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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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Need new DOT physical. I am switching to a new CPAP device from my older model. Still have my usage history from the older model. Do I need to have 30 days before the physical on the new CPAP machine? thanks
@ Vance G
It would work to your advantage, if it is at all possible, to be on the new unit for thirty days prior to your medical examination.
I have a driver who we have recently taken off the road as he has fallen asleep at the wheel twice. The company is paying for him to have a sleep study and he’s been advised to visit his PCP for a check up. His DOT physical does not expire until 10/19. Will he need to get this repeated sooner once all his testing has been done even if the test proves negative for OSA.
Thanks!
@ AJ
Yes he would need to have a new DOT medical certification examination done, even if he tested negative for OSA
I was diagnosed with moderate OSA roughly 10 years ago. I tried for several months to use a CPAP without success (multiple style masks were tried.) I finally gave up the idea of using the CPAP and went back to sleeping as usual, complete with loud snoring. I am trying to renew my DOT physical and the doctor wants me to repeat the sleep test. Is there any alternative to the CPAP that is DOT approved for OSA? Specifically, is the Inspire treatment system acceptable? I have heard good things about it, but has DOT accepted it yet?
@ Rick C
The Inspire system would be acceptable, once you are fully recovered and been on the system for a period of time, without incidence.
I was recently told to get a sleep study done. went to the in house sleep center had a panic attack was unable to complete. can I take a home test will that be accepted by the doctor. I also was told nothing about this 30 day comp thing will she be able to issue me another 90 day card or will I just lose my job
@ jerry j
Not sure that the DOT has fully approved any home sleep study packages. If you don’t experience day time sleepiness, regularly, then you may not be a candidate for a sleep study. Check on getting a second opinion.
My husband has been told by the DOT CME that he needs a sleep study because his BMI is 39 and his neck is 18 and to have his primary physician to write the prescription for the sleep study. However his primary DR, said the he does not need a sleep study. So now how does my husband get his CDL for longer than the 3 months the CME gave it to him for.
@ Linda W
He needs to get a second opinion at another facility, when his 3 months is nearly over. FMCSA does not have regulations on this issue, only guidelines for the CME’s.
I am going through the exact same thing. Got a 6 month card in Jan. I’m 35 yrs old and my bmi is high and neck is 18 inches which wasn’t even measures properly. Been this way for 15 years never any issues as I don’t have any symptoms of sleep apnea. Before the CME even did my physical he walked in and said I had to have a mandatory sleep test. Here’s my question. I told him I was going to get a second opinion. He told me that he was sending my info into a data base with fmcsa. He said even if you get a 2 year somewhere else your in a data base and if the fmcsa doesn’t get results for the sleep test In the 6 months that fmcsa would suspend my license. Is this true or can I go to a new Dr and get a second opinion and a 2 year card? I don’t want to be in a weight station 10 months down the road and them tell me I don’t have a liscence.
@ Nate F
That is complete ‘Bull Nuggets’. You are welcome to get a second opinion anytime, for any reason.
If you pass on a second opinion, then the new FMCSA entry is the medical card on file and valid.
I went to get medical card deiny because I didn’t do a sleep study on a ninety day card in Jan to April of 2018 however I did not use this card did not did not take the job went to addiffer job use a different dot clinic pass no problem jot a one-year card company now uses same dot clinic because didn’t do study won’t issue 90 day card can they do that company shut me down till I get one does it get reported to the state company safety said it did however second clinic had no issues never used it
@ Gerald b
You have the right to get a second opinion.
Just got a DOT physical and received only a 3 month card, CME wants me to get a sleep study done. How much time do I have to get a second opinion? Have to still get referral for study from my primary doctor. My BMI was 33 neck size 17.5 6’4″ 266. Just 4 yrs ago same CME while I was 295 lbs BMI 36 NECK 18.5 gave me a 1 yr no problem. How can the be?
@ Steve B
You can request a second opinion within the 90 day period, before your current medical card expires.
Follow up question. If I already handed in the long form with osa evaluation written on it to mvd. Will the second opinion supercede that one if it clears me for a year?
@ Steve S
Yes.
