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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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Does anyone know what the requirements are for a retest for sleep apnea? I had a new study done showing negative and now my company’s compliance department tells me that they will not accept it because I did not stop using my machine 48 hours before the new study. Has anyone else had this issue?
Hello I have sleep apnea and can’t use a cpap can I use the oral instrument instead to make me compliant.
@ Jerry T
For DOT/FMCSA class A cdl, you are going to need to provide significant medical documentation to support having your condition under control. But it is possible. For lesser class license, you fall under the states guidelines and regulations.
I never had a problem passing the physical, however, my primary doctor no longer does physicals. I was at a pharmacy picking up a prescription and noticed that they did walk in physicals. I took the physical, the nurse practitioner stated that due to being a male over 50 along with my weight and a history of high blood pressure, even though it is under control while taking medication, she said that I have to go for a sleep apnea test and was limited as to timing or would have to take another complete physical. I explained that there is no family history for sleep apnea, as well as answered a questionnaire online which resulted in not having a sleep apnea issue. She claimed that her insistence for me taking the test is mandatory based on changes to the requirements. I’m unsure about where to go for a second opinion, as well as the timing and cost of having to go through another complete physical in which may bear the same results. I haven’t driven a truck for many years but do not want to give up my license which I’ve had since inception.
@ Dan B
Sorry you went to a ‘doc in a box’, there is no such regulation in the DOT/FMCSA for a mandatory sleep study, unless there are a multitude of signs and symptoms. Go to a CME that understands the guidelines and regulations and get a second opinion.
I had same thing happen to me.I have 0 symptoms 6ft 6 270 lbs 18 Inch neck. Rude doctor would not listen. I understand that there a lot of doctors with this false belief. It’s wrong. Needs to stop.test is expensive if I deductible I pay to prove . Got a 2nd opinion
@ Bill F
It is unfortunate that some doctors and the facilities they work for have a conflict of interest with sleep study groups. FMCSA is pretty clear on their side of the requirements and regulations, but some examiners are not looking to be driver friendly, but looking for any reason to be non-driver friendly.
I was diagnosed with sleep apnea a few years ago and use a cpap machine to keep my cdl. Since then I have lost alot of weight and am trying to get off the machine. I recently retested and AHI is at 5.8(mild). Willni still be required to use cpap or is it only required for moderate to severe apnea?
@ Ruben
You will need a note from your doctor indicating you are off the cpap and are doing fine. Supporting medical documentation and a medical release form from your doctor will aid in the CME’s decision making process.
Hi, I’m in Ny state and I need to know what the class b Cdl requirement is for a 1 year medical card renewal with a cpap machine. 30 days or 90 day cpap compliance?
@ Darryl H
Your class B is state, not federal, and will be best answered from your local driver license department.
Went for a first ever DOT physical in order to take the CDL class A permit test in Florida. Medical Examiner measured my neck and my height and weight and said “per DOT, My BMI indicates i need a sleep study”, which I did and I have been diagnosed with sleep apnea. The Medical Examiner says I have to be on the CPAP machine for 30 days before she can grant me my medical card and I Cannot take the permit test until that is complete and certified.
My question is, Is what I’m being told legitimate? I’ve spoken to a friend who is going through the same thing and has also been told his BMI requires a sleep study but he was given his 3 month card to start his licensing process. He went to a different Medical Examiner.
Also- I am a bit confused because i read in this guide that there are currently NO BMI-regulation as per DOT.
Thank you
@ Brian
Neck measurements, BMI and weight are a very small portion of a preliminary diagnosis and the DOT/FMCSA states that there should be many significant findings on top of those three. There are no specific DOT/FMCSA regulations for BMI, neck measurements, that would warrant a sleep study all by themselves. A 3 month medical card for an individual just starting a cpap is not a normal issuance. DOT/FMCSA for a class A driver would be 90 days, with a readout for the last thirty days, showing good compliance.
I have a diagnosis of EDS from a sleep practitioner after having 2 separate sleep studies and ruling out sleep apnea. Correct me if I’m wrong, but would taking Ritalin (methylphenidate) cause an immediate fail of the DOT physical? If I’m stable on Provigil, would that be considered okay, or also bar me from driving?
