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.
How can they make us use the cpap machine on our days off? Anything that is related to our jobs we should not have to do on our time off right?
@Eric
CME is looking for a 70% compliance, you can do what ever you want in your down time. Just make sure you can demonstrate proper compliance.
I have a 78% usage but my AHI is 11…The doctor says it has to be 5 or lower for him to extended my medial card for 1 yr . 5-20 Ahi is mild apnea …so my question is. What is the Ahi compliance number for a new medical card. Is there a web site i can download the info from to take to my medical examiner if he is wrong.
@Gerry
How long have you been using your unit and what does your doctor have to say about it? If you have been on the unit for quite a while and your doctor is monitoring you, then make sure you have a medical release explaining your situation. This is not an uncommon issue and needs to be supported by your primary doctors findings. In a perfect world the CME wants it under 5, but in the real world, those numbers vary. You could scan the FMCSA website, not sure you’ll find anything there.
One dr is denying me a medical card because my ahi is over 5. The sleep clinic is telling me my numbers look good and is confused at why the dr is refusing me the card. Kaiser hospit here in california tells me they would issue me a mesical card but can not because the orignal dr hasnt issued a 1 yr card yet. Seems the drs and sleep clinic are on 2 different level of what is legal. So my question is does the AHI have to be under 5 to be issued a 1yr medical card?
@gerry
Your numbers sound good, not sure who is over-reading the guidelines. If the hospital can issue a medical certificate done by a CME on the NRCME, then get it from them. You do not have to have one card to get another card, as long as it is done by a CME on the registry.
I recently had a sleep study done and was told I had sleep apnea, 9 others that I work with were told the same thing. I find it odd that the place that did the study also gave us the machines, could they be telling everyone they have sleep apnea just so they can get money from the insurance company?
@Eric
A very good observation my friend.
My pulmonary doctor tried to read the card and said it would not download any information from the card. I had to take my CPAP machine in for them to read it. They also determined it was not saving the information to the card. The information on the card only shows 60% usage. What options do I have? It is not my fault that the machine is faulty.
@Robert
Try a medical release form from your doctor explaining the situation and an explanation about the CPAP card. That should help.
I am currently being treated for sleep apnea by a low pressured cpap machine. I have a co worker that was “cured” of his sleep apnea by using a dental device. I have a one year medical card while he has regained his two year card. I am trying to decide if a similar device is worth the expense. After speaking with a sleep specialist dentist I have learned the new oral devices have chips/card as well. I haven’t been able to locate anything on medical recertification in regards to sleep apnea and oral devices. Any help or info is greatly appreciated.
@Raymond
Only heard of this device recently. Not sure how FMCSA is going to rule on this. Diagnosed with sleep apnea and treated with a medical device, if the usage can be confirmed and there is at least a 70% compliance, then you would have to take this issue up with your examining CME. Bring a medical release form from the dentist along with information about its usage and you will, probably, get a one year medical card. Not sure about a two year card with diagnosed OSA.
Iam really worried right now.i just dropped off my cpap data to a concentra.my compliance was just under 70 %.it was65% I have only been on my machine for a month and I used it every night.i hope I don’t lose my license over this.i know I can get better at using it.they told me the doctor will call me later or by tommorow.is there any kind of way to get an extension.my card runs out in 2days.
@jerry
Maybe, since you just started, but you need at least a 30 day with 70% compliance.
If the CME understands, he may do another thirty day to see if you are doing OK. BUT, that’s all a maybe.
When I got my last medical card, they gave me a 6 month card and required me to get a sleep study done. This wasn’t really explained to me very well until it came time to renew. They told me in order to get a new medical card and be legal, I had to get a sleep study done. It’s entirely way too expensive. My medical card expired and my Texas CDL was automatically downgraded to a regular license.
Do I really have to get a sleep study done?
@Jack
There should be a series of health criteria evaluated by the CME before anyone would recommend a sleep study.
If the CME based their findings on the easiest things, like neck size and BMI, then you should just have the DOT exam redone somewhere else and go from there.
i have never had a problem being sleepy at work one day I went to my DOT physical he took out the tape measure my neck was 15 inches borderline ? I did the sleep test got pulled off my job put on disability 45 days 2 years ago , I struggle with my mask I can’t sleep because I’m constantly messing with it or it hurts my nose , my dog chewed up my mask a couple montages ago I was off it for 3-4 weeks before they would approve a new one now I am due for my physical again this month I just went to download and I am under I am at 62 percent supposed to be 70 I really have been trying I feel more tired from stressing over that Cpap every night what will happen when they see I’m not 70 percent? I can’t afford not to work ?
@Ellen
FMCSA wants a 70% compliance readout. If you explain your situation, you may get a very short card to get your readouts to where they need to be, maybe. Also talk with your cpap people and tell them about your not being able to sleep with the present units mask. They should be able to help you out with this issue.
Hello doctor … thank you very much for this blog… very very helpful!!
