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See our BLOG Category on Sleep Apnea for articles and more information.
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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are DOT Dr. that work sends us to thought this sleep study on me cant get it done with in the time he gave me know my med card was done today and work said come back when I get it and wont send us to another Dr. can this Dr. how can this guy put me out of work over a sleep study PLZ help
@Cliff
By law, after 30 days you can go to any certified medical examiner you wish to go to.
Now you may have to pay for it yourself, but you do have rights that supersede your employer.
And there is no new rules and regulations regarding sleep apnea testing or the diagnosis there of, so don’t get fooled by someone telling you have to do a sleep test when there are no issues that point at you having sleep apnea.
For more information to understand this issue read our blog articles on sleep apnea.
Can my husband keep his cdls if he was recently diagnosed with narcolepsy and takes medication?
@Jessica
He will need to have the condition completely under control and have his medical doctor complete a medical release form before he goes in for his next DOT examination.
That will help answer many of the questions that the CME will have. Take the medical release form with him to the examination. Also, explore what is the underlying cause of the condition.
If a DOT physician has said you need a test for sleep apnea,is there an appeal process you can go through in the state of Tennessee?
@Melinda
One, there is no policy regarding sleep apnea, unless there are serious health issues.
But if you want to enter into conflict with the examiner, look/hunt through the FMCSA website. There is a place to do so.
Otherwise wait thirty days and go somewhere else, for your physical exam.
Or ask to see the rules from FMCSA. Read our articles on Sleep Apnea to better understand this issue.
My husband had his DOT physical this fall.His DOT physician said he needed to do a home test for sleep apnea,due to “new” federal regulations,and due to my husband’s neck size,weight,and BMI. By federal and/or state laws,does he have to do the test?His physician,while DOT certified,that his company chose,is a chiropractor.My husband was given a 90 day certificate.Can he get a second opinion without being flagged?
@Melinda
A lot of the new CME’s are under the impression that there were new rules regarding sleep apnea. There are no new rules.
So unless there are other serious health issues, either ask to see the law (which does not exist) or go somewhere else just before your medical card expires. There is no flagging procedure with the FMCSA.
Just had study done and will now be tethered to CPAP machine. I have friend who is willing to give me the machine that he will not use, HUGE savings for me. This machine is 4-5 yrs old, and I’m just wondering if it will meet the standards for what is required to satiate the doctors and politicians. I guess I’m looking for memory/download capability information. Would LOVE to not put out the thousands
(why so pricey?) of dollars for new machine if older model will work. I just love having the DOT in my bedroom.
You stated there are no laws just guidlines regarding testing for sleep apnea. If a driver see’s a doctor and the doctor orders a sleep apnea study and issues a 90 day medical card extention for the driver, can the driver get a second opinion prior to the sleep study or is he flagged in the system and committed to this test? Will the driver have issues at DMV if the second physical passes?
@James
FMCSA has a conflict resolution section on their website. I know that it exists, but you will have to dig around on the site to find it.
Just because a CME says he wants a sleep test, it is just his opinion, not a ruling, not a regulation, not a law just an opinion.
A second opinion is a second view of the same thing with a little different observation.
So no, you are not flagged and the DMV does not have anything to do with the FMCSA rules and regulation. So get your second opinion before the sleep study and then use the medical card that he issues or hunt the FMCSA website and enter into conflict with the first doctor.
CME’s are to determine medical fitness for duty to operate a commercial motor vehicle safely, that’s their job, nothing else.
Update: Driver went to Concentra and was ordered to get a sleep apnea test. Driver felt it wasn’t necessary as they only did a visual check of his neck circumference and he didn’t have any symptoms such as loud excessive snoring and waking in the middle of the night gasping for air. Insurance would not cover this test of nearly $700 + $1000 for the C-Pap machine. Driver waited 30 days ( is that necessary?) and had a second opinion completed. Driver passed the 2nd physical and is good for 2 yrs. Driver will follow up with his Primary Doctor to answer possible sleep apnea questions but won’t be restricted and regulated with DOT in the process. I wanted to share this with you and your viewers. Thanks for your input-James
@James
30 days is an FMCSA recommendation, to prevent doctor shopping. Another reason to not leave your renewal to the last minute.
