June 27, 2013

Sleep Center helps barge pilots stay on course

At the helm of a towboat navigating more than 20,000 tons of cargo down ever-shifting river channels, feeling sleepy is not an option for pilot Darrell Koontz.

The Vanderbilt Sleep Center is partnering with Ingram Barge Co. to provide sleep apnea screening, treatment and coaching to their employees. (photo by Joe Howell)

At the helm of a towboat navigating more than 20,000 tons of cargo down ever-shifting river channels, feeling sleepy is not an option for pilot Darrell Koontz.

“Normally there are eight other people besides myself on the boat, and I have their lives in my hands, not to mention other people on the water or on bridges,” said Koontz, a Paducah, Ky., native who pilots the M/V Daniel T. Martin for Ingram Barge Co.

Project coordinator Patience Bridges with towboat pilot Darrell Koontz.

Good sleep is essential for towboat captains and pilots, but there are many barriers. The job is not physically active, so fatigue sets in much faster. To mitigate that, they keep what is known as a “square watch” — six hours on, six hours off. But that means they need quality sleep during two different chunks of time, while also making time to eat, exercise and do chores like laundry. There is also the boat’s movement and noisy docking and loading to contend with restful sleep.

On top of that, workers in the transportation industry have disproportionately high incidence of sleep apnea, a disorder in which a person stops breathing for short periods of time while sleeping. In the general population, sleep apnea occurs in about 24 percent of adult males. For truck drivers, the estimate can be as high as 50 percent.

“By its nature, piloting towboats is sedentary,” explained Raghu Upender, M.D., medical director of the Vanderbilt Sleep Center. “When you add high calorie diet, limited opportunity for exercise and suboptimal sleep, there is high incidence of obesity in this population. Obesity is one of the major risk factors for sleep apnea.”

Knowing the high stakes and risks that come with this profession, Ingram Barge Co. partnered with the Vanderbilt Sleep Center to provide sleep apnea screening, treatment and coaching to their employees.

The program builds on a longtime partnership between Ingram Barge and the Vanderbilt Dayani Center, which provides health screenings and wellness programs. Much like airline pilots need health clearance to fly, towboat captains and pilots must meet certain health standards set by the U.S. Coast Guard (USCG).

The USCG once considered requiring sleep apnea screenings for all mariners with a body mass index (BMI) 40 or above, and although it hasn’t yet enacted those requirements, Ingram proceeded with the screening.

“Ingram has always been proactive with health matters,” said Dave Brown, vice president of Human Resources & Safety at Ingram Barge. “It’s really about taking care of your people. We’re doing the best we can to minimize fatigue and make sure our guys have a high level of vigilance and are at the top of their game.”

An initial cohort of 16 captains and pilots with BMI over 40 were given sleep studies, and all were diagnosed with sleep apnea.

The key to the program is its convenience. All the necessary consultations and sleep studies are scheduled over two days, a process that could take as long as 30 days for the average patient.

This is an example of the sleeping quarters typically found on a towboat.

“We work 28 days on the boat and then have 28 days off. Guys want to go home and be with their family and enjoy their time off. They don’t want to spend it all in Nashville at the doctor,” Koontz said.

Sleep apnea is treated with a continuous positive airway pressure (CPAP) machine, which uses a face mask to deliver mild pressure to keep the airway open, but patients often find it difficult to adjust to wearing it.

Patients in the program average CPAP compliance of 80 percent, compared to about 50 percent in the general population. That success is credited to Patience Bridges, project coordinator and administrative assistant in the Vanderbilt Sleep Division. Once a towboat captain or pilot is diagnosed with sleep apnea, he or she is required to report proof of CPAP compliance to the Coast Guard. Bridges has made her mission to get the patients to 100 percent CPAP compliance.

“All of the patients get set up online for monitoring and troubleshooting purposes,” Bridges said. “A big part of my job is to expel the fear that surrounds using CPAP and wearing a mask at night. Honestly, it is very difficult to get a patient acclimated if we don’t stay with them through the first 30 days. Knowing that they have someone trying to work with them is a big deal.”

Koontz has Bridges on speed dial.

“I probably talk to her every week. I call or text her if I haven’t gotten a package of supplies or if my machine is acting up or if I just want to know my numbers. It’s great I don’t have to go to Nashville to do that,” he said.

Bridges’ coaching is especially powerful because she has been diagnosed with sleep apnea and knows what wearing a CPAP entails.

“It’s totally tough love. When they want to complain about something, I can always find a reason for them to keep at it. I want them to live well for a long time.”

Koontz admits he was initially hesitant to have the sleep study because, though he was only getting four hours of sleep, he didn’t think he had a problem. Now that he is at 100 percent compliance with his CPAP therapy, he is amazed at the difference.

“I’m getting quality sleep out here. I can guarantee six-eight hours of sleep every day,” Koontz said. “I try to get in bed as fast as I can because I won’t get the hours if I don’t hurry up. There’s no time to lollygag.”

Ingram and Vanderbilt Sleep Center are now expanding the program to employees with BMI below 40. They hope to have 100 patients enrolled by the end of the year.

“Ingram Barge is really being a leader in this. Instead of waiting for regulations to tell them how to manage their crew, they’re being very proactive. Most industries are focused on the bottom line, but they’re really investing in their crew,” Upender said.

Beth Malow, M.D., director of Vanderbilt’s Sleep Disorders division, believes that the innovative care being provided through the collaboration can serve as an example for sleep apnea treatment in other industries and across the country.

“This program is a fabulous model for optimizing care of patients, enhancing patient satisfaction and improving public safety,” Malow said.