What Are The Symptoms Of Sleep Apnea
Symptoms medical examiners can take as suggestive of sleep apnea include:
- Daytime sleepiness
The medical expert panel for the FMCSA states that drivers with a BMI greater than or equal to 33 may be conditionally certified to drive depending on a sleep study.
If you have diabetes, high blood pressure or previously suffered a stroke You should consider talking with your doctor about a sleep study before your DOT physical exam. By being proactive, youll eliminate any unnecessary delays in your certification.
If you have a BMI of 35 or higher, it may be time to consider bringing up sleep apnea with your doctor.
If you have a BMI of 35 or greater, you should be proactive and get yourself tested.
Not sure what your BMI is? Find out with the National Heart, Lung, and Blood Institutes free BMI calculator.
Risks Of Sleep Apnea For Truck Drivers
People with sleep apnea may experience a period of shallow breaths or repeated breathing pauses for ten seconds at any time. When the body stops breathing due to this disorder, it keeps waking itself up to continue breathing, a cycle that can occur several times in a single night. Consequently, the patient fails to reach the most restful stages of sleep. An individual might think they had a full nights sleep, but in reality, their mind and body would still be exhausted.
When fatigue kicks in during the day, most wouldnt know that sleep apnea is the culprit.
The National Highway Traffic Safety Administration states that drowsy driving results in about 100,000 crashes reported to the police every year. Commercial truck drivers with untreated sleep disorders like sleep apnea are among those more likely to drive while drowsy.
Truck drivers can take poorly calculated reactions when driving or find it hard to focus their eyes or stay awake. This increases the risks of being involved in or causing a crash.
Using Medicine And Supplements
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When You Dont Treat Sleep Apnea
People with untreated sleep apnea :
- are more likely to have a heart attack
- have a 2 to 3 times higher risk for having a stroke
- face more than 3 times the risk of premature death
In addition, people whove had sleep apnea for up to 5 years have a 30 percent increase in their risk for having a heart attack or dying, according to research conducted at Yale University.
The more severe ones sleep apnea, the higher the risk for either an attack or death. In the Wisconsin Sleep Cohort follow-up published in Sleep in 2008, 42 percent of the deaths in people with severe sleep apnea were due to heart disease. Severe, in clinical terms, is defined as having an apnea-hypopnea index score of 20 or more respiratory events per hour.
Also, the risk of cardiac-related death was more than 5 times higher among those with untreated severe sleep apnea when compared with those who did not have sleep apnea.
Research findings published in The New England Journal of Medicine in 2005 also suggest that people with sleep apnea are more likely to die in their sleep due to sudden cardiac events, whereas most others who die of heart attacks suffer these events during the day. Low blood-oxygen levels lead to surges in blood pressure, oxidative stress to the walls of the heart, and disruptions to the hearts electrical rhythms.
Other celebrity deaths where sleep apnea was a factor
- James Gandolfini
- Daniel Lawrence Whitney
- Musician and American Idol judge Randy Jackson
- Musical legend Quincy Jones
Association Of Sleep Apnoea With Road Traffic Accidents
The relationship of sleep apnoea to road traffic accidents has been recognised for over a decade. In 1988, Findleyet al. reported that patients with sleep apnoea had a seven-fold greater risk of road accidents than normal subjects and, furthermore, the automobile accident rate of sleep apnoea patients was 2.6 times the rate of all licensed drivers in Virginia, USA. In addition, 24% of sleep apnoea patients reported falling asleep at least once per week while driving. In a community study of 1,001 males in England, Stradlinget al. found that regular snorers were significantly more likely to almost have a car accident due to sleepiness than others 5.8).
Patients with sleep apnoea also perform worse in simulated driving situations than controls , and the performance on one of these simulated driving situations has been demonstrated to correlate with accident risk. However, the demonstration was made using comparisons between groups, and little is known concerning the within-group variability of the relationship between poor performance on the simulator and real-life accidents.
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Should Recommendations Be Different For Commercial Drivers If So How Should All Professional/commercial Drivers Be Screened For Osa If So How
For drivers of commercial vehicles, recommendations for fitness to drive should be more stringent than noncommercial drivers for many reasons . First, commercial drivers spend more time on the road, thus increasing their overall collision risk . Second, because commercial vehicles are generally larger than noncommercial vehicles, the collisions may result in greater property damage and human morbidity/mortality . Third, drivers may be subjected to abnormal sleep/wake schedules resulting in circadian misalignment and sleep deprivation. Fourth, commercial drivers and other professions that affect public safety are usually held to a higher medical standard than those that do not. For example, fitness-to-drive criteria based on hearing and vision impairment is more stringent for commercial than noncommercial drivers. Of note, commercial drivers would be considered as members of a safety-critical occupation and should ideally be seen within four weeks of referral to a sleep centre as per the 2011 CTS sleep apnea guidelines.
