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Alexander Hawes, LLP: Truck Accident Lawyers: Truck Crashes Caused by Drivers Asleep at the Wheel: Sleep Apnea a Common Cause
By Richard Alexander (bio)
Truck crashes often are caused by truck drivers who fall asleep at the wheel. Truckers who survive report they "don't know what happened" or "I never saw him." And in many cases they are telling the truth, because they only awoke after the collision was underway and the outcome inevitable.
Many truck crashes are beyond explanation, unless the role of sleep apnea is understood and included in the post-crash reconstruction.
Apnea means "without breath." People with obstructive sleep apnea stop breathing in their sleep and their oxygen level drops, denying necessary oxygen to the heart and brain which precludes life-refreshing sleep. Sleep apnea causes severe fatigue during waking hours, dulls alertness, and falling asleep during the day, even while driving or sitting at a traffic light.
Anyone who drives, knowing that they suffer from sleep apnea, is acting recklessly and in conscious disregard for the safety of others. Any trucking company that employs drivers without screening them for sleep apnea is equally reckless. Both should be liable for punitive damages for their contempt for public safety, in addition to being responsible for the deaths, injuries and destruction caused by their misconduct.
Nearly twenty million middle-age men, many overweight, are estimated to have obstructive sleep apnea. Although airline pilots are screened for sleep apnea, the trucking industry does not do the same for truck drivers and like the general population, many with obstructive sleep apnea are undiagnosed and untreated until it is too late.
For decades, trucking companies and the trucking industry have lobbied for rules that only allow drivers 8 hours off in every 24 hours, so that many drive long hours to meet schedules. Eight hours is insufficient time off for health and hygiene.
For a driver to maintain top alertness, at least 8 hours of quality sleep is required, providing that sleep is free of disruption caused by sleep disorders. At a minimum drivers should be required to be off 10 hours in every 24 to assure at least 8 hours of quality sleep and 2 hours for meals, hygiene and the decompression time necessary before sleep.
Full health screening and driver education on obstructive sleep apnea are over due. Trucking companies could easily screen drivers for sleep apnea and all commercial drivers should be examined for sleep disorders that cause loss of alertness, fatigue and sleepiness.
Obstructive sleep apnea is treatable. It occurs when the body's muscles naturally relax during sleep. Once the throat muscles relax, a person's airway narrows or collapses, air does not get to the lungs and breathing stops. Tissue in the back of the throat, large tonsils, nasal obstructions and being overweight are the precipitating causes, which result in snoring, cessation of breathing, and then gasping for air, the hallmark of the condition.
The deprivation of restful sleep patterns has major health impacts: severe fatigue, grogginess, loss of concentration, memory loss, depression, sexual dysfunction, and morning headaches. Long-term sleep disorders increase the risk of high blood pressure, heart attacks, strokes, and profound fatigue that causes collisions and work place injuries. It is the reason why many people with high blood pressure suffer heart attacks early in the morning, after being oxygen deprived through most of the night.
Anyone who is not getting restful sleep, snores heavily, gasps for air while asleep, or who suffers heavy fatigue on a routine basis, should obtain a full sleep evaluation from a sleep clinic. After an initial screening, patients sleep overnight in a testing facility under the care of a sleep doctor. Throughout the night an EKG, EEG, and other monitors record the patient's breathing, blood pressure, heart rate, oxygen level, muscle activity, rate of respiration and periods of REM sleep. It is all done under the observation of nursing staff trained in this specialty.
If obstructive sleep apnea is diagnosed, the most common treatment is continuous positive airway pressure or CPAP, a small quiet pump which provides a positive flow of air through a mask to keep air pushed through the airway throughout the sleeping hours. Positive pressure keeps the airway open and eliminates obstructive apneas.
A CPAP creates regular breathing patterns that stops snoring, maintains appropriate oxygen levels, and assures restful sleep. It works best when combined with weight loss, exercise and avoidance of alcohol and provides substantial improvement when used on a continuous basis. That requires working with a licensed respiratory care sleep therapist to assure the equipment is being used reliably and effectively and making return visits to the sleep physician to assure proper CPAP settings to maximize restful sleep. CPAPs are available with humidifiers, bi-level pressures, and auto adjustments for inhalation and exhalation to maximize effectiveness. New compact models easily fit into a suitcase for trips away from home.
CPAPs are not the answer for all patients. Some patients will develop stomach bloating and belching from the increased airflow and those who chronically exhale through their mouth will experience severe drying of the mouth and throat that irritates and awakens them from sleep.
One additional method to increase airflow during sleep in conjunction with a CPAP is to expand the inferior nasal turbinate, the spherical tube in the nose through which air enters from the nostrils to the throat. Formerly this only could be accomplished by nasal surgery under general anesthesia. Today in a half-hour office procedure, using a local anesthetic commonly used in dentistry, radio frequency heat is applied to the anesthetized turbinate airway. The procedure causes the underlying turbinate bone to recede and contract over a period of weeks, providing for the easier passage of air, but allows the mucosa coating the turbinate structure to remain intact to cleanse incoming air of particles. Patients with very severe conditions also may benefit from surgical reconstruction of the uvula, palate, nose, tongue, throat or jaw by a board certified surgeon experienced in these specific surgeries who is recognized for surgical correction of sleep disorders.
Understanding sleep apnea and being alert to its warning signs is essential. The consequences for public safety and public health cannot be ignored. But that is what the trucking industry has been doing for years. The industry and government regulators will need to address this important safety issue and incorporate both driver education and screening for obstructive sleep apnea into every trucker's medical examination and certification to safely drive heavy equipment, just as the FAA has required for airline pilots.
For more information on sleep apnea see the National Sleep Foundation's websites at www.sleepfoundation.org and www.drowsydriving.org. To survey the availability of CPAPs and the latest information on treating sleep disorders see www.sleepquest.com, a leading provider of CPAP equipment.
If you have been the victim of a truck accident, contact Alexander Hawes, LLP immediately to protect your rights. (Your privacy is assured). Act now, as delays can harm your case. You may contact us with the simple form below or you may call us toll free at 800.921.1776.
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