- 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.
“There is no reason to have a sleep study done unless you feel there may be a problem”. If you do not have a cdl. Why is this as the DOT also regulates all non-commercial traffic as well. A Prius doing 60 with an office worker behind the wheel can do just as much damage as a commercial driver in whatever vehicle he / she is in. And there are 10x + as many of them. If this is really a “disease” that treatments are needed for lets run the whole driving population through these screenings and test procedures. It is discriminatory not to. Its only fair.
so if I understand correctly unless you have a problem there is no regulation that states if you are over wight you have to have a sleep study.
I have lost 20 pounds since last physical and was told if I don’t loose 30 more or have a sleep study I won’t be renewed.
Hi . My name is Eli.I.am.diagnosed with sleep Apnea after being tested. So was able to purchase a CPAP and been on it for a month now. I have a 3 month temp DOT healed card..Have I been on my CPAP.long enough to get a 1yr card..I.can’t move on and sign paperwork to buy my own truck until I obtain a 1yr card.
I have been on my CPAP for 30 days now.
I just received my results from my sleep study. I was told I have moderate sleep apnea and need a cpap machine. However my individual insurance will not cover equipment and supplies. Since I work part time, my employer does not offer me a group insurance. I was told coverage for such equipment is only covered through group policies not individual. I have kaiser. Is there anyway I can seek compensation from my employer?? Please advise
@Sassy
Sorry, can’t help you on this one. Our expertise is about qualification for a medical card at the Federal level.
Can’t help on insurance, employer policies, state CDL regulations, etc.
https://www.gofundme.com/x3sgv24k
Our Ready mix company uses us health works and now they have started weighing (bmi) and measuring necks and then looking at a chart to determine if you have to have a sleep apnea test. Our company won’t let us use any other doctor and we are local…not otr. Most of our drivers are being told they have to be tested….what can we do if anything? It is a financial hardship even with insurance.
@Maureen
Sounds like an issue you need to take to the powers above you and file a proper complaint. Since there were NO NEW RULES on this issue, you guys are being taken advantage of. File a complaint with management. If they are going to help pay for the testing thats one thing, if the company is willing to lose good drivers because of this issue, thats a company decision. Your company has a contract with the examiner facility because they are cheaper by the dozen, but if they start losing good drivers because of this scam, then they will change to another examining facility or continue to lose good employees.
Absolutely, theres no fmsca rule or law passed yet that says sleep apnea is a factor especially to local drivers, for the most part its the medical treatment centers that are pushing it to drivers to try to make extra money off the drivers, you can try to get your physical card at any other facility which might come out of your own pocket but unless its a company policy theres no obligation to get your physical card at a specified location. And if it is a company policy you need to confront your boss to find out why they would want to sacrifice good workers for something that isnt regulated yet and hopefully never will.
I recently went for my recertification (class B). I took a sleep apnea test already and passed. I was told by the examiner this time that I.have to take the test again(I have no insurance). Even though I am the same weight as before and blood pressure is good. I refused to do this. So she proceeded to tell me if I don’t lose 20 lbs.in two months she will not renew my recertification. What should I do?
@Angela
Take your existing medical and use it until it is about to expire, then go somewhere else and get a second opinion. Whomever you are dealing with right now is overstepping their limitations and supposed authority by a long shot.
Last year, Aug 2014, I was diagnosed with colon cancer. I immediately underwent 6 weeks of radiation, then surgery – colon resection Dec 1, 14, followed by a colostomy due to lack of blood supply to the bowel on Dec 9, 14. I went on medical disability Dec 1, 14. Started chemotherapy in Feb 15 and completed that in Jul 15. My oncologist released me back to work Sep 1, 15.
My rectal surgeon told me that if I lose 100 lbs he will reverse the colostomy and put my plumbing back together. So, in Aug 15, I met with a weight loss clinic to discuss a gastric sleeve and started the preliminary testing necessary for the procedure.
At the same time, I was sent, by my employer, to Concentra to complete my DMV Medical Certification and Fit for Duty examination to return to work. The CME immediately said because of BMI, neck size and age (5’10” 325, 18″, 47 yrs) he has to send me for sleep apnea testing, and issued me a 3-month certification.
In the excitement of returning to work, I immediately took my certification long form to DMV and was cleared to return to work. That same day, I also visited with my primary dr. who referred me to a sleep disorder Dr., who in turn referred me to a sleep center to perform an in-lab test.
After completion of the in-lab test, the sleep Dr. reported to me the findings that I have modetate sleep apnea and recommends a CPAP machine. He asked if we could schedule a follow up to get me a machine. I refused, saying I would follow up with my primary. I got a copy of the sleep report from my primary, and have not taken it back to the CME at Concentra because I want to do more research first.
I found this thread in my research, and thought I would share my story here to get and receive advise from the TruckerDocs before I do anything else. Please help!
Sean
@Sean
So you were diagnosed with sleep apnea. You want to get the CPAP and get started with it as soon as possible. You will need at least thirty days of proper compliance before you will get a medical certificate issued. Proper compliance is 70% each night with at least four hours of usage.
