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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 got a physical and the Dr ordered me to get a sleep apnea test. I will have it done within a week of the physical but they tell me I have to do a full exam and pay for it again. They gave me a 3 month card. I am not getting a CDL but need it to drive a non CDL straight truck. Can they make me do another full physical and charge me again.
@James A H
For some reason the CME is trying to hold you to a class A DOT/FMCSA standard, you are not a cdl holder, you fall under the states variances. Either way you will have to get a whole new physical done. Go elsewhere for a second opinion and explain to the examiner that you are not a cdl holder and will be driving a straight axle. That should have the examiner evaluate from the states requirements and not the FMCSA standards of a class A driver.
I recently had one of my drivers ask about inspire. I gave him all of the info I have but was wondering if it would be an acceptable OSA treatment to a ME at a DOT? I am wondering if the driver produces his sleep doctor consultation reports following implantation of the device, this would suffice?
Thanks again in advance.
@ Company Nurse
It should suffice with proper medical documentation and follow-up test results.
One of my female school bus drivers went for her DOT Physical and was told she had to have a sleep study done because she is postmenopausal. Is that a valid reason, or even a legal reason for a medical examiner to require a sleep study?
@ Karm J V
Unless your bus driver is carrying a class A drivers license it is a invalid request. Have your driver go to an examiner that understands the difference between state requirements and your states variances. And it is not a federal DOT requirement for a class A driver either..
As a company nurse, I have a driver who was asked to either lose 10lbs or have a sleep study, he lost 21lbs and passed his DOT for 2 years. He recently asked me for help with a referral for a sleep study as he feels he is having symptoms of OSA. He tested mildly positive and is now on CPAP. He says he doesn’t need to report it as he ‘self referred’ I say he needs to have another DOT as he has a newly diagnosed condition not present at his last one. Who is correct? Isn’t that the FMCSA regulation or just a ‘guideline’. Should I send his compliance report anyway so they have it on file for him?
Thanks in advance.
@ Company Nurse
New diagnosis, new DOT examination.
During my DOT physical i was told due to my body mass i will have to due a sleep study. They gave me a temporary certification. I completed the study, used my bipap machine for 30 days brought the results to the medical examiner. I was infomed i have to take another physical before i received my certification.
Is this correct? 2 physical by the same examiner within 2 months.
@ Samuel B
New DOT each time. FMCSA guidelines require a new examination each time.
I am a 51 year-old male, and am considering getting a Class A CDL for the first time. I am in good health, and have a BMI of 23.
A long time ago (I think it was in 1997), I had a sleep study and was diagnosed with moderate obstructive apnea and moderate central apnea. I was prescribed a Bi-PAP machine, which I was never able to tolerate.
Not long after, I was found to have a severely deviated septum and enlarged tonsils. I had the septum corrected, and then my tonsils and adenoids removed. It was life changing, and I’ve done fine ever since without using the Bi-PAP. About 10 years ago I had another sleep study, and the doctor told me that I don’t have sleep apnea.
I’m concerned about the impact this will have on the DOT physical, both initially and going forward. Do I need to even mention it? Will I need to get the records from that later sleep study, or have to have another one done? Thanks for the help.
@ Paul
If things have been corrected some 10 years ago, then go for the DOT examination. You should not have any issues regarding the sleep study, since you have had the issue corrected. Unless other issues require further investigation you should be fine without any additional sleep study testing.
My employer pays for employee CDL medical evaluations in accordance with California Labor Code Section 231 – “Any employer who requires, as a condition of employment, that an employee have a driver’s license shall pay the cost of any physical examination of the employee which may be required for issuance of such license, except where the physical examination was taken prior to the time the employee applied for such employment with the employer.” My Medical Examiner is now recommending a Sleep Apnea Test. Is my employer mandated to pay for all costs associated with this test, or am I out of pocket?
@ Stacey A
You will need to check with the human resources department, or legal department, on this issue
How many months back do I have to print out from my machine to prove I’m using my machine to take in for my physical
@ Scott
FMCSA wants 30 days, if you are new to a unit, the examiner may want to see 90 days.
Hello, quick question to piggy back to Scott’s question. I read that the sleep apnea law was never passed. How is the sleep apnea requirement being enforced?
@ Quintin D C
Just follow the money. The examiners that are pushing the issue are in a conflict of interest, or have done more homework and utilize additional test protocol to make their final decision.
Hello, there.
