DRIVERS WITH UNTREATED OSA ARE A DANGER TO THEMSELVES, A HAZARD TO THE GENERAL PUBLIC, AND A SIGNIFICANT LIABILITY FOR YOUR COMPANY. IF YOU ARE NOT TESTING, TREATING, AND MONITORING YOUR ENGINEERS FOR OSA YOU ARE PUTTING UNSAFE DRIVERS AT THE CONTROLS. A management program keeps the roads, rails and skies safer.

1. MANAGING OBSTRUCTIVE SLEEPAPNEA(OSA)
FOR POSITIVE OUTCOMES
DRIVERS WITH UNTREATED OSA ARE A DANGER TO THEMSELVES,
A HAZARD TO THE GENERAL PUBLIC, AND A SIGNIFICANT
LIABILITY FOR YOUR COMPANY. IF YOU ARE NOT TESTING,
TREATING, AND MONITORING YOUR ENGINEERS FOR OSA YOU
ARE PUTTING UNSAFE DRIVERS AT THE CONTROLS.

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Table of Contents
3 8 12 19
page page page page
Sleep Background OSA Impact FIX the problem Dreams
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There are links to outside material which work
best in that view.

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OSAImpacts Lives Untreated Obstructive
Sleep Apnea (OSA) has
reached epidemic
proportions in our
society.
It is as prevalent as Type 2
Diabetes. OSA poses very serious
safety concerns throughout all
walks of life and across the broad
spectrum of business and
government.
OSA effects the safety, products,
profitably and health care costs
across a wide segment of business.
The transportation industry is
particularly at risk as is any
business where people operate
critical machinery or processes.
Football players to assembly like
workers are at risk.
Limiting the hours a person can be
in service does not address the
issue.
Having a process in place to
avoid and/or mitigate sleep
related accidents is a safety,
ethical, and business
requirement for the
transportation industry today.

4. A Little
Sleep
Background
O sleep! O gentle sleep!
Nature’s soft nurse, how have
I frighted thee,
That thou no more wilt weigh
my eyelids down
And steep my senses in
forgetfulness?

5. 5|
Sleep Well to Live Well
Good sleep is as absolute a requirement for
maintaining good health as nutrition and
exercise. Studies show that people with
untreated sleep apnea face a long list of
increased health risks, including hypertension,
diabetes, erectile dysfunction, memory loss,
chronic fatigue, obesity, and a doubling of the
chance of heart attack and stroke. The good
news is that sleep apnea has become easy to
diagnose and treat, which normalizes these
health risks.

6. 6|
OSAis breathtaking
Sleep apnea is a sleep disorder characterized by abnormal pauses
in breathing or instances of abnormally low breathing during sleep.
Each pause in breathing, called an apnea, can last from a few seconds
to minutes, and may occur 5 to 30 times or more an hour. Sleep apnea
is diagnosed with an overnight sleep test called a Polysomnogram, or
"sleep study". Home sleep testing is an alternate diagnostic
alternative.
Obstructive Sleep Apnea (OSA) is the most common type of Sleep Apnea
Syndrome (SAS). OSA most commonly occurs when the airway in the back
of the throat is obstructed, limiting the ability to breathe. This causes
the oxygen level in the blood to severely decrease and triggers the body
to release bursts of adrenaline and race the heart. These reactions
cause the person's level of sleep to decrease slightly (micro-arousal),
allowing them to get a gasp of air. The sleep level deepens again, and
the pattern is repeated throughout the night resulting in greatly
disrupted sleep. This all happens without the person remembering that
hey have basically been awake most of the night.

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OSAdisturbs sleep so
severely that the
person is chronically
fatigued and more
likely to fall asleep
during the day
Untreated sleep disorders in the workplace escalate the accident rate,
lower productivity, increase absenteeism, and accelerate healthcare
costs. People who suffer from OSA use health services more frequently,
take more medicine and are more frequently unemployed. The more
serious the sleep disorder, the higher the socio-economic cost.
OSA disturbs sleep so severely that the person is chronically fatigued and
more likely to fall asleep or lose alertness during the day. Untreated
OSA doubles the chance of heart attack and stroke, Type II diabetes, and
various cardiovascular problems. In general, OSA makes the individual
less healthy, more of a liability in the workplace, and more expensive to
insure in terms of medical care costs.
There is significant cost associated with lost productivity due to sleep
disorders. Building up a “sleep deficit” through a lack of proper rest or a
clinical sleep disorder makes it difficult for the brain to function. Studies
of the workplace and transportation industries reveal that human error
causes up to 90% of accidents—inadequate sleep represents a major
factor in human error. Numerous studies have demonstrated a strong
association between worker sleepiness and both lower productivity and
increased healthcare costs. Employers are burdened with higher
insurance costs and a less productive, less safe workforce.