I’m a driver with 30 yrs experience and good health. In a nutshell. Some DOT Physicians with NO written FMCSA “guidlines or rules”, are on their own (with NO sleep apnea training what so ever themselves) are acting as middle men by sending drivers to sleep apnea testing to satisy other doctors who are “stake/share holders” in the sleep the apnea ASSOCIATION which is suddenly making obscene amounts of $$$ by doing the tests, Some are more than likely getting “kickbacks” for sending drivers to them to have it done. Pass all the usual standard dot tests, but blood pressure a little high on dot physical renewal day, “You need a Sleep Apnea Test”, “Its now required”, and can only be certified for 3 months until its done. Have a slight cold and body temp is up a tad, same thing, “You need a Sleep Apnea Test” etc and etc… The paperwork provided by dot physicians for dot physicals now includes questions that has to do WITH sleep apnea for patients who will have “Weight Loss Surgery” (it says so right on the paperwork).The Sleep Apnea test is nothing but a $$$ making SCAM that has absolutely nothing to do with commercial driving. For the truckers who are very fit and in excellent shape who spend hrs in the gym with a neck greater than 17 inches,, ooh boy! look out! “You now need a sleep apnea test…
No what you mean David, had two different doctors tell me they agree that sleep apnea testing is just a money-making scam!
Thanks David S! I fall into that category of former Division 1 athlete (football) and periodic weight lifter, of course my neck is going to be bigger than 17 inches! Many medical professionals don’t know the difference between “big by muscles” versus “big by fat”. Mathematical computations done by neck and BMI measurements don’t tell the whole story and are falsely requiring many healthy “big” people to take sleep apnea tests or lose their CDL.
I have a friend that is a body builder. 6’03” tall, weighs 290 lbs, neck size is 20 inches……they tried to force him into the testing. The guy is a wall of muscle. All this is nothing but a money grab.
I had a a1c level of 10 only was giving a 3 month card had to retake 3 month’s later results or still same will i be able to get another 3 month’s
@Clifford
You may need to work more closely with your doctor. You really need to get your numbers down lower. You may be given another three months to get the condition under control, but you will, most likely, only be given one more time at the most. Then you will have to have your numbers down or be disqualified.
By taking medicine and exercising and eating more veggies and cutting out sugar you should be able to get your A1C down below 10.
I take Metformin and have cut out sugary breakfast cereals and sugary soda. I try to eat more veggies like peppers and onions. My A1C went from 10.4 to 7.3.
concentra is a joke and rip off if your company sends you to concentra , flat out refuse
they weighed me wrong and added extra lbs and I was 1 inch shorter that day than I was at my doctor two days before, they are afraid to give any cards cause almost everyone I have talked to that has been there was told they need a sleep study
I can not afford the cost of all the tests machines and upkeep on everything and to boot I would need a power inverter in my truck which I cant afford, so I have resigned my position with my company and will not be able to get my card to drive, and no one seems to care.
my personal doctor also sent concentra their form back saying he did not think my degree of sleep apnea would interfere with my driving, concentra said they didn’t care what my doctor said
someone needs to get involved with this or a lot more people are going to be unemployed and maybe that’s the goal to get rid of the old guys
37 plus years with no accidents tickets drug failures but that means nothing
maybe just maybe it would cause a strike just hoping
Hi,
Yes, I was sent to U.S. Health works for my exam.
The P.A. added 3 points to my BMI, my true BMI was 35…he raised it to 38. Also, I wasn’t told about the 30 day study. He gave me a 3 month card and said I needed to get a sleep study done. What confusion! If my BMI was originally correct, I just could have lost 5 lbs. What a waste of time this all has been.
I agree…what a rip off!
I’ve got an out of pocket physical this Wednesday and I’ve lost a few lbs. My fingers are crossed!
I also went to Concentra, same fraudulent service. The first time I was flagged for high BP, nothing said about BMI or sleep apnea as reason for denial of 2 year med card. I went to my doctor and got treatment for BP, went back to the same Concentra two months later, and now they reject me, requiring a sleep apnea test. They also didn’t measure my height, weight, or neck correctly, the nursing assistant just rushes haphazardly through those measurements. She was a 1/2 inch off on my neck, 1 inch on my height, and she weighed me with STEEL TOE SHOES ON!!! All of these numbers are critical to the BMI and sleep apnea calculations!
I went in today to get a recertified medical card as it expired last Sunday. I was told my neck circumference was greater than 17 in and my bmi was to high at 47. I’m 6’3″ at 380lbs with no health problems whatsoever and never have. She issued me a 2 month card and was told to go get a sleep study done. My main question is can I go get another test done and if I pass will it look weird that I did it within a certain amount if time.
@Jason
If you are going to go to another examiner, wait for last least 30 days, otherwise FMCSA sees it as doctor shopping. Since there were no new rulings regarding neck sizes and BMI to determine sleep apnea, you are really only looking for a second opinion.
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.