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.
Well i got hit with a cpap machine i dont get tired during day and i only sleep 3 to 4 hours a day been that way since I was a kid. Now this machine makes my throat so damn sore i cant talk half the time nor can i eat. Because of the pain the doctor says i just got to live with it. I cant find a exemption. And i have a learning disability and have no education. So i guess i am screwed. Is there any type of wavier i live in NC and cant find any info on my states requirements.
@ J Holston
What prompted the need for the CPAP to begin with?
I went to the doctor because my wife was complaining about my snoring. I have had three neck surgeries in the front of my neck. So I have problems swallowing and snore at night. I had a sleep study done and was positive. So I started to use a cpap. The last few months I haven’t been using it. I had no idea that it effects my cdl. Now I just scheduled my physical and they asked for a report on my cpap. Since I haven’t been using it, what do I do. Please help. I am not over weight or have a large neck. I didn’t know that this effects my cdl.
@ Mike B
Since you are supposed to be using the cpap, the examiner needs to see a thirty day readout off your machine showing a 70% compliance. That’s a FMCSA guideline and the examiners will need it to go forward with your DOT examination.
I just had an “at-home” Sleep study done. Got the results today. I used Concentra in Lewiston maine to get a 90 day medical card. And one of the conditions was having to get a sleep study. I plan on calling them on Monday for some more information on my sleep study results. But thought I could ask a question here, after finding your lovely and helpful sight.
I have been diagnosed with “MILD” Obstructive Sleep Apnea. My AHI is (5.1). Now does the qualify me to have to use a CPAP machine to get a 1 or 2 year medical card?
On the sleep study results, the doctor noted under prescription that I should have an AUTOCPAP and limited use. For 0-6 months. I’m honestly hoping to have to avoid this if I can. I currently don’t have a primary care provider (pcp). And the 2 sleep studies in my area require referrals from a PCP.
I am waiting until I get medical insurance to get a PCP. Which happens 90 days after employment. Coincidentally same time, my 90 day card expires.
@ Shane
If you are experiencing any daytime sleepiness, then you will want to do a clinical sleep study for a better diagnosis. You may want to get a second opinion at the end of your 90 day card.
I was just forced to get a cpap test in March. Admittedly I feel much better and I use to sleep 10 hrs and be tired, now I sleep 6 and I’m fresh.
My question is this. I drive in a team. From when I start work one day,until I start work the next day is Usually 26-28 hours. With this time shift every day I only go to sleep 6 times in 7 days. And I only sleep 6 hours. The problem is that according to my cpap compliance I am not compliant because I only used in 6 times and about twice a week its will show I used it less than 4 hours in a day. Is there a difference in the letter of the law of 4 hrs a day and the spirit of the law which is 4 hours each time you go to sleep?
@ Jordan
The CME is advised to follow the guidelines and will be looking for the 4 hours a day with proper compliance. But they are FMCSA guidelines, not regulations. A medical release form from your doctor and an explanation may be all you need.
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