Deemed untreatable

Julie · Post by **Julie** » Thu May 01, 2014 4:03 pm

JNK - Absolutes, absolute pronouncements, are not helpful to anyone and your deciding that anyone, regardless of circumstances, who says they aren't sleepy in the daytime even if PSG's show severe apnea, is one of those things. Everyone's different and experiences the world differently. I was never sleepy in the daytime and had zero issues driving. The reason I did the sleep lab was because my ex told me I quit breathing at night and then had the usual big gasps, etc. I also incidentally have some very old version of adhd - not the ad part (no trouble concentrating or being distracted, but also unable to just sit for very long without wanting to jump up and do something, and I believe it's very possible that it made a big diff to my apnea in terms of being very 'awake' all along (never have had more than 6 hrs of sleep in my life). Being told by you that I'm fooling myself or any other version of that is not terrific and all my life have wished I could be different, but I'm not. Now that I'm older I take a fair amount of time to 'get with it' in the mornings, so I'm careful about things, though have never, ever (honestly ) been the cause, sleepy, distracted or anything else, of a driving accident. I choose not to live on meds to slow down or anything else, but I don't think you should decide that everyone's the same. BTW, tho', for what it's worth, I''ve also never had insomnia and always fall asleep within a few minutes.

kaiasgram · Post by **kaiasgram** » Thu May 01, 2014 4:30 pm

Julie, I think JNK's post will indeed be helpful to some. It's OK if you feel that what he has to say doesn't apply to you, and it's equally OK that he holds strong opinions about this.

How many times have we admonished those who come onto the forum in denial about their sleep apnea and its impact on themselves and others? Jeff simply does it in an eloquent way.

I have no idea whether his message is relevant to your case and I wouldn't challenge what you're saying about your own situation. I'm just saying that Jeff's message has merit.

Julie · Post by **Julie** » Thu May 01, 2014 5:10 pm

And I never said it didn't.

Todzo · Post by **Todzo** » Thu May 01, 2014 5:38 pm

robysue wrote:You say
Todzo wrote:I think we need to move toward vigilance monitoring as a reasonable way to handle this.
But just what the heck does "vigilance monitoring" mean in your opinion?

I am talking about real time (indeed at the time) in truck and on truck monitoring of the drivers alertness and driving performance on a constant basis when the truck is in motion.

Likely technologies to be used are eye and face posting[2], IR brain function[1], as well as things that can look at following distance, deceleration profiles, and over line driving.

So if there is OSA or any other reason to suspect bad driving monitor. Too much loss of vigilance, off the road.

[1] IR brain function: http://www.biomed.drexel.edu/techport/c ... r_tpv2.pdf

[2] Eye and face posting:

http://citeseerx.ist.psu.edu/viewdoc/do ... 1&type=pdf

http://www.robesafe.com/personal/bergas ... TS2006.pdf

jnk · Post by **jnk** » Thu May 01, 2014 5:42 pm

I appreciate your balancing words taking the edge off my rant, Julie. I tried to specify "very-severe OSA." (My untreated AHI was 114.7.) But anyway, thanks for giving the other side. There are exceptions to all rules of thumb--even mine. And the freedom to point that out is one of the beautiful things about the forum format. So I consider your speaking up with your reaction to my post to be a form of having my back.

Thanks, Julie. I value your reaction. And your other posts as well.

chunkyfrog · Post by **chunkyfrog** » Thu May 01, 2014 5:55 pm

@Robysue:
I predict that before the year is out, Todzo will appear on Shark Tank,
promoting his network of personal trainers, dieticians, and DIY eucapnic breathing kits.
Either he will become very rich or be removed from the studio in full restraints.

ems · Post by **ems** » Thu May 01, 2014 6:00 pm

Todzo wrote:
robysue wrote:You say
Todzo wrote:I think we need to move toward vigilance monitoring as a reasonable way to handle this.
But just what the heck does "vigilance monitoring" mean in your opinion?
I am talking about real time (indeed at the time) in truck and on truck monitoring of the drivers alertness and driving performance on a constant basis when the truck is in motion.

