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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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I recently went in to renew my CDL and everything checked out normal however since I was over the age of 42 and I am a male the doctor gave me a 45 temp card and told me before he could give me my 1 year medical card I had to get a sleep apnea test done. My neck size and my BM checked out normal, can he do this to me?
@Marty
If you don’t have a diagnosed pulmonary condition and everything else is within normal limits, then I would ask to see the law in writing that states you have to have a sleep study. There are a few guidelines that point in that direction, but no law / regulation. The guidelines look for additional conditions or reasons to do this level of testing, but not age and sex.
Ask – Show me the law.
Went in for my DOT physical on may 9th the nurse parcationar asked me about a sleep apena test, I said yes I had One last year I was a mild case and cpap was not required she said it is a DOT “rule ” you must have a new test every year but I will give you a thirty day card to get a new sleep test. Went to front to wait on card and then was told to fill out sleep evaluation sheet of switch. I only answered yes to one question, do I have a sleep disorder? I then moved in to section A and answer all questions NO and answer all NO’s in section B,C, and D nurse parcationar took it looked at and said no thirty day card til you do a sleep study. I questioned she said you answered yes in section A your are disquilifed but I did not. All said and done cost me three weeks getting this done and fixed my company was totally confused. I’m thinking of suing them. Do I have a case Doc. ?
@Rick
I am not a lawyer, so no legal advice here.
I am unable to find anything in the FMCSA that makes sleep study testing mandatory, so if they can’t show you the law / regulation, then they do not have a way to enforce their decision.
Get a medical release form completed by your primary healthcare provider stating no need for the test and take it back to the examiner.
If they stick to their guns, then ask to see the law. If they can’t, then there is a section in the FMCSA (49 CFR 391.47) that allows you to address conflict between examiners. This will take time and a lot of paperwork.
Or contact a lawyer, if you feel that you have been wrongly judged.
I live in the state of VT, i have been put on a cpap machine for sleep apnea, which i am doing very well with, i have no other medical issues, other then being overweight, blood pressure and everything else is good. I’m being told that as long as i am on cpap, my medical card is only good for one year instead of the normal two year card in Vt is this correct, or is it it just up to the Dr,s discretion?
@Scott
No, it is not at the doctors discretion. FMCSA passed a ruling that any driver on a CPAP must be monitored more closely and so everyone who uses a CPAP is limited to a one year medical card.
Also, make sure when you go for your next DOT medical examination that you take a note from your primary doctor stating that you are using your unit as prescribed and that you are doing well and, if at all possible, take a copy of your latest reading report with you.
I have failed my dot physical for a pre employment test due to my sleep apnea. The doctor has said that I need to do three different tests.
1) retake of sleep test
2) some sort of wakefulness test (not sure the real name)
3) reading of my cpap card
Is this really what is needed with the new laws? How do I find this stuff out? How do I go about doing this stuff?
This doctor is DOT certified.
@Jacob
Unless there is a lot more information regarding this, you are being led down a trail of misinformation.
All you should need at this point is a medical release from you primary doctor who deals with your sleep apnea and a copy of your cpap reading. The release tells the DOT examiner that your doctor knows and understands what he is signing. The record also shows that you are using your equipment as advised and that all is well.
Once again I have failed my dot physical because of sleep apnea. I did as you have said and the DOT certified Doctor said that on FMCSA pages 176 & 177. States that I still need one more test and it has to be one of these two: 1) maintenance of wakefulness test or 2) multiple sleep latency test. Also it does state that these do have to be done yearly.
@Jacob
I guess with the examiner you are dealing with, you are going to have to have one or the other test done before he will let you go. He is basically following the guidelines to the letter, so I don’t have a better answer for you in this case.
I have retired 6 months ago.My medical is due soon and the state of Texas sent a letter saying I must renew physical to retain my CDL.I have had a cpap since 2013, but my former employer took care of yearly readout and physical.I need a readout for this year ,but Iive in different area from where I worked.I contacted company that monitored cpap previously but they want 150$ for readout.Is there a less expensive route I can take,or possibly do it myself?I do have Medicare and supplemental but not sure it would help.
@Raebon
Check with any cpap provider and see if they can do a readout. $150.00 seems really steep for a simple readout.
