The Drowsy Driving Epidemic [Infographic]

February 11, 2015 | Daniel R. Rosen


The Cost & Consequences of 168 Million Sleep-Deprived Drivers

There are countless driving hazards every time we get behind the wheel of a vehicle. But one of the most common can also be the most deadly: driving while drowsy.

While texting and driving and drinking and driving are widespread and deadly problems, drowsy driving is even more pervasive in the U.S. More than a third of Americans fell asleep behind the wheel of a car last year, and there are 42 drowsy drivers for every one drunk driver on the road.

Drowsy driving accounts for hundreds of thousands of auto accidents, injuries and deaths, as well as billions of dollars in monetary losses every year. Driving while sleep deprived can even cause impairment that rivals driving under the influence of drugs or alcohol.

The infographic below explores the costs and consequences of drowsy driving across the U.S.


Source: Law Offices of Daniel R. Rosen.

Could Sleep Apnea Testing Reduce Major Transportation Accidents?

NTSB says the condition is a problem for truckers and train operators, but other officials aren't so convinced.

08:09 | 06/27/2014

Accidents Due to Sleep Apnea

Asleep at the Wheel: Could Mandating Sleep Apnea Tests for Transportation Operators Reduce Accidents?

Jun 27, 2014, 7:16 PM ET

By GIO BENITEZ, GEOFF MARTZ, GERRY WAGSCHAL, STEPHANIE WASH and CONOR FERGUSON 

GIO BENITEZMore From Gio »

GIO BENITEZMore From Gio »

Correspondent

STEPHANIE WASHMore From Stephanie »

Associate Producer

via NIGHTLINE

Cars from a Metro-North passenger train are scattered after the train derailed in the Bronx neighborhood of New York, Dec. 1, 2013.

Edwin Valero/AP Photo

http://abcnews.go.com/Nightline/video/sleep-apnea-testing-reduce-major-transportation-accidents-24346235

Every day millions of passengers put their lives in the hands of train conductors, bus drivers and the truck drivers who share the road with them. All of these jobs require long, monotonous hours with few breaks in between, which can sometimes lead to drivers falling asleep at the wheel.

When that happens, the results can be catastrophic. While some accidents are caused by simple fatigue, others are caused by an easily diagnosed and treated medical condition called sleep apnea.

Four people died and 63 were injured when a train on New York City's Metro North line crashed outside of the city after the train took a turn too fast and slipped off the rails. The cause of the accident was determined to be the engineer suffered from sleep apnea, which was undiagnosed.

Sleep apnea causes the windpipe to constrict during sleep, waking you up temporarily and preventing deep sleep. Elderly people and those who are overweight are at higher risk.

National Transportation Safety Board member Mark Rosekind said sleep apnea is a national problem with drivers and conductors.

"We have accidents in rail, commercial trucking, commercial aviation, marine, pretty much every mode of transportation," Rosekind said.

Some companies are taking steps to combat this problem. Trucking company Prime has its own sleep lab to screen its drivers for sleep apnea. But so far, there are no nationwide rules to require drivers to be tested, which transportation experts say is a major and dangerous issue.

"One of the biggest problems with that is that many of those people don't know they've got it," Rosekind said.

Former school bus driver Diesha Clay, 30, of Charlotte, North Carolina, was one such driver. Clay was caught on camera falling asleep at the wheel of a school bus full of kids. Clay said she doesn't remember falling asleep, but she was immediately terminated 30 days after the video became public. She was never tested for sleep apnea before or after the accident, until "Nightline" brought her to Carolinas Healthcare System in Charlotte, North Carolina for a test.

"If I do have it, I would be a mixed feeling," Clay said before the test. "I will be happy to know cause then I know what to expect and what I need to do. And then also confused with like, if I would've known before, I don't think I would be in this situation."

To be tested for sleep apnea, a registered sleep technologist monitored Clay overnight, and then Dr. Jaspal Singh reviewed the results with her the following morning. Singh told her she stopped breathing roughly seven times an hour, meaning Clay had "mild to moderate" sleep apnea.

She was given a machine called a CPAP (Continuous Positive Airway Pressure) to wear when she sleeps and help regulate her breathing. Since her diagnosis, Clay has contacted a Human Resources lawyer in the hopes that she may be able to challenge her termination, due to the fact that she had undiagnosed sleep apnea. Clay did not initially challenge her termination.

"To think about the people who don't know they have sleep apnea, it's scary because honestly some people do not know," she said. "For example, like me. I did not know. I didn't have a clue. … In my opinion, I feel like there should be wide testing when it comes to transportation."

But the NTSB says their recommendations for national testing of train conductors, school bus drivers, pilots and truckers are not being acted on fast enough.

