- 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.
Also, I have a dot card that is still currently good for another year, but not a cdl one. So if I get cdl one same should apply then?
Hi there!
I was curious. About 4 years ago I was given a diagnosis of sleep apnea. I used a cpap for short time the nurse at the sleep study said “when I slept on my side it was almost non-existent”. Ever since then I sleep on my side. I get headaches sometime but that’s it. Havnt used cpap in about three years. Is this going to pose a problem when I get my cdl?the last two driving jobs I had for chauffeur jobs I stated this and had no problem clearing the physical. Will same apply? I’ve lost the pounds Bmi is where suggested to be finally. Will this pose a problem?
@Joel
Get a medical release form from your primary doctor explaining your situation and you should be in good shape for the next DOT examination. Make sure that your doctor explains your sleep situation in detail, otherwise there will be flags all over the place that will need further explanations.
I have had a medical card for the past 8 years and I recently went to have my medical card renewed and was asked to dis-robe down to bra and panties and was given a paper gown. I knew prior to getting my medical card renewed that the physical was more in depth than previous years. I was also asked to “duck walk”. I was upset about the removal of my clothing for the exam at the time but nothing compared to my shock and anger when I spoke to drivers that recently had their exams completed and when they told me they didn’t remove their clothes or even disclose any medical conditions or even perform the dreaded “duck walk”, I was livid!! I thought all these new regulations were suppose to give consistency and ensure all drivers with a cdl were physically able to perform their jobs safely. Did I just choose the wrong Medical examiner?
@ Very disappointed
The purpose of the FMCSA wanting to have Certified Medical Examiners, CMEs, was to provide a normal ‘fit for duty’ examination by doctors that understand what a OTR driver does for a living and to standardize the type of examination.
As far as people having to disrobe (but provided a gown) is not unheard of, but not the everyday normal.
And as far as drivers not giving the examiners all the information that is required on the medical health form, that is one of the things that hurts drivers, when it is found out. And can cost them their driving privileges.
You may have chosen an examiner who is not so driver friendly.
I had to get my Medical card renewed about 4 months ago so I went to the medical examiner my job required and they said based on my bmi, neck size, large tongue and because I still had my tonsils that I had to get a sleep apnea test before they would release me. So I went and got a test done and they said I had a mild sleep apnea and needed to get a machine. I’ve never had a problem sleeping in my life but they told me in order to be able to keep driving I had to get a machine, so i did. They required me to do 30 days on the machine so they gave me a temporary medical card for 30 days. I passed that so then they told me I had to do another 60 days on the machine then bring in the results so they gave me another 60 days temporary card. I also passed that. Then they told me I had to do another 90 days then bring in the results before they would release me for a year but then I would have to bring in my results yearly. I sleep worse with the machine then I do without. I feel more exhausted since I started wearing this machine then I ever had so I haven’t been wearing the machine that much in this last 90 days. I’m probably going to fail the 90 day. Also I only drive in state (CA) and I only drive during the day on a regular 8 hour shift. I deliver propane tanks to stores. My questions are, is there anyway I can go to a different doctor and get released so i don’t have to wear this machine anymore? Does this go into the national registry that I have sleep apena? Am I going to have to deal with this problem as long as I have my medical card?
@Kev
As a class A driver you still have to pass the class A medical certification process with the CME, but you could explain that you travel intra-state only and the rules in california may be more lenient. Check with the california DLD and see what they say.
My CDL card expires on the 24th of may it is now 20th. I took my cdl physical and passed under same conditions for four years now they say i am not in compliance. In other words my doctor issued my card and should not have for last four years. Now they failed me and I am trying to get this all squared away in a few days,but running out of time. Do I have any options I can take? Did sleep test and waiting on cpap and set up but time will run out before I can get all this done. My employer has been letting me draw sick pay but I dont know how long this will go on.Concerned in Kentucky.
@Dennis
If you have sleep apnea and you are just getting started in the process, you will be disqualified while you go through the waiting period and acclimation period. If you are driving within the state boundaries, you may be able to go intra-state only for awhile and still work while you go through the process of acclimation. Without all of the information it is difficult to say what other options you may have.