My husband has been using a CPAP machine for 7 years now (did the sleep study 7 years ago) and has yearly taken his printouts into the Sleep Doc, who then fills out paperwork for the DOT physical. This year he went to a new DOT certified doc and she refused to give him clearance stating that the new laws say he needs to have a sleep study done yearly. I have been searching all over and even his sleep apnea specialist is not aware of this – Does he in fact have to have an annual sleep study?
@Michelle
There is no such law or regulation.
All you need is a medical release completed by your treating physician and a copy of your last test results showing proper usage and compliance. You should have no problems. You will be restricted to a one year medical card due to the CPAP.
If there is any further discussion, I would ask (politely) to see the regulation in writing in the FMCSA guides.
I only use a cpap for sleeping not driving. The job I am applying for is a delivery driver 3/4 ton truck, day only and numeroys stop and go driving and no long hauls and no driving distances longer than 30 minutes. I do not use my cpap for driving does that disqualify me for a DOT certificate.
@Jerry
No, not at all. The use of the cpap is only for sleep time, so you will have no problems.
You will want to bring your last download report from your cpap with you at the time of your DOT examination. It answers some questions that the DOT examiner may have.
can I take nuvigil and have a cdl
@Lisa
The medical examiner’s first question is – “Why do you take this medication?”
The med itself does not appear to be listed a disqualifier.
You will need to have a doctor’s explanation for its use and efficacy with your condition. With this in hand you should not have any issues.
WHATS THE MAXIUM TIME THE MED EXAMINER CAN ALLOW ON A MED CARD TO GET A SLEEP STUDIE DONE
@Duayne / S-Dash
These questions stir up more questions than answers.
Without knowing why you think you need the cpap for more air flow to the brain while driving, there are no answers to these questions. Lots more information is needed before we could answer your questions. Your situation is best addressed in a physical examination situation.
CAN A MED EXAMINER REVOC YOUR DOT CARD BEACUSE U THE CPAP FOR BETTER AIR FLOW TO THE BRAIN WHILE DRIVING
can the cpap be used while driving to have better air flow to the briane
Does your neck have to be certain size. Mine is 19 & they tell me I have to have a sleep apnea. Is this true with the guidelines?
@wildslim
There is nothing in the FMCSA guides regarding neck size.
If you have a multitude of other health related conditions, then your examiner may request a sleep study. But it is not based on neck size alone.
1) Is there a Medical examiner certification process now in order to do DOT physicals in the state of Ohio? 2) I do not see anything in the FMCSA guidelines that addresses sleep apnea in any way. Yet, some examiners are requiring drivers to go have sleep studies done based solely upon BMI and neck circumference. How can that be?
@Mark
The NRCME programs are supposed to go into effect by May 21, 2014, and that goes across the board to every state, including Ohio.
As far as your main question – Here’s a conflict of interest, “follow the money” scenario: You are a doctor and you think FMCSA is going to make a big deal out of the sleep apnea, so you invest $100,000 in a new sleep study facility. Then FMCSA has to retract their stand on sleep apnea guideline. Darn, you just invested a $100,000 and you need to get your money back.
As far as we can tell, at this moment, there are no set rules in place regarding sleep apnea.
But do be aware that a three strikes program may be at work:
1. You’re way overweight;
2. You have high blood pressure and are on medications;
3. You’re a type 2 diabetic on meds.
These are some examples of strikes and you are going to be asked to do a sleep apnea study because with these conditions you have a much greater propensity to sleep apnea than a healthy driver.
I’ve had narcolepsy for many years, but it is brilliantly controlled with meds and I’m in full compliance. I do *not* suffer from cataplexy (the muscular issue you mention). My neurologist wrote me a letter stating that in her opinion, I was safe for approval as a professional driver. Still no dice from the DOT. Any thoughts?
@Delilah
Yes, this one is no dice from DOT. This is an FMCSA regulation, and regulations are law, not guidelines. So unfortunately, there is nothing else that can be done on this one.
I got a 90 day medical card because I needed a sleep study, and got it on the last 5 days of my 90 day. The sleep study showed that I’m moderate, I know I need to loose about 25 pounds and run now and then, making my high blood pressure and BMI; Do u think doing will make everything better, and if so…… WHEN will I be able to take another sleep study to make this all go away.
@Danny
More information is needed. Did the sleep group recommend that you start using a CPAP machine?
