How may I overcome OSA to get my UK driving licence back?

[welshmike]

Hello,

I'm a newbie to this informative forum and have had a number of helpful replies to my messages posted in other threads.
I've had my driving licence revoked by the UK Driver and Vehicle Licensing Agency and want to be permitteed to drive again as soon as my "inappropriate drowsiness" is controlled.
So I'm now using an ResMed S9 Autoset APAP device and a full face mask. (I'm a mouth breather and my default sleeping posiion is on my back).
My best near OSA free nights thus far have been when:
- The APAP was on my bedroom floor
- I slept on my left side being kept there by wearing a backpack stuffed with rolled up towels.
- The hose came over the left hand side of my bed into my face mask.

However more than 10 central apnoeas were recorded each night, the longest being for 26 seconds.
Last night there were 13 central apnoeas and jusr one obstructive apnoea. It was 77 seconds long.

So I would like to know what results from the ResMed recordings will make me eligible to meet the DVLA's requirement.

It is difficult to get my UK NHS, National Health Service, respiratory consultant to reply as she is very busy.
Do members have any suggestions on what I should be looking for in the recordings and how I may move towards apnoea free sleep?

Mike

[Julie]

Hi - couple of things - we know nothing about your driving/licensing body there as most of us are from N. America, though there are members from Australia, the UK and other countries. Secondly, if you've been under the impression that apnea can be cured, never mind quickly (in terms of getting your license back), it's highly, highly unlikely to happen as, while a few people have been able to come off Cpap over time, it's generally as a result of having lost a large amount of weight, changing their lifestyle completely and possibly not having had very serious apnea (or being misdiagnosed) to begin with. It is a condition, like diabetes, which is not so much cured as managed, and the great majority of us work on living with Cpap as well as possible, by finding the most suitable equipment for us and learning to understand our treatment and progress (to have fewer apneas each night) as followed by using special software and card readers to do it.

If you'd like help to make your Cpap experience the best it can be, tell us if your problems seem to centre on the mask - they so often do - or possibly with sleep 'hygiene' - whether you get a consistent # of hrs each night, whether you are eating the 'wrong' foods and/or alcohol and therefore being awoken or disturbed while sleeping by GERD (acid reflux), just finding you've pulled the mask off overnight without realizing it (very common when starting out, but fixable), the hose tangling in bedding (very fixable), etc. There are many knowledgable people here and I imagine that if you can show consistent use of Cpap, your license will be returned. I'm certain that of the thousands of people in the UK with apnea, most are driving, licensed.

[Pugsy]

While it is nice to be apnea free with AHI of 0.0, in reality very few people will be totally free of any apnea events.
I doubt that you have to be totally apnea free to get your drivers license back. Do you know exactly what requirements you need to meet?
Here in the US it is the over the road truck drivers who are at the moment have to meet certain usage requirements to maintain their drivers licenses.
Mostly it is simply hours of use and not a specific AHI.

So exactly what are the requirements in the UK? Is it proof of so much usage each night (compliance) or some sort of AHI number. Here in the US it is mainly hours of use. Typically 4 hours a night for 70% of the nights.

Generally speaking an AHI of 5.0 or less is considered acceptable therapy (here in the US). That's a per hour average over the entire night.
Total number of events over the entire night doesn't tell us much because we don't know how many hours you slept and used the machine.

Centrals...they might be simply awake breathing irregularities getting flagged because the machine doesn't know if you are asleep or awake. It just flags what it senses. Also, it is entirely normal to have what we call sleep onset centrals during sleep stage transition. Nothing we can do about them or would want to do about them unless they are present in large numbers or causing oxygen level drops. A central here and there is no big deal. Everyone can have them at some time or another and will have them from time to time. Even people who don't have the OSA diagnosis.

Are you sleeping well with minimal awakenings or are you waking often for whatever reason?

[SuddenlyWornOut45]

There is only one way to "cure" obstructive sleep apnea that would probably get your UK drivers license back. And that is to get one of those stoma surgeries in the throat. That negates the need for CPAP entirely. That does not work for central apnea or mixed apnea, I have read. But for pure obstructive sleep apnea, it cures OSA.

Its also expensive and in the UK with your socialized medicine you might have trouble finding a surgeon and getting your government to pay for your surgical procedure. It might not even be a UK approved treatment for OSA, I have no idea Im not from the UK. Here in the USA, that surgery is the "cut thru all the crap get it done fast" treatment to OSA. There are surgeons in the USA, who if you paid them the money would do it in a heartbeat for you. If you paid them out of pocket, but it would be very expensive without American style insurance.

