Sleep for Fleets and Commercial Drivers

Jill Glenn, CTP, RPSGT Dedicated Sleep

jmglenn@dedicatedsleep.netwww.dedicatedsleep.net

360-907-7534 direct

Dedicated Sleep 2018

Disclaimer

Dedicated Sleep is a healthcare management services company.

The information presented here is not intended to treat, cure, or diagnose any medical condition.

The information presented here is not intended to provide legal advice.

Our Mission

“All people deserve the highest level of sleep and wellness care available, AND at the lowest cost possible, because sleep wellness is a right which belongs to everyone.”

Jill Glenn, President, Sleep Health & Wellness, Sleep Magazine, January Edition: 2004

Why is Sleep Important?

• Sleep Apnea causing Short-Sleep: Short-Sleep is considered a CAUSE : Hypertension, Obesity, Diabetes, Stroke, and Depression.

• Short-Sleep creates fatigue, weight retention, and increases muscle injuries.

• Short-Sleep enhances irritability, anger, confusion, and impulsivity.

• Sleep Apnea/Short-Sleep is associated with 2-7x increased risk for crash.

• Treating Sleep can have a profound positive effect on the above conditions.

NSF foundation website 2013, muscle study, 2018.

Why is Wellness Important?

“Lifestyle Diseases” are driving up the prevalence and cost of Chronic Disease:

• Sleep Apnea

• Diabetes

• Heart Disease

• Obesity

• Chronic Pulmonary: COPD

• Hitting “ younger workers”

Chronic disease is no longer just for older age groups….shift is trending towards “ working” population.

Rand 2013 Workplace Wellness Programs, U.S. Dept. of Health and Human Services

• Hypertension

• Diabetes

• Cardiovascular Disease

• Aging Workforce

• Obesity

• Muscle Injures

Treating short sleep/sleep apnea and fatigue reduces costs in all of the above areas…average ROI 3-6/1

* accident reductions, health care cost reduction, decreased turnover*

Top Healthcare COSTS for Commercial Drivers

Rand Wellness Study 2013, NAFMB website 2018NPTC survey 2016

Posted: 2014 FMCSA web page: Medical Expert Panel Recommendations: ( 2008)

“Medical Examiners cannot issue an unconditional medical certification, if sleep apnea is suspected, or known to be present”.

• Medical Examiners will issue initial short card to complete:

• Outside Physician Consult/Visit

• Sleep Test ( PSG, HST, MWT)

• Cpap Treatment Setup

• if AHI above 20.0,

• OR physician states moderate or severe sleep apnea is present- AHI 5-15/hour, with symptom, or co-disease

• Minimum of 7 days of effective cpap usage at a level of 5 hours per night, 5 of the 7 nights. (70% average).

• Effective Usage: AHI below 10.0, Physician stating driver does not have sleepiness…

NAFMB website, FMCSA medical modules 2018

Conditional Certification

• Second short card to show additional 90 days of cpap compliance (at 70% level of usage compliance), AHI average below 10.0 AHI. ( All days)

• Then: Annual Card, but drivers have to stay at 70% usage compliance overall, must present actual compliance data to DOT examiner.

• Costs have been greatly reduced, compared to early numbers…

• Use of Home Sleep Tests, with COC, allow faster turnaround time, and reduced costs.

• All driver with SA, are patients…with all patient rights intact. ** Oral Appliances or Other Options are Allowed**

NAFMB website, FMCSA medical modules 2013

Understand the Trucking Industry.

Understanding the trucking industry, unique needs

• Shift-Work Management and Coaching. Environmental: Truck-Cab, Hotel, Heat/Cold, Altitude, HOS

• Equipment Technical Specs: all cpap machine types, power

• Truck types: LTL box trucks, step vans, hazardous materials tankers and Class 8 sleeper trucks

• Driver Classifications: New Hire, IC, OTR, daily driver

• DOT Medical Card: Timing, Extensions, Short-Long Cards

• Educate/Help the DOT ME

• Attempt to follow FMCSA MEP Recommended Guidelines: to ensure “signoff”

Referral Criteria-Sleep ApneaNRCME Core Curriculum: American Medical Association ( AMA).

• BMI≥33, OR

• Judged AT High RISK by way of Berlin Questionnaire, OR

• Clinical Evaluation (consider risk factors below)-2 or more

• Advancing age (over 40)

• BMI≥25 overweight, BMI ≥30 obese

• Small or recessed jaw

•Neck size ≥ 17” male, 16” female

• Small airway ( Mallampati Scale score of Class 3 or 4)

•Waist circumference > 40” males, > 36” females

• Family History of sleep apnea

• Hypertension: 140/90

• Type 2 Diabetes

•Male

Sleep “ Complaints"

Subjective/ Complaints:

• Loud Snoring-according to self/bed partner

• Morning Headaches

• Messy Bed

• Disrupted Sleep

• Waking from sleep, to use bathroom

• Feeling “ hung over” after sleep

• Not wanting to sleep on back/ inability to sleep on back

• Witnessed apneas, gasping during sleep

• Impotence

• Dry mouth/mouth stuck shut in the am

• Trouble falling asleep/maintaining sleep

• Acid, Indigestion during sleep

• Kicking/moving a lot during sleep

NPTC Council on Sleep Apnea September 2012

Shift WorkHealth Impacts

Studies have shown that several diseases are associated with night work and shiftwork. * Short Sleep.