"When the NTSB investigates we try to make recommendations so that horrible crashes don't happen again, and so we're going to tell agencies, 'you have to address sleep apnea,'" Rosekind said.

The Department of Transportation declined our request for an interview, but in a statement said, "Safety is the top priority at the Department of Transportation and we recognize that sleep apnea can have a direct effect on those responsible for transporting goods and people. DOT is committed to ensuring that all train operators, truck drivers and pilots are fit for the job and receive the treatment they need to combat sleep apnea."

While critics say nationwide rules for sleep apnea testing are needed immediately, others are not convinced sleep apnea is the sole cause of accidents.

Todd Spencer, the executive vice president of the Owner-Operator Independent Drivers Association (OOIDA), said the theory that sleep apnea causes accidents is "junk science."

"We've not see the impact in safety and health [of sleep apnea] that [the NTSB] talks about," Spencer said. "Generally when somebody's saying, 'This is--we're killing people, we're killing people,' they have an economic interest in pursuing this… either they're make money from treatment, they make money from diagnosis, they make money maybe through lawsuits."

But the DOT said one of its agencies, the Federal Motor Carrier Safety Administration, has begun research that could one day lead to sleep apnea regulation under a law President Obama signed last year.

However, Spencer worries about the cost of getting each driver or conductor tested.

"Just the cost of doing that test is over $2,600," he said. "That's a pretty big piece of change, and that's just for doing the test."

And medical testing is not the only solution. There is also a new low-speed, autonomous breaking device, already widely available in high-end cars, that has the technology to brake to avoid a collision and alert drivers as they start to nod off.

Spencer of the OOIDA is skeptical and believes "technology will never stop crashes," but the NTSB says these high-tech solutions, some of which are just beginning to be available as optional extras on trucks in the United States, hold promise.

"We specifically have looked at some things in rail and trucking and have made recommendations to find innovative technologies that could make a difference in alerting a driver to their fatigued state," Rosekind said.

Dr. Michael Caldwell of the ABC News Medical Unit contributed to this report

Sen. Charles Schumer Targets Sleep-Deprived Truckers After Tracy Morgan Crash

Notes from Dr. Norman Blumenstock

We need safer highways.

ALBANY, N.Y. (CBSNewYork/AP) — In the wake of an accident on the New Jersey Turnpike that injured actor and comedian Tracy Morgan, Sen. Charles Schumer is launching a plan to keep tired truck drivers off the road.

On Sunday, the New York Democrat called on the U.S. Department of Transportation to speed up a requirement that companies and drivers use electronic logging devices to accurately log hours driven. He says most truck drivers currently log their hours manually.

“Each year, thousands of people are hurt and even killed in truck crashes due to overworked and fatigued drivers,” Schumer told reporters, WCBS 880′s Jim Smith reported.

The handwritten logs are easily falsified, Schumer said.

“With a black box in the cab of the truck, we’ll know if the truck driver drove more than 11 hours a day, if he or she took a half-hour off — as they’re supposed to in that 11 hours — and if they drove more than 70 hours a week,” Schumer said, 1010 WINS’ Carol D’Auria reported.

There is a federal law requiring the electronic devices, but Schumer said the implementation is several years behind schedule, D’Auria reported. He wants the black boxes required in the next two months.

Schumer is also asking for the DOT to issue a study and increase insurance coverage by trucking companies in the case of a massive accident.

Schumer’s request comes on the heels of a crash involving a tractor-trailer and a limo bus in which Morgan was riding. Morgan, the former star of “Saturday Night Live” and “30 Rock,” and two others were critically injured, and comedian James “Uncle Jimmy Mack” McNair was killed in the accident on June 7.

Kevin Roper, 35, of Jonesboro, Georgia, was driving a Walmart truck early Saturday in Cranbury Township when authorities said he apparently failed to slow for traffic ahead and then swerved to avoid a crash. Instead, authorities said his big rig smashed into the back of Morgan’s chauffeured limo bus, causing it to overturn.

According to the criminal complaint, Roper operated the truck “without having slept for a period in excess of 24 hours, resulting in a motor vehicle accident.” It doesn’t specify the basis for that assertion.

Roper has pleaded not guilty to death by auto and four counts of assault by auto.

Morgan, 45, suffered a broken femur, a broken nose and several broken ribs. He underwent surgery for his broken leg and is in critical-but-stable condition. Morgan is expected to remain hospitalized for weeks.

FAA CONTROLLERS WORKING EXHAUSTING SCHEDULES

Notes from Dr. Norman Blumenstock
Are fatigued air traffic controllers putting air travelers at risk? What are your thoughts?

BY JOAN LOWY 
ASSOCIATED PRESS

WASHINGTON (AP) -- Air traffic controllers are at greater risk for fatigue, errors and accidents because they work schedules known as "rattlers" that make it likely they'll get little or no sleep before overnight shifts, according to a government-sponsored report.