Ive actually thought about having it done. The only thing is I'd have to give up aquatics and I like to swim laps sometimes.

Eric

[robysue]

There is only one way to "cure" obstructive sleep apnea that would probably get your UK drivers license back. And that is to get one of those stoma surgeries in the throat. That negates the need for CPAP entirely. That does not work for central apnea or mixed apnea, I have read. But for pure obstructive sleep apnea, it cures OSA. (emphasis added)

This is wild speculation about the UK laws.

Chances are the UK has provisions that allow a fully compliant CPAPer to earn the driver's license back with certain well defined provisions.

As a very rough analogy: Here in the states it is possible for people with commercial driver's licenses to lose their license when they are diagnosed with OSA. However if they are compliant with CPAP therapy and their doctor is happy with the resolution of the excessive daytime sleepiness symptoms, it is a pretty routine procedure for professional drivers to get their commercial driver's license back and keep it---as long as they continue to be compliant with CPAP therapy. (And yes, the state DOTs and the national DOT can and do check on compliance for truck drivers with OSA.)

To the OP: You need to contact the folks in charge of issuing drivers licenses in the UK and find out exactly what the rules are on your side of the pond. Then you also need to work with your doctor to make sure that your PAP therapy is indeed optimized. And then if you are still dealing with excessive daytime sleepiness, further investigation into what might be causing it is warranted.

Best of luck.

[Julie]

Those surgeries don't always work and often just complicate the issue, plus unless you're 100% sure your apnea is caused ONLY by throat obstruction and not some related neurological or respiratory problems, you'd be going through misery for nothing (or the rest of us would have done it long ago).

[chunkyfrog]

You may also check with a truckers association.
The group in the US even has a section dedicated to truckers living with apnea.

[welshmike]

Thanks for your message Eric,

It is possible that the surgery here in the UK may be done by the UK National Health Service, NHS.
It may first be necessary to demonstrate that persistence with an APAP has been unsuccessful and may be a last resort http://www.britishsnoring.co.uk/snoring ... noring.php.
I expect there will be a very long waiting time with the NHS as it is not critical.
I will inquire about having the surgery privately here in the UK as I have a ring fenced savings account for private medical treatment that I have continued to build up for the last 19 years. The alternative was to take out private medical insurance. That is probitively expensive here in the UK and increases significantly as one ages.

Why would such surgery stop your laps swimming? (I also swim laps regularly).

Mike

[sleepinglass]

Hi Welsh Mike
If you do a google search DVLA and sleep apnoea and getting your licence back there is a lot of information out there. You need to re apply for your licence and need to speak to your sleep doctor or your general physician to get it back, as he/she needs to give the all clear.You can down load the form from the internet to reapply for one.

Presumably your licence was revoked before you had a cpap machine.A lot of people who have sleep apnoea drive, all over the world. You obviously need to prove to your sleep clinic that you are compliant and they will also need to know how much day time sleepiness you have according to the epworth sleepiness scale. How long have you had a machine?

[welshmike]

Do you know exactly what requirements you need to meet?
So exactly what are the requirements in the UK?
Centrals... it is entirely normal to have what we call sleep onset centrals during sleep stage transition. A central here and there is no big deal.
Are you sleeping well with minimal awakenings or are you waking often for whatever reason?

Thanks for you message Pugsy,

I will need to get a reply from my NHS respiratory consultant to find out the requirements. She is hard to get a reply from.

It is a relief to read that Centrals may not be a big issue.

Currently I am having many awakenings because sleeping on my side is unnatural for me and I also need time to get used to the facemask and air movement.

Mike

[welshmike]

To the OP: You need to contact the folks in charge of issuing drivers licenses in the UK and find out exactly what the rules are on your side of the pond. Then you also need to work with your doctor to make sure that your PAP therapy is indeed optimized. And then if you are still dealing with excessive daytime sleepiness, further investigation into what might be causing it is warranted.

Best of luck.

Thanks robysue,

My understanding is that the DVLA here need confirmation from my NHS respiratory consultant and GP that the CPAP is being effective in preventing me having "inappropriate drowsiness* and completion of this form http://www.direct.gov.uk/prod_consum_dg ... 066653.pdf

[malkie0831]

Mike

I am a UK Sleep Apnoea sufferer, but I did not suffer from excessive daytime drowsiness, so have not had to stop driving. I did have to declare my condition to the DVLA though. I assume you have completed Form SL1 and have seen the DVLA leaflet "Tiredness can kill - Advice for Drivers"?

