Friday, April 29, 2011

Asleep at the Wheel

At age 52, Tim had been driving long haul trucks for 20 years and had an excellent driving record with no significant mishaps. He was fairly healthy, but like many men his age, he'd gained 50 pounds over his high school weight with a noted increase in collar and belt size. He'd always snored a bit, but now he was really disrupting his wife's sleep. "Honey!", she'd poke him at night, "You're not breathing, roll over!" She was worried about Tim and irritated that she couldn't sleep listening to him gasp and choke. She'd finally had to move to the sofa to get some needed sleep.

Tim started to have to get up to the bathroom two or three times a night and his throat was as "parched as the Sahara". He would awaken in the morning unrefreshed and often have a headache. His driving scheduled time was regulated for adequate rest time, but he began to feel more sleepy during the day.

On a warm summer day at 2PM on a long stretch of highway, Tim felt overwhelming fatigue. He tried opening the window, turning up the radio volume, singing, and biting his lip. But then he involuntarily closed his eyes - and it was all over. Tim left his side of the road plowing into a minivan. He was brought to our ICU with blunt chest trauma but none of the four persons in the minivan survived.

Tim's chest wall and lungs were bruised so he didn't require a very long stay for observation. The vigilant ICU nurses though made the diagnosis. "Dr. deMaine, this patient has severe sleep apnea. Every time he falls asleep he stops breathing and his oxygen saturation drops from 95% to 60% until he starts breathing again." They estimated this happened at least every minute or so.

We were able to arrange a sleep study at Tim's bedside. The findings, as expected, were dramatic. His breathing slowed or stopped for 10 seconds with a drop in his oxygen levels a remarkable 72 times an hour. With the application of a positive air pressure mask, the apnea completely resolved. When Tim awoke after a night of the CPAP (continuous positive air pressure) he felt refreshed for the first time in years.

Comment: Tim's diagnosis and treatment came too late for the unfortunate souls in the minivan. The delay was emotionally devastating to so many, plus there were economic, legal, and job loss effects. I probably saw my first case of sleep apnea at Philadelphia General Hospital in 1962 when I cared for an obese plethoric patient in heart failure who couldn't stay awake. No one knew what was going on so none of the treatments were helpful.

Finally, in 1982 an Australian doctor, Colin Sullivan, published a paper in the journal Lancet describing the first use of CPAP for sleep apnea. Now sleep labs and CPAP machines are quite common and a new industry in medicine has been born.

But what about driving and industrial accidents. In seeing a number of truck drivers to evaluate for sleep apnea over the years, they would confide to me how that sometimes fell asleep "for seconds" behind the wheel. Indeed frequent micro-naps have been identified by doing brain wave testing on working truck drivers. A sleep impaired driver is as impaired as a drunk driver, but there's no roadside simple test to confirm that impairment.

"Each year, potentially 980 lives could be saved and $11.1 billion in automobile-accident costs could be avoided if drivers who suffer from a disorder called obstructive sleep apnea were successfully treated with continuous positive airway pressure (CPAP), according to a study by researchers at the University of California, San Diego (UCSD) School of Medicine."

Sleepiness has recently been in the news with air traffic controllers found asleep on the job. Falling asleep is not a willful act, but a biologic necessity. When people shift their work hours several times it interferes with their diurnal sleep/wake cycle so they cannot sleep satisfactorily. My take is that these workers should have been evaluated by sleep experts for both shift work disorder and sleep apnea. Perhaps they even had both disorders. Simply firing the workers is no solution. Indeed both the work schedules and the workers themselves deserve more care and attention. We all would be safer!

10 comments:

  1. save 11.1 billion.. Our country could be debt free if we had less fraud.Health Insurance Fraud Accounted for 5% of U.S. Health Care Expenditures in 2003, Report ...An estimated $85 billion, or 5%, of the $1.7 trillion in U.S. health care spending in 2003 was lost to health insurance fraud, according to a report released Tuesday by the BlueCross BlueShield Association,..I had cpap mask on and sleep walked out of semi while wife was driving about 60. I got a concussion and other injuries. I don't like using cpap it makes me sick. I get a sore throat, cough, eyes hurt, hard to sleep, feel bloated, and feel down one morning getting out of Truck. cpap - Undiagnosed Symptoms - MedHelp www.medhelp.org " used a cpap for a couple of years now. i'm still tired. plus i have problem when i use it sometimes my head will jerk uncontoled. i still have to much moving around at night, that keeps my wife up to". I…Roy Ijams recommend an article. Oct 31, 2012 Kenneth Dachman, N suburban businessman, pleads guilty to wire fraud articles.chicagotribune.com
    For years, Kenneth Dachman financed a lavish lifestyle - a Lake Forest mansion, a new Land Rover and cruises - by duping investors in his sleep disorder business, according to federal...

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  3. CPAP machine in Darwin is the best treatment for obstructive sleep apnea, which is the common disorder causing slow, shallow or painful breathing while the patient is sleeping.


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  4. My husband has sleep apnea but he was also diagnosed with Narcolepsy. I have read that there is no genetic link but his Uncle was also diagnosed with apnea and narcolepsy. They both had issues of falling asleep while driving and thank the Lord no one ever got hurt. Now neither of them are allowed to to drive at night and only can drive during the day with medication. It's scary to think that we are sharing the road with people who are falling asleep behind the wheel. My husbands Uncle fell asleep at a stop sign and a cop woke him up, that's when he knew he needed help.

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    1. I'm so glad your husband is being well treated. It is scary how many sleepy people are driving - and they can be just as impaired as those who are drunk. Education and awareness are so important. Thanks for your comments.

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  5. People don't even know the signs

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  6. Both my father and the uncle of a friend of mine has sleep apnea. It's scary because neither of them give any thought to how this could affect others. The unfortunate thing is that my friend's uncle did end up killing someone when he fell asleep at the wheel, which caused a serious rift between her and her uncle. Because of his refusal to get treatment, he drove her away and took an innocent life. I am guessing that people often times don't think that this sort of thing could happen to them.

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  7. I am a regular reader of your post.I appreciate with you.Thanks for sharing the blog and always keep it.

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  8. my father often falls asleep while driving . I don't know whether he has the same problem.After reading you blog i will get him diagnosed.

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  9. oh, i get some symptoms mentioned. Maybe i will take diagnose.

    ReplyDelete