- 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Previous FMCSA Proposed Recommendations on Obstructive Sleep Apnea were withdrawn by FMCSA in April 2012, and on October 15, 2013 the “sleep apnea bill” was signed into law by the President.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.
Does the fed dot require a certain usage percentage of a cpap machine? Wisconsin requires 80 percent usage to comply. They require a 90 day download at the time of your physical. Does the fed dot require a percentage of use and do they require a certain amount of days for downloads off the CPAP machine?
@ Brian B
70% compliance and if possible a 90 day readout showing your compliance.
Never been diagnosed with sleep apnea. How and where can I renew my DOT medical card in Charlotte, NC without being sent for a sleep apnea test?
@ Daryl W
Try to stay away from the ‘Doc in a box’ facilities. Look for a private examiner that understands the FMCSA guidelines and is not tied to a sleep study facility.
I have used a C pap machine since 2003, This machine has NO chip. In the passed I would take it in to get read, with no problem. . Can I still use this machine or do I have to purchase an updated machine
@ Gary R
Just make sure you have a recent reading off your old machine and you’ll be fine.
Why is the most replied response from the trucker docs “get a second opinion” and why don’t they answer when someone says they sleep better without the machine? I’ve been driving for 35 yrs, never fallen asleep at the wheel, been diagnosed with sleep apnea because I said I snored, I sleep horribly with the machine but as long as I use it I’m legal to drive but way more tired during the day, if I use the machine and am more tired and fall asleep and kill someone it’s just an accident because I use the machine… if I don’t use the machine I am way better rested and do not ever get tired during the day… it is a racket designed to do nothing but make money, machines are a thousand dollars or more plus all the tests… answer that trucker docs, hopefully it’s not your family I kill because I use the machine and am way way more tired…
@ John p
The FMCSA guidelines are spot-on at times and vague at others. There were no new rulings regarding neck size and BMI as a proper diagnosis of sleep apnea. There are facilities that take advantage of the vagueness. Get a second opinion, because in most cases, just like your, the facility may have taking advantage of the guidelines. Find a driver friendly CME that actually understands your type of work.
I feel the same way Trucker. The funny thing is …Everytime i see any conversation about Cpap…I see Concentras name…They sent me to get a sleep test and told me i have sleep apnea….Like you ..I’ve been driving for over 35 years…and never have an issue with falling alseep behind the wheel or any accident related to falling asleep behind the wheel. I started using the phillips cpap for 2 years now…and it doesn’t do me any good .Can’t sleep’ ,it is also under recall. i started breaking out in hives and face swelling. So i stopped using it. Now my med card renewal coming up I don’t know whats going to happen. I think concentra is working with someone to help selll these cpap machines.
@ Henry W
Go somewhere else beside that particular ‘Doc in a Box’.
CME’s should take all available information into consideration, without any sort of conflict of interest. DOT/FMCSA has NEVER mandated a sleep study be done unless there are a multitude of signs and symptoms that would put you at risk.
MY NAME IS TERRANCE D K (edited by admin for privacy)! I WAS DIAGNOSED WITH SLEEP APNEA IN FEB. 2018! I TRIED TO DO THE TREATMENT! BUT I COULD NOT GET ANY REST WITH THE MACHINE! THEN ALL KINDS OF THINGS STARTED HAPPENING, TICKETS, BAD DECISION MAKING, EVEN HAD TO STOP ON OCCASION JUST TO TAKE A NAP! SO I COULD FINISH DELIVERING MY LOAD! I DROVE OTR FOR THE LAST 3 YEARS AND I HAVEN’T HAD TICKETS OR MINOR OR MAJOR ACCIDENTS ON MY PART UNTIL I STARTED USING THE CPAP MACHINE! I COMPLAINED AND HAD NO LUCK, SO I LEFT THE JOB BECAUSE I WAS TEARING UP MY DRIVING RECORD, THAT I TRIED VERY HARD TO KEEP UP! I AM TRYING TO FIND WORK ELSEWHERE, BUT THERE IS NOTHING I CAN DO BUT GO BACK TO TRUCK DRIVING! AND I DON’T HAVE THE MACHINE ANYMORE AND THEY HAVE DROPPED MY CLASS A CDL W/TANKER TO A CLASS C! AND I CAN’T FIND A JOB ANYWHERE! I AM HOMELESS AND I AM ABLE TO WORK IF NOT FOR THE SLEEP APNEA STUDY AND CPAP MACHINE I PROBABLY WOULD HAVE HAD NO PROBLEMS BESIDES MAKING SURE I GET THE MILES I NEED TO MAKE A DECENT LIVING! IT SEEMS LIKE THIS SLEEP APNEA STUDY AND CPAP ARE TARGETING THE MEN IN THE TRUCK DRIVING INDUSTRY AND IS VERY UNFAIR, ESPECIALLY IF I PAY $1000.00 BACK CHILD SUPPORT A MONTH! I AM GLAD I AM NOT MARRIED BECAUSE MY WIFE WOULD HAVE LEFT ME ON THE ACCOUNT OF THIS! STILL! MY DRIVING CAREER IS ENDED! AND NO OTHER JOB I CAN GET WILL COME CLOSE TO THE PAY I WOULD HAVE MADE AS A TRUCK DRIVER! I AM THINKING OF FILING A LAWSUIT! BECUASE THIS MAKES NO SENSE! I NEED HELP!?
