Confusion Reigns after Sleep Apnea Rules Withdrawn by DOT

Initially, the Federal Motor Carrier Safety Administration (FMCSA) tried to issue informal safety guidelines that medical examiners were expected to follow when certifying drivers who were at risk for sleep apnea. However, Congress passed a bill that President Obama signed, requiring the agency to pursue action through the formal rulemaking process. As a result, the FMCSA and the Federal Railroad Administration (FRA) began pursuing formal sleep apnea rules in March 2016. The goal was to set clear standards because trucking companies felt the informal guidelines–a patchwork of state and federal guidance documents–was seen to be confusing and difficult to follow. In fact, some truckers and their companies have accused doctors and equipment providers of trying to profit from unclear rules. In the absence of clear rules, it remains up to individual medical inspectors to decide for themselves when sleep apnea needs treatment.

The ongoing confusion is evident from a quick Google search on sleep apnea trucking rules, with some results talking about new rules, and others saying there are no new rules.

In the absence of a clear federal rule, these tensions will continue, and it’s likely that drivers and trucking companies will be exposed to additional liability as a result.

However, the sleep rules were heavily criticized by trucking companies and independent truckers in large part because of the likely cost. Some studies suggest that as much as 40% of all truckers would have to undergo sleep apnea screening. And that many of them would end up requiring CPAP or oral appliance therapy to keep driving.

With the high proportion of drivers affected, there is no doubt that it would be expensive for the industry to implement any kind of comprehensive sleep apnea screening program.

The irony of the situation is that uniform screening of truckers would not only eliminate confusion, it would actually save money for truckers and trucking companies, according to a new case study. The study looks at Schneider National, the fourth largest trucking company in the US. Schneider decided to start screening their drivers for sleep apnea and requiring the use of CPAP for all drivers diagnosed with the condition.
The study looked at the medical costs related to untreated sleep apnea. It compared medical costs of 100 drivers diagnosed with sleep apnea and treated compared to those screening identified as likely to have sleep apnea, but without a formal diagnosis. The result: treated drivers cost $441 dollars per month less in medical costs compared to those untreated.

Considering a sleep apnea diagnosis test might cost as little as $500, it doesn’t take long for the savings to add up. Schneider National is self-insured, so it sees those savings directly. But even companies that pay for insurance are likely to see considerable savings on their insurance rates with regular screening and treatment of truckers.

Although the DOT release claims that there is not enough information to move forward with sleep apnea guidelines, there is actually much information available about the risk of sleep apnea for truckers and train operators. We know, for example, that 2013’s deadly Bronx train derailment was likely due to sleep apnea. This led to the screening of all commuter rail drivers.

We also know that truckers who have untreated sleep apnea may be five times more likely to be involved in an accident. And we know that getting sleep apnea treated reduces the accident risk to essentially the same as drivers without sleep apnea.

What we don’t know is how well the old guidelines will work to keep truckers–and those that share the roads with them–safe on the highway.