This is Part 5 of a 5-part series on Sleep Apnea Affecting CDL Medical Certification:
- Part 1 – 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 [You Are HERE] – Commercial Drivers Can Manage Sleep Apnea And Maintain Their CDL
Obstructive sleep apnea is a medical condition that can have serious consequences if not treated.
If you have reasonable suspicion that you have sleep apnea, it’s recommended you investigate it further, see your primary doctor and do a sleep test if necessary.
The best thing you can do is to be proactive – before it becomes an issue for your medical card, and before it becomes a serious issue for your health.
How Can You Be Sure You Have Sleep Apnea?
First understand the signs and symptoms of obstructive sleep apnea.
There are a number of way doctors can diagnose sleep apnea.
- The preferred method is an in-laboratory overnight sleep test, called a polysomnogram (PSG) or a “sleep study.”
- A PSG can also be conducted in-home, but may not be as accurate as in-laboratory.
- Other acceptable diagnostic methods are recording devices, as long as they include at least five hours of measurements of oxygen saturation, nasal pressure, and sleep time / wake time.
What is The Treatment for Obstructive Sleep Apnea?
The severity of obstructive sleep apnea is measured by the Apnea-Hypopnia Index (AHI).
Your AHI level is obtained during your PSG sleep test.
Your AHI level coordinates with your apnea as follows:
- Mild: 5-15 apnea events per hour of sleep
- Moderate: 15-30 events per hour of sleep
- Severe: Over 30 events per hour of sleep
If you require treatment for OSA, you should be referred to a physician who has expertise in managing OSA.
There are different potential treatments for sleep apnea depending on the level of severity. Here are some recommendations:
- Mild to Moderate Sleep Apnea (AHI levels 5- 20)
- Lose weight
- Avoid alcohol, muscle relaxants, and other depressants
- Quit smoking
- Periodic movement or mild exercise
- Sleep with your upper body elevated
- Sleep on your side, rather than your back
- Sufficient sleep time to feel adequately rested
- Special mouthpiece from a dentist to open your upper airway during sleep
- Moderate to Severe Sleep Apnea (AHI levels > 20)
- Include steps for mild to moderate sleep apnea
- In most cases your doctor will recommend a Continuous Positive Airway Pressure (CPAP) machine, which assists with inhaling.
- In more severe cases, a BiPAP machine may be needed, which assists with inhaling and exhaling.
- Another option is a surgical procedure to remove tissue and widen the airway.
Medical Certification
The following recommendations were made to the FMCSA by the Medical Expert Panel.
A driver diagnosed with obstructive sleep apnea OSA may be medically certified if:
- Diagnosed with mild to moderate OSA (AHI <= 20) AND has no daytime sleepiness. Does not need to be treated with CPAP.
- Diagnosed with moderate to severe OSA (AHI greater than 20). Must demonstrate satisfactory compliance with recommended PAP therapy and report that OSA is being effectively treated.
Conditional certification is determined by the medical examiner
- When you first start using CPAP you will be conditionally certified for one month. You must show compliance with CPAP use in order for your conditional certification to be extended after the first month.
- If compliance within the first month is demonstrated by a compliance report, your medical certification will be extended to a 3-month card. i.e. For an additional two months.
- If, after three months on CPAP, you are still compliant with use, and treatment is effective, your certification can be extended to 1 year.
- Drivers diagnosed with obstructive sleep apnea must be re-certified at least annually. Compliance data for the year must be checked.
Compliance Recommendations
The most effective treatment is 7 or more hours of CPAP use during sleep.
- The Medical Expert Panel’s minimum recommended compliance is:
- 4 hours of CPAP sleep per day
- 70% or more days.
- Your company/carrier is allowed to impose stricter standards than those recommended by the Medical Review Board.
- Some companies are requiring at least 6 hours of CPAP use, 80% of days.
The Consequences of Non-Compliance
Disqualification from medical certification is likely if:
- You have been found non-compliant with your CPAP treatment.
- You are experiencing excessive sleepiness while driving.
- You’ve experienced a crash associated with falling asleep.
Besides risking losing your CDL and impacting your livelihood, there are also life threatening health risks if you have OSA that is not effectively treated.
Put In A Nutshell
You Can Manage Your Obstructive Sleep Apnea AND Maintain Your Commercial Driver’s License!
Obstructive sleep apnea does not necessarily disqualify you for CDL medical certification.
Treatment, along with lifestyle changes, can help you get restful sleep and maintain your commercial driver’s license. Many drivers who have suffered fatigue for a long time, and then were diagnosed with sleep apnea and treated, report that they’ve felt like a new person since since they’ve been on a CPAP machine.
