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 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.