Thank you for sharing your experience, to help others understand this issue.
concentra also owns sleep clinics, it’s a racket, a lot of our drivers were told they needed sleep studies. Our company no longer uses them and very few of our drivers have been sent for a sleep study
I went for a physical for a new job I already had a medical card that was good till December of 2015. When I got to Concentra they gave me a DOT Physical and I passed everything but because my BMI is 36, my neck circumference is 18.5, I’m 50 yrs old and I take medication for High Blood Pressure that I have to have a sleep study done because I am a candidate for sleep apnea. The doctor told me that my current medical card was no longer any good and issued me a 3 month card till I get the sleep study done. I do not have any insurance so I would have to pay around $2000 for this study. I do not have any of the symptoms of sleep apnea. Is this true that he can pull my medical card and do I need to have a sleep study done?
@Ron
You have just been lied to. Your card is still good and you should wait thirty days before retaking your DOT medical – SOME PLACE ELSE…
If my card is still good then why should I take another physical after 30 days? My card is good till December 2015.
@Ron
Yes, your card is still good.
But if a new employer requires you to take a new physical, that’s why. It may be that an employer requires it.
Thank You very much you have put my mind at ease.
I am due for my two year DOT physical. I had an at home sleep apnea test done two year’s ago and was found not to have sleep apnea. I do not have high blood pressure though I have an 18.5 inch neck and a BMI of 49.5. My physician told me he had received a letter from the DOT stating that any doctor who passed a driver with a bmi of 35 or over with a neck size of 17 or over without a sleep apnea test would be held personally liable if the driver was involved in a sleep related accident. Including revocation of their medical license. I called the doctor to find out if I had to have another sleep apnea test and he said I would. So does this mean I’m going to have to do this every four years from here on out?
@Steven
Lets start with – “I would love to see that letter”. That’s a load of BS.
Secondly, there are no FMCSA rules or regulations in regards to BMI and neck sizing, for sleep apnea screening.
If you don’t have and have never been properly diagnosed with sleep apnea, then you don’t need to do anything.
If you go for a DOT examination and they start with the sleep apnea ‘rules’, ask to see the law or just get up and walk out. They can’t show you a law that does not exist on the FMCSA regulations.
Can someone tell me if using an “auto” cpap – where the pressure will change and there is the capability of downloading it to look at if it is helping or not – can be used in place of a sleep test? thank you
@Todd
You need a medical release form completed by your primary doctor and a readout demonstrating compliance with your cpap. You already have had the sleep test, now all you need is supporting documentation from your unit and your doctor.
I recently switched jobs.. I had to go for a dot physical for my new employer,end of August..The doc only gave me a two month card because my cpap readout was not compliant.. Went back today Oct 16th,showed him 97% compliance in a 48 day period with an an avg use of 4hrs 14mins a night..he said I only have an avg use of greater than 4 hrs 59% of the time.. For this reason he’s not sure if he can extend me at all?!!!
@Keith
You are demonstrating proper compliance and you should be extended to a one year card.
He only gave me a 6 month card.. He wants me to wear the mask over 5 hrs a night 70% of the time till next April 2015.. I was worried he wasn’t gonna extend me at all.. Guess I should be greatful.. Thanks for the time @truckerdoc!!!
Hi, im a school bus driver in new York state and had to re-certified my medical card, I passed the re-certification buts ome of my friends where not able to get re-certified, I have been asking a question but no one has a answerd my question is how long before some one has to recertified for 19a if they don’t pass a medical recertification? do they have to do the whole 19a process? Thank you all.
@Tony
Check with your state Drivers License Department. We work with the FMCSA guidelines, but am unfamiliar with each and every other states rulings.
I have my re cert and my new company sent me for a new hire physical and I have a cpap when I took sleep test I was working 12hr shifts 6 days a week now I am going back to driving I got my re cert done well the company I got hired on with sent me for a physical I no longer use cpap cause I feel worse when I get up now I already have a re cert concentra only gave me a one week card to prove I am in compliance can my pcp write a letter stating their is no need for cpap?
@Jeff
Get a medical release form completed by your pcp and that should answer all of the CME’s questions.
I just had to do a sleep study for recertification. The results of the testing were that I did not have any “significant obstructive sleep apnea/hypopnea syndrome”. Basically I don’t need to use one of these cpap or apap machines. My question is, how long are those results good for? I only get a 1 year card due to blood pressure, so is this something I’ll have to do every year? I certainly hope not! This cost me almost $400 out of pocket, I can’t due that every year.
