New Program Offers Free CPAP Equipment for Commercial Drivers
The issue of sleep apnea screenings has been controversial among commercial drivers, but new programs are making treatment easier and more accessible by providing quality PAP-therapy equipment free of charge. For those who are diagnosed with the disorder, full insurance coverage for therapy devices, as well as continued follow-up treatment, help to increase adherence and improve overall health and quality of life. And by treating sleep apnea proactively, the programs can not only cut costs on insurance premiums, but also reduce the number of accidents caused by sleepy drivers, saving lives as well as money. As a model approach to the problem of undiagnosed sleep apnea, these programs make standardized testing less of a burden on drivers, while at the same time saving costs for carriers in the long term.
A Model Program for the Industry
Freight company Schneider initiated the first program of its kind when in 2006, it became the subject of a study led by the University of Minnesota, Morris. The study tested the effects of using a mandatory sleep apnea screening system over time, finding that the rate of serious, preventable crashes was five times higher among drivers who did not adhere to the program’s mandated treatment.
The Schneider program requires all new driver employees to be screened for sleep apnea, without exception. Those diagnosed with the disorder have the costs of treatment covered by the company’s health insurance program. As a result, thousands of drivers were given free CPAP (or APAP) machines. Over the next 12 years, the study documented an estimated $441 in monthly medical insurance savings not related to the sleep apnea condition. The savings are even higher if other factors such as the costs of accidents are considered as well. In addition, likely comorbid conditions such as hypertension, cardiovascular disease, depression, insomnia, diabetes, and obesity tend to escalate in the absence of treatment protocols.
Using mandatory screening with full coverage for PAP therapy treatment made Schneider the first large-scale employer to address the issue of treatment adherence among commercial drivers, resulting in substantial reductions in both sleep apnea and non-sleep apnea-related medical insurance claim costs. In fact, these reductions in costs were evident within a year of the program’s launch, giving the National Sleep Foundation (NSF) incentive to offer a Healthy Sleep Community Award for its innovative approach to an ongoing problem in public health and safety.
Current Laws and Policies
There are currently no laws requiring commercial drivers to be screened for sleep apnea, but the Department of Transportation (DOT) does, however, require a standard physical examination for a commercial driver’s license (CDL) application or renewal, as well as for DOT medical cards. It’s essentially up to the medical practitioner to determine whether or not an applicant exhibits any risk factors for sleep apnea. If diagnosed, the applicant must then be treated for the condition in order to qualify for a commercial license. This is known as “medically-qualified-to-drive” status. An individual with a condition that could interfere with driving cannot be qualified without proper treatment and follow-up. The Federal Motor Carriers Safety Administration (FMCSA) has determined that moderate to severe sleep apnea interferes with safe driving and must be treated. Following treatment and approval by a qualified medical examiner, an applicant with a sleep apnea diagnosis can then reapply for a commercial driver’s license. While this system provides incentives for sleep apnea treatment, there are costs and other burdens that may have a negative effect on the individual seeking employment or attempting to renew a previously issued license. Company programs like the one at Schnieder provide further incentives by emphasizing its positive impact on safety and finances. When applicants understand that sleep apnea screening is a routine part of the application process, they are less likely to see the policy as overly intrusive or demanding.
The Cost of Untreated Drivers
According to the National Highway Traffic Safety Administration, drowsy driving causes lapses of attention and slows reaction time, which makes accidents more likely to occur. Studies supported by the FMCSA show that, given the odds deduced by recent accident meta-analyses, untreated drivers with sleep apnea syndromes may be expected to incur an additional $8,200 a year in average company costs. Given the high number of drivers with sleep apnea (17 to 28 percent), these costs add up to an estimated $2.4 billion a year when drivers are left unscreened.
On the other hand, when PAP therapy is implemented, steering performance and reaction time are almost immediately improved, leading not only to savings for the company, but also saving lives, as the reduction of accidents and improved health of drivers lead to a range of benefits that increase over time. The majority of research in this area has consistently shown that the benefits of screening and other incentives for sleep apnea testing and treatment far outweigh the perceived costs, often leading to increases in productivity for the company, and a higher quality of life for all employees involved.
A Free and Mandatory Compromise
The program at Schneider has inspired other freight companies to implement similar incentives for the screening and treatment of sleep apnea, including some smaller carriers. According to the study, medical insurance firms are looking into ways to lower net costs by offering companies of any size a quid-pro-quo reduction in premiums as long as the screening, diagnosis, and treatment of sleep apnea is mandatory. In time, providers and their company partners hope to reduce employee resistance to standardized sleep apnea screenings by making the results of a diagnosis cheaper and easier to take care of. By emphasizing the benefits over the costs, the programs become a win-win for companies and employees alike, improving sleep and health for drivers while reducing the chances of costly accidents, and as long as the adherence lasts, providing continued insurance premium savings.
Accident Analysis and Prevention – www.ncbi.nlm.nih.gov/pmc/articles/PMC3506009/
American Sleep Association – www.sleepassociation.org/sleep-news/truck-drivers-obstructive-sleep-apnea-dot-screening/
Thorax – www.ncbi.nlm.nih.gov/pubmed/10679542
U.S. Department of Transportation – www.transportation.gov/odapc/faq