The weight loss and exercise will help immensely. You made a good choice of addressing the issues at their cause rather that just trying to skirt the problem. BMI and high blood pressure are more related to lack of physical activity then any one thing.
The sleep issue is also related to the other conditions, so I would follow the recommendations from the sleep group. Their results will be what your DOT examiner will need to make his next recommendation.
Good luck for a continuation to good health.
My employer contracted with a large sleep medicine company out of Atlanta who came and tested drivers for sleep apnea in a hotel with portable equipment.
I do not meet any of the screening criteria for OSA except that I am diabetic so that’s why they flagged me for testing. I did not agree with their findings that I have OSA (18 out of 19 drivers tested positive for OSA – how is that possible?).
I had a second study done on my own dime at a local sleep lab that is certified by the AASM and results read by a Board Certified Pulmonolgist and the results show no signs of OSA at all.
The contracted sleep medicine company is sticking by their findings however I am opting to go with my own pulmonologist as my “treating physician” on this.
The Atlanta company already notified DOT that I do have OSA but my own doctor is going to send a letter to DOT to tell them that I do not have OSA but we don’t know exactly where to send the letter. Can you help with the appropriate address information? Is it to the DOT or Dept. of Public Safety in my state? or Fed?
Thanks so much for you help!
@Halabama
If this was reported to anyone, then it went to the FMCSA central data-base. So I would follow that trail.
One of our drivers went on his own to see if he has sleep apnea. The results came in and they set an appt for him 3 days after his dot medical card expires. He had his dot med physical scheduled 4 days before that. When he went to get his medical card the doctor refused to do the examine stating the driver has sleep apnea and he has to get treatment first before he will renew his card.
Can they refuse him when he is in process of getting treatment for sleep apnea?
Can he go to a different doctor?
@Allyson
The main issue here is the driver indicated he has sleep apnea and has not been treated for the condition as of the time of his DOT exam.
Once the examiner is made aware of this, he must see positive results findings following treatment procedures.
Because the driver is now marked as unsafe until treatment is proven safe, effective and stable, most DOT examiners are going to hold him from driving until treatment is stable.
As far as going to another DOT examiner, well that may run into the same situation if the examiner know your driver has sleep apnea.
It is my understanding that the DOT examiner can, if he/she chooses, issue a temporary medical card for 60 days that will alow him to drive while getting acclimated and compliant on CPAP therapy for his OSA. Then he goes back, bringing the printout from the SIM card in his CPAP machine to prove compliance and he can then be issued a 12 months medical card. The problem seems to lie in the fact that DOT docs won’t distinguish between guidelines and rules and won’t take it on a case by case basis. If the driver hasn’t had accidents and doesn’t have EDS then it would stand to reason that he would be safe to drive but if he suffers from excessive sleepiness (EDS) then there’s a liability issue for the company and an ethical issue for the doc. Our experience is that the DOT docs stick to one policy across the board for all drivers regardless of severity of OSA symptoms. I wonder if he can file for temporary disability (if a policy exists through company) while he works on getting acclimated and compliant?
I appreciate the help guys. I wasn’t sure if this is right or not But I guess it’s okay For another 3 month card. I’ll just continue to lose weight and then I won’t have to deal with this no more. I know they got to do something to change the rules Its just too ridiculous to have the doctors keep sending you for sleep apnea test every year. The hurdles you have to jump through to keep a decent job is just Stressful.
@Danny
You are very welcome.
The sleep apnea confusion has created stress all around. It is a complex issue, and the best thing that you can do is to take steps to avoid all the issues, which is exactly what you’re doing.
The driver lifestyle makes it really tough to find ways to stay healthy, but every little way you can find will go a long way to being in control of your life, and not having to worry about your livelihood being threatened by rules and regulations.
Stay well!
I seen on your Frequently asked questions that you can only have one 3 month card then you get your year card. But what does it mean if your DOT Physician says that i have to get my weight under control more and she is only going to issue another 3 month card. Is that right. I don’t weigh that much now when I first went in for my physical highway 273 and I started a low carb diet now I am down to 258 my target BMI is 243 she can see I made some progress but she only allows me another 3 month card I’m not sure if that’s right. The problem is that she wants me to do another sleep study and I just had that done 2 years ago with no signs of sleep apnea not even the slightest hint of it and she wants to force me to do it again. so I decided to drop weight so I didn’t have to flip another 2500 dollar bill out of my own pocket again for something that i dont have and the sleep study where I had done said it was useless for me to come back in and do it againi because they know I didn’t have it. So is this right can I get another 3 month card or is this going to cause problems
@Danny
Sounds to me like you have an examiner who is reading the guidelines very strictly. If you have lost weight and already done a sleep apnea test within the past couple years, then there should be no problems. There are no new laws regarding sleep apnea and no hardline BMI charts to go by, so I’m not sure about her level of thinking regarding this issue.
