[NOTE: This post was previously published on October 15, 2014. In light of the recent announcement that Metro-North railroad will be starting a pilot project in January 2015 to test drivers for sleep apnea, I thought I’d post it again.
“The railroad’s 410 train operators and 20 more in training will be screened for the sleep disorder by a Metro-North health department,” according to the New York Post. “Those recommended for additional screening after the initial evaluation will be referred to a company that specializes in sleep disorders, according to the MTA.”
This is truly good news for anyone who uses the railroad every day to commute to and from work. Yes, the public is becoming more aware of the dangers of sleep disorders, but unfortunately, it sometimes takes a horrific accident such as this one to get things moving.]
On the morning of December 1, 2013 a Metro North derailment in the Bronx cost four passengers their lives and injured 59 more, many seriously. Although the National Transportation Safety Board has not determined the exact cause of the accident, the agency has stated that the driver suffers from a condition called Obstructive Sleep Apnea, also known as OSA.
OSA is characterized by excessive daytime sleepiness, which is a result of night after night of poor quality sleep. When you have OSA your airway is partially blocked and your breathing repeatedly stops and starts multiple times during the night. Your blood oxygen level drops causing your brain to be aroused – essentially waking you up.
The airway obstruction and thus the drop in blood oxygen levels can be caused by a number of risk factors of which you may have one or more:
- Excessive weight
- Large tongue
- Big tonsils
- Small lower jaws that fall backwards while sleeping
- Long and floppy soft palates and uvulas.
If you snore, stop breathing, and toss and turn all night, it’s likely that you have OSA. Certainly if you are awakened frequently throughout the night, you will be exhausted when you get up and more exhausted as the day wears on.
Obstructive Sleep Apnea Treatment
Medical care for OSA is focused on encouraging patients to lose weight, a change in sleeping position, and even surgery in some cases. Tonsils, the uvula, and even the size of the tongue can be adjusted. But, the most common therapy is called C-PAP (continuous positive airway pressure) which involves the nightly use of a mask which is connected to a small machine that sits next to your bed.
As an alternative, or in addition to C-PAP, are oral appliances, which bring the jaw forward and move the tongue away from the airway. Ongoing research has shown that these appliances not only work well, but compared to C-PAP may be easier for patients to deal with night after night. Happily, there are now ways to test whether an oral appliance would be a good option for you (ahead of time while in your own bed!).
My Opinion About OSA Related Accidents
Let’s get back to last year’s Metro North accident. The driver reported that he had gone into a “daze” as the train careened many miles above the speed limit toward the curve. Before the accident, doctors had diagnosed him as obese and having hypothyroidism, high cholesterol, low testosterone, vitamin D deficiencies, B12 deficiencies, and mild high-frequency hearing loss.
But the driver had never been screened or examined for Obstructive Sleep Apnea until after the accident!
It’s impossible to ascertain how many deadly vehicle accidents are related to undiagnosed or poorly treated OSA. We will likely never know.
I believe that it should be mandatory for all drivers of public transportation vehicles (and all truck drivers who spend long hours on the road) to be tested and treated for OSA. Imagine…oral appliances could find their way into the overnight supplies carried by truck drivers who park at rest stops, pilots who sleep at airports, and train conductors who similarly catch a few hours of sleep during the course of their work schedules.
We have the tools, now is the time to become more effective educators and providers of care and keep the public safe from these mostly avoidable deadly disasters.
Read more about the Metro North accident here: http://www.huffingtonpost.com/2014/04/07/metro-north-driver_n_5107612.html
Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat problems associated with Obstructive Sleep Apnea.