What Are the Feds Doing to Address Bus Driver Sleep Apnea Issue?
In September of 2013, a Greyhound bus drove off of an Ohio highway, struck a tree and a fence, then overturned onto its side where it eventually came to a sliding stop in a cornfield. Thirty-five people sustained injuries in the bus crash, which happened at around 3:50 a.m. roughly 25 miles outside of Cincinnati.
Ruthie Allen was one of the 35 passengers who sustained injuries in the accident. She recalls yelling at the bus driver, but got no response in the seconds before the bus “started to tumble.” When the bus came to a stop in the cornfield, Allen remembers looking down to find a bone in her thigh protruding through her clothing.
In the wake of the crash, Greyhound bus driver Dwayne Garrett told investigators that he was drinking coffee, then started coughing and eventually lost consciousness in the seconds before the crash. But when investigators watched footage recorded by the dashboard camera, they didn’t hear any coughing.
While the cause of the crash is still under investigation, officials believe driver fatigue was a factor.
Bus Driver Sleep Apnea
A couple of weeks before the accident, a Department of Transportation official suspected Garrett might have sleep apnea, a common disorder in which a person has one or more pauses in breathing, or has shallow breaths while sleeping. The pauses can last for a few seconds or minutes and can happen 30 times or more over the course of an hour.
When breathing is interrupted during sleep, it causes a person to shift from a deep sleep state into a light sleep. Without deep sleep, those affected by sleep apnea often feel tired or drowsy during the day. According to the National Heart, Lung, and Blood Institute, sleep apnea is the leading cause of daytime sleepiness.
The DOT medical examiner told Garrett that he needed to get tested for sleep apnea within the next 90 days. He didn’t. Instead, Garrett visited his personal physician (who is also a DOT medical examiner) two days before the crash in Ohio. He told his doctor about the DOT’s suspicion that he may have sleep apnea but failed to disclose some key symptoms and the referral for a sleep test. This prevented his physician from evaluating his condition more closely.
In the end, Garrett received a court-ordered sleep test, which ultimately diagnosed him with sleep apnea. He is now disqualified from driving a commercial vehicle. If untreated, sleep apnea disqualifies a driver from operating a commercial bus.
Garrett’s case is not a unique one, according to a CBS News investigation, which found numerous instances where commercial bus drivers failed to disclose serious medical conditions on their DOT medical forms. It is expected that drivers fill the forms out truthfully, but many fear that disclosing a medical condition like sleep apnea could prevent them from passing their medical exams and landing a job.
According to a study sponsored by the Federal Motor Carrier Safety Administration (FMCSA), 33 percent of commercial truck drivers suffer from mild to severe sleep apnea. It isn’t difficult to imagine similar numbers for bus drivers. Both occupations are sedentary, high stress, and aren’t associated with healthy living. Some of the most common risk factors for sleep apnea include obesity, high body mass index, high blood pressure, and diabetes, all of which are not uncommon among truckers and bus drivers.
Like truck drivers, bus drivers are not required to undergo testing for sleep apnea before getting their commercial driver’s license. The FMCSA has long recommended sleep apnea screening for all commercial drivers. Airline pilots, for example, are subjected to sleep apnea screening; so why should commercial vehicle drivers be any different?
The federal government doesn’t presently keep tabs on crashes caused by commercial drivers with medical conditions, nor do states. However, CBS News was able to obtain medical information on commercial vehicle crashes in four states. A review of the reports found that drivers with medical conditions were involved in nearly 400 commercial vehicle crashes in 2013 and 2014 alone.
FMCSA Proposes New Rule to Address Bus Driver Sleep Apnea
This summer, the FMCSA proposed a rule aimed at addressing the bus driver's sleep apnea issue. The new rule would require all commercial drivers and railroad workers to be screened for obstructive sleep apnea. The government could also require treatment for drivers and railroad workers who are diagnosed with sleep apnea.
One sleep apnea treatment, known as continuous positive airway pressure (or CPAP), has already shown promising results. CPAP uses a breathing machine to push air into the nose and mouth. The breathing machine is essentially an internal splint that prevents the airway from collapsing, which keeps those affected with sleep apnea from leaving the deep sleep state.
“What we know is that for commercial drivers with obstructive sleep apnea who are treated with CPAP, we see a 73 percent reduction in preventable driving accidents,” says Dr. Nathaniel Watson, former president of the American Academy of Sleep Medicine. According to Watson, sleep apnea among those working in safety-sensitive fields, like commercial driving, could become a very serious health concern if unaddressed.
It remains unclear whether the new FMCSA rules would affect current commercial drivers. It is also unclear whether sleep apnea screening would be a determining factor in hiring new drivers. What is clear, however, is that something needs to be done to address the bus driver sleep apnea issue, otherwise fatigue-related accidents like the 2013 Ohio crash will continue to be a national problem.