I foresee a series of adjustments in the standards for compliance and treatment, and even in the diagnostics. There is a lot of me-tooing in the industry and medical community about sleep apnea, and a dismayingly large range of quality of care resulting from assessment, measurement, interpretation, treatment, and then follow-up for those who lose weight, have other conditions ameliorated over time, or who worsen for some reason. It's all over the place, and probably mostly driven by insurance industry standards. For example, some insurance schemes require the full polysomnography and a least 30 days of titration results with a set minimum compliance level. Some will give permission for, and will reimburse subsequent CPAP equipment purchases, only after an in-home overnight oximetry.
Business could use more systems-thinking in their decision-making. Few people can, or elect to, think in those terms when dealing with human factors.
PS- Do robots develop sleep apnea?
All of the other issues you raise are valid concerns that contribute to fatigue, however, if you have to deal with all those issues and you have moderate to severe sleep apnea, you are a safety risk to yourself and others. The compliance standard is a minimum of four hours per night, 70% of days. In other words, four hours per night in 7 out of ten days. Not a difficult standard to meet. Railroads are required by the 2008 Rail Safety Improvement Act to address those other factors, but FRA has dropped the ball on that as well. Bottom line, have run trains myself, I do not want to be out there meeting trains on single track or CTC territory who have moderate to severe sleep apnea.
selector azrail OSA is related to body weight. We seem to be getting fatter thus more cases of sleep apnea. Yet, here is one instance where the chicken/egg paradox is very much to the fore. Does weight gain necessarily raise one's measurable AHI (apnea/hypopnea incidence/hr)? No. Can it? Yes. Does apnea, in all its varieties, lead to weight gain? No. Can it? Yes. Just like it can lead to kidney disease, heart arrhythmias, hypertension, and so on. There is a strong correlation, but not a definitively causal relationship between each of these, not one with compelling and replicated empirical evidence. In fact, much of the evidence people refer to is of the 'post hoc' kind, and that kind has problems far to often.
azrail OSA is related to body weight. We seem to be getting fatter thus more cases of sleep apnea.
OSA is related to body weight. We seem to be getting fatter thus more cases of sleep apnea.
Yet, here is one instance where the chicken/egg paradox is very much to the fore. Does weight gain necessarily raise one's measurable AHI (apnea/hypopnea incidence/hr)? No. Can it? Yes.
Does apnea, in all its varieties, lead to weight gain? No. Can it? Yes. Just like it can lead to kidney disease, heart arrhythmias, hypertension, and so on.
There is a strong correlation, but not a definitively causal relationship between each of these, not one with compelling and replicated empirical evidence. In fact, much of the evidence people refer to is of the 'post hoc' kind, and that kind has problems far to often.
Correlation Does Not Imply Causation as the cliche goes, which is mostly true. On the other hand, one can examine causation beyond experimental designs by using more sophisticated designs and stats, such as LISREL. Hill's Criteria is used in medical research, for example.
Tell that to a relative of mine, he is skinny as a rail, and has severe sleep apnea.......
It doesn't just affect us fat people........
Randy Vos
"Ever have one of those days where you couldn't hit the ground with your hat??" - Waylon Jennings
"May the Lord take a liking to you and blow you up, real good" - SCTV
For those diagnosed with sleep apnea and using the CPAP machine, our railroad requires documentation that the employee uses it at least 70% of the time. Otherwise, you'll be pulled from service.
I'm sure the railroads love the idea that the problem with fatigue is undiagnosed sleep apne among their employees. It moves the focus away from line ups where you expect to go to work around one time, only to have the actual call move up, or back, 8 to 12 hours. Better yet, have line ups with ghost trains. Symbols that don't have power or cars assigned that are towards the top while active trains that are close are buried way down the list. Or maybe don't even show up on the line up and are called out of the blue.
Even if the line ups are fairly decent, there's also the issue of not properly staffing extra boards, pool assigned employees are forced off their regular assignment for a vacancy in the yard or other extra board protected job, the only notice being the phone ringing unexpectedly.
What are they going to blame for fatigue when they get everyone who meets the criteria hooked up to the machine? I'm sure they will still find some way to blame it on the employee.