I recently had DOT physical exam for my courier delivery driver job. I have sleep apnea and had to have my doctor or my cpap supplies store send them a compliant report and passed but is only good for a year since I have OSA. My questions is: Would I ever have a 2 year medical card instead of 1 year? And I’m suring that I would have to present my compliance report each time I got to renew…
@ John
Unless you are a class A driver you fall under your states guidelines and variances, not DOT/FMCSA. These may be two completely different guidelines. By FMCSA guidelines for class A drivers, you will only receive a one year medical card and must supply a compliance report each time. But you state may be different than DOT/FMCSA for your class drivers license, check with your local DLD.
Is there a regulation or rule that a driver on a cpap can not get a two year medical card. I have been on a cpap for two years and have gotten a two year card by two different CMEs. Now my company wants me to go back to the doctor and get a one year card. Is this the law or just guidelines. Thanks for your time
@ Brian
DOT/FMCSA recommend a one year re-evaluation for drivers on a cpap.
Doctor wants a printout of useage. My cpap is 15 years old and doesn`t have any provision for an sd card or anything else. I see no reason to get a new machine when the old one works perfectly. Cpap has worked well for my sleep problems.
@ David H
How does your doctor get a readout from your machine. If he can have him provide you with the latest readout to show compliance.
Does the state of Texas have a minimum number of obstructive episodes on a sleep study before they will remove the requirement of wearing a CPAP device
@ Grady
You need to check with Texas on this issue.
I was told that you need to be using a cpap machine for a minimum of 30 days, after your diagnosis, before a re-certification will be issued. Is this true?
Hi Earl. I am in the same situation as you. I was told by my pulmonologist that I need a 30 day c pap reading in order to keep my medical card. I am devastated by this as I was diagnosed with mild sleep disorder and cannot get a reading off my machine. I have tried many masks and nasal pillows and still have no reading. I have been fighting for my medical card for 3 weeks now. I am praying with all I have that the DOT examiner will override this decision as I also have COPD which I believe is the cause of my hypopneas. I wish you all the best
@ Earl
FMCSA would like to see 90 days immediately following preliminary diagnosis. You may get a 90 card so the CME can do proper follow-up.
How far in advance of my physical may I take my CPAP test? For example if my anticipated date of hire is November 1 and I took the physical October 28 would my CPAP of August 1 be accepted. If not when is the earliest date that I could take my CPAP test to be accepted by Oregon DOT?
@ Sandy
Take your most recent reading as close as possible your examination date. Make sure it’s for the last thirty days and shows a 70% compliance.
My bf was a semi truck driver. At the dot physical, Dr suspected sleep apnea and wanted a sleep study done before giving a full year medical card. He no longer has that job, and does a local job at waste management. Would the sleep study still be necessary since the stress of long distance driving was likely causing his possible apnea? Can he get another Dr opinion? We have no insurance to pay for a sleep study.
stress does not cause sleep apnea. sleep apnea is caused by restriction in the airflow to the lungs. hope this helps
@ Traci J
Go get a second opinion.
Hello! Im looking into getting my class A license. I am concerned though about sleep apnea. I was diagnosed back in 2012 with this condition. I am 50 years old male and am 5’11” tall and weigh 175 lbs and my neck size is 15″. Even with all those good numbers I just took a most updated sleep test and my AHI was 1.5 but my RDI was 19 so in the end the sleep Dr classified me with moderate sleep apnea. Also I don’t use a CPAP machine. I use a dental device which brings my bottom jaw forward. I am concerned because of my RDI score was high and the mere fact that I have had sleep studies and been diagnosed with sleep apnea. I have heard of experienced truck drivers who later in life usually due to weight gain developed sleep apnea and tried to move to another company and couldn’t get on due to their sleep apnea. They had experience and couldn’t get on. I have no experience and have sleep apnea. What are my chances of getting hired??
Thanks
Dan
@ Dan
Just make sure you explain your situation and bring any supporting medical documentation and test results with you for the examination. A medical release form from your sleep doctor will be a great help in the decision making process for the CME.
If you are using a Dental Device (as I am), your “Sleep Dentist” can provide a letter to indicate control of the Sleep Apnea. You should have had at least ONE Sleep Study while wearing the device. The results from that study will determine adequate treatment.
As a FMCSA Certified Examiner, I would accept that letter (and review of the Sleep Study Results) and issue a ONE YEAR Medical Certificate.
The debate about the Medical Requirements and FMCSA regulation is baseless. The regulations are in place for SAFETY of the Driver and the Public. Expert panels of Physicians make the recommendations based on sound and verifiable evidence and statistics.
