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 have been diagnosed with moderate sleep apnea since 2011, and have been using an oral appliance for 7 years. With appliance I have 0 episodes of apnea as proven by 2 separate in hospital sleep tests. Did one in 2011 and one in 2016. The Dr. at the medical exam place says that CPAP is the only acceptable treatment, and won’t renew my medical card. I read the rules on this, and nowhere does it state that CPAP is the only acceptable treatment. Tried CPAP first, kept taking it off in my sleep, so I tried this treatment and it works great. How do I get medical examiner to accept this ?
@ David M
Go get a second opinion from someone who understands the guidelines and regulations.
I live in the suburbs near Chicago, IL. My company uses Concentra for medical card renewal, but has told me I can go anywhere and they will reimburse the expense. Do you have any recommendations on a qualified medical examiner in my area that understands the guidelines? Any help on this subject would be greatly appreciated, as I have been frustrated by this issue for years ! Thank you
@David
Look up our driver friendly doctors at http://dotphysicaldoctor.com/find-cme-illinois/
I have been off of work since mid-Aug/2017 due to injury. Due to the nature of the injury, (upper extremity) and because of the length of time it took the Ins Co to approve of a surgery to fix the problem, the pain from the injury worsened by the week until I had the procedure in mid-Jan/2018. In mid-Dec/2017 I was having trouble getting comfortable enough to sleep, and using my C-pap equip wasn’t helping my cause. I stopped using the equip probably in late Dec/2017 and haven’t used it since. While I am still battling post surgical pain, I am challenged to be comfortable enough to get any meangingful sleep. I am still off of duty, but I imagine I may recover enough to resume work within the next 10-12 weeks. At that time I will have to go renew my medical card. Am I going to run into compliance problems or is it possible that I will get some consideration due to the injury situation to get waivered off of compliance temporarliy? Your advice would be greatly appreciated… Thank you.
@ Frederick
You have time to get back on your cpap and have a 30 to 90 day reading showing compliance. It would be unlikely that any examiner is going to waive compliance in this case.
I went for a dot physical..neasure my neck right away..request for sleep test..i was diagnosed with sleep apnea..i been waiting for my insurance for my cpap machine approved..dot doctor won’t extend another 3 months because is severe apnea he stated..i been doing my part..contating my doctor office and insurance..still pending..but now my medical card eill expire..what should I do..please help
@ Veronica
They all have you in a tight fix, but there really isn’t much that the CME can do for you at the moment. Stay on the insurance company and doctors office to keep things moving.
They do NOT give enough time to go through the CPAP process! We have had the same issue. The docs are sooooo booked up, 90 days is just not enough time! Who should be contacted that can fix this situation? We are without pay, even though my husband is jumping through all of their hoops, because all of these doc appointments, studies, approvals take much longer than 90 days. I’ve read the comments and we are NOT alone! Help!
@ Julie S
DOT and FMCSA would be who to contact. Also talk with OOIDA.
Is a commercial driver with very mild Sleep apnea required to be put on a CPAP machine to qualify for a DOT physical. 8 was my ahi number
I am from pa two years ago I had a sleep study cos I wasn’t feel well. had the one night in Home study and it showed I had mild apnea normal is 5 I had 8 she gave me options lose weight stop smoking or I could try a cpap. I chose the cpap to see if it made me feel healthier well it didn’t so I stopped using it after four weeks. Fast forward two years go to renew my medical card there’s a box for a sleep study have I ever had one said yes she ask What severity it was I said mild she ask if I was issued a CPAP I said yes but it was my choice to try it to see if it would work for me and it didn’t so she called over to the office where I had it done to get the paperwork and the doctor wrote it up like I needed to use it for my mild sleep apnea my thing is how can she revoked my medical card when The Dot regulations law says only people with moderate to severe apnea needed to be treated with the CPAP and mine was mild. Turns out back then I had depression because my son was diagnosed with leukemia that’s why I didn’t feel good. Now he’s cured and I feel great was the doctor in the wrong or what can I do
@Chuck
If you know you don’t have sleep apnea then go to another DOT doctor for a second opinion.
I was put on a crap machine about 3 years ago. I just quit my job with one company and was hired by another. They sent me to a doc for my company physical and he asked to see a printout from my machine. It shows I’m not compliant. Can the doc that the company sent me to give me a short card, so that I can get compliant. Or can he just refuse to give me a card altogether. I haven’t even started driving with the new company yet, and since I had already quit my job I no longer have any medical insurance. What do you recommend I do.
My employer is telling me that he needs all of my health records, I’ve been a truck driver for 20 CDL. I’ve worked for him for 10 years and he need requested it before. Now he says he has to have a copy. Is this legal and do I have to give him my records?
Because we are tired and sleep in truck stops with reefers starting and stopping all night no way we will never pass the sleep APNIA test. take the test expect to fail it and get fixed up with your CPAP machine and take it with you in the sleeper and you going to feel young again and live forever. After a couple of weeks you get up in the 53 footer and make some money and tell your lumper you’ll call them later.
I will probably be losing my 30 year + Career over this to some half trained person who will probably kill someone because he doesnt have the training and experience I have, So what does a 30
+year veteran do when I am disqualified? where do I get help with finding a new non- CDL Job? Am I to be put out on the street to live in a cardboard box now? What are my options? Fmsca has no rule for this do they? No medical practioner has a plan do they? I would implore any new driver to throw that CDL out the window and my advice would be never get one either, no future in it!
