Sleep apnoea: tiredness kills
At 8.35am on 8 August 2006, 25-year-old Toby Tweddell was waiting in a traffic queue on his way to work in Merseyside. Moments later an articulated lorry collided with a series of vehicles and his car was shunted forward under the flatbed of a Ford Transit pick-up.
So great was the damage to his car, it took an hour for rescue services to release Toby from the car. He died five hours later in the operating theatre.
The lorry driver, 54-year-old Colin Wrighton, had fallen asleep at the wheel. But on 5 August 2008, the coroner returned a verdict of Accidental Death rather than Unlawful Killing. This is because Mr Wrighton suffers from sleep apnoea - which was undiagnosed at the time of the accident.
Following the inquest, the coroner took an usual step and issued a Rule 43 Report (links to PDF) to the Lord Chancellor, calling for changes in the way sleep apnoea amongst lorry drivers is dealt with.
Toby's uncle, Seb Schmoller, wrote to iPM inviting us to investigate. You can read the full story and coroner's report on Seb's blog.
Thanks for the emails and ideas you've sent in about sleep apnoea after we mentioned it on the programme. All thoughts are very welcome - leave a comment on the blog, or drop us a line.
On this week's iPM, we'll be talking to Toby's parents and also to the lorry driver, Colin Wrighton, and considering whether changes need to be made.
Our extended inteviews are available here. Click "more" to hear from other contributors.
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I do not understand. Sleep Apnoea is the problem of not breathing when asleep. I new a intrepid lone sailor that had the condition. They feel tired in the morning so know something is wrong.
Sleep Narcolepsy is when you do not know you are drowsy.
Still a tiny problem compared to mobile phones and other activities carried out by truck drivers. When a car passenger, try looking backwards at a truck as you pass! I have had some bad incidents with trucks. The closest was the 3 cars next to me, in a queue, were crushed on the M25. All I remember is the hundreds of pieces of plastic raining down on the car.
As for mobile phones I was at a crossing last Sunday and the queue of traffic stopped. I started to cross but the driver of a little car obviously did not see the crossing because they moved forward as the queue moved. Just missed me, but stopped next to me. And there in their right hand just below the window height was a mobile phone and a thumb rapidly texting.
The window was down, and I think I startled her!
Trucks should all have black boxes that are randomly inspected. Just a GPS, breaking load monitor, and rumble strip detectors would soon capture the ones that have problems. Very simple to build and no sensing connections necessary to the vehicle.
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As a sufferer from sleep apnoea, I partly agree with justfloating, inasmuch as it is a condition of heavy snoring and temporary cessation of breathing, rather than an actual cause of [sudden] sleep, such a narcolepsy. That said, extreme tiredness, especially in the mornings, can be as a direct result of apnoea.
I drive 60 miles to work in the morning, often fairly exhausted after a night's noisy non-sleep. Although I personally have never nodded off when tired - not even sitting in front of the television, much less driving - I am nonetheless aware of the risk at which my reduced awareness places other drivers and myself. I use energy drinks to combat this, but it is less than ideal. Perhaps, more than anything, I keep asking myself who else on the road with me is in my condition or worse.
That said, sleep apnoea is just one among many reasons for being tired at the wheel. Hangovers probably account for far more and those driving in this state are far more culpable.
The affects of apnoea can be managed using either a gum guard specially designed to hold the lower jaw in place (to stop it sinking backwards during sleep) or, more drastically, with a CPAP mask (Continuous Positive Air Pressire - an Oxygen mask, just pumping air, not Oxygen). I find the first of these works well, although it can be uncomfortable, which is why I often leave it out or spit it out unconsciously while asleep. My condition is not so advanced as to warrant the second.
As in all cases of tiredness, stop the car, get out, walk around it a few times (this works especially well in a January rain storm) and get back in. Regularly. It costs a few minutes. If you can't afford those minutes, you should have left earlier.
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I suffered from sleep apnoea - it frightened the life out of my wife - i'd stop breathing for quite long periods. I was diagnosed at a sleep Laboratory in Southampton. The cure was simple - lose weight. Basically a collar size of 17 plus makes you liable to have the condition.
I get tired driving - especially at the wheel, and I have fallen asleep briefly, so far without a bad result. It only happens on motorways - on ordinary roads it doesn't happen. The cure is simple - get off the road and have a nap. I don't think this has anything to do with sleep apnoea. - I just get rtired and bored on long journeys. I am better now at getting off the road before I fall asleep.
