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Q&A
Is sleep apnea a disqualifier?
What is EDS? Is EDS a disqualifier?
If I’m overweight do I have to have a sleep apnea test?
Is there a BMI limit for commercial drivers to pass the DOT physical?
What does neck size have to do with the DOT physical exam?
What does snoring have to do with the DOT physical exam?
I take Restoril for sleep. Will that be a problem for the DOT physical?
Is sleep apnea a disqualifier?
Sleep apnea does not necessarily disqualify you for medical certification. Treatment with a CPAP machine and some basic lifestyle changes can help you get a 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 they’ve been on a CPAP machine.
You will need to bring a medical opinion letter from your treating physician before you can be considered for DOT medical certification.
Narcolepsy is a disqualifier regardless of treatment, because it poses a risk of EDS and may also bring on sudden muscular weakness.
What is EDS? Is EDS a disqualifier?
EDS stands for Excessive Daytime Somnolence or Sleepiness. Because fatigue and driver drowsiness are safety concerns, the medical examiner must rule out EDS before certifying. A driver who has EDS will be temporarily disqualified until the condition is being successfully treated. The medical examiner will want to see a medical opinion letter from the treating physician before issuing a medical card.
If I’m overweight do I have to have a sleep apnea test?
No. Being overweight, of itself, does not mean that you should be tested for sleep apnea. Overweight is an initial indicator for the medical examiner to make sure that other conditions aren’t present which may affect your ability to safely operate a CMV.
The medical examiner will evaluate your overall physical condition and health history. The medical examiner has a responsibility to have you tested for sleep apnea if he/she has reasonable suspicion that you may have sleep apnea. Many people suffer for years from sleep apnea and don’t know they have it until a doctor catches the symptoms.
Sleep apnea is not only associated with sleep deprivation. It’s also associated with an increased risk of cardiovascular disease, stroke, high blood pressure, arrhythmias, and diabetes. The most serious complication is a severe form of congestive heart failure. Sleep apnea sufferers also have a 30% higher risk of heart attack or premature death than those unaffected.
Is there a BMI limit for commercial drivers to pass the DOT physical?
There are currently no set specifics on BMI measurement in the DOT regulations. However, companies may set their own policies and have their own standards for these indicators, which may disqualify you to drive for that particular company.
What does neck size have to do with the DOT physical exam?
Neck size, weight, and BMI are all just indicators that the medical examiner looks at to determine if you may have a condition such as sleep apnea that would impact your ability to safely drive a commercial vehicle now or for the period for which the medical card may be issued. There are currently no set specifics on these measurements in the DOT regulations.
Other indicators of potential obstructive sleep apnea are enlarged tonsils and large tongue volume. Individuals with low muscle tone and soft tissue around the airway (e.g., because of obesity) and structural features that give rise to a narrowed airway, are at high risk for obstructive sleep apnea.
Because sleep apnea is associated with increased risk of other debilitating diseases, it’s the responsibility of the medical examiner to rule out suspicion of sleep apnea, for driver certification.
What does snoring have to do with the DOT physical exam?
Snoring, in combination with obesity, can be highly predictive of obstructive sleep apnea risk. That said, even the loudest of snorers may not have a breathing obstruction. The sign that is most suggestive of sleep apnea occurs when snoring stops. If both snoring and breathing stop while the person’s chest and body try to breathe, that is literally a description of an event called an ‘apnea’. When breathing starts again, there is typically a deep gasp and then the resumption of snoring.
For the DOT physical exam the medical examiner evaluates your overall physical condition and health history to determine if there are signs of a medical condition that may affect your ability to safely drive a CMV. If the medical examiner has reasonable suspicion that you have sleep apnea you may have to go for an overnight sleep test called a polysomnogram before you can be further considered for certification.
I take Restoril for sleep. Will that be a problem for the DOT physical?
The medication, Restoril, may cause side effects: Hangover effect, drowsiness, dizziness, nausea, and vomiting.
These will all be questions the medical examiner is going to ask you about. This medication is usually used on a short term basis and not for a long term sleep aid. So it will depend on the type of driver you are and would be a serious consideration within the DOT examination.
You will need a medical opinion letter from your prescribing doctor explaining his reasoning for the use of this medication and why he feels it would be safe for you to drive a commercial motor vehicle OTR. Otherwise this could be a disqualifier for OTR drivers.
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How often do I need to get a new medical call if I have sleep apnea ?
@Greg
If all else is normal, you will need to renew every year.
