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.
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.
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.