As a member of Congress, Marty Russo (D-Ill) served the land of Lincoln from 1975 to 1993. These days, the CEO of Russo Capitol Strategies is a sought after speaker on a variety of issues, including the regulatory issues surrounding sleep medicine.
The American Sleep & Breathing Academy sat down with Russo to get his opinions on a variety of sleep medicine topics, particularly the level of sleep apnea awareness among transportation professionals.
ASBA: How aware of sleep apnea are transportation industry officials these days?
Marty Russo: I think they've come a long way. They are more aware today than they were two years or five years ago. The National Transportation Safety Board in their 2016 report said one of the top priorities is to reduce accidents related to operator fatigue. Operator fatigue can happen from many different factors, but one of the biggest is untreated sleep apnea. They are much more aware today than they ever were.
ASBA: Among transportation industry officials what is the biggest misconception about sleep apnea and treatment?
Russo: I think they are aware that untreated sleep apnea is very dangerous, but transportation officials and patients are not always aware of the latest technology in treatment. Some patients respond better to CPAP, and others do better with oral appliance therapy. They both should be available. Both treatments are well documented as being affective when used. They key is when used. Oral appliance therapy has newer technology, and sometimes the latest advancements are not well known. Compliance is the critical question. Whatever you can do to make it compliant is what we should do.
ASBA: What is your opinion of the current proposal to issue a regulation (Federal Motor Carrier Safety Administration – 2014-0419)?
Russo: Before the final draft, regulators are getting input. When I speak to audiences, one thing I say is, you need to be part of the solution, not part of the problem. You need to share expertise on the latest treatment methods.
ASBA: How important is the comment period which has now been extended to July 8?
Russo: What you're seeing now, as a result of this comment period, is that a lot of the dental sleep experts are now responding and participating—which is important because they have a lot to offer, and not everybody knows as much as they do on this issue. When the government begins to legislate or regulate an industry, they don't have all the answers, and that's why they put these comment periods out there so they can hear from experts. It's critical that we have these experts commenting on those proposals.
ASBA: What do you say to people who say, 'Oh they don't read those comments'?
Russo: That's a cop out. People do read them. It's a public record. They need to respond to that. If they try to do this without public comment, and the public gets up in arms, then the public goes to the legislator and explains we've been shut out. They're making decisions without our input. Now they're getting input, and if they don't pay attention, you can go back to your congressman and say, 'Look, they've got all this information, and they still aren't doing anything right.' In this county, you have the right to petition your government to redress grievances. It's the first amendment.
ASBA: How much sleep-related regulation do you believe is needed, particularly in the transportation realm?
Russo: You've got people dying on the streets because of sleep fatigue. The biggest problem is untreated sleep apnea, so it's really important we do something to make sure it doesn't happen in the future. I'm not somebody who believes in overregulation, but I don't believe in no regulation. You have to balance the needs of both the operators and the trucking industry. But the key is safety comes first. We can't have individuals operating trains, buses, trucks, and working in air traffic control who have untreated sleep apnea.
ASBA: What specifically do you want to see?
Russo: We need to have clear standards for screening, identifying, and treating sleep apnea. We need to be consistent to be able to track compliance. This idea that you can use CPAP for four hours, and then you're ok, well what happens the other four hours? If someone is going to sleep, and they have sleep apnea, whether it's with an oral appliance or CPAP, they must use it the whole time they're asleep—not just for four hours. That is a stupid regulation. The regulation can't be so onerous that it causes a huge burden on trucking firms and truckers, so you have to balance everyone's needs.
ASBA: What's your main motivation in taking on this issue?
Russo: The number one key in everything we do is safety—protecting the public. That's the job of the government. One of the best ways to make sure this gets done is that everybody needs to be at the table; that means regulators, medical and dental professionals, industry reps, and actual people who operate trucks, railways, and buses. Some comments show that truckers are saying that they know their fellow truckers are not doing what they are supposed to do.
ASBA: What are your hopes for the proposed regulation?
Russo: I just hope the regulators listen to the public and the experts. The problems we're facing as a result of untreated sleep apnea are well documented. It needs to be a level playing field. Which modality will the patient actually use? What is in the best interest of the patient? I think the difference this time is that all the oral appliance people have spoken up. They have not kept quiet.
ASBA: How are industry organizations doing in the fight to highlight dental sleep medicine?
Russo: Big credit goes to the American Sleep & Breathing Academy. They're the impetus behind all these comments on the dental side of sleep. This is the first time they have actually participated, and they have done a good job. Their voices are going to be heard.
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