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.
New to trucking was givin a cpap and it wakes me up due to non stop pressure so i take it off medical supply says they didnt recieve data for weeks at a time so now im gonna be held for non compliance while payong 900 to my company for a mechine that not only showed no data more then once but one i couldnt use due to pressure being to high. Company wont do anything about it and medical provider says non compliance off the bat so what can i do…. Company says they will suspend me do i go back to where i got my dot card for two years before i went to them or do what no one will answer me
Recently passed 30 day compliance on cpap machine,received one year medical certificate.My question is during this next year will I only need to be 70% compliant on cpap machine to receive another medical certificate.
@Race
That is correct.
I work for the pbcsd as a bus driver and just recently had my dot physical and was sent to do a sleep study. The machine they gave me for home use to see if i had it didn’t work well but for some reason the doc said I was positive for sleep apnea. My question is can my pulmonary specialist override this decision? I believe these tests are designed to fail drivers as to soak up insurance money and or the money of us hard working drivers.
@James
Get a second opinion from your primary doctor and your pulmonary physician, along with a medical release form from them and you should be in good shape.
Have been unemployed and am looking to go back to work . Current medical card expires December /16 , new job requires new hire medical card certificate . Not 100% compliant with the use of c-pap machine and card was put on hold by ME till she receives more info from my personal MD as to treatment . Is a letter of opinion exceptable over data or not . Or submit limited data . Only use machine sparingly due to the fact that I sleep better on my stomach and don’t exibit the more severe systoms of sleep apnea . If I’m understand correctly ME should certify for 30 days and collect data , if sufficient then add 60 days and collect data and if found in compliance an additional 9 months added to make a year total . Then a yearly certificate unless found non compliant. Any recommendations ?
@Johnny
FMCSA wants at least a 30 day in compliance report for OSA. DOT examiners have the freedom to work with you, but not sure about your scenario of 30, 60, and 90 days.
I am a veteran who works for a local power company…. I was medically retired/discharged… during my medical screen process getting out of military they said I have a very mild case of sleep apnea… now I am having trouble staying in compliance 4 hours night 70% becuase I wear a mouth guard for broxism (grinding teeth / jaw always hurting) I am unable to use mask with with just nose piece cas I am a “mouth breather” but the other masks make it almost impossible for me to wear mouth guard and mask… so my choices are screw my teeth and jaw wear the mask and be in pain with out mouth gaurd. or what my VA sleep apnea doc and VA dentist says is they want to put me on the TAP III apparatus which is a oral devise. From what I see the is not a trackable devise for me to bring in compliance report so not aproved for cdl? Correct? Now my VA docs say after I get fitted for the tappIII apparatus I will take another sleep study wearing it and it will show that I no longer have a need for a cpap… is this true … what are my options…
@John
If the VA moves you to the TAP and it works, then have your doctors fill out a medical release form for you and take it to the CME doing the examination. Also explain that you are not an OTR driver and that you work and live locally.
Ok, I will try this… do I need to do this before my next dot physical then… being that they want to see I am complies every year …and do you have an example of said medical release form and what it should say… or just wait???
@John
Medical release form – click on the link!
I am a mechanic with a class A CDL because my company requires me to have one to move equipment. I just went for my recert and was given a 90 day card to get a sleep study, After working all day the technician met me at the garage and fit me with an at home sleep test that I found very uncomfortable an stressful to try to sleep with, on top of being sweaty and dirty so the leads had a hard time sticking to me. I was given the results of my test was 12 AHI, the tech said he has never passed anyone who has a study and already had the CPAP machine ready to hand me I tryed the face mask and found out no way could I sleep with them, I’m now trying the nose pillows which were comfortable enough to sleep with, but the machine and its auto pressure would change so much that I started finding it hard to breath because of pressure, when i open my mouth i sound like a balloon that the air was let out of as the air rushes to escape. I can literally hold my mouth open and the machine pushes air through my nose and out my mouth. After the air escapes I find it extremely hard to catch a breath because of the machine. After several trys I have given up, also everytime I take the machine off I have a headache for almost the entire next day. I now finding myself in non compliance and taking a chance at loosing my CDL and my job. Now sure what to do. As I am a mechanic I do not drive more than 15 miles in a commercial truck a day tops.
@Andy
Best bet is to get a second opinion from another CME. Home study test are unreliable and in most cases not accepted.
If home test are unreliable, why am I being made to buy a cpap machine and being denied work for noncompliance
@ Joseph LaF
The most reliable testing for the diagnosis of OSA is a clinical study. Home testing is simply not as reliable. But there are clinics and examiners that are interrupting the FMCSA guidelines to their advantage.
https://www.fmcsa.dot.gov/sites/fmcsa.dot.gov/files/docs/Sleep-MEP-Panel-Recommendations-508.pdf
Here are the recommendations from the scientific study. Nothing about treated ahi, but an untreated less or equal to 20 ahi is recommended to be certified. Where are these CMEs getting 5 or less???
