69 yo male with PMH of hypertension, CAD and DM2 presented to his PCP with fatigue and "falling asleep anywhere." After testing him for anemia, renal disease and thyroid disease, he decided to get a sleep study. The sleep study was grossly positive with an AHI (RDI) of 67 that occurred with both REM and NREM sleep. During the split night portion of the study, his AHI was reduced to 12 with CPAP of 11 cm H20.
He saw me after the study. When asked, he claimed to fall asleep reading the newspaper in the morning on the weekends, watching TV at night and had, on 2 occassions, fallen asleep while driving. He pulled over, napped for 10 minutes and started to drive again. There were no accidents and he needs to drive each day to get to work. He is constantly sleepy while driving and usually drives with the windows down in 20 degree temperatures to keep himself awake.
From our office, we arranged for CPAP to be delivered to his house the day of his appointment.
Would you ask him not to drive? If so, for how long?
Would you report this to the state (this is not required in the state of Michigan).
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I would advise him (and document) that it is dangerous, and that he should never drive if he feels "sleepy."
Besides the obvious ethical dilemma (danger to others) unfortunately there is also an issue of liability... what if he gets into an accident and claims he was sleepy but "nobody" ever told him it could be dangerous, so I would ask him not to drive until his sleepiness is improved on the CPAP and document it on his chart.
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