- 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.
I am a 59 yr old female from Texas, had my Class A since ’07. Other than high blood pressure which I have been taking a BP med for, and have since had the dosage lowered because it was causing my BP to drop too low, I have no other issues. I have answered all the sleep apnea questions in the negative, yet because my BMI is over the accepted number, I was told last year, I would have to have a sleep study done this year or my Med Card would not be renewed. I was told that while the FMCSA has never made a definitive ruling on requiring drivers to get a sleep study, they have left the decision on whether to enforce it or not, to the discretion of each Medical Examiner. The one I have seen the last few years is forcing the issue this time. Is there nothing that can be done other than going from one ME to the next and being told the same crap??? This is an absolute farce & just another way to get money!
@ Michelle
We agree, but your main option is to find a driver friendly CME that is not getting some type of kickback from the sleep study people (conflict of interest).
My husband renewed his dot physical last year 2022 and it expires 2024 but did not turn it end to the company so they told him he had to take another this year they sent him to concentra and because his neck size was a17 the dr tells him he needs a sleep study done and only have him three months what should he do
@ Erika
When you have to go to a doc in a box that is in bed with a sleep study facility (conflict of interest) it’s what you get. Go get a second opinion from somewhere else.
So do I turn this medical card in to my state
@ Erica
If you got a new medical, then take it to the state. If no new medical, either go get a new one or turn the one from doc in a box in.
i am class a cdl holder in pa, For last few yrs have been getting dot physical, company. have always had a printed report of cpap usage to take with to dr. This year when requesting re report, i am rolt my cpap machine is too old, and nothing has been recorded off it , so now i have no report to take to DOT dr. what can i do and will this affect my getting hew card?, thank you
@ Michael R
Since you are on a cpap, the medical examiner must see your compliance report. He may, if he chooses, give you a short medical card so you can get a reading report done.
I’m a long time CDL holder and 3 year ago decided to get a sleep test because wife says I snore. I was diagnosed with MILD sleep apnea with a score of 11.4. a neck size of 12. No other health problems whatsoever. It was suggested I make some lifestyle changes including lose weight ect.
I lost 35 lb. Feel great. Recently they still would not let me renew my med card without a new test. Which I did…and it was inconclusive. So now they have me a 6 month card and want me to retest…..I am feeling HARASSED now as even the first diagnosis wast not severe enough for me to be disqualified from full DOT compliance!
Mild sleep apnea with a score below 15 are still DOT compliant with no other requirements or treatments.
@ Richard P
You need to get a second opinion from somewhere else. There is no reason for a retest.
i lost a job hauling mail because of this bs. Its another way to suck money out of our pockets. Its ridiculous
On October 8th, 2022
My youngest daughter had an atv accident that required that she be life flighted. Both me & my wife were stressed out but able to pull it all together. I hadnt eaten allday & niether had my wife. The next mornin, I had waffles at the hotel for breakfast, I was starvin because of all the stuff that occurred & resulted in me not eating allday. I also attended orientation with a new carrier. They sent me to Concentra. Concentra pushed that dumbass sleep apnea BS on me after taking a urine sample & supposedly gettin a reading of 213dl glucose in my urine. Their quack of a doctor didn’t even do a damn physical. The idiot never checked my breathing, heart beat, BP, peripheral vision, looked in ears, mouth or eyes. He jus asked questions. Then took a measurement of my neck. 18″. He then weighed me & came up with a BMI of 35%.
I called BS & here’s why. I graduated in 1995, I weighed 180lbs because of conditioning for both football & wrestling & I joined the Navy. The Navy don’t use BMI because it’s very inaccurate, instead, they have their own standards for measurement. Using those standards with my current overall measurements I’m still eligible to join the Navy, providing I had a waiver for age. Ive gained 26lbs after leaving high school over 20 years ago. I weighed 195lbs when I came out of the Navy. Added 11lbs since leaving the Navy in 2000. 11 lbs in 22 years. I have 12% body fat according to Naval Standards. 35%BMI.
