- Part 1 [You Are HERE] – Can A DOT Medical Examiner Refuse You A Medical Card Unless You Have A Sleep Study Done?
- Part 2 – DOT Physical And Sleep Apnea Testing: Are Medical Examiners Caught Between A Rock And A Hard Place?
- Part 3 – Commercial Driver Awareness About The Sleep Apnea Issue
- Part 4 – OSA: How To Know If You Have It
- Part 5 – Commercial Drivers Can Manage Sleep Apnea And Maintain Their CDL
Commercial drivers are being told by some DOT medical examiners that they must be tested for sleep apnea before they can get a new medical card.
We’re seeing much confusion and frustration in the questions drivers are asking us on our FAQ forum.
“Does you neck have to be a certain size? They tell me I have to have a sleep study”
“The doctor our company sends us to says anyone with a BMI above 35 automatically has to take the expensive tests from his company’s sister sleep test division…”
“Some examiners are requiring drivers to go have sleep studies done based solely upon BMI and neck circumference. How can that be? “
“My husband who is 53yrs old just went for a physical to renew his medical card. They told him because he was over 50 and his neck was 17.5 he had to do the sleep study. I’ve been told by others that the age criteria is 55 and if neck is over 17in. Which is correct? “
“I recently went in to renew my CDL and everything checked out normal. However since I was over the age of 42 and I am a male, the doctor gave me a 45-day temp card and told me before he could give me my 1 year medical card I had to get a sleep apnea test done. My neck size and my BMI checked out normal. Can he do this to me? “
So why are so many people – doctors, as well as drivers – confused on this sleep apnea issue?
We’ve attempted to follow the breadcrumbs over time, to see how this predicament developed.
- 2008: The Medical Review Board recommended that the FMCSA require all drivers to be screened for obstructive sleep apnea.
- 2008: A health panel recommended to the Medical Review Board that CDL medical certification be conditional based on body mass index (BMI).
- The National Transportation Safety Board was one of the parties alleging a clear connection between driver sleep apnea and safety.
- May 2010: In response to such concerns, the American Sleep Apnea Association, the American Trucking Associations and the FMCSA co-sponsored a national Sleep Apnea & Trucking Conference about sleep apnea’s effect on truckers.
- April 20, 2012: FMCSA published a Proposed Regulatory Guidance for obstructive sleep apnea (OSA) and request for comment.
- April 27, 2012: FMCSA published a withdrawal notice on its Proposed Recommendations on Obstructive Sleep Apnea.
- September 12, 2013: A proposed sleep apnea bill was introduced, and passed the House and the Senate, requiring that FMCSA establish a formal rule rather than guidance relating to sleep disorders.
- October 15, 2013: The sleep apnea bill was signed into law by the President. The law forbids the Federal Motor Carrier Safety Administration from using guidance alone to address sleep apnea screening for drivers. It requires that if the agency take action regarding sleep apnea screening, that it do so via the formal rule-making process, and not guidance. Note: The law does not require that the FMCSA create a sleep apnea rule.
The ‘sleep apnea bill’ signed into law on October 15, 2013 forbids FMCSA from using guidance alone to address sleep apnea screening for drivers.
Put In A Nutshell
FMCSA has been called on their lack of proper rule making procedures regarding sleep apnea screening i.e. how to determine who should be tested.
The last response we can find from FMCSA on this issue is that “FMCSA will issue a notice to address obstructive sleep apnea through the formal rulemaking process after collecting and analyzing the necessary data and research.” As we publish this article, there is still no information available from FMCSA regarding sleep apnea screening.
There is currently no ruling by the FMCSA for sleep apnea screening on DOT physicals.
DOT Medical Examiners
DOT medical examiners are finding themselves caught between a rock and a hard place on this issue, as they are held responsible for ensuring that a driver is medically fit to drive a commercial motor vehicle.
Employers
Your employer may have more strict requirements and is allowed to impose their own screening criteria. A company must a least meet the FMCSA medical requirements. However, company policy may impose stricter standards than those required by FMCSA.
Thanks to Trucker Docs expert panel doctor, Dr. Kenn Seals, for contributing to this article.You can find Dr. Seals at Chiro Stop in Salt Lake City, UT.