8. OSA Impact
What early tongue so sweet saluteth me?
Young son, it argues a distemper’d head
So soon to bid good morrow to thy bed:
Care keeps his watch in every old man’s eye,
And where care lodges, sleep will never lie;
But where unbruised youth with unstuff’d
brain
Doth couch his limbs, there golden sleep doth
reign:
Romeo and Juliet (2.3.36-42)

9. 9|
9
Change is Necessary
Untreated Sleep Apnea is a
serious safety problem of
epidemic proportion.
“It is almost surreal that someone
with this ailment could be in
charge of a train with hundreds of
passengers on board. The tragic
outcome should haunt Metro
North officials” Senator Schumer
and Senator Blumenthal Joint
Statement
There is no national requirement for truck drivers,
train operators or pilots be tested for Sleep Apnea.
However the industry may expect legislation within
two years.*
ABC Nightline Sleep Apnea Report

10. 10|
Current scenarios
are in effective
Sleep disorders put
drivers at risk
Drivers/Operators - A drivers CDL is pulled if they are
found to have OSA. Treatment is expensive for individuals.
Drivers often feel little recognition or appreciation from
the company for adopting good health practices. There is
little understanding or recognition of the benefits of
treating OSA. In the present system there is little or no
coaching or compliance monitoring. For most drivers the
test takes a lot of time. Drivers feel that regulation and
treatment is intrusive and un-needed.
Companies - Some companies won’t act until the law
requires testing. They often take the attitude that it is the
driver’s responsibility especially 1099 drivers. They rely
on yearly physical to identify OSA. There is little
understanding or recognition of the severity of OSA. They
cite the programs expense while ignoring that fact that
treating OSA can save the company a significant
percentage of their health care spend and pay for the
program.
Result - To many OSA cases are not tested. There is wasted
and unnecessary health care spending. There is no single
source of control and information to assure compliance.
Sleepy, unsafe drivers are still on the road or operating
machinery.

11. 11|
Meet J cannel his
story highlights more
of the problem from
a driver’s point of
view
A comprehensive company
sponsored program would
have saved Cannell time,
dollars, and aggravation. It
also would have put a
valuable driver on the road
faster.
Click to see Cannell’s story
It turns out Mr. Cannell did
not have sleep apnea
Cannell was “caught” by the DOT medical
examiner and had to go for a sleep test. He went
to a sleep lab and spent the night. It turns out he
didn’t have sleep apnea. A comprehensive
company wide program would have diagnosed him
early using a simple home sleep test. He would not
have had to travel or spend $3,000 and would have
been routinely cleared to drive.

12. Fix the
problem
Thou hast no figures
nor no fantasies
Which busy care
draws in the brains
of men;
Therefore thou
sleep’st so sound.
Julius Caesar (2.1.248-251

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Diagnosis and
Treatment of OSAIS
Preventive Medicine
Preventive medicine focuses on maintaining optimum health and
well being while preventing disease. It’s clear from the quality of
life issues associated with sleepiness and the co-morbidities
associated with OSA that asking about sleep habits should become a
normal part of routine physicals for adults.
Even so the great majority of people with OSA are undiagnosed,
this means that on average, in the trucking industry, 28% - 30% of
the drivers in any fleet are needlessly experiencing compromised
health and elevated accident, liability, and medical expenses.
While most fleets are treating a small number of drivers, studies
show that 90% of people who have OSA don’t even know it.
The percentage of train engineers, conductors and other sensitive
personnel may be lower for the railroad industry but the
consequences are the same.