@ Terrance D K
The FMCSA, once upon a time, issued guidelines for neck and BMI for drivers. Those guidelines were up on the FMCSA website for a very short time frame, like two days. If those guidelines were to be followed it would have taken 60+% of the drivers off the road. So at this time there are no neck and BMI regulations. But some opportunist have used the initial FMCSA information to grease their pockets. If you have a true OSA situation then the cpap would have been a life saver, but there are many other test and questions to be answered before requesting a sleep study. But if the test is being requested based on neck size and BMI, we would recommend seeking a second opinion elsewhere.
Can you go to another medical examiner to get your dot card? Don’t they call that shopping?
@ Derek
If you disagree with a medical examiner’s opinion, you have the right to seek a second opinion.
Thats sucks man….
Hey there, I just had a DOT physical today and the doc told me I had to get a sleep study done on account of my weight and neck being over the limit. They gave me a three month med card.
My question is, if I lose weight, to be back under the threshold will that allow me to get my card renewed? Or do I have to get the sleep test no matter what?
Thanks!
@ Groxee
If you qualify without the sleep study, which was based on weight and neck size (which is not a true measure for determining whether you need a sleep test done). Then lose the weight and get a second opinion somewhere else.
My husband did exactly that and they said he still had to do the test due to his original measurement. He had only lost like 5 pounds and his neck went from 19 to 16 something. I don’t think the measurements were right in the first place. Now he has a diagnosis and the machine does the opposite of what it’s supposed to do because he can’t sleep with it on.
My husband is a school bus driver. He was diagnosed with sleep apnea 6+ years ago but had never uses his cpap. He got his CDL 4 years ago and has renewed his med card several times and has never been asked about SA until now, they have now told him he is denied renewal needs to supply a 30 day read out before they will approve him. He has an outdated machine and no chip. What should he do? He went to another dr for a second opinion and was passed but his work told him they only use this one place and that what he did was illegal and they told him he could not drive til he got this straightened out. I’m lost, couldn’t they have given him a 30 or 60 day card to try to get a new machine and read out? Please help.
@ Lilly P
Sounds like a company policy over-riding a CME. You could go ask the original examiner for a short card by explaining your situation and the need for a new machine that can provide a readout.
I’ve been driving school bus in PA since 2008. Was diagnosed with mild to moderate OSA in 2009, used CPAP as much as I could tolerate. Woke up with headaches and eye irritation. Did not have insurance to get retested. Was never asked for compliance until 2017 when I was sent for a new sleep study. Was diagnosed with mild OSA and given a CPAP with a lower setting than the one years prior. Used the CPAP for over a year then developed an intolerance to it. Wake up with a headache and feel just blah when using the machine. I end up pulling the mask off during the night and so not register 4 hours a night. Was asked for compliance report for 2019 physical and could not show 70% compliance. Doctor wrote on a script that the “driver has passed the physical and is safe to drive…pending further data” and would not issue a new card for any amount of time. Said to get a new study done as I may not need the machine anymore. Will not renew my physical. Did not give me the physical form saying I did or did not pass the physical. My license and job are now at stake. My insurance does not cover sleep study. The paper from my sleep doctor from 2017 states “patient does not meet clinical requirements for OSA” then on another line states diagnosis mild OSA.
What can I do?
I have forced myself to log 4 hours per night since my physical and have 16 consecutive days logged. If I can show compliance without getting a new sleep study done can I get my physical card? How many days will I be required to show to get my physical card? Can the doctor issue a 30 or 90 day card?
@ ADS
FMCSA guidelines request a 30 day cpap readout. The CME may opt to issue a short card if he feels that you are making an effort to comply with the thirty day request.
@ ADS
You are driving a school bus, which does not require a class A drivers license. Your examiner is holding you to a class A, over the road, long haul drivers requirements. You fall under the states variances and not FMCSA guidelines. Go get a second opinion from an examiner that understands the difference between federal guidelines for class A drivers and your states variances and guidelines.
What happens if your sleep cpap is stolen can I get a new one or will I not be able to work or will they take my cdl
Hector – Sorry to hear that someone stole your CPAP machine. If it was stolen from your truck or home hopefully you filed a police report and if you have insurance it may be covered for replacement. Or you may have to purchase a new machine. In either case you should contact you physician and have them order a new machine for you. Now if you have had your machine for some time 5+ years then you might be in need of a new sleep evaluation and if that’s case your medical insurance will cover some of the cost for the test and new CPAP equipment. Hope this helps.
If I have to get a new cpap machine can doc give me a 90day card to use new machine
@ Chris
Probably not until you can provide a 30 day readout.
If i been diagnosed with sleep apnea and didnt put it in my physical forms and passed whats the worse can happen or how will the clinic find out