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Why are we ignoring sleep apnea and other medical issues.

It has been several months since I have last prepared a blog. My wife reminded me to do so a few days ago and I told her that I was still trying to formulate one. Those who know me can state that I am usually not at a loss for words, yet, I have been going back and forth in trying to provide a proper expression of my thoughts. The issue deals with the reluctance of the railroad industry and its regulators, to develop a comprehensive set of medical standards that would deal with sleep related issues. In many ways, this is near and dear to my heart since I suffer from severe obstructive sleep apnea. I am aware of the insidious ways this disease can cause lack of awareness, how it can distract one from the task at hand, and how it can affect one’s general health and wellbeing.

We are all aware of several recent incidents where sleep was a factor. We will never know for sure how many close calls occurred. But, I am confident that there were many such close calls. Much research has been done in the past years on the effects sleep disorders have on worker safety. The effects of shift changes, irregular sleep patterns, and sleep deprivation have all been well documented. Sleep disorders and their effect upon a person’s performance and overall health have been well documented and widely presented in both the general and specialist press. Yet the response of the railroad industry as a whole, and that of the regulating agencies, has been sadly lacking.

Coming from a railroad background, I learned at an early stage of my career that sleep was often considered an effete luxury by many railroaders. Many took pride in working long hours, dealing with erratic schedules, and treating fatigue as a weakness. I recall that after being diagnosed with severe sleep apnea, several senior managers teased me about my needing to sleep, implying that I was weaker for trying to do so. But, after a while, I learned that many of my colleagues and peers also suffered from sleep apnea, but chose to keep silent.

Several of my colleagues participated in several committees which explored various medical issues, including sleep and fatigue. Recommendations and proposed rules were developed, and were brought to a discussion level, with representatives of railroad management and labor. Some of these issues resulted in recent hours of service limitations and a requirement for analysis of passenger crew scheduling. Other requirements dealing with fatigue management are reported to be in the pipeline. Unfortunately, the proposals dealing with medical issues did not progress beyond a series of initial discussions. So far, it seems as if the effort stopped there. Despite all of the work, no further progress has been made and the medical issues efforts have entered the “back for further study and evaluation process”.

This puzzles me. The effects of electronic devices in distracting train crew have been recognized as being dangerous for safe operations and a considerable effort has been made to develop rules and regulations concerning their use by train crew. But, the use of these devices is strictly voluntary in that the crew member can choose to not use the device at all. But, the effects of a sleep disorder or other medical issue are involuntary and are usually not preventable by the individual so affected. I did not choose to fall asleep during meetings-I did so because my body needed to sleep and it did so whenever it could and at its own volition. Medical issues, such as sleep apnea, need to be treated as equally seriously as the issues with electronic devices!

One of the most critical of the medical issues is that of sleep disorders, specifically, sleep apnea. Sleep apnea is in the same league of potentially dangerous, yet readily addressable conditions such as diabetes, and high blood pressure. Once diagnosed, an individual can be placed on a remedial therapy and be monitored to ensure compliance with the therapy.

Sleep disorder diagnosis is not a simple matter. But, enough research has been done that certain factors can be used to predict a person’s susceptibility. As an example, for sleep apnea, neck size measurement, overall body mass, and blood oxygen levels are common indicators of susceptibility. Follow up exams can then be performed to verify a possible diagnosis and a remediation program can then be developed. Sleep disorder remediation not only benefits the operation, it also benefits the individual and his family.

I have been informed that some of the labor organizations feel that sleep apnea testing will lead to stigmatization or discrimination. An effort should be made to educate the parties affected on the impacts of untreated sleep apnea and the benefits of remediation. There is a lot of information out there on sleep apnea and its treatment. What needs to change is the attitude towards sleep issues and ensuring that everyone has good information about the causes, effects and treatment options.

A few railroads have started to look into sleep apnea testing programs and I applaud their actions. But, I wish that more railroads follow suit. I wish that some of the most vocal politicians adopt the cause of adopting stricter medical standards that include testing for sleep disorders and post diagnosis monitoring. I was disheartened when well intentioned, but ill-informed politicians pushed through demands for such dubious methods of improving safety as in cab cameras, but totally ignored the beneficial impacts of improving medical standards.

My hope is that the Federal Railroad Administration will prioritize the development of new medical standards that will include fatigue remediation and sleep disorder testing and remediation. Strict medical standards already exist in the aviation industry and there is no reason why similar standards cannot be implemented for the railroad industry. Such medical standards should also require comprehensive risk reduction methodology, including implementation of fatigue management plans.

In my previous blogs, I have pushed for solving human factor issues by using human solutions, rather that technology. This request for improving medical standards falls into that category.

As for my sleep apnea, I use a CPAP (Continuous Positive Air Pressure) machine every night. Such a machine is a bit smaller than a cigar box and the new nasal pillow system replaces the Darth Vader mask. I have begun a program to lose weight and monitor my blood pressure. I am aware of how serious the impact of this disorder is and am taking appropriate steps. I can only wish that the railroad industry and its regulators do the same. Let’s not wait for the next tragedy to occur before action is taken.

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