My questions is what are the numbers that required me to have a Cpap? My sleep study numbers were 7.6 the examining doctor said I need a Cpap. The sleep study doctor said I don’t. Therefore I would like to know the FMCSA numbers that require a Cpap?
@Kevin
Not real sure where your examiner is getting his numbers from. If you do not exhibit a wide variety of signs and symptoms, then your sleep study physician is on the money. Sounds like there may be other issues here, so without further information, we would be hesitant to try an answer further.
FMCSA has their guidelines and within those guidelines, and they are guidelines, not regulations, they want the CME to do a full and complete history and evaluation. There are a multitude of signs and symptoms that should be present before asking for a sleep study.
If your sleep doctor does not feel that you need a CPAP, then take those results to someone else for a second opinion.
Hello Dr,
Okay here we go,,,,Last year got 3month card. Had to go into sleep study, had ahi 17. So i did get the sleep doctor to sign off no CPAP, per FMCA <20 not needed CPAP, Feb 2015,
Now fast foward went to DOT doctor yesterday my card is about to expire Nov ..Went to the doctor appoved by my work and passed with flying colors. ( went out of town to another approved company doctor). Now my works says i must get sleep doctor to sign off that I am good to drive. Guess what he will not do it unless I have another study done. SO ,,,now what did FMCA think we all have to be tested every year for sleep study. My weight is down and I am taller from the OVERBOARD DOT DOCTOR LAST YEAR. I would think it is in the hand of the FMCA approved doctor that i just went to yesterday if he thinks i need tested or not? Please reply on what your thoughts are..
Thanks
@Sam
It is up to the DOT approved examiner to make the final decision regarding your need for the sleep study. So if you are good to go, then where does the company come into this? And once you are cleared from the need for the CPAP, why would the company want you to get a sign off? And the FMCSA does want to see a running record of an individual who is on the CPAP, but FMCSA does not want the test done each and every year.
The company i work for uses a hire company to watch over the Med cards. The LPN with this company is telling the company i work for these are the rules. Seems that it is her way or no way. I did speak to FMCA and they told me to ask her where does she get this information from? FMCA says it is not out there. The final word is up to CME to make that final call and FMCA says this is why we have the classes to train them.
Now, the employer tells me no more contact with this LPN from Hire company and just have the sleep doctor sign off. Per FMCA I am in compliance.
Looks like they will have to fire me and then the employer and Unemployment judge can go over that I am in compliance with FMCA. I sleep fine with daytime sleepiness.
What a shame that it has to come to this…but they leave me no choice. I will NOT do another sleep study…the first one was all because of bad rules and guidelines that some folks do and did not understand. Any more ideas for you? I am trying to keep a postive outlook on this. Thanks for your reply.
Hi, my AHI is 8.8 and my doctor still does not want to clear me off without a CPAP. She does not want to go by the FMCSA website regulations. How did you get your doctor to clear you off. I do not know what to do anymore, they are driving me crazy.
@ UPS NC
Is your doctor a CME? If they do not want to go by the FMCSA guidelines, then you need to know what the issue is and then address it. If your doctor feels that there is a safety issue here then you need to address it, if there is no safety issue, then what is the problem and how do you correct it. The examination is supposed to be about safety, not anything else.
Print off the guidelines on AHI <20 WITH NO DAYTIME SLEEPINESS AND NO ACCIDENTS NO TREATMENT NEEDED. IT MAY CAUSE YOU MORE PROBLEMS THAN GOOD.
THEN SHOW THAT TO THE DOCTOR.
GOOGLE SEARCH THE AHI <20 FMCA ,,PRINT THAT OFF. TELL THE DOCTOR THAT HE IS DOING DOUBLE STANDARDS.IF THEY ARE GOING TO FOLLOW RECOMMENDATIONS ….IT GOES BOTH WAYS.
THERE IS NO LAW,,ONLY GUIDELINES ON OSA. IF YOU ARE IN GOOD HEALTH SHOULD BE NO PROBLEM. ALSO, YOU MAY HAVE TO FILE A COMPLAINT WITH FMCA ON THIS CME. JUST DO NOT BACK DOWN,,,YOU ARE IN COMPLIANCE WITH FMCA! STAND YOUR GROUND AND RESEARCH. THE FIRST CME THAT DID MINE IS NO LONGER A CME???
GOOD LUCK!
