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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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Please help my job depends on it. 31yo Class A holder, overweight, other wise healthy. No drinking, smoking, or drugs. I was out of work from January 2017 til May 2017. Just started working again. 2 different jobs I applied to made me take a DOT physical as part of the pre-employment hiring process. Both Dr’s gave me 3 month medical cards and refered me to get a sleep apnea test. No insurance or money to do that before my 3 month card runs out. Can I see one of your trucker friendly Drs for a second opinion? My new job is driving a dump truck locally during normal hours, I feel there is no risk of me falling asleep behind the wheel. Please help advise. If I had more time I would gladly comply and go get the sleep study. Thank you very much.
@Jon
You need to find a CME that fully understands your job requirements. These doctors are evaluating you as a interstate longhaul driver, which is not what your job is.
You can request a second opinion at any time. Sleep studies should be at a request from the CME because he sees or suspects a multitude of signs and symptoms which present as a risk/safety issue. So even a second opinion may not be the answer if there are possible risk of OSA.
hello, I am a school bus driver in the state of Tennessee , was recently diagnosed with mild to moderate sleep apena and was given a cpap machine , I am due in two months for my dot physical ., am I going to get disqualified ….I am over weight but other than having sleep apena , im healthy ….
@Carol
A lot will depend on the class drivers license you have. As a bus driver we suspect that with proper documentation and a recent cpap readout indicating a 70% compliance for the last thirty days, that you should be alright. You may want to confirm this fact with your local drivers license department.
Class b with ps Endorsements
how long after your sleep study do you have to wait to go back to work
@Alfred
The CME will want to see a 30 day readout with a 70% compliance before he would issue a new medical certificate. That’s if you were found to have OSA. If the test was negative for OSA, then you should be able to return to driving as soon as you have the results.
HOW MANY HOURS A NIGHT ARE YOU REQUIRED WARE THE DEVICE
@Ralph
The most effective treatment is 7 or more hours of CPAP use during sleep.
The Medical Expert Panel’s minimum recommended compliance is: 4 hours of CPAP sleep per day at 70% or more days.
Some companies are requiring at least 6 hours of CPAP use, 80% of days.
I do not snore nor do I smoke. I do not have daytime drowsiness but I am overweight. Do I have the right to refuse the test if suggested by a doctor at the time of physical since it is not Federally mandated?
@Dan
The CME can request the test if, in his opinion, there is a question. Many CME’s are trying to cover their behinds and over read the FMCSA guidelines.
You are entitled to go else where for a second opinion.
I have two? 1- If I go to a different medical examiner for my dot card, does my information follow me to the next? 2- Do I need to take a Nap study every yr, for mild sleep apnea?
@Troy
1. Your information is in the FMCSA data base, so it can be accessed.
2. If you are using a CPAP then you need only show 70% compliance for the last thirty days. You do not need a new study done each year.
If your sleep apnea is mild and you have not been diagnosed to need CPAP at this time, then it will be up to the medical examiner when you take your next DOT physical to determine whether your current health conditions point to the need to take another sleep test or not.
It’s been determined that I don’t need cpap… I have a mild case. So two years ago I took a nap study, to show no daytime sleepiness… I passed with flying colors… dr certified me for two yrs… Then I go for my dot physical last week, she says I need to take another nap study… Do I need to take another another nap study?
@Troy
Go somewhere else for a second opinion. There should be a multitude of things present before a sleep study is requested. Some of the CMEs are over reading the FMCSA guidelines for class A drivers.
i was diagnosed with a mild case of sleep apnea, when i took my first test, it was inconclusive, when i took my second sleep study the examiner kept coming in every 30 minutes pulling out wires plugging some back in, how can this be accurate? i used the machine for 3 months but gave it back to my insurance provider after recieving my 1 year medical card, now in august my card is expiring, will the non use of the machine for the past 5 months hinder me from getting a new medical card?
@SG
If you were diagnosed with OSA then the medical examiner is probably going to require another sleep study if you cannot show 30 day compliance on CPAP.
