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Editorial: Wake up to dangers of sleep apnea

Tuesday, May 27, 2014
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We all know lack of sleep can make someone nod off, which is bad enough for the average worker but much worse when that someone is a truck or bus driver, airline pilot or train engineer. Then it can be fatal, as it was last December when Metro North engineer William Rockefeller, who suffers from sleep apnea, lost control of his train in the Bronx as it approached a dangerous turn at 80-mph plus.

In the ensuing derailment, four of the 120 passengers were killed and dozens injured. It’s good that the railroad and unions are looking at establishing a sleep apnea detection program, but it shouldn’t be left to individual railroads. National standards are needed.

To ensure they get adequate rest, truck and bus drivers, pilots and engineers are currently limited in the number of hours they can work in a given period. But not all rest is equal. While ordinary people who sleep for eight hours are actually asleep most of that time, sleep apnea victims wake up repeatedly during the night.

It’s because their tongue and throat muscles relax too much during sleep, causing their airway to close and their breathing to temporarily stop — until they wake up gasping for a breath. Doing this five times an hour can make someone chronically sleepy.

When Rockefeller was examined by doctors after the crash, they found he woke up around 65 times an hour! That qualifies as “severe” sleep apnea.

One problem with detection is that it’s possible to have sleep apnea without knowing it, since sufferers aren’t usually aware of waking up.

But there are indicators. One is loud snoring. Others are obesity or having a large neck size, over 17 inches for men.

There are also tests, such as the Epworth Scale that asks people to rate their chances of dozing off during different daytime situations, including watching TV and sitting quietly after lunch. Boston’s Massachusetts Bay Transportation Authority gives this questionnaire to anyone hired to drive a bus or train.

And, importantly, there are effective treatments for sleep apnea, the most common being a mask-hose combination that pushes a steady stream of air pressure into a person’s airway during sleep.

When Rockefeller received this treatment following the crash, he reported feeling more energetic and his Epworth scale score improved dramatically, to the point where he was found to be getting enough sleep.

The goal of any screening programs in the railroad industry shouldn’t be to disqualify those who have sleep apnea. It should be to encourage people to be honest with medical examiners and questionnaires, and then to follow up any likely cases with overnight sleepobservation studies. They’re much more likely to be honest if they know they can still get medical certification to do the job as long as they can show their condition is being treated. That’s the Federal Aviation Administration’s policy for airline pilots. It should be the Federal Railroad Administration’s for engineers, as well.

 

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