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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 was told by my employer that I was only 59 % compliant and that they were going to monitor my machine closely and when I got to 70% they would set me. a co up for work. How long would it take for me to get that 11%????
@David
Compliance is at 70% for 30 days straight. That’s it!
So what if i was out of work for a week or two and wasn’t driving a commercial vehicle or didn’t have my machine for a week or two…was i still required to wear it?.. Even if i wasn’t driving?!?
I drive a school bus in Michigan. I made the mistake of going to a DOT physical exam a few months back in between my morning and afternoon run. This means that I had a full breakfast and half a pot of coffee which raised my BP beyond its normal reading but still under the 140/90. I’m a big guy so my bmi is not very flattering. They looked at that and my neck and that was all it took for them to want a sleep study done and only issue a 3 month card. I have always had two year cards prior to this. The examining doctor gave me a form to take to my doctor which if he signed off on it would’ve waived the sleep study. My own doctor threw me under the bus and wouldn’t sign it. Instead he gave me a referral to a sleep study specialist. I didn’t do anything about it because there was a “Driver friendly” doctor near me when i checked your site at that time. Now its not showing any in the entire state of Michigan. My 3 month card expires August 9th. What are my options? Help!
@Awesome
Go get a second opinion at any medical examiner that understands the type of driving you do, and that you should not be held to the conditions of a class A driver.
If that examiner thinks you need a sleep study then you do, if not, then you’ll have a new medical card.
My husband had his DOT physical yesterday, Passed everything. THEN the doc told him since he is on CPAP he has to get a letter from his doctor stating he is compliant and CPAP is effective. He hasn’t seen pulmonary Doc in years. CPAP is fine, no problems. Also, there is currently no ruling by FMCSA for sleep apnea!! The doctor refused to renew his medical card which expires today. Can he go to another DOT doc and explain this and possibly get card renewed? If not, as of today he will no longer be a truck driver!!!
@Susan
If his CPAP unit will give a readout that demonstrates 70% compliance that is all he needs. If his unit does not provide a readout then the CME is simply looking for supporting documentation.
He finally got a letter of compliance from pulmonary doc which is what DOT doc asked for. When he went back to DOT doc he said it doesn’t have the results of the test on it so will not accept it. This was not stated on the form the DOT doc gave him. Just a letter of compliance from pulmonary doc, signed by pulmonary doc!!! He is back on his way over to pulmonary to get results. It seems like the DOT doctor is deliberately being difficult!! Very frustrating.
If I get diagnosed with severe sleep apnea, and get the testing/machine. I know I’d be disqualified from getting my cdl. I didn’t start showing symptoms until my weight gain though. So if I lost weight after getting the machine, could I be retested and be able to get my cdl then of my apnea went away or at least calmed down quite a bit?
@Pokie
You’ll need to get a new sleep study to make that determination.
I was given a 90 day card at my last exam. I was told I have to do a sleep study because my bmi is too high. I wasn’t happy, but I went to see my doc to get the process started. He referred me to a sleep center. Problem is, my 90 day card expires this month (July) and the sleep center can’t get me in until the end of August. Can I get another card to get me through to my appointment with the sleep people? If so, should I go back to the same examiner? Or should I try someone else? The whole thing is stressing me out. Any guidance you can offer would be appreciated.
@Bob
Recommend that you get a second opinion from a different medical examiner.
I’m a School Bus Driver. I’ve had my CDL since 1999. My company sends all their drivers (over 500) to the same Work Clinic for our DOT exams. A lot of drivers are failing the exam for the same reason-Sleep Study. I took my Physical in January- 2017. I have always received a 2 year card. Blood Presure- 120/69, Eyesight-20/30 etc. Everything is good. At the end of the exam, I only qualified for a 6 month card- yup, Sleep Study. I went to my Doctor. He set me up with a Sleep Clinic. Unfortunately, my medical insurance had to okay the Sleep Study. That took 2 months. It was almost 3 months before I received the CPAP and learned how to use it. I had a follow up with my Sleep Study Doctor on 6/23/17. I did my required 30 days (42 days) and passed. Yesterday, 6/26, I went to the Work Clinic to get my DOT card. I gave them all my paperwork. They said since it’s been almost 6 months (my card ex. 7/6/17), I have to take the DOT Physical again. Why? This doesn’t make sense. Shouldn’t the DOT go by the date for my Sleep Study? Not the date of my original Physical?
@Jo
Yes, you are required to have a new DOT physical. And the new FMCSA medical forms require the CME to complete a whole new medical certification.
First, thank you for providing this service. I am a Class A, Interstate CDL holder. I have TennCare (Medicaid). I need advise on initiating a sleep apnea test or not. I am overweight, hereditary high blood psi and I might have sleep apnea. I lost enough weight before my last DOT physical to get my BMI “under the limit”. My dilemma is do I continue to lose weight right before the physical to avoid any sleep apnea testing or go ahead and have the testing done while I have coverage that might pay for all of the costs? If I were eventually tested and didn’t have the coverage I have read the cost can be very high. On the other hand do I avoid having the “scarlet letter” of sleep apnea attached to my personal medical file for the rest of my life? Your advice would be greatly appreciated. Understand in no way am I asking for medical advice or diagnosis, simply broad general opinion of the matter.
@Zak
If you feel that you may have any OSA symptoms then go get the test.