I am a Physician Assistant- C in California and I have been encountering problems with the OSA patients. They are coming with some kind of report -compliance summary from their sleep center with several graphics and numbers which I get an idea if they are mostly in compliance and review the AHI …but I really feel umcomfortable reading them and assuming the interpretation of it. Should this be done by a MD or technician trained to do so?? Will FMSCA be OK with me reading them??
Patients are getting upset when I ask them to bring me an interpretation of it and even the MD or techs at those sleeping centers are getting upset when I ask them for it. They state “that is what they give everybody” to the police dept, firefighters, DMV, etc…and I should know how to read them!!? I have no problem with learning…but again, I am not trained to do so…should I??
Isn’t like sending an EKG to a dentist and ask him/her to read it??
I would appreciate very much your input on this…
@Gloria
Make a contact with one of the local sleep study facilities and have one of the techs go through the report so you know for sure what you are reading. You are just looking for clarity and that is the best way to get it. Maybe take a tech to lunch and talk about your needs for understanding based on the FMCSA requirements. You do need to know how to read the report. Good Luck
I am a transit driver and there is a doctors office in town who is using bmi chart to pass or fail the transit drivers i have always gotten 2 years but now they aré telling me i need a sleep Study because Of my 16 3/4 neck size. What can I do
@Ed
Read all the article on Sleep Apnea Screening in this series to understand the issues and your rights.
You already have a two year card. If you have no medical conditions that would indicate possible sleep apnea, do not do anything.
When it’s time to renew your medical card, find a doctor who understands how to fairly and appropriately apply the FMCSA guidelines.
I am 53 old school bus driver of 11 yrs. who holds a class B in Texas who has sleep apnea. I went for my yearly medical exam to re-new my medical card. I have been told by my employer, almost 2.5 months after the physical, that I have been disqualified by the DOT examiner because of low readings on my sleep apnea test a month earlier, from my medical doctors office. I went to my doctor and he told me his notes did state I should be cautioned when operating a motorized vehicle due to severe apnea.
They gave me 3 days to get this changed or….restructured. My doctor also said his notes were public knowledge to DOT and he could not re word anything. He did give me a note stating that I have a machine that is older, which does not retrieve or download data. He also stated I am in the process of getting another machine through insurance which is a process, but he feels using the old machine will help until a new CPAP machine arrives. Also, that I am doing everything in my power to comply with my CPAP and DOT.
Is there anything else i can do to get a temporary card until then to continue to work. I use my machine daily, not drowsy during day. I feel like I am being held hostage for my medical card. They don’t seem to care one way or another. What can I do at this point?
@William
I think you have done just about anything that can be done. Not sure about your records being public to the DOT. Without your consent that is a breach in HIIPA compliance.
Try having a medical release form completed by your doctor explaining your situation. That is about all you can do at the moment. With the release, you may be issued an extension, but don’t count on it.
Can a Montana cdl holder drive while using an oxygen concentrator ? Regular physician signed off on medical card lung specialist says else what and who do you go by?
@Natalee
If the doctor who signed off the medical card is a CME, then you can go with that.
If he is not a CME, then you will need to have your lung specialist complete a medical release form explaining your condition and supply a report for the CME to make the final decision.
I was diagnosed a year and a half ago by a medical equipment company administering the home test. I do not believe I have this condition. I’m divorced and severely hampered financially with alimony payments. My insurance didn’t pick up a dime of this bill, which was close to $2000. To make a long story short, they are holding my compliance report ransom over the billing. My medical card expires in two months and I’m looking for other options to get the report. I have obtained the software for my machine to print it out myself, will the medical examiner accept this? If not what other options do I have? There’s no way I can come up with the $1200 balance in what time I have left.
@Wayne
If you have the ability to print out your records, then you might be able to find a CME who knows how to read it and then go for your DOT examination. The CME’s are looking for a 70% compliance, but not everyone understands the readouts. That’s where I’d start and go from there.
This outfit I purchased my machine from has been nasty people. They threatened my license repeatedly. My first physical after my “diagnosis” they demanded $240 for an “annual monitoring fee” and refused to fax the report to the doctor until I gave them my credit card information. The doctor actually stayed an hour after his office closed waiting for it. This year they are demanding even more. They’re holding the report ransom. I wish I had recorded audio of my conversations with them on the phone. I also called another medical equipment company in my hometown Today and was told that I could bring in my machine’s SD card and they would generate the report and print it out for $20.00. Is that acceptable as well, or do I need to keep dealing with these people? For someone who is supposedly in business to help me sleep, they’re not doing a very good job, I’ve lost many nights sleep as a result of their constant threats against my livelyhood.
@Wayne
People like you describe don’t deserve your business or your money.
Spend your money where you can get the report you need, and the FMCSA / medical examiner will not have a problem with it.
Find out what the DOT doctor requires. I’m not positive if they just want a printout or if the sleep doctor has to sign off on it as well. I’m pretty sure they want a report from the sleep doctor stating that you are using you’re machine and it’s working properly. That’s what i get and the sleep doctor signs it.
