Drivers who come in to my office for a DOT physical exam often ask: “Why do I need a sleep study? DOT doesn’t require it.”
So here is the information a driver needs to know regarding if you need a sleep study or not:
The FMCSA states that DOT medical examiners should follow “best practice” guidelines when evaluating a driver for sleep apnea and ordering a sleep study. Here are the “best practice” guidelines that are recommended:
A driver with symptoms:
If the driver has one of the following 4 symptoms it is recommended that driver be tested for sleep apnea:
- Driver complains of consistent daytime sleepiness or fatigue.
- Driver has been involved in a sleep-related accident.
- Driver states that someone has observed the driver stop breathing while sleeping.
- The driver reports that he snores loudly (snoring is heard thru a wall or door).
A driver without symptoms:
If the driver has none of the above symptoms but they have multiple risk factors for sleep apnea, it is recommended that the driver be tested for sleep apnea. Here is a list of those risk factors:
-
- BMI of 33 or greater.
- Neck size of 17” or greater for a male.
- Neck Size of 16” or greater for a female.
- Driver has one or more of the following disease:
- Driver has High Blood Pressure
- Driver has Diabetes
- Driver has Heart Disease
- Driver has Hypothyroidism
- Driver has history of Stroke
- Male driver over the age of 50.
- Female driver post-menopausal.
- Driver has a Mallampati Score of 3 or 4.
Best practice recommendations for drivers that have had a prior sleep study:
A second sleep study is recommended if the driver has developed additional risk factors since the first study was done, or the driver has had a 10% increase in weight.
As always I am here to help and I truly care about the safety and wellbeing of every driver. The fact is, most health problems will not prevent you from passing a DOT physical, as long as you are treating the health problem. If you have any questions or concerns about any health issue please call me (314-739-7979) and I will take the time to talk to you on the phone, even if you are not coming to my office for your physical.
Dr. Knuuttila, Knuuttila Chiropractic
DOT Physical Exams in Bridgeton, Missouri
(see more than 50 driver reviews)
Sleep testing is not a regulation. It cannot be a recommendation or suggestion. That is LAW. Yes I said law. Look it up. Until the dot passes a regulation it is not required to pass an obtain a medical card. Not sure how a truck company could supercede that. But just to back up the law that is established, I emailed dot directly looking for a waiver/exemption. There’s always one or two. They sent back in my email that sleep testing IS NOT a regulation. There for it is not required and no waiver or exemption is needed.
@ Shawn
We have been saying this for years. As a medical examiner and according to the previous DOT/FMCSA handbook, it should be looked into ‘IF’ there were a multitude of signs and symptoms, then it would be recommended for further investigation. BUT NOT/NEVER WAS A LAW.
That goes beyond the scope of the regulations. Using some outside guidelines is still against the law. That is not good practice. Actually I’d say it is a bad practice to go against law. People usually go to jail when that happens.
@ Shawn
So you see the issue, come up with a solution. Then make your recommendations to DOT/FMCSA and President Trump. It’s all bureaucracy and double speak that needs to be corrected. We would all love to have clear set guidelines.
Yes I had a Dot physical done 3 days ago and past with no problem I received a call today say that they pulled a sleep study I had done in 2015 where they said I had a mild case of sleep apnea so my company and the doctor @ the sleep center said I did not need a c pap and the pa at the test center is now disqualified me saying I needed to be on a c-pap and I need to retest their is no accidents or weight gain and my neck size has decreased and so has my weight my question is can I go to another testing center to be reinstated or do I have to deal with her. She did not offer me a 90day card or anything she just put me out of work completely.
@ Lorenzo C
Go elsewhere and get a second opinion, you are being jerked around by people that have a conflict of interest.
Thanks I appreciate your help and for giving me confirmation on what to do next.
My husband went to the company doctor for his DOT physical and was seen by the dr’s FNP. She told him he needed a sleep study done because of his BMI and neck size and only issued him a 3 month card. He has no symptoms or signs of sleep apnea. She told him she could not order it, he would have to go to his PCP for the referral or get a letter stating the PCP could not find cause. Made an appointment with the PCP who had him fill out a questionnaire. The questionnaire along with his annual exam records (including labs, diagnostics and physical exam) indicates he does not need a sleep study. Therefore the PCP did not order and health insurance says they won’t pay for it. The PCP’s findings were sent back to the FNP that did his initial DOT physical, along with a letter from the PCP stating he finds no cause for the study, and she refuses to go ahead and extend his physical card. Who is supposed to pay for these studies, and schedule these studies, if your primary (who you see regularly and knows your health and history) says you don’t need it?
@ ConcernedWife
DOT and FMCSA have never established a mandatory sleep study be done based solely on BMI. Your hubby is being hoodwinked. Go elsewhere for a second opinion. The company doctor works for the company, not you. Unfortunately you get to pay for it all.