@Kennth
Hate to break bad news, but there is no such ruling regarding sleep apnea testing, BMI measurements and neck size measurements. So someone just made you take a test that you didn’t need.
Unless there is an FMCSA/DOT rule change in the next year, if someone tells you you need a new sleep test, get up out of the chair and go somewhere else. They are taking advantage of you not knowing the rules.
I have a cpap machine and I haven’t used it for 9 months. How long would it take me to get back compliance with dot?
@Camario
Why on earth would you stop using the unit? You need to get back on the unit for at least thirty days to show the required compliance and have your medical release form completed and in hand when you go for your DOT examination.
I need to renew med card in WI I only drive in state running a pulpwood truck 98k gross. I had a in home sleep apnea test done on my own through my primary doc which also is dot med cert doc. It said I had sleep apnea. I had seen a specialist nose throat doc and will be having the surgery in future as I have a deviation in my nose and also to much tissue in my throat. I am not on a cpap because I don’t think I could sleep with a mask or nose tubes. Will I still qualify for med card. ?? I also would like to say its bull what dot is doing people should be treated but taking away there job. ?? Most accidents are caused by cars and pickups not truckers. They should require all drivers to qualify not just commercial drivers. Most car driver put more miles on than me in a yr I can’t help buy find all of this a bit silly. Imo. Thanks in advance for your answer.
@Craig
Once the corrective surgery is done you will have a 3 month waiting period to go through.
Then be re-tested for sleep apnea to determine the effectiveness of the surgery. After that you should be good to go.
So I can’t get a med card for up to 4 months no income for 4 months. ??? But before these new rules I could get a 2 yr card with the same medical conditions. This is complete insanity. We truckers all need to strike. I’ve had it. So even if I go on a machine I can’t work ?? What about people who can’t sleep with this crap on. Have the people making these rules tried using these machines what a joke. This is all due to worthless gov officials and lobbyist. This country is going down the tubes. I have no trouble staying awake. This is complete bull.
I just don’t understand this new med card rules. Basically. I could be up to 5 months or more by time I had surgery waited got new sleep study and finally a card. So no work whole time. So after I go bankrupt from not working I’ll be just fine to get my card and go get a company job getting paid next to nothing to pay off my bankruptcy. But if I went in before may I could have a 2 yr card ??? Please make any kind of sense of this. If I can’t work for 4 or 5 months I’m out of business. Can I appeal this or sue the Fmcsa ???
Update got 3 month due to higher blood pressure from being so nervous not knowing what would happen. Need to go back retest pressure and get a 1 yr. My apnea test I had done was at my request not through dot. And few yrs ago. My neck size is under 17 in. My bmi has never been in there limits even in my 20’s when I was in really good shape lifting weights etc… Best bet for getting a card is going through your primary doctor if they are in the registry. I was told if its a new med card much stricter. This whole new set up is complete bull. I my opinion Fmcsa has and is going too far. Everyone of our elected officials and all government employees and every person who drivers license should have to go through this every year as well and see how long it would be till they were repealed. Easy to rule over others when you don’t have to follow the same rules. All doctors should be required to do this as well. I for one will start making plans to get out of the transportation business. Its only going to get worse.
In oregon – Husband had to renew medical card with physical in Feb.
Got a 3 month card ($95.00) and told to get with sleep specialist for apnea testing.
Were not able to get into clinic and do apnea test within 3 months – had to get another card (another $95.00 and full physical)(only issued for 1 month this time -doctors decision) so he could continue working while waiting for test results.
At end of 1 month had to get another physical (another $95.00) while 30 day CPAP machine testing was done (this time card good for another 3 months)…
Went to sleep dr – got results – made appointment to turn results into dr doing physical for a 1 year card – had to do another physical (another $95.00) –
Is there a reason that with the same Dr, same ongoing testing required now, we have had to pay $380.00 in physicals when nothing has changed. I feel like they are just out for the money making their own regulations – and don’t try to talk to ANYONE about the actual rules because NO ONE knows who actually knows them..
I want to know whats allowed and not allowed, I feel abused.
@Sarah
The medical examiner did the right thing as far as catching the need for the sleep study.
