- 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.
So, I did a sleep study at my current company. They told me that I need a cpap machine which they provided. I have not been able to keep the mask on my face for the required 4 hours. Now I am up against my 2 month medical card expiration. They are saying that I must be 70% compliant within the past 30 days prior to the physical. I already know that this will not happen. My question is if they shut me down or fire me will this follow me? Do I have to tell the next company that I go to that I have been diagnosed with sleep apnea? Buy the way, I NEVER did see a doctor about this. Just a sleep study company on company property.
@Tony
Before going to far, why not talk to the sleep study people about your mask. They make a low profile mask that is much easier to sleep with. To answer your questions. If you were to be fired or released from driving, most companies have a policy not to discuss the reasoning for the release. And if you truly do have sleep apnea, you need to tell the truth. I have a multitude of drivers with sleep apnea and they use their cpap machines daily. They won’t leave home with out it.
1. Besides the small mask, they also make nasal pillows, which can be very easy to get used to. Many people also need a chin strap, because their mouth opens during sleep. 2. Another problem can be that the pressure of air the machine is giving you is constant. Today’s machines have a setting that lowers the air pressure when you breath out, but it has to be turned on in the machine. Your sleep provider may not have turned this setting on. 3. Some patients worry about bothering the people too much where you got your machine. They made a lot of money when they sold you the machine and masks and things. They want you to be happy so you will come back again and again over years to replace your masks and tubing. If they are not willing to work with you to get your apnea under control in a way you can live with, find another medical supplier.
First of all let me apologize for what you are going through! My husband has been through the very same thing and he used to sleep like a baby and never snored. All because the doctor bumped up his bmi and neck size. DONT ever have a home sleep study because ins will not pay and it is not accurate!! He finally had to see a pulmonologist to get some answers and this Dr told him to go ahead and get through compliance and then we will address it. According to the results, my husband gets worse with the cpap. THIS HAS BEEN A NIGHTMARE! I hope our marriage can survive this disaster. He may very soon lose his job. The company will not allow a second opinion and the company doctor is a total quack. I feel helpless…….my suggestion? Find a very good specialist to help you through this!!!
i know this is a late reply but i have been going through the same stuff.. i actually have SLEEP APNEA… WITH THE CPAP.. i hate to say it but go through another pulmonologist. or… another way to prove is… if you can have or find a friend that knows and has sleep apnea… go through the company you got the cpap machine from.. tell them you want to see if the psi or whatever it is going through the mask is right. they will then give you a machine that test what your husbands readings are and so forth… (this is where whoever has sleep apnea comes in) have him wear the mask for a night. no big deal then your husband wears it. i have a program that reads the data card. look and see what his readings are so you guys can see for yourself and try and get a cammera and record him sleeping so then aka.. you just did your own. SLEEP STUDY. it will for sure determine and you will be able to see for your own eyes that if he has it or not if so. I appologize and i feel for him cause this crap sucks.. IF HE DOES NOT print out the paper of your friends or whoever that has sleep apnea that wore the machine and then the night that your husband used it. boom all done sign this paper please stating i do not have sleep apnea.. if the doctor does not.. ok next doctor.. any questions or anyone else does please email me graksjoe001@yahoo.com and good luck.
I did have enough time on my cpap can’t pass physical they want 70%I have 43%because the machine wakes me and I can’t go back to sleep.WHAT CAN I DO?WHO DO I CALL ? IF I DO NOT GET MY LICENSE BACK I WILL LOSE ME JOB AFTER 20 YEARS.COME FEDS LET US KNOW WHAT YOU CAN DO FOR US NOW!!!
@Mike
First identify the issues as to why you can’t sleep with the unit. Face mask may be too large or bulky, so see if the sleep folks can get you a low profile mask, that should help. If you can identify other issues, then talk with the sleep study people and see what other options they may have.
Probably because 1 its uncomfortably and 2 its beeps all night it a room as big as a closet you can only ignore it so long, my trainer wore a sleep apnea machine and every night i was in his truck i dreamed about school buses backing up.
When our federal government gets involved we already know we’re doomed.
STRIKE STRIKE STRIKE HIT THEM WHERE IT HURTS AND THINGS WILL CHANGE
I have had a sleep study in the past, it had nothing to do with my medical card. The results showed no signs of any sleep apnea. My BMI is over 35, my concern is will the examiner expect me to do a sleep study every 2 years? It was a pretty expensive way to prove to my wife that I didn’t have sleep apnea. I have to go get my card renewed next week, should I even tell them I have had a sleep study?