I have a valid dot card that doesn’t expire for a year. I went to start a new job which requires a recert for all new employees, at which came states I need a sleep study done and most likely a cpap. Which I was already in the process of doing on my own. Cme won’t sign off on my card until after everything is done. Can’t the cme issue a 3 mo Card since process already started if he won’t can I go to another cme? I don’t want it confused with doc shopping. Is my current card still valid until next year?
@Jon
This sounds more like a question for your new employer and their company policy.
If you are already in the process of getting the CPAP and have gone through the tweaking for your best results, then you should be able to continue with your existing medical card. Mostly you should be aware that as you are going through the calibration process of setting the CPAP up that your medical card is basically disqualified. Once you have the unit set and running correctly, you will need to take a record of your compliance report and a copy of a medical release form from your primary doctor with you when you redo your medical certification.
Can I get a medical card if they found sugar in my urine and they took blood from me and my A1c was 13. Will that stop me from getting a med. Card?
@Calvin
According to the FMCSA guides, there is to be NO sugar in a driver’s urine. It is an early indicator that the driver may be headed into diabetes and be unaware of his condition.
Once the situation is under control, you should be able to pass the DOT examination and continue driving. Your medical card will be for one year and you need to have your medical doctor fill out a medical release form for you to take to your next DOT examination.
Hello, I went for mine on Monday. Everything was fine, minor protein in urine. Of course I get the usual bmi and neck shit, must do sleep study. Got a 3 month card. I have no issues sleeping, no daytime sleepiness. I plan on losing weight in that time frame, can I use another cme when time is up without risk of being flagged or whatever it’s called? This cme I have never liked and seems to enjoy doing this to people. I need my job, I know the weight needs to go, and am hoping if I loose 40 pounds in 3 months it will suffice. I also usually get high BP only when this physical is due!! What do I do?
I also saw my primary 3 days later and he was not concerned with the protein
@Jonathan
You should be able to go to another CME in the 3 month period with out being tagged as doc shopping. Also look at ways to drop your BP. It will come down with weight loss, but don’t try to lose too much to fast. The first few pounds will come off easily, the rest will take a bit of work, but go for it.
Thank you very much!!! This past week has been very depressing. Id be concerned about my sleep if I wasn’t getting any, but I am. And there is no way everyone sleeps 8 hours every single night. It doesn’t take a doctor to figure that out. And I refuse to pay for something I don’t need! Sorry needed to vent. Thanks again and where can one get proof these sleep things are not mandated? It’s being twisted into something way bigger and I swear someone has become rich over it. Even my primary doctor said just cause you may have signs they r looking For, doesn’t mean I have it.
@Jonathan
There is nothing in writing, other than the FMCSA handbook, to guide the new CME’s and you can’t find the handbook any more because FMCSA pulled it from their main website. It’s being revamped, I hear. Mostly because the new CME’s and the companies that are teaching them how to do the job are giving the new CME’s mis-information. All we can do is keep guiding drivers in the right direction. Travel Safely & Be Well! Truckerdocs
Hi,
I just had a sleep study done, after a request from my current employer. I haven’t researched the issue in advance and felt pretty confident, that I will NOT be diagnosed with apnea. I was wrong. I was diagnosed with sleeping apnea and now I am told by my employer, that I have to use a CPAP machine in order to keep driving for them.
Is there anyway, that I can refuse using the CPAP machine and keep my job or at least keep my CDL license? If once diagnosed with sleep apnea, am I required to use a CPAP machine in order to maintain my CDL license?
Thank you for your help!
@Chicagski
It’s a little confusing. You must maintain a valid medical card to maintain a valid drivers license.
So in your state you most likely need to use the cpap to maintain a valid medical card.
Since your employer is following the letter of the law, not sure if you can bypass the situation. If you leave their employ, then it goes to the state DLD to make the next decision regarding maintaining your driver’s license.
If it has to go to federal, then yes you must show ongoing compliance with the cpap to maintain a valid medical card.