My husband was diagnosed with narcolepsy over 30 years ago. He has never experienced cataplexy or unconsciousness. He’s been on the same medication at the same dosage since his diagnosis.
He drives a BUS for a LOCAL transit company. That outfit hired him knowing – from his first interview – that he has narcolepsy; he’s been issued DOT cards each year that he’s worked there. His attendance record is spotless. He’s earned back-to-back safety citations throughout his tenure.
The medical examination firm that this bus company’s been sending all of its drivers to has been replaced by someone entirely unfamiliar with narcolepsy. He “gave it away” by asking how that CPAP machine was working out. CPAPs are for apneic patients – not for narcoleptics.
Certified Medical Examiners are REQUIRED to understand the role of the commercial driver. Clearly, this one does *not* and further can’t distinguish between OTR truckers and bus drivers and between narcolepsy and sleep apnea.
Therefore, while my husband’s DOT card was STILL VALID, he was taken out of service (unpaid, of course) because of it.
There are only FOUR parts of the DOT medical examination that are absolute and do not allow for discretion on the part of the physician: vision, hearing, diabetes requiring insulin and epilepsy. My husband has none of these and PASSED THE PHYSICAL in its entirety. Yet he was “disqualified”.
There are other disqualifying conditions such as tachycardia and Menier’s that are disqualifying. My husband has NONE of these, either and his treating physician has signed off, indicating there is no risk of his becoming incapacitated while driving. He, therefore, passes the §391.41(b)(8) and (9) tests.
There are medications that are disqualifying. My husband’s on methylphenidate – a Schedule II drug – which, by definition, is not on the 21 CFR 1308.11 Schedule I substances list. Ergo, his medication is not at issue per §391.41(b)(12).
The FMCSA clearly says – in its own rules that have not changed since April 2014 – that they provide GUIDELINES (not statutes) to assist the Medical Examiner in determining a driver’s fitness and that the “Medical Examiner MAY OR MAY NOT CHOOSE TO USE THESE GUIDELINES.”
MAY OR MAY NOT. Yet no doctor – on the “trucker-friendly” list or otherwise – seems to believe that they have ANY discretion in this matter at all. When they try to contact FMCSA for verification, they get no response.
You need to get the word out to these doctors that they DO have discretion.
SAFETY IS PARAMOUNT; DESTROYING CAREERS IS OPTIONAL.
UPDATE: Today, my husband drove an hour and a half to the regional FMCSA. The medical expert there said – definitively – that doctors have discretion as to whether to follow the guideline (or not).
Your husband got the “Pork without the Beans” I would recommend that he starts drinking heavily then after the hangover is gone, going and talking to a Manager at the Bus Co to explain the situation. If he has a good record like you say I’m sure they will work with him to find another CME. Drivers with a Class A/B CDL with Air Brakes are not easy to find.
Good Luck!
I already took a sleep test a little over a year ago. My blood pressure was elevated when I took my DOT physical again. The test says there is no sleep apnea present but the doctor says I need a new test done. I understand the need to control my blood pressure. But if I get that under control can she still prevent me from obtaining a new card? Is there anything else I can do?
@Stressed out
Get the blood pressure under control and if you have the results from the last sleep study available, take then with you. There is no need for a further OSA examination if you do not suffer from it. You might want to get a second opinion from another medical examiner.
I was recently diagnosed with “sleep apnea”. I put it in quotation marks because it seemed the place I had the study done that everyone walked out with a cpap machine. I’m overweight, smoke, and have 18″ neck. Recently had knee surgery and spent 20 years as a paramedic. My sleep is marginal at best buy yet I function with little sleep as is. Since I’ve started the cpap, I’m more tired after using it than when I don’t. No one listens to what I have to say. All I hear is I’ll get taken out of service if I don’t use the machine. I was taught to treat the patient not the machine. Is there anyway to fight this and if I change companies will it follow me? My primary care at the VA said to follow up with doctor who prescribed the cpap machine but I never saw a doctor.