Would you accept advice for a home plumbing issue from your vehicle mechanic or ask you Physician about which type of roofing material lasts longer?
Why solicit medical or legal advice from a fellow driver?
Was put on cpap machine , was given an in home test that scored me at 5.6 AHI which they said just a score o 5 AHI was their limit anything over 5 was considered sleep apnea. Now a year later , I was told by sleep center staff that DOT regulations were anything under 20 Did not require cpap machine. If so just how are these doctors getting away with this ??
Thanks for your help and advice
SN
Nashville TN
@ Scotty B
FMCSA does not accept in home sleep studies, so someone is taking advantage of the situation. Go get a second opinion from another CME.
This is a blatantly untrue response. The FMCSA has no regulation regarding sleep apnea (the propsed rule was withdrawn in 2017). Sleep apnea is addressed as a general respiratory condition. Medical examiners follow the FMCSA MRB recommendations from 2016, which specifically allow at home testing with proper chain of custody.
@ Laura P
You are absolutely correct and most ( a generalization, not to include all, but more than 50% ) of the CME and the organizations that they work for will not accept a home study. They do this because they will not look any further than the notes they took during the class. And if they are tied into a sleep study facility, then they follow the $.
What is the AHI number that triggers CPAP use I have heard it is 20
@ Chris
None/Minimal: AHI < 5 per hour. Mild: AHI ≥ 5, but < 15 per hour. Moderate: AHI ≥ 15, but < 30 per hour. Severe: AHI ≥ 30 per hour.
I apologize about the length of this message in a advance.
I currently hold a class A cdl with passenger endorsement. I have been diagnosed with sleep apnea for the past 3 years. I am 26 years old, Husband, Father of a 2 year old girl in a situation that is causing me to miss work. Now I know that I may not get the answers I want but I want to know the correct response for what is happening to me currently. Thank you ahead of time for your patience with me.
I was hired by Walt Disney World in Feb of this year 2019. I took a DOT physical on their property. I showed them at the time that I had 70% of the last 30 days over 4 hours using the sleep apnea machine. They gave me a 1 year DOT Physical card.
On May 10th, 2019 only a few months after the dot physical my managers approach me stating that I am not allowed to work and that I have been placed on medical leave without my knowledge or understanding.
I then call the Disney Health services to find out what happened. They are stating that I had missed a appointment for a 90 day dot compliance for sleep apnea. I stated that I have never herd of a 90 day dot compliance and I that I have received DOT physicals in the past while having sleep apnea. I stated that the only time 90 days comes into play is when you are first diagnosed with sleep apnea you are given a 90 day DOT physical card in which time you must complete the 70% of 30 days with 4 hours min using the sleep machine. They then stated that DOT requires 90 because i’m working for a new company.
I made a new app with the doctor. At the time I did not have the 30day compliance on the machine. They stated that untill I have 90 day compliance I can not work at all and that I should not have passed the dot physical because I did not have 90 days compliance.
He stated that until I get the compliance I wont get a year dot. I then stated to him that the doctor that did the first exam in Feb gave me a 1 year dot. The doctor was confused and then took the dot physical to exam it. He left the room with it then when he came back in he stated that my dot physical was now VOID and that I currently do not hold a dot. Also, the only reason I received the 1 year dot card was because doctors are no longer allowed to give 3month temporary dot physical cards,
When the doctors asked why I did not have the compliance right now I stated them that quite often after using the machine I would wake up tired and feeling ill. Also, that there are many times that i knock the mask off my face in the middle of the night. waking up to find I have to quickly put it on and sit away with it on. In order to get the needed compliance time. I stated to them that I have tried different things like changing the ramp speed, pressure, temperature of the humidifier, ect. Non of which were giving me any better results.
I stated to them that I am planing on seeing another sleep specialist once my insurance kicks in so I can afford to do so.
During all this I was also asked about how I was tested for sleep apnea. When I was tested I was in a hotel room on werner enterprise property in Dallas TX. I shared a room with another driver and only did one sleep test. From What I have read currently my test was not conducted correctly.
This I also stated to the doctors at Walt Disney World.
I do thank you for taking the time to read this long message. Now my questions if you can clarify
1. How many days are required compliance for sleep apnea to get a 1 year DOT?
2. Are temporary dot cards (3 month) no longer allowed to be used?
3. Is the doctor allowed to pull me off work on unpaid disability without my consent?
4. Can the doctor take the 1 year dot physical card away from me and state that it is now void before its expiration date?