@ Sarah S
Your condition and medication use will cause questions with the CME. The examiner will request additional information from your prescribing doctors, but neither of your meds are immediate disqualification from DOT/FMCSA. You will need to be on any new medications for a period of 30 to 90 days before a medical card would be issued.
I am a Sleep apnea patient. I am SO glad my doctor recognized it and have been using CPAP for 4 years now. I can tell any driver that without a doubt, I am better off for having been diagnosed.
That said, here’s my question/gripe (How do you make a driver gripe? Give him a job!). To get my 1year medical certificate, the CME needs a report from the Neurologists office that I am indeed using CPAP. To get the report, I must schedule an appointment which can take weeks/months depending on your location. Once obtaining the report, I then go see a CME to get my certificate. Then report it to the state all in time to prevent disqualification.
So, In planning ahead to clear the hurdles, I end up making appointments (and paying for them) weeks/months in advance. This then actually gives me an 11-month certificate since I have to stay ahead of it rather than be disqualified. As I see it, I should get a free year after a decade! (yeah, right)
Now to the question- How long is the report valid from the neurologist to the CME? If I can hold out to the last available days and get my certification within a week of disqualification, maximizing my 1-year ‘value’.
@ Chip W
The CME needs to see a recent 30 day readout. Questions, does your machine not provide a readout report or must you go to the neurologist for the report? If you have to go to the neurologist, then see if he will give you a 90 day readout. That will cover your bases right up to the last minute so you can get your one year for one year.
Hello I am a 54 year old truck driver. I am overweight and have a thick neck. I am dieting and losing weight however. In May I went for my 2 year physical. They made me get a sleep study and only gave me a 6 month card. The process for a sleep study is lengthy and complicated. It takes months to get a sleep study. Insurance will only cover an in home test which I did. I will not get the results for a week or two. My doc told me the results will only be positive for sleep apnea or inconclusive which will result in me having to take a study at their lab, which would be about 3 months from now. Meanwhile my wife and I are moving from Pa to Florida in August. If I get a positive for sleep apnea test the cdl doc wants a 30 day result of cpap tests to show progress before issuing me a 1 year card. Long story somewhat shortened. Suppose I would lose a bunch of weight and just blow off this insanely complicated process, move to Florida in August and since its 3 months before my medical card expires, I just get a new CDL Physical and not mention anything about my problems in Pa? Is this possible. I don’t think they put anything in the national registry about my potential sleep apnea. I mean I don’t want to do anything illegal or immoral or unsafe. I feel fine, I felt that cdl doc did not like me personally, for resons unknown. However I accept her findings, but am having trouble fullfilling these obligations. Would I be ok if I did that?
DOT/FMCSA does not have a mandatory sleep study requirement unless you carry a series of signs and symptoms. Best to get a second opinion somewhere else.
I am currently a school bus driver and my medical examiners card expires mid July 2021. However, I applied for a bus driver position at ANOTHER school district which required me to take DOT physical as part of their hiring process at a location of their choice. The Nurse Practitioner who did it concluded I needed a sleep apnea test and gave me a 3 month extension FROM THE DATE OF HER DOT PHYSICAL IN APRIL because I couldn’t schedule a sleep study until late June. So now the extension medical card expires in early AUGUST. Since that time however, I’ve decided not to pursue the job with this district and will remain with my current district. I am very disappointed by all this now because none of this would have come to light if I hadn’t applied with this other district! But now I need to go back for physical with DOT examiner who saw me LAST YEAR and who issued medical card that expires in mid JULY because according to them and my current employer, my medical card still doesn’t expire til mid July. They don’t know anything about me applying with another school district and getting another DOT exam with requirement for sleep test. So what should I do? Should I go through the sleep test anyway and be frank with this dr as to what has occurred or wait and see if this dr thinks I should have a sleep test done as well? Then tell him the whole story? Not sure what to do first. Please advise ASAP….thank you!
@ Stephanie
Well your new 3 month card should have been entered into the DOT data base, which voided your old card. Just go back to your medical examiner from a year ago and have a new DOT examination done.
Does a company have the right to pull a drivers physical card if they have video evidence of said driver falling asleep while driving a CMV. This has happened several times and there is concern.