@Brandon
If you don’t have sleep apnea, then don’t say anything about it. If they ask, then say you had the test done and you do not have sleep apnea. If they tell you your BMI or neck size is to big – get up and walk out, don’t pay, just leave. There are no new rules or regulations that address sleep apnea with the FMCSA.
Unless the company you work for will not allow a second opinion!! You will be red flagged for being overweight and will have to have a study. Do not have a home sleep study because ins will not pay for it and it is not conclusive. Good luck!
My question is , I passed my physical except I was over weight by the min. So the examiner only gave me a 3 month medical card , and he said I was to get a sleep ampnea screenning. Well I did what he said and it was all bad service . Because after doing everything involved in this sleep apnea issue I steel haven’t been able to get my medical card returned to me. So my job only have me 1 week to try to resolve this. I really need some 1 on1 help from someone who cares. I thank you for this web sight I hope you could help.
@Alex
Well first and foremost there is no weight rule in the FMCSA regulations. So you may be being taken for a ride.
If you do not have any other symptoms regarding your sleep, then you would not need a sleep study. There are a bunch of things that need to be evaluated before you are requested to do a sleep study.
I would go somewhere else and have the DOT examination done. Your 3 month card will be over-ridden by your new medical certificate.
Once again some companies DEMAND you only see the company doctor and will not allow a second opinion!! Then we are screwed! Especially if the company Dr is a quack!
my boyfriend just had his DOT Physical and they told him he had sleep apnea but we cant get in to see how much pressure he needs for the cpap machine can the doctor hold his medical card or does my boyfriend have the right to get a temporary medical card till he can get in with a dr to get the right pressure and machine
@Caroline
There is no such thing as “the right to have” a medical card. If the CME wants to give your boyfriend a limited timeframe medical certificate while he gets his stuff together, then he can, but he does not have to.
In other words……. The dot drs can pretty much do what they want to and not be regulated by anyone……
I have a driver that had a 6 month Med Card. Due to him moving and changing insurances he took his sleep study 2 weeks before his card expired. Now they are trying to work it out with his insurance just to cover the process of fitting him for a mask and machine. The doctor says that could take another 2 weeks for approval. He went to his original examiner and showed his progress and asked for a 3 month extension were he only received a 30 day extension. My question is if he gets the CPAP machine and starts to use it, will he be in compliance, or is he allowed to drive during this 30 day period of starting to use the CPAP. His examiner is saying that he is not allowed to drive during his 30 days while using the CPAP machine. Is this statement true even if he has a qualified medical card and driver’s license? The driver is telling me that I will be liable if he has an accident during his 30 days of wearing the CPAP machine. So confused right now.
@Raleigh
He would be legal to drive as long as he has a valid medical certificate. Otherwise your driver is operating a CMV without a valid medical certificate. The CME’s and the FMCSA want to see a thirty day profile before returning a driver to operating a CMV.
On the 9th of this month i went in to renew my DOT physical and the doctor only gave me a 1 month physical. He said that anyone who uses a cpap has to have a new sleep study every year. I am over weight but i do not have any health issues. I had just went to my doctor in March for a yearly checkup and i took the results of my blood work plus the last stress text i had to show that I’m healthy. I also took a readout from my cpap but he refused to look at the results saying they mean nothing to him, i have to have a new sleep study. What do i need to do to resolve this problem?
@David
You take the same information to someone else and take your business with you. If you have a medical release form from you doctor and a recent readout, that is all you need. So take your business elsewhere.
You keep saying to go elsewhere! A lot of companies DEMAND that you only see the company physician!!! They accuse you of doc shopping!
unfortuneatly.. the companies are saving their own butts (or think they are) but they jsut pushing drivers away.. but.. you have every right and DO NOT have to take a sleep study if they are just going by bmi, neck size and weight. otherwise once you get into the hook of this sleep apnea crap it is VERY VERY hard to get out of.
I had physical examination done June,2015 . everything was fine and the doctor gave me my 2 years validation. I applied at a new company which they sent me to get a new physical at a clinic of their choice. At this clinic the Dr. Gave me only 3 mnths of driving pending a sleep study, due to the fact that my neck was 17.5 cm. My question is, is my previous 2 year certificate no longer good?
@Roman
The CME would have entered the new information into the FMCSA database and that will now over-ride your previous medical card.