• Sleep

• Gastrointestinal

• Cardiovascular

• Mental disorders

Shiftwork, associated with heavy physical and/or cognitive demands, lack of work control, and other psychosocial stressors have a major negative impact on workers' health and wellbeing:

• Disruption of biological rhythms

• Aggravation of several physiological functions leading to higher morbidity of various types

• Earlier retirement

All interacting with family and social relations

Shift Work

Effects on Sleep & Alertness

• Accumulated sleep deficits

• Excessive sleepiness during and after work

• Biological disorders

• Difficulties in performing work

Increased rates of accidents and other ailments caused by unsafe/unhealthy working conditions unhealthy lifestyles such as:

• Smoking

• Alcohol consumption

• Sedentary habits

• Poor nutrition

Shift WorkHealthcare Shiftwork Data & Analysis:

• 2 week study, 12hrs on 36 hrs off, alternating day/night shift

• 176 workers tested

• Duration: Avg day sleep tested significantly shorter than night sleep on “off” day (208 min vs 497 min)

• Quality: Night workers sleep during day = worse quality than off day night sleep: Day workers worse night sleep prior to working day shift

• Alertness: Decreased in Night Workers , greatest drop in alertness occurring closest to dawn. Day Workers showed no significant change in alertness

Shift Work

Petrochemical Shift Work Data & Analysis:

• 22 Workers 2 t0 3 day shifts, followed by 2 to 3 night shifts, followed by 4 to 5 days off

• Duration: Night shift worker sleep during day showed lowest avg minutes slept of all test subjects

• Quality: No significant differences

• Alertness: Worse alertness resulted as night shift progressed

Shift Work

(2)Trucking Companies Shift Work Data & Analysis:

• 37 drivers tested, (13) fixed schedule drivers, (24) irregular schedule

• Duration: Fixed schedule employees had longer sleep than irregular schedule, relative to “time off” sleep

• Quality: Dayshift workers experienced mono-phasic sleep, night workers experienced poly-phasic sleep

• Alertness: More accidents occur during day hours, however 60% of all night time accidents are fatal.

Findings from Study

Shiftwork across all 3 industries in this study showed impacts in all 3 measured sleep variables, with the MOST SIGNIFICANT negative

impacts shown in “night” shift worker results.

Shift Work

Shift Work

As Managers and Employees, we can take the following steps in bettering the effects of shift work:

1. Look at scheduling more closely with regards to sleep health

2. Educate ourselves about good Sleep Hygiene practices

3. Apply strategies for staying alert

4. Apply strategies for “day sleeping”

Sleep Hygiene

Good sleep hygiene practices can prevent the development of sleep problems and disorders.

• Avoid napping during the day. It can disturb the normal pattern of sleep and wakefulness. ** Exception Shift Workers…..Short Naps Are GOOD.

• Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime. While alcohol is well known to speed the onset of sleep, it disrupts sleep in the second half as the body begins to metabolize the alcohol, causing arousal.

• Exercise can promote good sleep. Vigorous exercise should be taken in the morning or late afternoon. A relaxing exercise, like yoga, can be done before bed to help initiate a restful night's sleep.

• Food can be disruptive right before sleep. Stay away from large meals close to bedtime. Also dietary changes can cause sleep problems.

Sleep Hygiene

Good sleep hygiene practices can prevent the development of sleep problems and disorders.

• Ensure adequate exposure to natural light. This is particularly important for people who may not venture outside as frequently as children and adults. Light exposure helps maintain a healthy sleep-wake cycle.

• Establish a regular relaxing bedtime/sleeptime routine. Try to avoid emotionally upsetting conversations and activities before trying to go to sleep. Don't dwell on, or bring your problems to bed. Journal.

• Associate your bed with sleep. It's not a good idea to use your bed to watch TV, listen to the radio, or read.

• Make sure that the sleep environment is pleasant and relaxing. The bed should be comfortable, the room should not be too hot or cold, or too bright, and too loud.

National Sleep Foundation

Day Sleeping

Tips for sleeping “during the day”

• Wear dark glasses to block out the sunlight on your way home.

• Keep to the same bedtime and wake time schedule, even on weekends.

• Eliminate noise and light from your sleep environment (use eye masks and ear plugs).

• Avoid caffeinated beverages and foods close to bedtime.

• Avoid alcohol; although it may seem to improve sleep initially, tolerance develops quickly and it will soon disturb sleep.

National Sleep Foundation

• 47 Year Old Female

• Blood Pressure 126/76

• BMI: 32

• Non-Smoker

• Complaint of frequent headaches

• NO Complaints of Sleepiness or Fatigue

• No Complaints of Snoring/Gasping: per spouse

• Confidently states: “I do not have sleep apnea…” I just work hard”

*Sent for sleep evaluation by medical examiner, recent hard breaking event on file with safety.*

Case Study: 2 Million Mile Driver

Outcome Results:

• Positive for Severe Sleep Apnea AHI 46.3/hr

• Successfully Treated: 93% Compliant ( 5 hours or greater), 93% nights.

“I haven’t had a single morning headache since I started on my apap machine, plus I am way less tired.” “I didn’t know I could feel this way”.

4 month: 26 pound weight loss, reduction of medications, reduction of specialist visits, engaged in walking program.

Case Study: 2 Million Mile Driver

Take Home Points• Sleep matters, for heath, wellness, performance, safety, mood.

• Short Sleep can be caused by Sleep Apnea, and Shift Work.

• Short Sleep across multiple industries showed negative results in sleep quality, duration, and alertness

• Effective scheduling, and a proactive sleep apnea program, can provide resources to manage Short-Sleep.

• Educating drivers and shift workers to try and follow good sleep hygiene practices can help offset negative effects of Shift Work and Short-Sleep.

Sleep Well. Live Well™.

Thank You!!