@ Stan
Not sure if a company can pull the drivers medical card, but they do have the right to protect their property, the driver, and the public at large by dismissing the driver as unsafe and high risk.
I am a school bus driver and had to have a DOT physical. The doctor at Concentra stated I needed a sleep study done. Did the study and my insurance stated I had a mild case and it was not needed, my primary doctor’s office do not conduct DOT physicals and the the Concentra doctor would only renew my medical card at degrees of one month, six months and then one year. After two years I no longer needed the machine (that I paid for out of pocket) and stop using it for a year. Now for my my new dot physical she stated I needed an Exit Letter. For eight days I use it to show them I sleep well at night and 30 lbs lighter. I the doctors notes for the sleep center stated I only use the machine because I want to and the dot doctor will not sign off. What can I do, can I go to another DOT office or write a letter of complaint to the board.
@ Josephine M-H
You need to go else where and get a second opinion. For one: you are not a class A driver and should not be held to a class A drivers standards. Two: DOT/FMCSA does not require a sleep study unless you present with a multitude of signs and symptoms. Three: As a lesser class driver, bus driver, you fall under your states guidelines and variances, not federal DOT/FMCSA. You may be being taken advantage of with a company that has a conflict of interest, if they are recommending a sleep study facility for you.
My C-Pap reading is 85% and have an AHI of 13 is this passing for a CDL medical exam?
@ Bill W
If the readout from your c-pap indicates a better than 75% usage over the past thirty days, you should be fine. If all else is within normal limits.
In 2017 my husband was asked to get a sleep apnea test because he was overweight. The results came back a mild obstructive and he was granted a 2 yr medical card. It is now time for him to renew his medical card. The place he previous was going for his examine closed down because the physician passes away. This is the same physician that requested him to get a sleep apnea testing 2017. Today he went to Concentra and passed the physical and everything but was told he cannot get his medical card renewed because he needs the physician to write a letter stating he is cleared to operate a CMV. He doesn’t have a primary care physician who can review his medical history or clear him because he’ll be a new patient. What can be done?
@ Lauren
The DOT medical examiner has to function with DOT/FMCSA guidelines and regulations, so his request is legitimate. He / She are bound by the regulations. You need to find a new primary care physician that can sign a medical release form for you.
If your Ahi is 5.1 is that considered sleep apnea, and if it is a mild case does that have to be disclosed to the medical examiner
@ Timothy C
5 to 15 is considered mild OSA. 5.1 (Very mild). There are questions on the intake form which will ask the question. If you have any supporting documentation from your sleep study facility or doctor, it will be very helpful to the CME in his decision making process.
My husband recently went to see the doctor and was told that he should be tested for sleep apnea due to his migraines (he was told his migraines plus the symptoms of possible sleep apnea could be directly correlated to having sleep apnea). We are due with our first child soon so we can’t afford for him to be out of work/lose his CDL due to this test so can anyone answer these questions for us (we live in MN if that makes a difference):
1. Will he lose his CDL if he is diagnosed with sleep apnea?
2. What will happen to his med card – will it be taken away or will he just need to report the sleep apnea and have a note from his doctor saying he is being treated and then follow up with a 30-90 day readout from the machine proving compliance?
We are just extremely worried that he will lose his med card/CDL and therefore won’t be able to continue working. He only has a Class B currently but the company he works for wants him to get his Class A in the near future so answers based on Class A and B would be appreciated.
Thank you in advance
@ Brittany
1. The cdl is a state issued license and a diagnosis of sleep apnea would not revoke his cdl.
2. Get a second opinion on the DOT medical card examination. Your husband is a class B driver and falls under the states variances and guidelines, not DOT/FMCSA at this time.
Doing a follow up with the sleep testing would provide useful information and may be a huge help with his migraines. As a class A driver, he will fall under DOT/FMCSA regulations and guidelines. Mandatory sleep apnea testing is not part of the FMCSA unless other signs or symptoms indicate a need for additional information.
Get the medical card for his class B license.
AHIs per night were 5.6 and now we have a CPAP machine, I thought I read that the standard 20 AHI or more was the threshold?
What can I do to battle this nonsense?
@ Scotty B
Get a second opinion, especially if you feel that the first opinion is incorrect.