Three years after a series of incidents in which controllers were found to be sleeping on the job, a National Research Council report released Friday expressed astonishment that the Federal Aviation Administration still permits controllers to work schedules that cram five work shifts into four 24-hour periods.

The schedules are popular with controllers because at the end of last shift they have 80 hours off before returning to work the next week. But controllers also call the shifts "rattlers" because they "turn around and bite back."

The report also expressed concern about the effectiveness of the FAA's program to prevent its 15,000 controllers from suffering fatigue on the job, a program that has been hit with budget cuts. And the 12-member committee of academic and industry experts who wrote the report at the behest of Congress said FAA officials refused to allow them to review results of prior research the agency conducted with NASA examining how late night work schedules affect controller performance.

The FAA-NASA research results "have remained in a `for official use only' format" since 2009 and have not been released to the public, the report said.

An example of the kind of schedule that alarmed the report's authors begins with two consecutive day shifts ending at 10 p.m. followed by two consecutive morning shifts beginning at 7 a.m. The controller gets off work at 3 p.m. after the second morning shift and returns to work at about 11 p.m. the same day for an overnight shift - the fifth and last shift of the workweek.

When factoring in commute times and the difficulty people have sleeping during the day when the human body's circadian rhythms are "promoting wakefulness," controllers are "unlikely to log a substantial amount of sleep, if any, before the final midnight shift," the report said.

"From a fatigue and safety perspective, this scheduling is questionable and the committee was astonished to find that it is still allowed under current regulations," the report said. The combination of "acute sleep loss" while working overnight hours when circadian rhythms are at their lowest ebb and people most crave sleep "increases the risk for fatigue and for associated errors and accidents," the report said.

Responding to the report, the FAA said in a statement Friday that it is "adding limitations to its shift and scheduling rules." The statement didn't detail the limitations and FAA officials didn't immediately respond to a request for clarification.

The National Air Traffic Controllers Association defended the scheduling, citing the 2009 study that hasn't been publicly released. The union said in a statement that NASA's research showed that "with proper rest periods," the rattler "actually produced less periods of fatigue risk to the overall schedule."

In 2011, FAA officials and then-Transportation Secretary Ray LaHood promised reforms after a nearly a dozen incidents in which air traffic controllers were discovered sleeping on the job or didn't respond to calls from pilots trying to land planes late at night. In one episode, two airliners landed at Washington's Reagan National Airport without the aid of a controller because the lone controller on the overnight shift had fallen asleep.

Studies show most night shift workers, not just controllers, face difficulties staying awake no matter how much sleep they've had. That's especially true if they aren't active or don't have work that keeps them mentally engaged. Controllers on night shifts often work in darkened rooms with frequent periods of little or no air traffic to occupy their attention - conditions scientists say are conducive to falling asleep.

"We all know what happens with fatigue," said Mathias Basner, an assistant professor at the University of Pennsylvania medical school and the sleep expert on the committee. "The first thing you expect to see is attention going down, reaction time slows, you have behavioral lapses or micro-sleeps. ... If you have to react quickly in that situation, that is problematic."

After the 2011 sleeping incidents, the FAA stopped scheduling controllers to work alone on overnight shifts at 27 airports and air traffic facilities and increased the minimum time between work shifts to nine hours. But the agency revised its scheduling policy in April to permit single-controller overnight shifts in some circumstances.

The FAA has a "fatigue risk management program" for controllers aimed at detecting practices that increase tiredness, but budget cuts "have eliminated the program's capability to monitor fatigue concerns proactively and to investigate whether initiatives to reduce fatigue risks are providing the intended benefits," the report said.

Basner said the FAA was making no effort to determine whether there is a correlation between work schedules and controllers errors. For example, there were near collisions between airliners near Honolulu and Houston recently. Such incidents are often the result of controller errors.

The FAA and the controllers union have established a program that encourages controllers to report errors by promising they won't be penalized for honest mistakes. The reports are entered into a database that the agency is supposed to use to spot trends or problem areas. But controllers are sometimes too busy to file reports, and the report forms don't seek information on the controller's schedule or other details that might be used to determine whether schedules are contributing to errors, Basner said.

Driver Charged in Crash Involving Tracy Morgan Had Not Slept in 24 Hours, Prosecutors Say

By J. DAVID GOODMANJUNE 9, 2014

The Walmart driver whose truck collided with a van carrying the comedian Tracy Morgan and other performers had not slept for more than 24 hours before the crash, New Jersey prosecutors said on Monday.

