24 | HEALTH MATTERS
Sleep Apnoea – a Nightmare for Drivers
I
n this month’s column, Dr. Betty Maguire highlights Sleep Apnoea, which is a serious issue for professional drivers.
Sleep Apnoea, or Obstructive Sleep Apnoea is a serious condition in which airflow from the nose and mouth is restricted during sleep, resulting in pauses in breathing which can last 10 seconds or more, and can occur up to 400 times a night. As they don’t sleep properly lying down at night, people who have this suffer from various symptoms such as excessive daytime sleepiness, heavy snoring at night, falling asleep at inappropriate times, impaired concentration, unrefreshed sleep, irritability/personality change, and memory impairment. For professional drivers, these symptoms are potentially deadly. As driving is a skill which incorporates many simultaneous activities by the brain and requires full concentration, it is thought that up to 20% of fatigue related accidents are related to nocturnal sleep deprivation. Of course daytime sleepiness may occur in people without a sleep disorder, i.e. those who take certain medications – some anti-allergic medications, antidepressants, or sleeping pills, but Obstructive Sleep Apnoea has been found to be the most common reason for habitually drowsy driving. These drivers are as dangerous as those with high blood alcohol levels, and cannot be caught at Gardai Checkpoints, so the driver themselves have to be aware of their sleepiness. During investigations, it has been found that drivers who were involved in major incidents had stated that they had been fighting sleep when these incidents happened and had noticed themselves to be sleepy before the incident, but had failed to appreciate that extreme sleepiness is accompanied by a high likelihood of actually nodding off. In these cases there is a ‘micro sleep’ of a few seconds or so where the driver will have driven up to 100 metres or so while sound asleep. Obstructive Sleep Apnoea occurs most often in moderately or severely obese persons who attempt to sleep on their backs – 4% of men and 2% of women are affected. Obstruction of their breathing passages causes a repeating cycle of sleep, snoring heavily, sudden obstructive choking, then awakening with gasping. Daytime drowsiness follows.
This problem is one of the sleep disorders and can be diagnosed fairly quickly and dealt with equally rapidly. If a driver suspects they might have Sleep Apnoea he/she should be assessed as a matter of urgency, preferably by a specialist, as there are immediate measures which can be taken – there is a nasal mask which can be applied immediately and may eliminate the apnoea, and improve daytime alertness. Th is is known as the CPAP or Continuous Positive Airway Pressure. There are surgical treatments, which involve widening the airways, and also nasal surgery. There is the fairly drastic means of surgical weight loss – this has been found to have a most dramatic effect on sleep apnoea. However, some minor behavioural changes such as sleeping on the side rather than the back also helps. As Body Mass Index correlates closely with Obstructive Apnoea (and the professional driver has a tendency to be overweight) a Canadian Insurance company - who had details of driver’s weights - found that there was 2 to 3 times the risk of accidents with sleep apnoea in the overweight driver. It is important to assess the professional driver carefully, as their livelihood is at stake. As there is no good objective test to foretell sleepiness we must rely on the driver’s own report of sleepiness, their spouse’s assessment, any previous accidents due to sleepiness, and an assessment of their own att itude to the problem, including their stated intention to avoid driving while drowsy (as well as a medical examination).
All these factors were found to have improved in the drivers who wore the CPAP. In fact, in professional drivers, who require a higher standard of fitness than those who only drive for short distance, there is evidence that even though there is some sleep apnoea in these drivers, their accident rate is generally low. Bearing that in mind, fear of losing their licenses should not inhibit them from self reported episodes of sleepiness as the problem might then go underground. As obesity is the single most important factor in causing obstruction in the upper airways, weight reduction should immediately be attempted. However, it is acknowledged that substantial weight loss is difficult to achieve, hard to maintain and takes a long time. It is fi nally the driver who has to decide whether or not to drive if he or she is sleepy. Some responsibility also falls on the driver's General Practitioner, and also those who are involved in driver licensing. Greater awareness, rapid diagnosis, and immediate treatment where appropriate would seem to be the answer to this problem.
As part of a study of the mechanism of accidents, a steering simulator was used, and this was found to demonstrate impaired steering ability with increased wandering around the road and delayed responses to distracting events. This was found in persons with sleep apnoea, and was a result of a combination of increased sleepiness and poor hand/eye co-ordination.
Need a quote? 01 6714288
MIKE MURPHY INSURANCE
or Log onto www.mikemurphyinsurance.ie TODAY! Mike Murphy, the only man for your car, home or van. • Employers, Public & Carriers Liability • Single Truck Insurance & Fleet a Speciality! CELEBRATING 40 YEARS IN INSURANCE Mike Murphy Insurance is a trade name of New Sure Life Ltd. and is regulated by the Central Bank of Ireland.
FLEETTRANSPORT | APRIL 14
Text: Dr. Betty Maguire - enquiries@fleet.ie