and other experts say truck drivers are generally resistant to being tested for the condition. "Most drivers don't want to be told they have sleep apnea," Stanton said. "They're afraid of losing their medical card (physical exam certificate)."

However, screening and treating drivers can actually save fleets money. A study by the Virginia Tech Transportation Institute found that one trucking company, by implementing a mandatory employer-sponsored screening, diagnosis, and treatment program,saved $441 per driver per month.。

Additionally, Stanton points out that drivers often face a deductible of around $1,400. He therefore urges carriers to reform insurance rules to cover sleep apnea treatment at 100%. This would help dispel the myths circulating among drivers that apnea is a "fake disease" or a "money-making scheme."

The American Sleep Apnea Association says the disease can lead to weight gain, sexual dysfunction, high blood pressure, and cardiovascular disease. For drivers, the risks multiply because the condition can cause daily memory problems, headaches, daytime fatigue, and difficulty concentrating on the road.

Common Symptoms of Sleep Apnea

• Loud snoring.
• Morning headaches and nausea.
• Gasping or choking during sleep.
• Decreased libido/impotence.
• Excessive daytime sleepiness.
• Irritability and/or depressed mood.
• Disrupted sleep.
• Problems with attention and memory.
• Frequent nighttime urination.

A recent VTTI study found that up to 47% of commercial vehicle drivers are at potential risk for sleep apnea based on weight or neck circumference factors. According to VTTI research scientist Jeffrey Hickman, the institute surveyed about 20,000 drivers. Hickman believes the actual diagnosis rate of apnea in the general population is between 6% and 17%, while among truck drivers, it's about 33%.

"That's higher than the national average, and by a lot," Hickman said. "If you treat (apnea), not only do you make the driver healthier, you make them a better driver."

Trucking companies are therefore wary of undiagnosed drivers, and some carriers have stepped up efforts to eliminate apnea from their long-haul fleets. In 2006, Schneider became the first major company to "screen, diagnose, and monitor" for obstructive sleep apnea. According to Schneider's website, in 2019, Schneider received the National Safety Council'sGreen Cross for Safety Innovation awardandthe Robert C. Johns Research Collaboration Award。

Most carriers seem to handle the issue quietly, but Schneider has a dedicated webpage explaining its treatment program. Schneider requires all new drivers to undergo apnea screening. If diagnosed, the full-truckload carrier provides the necessary treatment.

Tom DiSalvi, Schneider's vice president of safety and loss prevention, said the initial problem was getting truck drivers through screening, diagnosis, and treatment in a timely manner without delaying their time on the road. DiSalvi said this process could take up to eight weeks in 2006. "We realized there was a lot of delay in the process," DiSalvi said.

Schneider began to shorten delays and streamline the process, starting with a questionnaire-based screening. Schneider also sought out suppliers of CPAP (continuous positive airway pressure) devices—small machines that provide a steady flow of positive air pressure during sleep. Schneider had to consult its original equipment manufacturers (OEMs) about powering the devices, because initially CPAP required trucks to have inverters and burn diesel while idling. DiSalvi said inverters and idling are no longer necessary today.

Schneider also made the process completely free for insured drivers. Today, the result is a savings of $440 per driver per month in health costs. When a third-party study first reported this figure to the company, DiSalvi said it must be a mistake—the report should have said "per year." Schneider also reports improved employee retention, with a 30% higher retention rate among drivers with apnea.

A concept some in the industry call "fatigue management" is taking root in trucking. According to Mary Convey, vice president of corporate health and wellness programs at SleepSafe Drivers, a fatigue management company focused on transportation, several fleets including Marten, Maverick, Old Dominion, Saia, and Southeastern Freight have implemented apnea and fatigue management programs.

Unable to Breathe

Richard Bren, a board member of the American Sleep Apnea Association, has worked in the trucking industry's risk and insurance sector for over 25 years. The issue is particularly personal for him because he also has apnea and has used a CPAP for 18 years. "My father had it (apnea). It's in our genes," Bren said. He explained that apnea is caused by airway collapse during sleep, with weight and neck circumference as possible triggers.

For Bren, now 58, the disease means his airway collapses about every 40 seconds during sleep. His sleeping body gasps, waking him slightly, and then he falls back into one or two minutes of deep sleep. "You can't get into deep sleep," Bren said.

Now, Bren wears a CPAP mask to sleep, joking that he looks a bit like a jet fighter pilot. He says the machine's intrusion into his bedtime routine is exactly why many people eventually give up on CPAP. But, he adds, the technology is highly effective. "The first time I was treated, my wife thought I was dead," Bren said. In reality, he was in deep sleep and not gasping. The CPAP forces airflow into his airway, allowing him to sleep peacefully. The next day, Bren felt refreshed and energetic. "I felt like I'd had a Red Bull," Bren said.

Common Risk Factors for Sleep Apnea

• Family history of sleep apnea.
• Narrow upper airway.
• Being overweight.
• Receding chin, small jaw, or severe overbite.
• Large neck circumference (17 inches or more for men, 16 inches or more for women).
• Smoking and alcohol use.
• Age 40 or older.
• Race.

New York physician Dr. Jordan Stern treats sleep apnea and has treated transportation industry workers. Stern says workers are reluctant to be tested for the condition, but he has been researching options for his patients. "CPAP is just one treatment for apnea," Stern said. "70% of our patients don't want CPAP."

Stern says he offers patients CPAP machines and medical oral appliances, and conducts testing via telemedicine. His sleep tests can be done at home. Stern calls in-clinic sleep testing a "dinosaur experience" and says better technology has existed for 15 years. Stern's office mails patients a disposable diagnostic device to use while they sleep.

"I felt like I'd had a Red Bull." — Richard Bren, Board Member, American Sleep Apnea Association

Stern says more transportation companies are requiring employees to get tested. In New York City, the Metropolitan Transportation Authority requires employees with a body mass index (BMI) over 30 or a neck circumference above normal (17 inches for men, 16 inches for women) to undergo apnea testing. Some MTA employees come in resistant, Stern says. He can usually detect this resistance when adults claim they aren't sleepy during the day. Anyone referred who claims their sleep is perfectly normal raises his suspicion. For this resistance, Stern has a simple response: "I say, 'Listen, I'm going to cure you.'"

FMCSA's "Catch-All Clause"

Stanton says the FMCSA needs to improve its rules on apnea, and the first step is to explicitly mention the condition in its regulations. Currently, obstructive sleep apnea falls under a catch-all category of conditions that, if untreated, reduce safety. The FMCSA is a member of the North America Fatigue Management Program, which aims to "develop guidelines and materials that enable carriers to implement comprehensive fatigue management programs (FMPs) and provide FMP delivery tools to carriers across North America." Stanton believes that if the FMCSA explicitly mentions apnea and creates a rule, it could establish testing formats and treatment guidelines.

Bren compares the disease to high blood pressure—if untreated, it worsens and affects other organs and conditions. "These problems start to pile up," Bren said. Many long-haul drivers are already documented with other conditions like type 2 diabetes, high blood pressure, obesity, and heart problems. Stanton says obstructive sleep apnea only exacerbates these conditions.

Bren hopes to see more carriers openly discuss sleep apnea. He says the disease needs to be widely publicized and handled properly internally so it doesn't become a major issue that forces the FMCSA to regulate strictly. Convey says she doesn't think federal regulation is coming, but believes the apnea problem can be solved without legislation and congressional intervention. "It takes everyone, including your healthcare provider," Bren said. "The trucking industry better solve these problems itself rather than let federal regulators get too deeply involved."