The recent case of a NSW truck driver using sleep apnea in his defence against culpable driving brings out some interesting issues for the transport industry. The defence argument was dismissed, which meant bad news for the charged driver. But it could well have been worse. It could (and may still) lead to the inability of sleep apnea sufferers to qualify for a long distance driving license.
This may sound harsh. However, it's already the case in some European countries and Canada. A special Parliamentary committee in NSW discussed the issue some years ago, and it is likely to be resurrected again before long.
Why apnea? And what can drivers and managers do about it? More importantly, what is sleep apnea and how can it be avoided?
The word apnea means 'the absence of spontaneous respiration'. During sleep, this represents long periods where the body 'forgets' to breath. Watching apnea sufferers, one may be excused for thinking they were dead - some times for up to half a minute. They then snap back into action with a large gulp of air and several short breaths to make up for the lack of oxygen circulating around the body.
Sleep apnea sufferers quite often don't know they have a problem. Because they're asleep, they are not usually aware of the regular long delays in breathing. However, their sleeping partners or other household members usually are, because one of the most common symptoms of sleep apnea is snoring.
In about 80% of sleep apnea cases, the sufferer is overweight. For men, this usually means a 'pot belly' which makes it difficult to sleep on their side or front. Hence, they tend to wind up sleeping on their back for most of the night. With the increase in belly fat also comes an increase in fatness of the tongue! This, plus the extra pressure of fat around the neck, then blocks the windpipe, causing the airways passage to collapse in on itself and cause that ZZZZZ sound as too much air tries to get down too small a passage. A few drinks of alcohol before bed makes the problem worse as the windpipe itself then becomes loose and floppy, causing it to vibrate even more.
Because the heavy snorer (and sleep apnea sufferer) tends to have small awakenings (up to 300-400 times a night) to get a breath, he is then constantly tired during the day. For this reason, working in a job that is sedentary but requires concentration, such as driving a truck, can cause the sufferer to drop off to sleep at any time. And this is where the legalities can start.
The implication of the current medical knowledge of sleep apnea is that being overweight predominantly causes it. Up to 80% of sleep apnea cases are overweight or obese. Although there are genetic factors involved in being overweight, much of it is self-induced. In an environment where fatty fast foods are easy to come by and no real physical effort is required any more during the day to stay alive, it's easy to get fat. And lots of Australians do. In fact there are now 67% of men and 53% of women who fit into this category.
Of course suffering sleep apnea and its consequences - particularly the lack of energy and regular daytime sleepiness that follows - is bad enough. But this is not the only problem. Medical research has now shown that apnea raises blood pressure and increases the risk of heart disease. It raises blood pressure because the heart has to work harder during those periods where no oxygen is being breathed in. This means the pressure of the blood against the arteries becomes stronger and this, in turn, puts pressure back on the heart.
As well as that, apnea has been associated with type 2 diabetes, the fastest growing disease in the world at the moment, which is largely due to our changing lifestyles. While diabetes itself is unlikely to kill you directly, it can lead to heart disease, but can also result in having to have one or both legs amputated, and this is obviously a considerable disadvantage in the transport industry.
Some occupations, like computer technology, office jobs and truck driving are particular occupational hazards for weight gain, and hence so is sleep apnea - unless something is consciously done about this. So what can be done?
The symptoms can be treated with a device called a CPAP (Continuous Positive Airways Pressure) machine. This is a mask which has to be worn at night, with a pump beside the bed which blasts air at a pressure set by a doctor into the nose, keeping the airways passages open. The CPAP works well in most cases and helps sufferers get a good night's sleep. But it only treats the symptoms, and for this reason has to be used for the rest of the sufferer's life. As you can imagine, it does little for the sex life. It's also quite expensive to either buy or hire a CPAP machine.
Losing weight is obviously a better solution. Even a 10% loss in weight can cause a decrease in snoring and sleep apnea and an improvement in sleep. This then leads to a decrease in daytime sleepiness and less risk of dropping off at the wheel.
Dr Garry Egger MPH PhD Professor of Lifestyle Medicine at Southern Cross University and an Advisor to the World Health Organisation and Governments in lifestyle and chronic disease. Complete the free Lifestyle Improvement Questionnaire to assess your lifestyle based risks at http://www.lifestyleprograms.net/