She used BMI and neck size as the reasons, his neck size is 19″. However, his mallampati score is a 2. The PCP says the 2 is a key indicator he is not a candidate for a sleep study and the DOT examiner should have known that. Combine that with the questionaire and the PCP won’t order it, and health insurance won’t consider it. His company has told him that you can’t get a second opinion on a DOT. I will relay all this info to him so he can have another discussion with his supervisor. Thank you.
@ ConcernedWife
Our first question is who has the national registry number? The doctor or the FNP? You have the right to a second opinion anytime. Your physician is correct and the doctor on the registry should take this information into consideration. It sounds like a conflict of interest if the CME is mandating a sleep study without considering the additional information which has been provided.
It is most definitely a conflict of interest. We have since found out that the doctor sent the trucking supervisor a letter stating they were going to require the sleep study, even with the PCP’s letter in hand. Then in the same letter proceeded to give the trucking supervisor the cost of having the procedure done at their facility. Talk about a huge conflict of interest there.
@ ConcernedWife
This is why we said go elsewhere for a second opinion. If the company will not allow a second opinion, then the company is in on it somehow. You always have the right to a second opinion according to DOT/FMCSA if you feel the CME is incorrect.
Where can I find information about a second opinion from a Doctor according to DOT/FMCSA? Going through the same issue as my Carrier is asking personal questions pertaining to does your spouse/sleep partner complain about your snoring.
As per the DOT medical exam that i’ve located on the DOT site, there is no mention of any Q/A pertaining to Sleep Apnea.
Thank you
@ Ken K
Exactly, there are no questions about this on the DOT/FMCSA medical certification examination. You can get a second opinion anytime you believe the examiner has improperly diagnosed any condition.
WHAT DOCTOR ? GOING THROUGH THE SAME THING …
This is in Cape Girardeau, MO….Southeast HealthPoint.
I’ve had my CDL that I paid for. For 23 Pluss years and safe. Now sleep study.for what .these physicals are getting out of hand. Why do I have to pay for it .the doctor should pay. Lose your career because a doctor says your to have asleep apnea test . I have no diabetes.i have no highblood pressure. Now this
And not payingfor a 2nd opinion.bmi indext is false also . They don’t measure the cercumfrence of wind pipe. ps the wright to work . this is united States.
@ T
DOT/FMCSA has not established a mandatory sleep study based exclusively on a single bmi test. There should be a multitude of signs and symptoms before this test is requested. Get a second opinion, you have that right.
I’m a mini van bus driver, that works only 5 1/2 hours a day. My question is why I’m I being MADE to take this sleep study.
@ Gwendolyn P
Because you went to a facility that is in bed with a sleep study clinic.(conflict of interest) Go elsewhere for a second opinion.
And if you are not a class A driver, then you fall under the states guidelines and not federal DOT/FMCSA. So you should not be held to a class A standard. Besides, no one can MAKE you do anything.
Exactly !! the government is trying to push blame on fatigue accidents because the vast majority of drivers work 10 to 14 hour shifts everyday ! who wouldn’t get tired??as for the apnea test they also use HYpopnea to include in the result .. which is just slowed breathing . everyone’s breathing slows and speeds up during sleep with dreaming !! and to add more to the insanity the “rules” state you only have to use the cpap machine 4 hours a night 70% of the time to be “compliant” how is 4 hours of sleep any good!! Drivers need to fight back against the so called “CERTIFIED MEDICAL EXAMINER” which doesn’t even require a degree.
@ R B
Most CME’s are doctors and ‘licensed’ health care practitioners. They have to be to be on the registry. Cheap doctors use staff to do the job that they are supposed to be doing. And the DOT/FMCSA is not listening to the drivers point of view in the current situation. If you want to make a difference with the rules and regulations, take it up with the rule makers, not so much the CME’s. They are stuck trying to keep you guys on the road and not lose their license because they tried to work with a driver that does not fit the “one size fit all” model.
I had 2 doctors tell me that they can’t issue me a new DOT card because I need a CPAP machine. My DOT card expires next week and I can’t even go to work with out it. There also a recall on the ones they want me on and they are telling me 10 weeks before issuing a machine for me. Is there another way around this?
@ Michael H
If two CME’s have indicated a need for a CPAP, then you must be exhibiting a multitude of signs and symptoms for OSA. You can try and explain the situation to one of the examiners and have him provide you with a short / temporary medical card until you can get a machine.
I am a utility worker. I have a class B cdl license because the company i work for require of me to have it. But i only drive a pick up Ford 550, do i need to renew my dot card and take the physical exam, or can i apply for an exemption. i reside in miami Florida
@ Sam
Most states require a valid medical card to maintain a cdl. Even though you only drive a pickup truck, it is a vehicle that is used for commerce for the company. Best to check with your local drivers license department and see if they have an exemption for you.
Went for a DOT physical and doctor said I might have sleep apnea and gave me a permit for 6 months can I just go to another doctor to do another dot physical try to get one for 2 years I feel great sleep great
@ Jose t
You can go and get a second opinion.