Hello Dr I’m having a hard time adjusting to Cpap I was diagnosed in late January and started Cpap shortly after and went for a dot physical and was given a 30day card and I failed to make compliance so Ive been trying to get used to it and I think I finally have I’m at almost 80% but my Ahi is at 7.8 and the doctor is telling me its high and wont renew my card. I cant find anything where the FMCSA has set a Ahi number other than the if your ahi is over 20 you have to get treatment
@Chris
You have been on the CPAP for a while and it would be nice if your numbers were a little lower, but they are not out of sight and your compliance is good. Try getting a second opinion or talk with the examiner and see if you can get a short, 30-60 day, medical card to let you try to get your numbers down a bit.
a lil over a year ago i was diagnosed with sleep apnea and was forced to use a CPAP machine which did Not work well for me at all, causing nightmares of drowning and suffocating in my sleep. i literally had to wake myself up to prevent dying. i panicked from this on multiple occasions and returned the unit and refused to use it since. now my current medical card is about to expire next month and I already failed my latest DOT physical this past Monday because of this (Dr. would not grant me another valid Medical card) I am not looking forward to resigning from my job and Trucking all together. Is there ANY other quick alternatives available? (DL8 Intrastate Excepted)????…can I just file that and stay within my home state? (just to keep my job)
@Timothy
If you go intra-state only, then you may be good to go. Interstate drivers have a different type of lifestyle and this sleep apnea issue is about safety to the driver and the public at large. Check with your local drivers license department and see what they have to say.
I was diagnosed with very mild sleep apnea a few months ago, I have no symptoms and I’m often told that I have more energy than any other person in my company, and I’m twice as big as anyone. Ever since I started to use this machine I have been losing sleep, surprisingly I have not yet suffered any extra tiredness or negative effects other than the emotional strain of feeling like I have had my dignity and freedom taken away. I get no benefit at all using this machine, it has only reduced my quality of life by keeping me tethered to it. I told the sleep doctor I have been seeing that I don’t need this, he says if he were to say that I don’t need the machine, and I we I told the sleep doctor I have been seeing that I don’t need this, he says if he were to say that I don’t need the machine, and I were to get into a wreck then he would be sued. On top of that he has not directly called me a liar, but heavly implies that I must be lying that I have no sleepiness. I’ve been reading a lot of medical journals and Dr. blogs, apparently no one even knows for sure if the CPAP machine even has any positive effects on people with mild sleep apnea, I know for a fact it has only had negative effects on me. I gave it a shot and I refuse to live like this, is there anything I can do or say to get this doctor to sign off on me not using the machine, I don’t think he understands the rules, what can I do to convince him?
@Logan
Sounds like you are between a rock and a hard spot. If you explain to the sleep doctor that you are not sleeping well with the unit, then he needs to be working with you. Most drivers that have sleep apnea and use the CPAP, won’t leave home without it. Your sleep doctor can release you from usage if he feels that you don’t really need it and he is not being held responsible for anything. He may be over-reading the guidelines. Just try to get your point across to him. If he does not understand, then try for a second opinion and see what they have to say.
I having been setting up truck drivers on cpaps for years. And have seen plenty of mild cases where I honestly feel bad they have to be tethered to the cpap just to keep their job. I do my best to fit patients with the correct mask, and that’s what it usually comes down to, finding the right mask that will let you sleep comfortably. If uncomfortable your body will let you know in the middle of your sleep causing you to wake. Also many of todays cpaps have plenty of comfort features, features that can make a difference in your compliance. Google your cpap unit and find out all the comfort features it has to offer, or just ask the Therapist to explain all features. Most of these features are defaulted “off” when unit comes out of the box.
How do I get the records from my sleep apnea machine online
@Mary
Check with your machine manufacturer and ask them, they should have a way for you to do what you’re looking for.
I have been denied a recert card. for not having “90” days of compliance reports. I have a “NEW” modem data cpap machine thru the VA . I provided dot doctor 8 days of data , a letter signed by my primary physician, letter from sleep therapist”MEDICAL RELEASE FORMS ALL SIGNED SAYING OK TO DRIVE”.. This was new machine and could only provide 8 days compliance . I have been on cpap machine for 18 of my 33 years driving . I have my prior machine but from different physician and he has retired i cannot get the data.The machine shows 8987 hours use at 90 %. I have offered to bring it in to the dot doctor .That was turned down .. QUESTION is if they allow 90 day cards for the dot doctor to initiate a sleep study and then 30 days and follow on compliance reports in the case of dot doctor ordering it. Why would i not be allowed to have the 90 day recert card in order to allow my VA primary doctor and my sleep doctor to print out the data even if its 30 days at time til 90 days is obtained..The dot doctor did not initiate the study nor diagnoses . I got new study machine thru VA because my primary doctor said after 5 6 years time for new study and machine ..I said fine .i love my cpap machine use it every night.
@ Bob
Go get a second opinion. Someone is not fully understanding the FMCSA guidelines.
Is there any where in the regs that states that if I have a CPAP machine and I could possibly get held out overnight that I have to take my machine with me in the truck
@ Tomlika
Any CME is looking for a 70% compliance over any thirty day period. So if you use your machine routinely and are home most evenings, then you should be within compliance. Most drivers that we know, that need the unit, won’t leave home without it.