I don’t understand the need for re-doing (at full cost) the physical. Re-doing the full DOT examination, when all that is needed is to update the information, seems a bit of overkill and overcharge. Most offices are charging a minimal fee for their time and materials, to update the previous examination.
When I went for my medical card renewal in June, the examiner said all drivers with sleep apnea are required to take a MWT (Maintenance of Wakefulness Test) each year now. I took the test, and my sleep latency average was 32.5 minutes. Examiner automatically denied card; they wouldn’t even see me in the office. His nurse called over the phone, said my card was denied, and there was nothing further I could do. They said anything less than 40 minutes is “inconclusive”, and that while my sleep doctor had written that his professional opinion was that I am perfectly safe to drive (I am a bus driver, not a trucker), she said “he isn’t the one signing your card.”
My initial sleep study put me at a 19, which is just barely below the 20 where CPAP use is required. Examiner still required me to agree to CPAP therapy in order to renew my card last year. Now this year I’m being told I need to take this MWT yearly. Can I fight this decision in any way?
@Kimberly
You’re a bus driver and not an interstate driver, so wait a few weeks and go somewhere else, with all your information from your sleep doctor. Make sure you have your medical release form and your sleep study stuff in hand at the time of your exam. That will satisfy the CME’s need for more information, and let them know you drive bus, not OTR. Good Luck
I have difficulty using my c pap . Will a mouth guard satisfy dot if It works.
@Marty
I don’t know how you would demonstrate usage and proper compliance with a mouth guard, especially if you have a confirmed diagnosis of sleep apnea. So, I don’t believe you will be able to use just the guard.
You might talk with your sleep doctor and see what his take is on this issue. If he feels that it will work, or has something that will help you be more comfortable with the CPAP, and he can explain that to the CME then there is a chance. Good Luck
So my husband has been a truck driver for over 30 years. He had surgery for sleep apnea back in 1998. He went in last week to renew his medical card and the doctor noticed when looking in his throat that he had had the surgery. He asked him to get a follow up with the doctor. My husband explaioned to him that he has not had any issues since the surgery. The doctor that he saw is now in private practice and has no record of my husband in his systems. They said he would have to pay 300.00 to be a new patient just to have the paper completed to get the renewl. This is ridiculous that you have to re do the entire sleep study just to justify the DOT doctor. This is the first time any of the DOT doctors have ever said anything. My husband has no insurance and was only given a 90 day renewel. Can they do this? If we can’t pay for the follow up my husband will not have a job.
I worked in the Nursery and Landscaping industry for over 30 years, in that 30years I was a wholesale driver for a greenhouse here in town for 12 of them years, I get up around 4am every morning have breakfast not tired at all, was able to make my deliveries never falling to sleep while I was driving; then I retired from the job in September 2012. I started to gain weight but because I had 2 knee replacements and a hernia I wasn’t able to do much, but I had surgery in 2011-2112 which covered both. Now since I went in the tired to renew my CDL license I was told my BMI was to high 37 and was told I had to get a Sleep Apnea test, well here is the problem since I go to bed at 8:30 each night mostly all my life I am 74 but do not go to sleep right away I keep failing the Sleep Apnea test which I have had 4 times, the Dr. indicates he cannot get my pressure and doe not issue the machine which I think I need; why I do not know why, can’t I get the pressure AFTER I GET THE MACHINE. I am due again on 9/12/14 to try it again . #5, While breathing I seem to grunt a little, I do not know what it is and going in to see my pulmonary Dr. 8/26/14 and my throat Dr. 8/25/14 I do not why I do this and that might be thats why I fail the test. YES i do have an Allergy and I take medicine for it and I am a minor diabetic. I am also ging to take a blood test for my Thyroid on 8/25/14.I have trouble breathing why laying down, but do not have trouble sitting up why!
@Andrew ask for a Home sleep test. IT will allow for you to complete at home at your bed time to get the results needed. However if you are positive for sleep apena, you will need to have an in lab CPAP titration study to get your pressure settings. If that doesnt work ask your physician to write an order for an Auto CPAP for 30 days in house. Once you are on your CPAP for 30+ days, you will need to have a MWT to check for complience that you are able to stay awake during the day. Hope this helps.
Rashida
@Andrew
At 74 years of age, do you believe you are going to go back to over-the-road or long haul interstate driving?
If the answer is no, then why not just downgrade your drivers license to drive intra-state and go from there.