CME said I had to have a sleep study. Results were at level 5.8. Sleep study doctor said that D.O.T. regulations require me to use a cpap is this true?
@Mark
According to the FMCSA @ 5 +, you may have a diagnosis of mild sleep apnea.
The primary sleep study and sleep doctor can now make a decision as to whether you need to be on a CPAP unit. I would check with the doctor and ask a few questions regarding this issue. If you do not suffer from any of the principle issue of sleep apnea then he can fill out a form that explains his standing on this issue. The FMCSA does not have a standing regulation/law that demands that you be on a CPAP, unless the doctor feels sure that you suffer from other signs and symptoms of sleep apnea.
I currently have a class A commercial license. I went to tractor trailer school in 1978. I had retired from the Teamsters recently, but I haven’t driven for over two years, so my medical card had expired and it’s been too long for a recert. I was offered a position to drive elderly to and from the doctors, but the company requires a DOT physical. I do have sleep apnea and I have been using it nightly for a couple of years. Would this be sufficient for the medical examiner if I take my C-PAP with me to my physical?
@Joe
Your best bet may be to downgrade your class A to a lower class, and then get your medical card.
Have your primary complete your medical release form for you before you go for the examination for your medical card. That will include the stats from your CPAP. That release will answer many of the examiner’s questions right up front. Good Luck
Hello I just now found out about this sleep study thing.I used to have sleep app but had my tonsils and my uvila snipped. I went back for a sleep study and was cured. Question is that my test was done in 2006 is it to long ago to take this record to the cert exam for dot or will they except it.thanks in advance…Dom
@Dom
No, they will not expect anything. You have far surpassed any requirements. So just answer any questions and you should be good to go.
Thank you very much …very good forum
@Dom
You are very welcome. Thank you for visiting.
Please support our doctors and you will have a very good DOT physical experience.
I was forced to take a sleep apnea test for work i drive tanker trucks and was diagnosed with mild sleep apnea i have a ahi of 10.1 and was given a cpap machine and i really dont feel i need one was never sleepy in the daytime i dont snore even the test said no snoring no urination in the night no limb movement just a bmi of 40 and a neck size of 17.5 i looked up and the guidelines say u have to be at a ahi of over 20 to be on a machine i dont know what to do
When the new guidelines were published, I realized that I could retire rather than go through the training and certification to continue doing DOT exams. So I’m now a full time gardener rather than a miserable doctor having to take drivers’ livelihood away without real evidence that it will improve safety. Mammograms and the PSA test are being questioned because – – although they find disease – – it’s not clear that they save lives. The new guidelines were put into practice with no requirement for assessing risk, cost, and benefit. Evidence based medicine apparently has no place at the FMCSA. They were satisfied with showing that they could tighten up the DOT medical exam process, without balancing it against the enormous cost to individual drivers and society as a whole, and also without showing that more rigorous testing would actually improve safety on the roads. They just assume – – like the promoters of mammograms and PSA tests – – that a “better” test will automatically lead to a better outcome. I am so glad to be out of this business and spending my days with tomatoes and beans (and not having to wonder whether there will be any drivers left to move my vegetables).
Does a driver have to recertifiy when he is put to sleep gor a medical procedure
@Monty
FMCSA states that any illness, injury, or condition that takes a driver from behind the wheel and has him at less that “medical fit for duty” must be re-certified for duty.
So my understanding is, Yes, you would need to re-cert.
I went ahead & recertified anyway . Thanks for the info
@Monty
You are welcome. Glad to hear all went well.
Question, my husband is in the process of going for his CDL and he is in the DOT process. They told him that he needed to have a sleep study done because of his BMI and bcs of his father has sleep apnea and of course he did and they dx him with a very mild case that does not need any sort of tx and that he would be fine to drive. The DOT examiner then told him that his results from the sleep study would only give him a year cert. Is he just going to keep having to do these expensive sleep studies every year? Or should we try with a different examiner the next time he goes to get DOT certified?
@TinaBear
Your last option is your best option.
Since its all about money.I have been on cpap for 14 years and used every night .because I sometimes would hold my breath.sleep study said I had sleep apnea. Not any body decided on the medical side thought it was a big deal until now . I just need data compliance to prove to medical examiner that I use my machine.with high deductible im looking at at least $1500.00 out of pocket to keep my card for 1 year what a deal
can’t afford sleep study. want to buy c pap machine that has Data feature without going to insurance . can I get places like apria to check machine without buying machine from them.what will I need to do . its all about saving money.