My husband wants to go get his cdl license. He has sleep apna and is already using a cpap machine. He is also on medication for high blood pressure. He uses his cpap and takes his medications as directed. Will he have a problem getting his license? Should he continue to pursue this career? We live in New Hampshire.
@ Joanna
State CDL may require a medical certificate. If so, take your latest test result from your cpap with you and a medical release form from your cardiologist or primary prescribing doctor.
Found this online. BMI over 40 is automatic sleep study. If BMI is 33, and you are a man older than 42, then only ONE of these factors makes it automatic. That’s almost everybody that’s middle aged.
Medical Review Board recommendations on obstructive sleep apnea August 2016
Referral for diagnostic sleep study for OSA if:
BMI of 40 or higher
OR
BMI of 33 – 40 in addition to at least 3’of 11 risk factors below:
• Hypertension’ (treated’or’untreated)
• Type’2’diabetes’ (treated’ or’untreated)
• Neck’size:’male’>17’inches,’female’>15.5’inches
• History’of’stroke,’coronary’artery’disease,’or’arrhythmias
• Loud’ snoring
• Micrognathia or’retrognathia (small’or’recessed’jaw)
• Witnessed’apnea’symptoms
• Hypothroidism (underactive’ thyroidm’untreated)
• Age’42’or’older
• Male’or’post@menopausal’ female
• Mallampati Scale’score’of’Class’3’or’4′(small’airway)
@ Bob’s
FMCSA guidelines?
I retired 2 years ago,was useing cpap machine,i have lost weight and no longer take blood pressure meds,my neck measures 17in, will be taking another dot physical for new class a job do i need to tell dr i had been diagnosed with sleep apena
@ Frank m
It is a question on the intake form. You can explain to the examiner, but he may require documentation from your primary physician.
So i recently graduated truck driving school and had recieved a 2yr DOT card. I applied to a company, arrived at the terminal and was told i had to have another physical by there examiner. After having the physical there, the company examiner said he was going to issue me a 3mo card pending a sleep test. Soo does that mean my 2yr card is null and void?
NO your 2yr card is still good go to a different company YRC Freight best company for new drivers Teamster union stay at hotels don’t sleep in truck only on team runs.
@ Daniel
If the three month certificate was reported to the FMCSA, then the two year card is invalid. But if you qualified for a two year card before and the company doctor is sending you in for a sleep study, you need to be asking some serious questions. Sounds like a conflict of interest. Go some where else.
So I have had 3 physical in the last 5 months one doctor told me to loose 25 to 30 lbs and she would pass me but I lost 50 lbs and did not go back to her because I started a different job so I went to another doctor he gave me my one year card so just this passed week I changed jobs and went to another doctor and he gave me a six month card and said he wants me to do a sleep study now can I go get a second opinion
@ Leroy a
Yes.
I was diagnosed with minor sleep apnea with 5.8 breath disturbance per hour at 88% oxygen level 3 years ago. it was recommended I get a oral appliance an have not done so, now that I go for my yearly physical they denied me my medical card because it was untreated. I read on this site that I don’t need to treat mild sleep apnea but moderate to Severe I do. If that it indeed correct can someone tell me the federal statute number or where I can find such information? Thanks
I was given a 45 day pending determination on my recent D.O.T physcial due to a suspicion of sleep apena . I went for the sleep study and was found to have sleep apena . Anyways, my 45 day pending determination expired before I was able to get in with the sleep Dr. and get the results. Just yesterday saw sleep dr and he gave me a 30 day fit to drive letter and my 2 week print out of 100% usage of the cpap machine . Will my Dr. Be able to write me a 30 temporary medical certification and be able to go back to work for 30 days as a school bus driver In Tennessee or is the 2 week print out of 100% compliancy letter insufficient and she will still need a 30 day print of compliancy letter ?
@ F.m
If you hold a class A license you fall under the FMCSA regs and will be required to produce a 30 day readout before re-testing and certification. If you hold a lesser class license, then you fall under your states variances and not FMCSA. Check with your local DLD for the best answer.
I took sleep test. I was 100%compliant 0n the use of my CPAP. the machine had a data card problem and information was etaken off the hard drive and that was only the last 30 days. I then purchased a new CPAP machine to comply. My Dr. sent a letter asking for a 90 day extension on my current phycial. The examiner told me that their is no extension available. Is this FACT or is this her plessure I amaretired Fire fighter, and a Vet. Medic. I feel that this person in giving all over weight people problems even after they comply with her request.