Prosecutors in Middlesex County charged the truck driver, Kevin Roper, 35, of Jonesboro, Ga., on Saturday with one count of death by auto and several counts of assault by auto in connection with the pileup early that day on the northbound New Jersey Turnpike in Cranbury Township, about 45 miles from New York City. One comedian, James McNair, known as Jimmy Mack, was killed, and Mr. Morgan was critically injured.

In a criminal complaint released on Monday, prosecutors said that at the time of the crash, Mr. Roper had been operating the tractor-trailer “without having slept for a period in excess of 24 hours resulting in a motor vehicle accident.” In a statement issued on Monday, a Walmart spokeswoman, Brooke Buchanan, emphasized that the company believed Mr. Roper “was operating within the federal hours of service regulations,” which limit work shifts to 14 hours, with only 11 of those behind the wheel. She said the company was cooperating with the investigation.


Tracy Morgan, 45, a former cast member of “Saturday Night Live” and “30 Rock,” sustained serious injuries, including a broken leg, a broken femur, a broken nose and several broken ribs, his publicist said Sunday.   Credit Slaven Vlasic/Getty Images


Under New Jersey law, a driver can be convicted of vehicular homicide if it is shown that he had been without sleep for at least 24 hours when the accident occurred.
A preliminary police investigation found that Mr. Roper had failed to perceive slow-moving traffic ahead of him, and, at the last minute, swerved in an attempt to avoid a collision. The complaint did not explain how the New Jersey State Police determined that Mr. Roper had been sleep deprived.

The crash occurred as Mr. Morgan, 45, a former cast member of “Saturday Night Live” and “30 Rock,” was traveling to New York City from a comedy show in Delaware. Around 1 a.m., a Walmart tractor-trailer collided with the back of the van, a 2012 Mercedes-Benz Sprinter, setting off a chain reaction that involved four other vehicles.

Mr. Morgan sustained injuries including a broken leg, a broken nose and several broken ribs. After the crash, he and his assistant, Jeff Millea, 36, were airlifted to Robert Wood Johnson University Hospital in New Brunswick, N.J. Another comedian, Ardie Fuqua, 43, was also injured.

By Monday, Mr. Morgan was responsive but remained in critical but stable condition. “This recovery will be arduous,” his publicist, Lewis Kay, said in a statement.


The truck driver, Kevin Roper, 35, was charged with one count of death by auto and several counts of assault by auto in connection with the accident on Saturday.CreditNew Jersey State Police, via Associated Press Photo


The National Transportation Safety Board said Monday that it had sent a team of investigators to New Jersey to focus on the larger issue of the safety of commercial truck operators. The board noted that the number of fatal large truck crashes has steadily risen.In 2012, there were about 333,000 large truck crashes, which resulted in 3,921 deaths and more than 104,000 injuries. Of those killed, about 73 percent were occupants of vehicles other than the large truck.

“The upward trend in crashes, fatalities and injuries involving large trucks is a cause for concern,” said the statement, prepared by Don Karol, director of the board’s Office of Highway Safety.

“Too often, responses to our recommendations have been slow or, in some cases, nonexistent,” the statement said. “It should not take additional crashes and loss of life to inspire change.”

Mr. Roper’s next appearance in Middlesex County Superior Court in New Jersey is scheduled Wednesday. He was released Saturday after posting $50,000 bail.

Walmart Driver Kevin Roper Pleads Not Guilty in Tracy Morgan Crash

A Walmart truck driver pleaded not guilty on Wednesday to charges of vehicular homicide and assault in connection with the New Jersey highway crash that left comedian Tracy Morgan in critical condition.

Kevin Roper, 35, did not speak during the arraignment in Middlesex County before he was released on $50,000 bail he posted after his arrest.

In a criminal complaint, Roper was accused of operating his big rig "recklessly" after not sleeping for more than 24 hours, causing the early Friday pileup on the New Jersey Turnpike.

His truck slammed into a limo bus carrying Morgan and his entourage, police said. Morgan's mentor. James McNair, was killed. Three others, including the "30 Rock" star, were critically hurt.

A Walmart spokesman has said the company believes Roper "was operating within the federal hours of service regulations."

Federal regulations limit truckers to 11 hours of driving during a 14-hour work day, with no more than 70 hours a week on the road without extra breaks. Drivers who are too sleepy to drive safely must pull over.

— Tracy Connor
First published June 11th 2014, 1:51 pm

Metro-North to Require Sleep Apnea Evaluation.

Notes from Dr. Norman Blumenstock

Train engineers need to be test now on the Metro North trains.

http://abclocal.go.com/wabc/story?section=news/local/northern_suburbs&id=9512820#

Eyewitness News

NEW YORK (WABC) -- A new Metro-North directive would require the 350 engineers who work for the railway to be evaluated in the coming months for sleep apnea.

Earlier this month, the National Transportation Safety Board revealed that the engineer, William Rockefeller suffered from a severe form of sleep apnea in a derailment late last year. The incident left four people dead and dozens injured.

