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See our BLOG Category on Sleep Apnea for articles and more information.
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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Tested positive for sleep apnea,how long will I need to be on treatment before going back to dmv to show improvement dealing with sleep apnea
@Alvin
At least thirty days with a minimum of 70% compliance for at least 4 hours a day.
I had neck of 19 1/2″ and BMI of 32 and was sent to get sleep study before I could get longer than a 6 month card. Did home sleep test (worst I’ve ever slept if you can call it that, slept 2 hours maybe) and they said results show I now need to do lab test. I told them to get screwed. I don’t believe their results have been submitted to DOT because they are separate from my med examiner who did physical. I have a co-worker who is just as big as me and got cleared no problem. Can I get second opinion or will I get in trouble even though I’ve already done home study?
@Alex
Yes you can get a second opinion.
No one is going to accept the home study results. They are too inconsistent for any CME to accept for DOT.
So do I need to get lab study or am I clear to just see another ME for physical? After initial visit when I was told to get study, I received 6 month card until I came back with study results.
@Alex
Get second opinion first and go from there.
Just went for 2nd opinion and this doctor cleared me. Thanks for your help
Long story short….Last year I got flagged for sleep apnea during my DOT physical. I went & had the sleep test & my ahi was 11. The sleep Doctor set me up with a cpap machine. I’ve used it 100% the whole year. I went today for my yearly DOT physical & the doctor made the comment while looking at my sleep report that my ahi is low & that my use is optional. However he only recertified me for one year because of sleep apnea! I am so confused! So do I HAVE to continue using CPAP? It definitely hasn’t helped at all, it’s made my sleep worse to the point I feel drunk when I wake up. I’ve been prescribed Nuvigil to help with this.
What do I do to be able to quit using CPAP?
@Leslie
Check with your sleep study facility and ask them if you truly need the unit. If it is just a mask thing, then see what options they have.
As long as you use the CPAP your DOT medical card will only be good for one year at the time. If the sleep facility says that you do not need to use the unit, make sure you have them put it in writing so you can take it off your medical examination findings.
Will do! Thanks ????
Okay finally got with my sleep doc & because I’ve been diagnosed with sleep apnea even though it’s just an ahi of 11 he will not sign off stating I’m clear to NOT use cpap to maintain my certification. So I’m stuck using cpap even though it’s made my sleep worse & I’m having to take Nuvagil just to function everyday! ????
I’m from Iowa and wondering about sleep apnea test guidelines. My neck was larger than the guidelines so I took the sleep apnea test and it came back 19.8 events per hour. I was told this is borderline for my CDL. Are more tests required? I can’t get an answer from the dr. He thinks I need more tests..What are the guidelines for Iowa..I’ve been driving school bus for 19 yrs.
@Dale
If all you are driving is a school bus, then you should not need any additional testing. You should not be being held to a class A interstate drivers standard, so check with your local drivers license department and see what they have to say. Since there were no new regulations regarding OSA and you drive locally and are home each day, you should only check with the sleep study group and see what they have to offer.
My husband had a TIA 1 1/2 years ago. The Neurologist (who also ran and owned a sleep study center) required he go through a sleep test. His employer required him to complete the doctors request and receive a clean bill of health before he could return to work. It just so happened that my husband had very slight sleep apnea. Strapped with a cpap he went on with life in order to keep his job. This year he had an at home study done and was told by his PCP that he didn’t need a cpap and took him off of it. His employer released him from any further requirements. Now he is trying to get his medical card renewed. The doc. at Concerta will NOT accept at home test results. He is requiring him to either show him an in clinic study results or 70% cpap usage. Do we have to comply? His employer will ONLY use Concerta.
@P S
The CME is going to question the at home studies because there is no verification printout to go along with the study. So they will require a new study be done, with readouts to support the no need for the cpap. Also a medical release form from your primary doctor will be helpful in this situation too.
Husband had his DOT physical Monday. Was disqualified due to his eyes. Had an eye exam got his glasses. Called to make his f/u appt. and was told by the examiner since his BMI, Age and because he is male she is now asking for a Sleep Apnea test. Nothing is on the form but to see an eye doctor. What should we do?
@Linda
Go somewhere else for a second opinion. No FMCSA guidelines on age or BMI, so second opinion time.
My son was told He needs a sleep apnea test because of his neck size and being overweight. Does he have to take the test or should he try elsewhere. If he does go elsewhere does he have to tell the second Doctor that the first one suggested the sleep apnea test.
I’m in the exact same boat. Just got out of cdl school and never had a family Dr.
Went to get the i itial physical from the dr the cdl school referred me to, who gave me a 90 day card. The cme told me to have my family Dr get me a sleep test to get the full length med card.
Now found a family Dr, and he wants me to get the sleep test also, but the initial appointment with the sleep dr is 2 weeks after my 90 card expires! So now I dont know what to do, as I lose my cdl status if I dont have a valid med card. I’m hoping a dot physical fairy drops a card under my pillow as I’m sleeping….without apneas of course!
If only there were a dr like the old days with car inspections where you pay double, and they give you a card…lol
Seriously though, it’s absolutely outrageous .
I got my results back today from sleep clinic I see online that levels 20 or below of ahi dont require u to wear a cpap machine to Maintain my medical certificate card is that true my level is 12.5 does anyone have an answer for me
@Kyle
Your results indicate mild sleep apnea which most likely do not need a cpap.
The medical examiner should be looking at a combination of medical conditions to assess your overall risk of sleep apnea.
See these articles on our blog to better understand sleep apnea screening for the DOT medical qualification. http://dotphysicaldoctor.com/category/sleep-apnea/