PHYSICIAN: TRUCKING MUST GET AT ROOT CAUSES OF FATIGUE

Mobile teams, analytics can boost sleep apnea care, sleep doctor contends
Fleets widely use uplinked data and analytics to optimize trucks' operation. Maybe it's time to apply the same formula to drivers' care to get more out of fatigue-fighting programs, one company argues.

"Companies can optimize their trucks — they can put in things like video cameras and lots of systems to help reduce risk and improve safety from the vehicle side of things," points out Dr. Jeffrey Durmer, co-founder of population sleep health program provider FusionHealth.

"But once a driver walks in and they're sleep-deprived to begin with, there's really nothing you can do," he adds.

Georgia-based FusionHealth offers its programs across the United States, and specifically for trucking, the primary target is sleep apnea. Durmer contends that many anti-driver fatigue programs don't address underlying causes of the problem and instead focus on making scheduling less onerous.
"A lot of fatigue management programs out there do a great job at optimizing shifts and scheduling — the timing of when someone will be at maximum performance — and that's great, as soon as you have a workforce that's rested.

"Until you have that, though, all those little tweaks don't really add up to much," he continues. FusionHealth's program, according to Durmer, is designed to get at a big root cause of driver fatigue by treating sleep apnea in particular.

Being a commercial truck driver is very demanding in that sleep-wake cycles can easily be thrown off, he says, building up fatigue and causing or exacerbating other health problems as well. "Drivers can be way off their sleep time, regardless of the regulations around hours of service," Durmer contends.

"You've got to take care of the human factor that's the underlying, core cause in the vast majority of people having fatigue," he explains. "Sleep apnea is so common in the truck driver population — we're really at a point where it's not about the technology in the vehicles, it's the human factor.

"It's about the drivers getting enough rest."
Not if; how much

People tend to think of sleep apnea as a problem for certain individuals, but guess what: we've all got it, Durmer points out.

"It's part of being human," he says. "We have this little kink in the back of our airway that's only held open by muscle tone because we walk on two feet, not four legs. We also have a vocal box that's very vibratory and very flexible."

Those factors together cause "a little bit of insufficiency" in any person's airway while he or she sleeps, according to Durmer. Having up to about five apneic events an hour while asleep is considered normal.

"So it's really not about having sleep apnea or not," he points out, "it's how much."

When a person experiences in the neighborhood of 10-15 apneic events or more per hour while sleeping, that's where you get into disease-causing, sleepiness-inducing apnea, he tells Fleet Owner. That higher level of sleep apnea is when there are too many disruptions in breathing for getting healthy sleep and the deeper, restorative rest that's needed.

There's a hereditary element at work, so a person is at greater risk for sleep apnea if snoring is common in the family. And being overweight also makes it worse, Durmer says: weight becomes another factor in that it can put additional pressure on airways, for instance.

With being overweight as prevalent as it is among the truck driver population, "there's the obvious need" for a better program to address the situation, he contends.
Data-driven mobile care model

With the history of the company and the population care delivery model it has now developed, you'll find there's actually some fusion in FusionHealth.

"We have a research background, but also a technology R&D background," Durmer explains. His partner and company co-founder, Sigurjon Kristjansson, once led a group of Icelandic and German engineers in developing the first device used to test people for sleep disorders outside of the laboratory setting.

Meanwhile, Durmer's background is in practicing sleep medicine, but at the same time he was always "really looking for ways to solve the larger problem of delivery of care," he says. Durmer notes that he and Kristjansson started FusionHealth drawing from those different angles of past experiences and taking on trucking companies "as our first line of research."

The FusionHealth delivery model for the sleep disorder breathing program is designed for much faster turnaround time, he says, and helps nearly all its patients keep to their treatment long-term — strikingly more so than with traditional sleep apnea diagnosis and treatment.

In the FusionHealth program, drivers first answer an online questionnaire to help determine their risk of sleep apnea. The next step is for those at-risk drivers to be tested, and that's where the program has some notable differences vs. traditional care.

Teams of FusionHealth physicians travel to the particular customer and might set up the testing in a hotel or other location that the fleet or trucking company wishes to use, essentially testing the drivers "wherever they are" rather than in a laboratory environment. Durmer likens the doc teams to mobile army surgical hospital — MASH — units made famous in the military and pop culture.

The drivers go through a physical exam and telemedicine components of the FusionHealth model and then are tested for sleep apnea. That includes wire leads stuck to their faces: FusionHealth uses the same testing technology Kristjansson's group developed just like would be done in a lab, only delivered on-location. When a driver wakes up after the test, he or she "can take off all the [test device] leads, jump in the shower and drop off the device the same place where they picked it up," says Durmer.