Likely technologies to be used are eye and face posting[2], IR brain function[1], as well as things that can look at following distance, deceleration profiles, and over line driving.

So if there is OSA or any other reason to suspect bad driving monitor. Too much loss of vigilance, off the road.

[1] IR brain function: http://www.biomed.drexel.edu/techport/c ... r_tpv2.pdf

[2] Eye and face posting:

http://citeseerx.ist.psu.edu/viewdoc/do ... 1&type=pdf

http://www.robesafe.com/personal/bergas ... TS2006.pdf

Todzo... what in the world are you talking about? I'm sure you are well intentioned but most of the time I don't have any idea what you are talking about. Do you?

I have tried to follow more than a few of your posts... usually I just shake my head and move on to a different thread.

Todzo · Post by **Todzo** » Thu May 01, 2014 6:02 pm

robysue wrote:Todzo,

I just can't figure out where you are coming from.

That became very clear to me as I read your post.

robysue wrote: From reading your many posts, it seems clear to me that you do think doctors should be responsible for preventing people with untreated OSA from running around driving large eighteen wheelers and commuter trains (See (A))

Failure to find Sleep Apnea 80% of time is not acceptable. And it kills more than just the ones who suffer from the disease. Considering how easy it is to do an initial screening inexcusable.

robysue wrote:, and that people with untreated OSA really don't know just how bad their cognitive skills and reaction times can be affected by the untreated OSA (See (B)). But at the same time when a trucker who is required to treat his/her now diagnosed OSA complains of having problems adjusting to the one DOT-approved therapy for his/her condition, you also seem to think it unfair that the trucker either has to figure out a way to make CPAP work or give up his/her CDL. (See (C).)

You seem to have missed my basic point and initial response to Gfm. Let me remind you:

Todzo wrote:
Gfm wrote:Problem! I am a commercial driver, diagnosed with severe sleep apnea, I am not tierd during day, I know I stop breathing at night, but I sleep! When I try to use resmed Quattro- air mask I am exstreamly tierd during day! So I don't use it. Now my Veteran's Adm Doctor said I am untreatable and she is going to contact D.o.t. to take away my comm. lic. I am very scared! P.S. I also stop beathing with mask
There are indeed nonanatomic causes of Sleep Apnea which CPAP exacerbates rather than helps. That is why, I do believe, so many find themselves unable to benefit from CPAP use.

But that also means that truck driving is not for you.

So someone who has untreated OSA needs to be off the road.

robysue wrote:And that's contradictory in my opinion: You can't have it both ways. You can't say docs are responsible for getting truckers and train engineers with OSA off the roads until their condition is treated and at the same time tell the truckers and engineers who run into problems with PAP that PAP doesn't work and they should not have to comply with therapy.

And I did not. I told them they needed to do other than truck driving.

Frankly I do not care how they treat the Sleep Apnea as long as it works. Which is why vigilance monitoring makes much more sense. One might very well meet the standards for compliance yet be under or ill treated regarding their sleep apnea. So we need to look at actual performance.

chunkyfrog · Post by **chunkyfrog** » Thu May 01, 2014 9:34 pm

ems: I see what you mean . . .

The Latinist · Post by **The Latinist** » Thu May 01, 2014 9:49 pm

ems wrote: in the world are you talking about? I'm sure you are well intentioned but most of the time I don't have any idea what you are talking about. Do you?

I have tried to follow more than a few of your posts... usually I just shake my head and move on to a different thread.

I've only been around here for a couple of weeks and I've already come to the same conclusion.

49er · Post by **49er** » Fri May 02, 2014 4:51 am

As one agrees with the comments about Todzo's postings generally, in my opinion, he does have a point regarding this exert:

Frankly I do not care how they treat the Sleep Apnea as long as it works. Which is why vigilance monitoring makes much more sense. One might very well meet the standards for compliance yet be under or ill treated regarding their sleep apnea. So we need to look at actual performance.

Many people have stated that even though they are 100% compliant with cpap, they actually feel alot worse which has been also mentioned by Dr. Stephen Park. So if any of these folks are commercial truck drivers, cpap compliance is not necessarily making our roads safer. Hopefully, this isn't a huge percentage but so far, there haven't been serious studies on what that really is.

