- Part 1 – Can A DOT Medical Examiner Refuse You A Medical Card Unless You Have A Sleep Study Done?
- Part 2 [You Are HERE] – 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 – Commercial Drivers Can Manage Sleep Apnea And Maintain Their CDL
More and more drivers are being held-up (not able to renew), or held on a very short leash (30-60 day medical card) by the sleep apnea testing issue.
Some DOT Certified Doctors, aka Certified Medical Examiners, are stating so-called FMCSA sleep apnea guidance or rules that the driver “has to have a sleep study test done” before getting a new medical card. Drivers who have never been diagnosed with any type of pulmonary or sleep related conditions are being targeted because their BMI or their neck size is “too big”.
As the situation currently stands…
There are NO FMCSA guidelines or rules on sleep apnea.
Previous FMCSA Proposed Recommendations on Obstructive Sleep Apnea were withdrawn by FMCSA in April 2012, and on October 15, 2013 the “sleep apnea bill” was signed into law by the President. The law forbids the FMCSA from using guidance alone to address sleep apnea screening for drivers. It requires that if the agency take action regarding sleep apnea screening, that it do so via the formal rule-making process, and not guidance.
The sponsors of the sleep apnea bill inferred that guidance alone would make the transportation industry extremely vulnerable to litigation.
In short…
– THE ROCK –
There is no FMCSA sleep apnea guidance or rule.
So let’s explore the doctor’s perspective.
– THE HARD PLACE –
The Medical Examiner is held responsible for ensuring that a driver is medically fit to drive a commercial motor vehicle.
Medical Examiner’s Certificate
The primary responsibility of the Medical Examiner is to determine the driver’s medical fitness for duty to safely operate a commercial motor vehicle.
- FMCSA Regulations: The examiner must comply withFMCSA regulations.
- FMCSA Guidance: FMCSA provides medical guidance or advisory criteria to assist in the evaluation of medical fitness to operate a commercial motor vehicle. These guidelines are based on expert review and considered best practice.
The examiner may or may not choose to use these recommended guidelines. When the certification decision does not conform to the recommendations, the reason(s) for not following the medical guidelines should be included in the documentation / long form.
- Refer for further Testing / Evaluation: The examiner does not have the job of diagnosing or treating any condition that a driver may present with. The examiner is responsible to refer the driver for further testing / evaluation if the examiner suspects an undiagnosed or worsening medical problem.
This puts the Medical Examiner between a rock and a hard place and there is lots of room for interpretation here.
And where there’s interpretation, there’s opportunity for litigation.
The last thing a doctor needs is litigation – for the price of a DOT physical exam!
So…
Some doctors are being extra cautious, and…
The “you-know-what” continues to roll downhill, and…
Commercial drivers are at the bottom of the hill!
What can commercial drivers do to avert this situation?
Be aware of the difference circumstances and perspectives around the sleep apnea issue that could affect both your livelihood and your life.
Put In A Nutshell
Since there is no FMCSA regulation regarding sleep apnea evaluation and the basic parameters are subject to interpretation, then be aware of the Medical Examiner’s position.
- The medical examiner’s job is not to diagnose. It is to assess the driver’s medical fitness to determine if any safety risk issues exist.
- If there is a reasonable chance of risk then the examiner will request that a specialist in that field provide a proper diagnosis and treatment if necessary.
- If you’ve been diagnosed with sleep apnea, then another set of regulations apply.
By being proactive, you get to manage this before it becomes an issue.
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.
Hi my name is Mario I went for my dot physical on three days ago I was told to take a sleep study because my BMI and my neck size is 18 inch can I ignore it and wait for my three month medical card to expire then go somewhere else if I reduce my BMI within those three months? or will they cancel my card because I did not showed up at the sleep doctor I was referred to? can I choose my own sleep doctor? thank you
@Mario
Yes you can choose your own sleep doctor, but you want to make sure you use this 3 months to address the problem, and get in compliance with a cpap if you need one.
I m on cpap/ bipap machine i had septoplasty and tonsillectomy surgery to correct my snoring i no longer snore had a new sleep study dr said that im mild sleep apnea no machine required will this be enough info for examiner to be taken off machine also what are the numbers that a examiner is looking for that put me in the mild category for California. Thanx
@Pablo
Get a medical release from the sleep study doctor and take that to the CME for your next DOT physical exam.
My husband took a physical, got a three month extension because he was sent for a sleep study. He just did the sleep study last night and it was a split night test (they put a cpap on him around 1am).
He does not agree that he needed to go for the sleep study at all, can he get a second opinion 1/2 way through this process or does he need to see this all the way through?
Currently his CDL is in CA
@Rachel
If he feels that the sleep study is uncalled for and that he and his doctor agree that he does not demonstrate symptoms of OSA, then you can go somewhere else for a second opinion.