I had a sleep study done 5 years ago and was told i need to use a CPAP, if i want to keep my class A CDL. i refused to use the CPAP , because i was not tired and didnt feel problems sleeping. I quit the trucking and surrendered my CDL. Now I want to start a non CDL driving job (delivering packages). But the job requires to take a DOT physical. Do i need to declare that i was diagnosed with sleep apnea before, if its not a CDL job? if i do, will i need to do a sleep study again? Texas
Thank you!
@ Red
DOT/FMCSA medical examination protocol was established for CDL, class A drivers. A medical card for a non cdl driver then falls under the states variances and guidelines. Make sure the medical examiner understands the difference between the two and uses the states variances instead of the DOT/FMCSA guidelines. Sleep apnea will not be a part of the states variances unless there are a multitude of signs and symptoms present at the time of the medical examination.
I was issued a 1 year physical due to being borderline for a sleep test and got hired in at a company with that physical. They told me to lose weight before my next physical or a sleep study would be needed. I didnt lose weight so i got my sleep study and a cpap. My next physical they said that since the only issue I had was sleep apnea, and been corrected with a cpap,I was given a 2 year medical card. But my company is making me redo my physicals every 1 year even though my card is for 2 years. Can u have a 2 year medical card with a cpap? I lose hours at work because I have to do a physical during the week.
@ Matt
According to the DOT/FMCSA guidelines, use of a cpap only qualifies you for a one year certificate. And you will need to bring in a thirty day readout from your unit each time you go for a recertification.
My husband has been diagnosed with sleep apnea. He has his physical yesterday 6-5-2020. The machine has a video call today for him to set it up 6-5-2020. The deadline in PA is 6/30 for med card re newal. The DOT physician told him she needs to “see him use it more than not”. What if there isn’t enough time between today and the 30th, for proof he’s using it? Will he loose his med card and cdl?! Is there anyway they give you an extension on it to work with you? He’s also going for biatric surgery July 2, so this “sleep apnea”, will be cleared up following the surgery.
@ Allison
If the CME issued a short card for your husband, then he will need to show thirty days of compliance with the cpap. She may issue another short card if she feels that the unit is being used 70% of the time. It will be up to the CME to extend the length of of the card until full compliance is met.
She did not issue any card. She told him she “needs to see him use it more than not”. He has a follow up appt. for the CPAP on 6-16.
@ Allison
Then the CME is going to be looking for a 30 day report with a 70% or better usage.
I had a DOT physical yesterday, I have no sleep related problems but my BMI has s at 41, the doctor wants me to do a sleep study within three months. Can I get a second opinion and another physical and erase the findings of the first one?
Can I get a second opinion on my DOT physical if I disagree with the doctor saying that I need a sleep study?
@ Gibson R
Yes, you can and should get a second opinion.
Currently I’m a otr truck driver my current company wants me to do a sleep study to renew my medical card. I have another job trying to hire me do I still have to do the sleep study for my new company?
@ Jason C
Sleep studies requested by the company are not a pert of the DOT?FMCSA protocol. You would need to ask the new company what their hiring criteria are.
I was just told that I have to get a hysterectomy because I have low iron by my DOT doctor. My OB GYN Doctor told me that my tumors are shrinking and there is no need for me to have surgery. I do receive iron infusion when it gets low. The DOT doctor says I’ve passed the physical part but due to dot regulations he wouldn’t give me the card. Now I toke the the physical last week and was given the card by the same dot doctor. My job started digging in my file and brought that up. Can they do this from low iron?
Help
@ Victoria L A
DOT/FMCSA certified medical examiners are not to do medical diagnostics or make medical judgment calls. Their job is to administer the DOT/FMCSA examination and take all available information into consideration. Your OB GYN knows best about your health and your situation.
Been using CPAP machine for the last two years and within the last 3 months lost close to 40 Ibs. I haven’t use the CPAP for a month and a Half and has no problem sleeping at night. I brought the provider a copy of my CPAP read out to show that I was using regularly until the beginning of November. My question is can he turn me down for getting my medical card because of the month and half I did not use CPAP?
@ Dwayne C
Most likely, yes. Until you can provide medical documentation that you no longer need the CPAP, the CME will want a recent 30 day readout.