14. 14|
Services Essential to
Achieving Positive
Outcomes
Screening - The process begins by screening employees. If the screening
indicates a possibility that the person might have sleep apnea the next
step testing.
Testing and diagnosis - There are to kinds of tests both are diagnostic. A
home sleep test is just that. Equipment is sent to the employees home (or
any other place) and worn during the night. The chain of custody is
assured by proximity or other accepted method. If as sometimes happens
more information is needed for the diagnosis then the person requires a
Polysomnogram in a sleep lab. All results are certified by a physician.
Treatment - The accepted treatment for OSA is a CPAP. Successful use of
the machine requires coaching and follow-up through an adjustment period.
Ongoing coaching and monitoring - Like a life jacket the CPAP won’t work
unless it is used. CPAP’s have a monitoring device which phones “home” to
a central database assuring that the machine is being used properly and for
the prescribed amount of time. If there is no monitoring or coaching CPAP
treatment often fails and the driver goes back on the road increasing the
danger for everyone.
CPAP Supplies - Automatic tracking and delivery of CPAP supplies through
out the year keeps costs down and helps assure. patients maintain their
machines.
Information Management - An integrated single database to manage the
entire population and process is an essential program component. If this is
not present there is no way to coordinate and manage screening, testing,
treatment or compliance. It is truly an essential component of a successful
program.
Ask yourself this question: What do I want
from an OSA Management Program?
If the answer is to assure all company
drivers are safer operators after a positive
OSA treatment outcome and to maximized
financial, safety, and operational benefits
for the company, a single source integrated
OSA management program must include
these essential services.

15. 15|
ASingle Source OSA
Management Program is
the Most Cost Effective
SolutionAssures The
Highest Rate of Positive
Outcomes
Individual
If an individual were able to obtain essential services the cost could
be between $8,000 and $10,000 dollars. This is clearly prohibitive for
most commercial drivers.
Company Sponsored Unintegrated Multi-Source Program
A company sponsored program that relies on fragmented sourcing can
cost between $5,000 and $7,000 thousand dollars per person for the
first year of services plus new staff to administer and monitor
compliance.
Company Sponsored Comprehensive Single Source Program
Cost of essential outcome based services drops dramatically using a
single source provider. In addition, health and compliance
information is HIPAA compliant, in one place and accessible at every
stage of the process. Through economies of scale and the use of a
single integrated database a single source program would cost
between $3,000 and $5,000 thousand dollars per person for the first
year of services. Administrative staffing and long-term monitoring
are the responsibility of the provider.

16. 16|
16
Treating OSAImpacts more than
just health and Quality of life
Companies that implemented
integrated company wide program to
screen, test, treat and manage
employees with OSA realize huge
advantages from their program. In
one major trucking company the
number of accidents decreased by
30% and the cost per accident
decreased a startling 50%.
The savings didn’t stop there. Across
all segments of their population, age,
and work schedule, health care
spending per employee per month
decreased between 52% and 64%.
The Union Pacific Railroad lowered
their health care spending $200 per
employee per month. This is lower
than the trucking industry but still
significant.
$0
$500
$1,000
$1,500
Year One 52% Year Two 64% Year Three 57%
Per Employee Per Month Health
Care Cost Savings
Pre CPAP Post CPAP

17. 17|
When a company
begins to take
responsibility for
managing sleep
disorders good things
happen.
It is imperative that employers
clearly understand both the
magnitude of the problems and
the strategic solutions. Most
employers are not fully aware of
the extent and seriousness of
major sleep disorders such as OSA.
The relationship of sleep-
deprivation to accidents has been
recognized, but few managers or
workers understand the natural
cycle of sleepiness and alertness
or how to reduce sleep-related
accidents and errors.
Remember
Financial - Early programs have documented that they more than
pay for themselves in reduced accidents, medical expenses, and
employee turnover.
Safety / Risk - Evidence is clear that untreated drivers are 3-7
times more likely to be involved in accidents and are as impaired
as drunk drivers.
Practicality - It is now a relatively simple matter to profile a cross
section of employees and determine a target population of
employees that need further testing.
Logistics - Sleep labs can be located near employers’ home offices,
transportation hubs, and in areas where the bulk of the employees
live and work.
Success of treatment - Once identified as having OSA, treatment
methods are well understood and high-compliance treatment can
be achieved for 90% of employees. With risk sensitive job
categories, it is critical to use a program to help ensure employees
get optimal coaching and support toward achieving great long-term
compliance.
Liability - Many legal experts now say that as awareness of the
issue continues to grow, the option of claiming "plausible
deniability" of ignorance of the issue has passed. Failure to make a
good faith effort at starting a program could lead to lawsuits for
gross negligence.
"Stewards of public safety" - Safety Managers hold the
responsibility of being sure employees are fit for the responsibility
of their duties. As stewards of public safety, the onus is on
employers to ensure that employees are not putting others at risk
due to the negative effects of sleep apnea.

