Sleep Disorders + Shift Work = Danger

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NTSB investigators retrieve an event recorder from the derailed Metro-North train in the Bronx.

The sleep disorder known as sleep apnea is a problem across the transportation industry, not just for the engineer at the controls during Metro-North's fatal derailment in December. But sleep problems may be endemic to the job.

The most-likely sufferers of sleep apnea—a chronic condition which disrupts sleep—are overweight, middle-aged men with big necks.

Basically, "any male who has a collar size greater than 16 inches," said Dr. Michael Thorpy, the director of the Sleep-Wake Disorders Center at Montefiore Medical Center.

Combine sleep apnea with a schedule that changes often, and you are laying the table for daytime drowsiness.

"If you've got somebody in the transportation industry who has the combination of an underlying sleep disorder and has a variable sleep pattern related to work shifts, that's a very bad combination," said Thorpy. "Transportation workers who are responsible for the lives of others need to be evaluated as to whether they have any underlying sleep disorders."

While both the Federal Aviation Administration and the Federal Motor Carrier Safety Administration (which regulates bus and truck drivers) have regulatory guidance in place to deal with sleep apnea, that's a work in progress at the Federal Railroad Administration.

Kevin Thompson, an administrator at the FRA, said the agency is working on rules dealing with fatigue management.

"We have taken a variety of steps to combat worker fatigue, including amending the hours of service regulations to provide rail workers with maximum on-duty periods and consecutive-days limitations; requiring the use of fatigue management tools to analyze worker schedules; and establishing the Railroaders Guide to Healthy Sleep website, in partnership with Harvard University’s School of Medicine," Thompson said. "We expect to issue a proposed rule in the near future on the adoption of Risk Reduction Programs by passenger railroads, which would require fatigue management plans that address medical conditions including sleep apnea and other sleep disorders.”

"I'm dealing with problems all the time," said Thorpy, who pointed out that sleepiness is a major factor in car crashes as well. Even if you don't feel lack of sleep is an issue with your driving, Thorpy has a warning: daytime drowsiness of any kind isn't normal.

"No. No," he said. "Normal is having one-third of the night in sleep and two-thirds of day being awake. People that can fall asleep easily during the daytime, there has to be a reason."