@Mark
Sorry we cannot help you with product/vendor information or recommendations.
Our advice is limited to questions about the DOT physical exam and medical card.
TRY SECOND WIND CPAP WHERE YOU CAN PURCHASE SLIGHTLY USED CPAP MACHINES THAT COME WITH A WARRANTY AT REDUCED PRICES. HOPE THIS HELPS YOU OUT.
My question I am a large guy. Went to place for my medical card dr told me only will get 1 yr card due to BP meds ok np but she telling me I need 90 days or history on my cpap I only had 30. Got them the 90 finally. What are the requirements on percent of use. I can’t find any were this info is available.
@Jon
The Medical Expert Panel’s minimum recommended compliance is: 4 hours of CPAP sleep per day; 70% or more days.
Your company/carrier is allowed to impose stricter standards than those recommended by the Medical Review Board.
Some companies are requiring at least 6 hours of CPAP use, 80% of days.
This is explained in Part 5 of this series of articles on Sleep Apnea.
When is this sleep study law come infect in Michigan going to this Dr. I get only one year card because of diabetes wanted a1c did blood work got never got card call them oh know he wants sleep study done 10 days left then no cdl is this the law I need to work
@Cliff
As this article explains – THERE IS NO SLEEP STUDY LAW.
Please read all the parts of this sleep apnea article so you understand your position as a driver, and how to establish if you may be at risk for having sleep apnea.
The final call on sleep apnea screening rests with the medical examiner, but it is based on your overall health picture, not a check list of items such as BMI, neck size, age, etc.
He will not give me a card work tells me they need me now or there replacing me no work no unployment not med. Ready for work this Dr. Making me lose my job whant do I do got a sleep study DEC 29 but I’ll be job less by then please help
@Cliff
There is no new law requiring you to take a sleep study.
So go somewhere else and get your new medical card.
So I am hoping you can help clear up my confusion. I went to the CME that my employer sent me to last week. Was given a 1 year physical. I have a blood pressure issue and understand this. But during the exam the CME, he asked me about any sleep or being tired issues. I marked no on the medical form, and honestly told him I wake up feeling awake and refreshed and do not get tired during the day. But he measured my neck, 17.25”, my BMI is over the 35, and I am over 40, so he said I had to have a sleep apnea study before next year’s physical. Tried to discuss with him, he stated as he walked out “it is mandatory, the law as of May 2014” and would not talk to me anymore. So I have talked to other CME’s that said odds are they would have not put the sleep apnea study requirement on me, but because he did, and now have to do it. I called the Regional Office of FMCSA, and was told that because he wrote it on my paper work that now I have to do the study. But I see in other posts here that it seems recommend that a person should/could wait 30 days and go to different CME. So my confusion is when my year is up can I go to a different CME as option, or do I have to do the sleep apnea study route now?
Also 1 of my co-workers went to the same CME Clinic in May and was flat out failed till he does the sleep apnea study. He is also a big man, over 40. But I was given a year, and he was just failed, same clinic different CME’s. He has not done anything as of yet, he is the shop foreman and does not drive that often. Could he just go to a different CME?
Just total confused and flustered, looking for good direction.
Do the CME’s submit their notes and results or only pass fail and time frame of physical to FMCSA and the State? If so HIPPA laws don’t apply?
Thank you,
@Bob
When it seems out of line, ask to see the law. It does not exist and you are not mandated by anyone, including the FMCSA to do such.
Just go somewhere else when its time for the next DOT. You will still be on a one year card with the blood pressure medication and unless you can get your doctor to remove you from those meds, it will stay that way.
But there is no law or guidelines for neck and bmi in relation to sleep apnea.
I have a current medical card good for 1 year, due to blood pressure. I was given a sleep study referral by my primary doctor, but a tritation test was done, not a sleep study so I really do not know if I have a problem. I was told that I have hypopnea. I now have a cpap with the sleep study cpap salesman of a doctor threatening to remove my cdl for non- compliance. Can he do that if he is not my DOT medical examiner?
@Elkomom
No, they can’t take something away from you that you already have.
