I Hate Cpap! Founder Attends Sleep Apnea And Trucking Conference In Baltimore

May 23, 2010 - PRLog -- The excellent seminar on May 11-12 was presented by the American Sleep Apnea Association and co-sponsored by the ATA, American Trucking Associations and the Federal Motor Carrier Safety Administration.  

There is considerable research that shows that patients with savere sleep apnea have significantly more crashes and crashes that involve severe injury.  One study showed that even patients with mild sleep apnea have a 300% increase in accidents that involve serious injury.  Another study showed a 300% increae in MVA in snorerers and another study showed that patients with mild apnea had slower reaction times than drivers who were legally intoxicated.

These facts and others explain why both the federal government and the trucking industry are keenly interested in adressing this serious problem.  A study of the incidence of Sleep Apnea among truck drivers was presented that showed almost one third of CMV (commercial motor vehicle) drivers had mild to severe sleep apnea.  This study may have undrestimated the problem as it was skewed to show an increased number of short haul drvers.  

Increasing age and obesity increase the risk of sleep apnea but even young healthy drivers at ideal weight can be affected.  The speakers also indicated that fatal crashes have the most research.  Crashes due to sleep apnea are a portion of the total crashes due to excessive sleepiness.

The Gold Standard for treatment of Sleep Apnea is CPAP, or continuous positive air pressure but there are sever problems with patients compliance.  Recent studies have shown that 60% of patients reject CPAP.  Dr Lawrence Epstein of Harvard gave a lecture on  basic facts of sleep apnea. He cited that Excessive Daytime Sleepiness resulted in increased motor vehicle crashes, poor jaw performance, decreased quality of life and increased work-related accidents.

Dr Epstein also presented results of studies showing  that CPAP FAILED THE MAJORITY OF PATIENTS and that many patient's usage of CPAP dropped rapidly after initiation of CPAP.   Objectively measured use of 4-5 hours/night  was only found in 46% of patients in another study he cited.  

ANOTHER STUDY CITED SHOWED THAT ONLY 5% OF TRUCK DRIVERS UTILIZED THER CPAP MACHINES.

Among the general patient population wearing CPAP 4-5 hours is considered a success.  Dr Shapira brought up in the question answer period a  little discussed problem that heart attacks and strokes associated with sleep apnea usually occur in early morning hours when patients have already removed their CPAP masks.  A bigger concern for the trucking inustry is that even 4 hours nightly may be insufficient for safety.

Truck drivers frequently avoid sleep studies to diagnose sleep apnea because of fear it could preclude them from driving.  Bob Stanton gave a lecture titled "JUST A TRUCKER WITH SLEEP APNEA" and explained how he almost lost his job when he first disclosed he had sleep apnea.  Bob was an extremely impressive speaker and his voice is important.  

The problem is what do you do when the majority of patients reject treatment or severely underuse it.  Schneider National trucking is leading the industry in solving this problem.   They created a study program (2004-2006)  that enrolled 339 truckers and evaluated safety and performance and health care costs in 12 months before and after treatment.  The results were impressive: Preventable crashes were reduced 30% and the median cost of crashes was reduced 46%.  Even more impressive were health care costs dropped by over 50% resulting in monthly savings of $539 a month.  An expanded study in 2006 included 788 drivers with similar results.  

Patients who do not tolerate CPAP are often lost to treatment, and this is a serious problem for the trucking industry.  The best alternative to CPAP is use of an Oral Appliance  (see http://www.ihatecpap.com) which has been accepted by the American Acaemy of Sleep Medicine as a first-line approach for mild to moderate sleep apnea and an alternative to CPAP for severe apnea when patients do not tolerate CPAP.

Oral Appliances will likely become the first line treatment for mild to moderate sleep apnea in the future.  Studies have shown that oral appliances are preferred by over 90% of patients offered a choice of CPAP or Oral Appliances.  In fact, two manufactures of Oral Appliances had booths at the meeting, TAP and Somnomed.  The TAP appliance has been shown to be the most effective oral  appliance for treating severe sleep apnea and both are excellent for mild to moderate sleep apnea.  The problem with oral appliiances is that there is no objective measurement to prove they are being worn.  Patients report extremely high levels of satisfaction with their oral appliances and often feel more rested and alert than they did with CPAP.  