5. If on the ground I only need 30 days compliance with the sleep machine to get a 1 year dot. Can my employer request my sleep results checked when ever they want?
6. What actions should I take next. Please help me.
if there are any official documents that you can attach to a response email so I may add to my documents. Thank you for your time and I pray you have a good day.
@ Kyle
1. 30 days @ 70% compliance.
2. 90 Day cards are only for individuals that are trying to get further information or to get a condition/situation under control.
3. Company policy, check with the HR department.
4. No
5. Company policy, check with HR and ask to see it in writing.
6. Talk to the HR department @ Disney and state your concerns. They should be able to help.
I have worked the last 7 years for a company who monitors DOT mandated drivers. Until 3 yrs ago DOT examiners only wanted to see a 30d usage history report with 70% or higher compliance, 4 hrs or more avg hrs usage and AHI under 5. All the DOT examiners across the USA that we deal with require 90d usage history. The reason they started s=doing this is because drivers were not using device compliantly through out the year and then using a month or so before their DOT card expired to have 30d @ 70%. Unfortunately the “bad apples” spoiled it for the good ones!
Also an individual company can go by any rule/regulation they choose. Example: I have seen trucking companies make their DOT mandate employees have 80% compliance instead of the 70% required. This is a companies choice.
Definitely talk to your HR department. Good Luck.
Say you got a year medical, do you have to get the full year of 70% or of 30days?
I’m an Idaho class A holder but drive class ready mix cocncrete truck in town that’s class B…question is how many hours of sleep do I have to have before I can drive since I’m a CPAP user.
@ Ryan M
If you follow the guidelines set forth from FMCSA for class A drivers, 10 hours rest time.
Doctor. I have BMI 41 and neck size 17″. Was sent to primary care Doctor. Primary Doctor say no reason for Sleep study did blood work no enlargement of cells. Is this enough to pass or do I still need sleep study?
@ Nick
As long as there are no other signs of OSA, then you should be good to go FMCSA never put mandatory sleep studies based solely on bmi. If the CME recommends it, go get a second opinion.
I am a 39 year old school bus driver in colorado. I recently went for my D.O.T physical and was told to get a sleep study done. My question is did the examiner have a right not to give me an extension on my D.O.T card.
@ Tracia J
You are a school bus driver and should not be being held to FMCSA guidelines. There is no extension, but you may want to go elsewhere for a second opinion. Sleep studies are not a requirement unless there are a multitude of indicators.
Is this State specific? I am a school bus driver. I hold a Class B license. This doesn’t sound like the guide lines for Washington State? Our requirements just recently changed and they are ridiculous. “We” feel it is a money grabber for the State and the approved clinics.
@ Sammie M
FMCSA guidelines were established for class A long haul drivers and is federal DOT. You are class B bus driver and fall under your states variances.
I’ve been seeing a sleep nurse practitioner in Fort Wayne, IN. And it will be the last time with this individual. I’ve been using my C-Pap machine at 85.6%. I thought it was 70%? This nurse practitioner rudely stated she wants my cpap usage at 100.0% & DOT now requires 100% usage. Is this true? Said she’s fed up with putting her license on the line for semi drivers. Stated how sick she was of truck drivers. So she failed me & wrote that I’m noncompliant. I’m a female who’s lost 81 pounds & I started crying when she told me to park it at home with my CDL. She refuses to write an order for me to get new cpap supplies. She accused me of falling on the ground which I never did. I was livid! Please tell me what percentage DOT requires drivers to be at on their cpaps. P.S. I’m getting a new sleep apnea doctor.
@ Eileen C
First question, no this is not true. Go get a second opinion from someone who understands the FMCSA guidelines. Second question, FMCSA 70% within a thirty day cycle. Get a new sleep doctor and write this one off.
Question : When you have to prove that you are wearing your cpap machine to get your cdl renewed , Is that a federal law or state law ?
@ Waterboy
Federal lawif cld is class A. States vary on this issue.
Question: I was recently diagnosed with Mild sleep Apnea 1month ago. I went in to do a recertify 2 weeks ago and the doctor disqualified me. Since then I’ve been on the CPAP machine for 2weeks now. Am I required to be on CPAP for 30 days before going back to recertify? Can I go in sooner if my doctor says that the machine is showing great results? Also, in MN for interstate driving, dont i get to be certify for 30days until I get my 30 day results?
@ Tou
If you’re class A, interstate, FMCSA requires at least a thirty day readout.