Fight the discrimination, Public Law 113-45 prohibits forced sleep apnea study with out it being a rule. If 80 percent of persons have some level of Sleep Apnea then why do DOT certified doctors not require every one to be tested? Because it is not a rule that’s Why. Fat discrimination is still discrimination and is illegal. And Yes I am seeking help from the ACLU on this as well.
Please help me raise enough money to fight the discrimination. Please share this. Thank You.
https://www.gofundme.com/x3sgv24k
I was ordered today to take a test even after I told the examiner I had no previous problems with sleep apnea. Because I am fat he sent me only giving Mr a 3 month card.
@ Kurth
Go somewhere else for a second opinion. No new rules on sleep apnea, just someone over-reading their interpretation of the FMCSA guidelines.
I have just been to dot doc to get recertified, I have sleep apnea, this doctor told me I have to have a sleep study every year to be recertified. I gave him the print out of my usage and I’m 95% compliant. the doc said this report is not enough and he has to see a report of two studies every year. is this true?
@James
The guidelines are being over-read by the CME. If he is requesting an additional test then he is not understanding the guides in their full ramifications and how it effects a drivers lifestyle. Best bet is to go and get a second opinion from a different CME.
I have severe OSA and have been treated with a CPAP for the last 5 years. I am at 99.3% compliance for those 5 years. My employer just informed me that if I did not get a CPAP with a cellular modem so that they can track my usage daily that I would be deemed disqualified. Any suggestions? I
@William
Since when did a company make that kind of a requirement? If your present unit has the capacity to download your reports for compliance usage, then you do not need a new unit. Now if they want to buy you a new unit that fits their new request, hey why not. NRCME only needs a readout of your unit, not a cellular modem.
My wife started at a new company where she was given a device to wear on her hand while sleeping at the hotel. Sort of an “at-home” sleep study. Unfortunately, she was so stressed out by this contraption she ended up not sleeping and instead sat outside smoking. Of course, it diagnosed her with sleep apnea due to the inhaling while smoking. Now she works for a different company and her medical card expires in November. She is willing to have a sleep study done (we’d pay out of pocket for it), but is worried that if the test comes back saying she doesn’t have OSA that every two years she will have to do another sleep study at our expense. Are there any regulations regarding this? I’ve been looking and cannot find anything. Thank you
@AVirginiaVirgo
Since there were no new rules regarding sleep apnea, then there should not be any new questions.
Now the new medical examinations that will be in effect by the time she has to redo her medical certificate examination will ask if she has ever had a sleep study, then she would answer yes. Even with the test done and a valid confirmation that she does or does not have sleep apnea, she should not have to retest each time. If she does have sleep apnea, then she won’t leave home without a pap machine, it is a life saver for those with the condition. If she does not have the condition, then there should not be any further questions. If ask to redo the test at the time of the examination of her medical certificate, then it’s time to test elsewhere.
Hey doc.
I was diagnosed with severe OSA about 4 years ago Been on supervised treatment since then..
Have it bad.. AHI was 104..Heart would stop beating 4-5 seconds at a time..
Feel a heckuva lot better now that I’m in treatment..
Went to Pulminary Dr. today..says my episodes while treated (AHI) has gone up to 5.3 so he says come back in 2 months try to loose a few pounds and we’ll look at it again..We may have to do new sleep study and get different machine…
However…Last year he built a Brand new 2 story office building with an in-house sleep center..
I’m thinking maybe he’s trying to raise revenue for this new building…
What do you think?..
@Frank
Trust your gut and also how you have been sleeping. Watch your own numbers, but trust how you have been feeling and sleeping.
I didn’t have success with the cpap. It was too much constant air based on the events I had at my sleep study, in which I couldn’t sleep at all with all the wires and monitors. I’m on the apap now and have no issues with it. Not sure if you’ve tried it, but worth a try if you haven’t.
Can my husband be disqualified for having serve sleep apnea if he is compliant?
@Lucy
As long as he has been on the cpap for a while and he is 70% or better compliant, then he should be fine, if that is the only issue.
I recently received a recertification med card valid for two years from the company that my carrier requires we use for exams. However, after sending it to the state, and the carrier I’m told that they will only update this physical for 30 days because “driver now meets the criteria for a sleep assessment” at a facility that I belive the carrier owns and operates.
Obviously I’m concerned with the HUGE conflict of interest, and after reading this blog, I honestly do not believe i have the medical condition.
I have yet to go talk to their payroll doctor, but am sure the first words out of his mouth will be “neck size, bmi”
How would you suggest I proceed?
@Tony
Find out where they want to go with this. If they are requiring the test then they should be paying for it too. If you do not feel that you have the condition and they want you to pay for the test, it might be time to reconsider the job.
Hi
My new company’s dot dr had me do a sleep study based on my neck size . My ahi was 5.5 . I have never had daytime drowsiness EVER. Now they are forcing me to use cpap .
@Greg
Since there were no new rulings regarding sleep apnea, then someone is overreading the guidelines.
Try getting a medical release form from your primary doctor stating his professional opinion regarding the need for the CPAP and see if that helps. Your numbers would imply a mid case of OSA, but the mask may be more of an issue that your mild OSA.