By Brenda Flanagan
Correspondent
A diagnosis of this truck driver’s sleep patterns shows he’s gasping for breath all night long. The driver bedded down here for a sleep apnea screening, at Saint Peter’s Center for Sleep and Breathing Disorders, where patients get wired up before they doze off. Red lines on the graph repeatedly signal serious trouble.
“In this two minutes of data, he has a 16-second apnea and a 25-second apnea. He’s having basically more than one a minute, which is more than severe. He’s not breathing for over 30 seconds,” said Polysomnigram Technologist Darious Uknuis.
“If you’re sleep deprived, you’re not going to be safe behind the wheel,” said Dr. Ashgan Elshinawy.
Elshinawy read about the fatal Hoboken train crash that killed one and injured more than 100 passengers. NJ Transit engineer Tom Gallagher suffered from undiagnosed sleep apnea, according to his attorney. The NTSB interviewed Gallagher.
“The engineer says he has no memory of the accident. He remembers waking up on the floor of the cab,” said NTSB Vice Chairman Bella Dinh-Zarr shortly after the crash.
“What happens is, your brain literally just shuts down for a few seconds. It goes into what’s called a stage one sleep, usually,” Elshinawy said.
Investigators found undiagnosed sleep apnea was also a factor in the 2013 Metro-North train crash that left four dead. The NTSB has reported “…fatigue is prevalent throughout the railroad workforce, especially in train crews that are not on fixed work schedules.” It’s repeatedly recommended “…that the FRA require railroads to medically screen employees in safety-sensitive positions for sleep apnea and other sleep disorders.”
“We’ve known about this for so many years. Why are we not addressing it yet?” asked Elshinawy.
The FRA issued no mandates but promised to issue safety advisories “in the coming days,” and urged, “ …railroads should not, and do not, need to wait to take action.”
Here’s the question: at what point can someone with sleep apnea safely return to work, whether it’s driving a cab or a train? What should regulators require?
Metro-North screens for sleep apnea and lets workers under treatment return to duty. NJ Transit says it’s had a similar policy since 2005, but after the Hoboken crash, the Jersey agency revised its rules. Now workers with sleep apnea “…are declared not fit for duty and will only be reinstated in their craft if they get the appropriate certification attesting to the satisfactory correction or control of any existing abnormality.”
“So it’s kind of a big responsibility for that physician and shouldn’t be taken lightly,” Elshinawy said.
In other words, it’s not enough to say I’ve been diagnosed and I’m in treatment?
“No. And the people that hire these individuals also should be responsible to make sure they are following up with their physicians,” Elshinawy said.
The gold standard for treatment is a breathing machine that keeps a sleeper’s airway open with positive pressure and those machines let sleep specialists electronically monitor patient progress and compliance. Elshinawy says she’s not just certifying the pilot or the engineer for duty.
“I’m taking responsibility for everybody they are responsible for,” she said.
Basically, every passenger they convey.