Much of the discussion at the workshop meeting and subsequent telephone conferences focused on the proposed FMCSA recommendations from the MEP and whether these would be reasonable to adopt in Canada. Each recommendation was extensively reviewed and potentially modified based on the suggestions of the working group until consensus was achieved. The MEP recommendations and adapted recommendations for Canadian practitioners are outlined in .
Staying Alert Behind The Wheel
The best way to avoid fatigue-related crashes or accidents is to get a good nights sleep.
For those with sleep apnea, that means a trip to the doctor to discuss common symptoms of sleep apnea such as snoring, fatigue, waking in the middle of the night or being told by a sleep partner that you stop breathing while sleeping.
The next step may be a sleep study to diagnosis sleep apnea and establish therapy with continuous positive airway pressure, or CPAP.
CPAP is one of the most effective therapies to treat sleep apnea, which leads to enjoying a consistent restful sleep.
Think your sleepiness behind the wheel could be sleep apnea? Take this online quiz to assess your risk of OSA and gain insight into risk factors and symptoms you should discuss with your doctor.
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Southern Cross Medical Library
The purpose of the Southern Cross Medical Library is to provide information of a general nature to help you better understand certain medical conditions. Always seek specific medical advice for treatment appropriate to you. This information is not intended to relate specifically to insurance or healthcare services provided by Southern Cross. For more articles go to the Medical Library index page.
Can I Lose My License If I Test Positive For Sleep Apnea
FMCSA has concluded that moderate to severe sleep apnea levels interfere with safe driving. If you are diagnosed with moderate to severe sleep apnea, youre considered unsafe for driving a CMV and will lose your CDL. Once you begin treatment and are approved by your medical examiner, you will be able to reapply for your CDL.
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Risk Factors For Sleep Apnea
Sleep apnea occurs in all age groups and both sexes, but there are a number of factors that may put you at higher risk:
- A family history of sleep apnea
- Having a small upper airway
- Being overweight
- Having a recessed chin, small jaw, or a large overbite
- A large neck size
- Smoking and alcohol use
- Being age 40 or older
- Gasping or choking while sleeping
- Loss of sex drive/impotence
- Irritability and/or feelings of depression
- Disturbed sleep
- Frequent nighttime urination
Is It Possible To Die From Sleep Apnea
Some would argue that you might not actually die in your sleep from apnea. When the body senses its not getting enough oxygen during sleep, it forces an awakening. At this time, the breathing airways open and breathing resumes. Because of this mechanism, you stand no chance of suffocating in your sleep.
But thats not the point. In fact, its like saying people dont die from AIDS. No, they die from the inevitable complications that come from HIV. Its true for people with diabetes, as well. No, diabetes does not kill a person outright its a long process that results in poor quality of life, disability, pain, dysfunction, and a shortened lifespan.
Semantics dont change the facts: mortality risks have been shown in clinical research to be higher in those who have sleep apnea. Sleep apnea disrupts circadian rhythms, imbalances body and brain chemistry, interrupts cardiac and respiratory function, elevates blood pressure, and speeds up the hearts rate. When allowed to continue, untreated, it absolutely will lead to higher mortality for those who dont treat it.
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Does A Dot Physical Require Sleep Apnea Testing
There are currently no laws requiring a DOT physical for sleep apnea. However, DOT does require a medical examination for drivers to receive and maintain a CDL license.
During the examination, a medical examiner will determine if you require sleep apnea testing. Itâs up to the medical examiner to determine whether or not your health condition can interfere with your driving.
If you are diagnosed with sleep apnea and refuse treatment, you will not be cleared to resume regular truck driving. If you accept treatment, you will be able to choose from a range of options to help treat your condition. It should be noted that plenty of truck drivers are able to perform their jobs even with sleep apnea so long as itâs treated.
Which Noncommercial Drivers With Osa Should Be Considered Not Fit To Drive
This topic was discussed by the entire participant group, which made a distinction between the roles of the physician and that of the motor vehicle licensing authority. The role of the physician is to assess medical fitness to drive, while the role of the licensing authority is to determine eligibility to drive and issuing/restricting driving licenses. The decision of the licensing authority to restrict driving should take into account the information and recommendations provided by the sleep medicine physician and should follow provincial guidelines.