Yall see the difference yet. How is it that I can still be eligible to join the Navy, but not healthy enough to pass a physical. I took a bloodtest to see if I had diabetes. Got the results, submitted them to Concentra. They refused the independent results because the test wasn’t performed by their quack. I went & took a physical at my primary. Passed. Got a 2yr card. The company I was working for, refused to honor the new physical, even after 1 of their safety team member rode with me to Concentra & witnessed them refusing the test that proved I was healthy
@ Joshua C
Good reason not to use the ‘Doc in a box’ chain facilities. They are in it to make money, not work with the drivers.
sucks man I lost a job running the mail, it was concentra as well… went to my dr and 10 roads wouldnt accept it
I’m in the same boat I had mild apnea 8.5 ahi. Concentra Saud to use cpap couldn’t tolerate it went back non compliant did not renew I’m getting 2nd opinion. What your saying is 10 roads won’t except 2nd opinion? Or do I have to go back to concentra?
Same here. Work for a moving company and they said I can’t go get second opinion. Mild sleep apnea. Concentra refuses to give me one bc I can’t do cpap. I tried. Even pointed out info on their own website about mild sleep apnea.
@ Nichole
The examiners you are being forced to use have a ‘conflict of interest’ because they are in bed with a sleep study facility.
Hi so my husband got his dot done and then got his cdl everything was all good his medical card was good for 2 years. He started with a company and they did their own dot and their dr said he needed a sleep study , he did the sleep study and was 5points over so they gave him a machine and told him that he needed to show compliance with it for 30 days but he has nothing but trouble with it. He has had a hard time finding masks to fit him , the machine doesn’t want to keep signal to show his data. He unsure if he does’nt show the compliance what will happen considering he already had a dot will this hender his job or will this also hender his dot and cdl. Any advise on this please. I should also state that he was told that since he was only 5 points over if he could at least lose 20 lbs he could get restested which he has done he is just waiting for them to retest him
@ April P
You are in a waiting game now for the retesting to be done and new results. Hopefully it will flip the need for the c-pap and you will not any further issues.
I was diagnosed with sleep aponia, and a CPAP machine are not even being made because of the cancer related problems with them, I lost 40lbs and changed my habits, I sleep much better and for some reason the sleep center will not let me retest after these changes, what can I do? Should I get a lawyer, call the insurance company?
@ Albert S
You may need to take legal action for your rights.
My husband was given a 3 month med card. While waiting to get in with the doc time ran up fast. They said he can get the test done next week and it could take up to 3 months for him to get a cpap machine. Is there a waiver or extension he could get while waiting on the machine?
@ Shanna
There is no extension for this. He could go for a second opinion. If he has OSA, then he will need 90 day re-out before getting a new DOT/FMCSA medical certification examination.
Hi I’m a truck driver out of California i just did my second sleep apnea test last night. Im required to show proof that i been using the cpap machine for 30 days but i still haven’t gotten my machine yet since I just did the 2nd test like i mentioned so my question is what happens if I don’t have a cpap machine and my medical expires in less than a month from now?
@ Migurl
Explain your situation when you go for your new medical card. The CME may offer a short card until you can fulfill the requirements.
I am a 49yr old female, with a BMI of 39 was told won’t give me a medical card unless I do a sleep study along with paperwork from cardiologist. I was told not even a 3mth card till I get in for sleep study. What do I do? How can the Dr say your not fit? They are going by a chart that has someone extra fit before kids, aging !! They need to revise that crap!!!!!
@ Paula
DOT/FMCSA does NOT have a mandatory sleep study requirement unless you have a multitude of signs and symptoms. There is no such chart that the CME goes by. If the CME has an interest in a sleep study facility, then there is a conflict of interest. Go get a second opinion some where else.
Based on your article and what I read on Fmsca I believe that doctors cannot legally refuse medical cards based on assumptions of sleep apnea by neck size alone.All research I have done shows it is not medical fact but assumption. Other symptoms must be present. Even to qualify for a test per sleep study programs.Doctors need to be stopped from this practice.I’m following a complaint with NJ medical board
I agree. I have no symptoms other than a larger neck size and they said I need to do a sleep study. For what? I don’t snore or stop breathing. On the other hand, this small necked teammate I had has sleep apnea, but got away with it because his neck is small. He can wake up a whole neighborhood with his snoring and freaks me out when he stops breathing for like 2 minutes.
@ Cyn
Any CME that is basing a sleep study on neck size or BMI has not read or understand that OSA has a multitude of signs and symptoms. DOT/FMCSA has no set rules for a sleep study based solely on these two conditions. Or the examiner/facilities are in bed with a sleep study facility. Conflict of interest?