The device beams its data to FusionHealth sleep professionals, who determine if the driver has sleep apnea. If so, the driver might get a prescription and training for positive airway pressure (PAP) device treatment, and the company uses automatic PAP machines, or APAPs, that can adjust airway pressure as needed.

That's typically the point where with standard sleep apnea treatment, the patient hears something like, "Okay, good luck — I'll see you in a couple months," Durmer contends. However, the APAP devices drivers use with the FusionHealth program record and send data back for review each time they're used, and the drivers' relationship with the FusionHealth team continues.

"We can see if there's residual apnea or if the apnea has changed in some way," Durmer explains. "We can look at other things like pressure changes over the course of the night, position changes, air leaks or whether the driver is using [the APAP machine] the proper number of hours.

"We get that data through wireless networks all over the country," he continues. "Wherever the drivers go, data is uploaded whenever the driver wakes up from a major sleep episode."

The program allows FusionHealth to intervene as necessary if problems arise with a driver's treatment. For example, if a driver's allergies were to flare up suddenly and make it difficult to use the APAP machine, FusionHealth physicians can communicate with the driver to determine what's going on and could have a necessary prescription waiting at an pharmacy — perhaps even on at a truck stop, which sometimes is equipped with those facilities.

The ongoing relationship with drivers "has really changed the dynamic in terms of outcomes with PAP therapy when we put people into a care-managed sleep coach program," Durmer claims. Over some four or five years working with the telehealth care delivery model, FusionHealth has seen 96-97% long-term treatment compliance across its thousands of patients.

That's a significant figure. With traditional sleep apnea diagnosis and treatment, typically more than half of patients have stopped using their PAP machines after a year, Durmer says.
Costs and associated problems reduced

Beyond a higher compliance rate with treatment, the FusionHealth program can also save fleets money in terms of their overall sleep apnea and other health care costs, according to Durmer; the company uses a bundled billing approach that charges for care only when drivers actually get sleep apnea treatment.

But sleep apnea and fatigue can drive costs indirectly through things like preventable or more severe accidents. "The higher your risk for sleep apnea or the more severe the sleep apnea a person has tends to also predict more severe crashes and safety issues," Durmer tells Fleet Owner.

One FusionHealth client defined which of its accidents were "preventable," he says, and the client saw 68% and 75% fewer preventable accidents, respectively, in the first and second years after drivers were treated in the sleep disorder breathing program.

"They now do [the program] across their entire fleet, and in fact they're even looking at doing it with their non-driving employees because it has had major effects on productivity, health and well-being," Durmer contends.

Pittsburgh-based trucking company Pitt Ohio, another customer, finds that the FusionHealth program helps its drivers be better prepared before going in for necessary Dept. of Transportation exams and additionally says the follow-up with care is key. "FusionHealth has done a really good job being there and working with our drivers," says Jeff Mercadante, vice president of safety at Pitt Ohio.

"Before, our drivers would just go to a regular sleep center and they wouldn't get the care they're receiving now," he explains. "Drivers would have to schedule a sleep study, but now they don't have to because FusionHealth will come to us."

Once drivers are tested via the FusionHealth platform, it's a quick turnaround, according to Mercadante. "When a driver wakes up, if they have sleep apnea, FusionHealth will give them the report, give them a [PAP] device and show them how to use the machine. The driver will start using it that night or day," he says.

The FusionHealth care team's follow-up with drivers "helps them stay in compliance with the treatment," Mercadante adds. But the most telling bit of info is this: Does Pitt Ohio plan to keep using the FusionHealth service?

"We absolutely will continue to use it," Mercadante says. "Their operations team is on it, and they deliver a good product."

Rather than just some side issue, Durmer is clear in emphasizing that drivers getting proper rest — getting at the root cause of built-up fatigue, which he says is "a significant problem" in trucking — is a foundational health issue that connects with many other aspects of health and well-being.

"We've actually taken a lot of guys off medications over the course of time with their doctors," Durmer says. "We may find that the apnea we're treating has [in turn] reduced their hypertension or has treated their diabetes to the point where the medications are no longer needed or can be reduced." FusionHealth has also seen drivers losing excess weight and other positive effects come out of the program.

"This is about keeping guys on their therapy in an effective way," Durmer explains. "That reduces problems related to sleep apnea like cardiovascular disease as well as preventable accidents and the severity of accidents — we know that's pretty significant when it comes to fall-asleep driving accidents."
By Aaron Marsh
http://fleetowner.com/technology/physician-trucking-must-get-root-causes-fatigue?page=4

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