The three month card is for the driver that needs to get things under control and is then re-checked by the same examiner to confirm that the issues in question are truly under control. DOT allows an examiner to continue with another three month card if the condition or situation is improved but not fully under control. I believe the part that you read was pertaining to a three month card to get blood pressure under control. Once the blood pressure is controlled, then the examiner can certify the other nine months to the driver in question.
As far as sleep apnea and the FMCSA is concerned, you will find that FMCSA has been called on their lack of proper rule making procedures regarding sleep apnea and there is no new law regarding this study. It was a guideline for drivers that had a multitude of things going on… e.g. high blood pressure, overweight and out of shape, and a diabetic. This combination would warrant the possible need for a sleep study.
I trust this answers your question.
I think the doctor our company sends us to is interpreting the DOT regulation as strictly as possible; he says anyone with a BMI above 35 automatically has to take the expensive tests from his company’s sister sleep test division. Can I go to any other approved doctor for a second opinion? (If I pay for it) Isn’t a DOT card a DOT card? Isn’t the card that your doctors issue just as valid as this “company” doctor?
@Andy
Yes – You can go to any doctor who understands what a driver does for a living to get your medical certificate. This changes May 2014, when you must go to a FMCSA Certified Medical Examiner to get certification. See more info in FAQ FMCSA Regulations.
And Yes – A DOT medical card is a DOT medical card, good everywhere in the United States.
I have a temporary 90 day card from a doctor who clearly doesn’t follow the guidelines in your FAQ (or the DOT), can I go to another doctor for a second opinion, or do I have to go back to the same doctor who issued the temporary card?
@Andy
You have the right to have your medical examination done by a doctor you choose, as long as they understand your role as a commercial driver. The only exception to that rule may be what your company policy is regarding who does your medical certificate.
If you have not been diagnosed with osa, have no obvious signs of osa, but the examiner states it is a state law (there is none in Ct) that you HAVE to get one done or they won’t give you your certificate, isn’t that fraud?
I do believe though that your employer demanding you screen for a disability falls under the scope of the EEOC and ADA (Americans with Disabilities Act.) The way the regulations were written by congress the language is clear that both disabled and non-disabled persons already employed cannot receive employer inquiries regarding any medical condition or disability that is not of business necessity. And to boot there has to be some kind of objective observation that you have (osa in this case) , that osa would effect your job, and there is a direct and immediate threat that you will pose a hazard at that moment. Other things that are considered is the chances of having a mishap (maybe you only driver two hours a day or something along those lines), and if there is an imminent threat if you were to drive. Even in the extreme case the individual has to be evaluated before an employer can demand a screening ( further inquiry as to a condition or disability).
Check out the EEOC regulations and ADA
Don’t let anybody tell you you HAVE to get a sleep study done. There is no law requiring you to do so.
Don’t let the healthcare provider intimidate you, and don’t let the employer deprive you of your rights in accordance with Federal Labor laws.
If you have to, your state labor department can provide you with legal assistance or referrals. And the EEOC is a heavy hitter and loves to make examples of employers who flaunt labor laws, discriminate, and bully the worksers.
Any good lawyer can get you damages too for fraudulent and intentional misrepresentation from the healthcare provider and or employer if they tell you an osa screening is mandatory (of course there is always the referral to a clinic… Possible insurance fraud). In Ct., there is also a contingency for pain and suffering along with the economical loss past-present and future.
Stand up guys and gals. We are being raped and need to defend ourselves!
Required testing based on risk factors is called profiling, where an assumption is being made based on something other than your job performance. This too is addressed in federal labor law, EEOC regulations, and the ADA. Now if you need treatment, please seek it out, but unless they are gonna screen you for everything that causes driver fatique, then say NO to screening. Soon you will have to forget movies, romance, kids, or anything that keeps you awake and not sleeping! For crying out loud!