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That picture reminds me of the Atlantic City Expressway, which connects Atlantic City, New Jersey, to Philadelphia. They have a series of three yellow signs that read "Stay Alert," "Stay Awake." and "Stay Alive." It's a sobering reminder that people lose more than their spending money after a night of gambling in A.C.
For the edification of justfloating, I would like to share the following. Several years ago I was unable to stay alert during the day. I was all-but narcoleptic, fighting to keep my eyes open at work. Fortunately I was behind a desk, not a steering wheel. The worst risk I faced was sending my boss an email that said "aadjfhaljaaaaaaaaaa" (the tell-tale sign of sleeping on a keyboard).
The very first thing my doctor tested for was sleep apnoea. Sleeping is only restful for the body when you are actually breathing while doing it. If you aren't breathing, you are depriving your body of oxygen. This, in turn, leaves you unrested - even after a full night's "sleep". That's why the CPAP or mouthpiece are used; they keep oxygen flowing into the lungs.
In my case, it was not apnoea but chronic stress that caused my poor sleeping. Ever since my ex-wife left, I have been able to sleep soundly and stay alert all day long.
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Crashes are caused by trucks not stopping or wandering out of lanes.
The sleep apnoea is just an tool used in court.
So spending money on targeting a lawyer's tool is not going to help much.
Targeting the real causes means looking at the trucks as a whole unit. You will catch more problems for the same money spent.
As for coroners reporting a trend. Useful but far too late! Someone is already dead.
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Looking trucks "as a whole unit" is important, as justfloating proposes in his or her first post above:
"Trucks should all have black boxes that are randomly inspected. Just a GPS, breaking load monitor, and rumble strip detectors would soon capture the ones that have problems. Very simple to build and no sensing connections necessary to the vehicle."
and wakefulness/sleepiness detectors have already been developed, and their fitting to trucks could be made compulsory.
That said, the Coroner Sumner did more than "report a trend" following the inquest into my nephew's death. Coroner Sumner's Rule 43 Report to the Lord Chancellor, to which a formal response must be made by Government within 56 days, calls for changes in the way that sleep apnoea amongst lorry drivers is dealt with:
* regular medical screening for all lorry drivers;
* amendment of the DVLA Medical Examination Report form to improve identification of undiagnosed sufferers from Obstructive Sleep Apnoea;
* fast track medical assessment of commercial drivers involved in road traffic collisions;
* better education of all drivers on the dangers of tiredness when driving, in the same manner as drink-driving campaigns;
* better education of commercial drivers to make them aware that a diagnosis of OSA is almost certainly not the end of their livelihood as a driver.
However, overall what is lacking is a "safe systems of work" approach to the problem; and it is truck operators, owner drivers, and the manufacturers of trucks that need to provide it.
Unfortunately, at present, Government relies on a defective process for licensing drivers of Large Goods Vehicles, rather than on applying that safe systems of work approach.
The latter would need the involvement of the Health and Safety Executive, which could require (but never has required) action on this problem from truck operators (and from owner drivers) under Section 3 of the Health and Safety at Work Act.
For more on this, see this document (which contains the Coroner Sumner's Rule 43 Report in full, along with a comprehensive report to the Inquest by Dr Dev Banerjee):
http://preview.tinyurl.com/4d6a5r
Seb Schmoller
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Jack Semple of the Road Haulage Association is either ill-informed or being disingenuous.
Between October 2007 and February 2008 four cases went before the courts in the UK involving nine people being killed by lorry drivers who had fallen asleep at the wheel and who were later found to be suffering from obstructive sleep apnoea. (On 1 August 2005 Alice-Anne Fuge, Nestor Siles and Jessie McCann were killed on the A82 near Alexandria, Scotland. On 21 July 2006 Malcolm, Janice, Richard and George Dowling were killed on the A34, near Bicester. On 8 August 2006 my nephew Toby Tweddell was killed while waiting in a traffic queue at the M62 Rocket Interchange, Merseyside. On 14 April 2007 Leonard Nicholls was killed on the A48, Eastern Avenue, Cardiff.)
