Sleep apnoea is when a person’s breathing stops and starts while they sleep. It is caused by the airways becoming relaxed and narrow while a person sleeps and the main symptoms include making gasping or choking noises during sleep, loud snoring and feeling very tired during the day.
Many vocational truck and van drivers fear that if they come forward to seek medical help, they could risk losing their driving licence, and therefore their livelihoods. However, it is important to recognise that drivers who suspect they may have the symptoms can come forward and get the treatment they need without losing their licence or becoming a danger on the roads.
Dr Sophie West, a consultant respiratory physician and lead of Newcastle regional sleep service, said: “Drivers should not panic as there are highly effective treatments available. Sleep apnoea is divided into severity levels of mild, moderate or severe, however, for anyone suffering from excessive sleepiness, this may have an adverse effect on driving safely. The best advice for drivers is to talk to a GP first and ask to get help straight away.”
Under normal circumstances vocational drivers are some of the safest on the roads but sleepiness from obstructive sleep apnoea (OSA) can be highly debilitating. DVLA advice is that someone with the problem must not drive, and that a driver should let their employer know too.
In the UK many hospitals have specialist sleep centres that will provide fast track support for vocational drivers including a sleep study assessment. Dr West said: “Sleep centres are geared up for drivers and we are keen for drivers to attend and get the help they need. We want to make the whole process as quick and as painless as possible for drivers.”
A continuous positive airway pressure (CPAP) machine is the most commonly prescribed device for treating sleep apnoea disorders. This keeps a person’s airways open and helps them breathe normally. A CPAP machine’s motor generates a continuous stream of pressurised air that travels through an air filter into a flexible tube. This tube delivers purified air into a mask that is sealed around the nose or mouth as a person sleeps. The airstream from the CPAP machine pushes against any blockages during sleep, opening the airways so the lungs receive plenty of oxygen. Without anything obstructing this flow of oxygen, breathing doesn’t pause and as a result, a person will not constantly wake up in order to resume breathing.
Dr West said: “Putting someone on a CPAP can improve sleep quickly meaning they can be safe to drive again fairly quickly. There is a case study where a bus driver had been experiencing symptoms of OSA, a sleep study was carried out, he was diagnosed and put on a CPAP. He made a recovery within two weeks and fortunately his employer was also understanding of his situation and he returned to his job.”
Causes of sleep apnoea commonly include being middle aged or older, male and having a high body weight. For men, body fat gathers around their neck and tummy which means sleep apnoea is more likely. Dr West said: “Even modest weight loss can be helpful and a few kilos weight loss can make a big difference. There are lots of suitable diets out there such as the 5:2 diet, and it’s worth drivers looking at portion control and decreasing their calories generally. Lifestyle changes can also be important such as increasing sleep time and getting into a good sleep pattern. It’s also worth checking for Type 2 diabetes and this can be investigated with a blood test. However, there is no medication for OSA, although weight loss medication may help in some cases.”
In the case of severe OSA, people can wake up hundreds of times a night without knowing it. For professional truck and van drivers, feeling tired when waking up means potentially falling asleep at the wheel, with possibly catastrophic consequences. Sleepiness is cited as a major contributory factor in up to 20% of motorway traffic accidents and is associated with an increase in the severity of an accident, because driver reactions are impaired.
Dr West said: “More enlightened employers will redeploy drivers who are diagnosed with the condition to alternative suitable employment while the condition is investigated but unfortunately in some companies, drivers have been shown the door in these circumstances. Fleet managers should make themselves aware of the condition if they are not already, and more importantly how to get those who are suffering access to the highly effective treatment they need.”
In a recent survey of 905 truck drivers in Italy, it was discovered that about half suffered from at least one sleep-related breathing problem that could potentially cause them to fall asleep at the wheel. In the USA the figures are estimated to be something like between 25% and 50%.
Dr West said: “The Sleep Apnoea Trust website is also full of very useful information. The key is not to be scared, there is plenty of help out there and the problem can be tackled. Vocational drivers should get the treatment they require so that operators have the time to find them alternative non-driving duties if necessary.”
Another organisation, The OSA Partnership Group, aims to raise awareness of the symptoms of the condition, the availability of treatment to manage these symptoms and the implications of the condition if untreated. As a result, much of its campaigning involves working with driving organisations, transport trade bodies and sleep clinics to make the process of coming forward for treatment as straightforward as possible. It includes representatives from DVLA, SMMT and RAC.
Dr West, who is a chair/medical lead to the group, said: “It is a collaboration of individuals and organisations with an interest in the condition. There are representatives from the commercial vehicle sector, clinicians, patient groups and those interested in health and safety at work. It meets regularly and the good working relationship with the DVLA has helped change guidance for drivers with OSA for the better.”
For more information visit https://sleep-apnoea-trust.org/