From the discussions I had with my Consultant, and comments I heard relayed to others when I collected my ResMed S9, I believe you have to complete 30 days of therapy and achieve better than 4 hours treatment per night. If you have an AHI average over those 30 days below 5, then you go back to your Consultant, (you should already have been given an appointment), they review your data, check you on the Epworth test again and they should be willing to give their opinion to DVLA that you are safe to drive.

I must admit I have found the sleep clinic at my local NHS hospital very approachable and very responsive to questions.

Best of luck with your treatment.

Malcolm

[SuddenlyWornOut45]

It is called tracheostomy. It is considered a last ditch treatment for obstructive apnea here in the USA, but if done correctly, "cures" obstructive apnea but not central or mixed apnea.

http://www.webmd.com/sleep-disorders/sl ... leep-apnea

If you have the surgery, you cannot do aquatics anymore because you can drown. The water enters the stoma hole and goes right into your lungs and you have no control over it. To me it is the main disadvantage to this surgery.

And yes, this surgery only works for purely OBSTRUCTIVE sleep apnea. Such as a very narrow airway, obesity and so on. It wont work for you if you have mixed sleep apnea or central apneas and Ive even read the surgery can make central apnea patients worse. I dont know the mechanism as I am not diagnosed with mixed or central apnea so I have not read up on the details.

Stay away from ANY sedating medication, prescription or OTC. Also become a teetotaler...booze is the worst drug for worsening sleep apnea it makes your airway collapse in your sleep. Booze just it the worst for OSA. If you are on ANY sedating medication, I'd get off of it. If you take anti-hypertensives, I'd get on one that is not sedating. For example ACE Inhibitors are not very sedating compared to beta blocker blood pressure meds. Beta blockers are very sedating. Anything you can do and it adds up.

Eric

Thanks for your message Eric,

Why would such surgery stop your laps swimming? (I also swim laps regularly).

Mike

[Guest]

It is called tracheostomy. It is considered a last ditch treatment for obstructive apnea here in the USA, but if done correctly, "cures" obstructive apnea but not central or mixed apnea.

If you have the surgery, you cannot do aquatics anymore because you can drown. The water enters the stoma hole and goes right into your lungs and you have no control over it. To me it is the main disadvantage to this surgery.

And yes, this surgery only works for purely OBSTRUCTIVE sleep apnea. Such as a very narrow airway, obesity and so on. It wont work for you if you have mixed sleep apnea or central apneas and Ive even read the surgery can make central apnea patients worse. I dont know the mechanism as I am not diagnosed with mixed or central apnea so I have not read up on the details.

Stay away from ANY sedating medication, prescription or OTC. Also become a teetotaler...booze is the worst drug for worsening sleep apnea it makes your airway collapse in your sleep. Booze just it the worst for OSA. If you are on ANY sedating medication, I'd get off of it. If you take anti-hypertensives, I'd get on one that is not sedating. For example ACE Inhibitors are not very sedating compared to beta blocker blood pressure meds. Beta blockers are very sedating. Anything you can do and it adds up.

Didn't know you were a doctor able to prescribe drugs..... or be able to tell patients what to take for meds..............

Eric

Thanks for your message Eric,

Why would such surgery stop your laps swimming? (I also swim laps regularly).

Mike

[guest99]

guest99[quote="Guest"][quote="SuddenlyWornOut45"]It is called tracheostomy. It is considered a last ditch treatment for obstructive apnea here in the USA, but if done correctly, "cures" obstructive apnea but not central or mixed apnea.

If you have the surgery, you cannot do aquatics anymore because you can drown. The water enters the stoma hole and goes right into your lungs and you have no control over it. To me it is the main disadvantage to this surgery.

And yes, this surgery only works for purely OBSTRUCTIVE sleep apnea. Such as a very narrow airway, obesity and so on. It wont work for you if you have mixed sleep apnea or central apneas and Ive even read the surgery can make central apnea patients worse. I dont know the mechanism as I am not diagnosed with mixed or central apnea so I have not read up on the details.

Stay away from ANY sedating medication, prescription or OTC. Also become a teetotaler...booze is the worst drug for worsening sleep apnea it makes your airway collapse in your sleep. Booze just it the worst for OSA. If you are on ANY sedating medication, I'd get off of it. If you take anti-hypertensives, I'd get on one that is not sedating. For example ACE Inhibitors are not very sedating compared to beta blocker blood pressure meds. Beta blockers are very sedating. Anything you can do and it adds up.


I really botched previous post.........
Eric.. Didn't know that you were a doctor able to prescribe or tell patients what or what not to take........