Al Bensusen’s license plate reads CPAPMAN. Bensusen doesn’t suffer from sleep apnea. He doesn’t need a continuous positive airway pressure machine to keep him breathing while asleep.
But since his early research days at Stanford University’s pioneering Center for Sleep Science and Medicine, Kern County native Bensusen has embarked on a lifelong crusade to find and help the millions of Americans who have sleep apnea.
The owner of Sandman Sleep Lab in Bakersfield, Bensusen operates one of the hundreds of labs in the U.S. that tests and treats people with potentially life-threatening sleep apnea.
Sleep apnea involves interrupted breathing. In rare cases, the interruptions are caused by neurological factors. But most commonly, breathing is interrupted when throat muscles relax and block the airways during sleep. This is referred to as obstructive sleep apnea.
Severe sleep apnea generally is diagnosed when sleep is interrupted 30 times in an hour. But Bensusen said he has seen patients gasping for air 120 to 150 times an hour. During these episodes, patients’ oxygen levels decline and their sleep is interrupted. After spending restless nights, they awaken with dry mouths, irritability and fatigue.
Although sleep apnea is generally associated with loud snoring, it is often called a “silent killer” because of its stealth association with so many fatal illnesses and workplace risks.
Bensusen explained that sleep disorders — the inability to sleep or constantly waking up — were originally treated as psychiatric disorders. But in the 1960s and 1970s, Stanford University researcher Dr. William Dement, who is credited as being the father of sleep medicine, identified physiological causes and links to a wide range of physical disorders and diseases.
After leaving Stanford University, Bensusen returned to Bakersfield, opened Sandman Sleep Lab and focused on educating local doctors, including student doctors at Kern Medical, about the dangers of sleep apnea and how to identify and treat the disorder. Physicians specializing in pulmonary diseases are now the leading sleep apnea experts.
“Starting out years ago, there were about 10 ailments that were said to be linked to sleep apnea,” said Bensusen. “Today, it takes me an extra hour just to cover all the links that are so broad.”
In addition to being associated with such scary fatal events, such as heart attacks and strokes, sleep apnea is considered a contributing cause in many chronic conditions, including diabetes, high blood pressure, dementia, a variety of digestive problems and even nighttime grinding of teeth.
The significant link between sleep apnea and congestive heart failure results from the stress that interrupted sleep places on the heart. Researchers have discovered that both men and women who have obstructive sleep apnea are more likely to have enlarged walls in the heart’s left ventricle — the chamber of the heart that pumps blood through the body. This forces the heart to work harder, which in turn increases the risk for heart disease.
“More than 54 million adults in the United States have sleep apnea, with more than 80 percent undiagnosed or untreated,” said Randy Thinnes, director of occupational health programs at ResMed, an international manufacturer of CPAP and other therapy systems that is headquartered in San Diego.
ResMed is cooperating with many health care organizations to research the disorder and develop innovative and convenient treatments. The research has found 83 percent of people with drug-resistant high blood pressure also have sleep apnea, as does 77 percent with obesity, 76 percent with congestive heart failure and 72 percent with Type 2 diabetes.
“Sleep apnea is increasingly linked to tragic events, like two train derailments in the New York metro area, as well as the deaths of notable figures, like actress Carrie Fisher and Supreme Court Justice Antonin Scalia,” said Thinnes.
According to the National Transportation Safety Board, obstructive sleep apnea has been cited as a proximate cause or contributing factor in the probable cause of 13 highway crashes and rail accidents that combined have killed 50 people and injured 373 others since 2000.
“Sleep apnea has been proven to be a high-cost chronic condition where untreated adults utilize twice the cost of medical spending than those who have been diagnosed and effectively treated,” said Thinnes.
“With the constant changes in health care, especially higher deductibles and increased cost of care, providers and self-funded employer groups utilizing claims data have identified ‘addressing sleep apnea’ as low-hanging fruit for producing cost savings by proactively engaging in the education, identification and treatment of those effected,” said Thinnes.
For the past several years, the National Transportation Safety Board and other agencies have identified the need to test and treat workers in critical industries — particularly transportation industries — who suffer from sleep apnea and pose safety risks.
A study by the University of Pennsylvania and sponsored by the Federal Motor Carrier Safety Administration and American Transportation Research Institute concluded that about 28 percent of commercial truck drivers suffer from mild to severe sleep apnea.
Since 2001, the NTSB has recommended screening employees in safety-sensitive positions for sleep apnea.
In 2016, federal agencies began a rule-making process titled “Evaluation of Safety Sensitive Personnel for Moderate-to-Severe Obstructive Sleep Apnea.” The public was invited to comment on the cost and benefits of requiring motor carrier and rail transportation workers to be evaluated and treated for obstructive sleep apnea. A similar proposal was suggested for aviation employees, such as pilots.
But with the incoming Trump administration’s focus on eliminating regulations, rather than adding them, the effort to require testing and treatment of workers for sleep apnea was abandoned in 2017.
While some safety advocates are discouraged by the move, Bakersfield sleep expert Bensusen is less concerned.
The Trump administration may “no longer require some industries to mandate sleep apnea testing and treatment,” Bensusen said. “But the final say will be with the insurance companies that rule the world.”
With increasing evidence that sleep apnea is causing companies to lose money from decreased worker productivity and increased healthcare cost, and that sleep-deprived workers are safety risks, insurance companies will demand the testing and treatment of workers in a wider range of industries.