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.
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.