Furthermore there is substantial published scientific evidence, of which the Government is aware, that a sleep apnoea sufferer is more likely to suffer a road accident than a non-sufferer. (A sleep apnoea sufferers' performance is likely to be impaired as badly or even more seriously than that of someone who is over the legal limit with alcohol.)
The absence of any reference to sleep apnoea on the RHA web site is surely a sign that the road haulage industry has not got its act together on the problem of sleep apnoea amongst truck drivers, and that pressure now needs to be put on the industry to get the problem controlled.
Seb Schmoller
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I recently read this interesting, if slighty scary, description of obstructive sleep apnoea, and recommend it highly:
http://blog.360.yahoo.com/blog-TBPekxc1dLNy5DOloPfzVvFIVOWMB0li?p=264
And it's treatment:
http://blog.360.yahoo.com/blog-TBPekxc1dLNy5DOloPfzVvFIVOWMB0li?p=268
I'd also recommend his writing on programming, but I expect this is the wrong audience!
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The comment that 'justfloating' made (no.1) seems to have been largely ignored. Why? I've just heard Eddie hectoring the guy from the road haulage association as a result of what may have been a misunderstanding.
I believe sleep apnoea makes people stop breathing and wake up when they need to sleep at night. (I have a friend currently being tested for this condition and its effects are unpleasant.) They are therefore tired during the day and tiredness can cause road accidents. This tiredness is no different from any other tiredness, as far as I know, it's just the cause that's different.
The road haulage guy was trying to say that employers can see when people are tired, not that employers can diagnose sleep apnoea. I would hope that drivers can also tell when they're tired, no matter what the cause, so aren't apnoea sufferers as culpable as anyone else who drives when tired?
I don't know anything about sleep narcolepsy, but if it's what 'justfloating' describes then there would be more justification for finding out whether potential drivers suffer from this condition.
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Absolutely right, Vandyke. You've just taken the words out of my mouth. Eddie failed to get the point the road haulage guy was making.
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Why didn't PM interview anyone from the HSE or the Department of Transport? Surely they are the ones who can make changes here? And why the silly sound effects when we 'went back in time' to last week's item on a similar theme? The levity was inappropriate to introduce such a tragic and moving piece.
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I am a truck driver working in the container sector of the industry and I have suffered from sleep apnoea for the last ten years but I do not find sleepiness whilst driving to be a problem, this is because I underwent a sleep study at the sleep disorder unit at Papworth Hospital in Papworth Everard, Cambridgeshire, they are wonderful there, they set me up with a CPAP (Continuous Positive Airways Pressure)machine which I use every night both at home and in my truck, they supplied me with a 12volt addaptor for that very purpose, it work by blowing a continuous stream of air up my nose and thus keeps my airways open and the apnoea is therefore not a problem.
I would recommend that all HGV drivers consult their GP's with regard to having a sleep study done particularly if they are overweight, have a large collar size and if they smoke but most importantly if they snore, snoring is a particular symptom of sleep apnoea and the condition is controlable although it is also legally notifiable to the DVLA.
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I would like to say to justfloating that he/she needs to do some research into the subject of trucks before he/she says anything else derisive obout us drivers, most accidents involving trucks are acually caused by car drivers who cut in at the very last minute because they want to get off at the next junction or just because they are being pig headed and just hate trucks because they are slow and take up a lot of room on the road. I would like to point out to him/her that without trucks this country would grind to a halt, everything that he/she buys in a shop has arrived at that shop because at some point it has travelled on a truck, the petrol for his/her car was delivered to the filling station by a truck and the very car that he/she drives also arrived on a truck, the components used to make that car were delivered to the manufacturer on a truck, without trucks you would be stuffed. As for the standard of driving by truckers, Brtish truckers are amongst the safest in the world and by far the safest in Europe because the level of training required to pass the test is very strict and the test is no pushover either, I doubt if he/she would even be able to pass it because they have no idea as to the importance of our road hauliage industry and in my opinion that is a must. I am a resopnsible truck driver and as I said in an earlier posting, I suffer from sleep apnoea and have done for ten years, I notified the DVLA and as a result I have to have a medical examination every twelve months and now that I am over forty five I also have to have a mandatory medical every five years in order to keep both my HGV and my PSV licences so I would appreciate it if he/she would stop harping on and do some research into the subject, Most accidents involving lorries where the driver of the lorry is a fault involve foreign trucks not British trucks.
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