18. 18|
What does all of this
mean for the
railroad?
Metro North has about 3,000 drivers. If they are similar to the nation
average more than 25% or 300 drivers could have OSA. Without a central
database to monitor the fleet the railroad doesn’t know who the drivers
are.
At an typical health care spend per driver per year of more than $8,000
the railroad is spending conservatively $800 thousand on these drivers
alone. If they are treated for OSA savings per year drop by more than
50% or $400 thousand.
Treating OSA using AEON’s program could reduce pay for itself in the
first year and still reduce health care cost by $100.
Remember that the cost savings are just part of the story. The chance of
accidents and their severity drops, drivers are happier and are more
likely to stay with the company. Loads get delivered safely and
customers come back again and again. Most important the railroad takes
unsafe drivers off the road.
Without a comprehensive
company wide program to
screen, test, treat and
manage sleep apnea
compliance the railroad
could be putting unsafe
operators on the tracks.

19. Dreams
To die, to sleep;
To sleep: perchance to dream:
ay, there's the rub;
For in that sleep of death what
dreams may come
When we have shuffled off this
mortal coil,
Must give us pause.
Hamlet (3.1.64-98)

20. 20|
TheAeonAdvantage
AEON’s Advantage avoids and/or mitigate sleep related accidents. It is a safety, ethical, and business
requirement for your Business. Make the AEON Advantage YOUR Advantage.
Click Here to get started now.
Analysis/Interpretation - All studies are analyzed by a
Registered Polysomnographic Technologist and interpreted by a
Board Certified Sleep
Physician - Test results and recommendations are reviewed with
patient. Participant population analytics will be provided to the
employer.
Treatment - The Aeon program includes OSA treatment as
recommended by the Aeon physician interpreter and includes
options for the Continuous Positive Airway Pressure (CPAP)
device, mask, hoses, filter, and headgear. All CPAP devices
contain cellular technology for compliance data reporting. CPAP
dispensing includes mask fitting, education, coaching, the Aeon
7-touch follow-up program, and 24-hour telephone support.
Compliance Monitoring - Long-term monitoring includes daily
wireless compliance data collection and review.
Additional Aeon Advantages - A compliance-only plan is
available for those participants who have already initiated OSA
treatment but are in need of the compliance and coaching. A
pilot program may be available to demonstrate the basics of the
program and efficiency of implementation.
Aeon provides a single source integrated obstructive sleep apnea
(OSA) management program to assure continuity of care, cost
and time efficiency, and vital quality control. Our focus is on
successful outcomes. This program includes:
Participant Screening – Screening is generally conducted using a
web-based portal which incorporates a health, sleep history,
and demographic questionnaire. This questionnaire is available
in hard copy. The screening questionnaire identifies patients at
risk for OSA. This provides a means of estimating (for budgeting
purposes) how many participants will require testing and
treatment. The resultant data helps to determine what kind of
sleep test is appropriate for each individual. Screening is done
at no expense.
Testing for OSA (two methods) –
Home Sleep Test (HST) - HST is a commonly accepted method of
testing for OSA. HST saves health care dollars, is efficient and
accurate, is much more convenient for the patient, and
minimizes time away from work. Test results that reveal
moderate or severe OSA allows the participant to avoid further
clinical sleep lab testing and go directly to treatment.
Sleep Lab – Participants who do not qualify for an HST, who are
experiencing problems or lack of results following an HST and
subsequent treatment, or who have a strong OSA history but
have negative HST results will undergo a sleep lab based
polysomnograph (PSG) test.

21. 21|
MTAandAEON
Driving Forward Toward a
Safe Tomorrow.
Let’s take the next step
and get together and make
a road map of how we will
work together, the specifics
about cost, time tables and
support.
Thank you for reading
Let’s talk!

22. 22|
Appendix
Story Links
Contact Us
Click here to write us for a copy of:
Aeon Sleep Groups Sleep Medicine
Backgrounder
AEON Sleep Group OSA Program Executive
Summary
Integrated Obstructive Sleep Apnea
Management A Path to Successful OSA
Treatment
WCNC Charlotte -
Sleeping disorder puts
drivers at risk
Nightline – Asleep at the
Wheel: Could Mandating
Sleep Apnea Tests for
Transportation
Operators Reduce
Accidents?
J Cannell - Truckng
Sleep Apnea DOT testing
and requirements
Take my breath away
Contact us:
Bill Kellenberger –
President
Burke Mays – Vice
President
Business Development
Executives
Bill Koch - (908) 204-1226
James Hisey - (203) 307-
5123
Kathi Williams
Ben Williams