My husband went in August to get his DOT cert and due to the size of his neck, his physician told him he needed to get a sleep study. He only certified him for 90 days. My husband ordered the home study from place doc recommended. The results came back mild to moderate sleep apnea. Doc then referred him to Pulmonologist who we thought was gonna determine IF he was gonna need a CPAP. We went there today and paid another $171 for doc to tell him what he already learned from home study. He looked at his throat and checked his blood pressure. He’s an overweight guy, but has always had a perfect blood pressure. He doesn’t get sleepy during the day nor does he get sleepy while driving. The Pulmonologist told him today that he has to do another study at the hospital which I “assume” is to determine settings on machine. They don’t know cost and we are paying out of pocket. The hospital said that depending on which test is required, it’s either $1200 or $1900. His 90 days ends in 5 days and his CDL expires on the same day. He is our only income and he’s already missing a paycheck for this bs. Is there anything else we can do? We already can’t afford all of these tests out of pocket, but missing a week of work definitely isn’t helping our situation. We have a little one to take care of! He also has a good driving record with many years OTR experience. Please help!
What are the readings from AHI? If <20, and no daytime sleepiness…Then PER FMCA NO CPAP NEEDED, you must get some prints outs on fmca on ahi <20 and give them to dot dr and sleep dr. We went through the same BS and finally got dr's to read it and sign off. I told them both, double standards..if you are making me follow recommendations by fmca and no new laws…Then step up and follow the same ! Stand up for yourself,,,fight them to the end. From the get go, the sleep dr looked at me and did his test and said I DONT THINK YOU HAVE OSA…BUT, WE HAVE TO PROVE IT TO DOT. I so wished i would have had my recorder on. If i have to go through this ever again, I will record all DOT EXAMINES FROM NOW ON. Good luck to you !
remember that there are at least two types of sleep apnea OSA, CSA and or a mix, Most home study can only detect OSA. Day time sleepiness isn’t the only factor here It also involves alertness to say the least. Untreated sleep apnea above 5 AHI can lead to medical conditions that will be unsafe for driving. there are even studies that show untreated SA for ten years can and does contribute to Dementia which is a NQ condition no make what the degree is.
Mr. Dr, at this time…we are talking about OSA,,I have NO PROBLEM SLEEPING AT NIGHT. WHEN THE SLEEP DOCTOR TELLS ME…I DONT THINK YOU HAVE IT BY DOING HIS IN OFFICE SCREENING…BUT, WE HAVE TO PROVE IT TO DOT !! THIS IS WRONG! THEN,,,DOES NOT MARK OFF MY SHEET MEDICAL NEEDED FOR THE SLEEP STUDY MACHINE I HAVE TO PAY OUT OF POCKET FOR THIS RACKET,,YES, I DO HAVE A PROBLEM WITH THIS SO CALLED GUIDELINE. I DID NOT WRITE THE FMCA GUIDELINES ON THE AHI <20. FROM WHAT I HAVE BEEN TOLD, IF AHI IS LOW AND THEY MARRY YOU TO CPAP IT MAY CAUSE YOU MANY MORE PROBLEMS!
ITS ALL ABOUT THE MONEY! I AGREE, IF YOU HAVE PROBLEMS AND YOU KNOW IT, THEN TELL THE CME AND SLEEP DOCTOR AND RUN IT UNDER YOUR INSURANCE. THANK YOU! REMEMBER DRIVERS,,,WE MUST FILE COMPLAINTS ON THE OVER THE TOP CME. FOLLOW THE MONEY TRAIL. MY TOWN,,THE HOSPITAL OWNS ALL OF IT!
I was sent to get sleep study done, was told I have mild sleep apnea ,was told I scored a 22 at the time . I have over2 million miles on my cdl with no accidents. Now I must use machine every night, can’t sleep , nose runs , sneezing , all they tell me is I need another type of mask, of course it always cost around $200 , this is a money scam all the way. Now I’m just ready to quit driving and get on welfare
@Tracey
Go some where else to get another DOT examination. That will cover your need for a new medical card. There were no new rules or regulations regarding sleep apnea, so you may be being taken advantage of. If you have daytime sleepiness and high blood pressure and restless leg syndrome and a list of other symptoms, then get a sleep study done. If you don’t, then just go get a new physical.
I have held a MA CDL for twenty yrs with a pristine driving record. I am 6 foot and weigh 280. I bench 285 lbs and miitary 325 lbs so i am not weight porportinate and have a 18 inch neck. I experience no symptoms of sleep apnea but to Dr ordered a take home test. I scored 2.6 which is below the standard that is 5 for mild apnea. insted of giving a thumbs up he said the test was inconclusive. Can I see a different Dr with my results and get certified
@Paul
Yes. If you do not have to do the new examination quickly, then give yourself a few weeks before you go for a new examination. FMCSA sees it as doc shopping if you do a follow-up one on top of the other.