Hello,
Another lucky driver that was told I must get sleep test. 6ft and 211 pounds have larger neck. Anyway, I took home test and I was 17.1 AHI . Told the DOT DR that I do not need cpap per FMCA. I do not have sleepy periods during day. Got my One year card good now. But, what do I put on my form when I go back to CME DR for new CDL test next year? AHI <20 and no daytime sleepy , no crashes , NO CPAP NEEDED. I have been told they may make me spend another 900.00 dollars again to take another test. ? Your thoughts.. Thank you, for helping us daily drivers.
@Steve
You don’t have to put anything like that on the form.
Just make sure that you try to find a Certified Medical Examiner who knows the difference between guidelines and regulations. If anyone starts with the “bmi and neck measurements”, get up and walk out, you are done there.
I was diagnosed w/ mild sleep apnea w/ no restrictions my 3 month card is almost expired. I’m on cpap but I just got my machine not even a month ago. I don’t have thirty days compliance… yet but went today to different physical doctor. and got one for 2 years. I feel im doing something wrong and lying is not in my nature. what would the penalty be for doing such a thing… and if this is a no-no.. then how can I rectify the situation.. please respond a.s.a.p. in another 10 days i’ll have a month compliance
@Mike
Some one does not understand the rules and regs. If you stated that you had sleep apnea and you are using the cpap as prescribed, then your medical card is good for one year. And you would need a compliance note or report that you are using the unit. I would not worry too much about your compliance report until you have at least 30 to 45 days of usage. Not real sure what could happen if someone questions the length of the medical card, but that is not your problem, if you told the truth.
In 2012 I took a sleep apnea test and the finding was the disturbance was consistent with a severe obstructive sleep apnea syndrome. CPAP was increased to 10cm of pressure and the results were “a very significant improvement in patient’s respiratory function.” The apnea/hyopnea index improved to normal. The lowest SaO2 recorded was above 90% and there was “no significant desaturation”.
2 days ago I went in to get a Dot exam for a CDL (I’ve never tried to get one before) and the Doctor stated I needed to take another test before going any further and gave me 3 months to complete this. I have lost over 30lbs (from 325 lbs) and am wondering if I need to go through the whole testing process again or just buy a CPAP machine and have it record the data.
What is the best recourse for someone in my situation? What are the chances I could be on the road by June 1st?
@Troy
Get your recent primary doctor to complete a medical release form for you. Make sure he explains that you show excellent compliance with your CPAP. If your older machine does not allow a printout, then you might consider a newer machine. The CME needs to see proper compliance before he can move forward.
I live in California I have been told I have Sleep Apena. In order to keep my commercial license. I will get my machine today and my question is in California is the a required time that I need to be on the machine before they will approve my license?
@Rick
For the FMCSA there is a minimum of 30 days before being given clearance to drive commercially.
Not sure about what the republic of California may want. Check with the california DLD and see what they say, but federally it is at least thirty days.
I have never had a CDL before and I got a job where I will be driving a Public Trasit bus. I went in for my DOT physical and was told becuse of my BMI I needed to have a sleep study done. So I was given a 3 month card. He also said it was because of the DOT. The examiner had a pad of referal forms from a sleep center that they do business with. After all the comments I have read on your site it seems suspect to me. I saw the questionare that the Sleep Center has and the only thing I have is that I snore. I am a morning person and have never been told I stop breathing while I sleep by my partner. Now I am not trying to get away with anything and want to get tested but my medical card expires in 2 months and it could be as long as 3 months before I can be tested. Is it ok to go and see a different medical examiner before my medical card expires?
@Anthony
Yup!
There are no new laws regarding sleep apnea, so go elsewhere. And if they start in with the sleep study, get up and walk out. Or ask “politely” to see the law. It ain’t there, so hold your ground or get up and leave.
I went for my yearly DOT renewal and the Dr. wanted an evaluation from my Dr about Sleep Apnea. I have been on a Cpap for almost 3 years now nd use it every night. Can I be denied a renewal by the CME over Sleep Apnea?
@Larry
Yes, if you can’t or won’t provide the CME with the information that he needs to make a safe determination.
Just get your primary to complete your medical release form for you and take your latest readout with you to the CME. That should do it.
I’m using cpap as required , but my examiner says more information is needed . My current machine is not able to provide this , so their saying I need a newer updated version . These machines are not cheap and I,m wondering if I really need this or just a different examiner ?I have mild apnea and use the cpap over 90% of the time .
@Doug
Tough call. The challenge is to demonstrate compliance. Try getting your primary sleep doctor to complete your medical release form for you and take it back to the CME. Or you might try choice #2 in your question.
My medical examiner is trying to tell me that there is a requirement to have yearly sleep studies done even with a diagnosis and effective treatment with a CPAP. Is this true? I live in NY.
@Scott
If you have your medical release form completed by your primary doctor and it shows proper compliance with your CPAP unit, then you should be OK. The examiner is just needing more information to back his decision making process.