And as was mentioned in previous thread about a year ago, as long as there continue to be regulations in the trucking industry that put extreme pressure on drivers to deliver goods very quickly without adequate rest, that isn't obviously going to be good for road safety. So cpap compliance sounds good politically in the name of road safety but without covering the other issues, it is like simply plugging a hole in the wall as larger ones appear.

49er

zoocrewphoto · Post by **zoocrewphoto** » Fri May 02, 2014 5:06 am

49er wrote:As one agrees with the comments about Todzo's postings generally, in my opinion, he does have a point regarding this exert:

Frankly I do not care how they treat the Sleep Apnea as long as it works. Which is why vigilance monitoring makes much more sense. One might very well meet the standards for compliance yet be under or ill treated regarding their sleep apnea. So we need to look at actual performance.
Many people have stated that even though they are 100% compliant with cpap, they actually feel alot worse which has been also mentioned by Dr. Stephen Park. So if any of these folks are commercial truck drivers, cpap compliance is not necessarily making our roads safer. Hopefully, this isn't a huge percentage but so far, there haven't been serious studies on what that really is.

And as was mentioned in previous thread about a year ago, as long as there continue to be regulations in the trucking industry that put extreme pressure on drivers to deliver goods very quickly without adequate rest, that isn't obviously going to be good for road safety. So cpap compliance sounds good politically in the name of road safety but without covering the other issues, it is like simply plugging a hole in the wall as larger ones appear.

49er

Very true.

My nephew is a truck driver and about 6 months into his first job, he was trying not to be late (again), so after a short nap, he got on the road again. He flipped his semi into the median. Thankfully, he only had a few scratches, and he didn't hurt or kill anybody else. I was 2am, a time when he is normally alert. He is a night owl like me. He lost his job of course and had to wait 3 years before getting his next driving job.

While I don't think people diagnosed with sleep apnea should skip their cpap machine, I do see the need for serious help in adjusting, and realistic solutions if they can't get it to work in a fairly short time. They need to be employed, and their employer needs drivers. There also needs to be a better way to keep these drivers employed, yet not being stressed with such tight deadlines. My nephew's second driving job was team driving, so he was paired with a more experienced driver, and while one was resting, the other was driving. This kept the truck going long haul, but also had somebody else in the vehicle who had good interest to make sure the other driver was safe (since his own life and job could be on the line of there were an accident).

49er · Post by **49er** » Fri May 02, 2014 5:55 am

Very true.

My nephew is a truck driver and about 6 months into his first job, he was trying not to be late (again), so after a short nap, he got on the road again. He flipped his semi into the median. Thankfully, he only had a few scratches, and he didn't hurt or kill anybody else. I was 2am, a time when he is normally alert. He is a night owl like me. He lost his job of course and had to wait 3 years before getting his next driving job.

While I don't think people diagnosed with sleep apnea should skip their cpap machine, I do see the need for serious help in adjusting, and realistic solutions if they can't get it to work in a fairly short time. They need to be employed, and their employer needs drivers. There also needs to be a better way to keep these drivers employed, yet not being stressed with such tight deadlines. My nephew's second driving job was team driving, so he was paired with a more experienced driver, and while one was resting, the other was driving. This kept the truck going long haul, but also had somebody else in the vehicle who had good interest to make sure the other driver was safe (since his own life and job could be on the line of there were an accident)

Wow Zoo Crew, I am so glad your nephew didn't suffer from his accident. That could have been really serious.

Team driving is a great idea. Do you know what percentage of truck companies use that?

zoocrewphoto · Post by **zoocrewphoto** » Fri May 02, 2014 6:42 am

49er wrote:
Very true.

My nephew is a truck driver and about 6 months into his first job, he was trying not to be late (again), so after a short nap, he got on the road again. He flipped his semi into the median. Thankfully, he only had a few scratches, and he didn't hurt or kill anybody else. I was 2am, a time when he is normally alert. He is a night owl like me. He lost his job of course and had to wait 3 years before getting his next driving job.