It was noted that although the risk for collision is greater in patients with OSA, the majority of patients will not experience such an event. A large part of the discussion revolved around whether any firm thresholds of sleep apnea severity or other indexes exist above which patients should be considered not fit to drive. One consideration was adopting the recommendations of the MEP to the FMCSA , and use this threshold for drivers of noncommercial vehicles. Another option was to consider a higher threshold with physician judgment at lower levels of sleep apnea severity.
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Recommandations Pour Valuer Laptitude La Conduite Chez Les Conducteurs Non Commerciaux :
1. La gravité de lAOS nest pas un prédicteur fiable du risque de collision et, par conséquent, ne doit pas être utilisée isolément pour évaluer laptitude à la conduite. 2. La gravité de lapnée du sommeil devrait être prise en compte avec dautres facteurs pour évaluer laptitude à la conduite. 3. La décision finale de restreindre la conduite incombe au bureau dimmatriculation, qui devrait toutefois tenir compte de linformation et des recommandations du médecin spécialisé en médecine du sommeil et respecter les directives provinciales. 4. Chez les patients traités par ventilation à pression positive continue, il faudrait consigner objectivement la compliance au traitement. Il faudrait également en consigner lefficacitéà renverser les symptômes et à atténuer lapnée du sommeil, selon une surveillance physiologique. 5. Chez les patients soignés par chirurgie ou dispositif oral, il faudrait sassurer que le traitement de lapnée du sommeil fonctionne bien. 6. Un conducteur à qui on diagnostique une AOS peut redevenir apte à conduire, compte tenu de lévaluation de ses symptômes et de la preuve de son respect du traitement. Cette évaluation devrait avoir lieu lors de la période de renouvellement provincial de son permis.
Resource Implications For The Investigation And Management Of Sleep Apnoea Syndrome
Measures to reduce the impact of sleep apnoea and the related driver sleepiness on road traffic accidents have little meaning if there are inadequate facilities available to investigate and manage patients with the disorder. Such facilities are inadequate in most countries throughout Europe, which reflects the high prevalence of the disorder and also the fact that sleep apnoea is a relatively recently recognised clinical problem. Thus, hospital administrators and clinicians from other disciplines may not recognise the importance of providing appropriate facilities for the practice of sleep medicine. Even many sleep specialists have been surprised at the high prevalence of the disorder and most clinical sleep centres have long waiting lists of patients awaiting investigation and/or treatment. Current epidemiological data indicate that there are likely to be at least 5million patients suffering from sleep apnoea throughout Europe, and this disorder is second only to asthma in the prevalence league table of chronic respiratory disorders. Thus, the provision of appropriate clinical facilities to investigate and manage these patients represents a major challenge for the health services in each European state.
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Assessing Your Medical Fitness To Drive
Your health professional will assess your medical fitness to drive.
When making your appointment to see your health professional, we recommend that you advise the reason for your visit so that an appropriate length appointment can be made for you.
It is recommended that you also complete the health questionnaire on page 1 of the Private and Commercial Vehicle Drivers Health Assessment form prior to attending your appointment as this information will assist your health professional with undertaking their medical assessment.
Your medical fitness to drive will be assessed against medical standards that are the same across all Australian driver licensing jurisdictions.
There are 2 medical standards:
- private vehicle driver standard
- commercial vehicle standard.
You will be assessed against the standard of driver licence that you hold, or apply for and the purpose for which you drive, or plan to drive.
You must respond truthfully to questions from health professionals regarding your health status.
If These Steps Are Unsuccessful
6.1If the problem lies with your GP, contact the local Clinical Commissioning Group to which your GP practice belongs.
6.2If the problem lies with your Sleep Clinic, contact their Patient Advice and Liaison Service and raise a formal complaint
6.3Write to your local MP with a copy of any correspondence with the CCG or PALS, a copy of your diary of events and all the paperwork and ask them to contact the DVLA and help you get your licence restored.
Sleep Apnoea Trust Jan 2019
Further information from the DVLA and British Thoracic Society is available through the following links to help you:
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Driving Regulations Concerning Sleep Apnoea And/or Excessive Daytime Sleepiness In Different European Countries
In European Union countries, driving licenses are specific to the vehicle driven, according to the following classes: class A: motorcycles class B: automobiles < 3,500kg, fewer than eight seats excluding the driver class C: automobiles > 3,500kg class D: more than eight seats and class E: trailer > 750kg. These classes are pooled into the following two groups: group 1, which includes classes A, B and B+E and group 2, which includes classes C, C+E, D, D+E and class B professional drivers .