I have mild case of OSA ( number is 8) I have a class B CDL and drive a school bus. CME will not renew my medical card. I can not tolerate the CPAP machine. Can I get a second opinion. And keep seeing something about interstate driving. I am about to lose my job
@Kim
Go get a second opinion and explain to the examiner that you drive a school bus and are not trying for an interstate certificate. With that information the CME can make a more informed decision. If you never drive out of the home state with the school bus, then talk to them about intra-state only. There are different regulations regarding interstate and intra-state drivers.
I have been looking at this for the first time but i have know about it guess their is no way around it but to lose weight I will take my 3 months and prepare for a new job because this is ludicrous it’s legal discrimination a pay to work and work to pay attitude this will blow up in their faces and if i have not settled down on another job I guess i will come back to driving keep safe out their over the road guys
Concentra is running a money game racket and the feds should be checking this out, because I have been getting my D.O.T physical there for the last 5 years and everything has stayed pretty much the same with my BMI and my neck size and now all of a sudden they want me to go have a sleep study done and I would have to pay for it myself and I have no insurance coverage or no full time job. so I simply cannot afford it, so they will give me a 90 day certificate only and when it expired I went back in to have another D.O.T. physical again the same thing again only a 90 day certificate, this is getting expensive and a little annoying and I have never had any diagnosed sleep problems in the past and I don’t get sleepy during the day so they are just discriminating for my weight and the Trucking Industry will be losing a good driver here soon with over 35 years of accident free driving because of all of BS the government wants to pull.. I just wanted to vent. thank you
I am having the same problem
I have been diagnosed with sleep apnea. I have been using cpap for 3 months now and on my report it says i have 5 or less ahi. This is mild osa correct? If I show this to concentra when I go for my 90 compliance, can they say I dont need cpap due to my ahi is very low? Thanks for your reply
@Mike
Not without a note from the sleep doctor.
You are showing good compliance, but you are still using the CPAP.
its all a money issue.they dont care if u get better or not,they dont even care if there is anything wrong with u at all..theres no money in a cure, only in the meds. they dont care how many lives they mess up over nothing..do the research and tell me how many people died due to this so called sleep apnea. none…
Hello, what are other indicators that Dr, PA or NP use to determine you may need to have a sleep study? If neck size and BMI are not to be used? If your blood pressure, heart rate and hypertension are all well and gd what else is there?
Thanks for your time
@Carla
There are many indicators that should be looked at. Neck size and BMI are the two laziest ways to make that evaluation. You could start with things like excessive daytime sleepiness, restless leg syndrome, hypertension, etc. There are tests that can be found on the internet that will answer this question in more detail.
I just had my exam done at concentra and they gave me a 90 day card and said I had to have a sleep study done. First I looked at last years results and my BP weight and neck size was exactly the same BP was a little lower, even my pulse rate was exactly the same but no sleep study. I sleep on my stomach and I want to know how am am going to do the sleep study and wear the cpap. I will not change the way I sleep for a machine because then I will not get any sleep. I told the examiner this and I don’t even considered this. But what I really want to know is same results last year as this year and I go from normal to abnormal. What kind of guidelines are they using dart or what?
@Steve
They are using the new guidelines that are made to make them more money by taking advantage of the drivers not knowing the rules or guidelines.
Try getting a second opinion somewhere else.
I am a self-pay for my cdl recert. medical card. I had it done on April 13th and doctor said that I needed clearance from a sleep medicine specialist to get my year card. I do have a high BMI and neck size was around 16 (I am female). I only work 20-25hrs a week and I am never EVER sleepy. He gave me a 90 days card (7/13/16) and gave me a form to give to the specialist to fill out. I went to sleep doc, had home study done and it was inconclusive because I move around a lot at night and the specialist still told me that I MIGHT, I repeat MIGHT have very VERY mild sleep apnea. At this point, I am thinking of going to another CME to get my medical card. I temporarily made an appointment for May 12th. What do you think?
Any/all advice is helpful!
@Stormchaser
Good Idea!
who pays for the hospital sleep apnea study the employer or me?
@Jeff
There is no regulation on this, so the only person who can answer this question for you is your employer.
Concentre is running a racket.to make more money. you have to go do a sleep study then come back in 90 days and they make more money everything you come back. someone needs to get a lawyer in on this! They just told me I had to have one on a resurt and my last physical was 3 months ago at the same place only difference is I’ve lost weight.
I had a home sleep study done because my dot card expires in 6 weeks.I wanted t be ahead of the game. When I woke up the hose that goes into my nose had fallen off during the night. I sent the kit back and they told me I had 40 episodes that night and that I needed the cpap. I have been using the cpap for 2 weeks and I only have 1.5 to 2 episodes per night.Is it possible the test was inaccurate? I have no symptoms of apnea. I weigh 350 lbs and a 18 inch neck. I feel no different using the cpap. I am going to a pulmonologist next week to try to get a second opinion. Will concentra tell me I have to go to a sleep study place that requires over night study? My company’s policy is that we have to go to concentra and no other place even if we pay out of pocket. Is this allowed? Thanks for your help
@Mike
Get a second opinion from your pulmonary specialist. That should be sufficient.
