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The Cardinal Manifestations of Sleep Disorders. Andrew Mouton, PhD, D.ABSM, CBSM Associates in Sleep Medicine, LLC The Center for Sleep Medicine Chicago, IL. Associates in Sleep Medicine, LLC. 14 member sleep medicine practice multidisciplinary (medicine, behavioral health, dentistry)

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the cardinal manifestations of sleep disorders

The Cardinal Manifestations of Sleep Disorders

Andrew Mouton, PhD, D.ABSM, CBSM

Associates in Sleep Medicine, LLC

The Center for Sleep Medicine

Chicago, IL

associates in sleep medicine llc
Associates in Sleep Medicine, LLC
  • 14 member sleep medicine practice
    • multidisciplinary (medicine, behavioral health, dentistry)
    • multispecialty (pulmonology, neurology, psychiatry, internal medicine, pediatrics)
    • 40 beds in 7 AASM accredited centers
    • 7,000 sleep studies per year

Associates in Sleep Medicine

slide3
Illinois Trucking Association

Mid-West Truckers Association, Inc.

1. seminars for associate members

2. provide educational materials

3. attend monthly safety meetings

Associates in Sleep Medicine

350 member companies
350 member companies
  • Small carriers
    • Utilize owner/operators as independent contractors
    • Aware of risks associated with fatigue/sleepiness
    • Awaiting regulations from FMCSA
    • No insurance plan
    • Owner/operators unable to afford cost of screening/diagnosis/treatment

Associates in Sleep Medicine

350 member companies5
350 member companies
  • Large carriers
    • Very aware of costs/dangers associated with fatigue/sleepiness
    • May have fatigue management program in place
    • Not waiting for specific guidelines from FMCSA
    • Have insurance/money to fund program

Associates in Sleep Medicine

archer daniels midland co
Archer Daniels Midland Co.
  • Obstructive Sleep Apnea program
    • Educational materials
    • Screening by occupational medicine
    • Encourage drivers to self-identify
      • 100% insurance coverage for testing/treatment
      • Paid for testing period

Associates in Sleep Medicine

archer daniels midland co7
Archer Daniels Midland Co.
  • Assessment/diagnosis/treatment of non-apnea sleep disorders
    • ASM collaboration with EAP
    • Coverage at 100% for up to five visits
    • Behavioral Sleep Medicine focus

Associates in Sleep Medicine

kenan advantage group inc
Kenan Advantage Group, Inc.
  • One of the largest tank truck/hazmat carriers
  • 7500 Drivers

Plan:

All drivers evaluated by a sleep medicine specialist

Why?

Associates in Sleep Medicine

june 26 th 2009 miami ok
June 26th, 2009Miami, OK
  • Commercial truck driver going 69 mph
  • Cruise control on
  • Hit 6 vehicles
  • 10 lives lost
  • 5 injured

Associates in Sleep Medicine

ntsb findings
NTSB Findings
  • “the driver’s fatigue, caused by the combined effects of acute sleep loss, circadian disruption associated with his shift work schedule, and mild sleep apnea, which resulted in the driver’s failure to react to slowing and stopped traffic ahead”

Deborah Hersman

NTSB Board Chairperson

Associates in Sleep Medicine

fatigue caused by
Acute sleep loss

Circadian disruption associates with shift work schedule

Mild sleep apnea

Insufficient sleep syndrome

Shift work sleep disorder

Sleep apnea

Fatigue caused by:

Associates in Sleep Medicine

policy implications
Policy implications:
  • “develop standard medical exam to screen for sleep disorders and require its use”

Hon. Mark Rosekind, PhD

NTSB member

Associates in Sleep Medicine

cardinal manifestations of sleep disorders
Cardinal manifestations of sleep disorders:
  • Insomnia
    • Difficulty falling asleep
    • Frequent awakenings
  • Hypersomnia
    • Excessive daytime sleepiness
    • Sleep at inappropriate times/places
  • Unusual sleep behaviors

Associates in Sleep Medicine

what if a driver screens positive
What if a driver screens positive?
  • 391.41(b)(5)
    • A person is physically qualified to drive a commercial motor vehicle if that person:

Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with the ability to control and drive a commercial motor vehicle safely.

Since a driver must be alert at all times, any change in his or her mental state is in direct conflict with highway safety. Even the slightest impairment in respiratory function under emergency conditions may be detrimental to safe driving.

There are many conditions that interfere with oxygen exchange and may result in incapacitation, including emphysema, chronic asthma, carcinoma, tuberculosis, chronic bronchitis and sleep apnea. If the medical examiner detects a respiratory dysfunction, that in any way is likely to interfere with the driver’s ability to safely control and drive a commercial motor vehicle, the driver must be referred to a specialist for further evaluation and therapy.

Associates in Sleep Medicine

for sleep disorders
For sleep disorders:
  • A person is physically qualified to drive a commercial motor vehicle if that person:

Has no established medical history or clinical diagnosis of a sleep disorder likely to interfere with the ability to control and drive a commercial motor vehicle safely.

Since a driver must be alert at all times, any change in his or her mental state is in direct conflict with highway safety. Even the slightest impairment in alertness under emergency conditions may be detrimental to safe driving.

There are many conditions that interfere with alertness and may result in incapacitation, including insomnia, circadian rhythm disorders, sleep apnea, narcolepsy, and hypersomnia. If the medical examiner detects a sleep disorder, that in any way is likely to interfere with the driver’s ability to safely control and drive a commercial motor vehicle, the driver must be referred to a specialist for further evaluation and therapy

Associates in Sleep Medicine

slide16
“the driver must be referred to a specialist for further evaluation and therapy”

Associates in Sleep Medicine

advantages
Advantages:
  • Allows for comprehensive evaluation of all sleep disorders
  • Meets standard of care in sleep medicine
  • Cost effective
    • Many sleep problems don’t require testing
    • Testing performed only when indicated following comprehensive sleep evaluation

Associates in Sleep Medicine

drawbacks
Drawbacks?
  • Are there enough sleep specialists?
    • 72 ACGME accredited sleep medicine fellowships
    • 2700 physicians certified in first two sleep board examination cycles
    • 3445 specialists credentialed by ABSM

Associates in Sleep Medicine

will it cost too much
Will it cost too much?
  • 2011 Medicare reimbursement:
    • 99204 $169.07*
    • 99214 $110.08*
    • 95810 $734.78*
    • 95811 $792.80*

* 2011, Cook County, IL

Associates in Sleep Medicine