Wednesday, October 1, 2008

I think we should sleep on it

Sometimes, issues are real, and require real attention.

Sometimes, they’re artificial, and still get attention because someone inflates their importance in order to serve their own agenda.

Sleep apnea is a little of both.

On the one hand, we have the FMCSA’s Medical Review Board, which wants to force anywhere from a third to half of all American truck drivers to be tested for the illness every year – at an out-of-your-pocket cost of thousands of dollars. They want that test whether you’re really at risk for the disease or not.

On the other hand, you have those who have criticized opponents of that plan – including OOIDA. Some have claimed we haven’t covered it enough on Land Line Now, or that truckers don’t really understand the problems.

I think that’s a criticism I need to address.

First, I don’t think anyone wants someone who really might have apnea to avoid a test.

Also, I think many of us have a very good idea what apnea is. Many of us have it – myself included.

And finally, we actually have talked on this show with a number of medical professionals about what apnea is and what it does to people who have it. We’ve also talked quite a bit about CPAP machines and how they treat the illness.

However, that’s a whole different matter than what the Medical Review Board is talking about. They want any trucker with a BMI, or Body Mass Index, of more than 30 to have the yearly testing. The last estimate I saw indicated that could be around 42 percent of all truckers.

It’s uncalled for, and it’s unnecessary.

In talking with folks on the air and off, virtually all say the simple Body Mass Index test is inaccurate in determining whether someone is obese. And it’s a very inaccurate way to determine who’s at risk for apnea.

Again, this isn’t just some Joe off the street – this is information that comes from medical professionals.

The method used here to measure BMI is to simply compare your weight and height. A truly accurate BMI test involves placing you in a tank of water and measuring your displacement. Far fewer people would show a BMI of 30 with that test.

Second, while obesity – when correctly measured – is one indicator for apnea (not a guarantee you have it), it’s not the only indicator.

Here are just a few of the possible factors that can indicate you are a potential sleep apnea sufferer:
  • People who are overweight;
  • Men with a 17-inch neck or larger;
  • Women with a 16-inch neck or larger;
  • Older men and postmenopausal women;
  • Adults and children with Down syndrome;
  • And children with large tonsils.
Again, that’s just a few of the kinds of people who are at risk.

Whether you get tested for apnea is a decision that should be made by you and your doctor, not by some bureaucrat who is sitting at a desk a thousand and a half miles away.

So why are they doing this? Why use BMI as a method to decide who’ll get tested for apnea?

The answer lies in who is calling for this.

Charlie Morasch, who’s one of our writers down at Land Line Magazine, found some interesting facts when he looked.

For example, he discovered that one member of FMCSA’s Medical Review Board is an executive committee member and board member of the National Sleep Foundation. The National Sleep Foundation is funded largely by drug companies, and also receives funds from CPAP manufacturers.

Gee, do you think that person might have a vested interest in hundreds of thousands of truckers being required to undergo sleep testing – which would be performed by companies represented by the National Sleep Foundation – and being required to buy machines – which would be provided by the CPAP manufacturers?

So here’s the upshot. I’m with those who say we need to treat apnea seriously. But I’m not in favor of forcing people into unneeded medical tests. And I’m not into forcing hundreds of thousands of truckers who don’t have medical insurance to have to pay for those tests out of their own pocket, or give up their livelihoods.

Let’s let doctors who know their patients decide what testing is necessary. That’s the way it is now, and that’s the way it ought to be.