Mike Doyle, general chairman of the Officials with the Association of Commuter Rail Employees union, told Eyewitness News in a statement that, "recognizing that an undiagnosed sleep disorder likely was a major contributing factor to the tragic accident ... our organization is working with Metro-North to establish a program to help identify engineers who may suffer from the same medical condition."

MTA chief spokesman Adam Lisberg said there are still a lot of questions about the screening and that it will be extended to all safety-sensitive personnel. "We haven't agreed on what to do in the program," he said. "We're working on plans for addressing sleep apnea for critical safety personnel, but have no final plans yet for what we'll do."

Dr. Steven Feinsilver, of Mount Sinai, is an expert on sleep disorders. He applauded the move, but warned that screening for sleep apnea is easier said than done.

Feinsilver said the best testing is an overnight sleep study which can be a "relatively complicated thing to do."

"It's a serious public health problem. It's a common disease," he said.

Train engineer suffered from severe sleep apnea

Notes from Dr. Norman Blumenstock:

An investigation shows the train engineer who was at the controls of a fatal commuter train crash in New York in December suffered from "severe" sleep apnea.

Updated: Tuesday, April 8 2014, 08:17 AM EDT

http://www.wwmt.com/shared/news/features/national/stories/wwmt_-train-engineer-suffered-severe-sleep-apnea-7403.shtml#.U0a5nq1dVuC

NEW YORK (NEWSCHANNEL 3) - An investigation shows the engineer who was at the controls of a fatal commuter train crash in New York in December suffered from "severe" sleep apnea.

A report from the National Transportation Safety Board says William Rockefeller didn't know he suffered from the condition.

The report also says he took an antihistamine the day of the crash because of a respiratory infection.

The train was speeding when it hit a curve and jumped the tracks, killing four people.

An official cause of the crash has yet to be determined.

New Trucking Study Says Two Nights Sleep Safer than One

Notes from Dr. Norman Blumenstock
The U.S. Department of Transportation’s Federal Motor Carrier Safety Administration (FMCSA) released findings from what government officials are calling a “real world, third-party study” that shows two nights rest is better than one.

The U.S. Department of Transportation’s Federal Motor Carrier Safety Administration (FMCSA) released findings from what government officials are calling a “real world, third-party study” that shows two nights rest is better than one.

The FMCSA news release says the latest study provides further scientific evidence that the restart provision in the current hours-of-service rule for truck drivers is more effective at combatting fatigue than the prior version.

“Safety is our top priority, and this new study shows more data-driven evidence that our safety standards help truckers stay well-rested, alert and focused on the road,” said U.S. Transportation Secretary Anthony Foxx. “The hours-of-service rule is helping to reduce truck driver fatigue and making every traveler on our highways and roads safer.”

Scientists measured sleep, reaction time, sleepiness and driving performance in the study. They found that drivers who began their work week with just one nighttime period of rest, as compared to the two nights in the updated 34-hour restart break:

• exhibited more lapses of attention, especially at night;

• reported greater sleepiness, especially toward the end of their duty periods; and

• showed increased lane deviation in the morning, afternoon and at night.

“This new study confirms the science we used to make the hours-of-service rule more effective at preventing crashes that involve sleepy or drowsy truck drivers,” said Federal Motor Carrier Administrator Anne S. Ferro. “For the small percentage of truckers that average up to 70 hours of work a week, two nights of rest is better for their safety and the safety of everyone on the road.”

The study “Field Study on the Efficacy of the New Restart Provision for Hours of Service“ was conducted by the Washington State University, Spokane – Sleep and Performance Research Center and Philadelphia-based Pulsar Informatics, Inc. FMCSA officials claim it is one of the largest real-world studies ever conducted with commercial motor vehicle drivers, and included 106 participants, 1,260 days of data and nearly 415,000 miles of driving that were recorded by the truck-based data acquisition systems.

According to FMCSA, working long hours on a continuing basis is associated with chronic fatigue, a high risk of crashes, and a number of serious chronic health conditions in drivers. The updated 34-hour restart, includes two nighttime periods from 1 to 5 a.m., and is intended to provide sufficient time for a driver to recuperate from cumulative fatigue if they work beyond the weekly maximum on-duty limits.

Source: FMSCA

FAA Rejects “Rulemaking” Process, Will Implement Strict OSA Screening

From Dr. Norman Blumenstock:

Hopefully this will make the skies safer for air travel.

The Aircraft Owners and Pilots Association (AOPA) is reporting that the FAA will move forward with implementing mandatory screening and testing for obstructive sleep apnea, despite opposition from the pilot and aviation medical communities.