Hi, I recently went to get my dot physical and was told that I need a sleep apnea study done, my bmi was 42.8. I passed everything else, they also said they found microscopic blood in my urine, which I’ve been told is actually somewhat normal. The Dr., only cleared me for two months pending a sleep apnea screening. Do I need to have it done or can I just go somewhere elsein two months from now? Thank you..
@Henry
The CME should have found a multitude of findings before he requested the sleep study.
If you have daytime sleepiness, then consider the sleep study, if not go somewhere else.
Do question blood in the urine, it may be nothing and it may be an early warning sign. Have your primary doctor check it out and confirm that it may be normal for you. He could then give you a note stating his findings and it would help the CME out also.
Thank you. I, and I’m sure everyone else here appreciate you taking the time out of your schedule to answer our questions.
You are welcome Henry!
I was diagnosed with sleep apnea about 8 yrs ago but I’ve only been a cdl driver for 6 yrs. I had been able to my medical card with no problems before because CME weren’t required to check for neck size and bmi required now by fmcsa and sleep study. And i never admitted to having sleep apnea to my examiner when going through the dot physical. My question is, now that it’s the law when i go for my renewal physical and the if dr orders sleep study because my bmi is way over 35 and my neck is over 18in do i tell him I’m already using cpap machine and should be in compliance.
@smiley
You should answer the questions honestly and that will tell the examiner that you already are using a cpap. You will need to have a recent readout with you and a medical release form from your doctor also. With the new physical coming out in late December of this year, you really are going to have to support all information that the CME needs. Falsifying your DOT examination could cost you your CDL.
Last year I was diagnosed with sleep apnea went for new job sent for re-cert was given 90 day cert CME was extremely rude wanted another sleep study done I waited two months & just went to a different CME they gave me a 2yr cert without even asking to see compliance with my cpap machine am I OK with my new card or should I be worried about dot coming after me
@Johnny
Everything about this smells bad. So, if you reported to the first examiner you had sleep apnea and he wanted another sleep study, then the examiner didn’t fully understand his position as a CME. If you went to another examiner and didn’t give him the same information, then you falsified the medical report.
The first examiner has already reported his findings on the FMCSA database. So you should have received a one year medical certificate at the time of the first examination.
If the second examiner reports that you have no issues and no sleep apnea, then both you and he are going to be up for questioning if the system kicks it out because of factual discrepancies.
You should provide proper information to a qualified medical examiner who understands the readout and sees that you are in compliance with your CPAP and you should receive a one year medical certificate.
I’m getting ready to get my physical done within the next three months. The last time I went where my employer sent me they tried to say I was required by law to have a sleep apnea test done based on my weight and bmi. My employer then sent me elsewhere and I was given a 2 yr card. Where can I find the laws and or recommendations concerning this In case they try again so that I am familiar with them. I have no problems sleeping. U really don’t want my employer or myself to have to pay thousands of dollars for something I know I don’t need. Thanks.
@Mighty Joe
As stated in this series of articles “There is currently no ruling by the FMCSA for sleep apnea screening on DOT physicals.“
I am a 69 year old school bus driver taking Tramadol 50 mg twice a day FOR KNEE PAIN ,DOT EXAMINER disqualified from driving until my doctor takes me off this medication. Last year I was taking Tramadol and didn’t have any problem getting my 1yr card.
@Robert
Your DOT examiner is over-reading his job description and is not in a position to make you do anything.
I would have your doctor fill out a medical release form and go somewhere else to do your DOT examination.
I had a new employee dot physical done the examiner gives me a 3 month medical card. Three days later another new employer sends me for another dot physical the examiner gives me a 1 year medical card. I put the same thing on both about my medical history. Is this considered doctor shopping and will I get my medical card pulled?
@Mike
If you were sent by your employer, then there shouldn’t be any real issues.
I have a friend that has been a truck driver for over 10 years. He uses a CPAP machine but not constantly. He is extremely active at work and with his son playing hockey. He doesn’t drive overnight.
I’ve read through the Mayo Clinic website about sleep apnea (and also DOT site about it) and one of the things they say “may” be a factor in having it is a large neck circumference. He has always had that even as a child. Also he does not use his machine every night but he is told he has to use it at least 70% of the week. How is that so when not everyone is the same and not everyone is that bad off? He also has a little weight to him but is still healthy. Just would like some of this clarified, please… Thank you
@Carter
FMCSA set the rules and regulations on this one.