I am waiting for my first 30 days of use ,the follow up to get Chip info,and then a return visit to my sleep clinic,before even starting to drive CDL.If I am in compliance for this month,you say I will receive a 90 day medical card ? I dint think a Trucking company is going to hire me with a 90 day card.I called Swift the other day and they said I needed a year just to train.Does this mean I have no chance of working ? Can a regular physician write a clearance letter ? Is it a requirement that I tell a different medical examiner of this “diagnosis”.I feel like I have been caught in a trap because my old company has used the same examiner,and even they are complaining that the doctor is sending everyone to the sleep clinic who is overweight.He has a nifty little flyer he hands out to refer you to a certain clinic,how convenient.All I want to do is comply,and go to work Long Haul.What can I do? does the Trump action benefit me in any way ?
Hi Rick. My name is Brandie StJohn and I am a Registered Sleep Technologist and a Certified Clinical Sleep Educator in Northern California. I would be more than happy to assist you on becoming compliant with your therapy. I have worked with many patients to be successful.
Sincerely,
Brandie
@Rick
With a short medical card you are going to run into the same problem with any training company.
The question is – do you really have sleep apnea? Because if you actually need to be on a cpap you will need to meet the compliance regulations for cpap.
Saw on national news that President Trump has halted DOT involvement for drivers that they SUSPECT with sleep disorders. Is the true of false? Please explain.
@Denise
FMCSA is has said in the past, and is saying again now, that it’s up to the medical examiner to refer drivers for apnea testing if they “believe the driver’s respiratory condition is in any way likely to interfere with the driver’s ability to safely control and drive a commercial motor vehicle.” A respiratory condition is what any reasonable medical examiner has used to determine the need for sleep apnea screening, not a random pick of criteria (some committees have recommended to FMCSA in the past that were never a ruling), some have used for their gravy train agenda.
I just received my BiPap a week ago and my physical is up for renewal. So therefore I will not have 30 days with it. What can I do to still get my medical card?
@Jackie
The medical examiner needs a 30 day, 70% compliance report to be able to qualify you. It’s up to the examiner to maybe give you a short card to meet this compliance.
If I am compliant for 30 days with less then 5 episodes a night can I use that data to over turn my Diagnosis
@Jonathan
Check with your sleep study specialist to make that determination.
I need to know how long a sleep test is good for? I was tested in 6/2013, negitive results. But went for dot physical a couple days ago. They want me tested again?????
@Mary
If the original study was negative, then the examiner must be seeing something else that causes questions.
When is a cdl driver required to report a sleep test?When the test is done or when the diagnosis is given by the doctor?
@John
When you complete the form for your DOT physical.
Once your tested you need to get tested every 5 years roughly, each medical professional will tell you this if you admit to being tested.
Is using cpap machine 21 days out of 30, and 4 hours per day on each of the 21 days 70% compliance rate?
@Marg
Your CME is going to want a readout of your last 30 days. Your math is correct as you interpreted the guidelines written here. Not sure how the CME will interpret this – that is where this issue becomes fuzzy.
Does 70% mean I have to use machine 21 out of 30 days. Or use every night with at least 21 days at 4 hours or more.
@Mark
Most CME’s want to see at least 30 days with 70% compliance with a minimum of four hours a day. FMCSA recommendation.
I was diagnosed with a moderate case of sleep apnea after an at home test. On January 2 I go in over night to have the mask fitting and to calibrate (I assume) the cpap.
I am trying to get in to a trucking job. Originally I was given a 1 year card in MD and told I need a sleep study within the year to be able to renew. I then attended a truck driving school sponsored and run by a trucking company in Iowa, where the CME there refused me a card and said I need the test BEFORE they will certify. So I know that my MD card is no longer valid since I had a fail after ward.
My question is, do I need 90 days of good data on the cpap (what the current company is telling me) or just 30 days for the CME?
I’m asking because I have an opportunity with another company that will accept my MD card (if I get one) and not force me to retest, and quite honestly 30 days of no income is easier to deal with then 90 days.
@Ed
FMCSA says they want a 90 day evaluation with a 70% compliance before issuing a new medical card. And there may be an issue with the home study too. But check with the CME and see what he has to say, he may have an alternate answer for you.
Thanks for the response.
I took your advice and called my local CME today. Was told they will take 30 days of data, and as long as I’m in compliance of 4 hrs min per night and 70% usage they will issue a 1 year card.
@Ed
You are welcome.
I have had my cdl b for 15 years, i have not used it in 5 so i had it set so it could only be used in the same sate i live in with no dot physical. I am starting a new job on 12/27 so i set up a dot physical at my local doctors who also treat me for sleep apea. I am compliant with the 70% usage, but how will this affect getting my medical card, do i have to notify my new employer?
@Laura
All you need is to bring your last sleep study record with you to the DOT examination. The CME will note that you are compliant and he will issue you a one year medical certificate so you can go to work. You do not have to volunteer any information to your employer, unless they ask.
I have mild to moderate OSA and I use a prescribed oral appliance that brought my AHI from 9 down to 2. The DOT physical Doc said I need a new sleep study for my medical card because the last diagnostic was to adjust my mouth piece and the last basic sleep study I had on record was in 2012. The Doc said I need a diagnostic for the whole night without all the wake ups for adjustments. Should I sleep with my mouth piece in for the study.
@John
You want to be able to demonstrate to the CME that the mouth piece is doing its job and that you do not need a CPAP unit.
In the state of PA if you drive a commercially licensed vehicle regardless of the weight case you must have a D.O.T physical. Even though I have a class C license I had to go and get a
new cpap machine so I could pass my physical. My old machine did not record the usage.