During a webinar last week, the Federal Flight Surgeon said the FAA would require aviation medical examiners to calculate body mass index (BMI) for all pilots. Those with a BMI of 40 or greater would have to be screened and, if necessary, treated for obstructive sleep apnea (OSA).

“The AME may issue a medical certificate at the time of the examination; however, the FAA will follow up with a request for additional evaluations, including a sleep study and evaluation by a board-certified sleep specialist,” wrote Elizabeth A. Tennyson of the AOPA. “Pilots who don’t undertake the evaluation within 60 days would face receiving a letter of disqualification. Over time, the FAA would lower the BMI requirement, compelling more pilots to be screened by a sleep specialist. The FAA currently lists 5,000 pilots with a BMI of 40 or greater and more than 120,000 who qualify as obese with a BMI of 30 or higher.”

Much like the trucking industry, AOPA and others have objected to the new testing requirements, saying they force AMEs to venture into predictive medicine, “rather than focusing on their mandate of determining the likelihood that a pilot will be medically incapacitated at some point in the duration of the medical certificate.”

The AOPA has argued that such a significant change should go through the more stringent “rulemaking process” to allow public input and the opportunity to explore less intrusive and less costly methods for addressing concerns about sleep disorders. Instead of “rulemaking,” the FAA is using its regulatory powers to implement the new guidelines.

Source: AOPA

Originally Posted At:  http://www.sleepdt.com/faa-rejects-rulemaking-process-will-implement-strict-osa-screening/

FAA to Ground Obese Pilots Until Examined for OSA, Pilots Fight for Rulemaking

Notes from Dr. Norman Blumenstock:

This may result in improved public safety in the air. Pilots fear that they can lose their livelihood if they can't tolerated CPAP.  Oral appliances may be the best solution for those pilots that have mild or moderate obstructive sleep apnea.

Published on Tuesday, 26 November 2013 10:09

By Sree Roy

Pilots with a body mass index greater than 40 and a neck circumference of 17 inches or more will soon have to be tested for obstructive sleep apnea (OSA) before being allowed to fly, according to a bulletin issued by Federal Air Surgeon Fred Tilton, MD. "Untreated OSA is a disqualifying condition for airmen and air traffic control specialists (ATCSs), and it is a concern for the other modes of the Department of Transportation," Tildon says in the bulletin. "Dr Nick Lomangino has been working on this policy for quite a while, and I think he has developed an outstanding product....The next step will be to require AMEs [Aviation Medical Examiners] to calculate the BMI for every examinee (both airman and ATCS [Air Traffic Controller]) by using a formula that is located in the examination techniques section of the AME Guide....Airman applicants with a BMI of 40 or more will have to be evaluated by a physician who is a board certified sleep specialist, and anyone who is diagnosed with OSA will have to be treated before they can be medically certificated."

Once the FAA has handled examinees with BMIs over 40, it plans to expand the testing pool to those with lower BMIs "until we have identified and assured treatment for every airman with OSA," the bulletin says.

The Aircraft Owners and Pilots Association (AOPA) quickly denounced this decision via a letter to the FAA administrator and is garnering some support in Congress, as, on November 21, a group of House General Aviation Caucus members introduced legislation to require the FAA to go through the rulemaking process before implementing policy changes related to sleep disorders. “We believe this policy inappropriately bypasses the rulemaking process; overlooks potentially more effective and efficient solutions; provides no clear safety benefit; and imposes unjustified costs on the user community,” AOPA President Mark Baker wrote.

Baker's letter asserts there are "more affordable and less intrusive options" for addressing sleep disorders, including a provision in the AOPA/EAA Third-Class Medical Petition that would require pilots to participate in a recurring educational course that would teach them how to better self-assess their medical fitness to fly. The letter also warns that sleep apnea testing for the 124,973 airmen identified as obese by the FAA in 2011 could cost as much as $374 million. Affected pilots would also have to apply for a special issuance medical certificate at a time when the FAA already has a backlog of 55,000 cases.

The issue is reminiscent of the argument for and against mandated OSA testing in the trucking industry. In that situation, Congress passed a bill requiring the formal rule-making process be followed and forbids the issuing of any informal guidance on this subject.

Pilots Push Back on FAA Apnea Screening Policy

Notes from Dr. Norman Blumenstock:

Should airline pilots get screened for obstructive sleep apnea?

November 20, 2013 by agpubs

The Aircraft Owners and Pilots Association (AOPA) is asking the Federal Aviation Administration to indefinitely suspend a new policy that would require some pilots to be screened and, if necessary, treated for obstructive sleep apnea before receiving a medical certificate.

An article posted on the AOPA Web site reports that at first, the screening would apply to pilots with a body mass index (BMI) over 40. Over time, the FAA would lower theBMI requirement, compelling more pilots to be screened by a board-certified sleep specialist. The policy is the result of NTSB recommendations, but AOPA argues that there is no evidence to support the need for such screenings among general aviation pilots.