Yes, you want to know if you have a condition that is unsafe for yourself and others, so continue on the present path to confirm or deny you have any conditions that would require monitoring by your doctor.
And unless you go and re-take a DOT examination, your non-CME doctor can’t take anything away from you at this point and there are no new rules regarding sleep apnea on the FMCSA books.
Thank you so much for your answers. You are a Godsend in this cpap nightmare.
But what will happen if I return the rent to own cpap machine ( they turned me in to the non-CME for non compliance) and cancel my Nov. compliance appt. with the non-CME doctor? When he reports me for non compliance, he really can’t have my cdl taken away as he threatened? And what about my next years exam? My CME doctor of 4 years was fully aware of all this when he renewed me for a full year.
@Elkomom
If you have a diagnosis of sleep apnea, then use the CPAP as prescribed.
If you do not have sleep apnea, then why would you need a CPAP.
And as far as next time, maybe some of these new CMEs will have read up on what the FMCSA handbook really says and you won’t have these problems. Either way, go elsewhere for your next DOT examination.
Hypopnea is abnormally shallow breathing or holding one’s breath, rather than it being an obstructive problem. This can originate with a central nervous system issue. It can result in the body not getting enough oxygen, the same result as apnea.
A (“without”) pnea (“to breathe”)
Hypo (“less than normal”) pnea (“to breathe”)
That is how it breaks down from the Latin.
It’s possible to be more severely effected by hypopnea if you’re holding your breath or breathing too shallowly (depending on oxygen levels during sleep) than a person who has mild obstructive apnea that occurs with less frequency and doesn’t reduce the oxygen levels as much.
I’m not a doctor but I have severe sleep apnea/hypopnea – I have obstructive events 59 times per hour, and I also don’t have a good inhale/exhale reflex from my central nervous sytem. So I have both issues and I’ve researched them. My oxygen levels in the lab went down to 70% pretty much all night without the CPAP.
The results to the body without getting enough oxygen, even if you don’t have *obstruction* events, can be really bad. Chronic acid reflux (which left alone for too long can lead to esophogeal lesions), weight gain, muscle pain, etc. Even if you don’t experience daytime sleepiness, which I never did, it can ruin your health.
Thank you, I just feel that overall health is so important on the road for even car drivers, the awareness of what lack of oxygen during sleep, from any reason, is going to run you into the ground and take your health either way, even if you’re not tired.
I recently renewed my DOT Medical card and the Dr. let me have it for one year due to high blood pressure that is controlled with medication. BUT he says I have exactly one year to lose over 100 pounds to be at the 30 BMI in order for me to continue driving next year. If I don’t he said I have to look for another job that FDOT requires the 30 BMI or less. Is this true? I haven’t weighed taht since junior high and I am also a mother of 3 and will be 60 next year. I have been driving public transportation bus for 36 years and now my job is at risk because of this issue. He also said since I am overweight then I have sleep apnea, “every overweight person does.” I do not snore or have sleeping problems. He said I HAVE to be tested as well. I am beginning to wonder if he has stock in the C-PAP machines or the Sleep Study Clinic.
@Laura
Such a ruling does not exist.
Yes your medical card is good for one year due to BP medications.
All else is a mis-interpretation of something that does not exist in the rules. Go somewhere else next time for your physical.
That being said, do whatever you can manage to be proactive about taking care of your health.
Is there any doctors out there that will bill a person who needs to have a sleep study done . I have no medical insurance .
@Gregory
We do not refer any sleep facilities.
Best to ask your primary care physician for recommendations. Or start with a Google search on ‘sleep study’ and do your research from there.
Having “no medical insurance” should not be a problem as long as you can pay personally. Many health facilities will give you a substantial discount for cash if you ask, and pay cash up front.
I was issued a 3 month medical card, and it was recommended that I go for a sleep study
because my bmi was 38 and neck size 18,with no other medical conditions present ,my blood pressure is within range and I am on no medications , I have lost 30 lbs and my neck size is now under 17, along with bmi now being under 34 . The medical examiner told me I must still go for a sleep study and he will not issue me a new card until I comply. He also stated that I can not go anywhere else and get a valid card because this is on my record now and I must comply even if I no longer show signs of sleep apnea. Is this true?
@Tom
Untrue.
