Dean Garvelink was shocked when he learned he’d stopped breathing 17 times during just a
Truck driver Dean Garvelink worried sleep apnea might put him at undue risk while driving but his employer, Schneider National Inc., had his back.Photo: Schneider National Inc.
single night’s sleep. The over-the-road truck driver from Myrtle Beach, S.C., wondered why he was tired during the day.
Sleep apnea is a medical condition that occurs when breathing stops for a moment or two during the night. Dr. Geoff Fernie, a senior research scientist with the Toronto Rehabilitation Institute, says someone whose breathing pauses for more than 10 seconds can be diagnosed as having an apneic event.
Obstructive version most prevalent
Roughly 90 percent of sleep apnea cases are classified as obstructive sleep apnea, where a person’s tongue falls to the back of the throat, blocking the passage of air.
“If you do this more than about 10 times an hour it’s quite probable you have sleep apnea,” Fernie said.
While obstructive sleep apnea is the major concern with truck drivers, Fernie points out another variation — central sleep apnea — occurs in the remaining 10 percent of cases when the brain and nervous system fail to instruct the person to breath.
With obstructive sleep apnea, the person often awakens and, like Garvelink, doesn’t immediately correlate this with drowsiness the following day. One concern is that when the air flow is interrupted even briefly the heart increases its output in order to continue delivering oxygen to the brain. This increases blood pressure, which strains the heart and blood vessels, possibly eventually inducing a heart attack, stroke or hypertension.
Garvelink says his father and grandfather both died of congestive heart failure, so cardiovascular issues were top-of-mind when he was diagnosed. But he also considered the responsibility that comes with his job. Whether driving long-haul across the country or covering a local or regional base for repair work, truck drivers put in long hours. It’s not uncommon for even the healthiest to nod off even if for just the blink of an eye.
While Garvelink worried sleep apnea might put him at undue risk while driving, his employer, Schneider National Inc., had his back. The Green Bay, Wisc.-based provider of transportation and logistics services reassured him it wants its drivers to be safe and stands behind drivers who use Continuous Positive Airway Pressure (CPAP) devices, which have helped many people with sleep apnea get a good night’s rest.
Company screens drivers
With Schneider’s support, Garvelink met with a clinician who diagnosed obstructive sleep apnea and explained how a CPAP device works: The patient wears a nasal mask when sleeping, and an air pump supplies a continuous flow of air into the nasal passages.
Garvelink found the device cumbersome for the first week but quickly got used to it. “Now, eight months later, I don't even realize that it’s on at night,” he said.
Garvelink also embraced a healthy lifestyle to reduce his cardiovascular risks. “I used to work out and run every day, but family responsibilities and life came first and my health was put on the back burner,” he said. “Over the years, I gained weight. I am hoping that by returning to exercise — and as I lose weight — that my sleeping will improve.”
Refreshed and energetic, Garvelink says his employer’s support and the CPAP device “changed my life for the better.” But he’s not alone. Schneider implemented its sleep apnea program in 2006, recognizing commercial drivers sometimes exhibit risk factors and even miss work for reasons associated with sleep apnea.
Tom DiSalvi, Schneider’s vice-president of safety and loss prevention, says the company had several hundred of its drivers screened as part of a pilot project. “We then followed these drivers and monitored things like accident rates, medical costs and retention compared to a control group and saw positive improvements in all areas,” DiSalvi said.
Following the pilot, Schneider launched a full-fleet program where, upon completion of initial training, every new company driver takes a proprietary survey designed and executed by a third-party vendor to determine if they might be at risk of obstructive sleep apnea. If so, a sleep study is then conducted.
In a 2016, study, researchers at the University of Minnesota at Morris documented the accident reduction Schneider saw as a result of its program: www.ncbi.nlm.nih.gov/pmc/articles/PMC4835318.
Sleep deprivation deadly
Schneider doesn’t require drivers within its service truck group to complete the survey but will conduct it for any service truck operator acknowledging fatigue or wanting to participate. “Any associate, driver, service truck operator, office or shop associate on our company medical plan will have zero out-of-pocket costs related to the testing and treatment of obstructive sleep apnea, since our OSA program is considered preventative,” DiSalvi said.
Sleep deprivation, whether attributed to a medical condition or long work hours, is a major
Nasal mask helps sleep apnea patients get a good night's sleep
concern throughout the industry. Attendees at Truck World in Toronto in April 2018 heard about a transport trailer driver on the return leg of a trip from Ontario to southern Ohio who fell asleep at the wheel, crossed the median and struck an oncoming car, killing its lone occupant.
“The driver of that transport truck was up 36 hours straight,” Const. Pat Martin of Halton Regional Police Service Martin told show attendees. “We determined he’d been all the way down to Ohio and had come all the way back up. It took a couple of years to convict him of criminal negligence, and he received seven years in custody.”
Completing such a lengthy trip in one go may have led to that particular mishap, but Geoff Fernie is part of a team in Canada looking at how sleep apnea affects long-haul drivers.
“More than one in 10 people have sleep apnea but only about 15 percent of the people who have it have actually been diagnosed.”— Dr. Geoff Fernie, senior research scientist, Toronto Rehabilitation Institute
“More than one in 10 people have sleep apnea but only about 15 percent of the people who have it have actually been diagnosed,” said Fernie, who specializes in illness and accident prevention. He points out that sleep apnea increases the odds of any motorist having a vehicle accident by roughly two or three times, and up to five times for truck drivers.
Study seeks participants
The study Fernie is working on is based out of the University Health Network, affiliated with the University of Toronto Faculty of Medicine, and is looking to offer a Canadian counterpart to research already done in the U.S. Study leaders are seeking 1,000 volunteers willing to sleep for one night wearing a small frame that holds a microphone and digital recording equipment that
captures data such as head movements and pauses in breathing.
Volunteers can wear the device wherever they sleep — even in their cab — and mail in a small
computerized card afterwards. Researchers will then let them know if they should get a full, proper diagnosis. Fernie says individual driver results will remain confidential and won’t be shared with employers, insurers or other parties. The point, he explains, is to come up with Canadian data, determine if there are any differences with U.S. data, and better understand causes and effects.
While Garvelink is comfortable with his CPAP device, his renewed commitment to exercise and healthy living stands to be a game-changer.
Fernie, meanwhile, recommends compression socks for anyone who spends a lot of time sitting. But he also advocates lifestyle adjustments. “It’s not good enough to just get up and get into the back of the cabin and lie down,” he said. “You need to walk around. Research has shown that when you sit for long times you get swelling in your feet, ankles and legs. Then, when you lie down at night, that swelling moves up your body — you can see the swelling moving up to the neck. That actually increases sleep apnea.”
Proper diagnosis and treatment are not just about preventing mishaps, Fernie says. “It’s also about helping truck drivers have happier lives,” he said. “It’s a question of enjoying driving a truck rather than fighting it and falling asleep.”
— Saul Chernos
Saul Chernos is a freelance writer based in Toronto.