While I don't think people diagnosed with sleep apnea should skip their cpap machine, I do see the need for serious help in adjusting, and realistic solutions if they can't get it to work in a fairly short time. They need to be employed, and their employer needs drivers. There also needs to be a better way to keep these drivers employed, yet not being stressed with such tight deadlines. My nephew's second driving job was team driving, so he was paired with a more experienced driver, and while one was resting, the other was driving. This kept the truck going long haul, but also had somebody else in the vehicle who had good interest to make sure the other driver was safe (since his own life and job could be on the line of there were an accident)
Wow Zoo Crew, I am so glad your nephew didn't suffer from his accident. That could have been really serious.

Team driving is a great idea. Do you know what percentage of truck companies use that?

No idea. He got laid off a couple years ago being the newest driver and them cutting back. He worked some other jobs for awhile before getting hired by a moving company. He worked for UPS during the holidays (not a route, but long haul), and now he works for yet another company that does a lot of shorter routes, so he stays in town all the time. He prefers long haul, but he is young, and has that accident on his record. It doesn't come up on the 3 or 5 year records, but when they ask about who he worked for and why he left, he has to explain it.

He was really fortunate with that accident as he really could have killed somebody, and that would be something horrible to live with. And he could have been severely injured himself. All it took was a long blink.

Todzo · Post by **Todzo** » Fri May 02, 2014 3:22 pm

StuUnderPressure wrote:
Todzo wrote:
I think we need to move toward vigilance monitoring as a reasonable way to handle this.

My city has an East - West Interstate and a South - North Interstate where the South - North Interstate ends at the intersection with the East - West Interstate but the South - North divided highway continues through the City & beyond.

The East - West Interstate has AT LEAST 2 accidents per month (sometimes 1 a week) involving 18 Wheelers where that driver was at fault. At least 50% of them result in 1 death, sometimes more deaths. In EVERY case the accident was caused by the inattention of the driver of the 18 Wheelers. Now whether they fell asleep or something else was the cause, the point is that these accidents are NOT being caused by anyone other than drivers of 18 Wheelers.

Further, the South - North Interstate that continues through the city only as a divided Federal Highway (no longer an Interstate once it gets into the City) has even more accidents than that involving 18 Wheelers. But the speed limit on that section is much less than on the Interstate part, so the accidents are not as severe (in a lot of the cases, but not in all of them).

There was 1 accident a couple of months ago where an 18 Wheeler plowed into a vehicle stopped at a stop light on that section. Killed all 5 occupants of the vehicle. He was on a section with a 55 MPH speed limit & the investigation showed he was speeding & never even slowed down before hitting the vehicle. Inattention on the part of the 18 Wheeler driver was cited as the cause of the accident.

There have been some major lawsuits filed & major damages collected because of these numerous accidents. Yet, they continue to happen.

The trucking companies pay the damages & move on, but never seem to do anything to try to address the problem of WHY these accidents continue to happen.

So, now the "gubment" steps in & tries to regulate what no one else seems to want to address. Now that has happened, everyone must live with those regulations until something better comes alone.

I am often driving on both Interstates, so I personally welcome those regulations. And believe me, I am not a proponent of government regulation.
These regulations may not solve the problem(s), but they make it a little less dangerous.

I am remembering as I read this being at a truck stop recently. I could find no fiber in the place, not a hint. No salad, no veggies. Obese person one after another went up to the skinny cash register attendant and almost every one of them was purchasing multiple bottles of pop. I guess that is the plan to maintain vigilance.

Trucking seems to involve long hours at the wheel often at times which mess with the circadian rhythms of the driver. A good way to make a person unusually tired and unable to properly focus and relax.

The Metro North Train incident had the perfect storm. Engineer recently moved to a very early morning shift (circadian shift). Engineer with undiagnosed severe sleep apnea. Engineer dealing with a cold. Coffee and a donut on the way to the fatal shift. Ah coffee and sugar. Alert for a time and then drop like a stone. In this case with fatal results.

With so many factors that do affect driver (or engineer) alertness I still think vigilance monitoring is the direction we should pursue.

In the mean time I am with you being glad that there is at least a first attempt to deal with such things.

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