Sleep Connect Inc also had a botth at the meeting and displayed an exciting new development that will change how sleep apnea is treated both by trucking companies and sleep medicine physicians.  They are currently Beta testing a compliance monitor for oral appliances.  This is extremely important to the trucking industry where legal and financial issues are more important than patient comfort.

THE SLEEP CONNECT WEBSITE STATES "Sleep connect provides the world's first objective compliance management system for Oral Appliance Therapy treatment of Obstructive Sleep Apnea. Sleep professionals using Oral Appliance Therapy are now able to objectively view patient use of the device and correlate use to care parameters."  

Monitoring of oral appliance use will drastically increase usage of oral appliances.  In Scandanavian countries where patients are free to chose therapy they overwhelmingly chose oral appliances over CPAP.  The future of sleep apnea treatment in the US will probably see oral appliances overtake CPAP use for mild to moderate sleep apnea.  The biggest obstacle is insurance companies.  The experience at Schneider National shows substantial health savings when apnea is treated.  The insurance companies will probably integrate better coverage for oral appliances due to cost savings as patients actually use their sleep apnea treatments.  

The liability lawyers will also be a consideration to insurance companies just as they are to the trucking industry.  If they promote CPAP  therapy that fails over half the population there may be legal implications both in terms of MVA's involving third parties and in terms of patients health problems when apnea is not treated.

The question of monitoring the general population may be a problem.  Many patients would not want anyone watching them all the time as it seems intrusive to personal freedom.

There were several companies working with the trucking industry who only use CPAP because they can closely monitor CPAP use.  These monitors can give dail monitoring of CPAP use or lack of use.  Well this close monitoring may seem Orwellian it is necessary because poor CPAP compliance is the rule.  This close monitoring, while intrusive allows the companies to work with compliance and eliminate non-compliant  CPAP drivers.

This is also the reason many drivers are afraid to be tested.  Schneider National found increased driver retention with its sleep apnea treatment program and Don Osterburg who institued the program was not sure if drivers appreciated the efforts of Schneider National or could not find other jobs due to sleep apnea diagnosis.

THE CURRENT PROGRAMS DISCUSSED AT THE MEETING RARELY INVOLVE THE USE OF ORAL APPLIANCES DUE TO LACK OF MONITORING SYSTEMS.  MANY TRUCK DRIVERS ARE DENIED ACCESS TO ORAL APPLIANCE THERAPY BECAUSE OF LACK OF A COMPLIANCE MONITOR.  THE AMERICAN ACAEMY OF DENTAL SLEEP MEDICINE SHOULD ADDRESS THIS AT THEIR ANNUAL MEETING IN JUNE IN SAN ANTONIO.

PATIENTS IN THE CHICAGOLAND METROPOLITAN AREA CAN EXPERIENCE A MORE COMFORTABLE ALTERNATIVE TO CPAP.  

CALL TODAY FOR FREE INFORMATION PACKET
1-8-NO PAP-MASK

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Dr Ira L Shapira is a pioneer in the field of Dental Sleep Medicine and is A DIPLOMATE OF THE AMERICAN BOARD OF DENTAL SLEEP MEDICINE. He is also the founder of Chicagoland Dental Sleep Medine Associaters (http://www.chicagoland.ihatecpap.com/) and Delany Dental Care Lt (http://www.delanydentalcare.com) and offers comfortable alternatives to CPAP in Gurnee, Skokie, Schaumburg and is soon opening an office in Highland Park, Illinois. He can be contacted toll free at 1-8-NO-PAP-MASK.
I HATE CPAP! LLC provides information on Sleep Apnea, Dental Sleep Medicine and alternatives to CPAP for patients who are CPAP intolerant. The website http://www.ihatecpap.com has valuable information on treating sleep apnea utilizing oral appliances.

Dr Ira L Shapira is the founder of I HATE HEADACHES LLC and the website http://www.ihateheadaches.org that concentrates on utilization of neuromuscular dentistry to treat migraines and tension-type headaches.