A look at the comment section following the article shows widespread support for suspending the policy. “[The FAA] admits to no data on the effects of sleep apnea on pilot performance, and they target the entire pilot database anyway,” writes one commenter. “These are not decisions based on aviation safety. They are a nanny style directive.”

“This policy seems to be based on one incident involving an airline flight,” said Rob Hackman, AOPA vice president of Regulatory Affairs. “In that case, the crew fell asleep and missed their destination but woke up and landed safely. Analysis of a decade of fatal general aviation accidents by the General Aviation Joint Steering Committee didn’t identify obstructive sleep apnea as a contributing or causal factor in any of the accidents studied.”

AOPA is composing a formal letter to FAA Federal Flight Surgeon Dr. Fred Tilton asking him not to implement the new policy and noting that there was no public comment period before the policy was announced. The new requirements could potentially affect thousands of pilots, adding to what AOPA calls the already significant backlog for processing special issuance medicals.

In 2011, the FAA identified 124,973 airmen who are considered obese, making them potential candidates for screening. According to reporter Elizabeth Tennyson, the new policy grew out of a 2009 NTSB recommendation that the FAA change the airman medical application to include questions about any previous diagnosis of obstructive sleep apnea as well as the presence of risk factors for the disorder.

The recommendation also asked the FAA to implement a program to require pilots at high risk for obstructive sleep apnea to be evaluated and, if needed, treated before being granted medical certification.

Source: AOPA

Spotlight on Sleep Apnea

The Federal Motor Carrier Safety Administration recognizes untreated sleep apnea as a risk to the public health:

Staying awake means staying alive. Sleep apnea is a major contributor to daytime drowsiness—a condition that could prove deadly for commercial truck drivers and everyone sharing the road with them. It is a condition where, during sleep, a narrowing or closure of the upper airway causes repeated sleep disturbances leading to poor sleep quality and excessive daytime sleepiness. Since excessive sleepiness can impact a driver’s ability to safely operate the commercial vehicle, it is important that drivers with sleep apnea are aware of the warning signs.

Drivers   Snoring - No Laughing Matter [PDF] When Snoring is More Than a Nuisance [PDF] High Blood Pressure & Heart Disease [PDF] Talking with Your Doctor [PDF] How's Your Sleep? [PDF]

Industry   Sleep Apnea & Commercial Drivers [PDF] Recognize the Dangers of Sleep Apnea Prevalence of Sleep Apnea Among Commercial Truck Drivers

Tools & Resources   Drowsy Driving Quiz [PDF] Sleep Apnea Fact Sheet [PDF] Sleep Diary Driving When You Have Sleep Apnea [PDF] Poster: Dangers of Sleep Apnea

DISCLAIMER

The materials contained on this page were developed under a contract with the National Sleep Foundation (NSF) and are being disseminated by the Federal Motor Carrier Safety Administration (FMCSA) in the interest of information exchange. The FMCSA assumes no liability of the contents or use thereof.

The materials contained on this page do not establish FMCSA policies or regulations, nor do they imply an endorsement or partiality by FMCSA of any product, the NSF, or the conclusions and/or recommendations contained in the materials. Trademarks or manufacturers’ names may appear herein only because they are considered essential to the object of the materials.

Originally Posted at:  http://www.fmcsa.dot.gov/safety-security/sleep-apnea/sleep-apnea.aspx

Sleep Related Trucking Legislation Takes Fast Track to Obama’s Desk

Bucking the trend toward legislative gridlock, new legislation to limit sleep apnea “guidance” has passed the House and Senate, and is now headed to the President’s desk. The bill was approved in the House by a vote of 405-0 in late September, and the Senate (also unanimously) passed it in October.

“The best part,” writes Charlie Morasch, of LandLineMag, a trucking industry publication, is that “Truckers are being hailed for their efforts to support the proposed law.”

Introduced in mid-September by Reps Larry Bucshon (R-Ind) and Dan Lipinski (D-Ill), HR3095 required the Federal Motor Carrier Safety Administration to go through its regulatory process and institute formal “rulemaking” instead of simply issuing “guidance” to physicians, drivers, and motor carriers.

As reported, the proposed Senate bill was co-sponsored by Sens Roy Blunt (R-Mo), and Mark Warner (D-Va). It aimed to “ensure that any new or revised requirement providing for the screening, testing or treatment of individuals operating commercial vehicles for sleep disorders is adopted through a rulemaking proceeding.”

“Both pieces of legislation were seen as a response to rumblings that FMCSA was preparing guidance that would urge physicians to require truckers with a Body Mass Index of 35 or greater to undergo overnight sleep exams,” writes Morasch. “Guidance – although it would carry the weight of FMCSA’s name – wouldn’t have required a public comment period or other measures common to the regulatory approval process.”