I went for my physical today and I have used a cpap machine for the last 26 years I have a machine that does not have a chip in it because it is older I do not know how I am supposed to get a record like they are asking me for what do I do I have had this license since I was 19 years old so basically 50 years
@Danny
If you can, get a medical release form from your doctor explaining that you are fully compliant with your unit and have no issues. Then when you go for your medical card examination take the release and explain to the examiner that your unit is older, but still functional. Drivers who need the units will not leave home without it.
Otherwise you may need to update your unit to a newer one.
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.
I had a sleep study done 12 years ago. 2 years ago I went back to the sleep doctor. They wanted to do another sleep study. Insurance denied the request and stated to put me on an Apap. Always have passed dot physical with flying colors. New dr for work only certified me tI’ll sept. To loose weight and get another sleep study. I told them my insurance will not pay for it. Obamacare. My new insurance when goes into effect might. But can he require me to do that. Another sleep study and loose weight. He also kept insisting that I could use them as my primary care dr. What to do about this. Work sends all there drivers there.
@Michael
Go somewhere else for a second opinion. The CME can request another study, but it is not his role to tell you what your primary doctor should have told you. As far as the company goes, they probably have a contract with the clinic and by doing so they get a financial break.
@Trucker Docs
I have been on a Bipap machine for 5 years now and I always had a 2 year medical card, Today the company doctor issued me a 1 year medical card because I have a Bipap machine. My question is, Can the company doctor only give me a 1 year medical card since I provided them with a compliance printout from my Pulmonary Special and Provider of my Bipap machine?
@Anthony
Yes. FMCSA guidelines request a one year medical certificate for your condition, with supporting documentation at each certificate examination.
My cpap machine is malfunctioning and cannot get the print out I need for my cdl medical exam. I have a loaner machine but only will have 4 weeks of readings before my medical card expires. They say they need 3 months. What can I do?
@Troy
FMCSA really needs a 30 day readout. Yes it is nice to have 90 days, but you have a situation that should be understood by the CME. Just explain your situation and have the thirty day readout in hand when you go for your examination.
That is great news. I thought the 30 days was only for newly diagnosed sleep apnea patients who had just started cpap therapy.
I have been a long haul truck driver in Alaska for about 3 years. At the end of November my wife said I stopped breathing while sleeping as well as was snoring really loud and I made an appointment with my general practitioner. The GP suggested I go get a sleep study done. The same day I was told to get a sleep study done I went to my employer and spoke with the Dispatcher as well as the safety director. I informed them my doctor thought I had bad sleep apnea. The safety director stated it wasn’t a big deal and I would just need to comply with DOT requirements in regards to sleep apnea.
I did my sleep study on December 20th 2016 and on January 15th 2017 I was involved in a rollover accident on the haul road. To this day I do not remember the accident or the events that happened. I was looking over the peoplenet electronic logs and they were those of someone who fell asleep at the wheel. I was shocked! I could have died or killed someone else and this has shaken my world in more ways than one. I called to inform my boss that I was just diagnosed with severe sleep apnea and the same day he fired me from my job. They ruled the accident preventable. I had an appointment on the 25th of January to get set up with a CPAP and unfortunately with getting fired I am having to pay out of pocket cause they cancelled my insurance 7 days after termination of my employment.
I was confused as to how they were justified in firing me and I started doing some digging and called the medical examiners office to get my records. My last medical card was issues in October 2016. They were shocked when I told them what had transpired and how severe my sleep apnea was. In my records it showed my BMI was 35 but had the wrong neck size written down. I am a male 38 years old and considered obese. I was informed by the clinical manager that I would have to get a new medical card and be compliant with my CPAP which I have been for the 3 weeks I have been using it. I went in today to get a new medical card and was told by the CME that I didn’t need to do anything. He admitted that I was only suppose to have a yearly card if that but he left my original 2 year medical card as the current one. I am horribly concerned at this point and cant afford to pay for another medical exam for my medical card until I start working. I don’t understand why I wasn’t flagged at the appointment in October 2016 as I fit most of the criteria. I am doing everything I can to make sure I am compliant but feel like this CME doesn’t know what hes doing or is purposely trying to get my license suspended. I did speak to the FMCSA in regards to this and they told me that I needed to get a whole new physical and medical card that would be for a month or 3 months until they have more compliance records and after that I would have to renew yearly. Is there something else I need to be doing or is this CME correct in keeping the original 2 year medical exam card in place where my sleep apnea wasn’t ever listed? Any help with this is greatly appreciated. Thanks
@AKtrucker38
FMCSA requires a 30 day with 70% compliance report with your cpap unit before you can test for your DOT medical certificate. Your card will be good for one year at the time and will need a compliance report each time you test, along with a medical release form from your doctor.
Your two year medical card should have been suspended / disqualified at the time of the accident.
A new medical certificate may have been issued for a short term to get the remainder of the sleep compliance report, or you are disqualified until you can support the 30 day / 70% compliance.
I am a school bus driver in Charlotte county FL. The school district has its own clinic and the nurse practitioner who does the dot medicals is sending almost all the male drivers for sleep apnea testing and a few female drivers. most of our drivers are over 50. The CME says everyone is lying to her so she is sending most everyone for testing. My question is can she get away with doing that?
@Ron
Not if all of you file complaints about how you were treated during the examination. File your grievances with the FMCSA and put this to an end. FMCSA needs to know that someone is not following the FMCSA guidelines and besides, you drive a school bus and they are trying to hold you to an OTR interstate drivers standard. ????