If you wait thirty days after your last attempt to get your medical card, you can go anywhere you like to get your medical certificate, as long as the examiner is on the National Registry.
And secondly, there is no regulation regarding BMI or neck size. Ask to see the law, it ain’t there so ???
Go somewhere else.
Same crap happened to me. Went in for a new employee everything despite having my two year card they said retake the physical doc said take a sleep test or no two year card, im waiting for a month then going to my doctor. Makes me wonder why my employer uses this doctor office.
So if you wait 30 days you can reapply for a new medical card even if a different doctor said you need a sleep study? Isn’t the results sent to the dot? Wouldn’t new results red flag the other medical card?
@ab
If the first DOT examiner found, after looking at all 7 or 8 criteria for requesting a sleep study, then yes it may flag the medical card. If the original examiner only looked at 1 or 2 of the easiest criteria, then no, because you could go to the FMCSA website and enter into conflict with the examiner. FMCSA does not want you to do that, so really you are only getting a second opinion.
I can understand that the DOT is concerned about accidents caused by sleepiness. I can say that after working since 1998 in the tourbus industry of San Francisco Bay Area, there are a lot of drivers who take any and all opportunities to sleep in their buses. Their ability to drop off in a driver’s seat so easily and set their smartphone alarms to wake up on time – amazes me. I simply cannot sleep in a bus or in a driver’s seat, in fact, nowhere but in a bed.
But now I am told my age, BMI, neck circumference and HP pills is forcing me to take a sleep test to keep the Class B (busdriver’s) licence. I have three months to do it.
If I lose weight enough (say 25 lbs) and lose an inch on the neck within these three months, can I skip the sleep test?
Or do they now have me locked in permanently as a sleep apnea patient? Could I go back and take the physical at another DOT place?
It seems to me that this is a real money-making scam. All the drivers I have known and seen for years sleeping and snoring away seem to be still doing so. Either they work too many hours, drink at night, or just stay up all night on this darn internet. Or it’s the kids???
What do you think – is this a moneymaker deal for some of Washington’s “sleep” friends?
@Mark
Ask anyone who says that you must have this to show you the law. It does not exist.
If you feel you are not at risk for sleep apnea then wait 30 day and go somewhere else for your DOT examination. The person who did your last test does not fully understand the rules and guideline that are being set forth by the FMCSA.
Read Part 2 of our Sleep Apnea Series to make sure you understand the medical examiners role. If there is a reasonable chance of risk in assessing your overall health situation, the examiner is correct in referring you for further testing.
I have a class B CDL for school bus driver. The Nurse Practitioner that I went to for my yearly physical is saying I have to get a sleep study done every year before I can get a new DOT physical. I can’t find that anywhere in writing. Is that just her call? She has given me a 3 month card to get a new sleep study done. My regular doctor says I do not need a new sleep study done at this time as I’m doing great with the cpap machine.
@SL Tracy
It’s just her call. Go somewhere else next time.
Thanks! I couldn’t find anywhere online where it said that it was a requirement. Even the nurse called after work last night and apologized for how the NP was treating me and gave me the number of someone else in our area who can do the physicals.
I’ve been told by the examiner to get a sleep test to get my year card. I do not have CDLs, just a regular license. Do I have to?
@Ron
There is no reason to have a sleep study done unless you feel there may be a problem. If you are not a class A driver, driving interstate, then no you do not have to have a sleep study done. If they insist, ask to see the regulation in writing – It ain’t there.
If a driver has sleep apnea, has started using machine within the last week. Can he get a medical card? What is a CONDITIONAL medical card and it’s restrictions?
@Marta
Once starting on the CPAP he will have a 30 day wait period while he becomes accustomed to the unit. He may be able to get a one month conditional certification.
At one month he must demonstrate satisfactory compliance with CPAP therapy. He should have his doctor fill out a medical release form to take to his next DOT medical examination. After one month, he may be extended to a 3-month card. If compliant at 3 months, he’ll get a 1-year certification.
After that his medical card will be good for one year at a time.
Is there any legal way around this 30 day wait period?
@SciTech
A CME may choose to put him on a thirty day card to allow him to drive while he is acclimating to the device.
This would be a medical examiner decision based on driver circumstances, not a standard guideline by any means.
Otherwise there is no way around the wait period, that I am aware of.