Start with a medical release form from his primary doctor stating that the driver is using his machine at least 70% of the time.
That will answer most of the CME’s questions.
Since everybody is different the FMCSA tried to keep it pretty simple, but it still does not fit everybody, just the majority.
Does a Class B license holder (schoolbus driver) have to meet the same physical standards as a Class A truck driver?
@Shelley
If you are going to be driving interstate, then yes.
If intra-state only, then you have to meet your state Drivers License Department rules. Check with your state DLD and confirm what those requirements are.
I recently went for my dot physical 1-31-15 I was told my bmi is to high and neck size is 18.25. My vision is 20/20,hearing is good, blood pressure is 120/80, and not diabetic. I was told I need to have a sleep study. Is this true? If not what can a do about it?
I was given a physical card that expires in 90 days. Do I have to wait to go seek another opinion?
@Len
No it is not true. If there are a multitude of other signs and symptoms, then there may be good cause. Otherwise go somewhere else to get your next DOT card.
I currently use a cpap machine. Am I able to use a second machine for the truck so I am not transporting back and forth? Both would have a card reader. Would I need to have 2 separate readings done for the dot physical?
@Bill
As long as you can show compliance with the unit, you should be fine. If you’re driving OTR then there is enough data on the card. If not you may need both card read-outs.
I am 53 years young on 1/19/15 I went to dr. to get med cert my neck size is 17he said that my bmi was 42.8 and said I need sleep study done . my cdl is set to downgrade 1/30/15 there is no time to have done before deadline as of now I have 7 days left. Please help is there any thing I can do.I am a army vet but they cant get me in in less than 7 days THANKS
@roland
Check with your state drivers license department. Also you should be able to get a short term medical card while you wait for the test and the results, so talk with the examiner about it.
Back in 2009 I was told by the doctor that I had to have a sleep apnea study done in order to get my medical certification. The sleep doctor said I had severe sleep apnea. I spent thousands of dollars on a prescribed dental device. A sleep test with the dental device resulted in the sleep doctor issuing a ruling that I did not have sleep apnea while using the dental device. Since that time I have written on the DMV medical form “sleep apnea effectively controlled by a prescribed dental device”. I can only get a one year medical due to blood pressure medicine I take. This year the medical examiner tells me that due to new DOT rules, I must have my primary care doctor give me paperwork to verify that the dental device is effective 5 years after the sleep doctor said it was working fine. My primary care doctor wants me to go to the sleep doctor again. The sleep doctor wants to do another sleep test before anyone will give me a medical cert. I have to have my class A license for my job as a firefighter, even though I almost never drive. I have to have the commercial license just in case I have to drive in an emergency situation when the normal driver goes in with the ambulance and patient to the hospital. I have two questions. Did they have the right to force me into a sleep test 5 years ago, and if not…it seems to me they should have no current right to force me to continue to takes any more sleep tests. It seems the equivalent of a cop without a proper search warrant kicking in a door and then finding something illegal. What he finds cannot be used since the initial action was not legal. My second question is: since I was cleared by a sleep study 5 years ago with the dental device, can they require me to go through another sleep study 5 years later when it’s already proven effective? Thank you for all of your help.
@Jeff
There are no new rules regarding sleep apnea. The guidelines have been in place for a long time, but people are misreading the guideline, which are not regulation. So my question would be; why would the original sleep doctor, the one who cleared you 5 years ago, want a new sleep study? And secondly, if your doctor cleared you with the device, all he has to do is complete a medical release form stating that the device is and has been working for the past five years.
I went in to get another dot physical done and passed everything I have taken a sleep study test and results were that I didn’t need a cap machine but the examiner says they won’t accept results since I gained weight from last test and wants me to take another can they do that
@Jake
There are NO NEW LAWS regarding sleep apnea.
Go somewhere else for your examination. Someone is just taking advantage of you not knowing this. Be polite, just leave if they start this with you.