If Concentra questions it, then by law you have the right to request a second opinion from the examiner of your choice.
Can’t give much help on company policy.
I went to a DOT Doctor yesterday and when they measured my neck she did not go directly around my neck she let it hang down to around my collar bone area. Is this normal?
@Thomas
NO!
Is there a way to argue this because now I have to a sleep test.
@Thomas
Yes, go get a second opinion elsewhere.
I am confused about the bmi and the neck size here tucson az they check your in side your mouth to see your in side your throat to determine if you have sleep apnea the federal goverment did not researched this very good a doctor just sees you hefty they want to send you for a sleep study you are discriminated because your hefty
@ Juan
Hefty is not a disqualifier from the FMCSA. Go for a second opinion from a doctor that works with drivers all the time. They have a better feel for the rules and regulations then the doc-in-a-box places.
Can I do a home sleep test I’m in California the lady at the center told me california don’t allow home study test and they want 1600.00 for the in office test and the Dr I saw said it the law that I take this test but I’m reading on here their no law requiring the test …. sound like BS
@Eldridge
The at home test are simply not as reliable as the lab studies. First you want to know if you really have such a condition. Any one who actually has sleep apnea will not leave home without a unit. But there are some clinics that say it is the law-and that is a lie. There were no new rulings regarding the condition and if you do not have a number of the issues that would necessitate the study, then someone may be trying to take advantage of your not knowing. So get a second opinion.
my cpap machine is outdated and has no chip in it. And my dot card expires in two weeks , my company wants it done asap, what do i do ?
@Robert
What are the possibilities of upgrading your machine? More than likely you will be needing a newer machine to provide the needed information for the DOT examiner anyway.
Hey there,
I haven’t seen this question completely answered so I’ll give it a go. What are the requirements for compliancy? Is it 30,60,90, 6 months or a year @ 70% < 4 hrs/night? I just left the examiner with a 90 day card because he said I need a year print out. I supplied him with a 30 day card @ 93% compliant
@Russell
90 days @ 70% & 4 hours a night, should be more than adequate for the examiner.
I had my dot physical done today for my job passed everything blood pressure perfect not overweight etc well during the questionnaire it asked if I snore and only if I’m exhausted I do and recalled talking yrs ago to my family dr about it but never had a sleep study done or any tests and I informed my examiner of this they contacted my old dr and they said that I was diagnosed w sleep apnea so bc of that they refused to sign off on my papers until I get this resolved idk what to do bc I may lose my job bc of it
Basically question I’m asking is 1.how can I be diagnosed w something that I’ve never been tested for
2. What do I need to do to get around this and if they make me take a sleep test what do they look for I’m not tired all the time I’m go go go I snore on occasion and don’t stop breathing
3 if they diagnose me for some reason can I still get certified if so how long does it usually take b4 they can do that
@aj
Who diagnosed you with sleep apnea? Since there were no new rules regarding sleep apnea and no neck measurements or BMI charts, who made this diagnosis and how. Try going to the original doctor from your past and have him give you a medical release form stating what his findings were. That should help the most.
Just got my cpap today and my dot medical card expires today. How long do I have to be on cpap before going back on the road? Thx
@Hefty
The CME will want to see a 70% compliance record for at least thirty (30) day before issuing a new medical card.
Hi, on 09/14/15 I renew my DOT card everything when well but towards the end the examiner said I was over weight n that my neck size was 14 n that he was giving me the card for 3 months n that I needed to have a sleep apnea done. I don’t feel sleepy during the day nor am I tired. I made the mistake of sharing this with my supervisor because I thought it was odd n now he said I can’t return to work until I get this test done. Can my supervisor do this to me? Thanks
@Adrianna
Only if it is a company policy.
The neck size is way under the mark, so I don’t understand why you would have been told such a thing. Why not go get another physical somewhere else and have it supersede the last one.
Hi, i’m 45 years old, I got sleep apnea and I can’t get use to a cpap machine, I wear it for about 5 to 8 mins and then I need to take it off, can’t breath. got a cdl been driving truck for over 22 years. I am worried about failing my med card now. what are my options? can I collect disability? Can I get help to get retrained in another field? help please very worried
thank you
@LeoBear
You should still be working with your doctor regarding your machine and its settings. Explain to him your situation. It may be as simple as getting a low profile mask and changing the setting on the unit. You should be breathing easier, not harder. You are going to have to demonstrate proper usage and compliance with your CPAP before you will clear with the DOT examiner. So talk with your doctor beforehand and get things under control.
Ok, it took me about 3 months to totally get used to my machine. Its the best thing I`ve ever done in my life. I feel better and I don’t fall asleep during the day.