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.
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.