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 really hope you can answer my question. I work for a company that uses box trucks (some have air breaks) to make deliveries. I went to get my DOT medical card. Not for CDL, so I can move some equipment from one warehouse to another, 2 towns away. Once a week. However, Doc failed me cause I’m on 10mg of Ambien that I take for sleep aid and NOT for sleep apnea. I’ve been on meds for 10+ yrs. She said that the rules say no sleep aid cause some can stay in system 12 hours. I live in Colorado. Thank you
@ Lori S
You fall under your states guidelines and variances, not federal DOT/FMCSA. Who ever did the examination is holding you to a class A standard/federal standard. Find an examiner that understands the differences and will do your examination by your states guidelines.
Can I just show my DOT examiner the MyAir report on my iPhone for apnea compliance instead of printing it out if I don’t have a printer available?
@ Emilio L
Most likely. He made need to take a picture, or have you send a copy via email so he can print it out for your file.
long story short, had to take test for cpap told i needed it tryed it was more tired with it then with out, but since i took the test now i have to have it to be legal, so i tried it again still am more tierd during the day when i use it then when i don;t so i give it up, can;t get medical card unless i go back to it, so if i do and i fall asleep driveing who will be at falt you guessed it me it is a scam after 39 years of driveing never have i fallen asleep and no accidents so i quite driveing out of state but i still drive in state non commersall, makes alot of sence
@ mark
You could try a second opinion regarding the need for the cpap. Explain to the examiner that the unit does not provide healthy sleep. Drivers who need the unit won’t leave home without it. But the whole issue of a mandatory sleep study, is bogus.
I’ve been on cpap for a years my pap stopped working, so I was off for approximately 8 days before getting a new machine.
I went to my sleep doctor to get a check up and also a prescription to get a new machine. At this time they also gave me my 6 month print out up to the date I came in for my DOT physical. Dates 06/18/2019-12/18/2019
It shows me at 58% compliance. I started on my new cpap on 12/27/2019
To current.
I’m I able to obtain a short card to meet the compliance 70% since I’m on a new machine with only 7 day usage right now?
@ Nelson
Just explain your situation to the CME and there should not be a major issue in helping you out.
Question: I snore at night. A friend recommended getting a machine. Did a sleep test and was told I have mild 6 events per hour. Doctor stated insurance would cover machine and asked if I wanted one. Being free, I did obtained one. I did not like it. I had trouble falling asleep because I could hear myself breathing. Went back for follow-up and explained above. They stated I would get use to it. Well, needing my sleep, I choose not to wear it. Now, my CDL medical renewal is due and I’m being told I need a CPAP Report. Of course,the report indicates I didn’t use the machine. My complaint, I was never told getting this test and/or machine would have an effect on my commercial license. I was never even asked if I had a commercial license. Now that my present medical card is about to expire? I am pissed I was uninformed and now have no time to correct what is required to renew my certificate and as a result, may lose my job and income. I don’t know what to do. What are my options?
@ Steve
You will need to supply a 30 day readout with a 70% compliance to satisfy FMCSA guidelines. You may explain your situation to the examiner and he may have a solution to your situation. A short term medical card would give you time to supply the readout.
Thank you for your reply.. What is a short term medical card? Is it something that is issued by the State or Federal DOT? Do I have to apply for it or can the dot examiner issue the short term card?
@ Steve
If the medical examiner is willing to work with you, then the examiner will issue the card.
Was given a medical card for a year, now my understanding after literally reading every one elses question 30days 70% compliance, now is that every 30days you have to have 70% compliance through out the year? Or you can show a 30day compliance when you go in for your exam? I’m confused on how it worked, I read the guidelines and I’m sratching my head.
@ Jeremiah N
FMCSA guidelines would like to see a previous thirty day reading with a 70% compliance. If that’s all you have, then it’s all you need.
I am in California. I have been off work from an injury since August and so have not been driving commercially. I also have not been using my cpap much while off of work but I have been using it for the last month and a half in anticipation of returning to work. I have a medical exam this week and after to speaking with a care coordinator a full year compliance readout is expected. If they will not except a 30 day readout what are my options?
@ Joe
FMCSA request a 30 day readout to show compliance, not a year.
Hi TruckerDoc. I am a Bus Driver in new york. I am under 19a bus law and medically certified by employers doctor not DOT. They pulled me out of service because I didn’t have 90 day compliance on my CPAP due to not using machine on vacation for 3 to 4 weeks. I have a perfect 30 day compliance report though but still won’t return me to work for 3 weeks. Is this all in their control to make their own determinations because they are not DOT? Frustrated…
@ Nathan from upstate ny
Unclear as to who pulled you out of service.
My dot physical was denied cause of this sleep deal. I was tested 2 weeks ago but still waiting for results but the still denied my physical. Its BS. I just found out I got sleep deal and go get a machine next week but still be they took my lively hood away for me for a month, wouldn’t even give me a 30 day physical.