Source: Owner Operator Independent Drivers Association (OOIDA)

Pilots snoozed at 30,000 feet in cockpit of 300-passenger plane

By Thom Patterson, CNN

updated 6:47 PM EDT, Thu September 26, 2013

UK probes whether pilots slept at same time

(CNN) -- Cruising at 30,000 feet, pilots snoozed in the cockpit of a 300-passenger airliner en route to Britain last August, UK aviation authorities told CNN on Thursday.

A spokesman for the UK's Civil Aviation Authority tells CNN that the Airbus A330 incident occurred while the aircraft was operating on autopilot on a long-distance flight. The CAA wouldn't reveal any other details of the flight, its route or its destination airport.

Sources told CNN's Richard Quest the airline is Virgin Atlantic. The airline in a statement said, "Virgin Atlantic can confirm no safety reports have been received about pilots falling asleep simultaneously whilst in control of an aircraft."

British pilots are allowed to sleep while in the cockpit under certain circumstances.

The August 13 incident appears to be the result of bad scheduling by the airline, said the CAA spokesman Richard Taylor. The pilots reported having only five hours of sleep over two nights "due to longer duty period with insufficient opportunity to sleep," the CAA report states. "Both crew rested for 20 minute rotations and fell asleep."

The aircraft apparently arrived at its destination safely. It's the first British incident of its kind in two years, said Taylor. He said it's unlikely the pilots will be disciplined.

"You can't have five hours of sleep in two days," says veteran airline pilot and aviation consultant Mark Weiss. "That doesn't work."

Fatigue ranks among the most sensitive issues in the pilot community. Rules surrounding sleep and relief crews vary from country to country.

Jim McAusian, general secretary of the British Pilots Association, used the incident to blast the CAA's record on pilot fatigue in a statement Thursday, accusing it of being "far too complacent about the levels of tiredness among British pilots and failing to acknowledge the scale of the underreported problem."

Next week, the European Parliament is expected to vote on new EU rules regulating pilot flying hours. McAusian said the proposed rules will increase "tiredness among pilots and the risk of dangerous incidents."

In the U.S., flights longer than eight hours require a relief pilot on board to take over so pilots can take a break to sleep. If the flight is scheduled to last more than 12 hours, an additional relief pilot must be added.

Should cockpit sleeping be allowed?

Believe it or not, some experts say pilots sleeping at the controls isn't always dangerous.

Aviation rules in some nations allow pilots to nap in the cockpit during ultra-long-haul flights -- across oceans, for instance. Rules vary, but generally, the sleeping pilot must be supervised by another pilot during the naps. There are also backup alarm systems in place to awaken pilots if an emergency arises.

The CAA refused to tell CNN whether it has evidence that both pilots were asleep simultaneously. The report is ambiguous, the agency says. If both pilots at the controls had fallen asleep simultaneously, Virgin Atlantic would be required to file a report with the CAA. The airline told CNN that it has no record of both pilots falling asleep at the same time.

It's possible the pilots were resting one at a time under an authorized cockpit napping program.

Among U.S. pilots, cockpit napping violates FAA rules. But some experts, including Weiss, favor the idea. "This is a personal belief," he said, "but I would rather have somebody take a nap during a cruise part of a flight so that pilot would be at peak performance during a high-traffic situation or a landing."

Unauthorized cockpit napping among U.S. pilots isn't "that prevalent," Weiss says, "but that's not to say it doesn't happen."

Curt Graeber, who was with Boeing for 19 years, headed a NASA/FAA study that recommended the FAA allow cockpit napping. But the FAA has never adopted the idea.

"I think it's political," he told CNN. "I guess it's difficult to tell the public that the captain is asleep on the flight deck."

"Everyone I talk to who uses it says it's a stopgap measure to improve safety and reduce the risk of sleep loss."

Studies have shown, Weiss says, that taking a 20-minute nap will allow pilots to regain energy. "It's not a bad idea to allow pilots to take short naps," he said.

Instead of allowing in-flight napping aboard U.S. airlines, the FAA has mandated that long-haul routes include relief pilots and special onboard sleeping quarters that must be available for the flight crew.

Other sleeping incidents

Of course the UK sleeping incident revealed Thursday isn't the first of its kind. Last February, the Dutch airline Transavia said it had launched an investigation after a Boeing 737 pilot was locked out of the cockpit and his first officer was later found asleep at the controls. The sleeping pilot had been left alone at the controls while his co-pilot took a bathroom break.

The incident took place in September 2012, when the airliner was flying from Greece to the Netherlands, a top Dutch safety investigation agency said. The 737 landed safely in Amsterdam as scheduled.