This Opinion piece appears in the May 4 print edition of Transport Topics. Click here to subscribe today.
By John Letter
President and Chief Operating Officer
and Dr. Jeffrey F. Durmer
Co-Founder and Chief Medical Officer
When you think of technological innovation in the world of transportation, images of automated stabilization, obstacle-avoidance systems, telematics and a number of efficiency advancements come to mind. What may surprise you is that there is a new field of technology emerging that has nothing to do with the mechanical and everything to do with the biological.
Human factors are a major area of study that focuses on controlling variables to develop safer, more reliable and more cost-effective transportation. The ability of a person to control a vehicle is dependent on a number of key human variables. One of these is situational awareness, which is the ability of a person to not only be aware of his surroundings but also properly adjust and react to changes in the environment. Time required for a particular task, the vigilance and experience needed to perform that task, and the medical and emotional state of the individual have an impact on situational awareness.
Alertness-detection technologies are available in many vehicles and include pilot cameras, pupil and eyelid detection systems, automatic driver-position detection devices and dashboard brake reminders. Having the ability to detect the effects of drowsiness behind the wheel can help to mitigate human error and accidents, but they are only as good as the driver’s ability to react.
New prediction-based technologies such as the multivariate prediction models are being used to improve alertness by identifying individuals with inadequate and/or unhealthy sleep. By managing sleep conditions before a driver enters a vehicle, the human factor of situational awareness can be maximized and fatigue minimized.
The most important determinant of fatigue is sleep quality, quantity and timing. Telehealth programs are deployed via mobile medical technologies to detect these sleep variables, which a number of technologically engaged transportation companies already are employing.
By comparison, the typical non-telehealth delivery of sleep health care requires a professional driver and his or her company to navigate a multistep process to arrive at an acceptable treatment. This usually starts when a driver is informed by a certified medical examiner that he or she is at risk for obstructive sleep apnea. The driver then needs to make an appointment with his or her physician to be referred to a sleep specialist for an overnight sleep laboratory test, called a polysomnogram. After the sleep test, the driver may be required to have an additional night of testing to prescribe a treatment — typically a positive airway pressure, or PAP, device. Finally, the driver needs to use PAP therapy for a specified period of time — usually two to four weeks — to download data that demonstrate acceptable use and control of sleep apnea before a one-year fitness-for-duty card can be issued. Scheduling and completing these steps can take between two and six months, depending on the availability of care providers and the outcomes of testing and treatment.
Employees in Web-enabled programs receive significant operational benefits when compared with traditional scenarios. The ability to provide all elements of care using a sleep telehealth approach can result in completing the diagnosis and treatment of obstructive sleep apnea in a single 12- to 18-hour period. In addition, some telehealth platform programs can receive and manage daily PAP treatment data directly through a wireless network. Using treatment data, medical algorithms and behavioral coaching, drivers can fulfill fitness-for-duty certification requirements under medical supervision while they are on the road during the first few weeks of treatment.
The ability to access specialty care quickly and provide proper treatment remotely are key efficiencies that new health-care technology provides for the transportation industry.
To further illustrate the benefits of this technology and care advancement, outcomes from streamlined sleep telehealth programs demonstrate reductions in accidents up to 45% per year, health-care costs by 5% to 22% per year, and increased retention of highly skilled drivers up to 98% over multiple years.
Luckily, sleep health is recognized by U.S. national health agencies as a way to prevent and reduce many chronic diseases, eliminate unnecessary health-care costs, maintain physical and mental wellness, and manage the safety risks associated with situational awareness and alertness.
The Center for Disease Control and Prevention recently defined four specific sleep-health goals in its 2020 Healthy People initiative for the United States. The first two goals include increasing the identification of people with obstructive sleep apnea and reducing the number of accidents caused by drowsy driving. These public health goals underscore the importance of human factors in transportation, especially the need to improve sleep conditions and to address the risks posed by common sleep disorders.
U.S. population estimates show that 18 million to 20 million adults suffer with sleep apnea, 60 million have chronic or persistent insomnia and 12 million are impacted by Restless Legs Syndrome. This is why the newest technological advances in transportation are focused on variables that affect human sleep, fatigue and reduced situational awareness.
As the transportation industry becomes more technologically advanced, reliance on highly skilled people behind the wheel will increase. The future of technology to mitigate the potential risk of fatigue due to poor sleep is not only possible, it is here — and all those who rely on a healthy transportation industry will benefit.
FusionHealth provides sleep health solutions aimed at improving wellness, employee engagement and bottom-line performance.