Do you have to disclose that the previous dot doc wants you to go for the test?
@Angela
If the test was required because you failed the examination and you pose a safety issue, then the next CME is going to require the same thing.
Without knowing what was requested, then you need to ask yourself if the test would be beneficial or not. Think safety first. The new DOT physicals are asking new questions and you would be lying if you did not disclose the previous information.
The DOT doctor in question did not ask and questions just said his neck was a size 17 and he was a little over weight so was going to require him to go for the test. We went to a ENT doctor because we needed a prescription for the test, which I called the DOT doctor for and said he only referrers to this one who’s card he had right next to where he examined my husband. Anyways the ENT doctor examined my husband and told him he would not send him for this test if it was not for the DOT doctor requiring it. He also said I would know if he had because I sleep next to him every night. Today our insurance told us the would not cover it so it will have to come out of our pockets. So it has been over a month now and time is running out and after seeing the ENT doctor could we see another DOT doctor for a second opinion? Btw, he had just received a physical 8 months before and passed with flying colors. He was only going for again for a new job. His old medical card was still good for a year or more.
Thank you.
@Angela
Best bet is to go some where else and get a second opinion. Since the first examiner is over reading the guidelines and neck measurements are nowhere to be found in the FMCSA guidelines.
Hello, My fianće has had his class A CDL for 15 years. He leases a truck from his company, so hes a contractor not employee-As we all know, the sleep apnea laws are hazey at best. Almost 3 months ago he went for his DOT physical at Concentra in Nashville, they would only give him a 3month temp and said he needed a sleep study! He is 285 lbs, 5’9, has high bp and pre diabetes which he is being treated for. They gave him a questionaire in which all of his reponses would NOT warrant a sleep study. We feel the drs decision was solely based on neck, being a smoker and bmi. Is this legal? We have no insurance for the $2k exam that we cant afford, plus machine if needed and we have a $500 a wk truck payment lease so he cant be out of work! Its not fair bc we are about to be ruined financially bc we feel our rights are being violated. His company says Concentra is the only company he can get his DOT from, so no second opinion. Is that even legal when hes not an employee? Is tjere anything he can do? We have 3 weeks until his dot expires and are grasping at straws here. He is obese and checked yes to neing a smoker at tje time, however he quit on the patch a week later! Any advice on how to stop tjis or laws we can quote to them or his company would be appreciated! Heres a better question, what exactly does a DR need to demand a sleep study? Thank you kindly!
@Joy
CDL’s and medical cards are two separate things and they work in unison with one another, so a CME is not the issuer of CDL licenses.
As an operator you can go to any CME that is on the National Registry, so unless it is some type of company policy, you can go to whomever you want. The company you spoke of is quoting rules and regulations that simply are not so, but very financially lucrative (to them) if you don’t know any better. Go somewhere else and get a new DOT examination.
I am a CDL truck driver and had to take a sleep apnea test which I passed no problem. My question is while my results were put on my medical records that I passed,but how long is that good for? At what point can they demand another test.
@Harold
If you did not have sleep apnea, then it should not be an issue at all. And since there were no new laws about sleep apnea and the need for testing, then it should not have been noted on your records, other than the study was done and you do not have OSA. And they can’t ask for another one unless you demonstrate signs and symptoms of OSA.
How long are the results of a sleep study good for??
@Carlos
Positive or negative findings?
I had a positive findings can I get this reversed anytine?
@Matt
Define positive findings??!
Is the BMI test a law or I mean is it a law that if the doctor or the PA said everything is good but your BMI is not good because your neck is over 17 1/2. So everything else is good but the PA I passed and could have a 2 yr. card but only gave a 90 day card. Can they do that?? This is my Job or my Boyfriends job so how can this be and in the past 3 physicals in the past year no one ever brought this up. What should he do? and at the same point I would like to say does this mean that bodybuilders that have buffed up and have a large neck, have a bad BMI?
According to NOVA medical centers in Humble, Texas if you have a certain BMI you are required by law to get a sleep study done, according to them, and on top of that you will only have 3 months to get it done. Out of that 3 months you have to be on the machine at least a month. I’ve had my cdl over 20 years with NO accidents and never had this problem. Good luck trying to get everything done in 3 months. Now I’m going to be automatically downgraded and not legally able to drive even a tricycle if it’s for commercial use. Good ole government regulation.