Usually I go to my sleep doc and he looks over my average and he gives me a letter and I take it to the dot doc and I’m done. This time I had a respiratory infection and didn’t use for about a week and a half. I went to the doctor he said he can’t give me a letter until my numbers come back up. So do I just lose my job?
@ Coleman
Seems a bit extreme, so check with your sleep doc, explain your situation and he should be able to help you.
They’re full of it I’ve had CPAP for two years I sleep less and worse with that crap on than without it what a complete joke and just another way to pull dollars out of drivers pockets
@ Jason
Your opinion is needed with FMCSA. Too many drivers are being hoodwinked on this issue.
I am asking this question on behalf of a friend. He was required by a DOT doctor to take a sleep apnea test because she said his neck was too big. He took the test and the results were that he did not have sleep apnea. She only renewed his CDL license for one year instead of two years like other drivers. Is this correct? Why was his CDL license only renewed for one year since the test indicated he did not have sleep apnea?
@ Esther
There must have been other reasons other than the OSA test. High blood pressure medications, borderline diabetes, etc.
So I have a resmed airsense 10 cpap, i have to show 30 days compliance, I bought this out of pocket so it’s not linked to a provider. How do I get the data on a print out for the 30 days. The myair app says it is only viewable and your provider may be able to get it for you. I dont have a provider. What do I do? Will the sd card have it? Please help. My job depends on it.
@ James
Your DOT examination provider may have a reader. See if they can get a printout of your last 30 days.
Hi – my husband is trying to get clearance for DOT CPAP compliancy and the DOT doctor said he needs 3 months of compliant data and not 1 month. Everything I’m seeing online says 1 month. This is for pre-employment purposes and we live in CA. Can someone answer this question? Also, could it be a company requirement versus federal?
@ Jennifer L
30 days is all the FMCSA requires. So there may be other issues that the examiner is questioning. It’s not federal and could be a request of the company and it’s policies.
Well i got hit with a cpap machine i dont get tired during day and i only sleep 3 to 4 hours a day been that way since I was a kid. Now this machine makes my throat so damn sore i cant talk half the time nor can i eat. Because of the pain the doctor says i just got to live with it. I cant find a exemption. And i have a learning disability and have no education. So i guess i am screwed. Is there any type of wavier i live in NC and cant find any info on my states requirements.
@ J Holston
What prompted the need for the CPAP to begin with?
I went to the doctor because my wife was complaining about my snoring. I have had three neck surgeries in the front of my neck. So I have problems swallowing and snore at night. I had a sleep study done and was positive. So I started to use a cpap. The last few months I haven’t been using it. I had no idea that it effects my cdl. Now I just scheduled my physical and they asked for a report on my cpap. Since I haven’t been using it, what do I do. Please help. I am not over weight or have a large neck. I didn’t know that this effects my cdl.
@ Mike B
Since you are supposed to be using the cpap, the examiner needs to see a thirty day readout off your machine showing a 70% compliance. That’s a FMCSA guideline and the examiners will need it to go forward with your DOT examination.
I just had an “at-home” Sleep study done. Got the results today. I used Concentra in Lewiston maine to get a 90 day medical card. And one of the conditions was having to get a sleep study. I plan on calling them on Monday for some more information on my sleep study results. But thought I could ask a question here, after finding your lovely and helpful sight.
I have been diagnosed with “MILD” Obstructive Sleep Apnea. My AHI is (5.1). Now does the qualify me to have to use a CPAP machine to get a 1 or 2 year medical card?
On the sleep study results, the doctor noted under prescription that I should have an AUTOCPAP and limited use. For 0-6 months. I’m honestly hoping to have to avoid this if I can. I currently don’t have a primary care provider (pcp). And the 2 sleep studies in my area require referrals from a PCP.
I am waiting until I get medical insurance to get a PCP. Which happens 90 days after employment. Coincidentally same time, my 90 day card expires.
@ Shane
If you are experiencing any daytime sleepiness, then you will want to do a clinical sleep study for a better diagnosis. You may want to get a second opinion at the end of your 90 day card.
I was just forced to get a cpap test in March. Admittedly I feel much better and I use to sleep 10 hrs and be tired, now I sleep 6 and I’m fresh.
My question is this. I drive in a team. From when I start work one day,until I start work the next day is Usually 26-28 hours. With this time shift every day I only go to sleep 6 times in 7 days. And I only sleep 6 hours. The problem is that according to my cpap compliance I am not compliant because I only used in 6 times and about twice a week its will show I used it less than 4 hours in a day. Is there a difference in the letter of the law of 4 hrs a day and the spirit of the law which is 4 hours each time you go to sleep?
@ Jordan
The CME is advised to follow the guidelines and will be looking for the 4 hours a day with proper compliance. But they are FMCSA guidelines, not regulations. A medical release form from your doctor and an explanation may be all you need.