[Diagnosis] Maintenance of Wakefulness Test

[SideSleeper]

Has anyone had their sleep  doctor suggest this test?  I googled it and it is a little scary!  My problem is that I lost my driver's license when I fell asleep and rear ended another car.  I couldn't get a sleep test within the 3 months they gave me because I tore my rotator cuff 10 days later--that wrecks sleep for months.  Did get license back after I started using CPAP--I have an excellent sleep doctor.  He has insisted I come back every 12 months to see him so will only sign off on my license for a 12 month period.  This time, even with 100% compliance for 2.5 years and a monthly AHI of 0.3 he continued the 12 month visit plus said he'd like to do the above mentioned test.  I don't think this link is against forum rules--it is from the American Academy of Sleep Medicine and explains the test:
http://www.sleepeducation.org/disease-de...ss-results

[holden4th]

I've had a look through this test and had two thoughts. Firstly, it would be very easy to cheat the test. Secondly, the test is discriminatory if it is not given to any driver who has a similar accident.

The concern is that money is being thrown at people who have already come to the party and that there is no real detection system for the thousands of drivers who have OSA and don't know it.

The fact that you can provide data to prove that you are compliant is being ignored by your doctor. This makes me wonder, based on the info in your post, if he has mates in the MWT testing business. While you think your doctor may be excellent he could also be generating business for himself and his mates.

When I did my sleep study in QLD, the lab that did it was meant to pass the results on to my GP. That didn't happen and at this point in time I have no constraints on my drivers licence for OSA. I intend to keep it that way.

BTW, it you want to know how to cheat the test please PM me. I've come up with three ways already.

[Walla Walla]

I reviewed the Oregon laws and noticed that Doctors are not held liable for any future accidents from patients being treated. I think there are easier, shorter, and cheaper ways to test someone's ability to stay alert. I think your being ripped off if they're making you do this test every year without cause.

[Hydrangea]

I know nothing of the test, so won't comment on that.

But I wonder if it would be best for you to get a PCP to sign off on your driver's license, and stick to seeing your sleep specialist when *you* feel like he can be of help to you.

[Hydrangea]

I just looked at the test. What a waste of time! I could understand putting a patient through that rigmarole if there was a need, but otherwise no way!

I'd suggest a new dr who can sign off on your license.

[KSMatthew]

I did the MWT. Not long after I started CPAP I needed documentation that it had helped with "excessive daytime sleepiness".

You get a comfortable semi reclined bed in a quiet room. Every hour or two they dim the lights, and tell you to lay back. The test lasts 20 minutes. If you stay awake you pass. Test gets repeated 3-4 times.

I asked the tech how many people fail. He said he had only seen two fails, both commercial truck drivers.

[Hydrangea]

Interesting!

Would this be a test to take *after* being on CPAP therapy? Because I'd think many of us would have failed the test prior to having begun CPAP therapy.

[car54]

What is the cost of this and I hope you don't have to pay for it.

car54

[mesenteria]

I did the MWT.  Not long after I started CPAP I needed documentation that it had helped with "excessive daytime sleepiness".

You get a comfortable semi reclined bed in a quiet room.  Every hour or two they dim the lights, and tell you to lay back.  The test lasts 20 minutes.  If you stay awake you pass.  Test gets repeated 3-4 times.

I asked the tech how many people fail. He said he had only seen two fails, both commercial truck drivers.

I suspect there is an interest, perhaps in the insurance industry more than anything, to get some empirical evidence confirming CPAP as a remedy to excessive daytime sleepiness and sleep onset.  One way to do that is to force some 'volunteers' into 'voluntold' status and make their data part of the study.  Obviously, those on CPAP who are still experiencing problems, but who are also deemed to be 'treated' with their CPAP, are going to be problems for the industry on how to deal with this persistent problem....sleepiness, narcolepsy, etc.  The government should have a say in the efficacy of CPAP and whether all patients using that therapy/variations of it are necessarily also cured of sleep disorders.  Maybe the data will say definitely not, in which case might have to test everyone who has a license.  That is to say, empirical evidence begets protocols, ethical policies and laws, etc.

I'm not playing devil's advocate.  But perhaps this physician is in receipt of information which leads her/him to suspect that this wakefulness test is strongly indicated in this one instance (we don't know everything there is to say about this patient).   He/she may have learned that the industry now suspects that this second test is almost necessary as a stand-alone measure of suitability to work around heavy equipment, to drive it, to drive at all.  A polysomnography and titration can only tell us how poorly or well the person sleeps at rest, not when driving a Greyhound bus.

[KSMatthew]

I did the MWT.  Not long after I started CPAP I needed documentation that it had helped with "excessive daytime sleepiness".

You get a comfortable semi reclined bed in a quiet room.  Every hour or two they dim the lights, and tell you to lay back.  The test lasts 20 minutes.  If you stay awake you pass.  Test gets repeated 3-4 times.

I asked the tech how many people fail. He said he had only seen two fails, both commercial truck drivers.

I suspect there is an interest, perhaps in the insurance industry more than anything, to get some empirical evidence confirming CPAP as a remedy to excessive daytime sleepiness and sleep onset.  One way to do that is to force some 'volunteers' into 'voluntold' status and make their data part of the study.  Obviously, those on CPAP who are still experiencing problems, but who are also deemed to be 'treated' with their CPAP, are going to be problems for the industry on how to deal with this persistent problem....sleepiness, narcolepsy, etc.  The government should have a say in the efficacy of CPAP and whether all patients using that therapy/variations of it are necessarily also cured of sleep disorders.  Maybe the data will say definitely not, in which case might have to test everyone who has a license.  That is to say, empirical evidence begets protocols, ethical policies and laws, etc.

I'm not playing devil's advocate.  But perhaps this physician is in receipt of information which leads her/him to suspect that this wakefulness test is strongly indicated in this one instance (we don't know everything there is to say about this patient).   He/she may have learned that the industry now suspects that this second test is almost necessary as a stand-alone measure of suitability to work around heavy equipment, to drive it, to drive at all.  A polysomnography and titration can only tell us how poorly or well the person sleeps at rest, not when driving a Greyhound bus.

In my case:  I have OSA, I have a CPAP, and I have a doc who helps me out.  I also am a pilot and have to keep FAA satisfied that I am not only compliant, but that the treatment is actually helping.  FAA has simplified that process a lot over the last 2-3 years.  Compliance is shown with annual Sleepyhead reports, and efficacy is shown through annual status reports from my doc.  My MWT was done, on my request and on the recommendation from a flight surgeon, that it would be a good preemptive move when getting my first FAA approval.  It worked.  That was a lot of years ago.

FAA is a subset of the Department of Transportation.  DOT is sensitive to truck drivers falling asleep at the wheel.  DOT has slightly different OSA rules for truck drivers and pilots, but a lot is driven by trying to avoid bad publicity.  I don't know if DOT requires MWT anymore or if it's only for special cases.