I would look into the FMCSA website and see if you can find the area that allows you to enter into conflict with this new examination. There were no new rules regarding neck size and BMI and you may be being taken for a ride. So unless you demonstrate other symptoms of excessive daytime sleepiness, the new CME is over-stepping how they read the guidelines.
Thank you very much. I’m definitely looking into that.
I got my first test done on my this sleep apnea test n it mild but my dr clear me to drive but my dot examiner keep telling no I can’t drive.so I’m getting a second opinion is that a good ideal. I’m only driving a class b n I’m from ohio
@Michael
Go get a second opinion and take a medical release form from your doctor with you. It will explain that there is no need for any further testing.
Besides you are a class B driver and not an OTR driver. Someone is over-reading their powers as a CME.
Thank you very much. Cuz I was thinking the samething Cuz if my dr clear me drive she should’ve too but I will let you no what happen today I go get a second opinion this morning
Got a second opinion no go now they went me on a cpap machine ugggggg
A few days ago I went to go get my DOT physical. I am overweight but have no adverse health issues, other than being overweight. At the doctors offices a practitioner walked in the room after the initial person did my drug test, eye exam and etc. When she first entered the room she informed me that I’m probably not going to like what she has to say. I thought I knew what was going on so I replied, yes I know, I’m overweight. She said no, you have to go for the sleep study. I questioned this, because in all my research for the DOT physical I must have missed that piece of information. She informed me, and I quote “By law I am required to send anyone with a BMI over 35 and a neck larger than 16″ to get a sleep apnea test done.” Now, what I don’t get, since a few days ago I’ve done a lot of research. I see a lot of words like ‘guidance’ but not once have I come across ‘law’, ‘rule’ or ‘obligated’. When I got home I remeasured my neck (she used a clumpy tape measure that she draped loosely around my neck) and found that I am just slightly over 16 inches, my BMI is high, I have no hypertension, no high blood pressure, no cleft pallet or throat obstructions. She is basing this expensive study off of me being overweight just because?….*Shrug*? She did issues me a 6 month medical card, but her notes reads as follows:
“Advised on need for sleep study & medical clearance for safe CMV operation. If study show (+) will need 1 month TX and compliance report with AHI (<5) & wearing device 4hrs/day 70% of time. Will need copies of all result.
I want to know the legal aspects of this, since it seems to be very far and few between online. How can a medical practitioner hold my license hostage just because I am overweight, instead of saying lose *blank* pounds to show initiative and be below 35 BMI (which for me is 220 lbs.) by next re-up of physical. Again, I passed everything else with FLYING COLORS….my weight was the only "risk factor".
I took this information to my employer and she was floored to this new "sleep study" stuff. As a school bus driver over 50% of the dwindling staff (retiring and leaving for better job options) will be categorized for sleep study. My employer was very discouraged with this new information and requested a meeting with the physicians at the company assigned physical place.
I've found this so far, there is no FMCSA guidelines or rules on sleep apnea. There has to be reasonable suspicion; BMI and neck width is not reasonable suspicion. Also they need to take previous medical history into consideration along with questionnaire that they administer in the office (which I also scored 0 on).
Please help!
I did forget to mention that this is a Class B endorsement with no out of state travel and a minimum of 22.5 hours per week.
@Peeved
You hit the nail on the head. No new rules, no regulations and someone who wants to be real important is making a judgement call without understanding. Find a CME who understands the drivers’ life and have them complete the examination for you.
Update again. I informed a coworker what you said. “Find a CME who understands the drivers’ life and have them complete the examination for you.” She went and had a second opinion done at her doctor who is DOT certified. Initially, on her first medical certificate, she was given 3 month and on the second which is her primary doctor she was given full clearance for 2 years with no issues. Our work will not take the second one because they only accept physicals from the physician they have a contract with. Not sure what is going on here. I’m glad I didn’t pay out of pocket to get mine done, but at the same time I’m still in the same boat I was originally because I have less than 5 months left on my certificate and haven’t found a doctor in my area that isn’t operating under this misguided information about sleep apnea and the “law”.
Recommendations?
@Peeved in Indiana
That may a company policy, but as I understand it, according to the FMCSA, if you disagree with the first CME you have the right to go to any other NRCME certified examiner. But if the company has some policy about who they get their information from, then you might want to work someplace else. But check with HR and ask to see the policy in writing, that should bring things to a head.
You can also take a dispute directly to FMCSA, but this is a long documentation intensive process.