@ Shelton M Jr
Examiners need a 30 day readout showing compliance, but FMCSA does not have an extension policy.
Was issued a 3 month card because of Sleep Apnea. I am getting Cpap and will use it
My question is must I return to the same doctor when the time is up? I will have the readout from the sleep doctor. Just not comfortable with where I was send
@ John D
You have the right to go to any DOT certified examiner you wish. Make sure you take a 30 day, or more, readout when you go for the new examination.
I went to get my card for a new job (they paid for the physical and drug screen) that I’ll be hopefully at in September and the examiner ordered a sleep test because my BMI was 0.5 over. Literally 5 pounds. He gave me a 3 month card. Am I now required to do the sleep test? Could I not just lose 10 pounds to be safe and go back in before the 3 month card is up and be good to go?
@ Mike
A 0.5 over BMI is not a FMCSA requirement, so lose the weight and try again. There is no new ruling regarding sleep studies, it’s examiners not understanding the regulations and guidelines.
I have been on cpap for 22 years. I couple of years ago I had to buy a new machine that would record use. I thought you had to use it for a minimum of 4 hours 70% of the time. My doc says different. I cannot find any time requirement for this. Where might I be able to see it and print it out?
@Greg
See info at this link http://dotphysicaldoctor.com/commercial-drivers-manage-sleep-apnea-maintain-cdl/
There is no written rule by FMCSA.
The Medical Expert (to FMCSA) Panel’s minimum recommended compliance is: 4 hours of CPAP sleep per day, 70% or more days.
Your company/carrier is allowed to impose stricter standards than those recommended by the Medical Review Board.
Some companies are requiring at least 6 hours of CPAP use, 80% of days.
The most effective treatment is 7 or more hours of CPAP use during sleep.
I have an employee who can’t get his medical card. Due to the fact instead of a cpap machine he got dental implants that where recommended by his dr. DOT dr said he needs a cpap machine is this correct
@ Paul
No, it is not correct. Proper documentation may be needed, but a dental implant is acceptable by FMCSA with documentation from his doctor. Get a second opinion from someone who understands the FMCSA guidelines.
I train new drivers. And they often wake me up to ask questions or get my help multiple days students waking me up causes me to not use it every “day” for 4 hours. Somedays I register 3 and the next I register 12, because of the per “day” understanding. But I use it 6-8 hours each “night” or more exactly each time I go to sleep. Also with each of us having a 14 hour clock we have a 28 hour “day” fairly often. Where can I find the dot regulations on cpap usage? If I take my logs and usage report showing I’m in compliance with the spirit of the law, which is to use it 4 hours each time I go to sleep, 70% of the times I got to sleep. Or do I really have to get a new job to be in compliance with the “letter of the law”?
@ Jordan B
FMCSA issues guidelines in this case and your situation should be considered by the guidelines , not regulations.
I was told due to an 18 inch neck o needed to due an at home sleep apnea test. I took it and was told I have moderate sleep apnea. Noe I am being told I must purchase a cpac machine that my insurance will not cover for hundreds of dollars or I won’t get my medical card signed. I read here that it’s only in severe cases that a cpac machine is required. I live and work in California and I deliver gasoline. Can you clarify what my requirements are. What are my options?
Thank you.
@ George
1. 18 inch neck is not grounds for a sleep study. 2. Home sleep studies are not acceptable for a DOT medical card.
If you are driving within the state and not traveling interstate on a routine basis, then we would recommend you go get a second opinion.
where is it stated that Home sleep studies are not acceptable for a DOT medical card? there is no mention of that any where, plus most companies that require a sleep study st you up with a Home sleep study !
@ Dave
Check on the FMCSA website. The guidelines that the CME’s have to follow are, or were, available there.
Typical they are lying to you and requiring a CPAP. Get a second opinion. Apnea and CPAP are a huge game of corruption and making dirty money! ALWAYS QUESTION ANY DOC THAT ORDERS A SLEEP STUDY! CPAP can kill you!
if the federal gov. has NO laws for sleep apnea how are these doctors threating our license??the DOT has no regulations about sleep apnea.