Jeff
PS. I just noticed in my home terminal a vacancy on the midnight yard engine, bulletined for 5 days. So for about the next 5 to 6 days I have to watch the extra board to see if they'll be someone to take the vacancy or will they start forcing the 1st out pool employee, and where I'm at on my pool board.
If it's a problem, it deserves a solution. The question is, is it the top problem?
From the post in the #2 thread, eleven deaths have been attributed to OSA in the past 17 years. I can't find SOFA data in the time I have available right now, but I submit that more railroaders may have been killed in switching accidents in that time.
There is also the overall fatigue factor - the irregular (at best) schedules of mainline railroading are a contributor to the problem, as attested by many here in the past.
Perhaps the biggest factor is simply cost. Someone has to pay for these tests, and the resulting treatment thereof.
Resmed.com provides the following information:
resmed.com ■ 1 in 5 adults has mild OSA ■ 1 in 15 has moderate to severe OSA ■ 9% of middle-aged women and 25% of middle-aged men suffer from OSA
■ 1 in 5 adults has mild OSA
■ 1 in 15 has moderate to severe OSA
■ 9% of middle-aged women and 25% of middle-aged men suffer from OSA
Faced with the possibility that between a fifth and a quarter of your crewmembers may have OSA, and one in fifteen may have a severe case, that potentially puts a heck of a strain on your manpower pool.
The cost to mitigate the issue may well exceed the costs accrued because of it.
Larry Resident Microferroequinologist (at least at my house) Everyone goes home; Safety begins with you My Opinion. Standard Disclaimers Apply. No Expiration Date Come ride the rails with me! There's one thing about humility - the moment you think you've got it, you've lost it...
I LOVE my CPAP machine! No more migraine headaches in the morning.
Semper Vaporo
Pkgs.
A few thoughts:
Pilots even suspected of having sleep apnea (three different kinds) must have a wakefulness test. It's a long, boring test that encourages the loafing mind to drop off. If one does drop off.......
The trucking industry is starting to come to terms with sleep apnea. The rails, if they aren't currently, will soon follow.
I was fully asymptomatic. Or thought I was. I was on the phone to Revenue Canada last summer and felt my heart flutter. An hour later, still fluttering, I was hooked up in emerg. Diagnosis was paroxysmal atrial fibrillation.
Over the next four months I underwent many forms of imaging, including MIBI stress test (you can look it up), echo cardiogram, and x-ray. They were all very positive...I mean encouraging. Whew. Cardiologist says, okay, now the last thing is to put you through a sleep lab for a polysomnography. A month after that event, I went to see the psychiatrist/sleep specialist about the results where I learned that I have 'severe' sleep apnea. I had no daytime sleepiness, no falling asleep at red lights, no irritability (wife begs to differ), no headaches...just the AFib. "So," sez the shrink, " I guess we know why you have the AFib."
I am now five months into treatment with a straight PAP machine (no bi-level or expiration pressure support). I am also on apixaban and metoprolol for life.
We learn that truck/car drivers drive through a crosswalk and mow down several people, or they cross the centerline and cause a head-on, or they end up engine-first deep into a store or restaurant. When the investigation is complete, the person found lying on their back in the hotel room three hours past their appointment had not brought their CPAP machine and hadn't used it. They had slept poorly, or dangerously, perhaps the night prior to entering the hotel, and the night just past. This happens more than one might think. Ask the EMTs.
I won't go on, but this isn't a 'if you build it they will come' type of problem. This is an ethical way of dealing with a growing health problem. If you think treating cancer is expensive, ask a physician how costly atrial fibrillation is. You'll get an earful. Then ask the hospital administrator and co-pays how they feel about AFib.
If this goes forward, I don't believe that everyone will be diagnosed with OSA. But everyone will have to be tested if they work a nighshift. The testing is worrisome because a person's job is at stake. If I was in this position to be tested, I would not necessarily trust the diagnosis.
If there's big money to be made detecting and treating the condition, the regs will follow.
I don't mean to demean the condition - it surely exists - but if you're a hammer, everything looks like a nail. Next thing you know, everybody will be diagnosed with it.
When I was a kid, they were going to cure cancer in "our" lifetimes. Too many people are making money off treating it now to have that happen.
Who says we don't a regulation to prevent more train collisions and derailments caused by train crews with untreated obstructive sleep apnea (OSA)? It certainly isn't the public.
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