- 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.
D.o I have to use the machine for 30 days.
@ Miguel B
30 to 90 days with a 70% usage compliance, according to DOT/FMCSA for Class A drivers.
How do you get medical card if I’m for CPAP machine
@ Michael L H
See your other answer, then take your readout when you go for a new medical card.
My medical card is basically being held hostage over a sleep study for apnea. Something I don’t have, *MY* Drs. know I don’t have, do not have the symptoms or signs of, no issues with, etc., & he’s making a mountain out of mole hills to order it. This jerk isn’t even my Dr. He’s not even a “Dr.” He’s a Physician’s Assistant. He is also known throughout the company for sending anyone he possibly can for a sleep study any chance he gets for any excuse he can come up with. His excuse for me is I have high BP, BMI, & asthma. But not really—I’m a mild asthmatic. So mlld that sometimes my inhaler usually expires before I use it all. & it’s only a problem in the winter. He tried to put me on preventative steroids with 5 mins.! I have mild fibromyalgia & don’t take meds for it because it caused me more issues, so yes, the chronic pain elevates my a BP little to the high end of normal & I had a migraine the day I was sent to him. I have hypothyroidism, even weight loss surgery failed & I hadn’t been on medication for it because I lost my previous job & had no insurance. All reasonable explanations & no serious issues or limitations. He’s an arrogant jerk, not using any common sense, & only issued my medical card for 3 months. Personally, I think he’s running a sleep study racket. He wouldn’t be the first. My company insists that I have to finish this with him or else it’s “Dr. hopping” & I’m not allowed to choose my own Dr. How do I get around this, get my medical card, & stop this abusive jerk?
@ Sher C
You are not doc shopping if you demand a second opinion, especially if you know you do not have a sleep disorder. Go elsewhere for a second opinion.
If your doctor says you don’t need one then have him write it down for you and give it to your medical examiner. They can’t go against your doctor. I know I had the same problem and my doctor said a lot of times the place is working with the sleep study to make profit.
@ Mark
We agree.
So I’ve decided to get a 2nd opinion for my Dot Card. One I found through this website. Previous examiner wants results from a sleep study bc my BMI is 33.5 and neck is 17.5 and I’m 48. Even though I told the examiner I’ve never had issue with sleeping in my life. Anyways, I did call some sleep study places and almost all of them are like “Wait list for a study is like 2-3 months out” WHAT? I can’t go that long without working. So my question is, if this new examiner I get a 2nd opinion from somehow tells me I need to get a study done, do they at least give you a temporary DOT card for 3 months or so, so you can at least still work while you’re waiting to take this unnecessary sleep test?
@ John Z
DOT/FMCSA NEVER established a required sleep study be done, based solely on BMI and neck size. You must present with a multitude of signs and symptoms before a sleep study is requested. Go for the second opinion with a CME that is not in bed with a sleep study group.
I am going through the same process right now
So I went in for a DOT exam, company sent me to Concentra. Age 48, BMI 34 Neck 17.5
Examiner tells me I need to go get a sleep study be I can be cleared. Like really, just by those 3 things I need to go do all that? I told the examiner that I don’t even snore or ever been told I snore or have any of the signs associated with Apnea. So she didn’t give me my DOT card. My question is, am I allowed to go to another DOT examiner and get a new physical done with them? One that I choose rather than who the company I want to work for sends me to? I think its wrong to make someone take such tests on merely a hunch they have apnea.
@ John Z
Yup, this medical exam facility is in bed with a sleep study group and has a major conflict of interest. Go somewhere else for a second opinion.
I took the home sleep study test and the results were 20.2. Just over the max 20. I believe just wanted to sell me the machine. The o2 sensor cut the blood supply off and I had to call the company and get permission to change fingers. The instructions said under no circumstances to move once the test began. I will use the machine to be compliant, but can I go to a real sleep study clinic and if I test below 20 can the cpap requirement be removed?
@ Clifford J
Most likely.
I had to get sleep test results were mild sleep apnea. Dot examiner said I need to start using cpap, gave me 90day cert. Wasn’t really doing me any good in fact I got less rest less sleep using it so I quit using it because I didn’t feel safe driving. Went back in 90 day not compliant didn’t renew my med card gave me 5 days to get compliant so I did then gave me 6 weeks and just could not feel safe driving after using cpap tried explaining that to examiner showed him where concentra and fmcsa doesn’t require cpap for mild apnea only moderate to severe. Did not matter to him he wasn’t going to renew my card we had an exchange of words some of which I wish I never said but basically amounted to him not being a doctor and how can you determine what is best for me and I walked out. Now of course I’m out of work. What do I need to do to get my med card back? I sent away for a second opinion from an online company called workstart have you heard of them and if comes back mild do I still have to use cpap?
@ James E
Get a second opinion from something other than a ‘Doc in a Box’ who is not getting a kickback from a sleep study facility.
I have, well, had, a valid DOT medical card through May of 2024 as I just did a new DOT Physical today (March 2, 2023). As a conditional job offer, the company requires (and paid) to have a new DOT physical done. They sent me to Concentra. The nurse told me, even before the doctor came in, that he was likely going to require me to get a sleep study, and he was right. I was given a new medical card that is only good for 3 months, as I need to comply with getting this sleep study done, and if results are good, the doctor will extend the card to 2 years.
When looking up questions on google, a lot of the answered were credited to Concentra. I am skeptical after reading some of these posts, that Concentra even cares, that they likely get a kick back from the company they refer (pamphlet I was given by Concentra, is for a company called betternight).
I am thinking of getting a second opinion from the doctor I used when I got my first DOT exam (as I only got my CDL in June 2022). COULD this other doctor, if they don’t think a sleep study is needed, just issue me a 2 year card without a sleep study?
@ Jason R
Yes. The company you were sent to has a record of the type of behavior you just experienced. Go get a second opinion.