Driver impairment due to drowsiness and fatigue is known to be a major contributing factor in thousands of trucks crashes each year. Reduced alertness caused by drowsiness has impacted nearly all drivers, and this issue continues to plague our transportation system. Driver drowsiness and fatigue is a sociotechnical issue that relates to choices (such as activities and food) drivers makeshours before the drive, the circumstances and forces (such as job requirements and pressures) drivers faces during their daily tasks, and the support the driver receives from his employer through management of work schedules and the technologies provided to detect and monitor the onset of drowsiness.
This section provides tools for understanding and dealing with fatigue and other sleep disorders, including obstructive sleep apnea (OSA).
Understanding Drowsiness and Fatigue
The Driver Drowsiness and Fatigue training module found on the CMV Driving Safety website provides an understanding of truck driver drowsiness and fatigue. More specifically, the module will help safety managers identify the onset of drowsy and fatigued driving in the context of commercial vehicle operations, countermeasures drivers typically choose to combat drowsiness, and systematic barriers that hinder drivers from making prudent decisions in staying alert. Finally, the module will suggest possible measures for detecting drowsiness and fatigue as well as tools safety managers can employ to manage/reduce the occurrence of driver drowsiness and fatigue in their fleets.
The CDC Driver Fatigue website is designed to address the issue of driver fatigue with a comprehensive approach that includes:
- Information on how to develop a corporate culture that facilitates reduced driver fatigue
- Fatigue management education for drivers, drivers’ families, carrier executives and managers, shippers/receivers, and dispatchers
- Information on sleep disorders screening and treatment
- Driver and trip scheduling information
- Information on fatigue management technologies
Obstructive Sleep Apnea
OSA is the most common sleep disorder faced by commercial drivers. OSA causes the upper airway to collapse during sleep, blocking the airway. This deprives the body of oxygen and interrupts sleep, leading to insufficient and poor quality sleep. One in four commercial drivers may be at risk for moderate to severe OSA. CMV drivers with OSA may suffer excessive daytime sleepiness which can impair performance and increase the risk of being in traffic or work related incidents. Additionally, OSA increases risk for serious health conditions.
There are many risk factors for and symptoms of OSA. If you have these symptoms, your doctor may send you for diagnosis at a sleep disorder center. There, you will be given an overnight laboratory sleep test or polysomnography (PSG). A PSG involves overnight monitoring of breathing and other body functions during sleep. The sleep test is then interpreted along with additional collected information, including other relevant sleep and health information.
- Risk Factors for OSA: Being overweight or obese, large neck circumference, high blood pressure, diabetes, smoking
- Symptoms of OSA: Loud snoring, breathing cessation during sleep, morning headaches, frequent urination at night, difficulty staying asleep, waking abruptly with a dry mouth, sore throat, or shortness of breath
The most effective treatment of OSA is nasal positive airway pressure (PAP) treatment. A PAP device delivers a stream of pressurized air to the airway to prevent collapse of the upper airway during sleep. This device prevents or reduces apneas and hypoapneas, allowing users to get a better night’s sleep. PAP users find they have improved attitude and daytime functioning, reduced fatigue, and reduced blood pressure and cardiovascular complications. Your doctor may also recommend other treatment options, including oral appliances (mouth guards) and surgical modifications of the upper airway, weight loss, and positional therapy.
Tips for Managing Your OSA
If you are diagnosed with OSA, you will need to follow your doctor’s treatment plan at all times, not just when you are at home. To do this, you may need the following:
- A Power Inverter: To enable over the road, in–cab PAP use, most drivers must have a power inverter installed in the cab of their trucks. A DC to AC inverter allows a PAP device with humidification to run from the power of a cigarette lighter socket.
- Increased Truck Idling Time: Many trucks must idle in order to provide power to PAP machines. Some PAP machines require more power or power for a longer period of time than a battery can provide. As a result, if you are on PAP therapy you may require more idling time than is allowed by law in some states. Drivers are urged to work with their supervisor or carrier to address this issue.
- Group Support: Group support provides a setting for you to meet with other CMV drivers who are facing similar health challenges. In a group setting, drivers can share OSA tips, such as PAP mask preferences, how the PAP machine is used on the road, etc.
The following are general tips you should follow to manage your OSA:
- Use Your PAP Consistently: Consistent PAP usage is the key to getting the biggest health benefit and increased alertness and daytime functioning. If you are prescribed a PAP, use it all night, every night, and during every nap.
- Obtain Spousal/Partner and Family Support: Your family should recognize the importance of consistent PAP use and should encourage PAP use. It may take you a while to get used to wearing a PAP device nightly. You may find it uncomfortable, restrictive, and even embarrassing to wear in front of others. Talk to your family about this. Your family’s support may help you to better adjust to treatment.
- Take Care of Your PAP Machine: It is important to clean the PAP machine and all accessories after each use. The small amount of time it takes to clean the machine can make a big difference. Dirty machines can breed harmful bacteria, causing illness and respiratory issues. The cleaning supplies can easily be transported in a truck, and sinks at truck stops can be used for washing and rinsing accessories.
- Maintain a Healthy Lifestyle: A healthy diet and regular exercise can help you lose weight or keep a healthier weight. This can lead to an improvement in your OSA symptoms.
- Limit alcohol and smoking: Alcohol relaxes your throat muscles and makes it much easier for these muscles to “collapse” and block your airway during sleep. You should restrict your overall alcohol intake, especially during the several hours before going to bed. Smoking inflames nasal tissues, causing them to swell, which can restrict your nasal airway. If you cannot stop smoking, try to cut down and especially reduce your smoking during the evening and before bed.
For those looking to improve their sleep, many organizations provide useful tips and guides. A few of these resources are included below.
BestSleepHealth.com provides tips for improving your sleep and for creating nighttime habits that foster a restful sleep.
John’s Hopkins guide on exercise and sleep provides a review of what the research shows about how exercise can promote healthy sleep.