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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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I got a call from my boss yesterday that my DOT medical card was no longer valid due to my recent diagnosis of Idiopathic Hypersomnia. I had to keep my boss informed of my medical condition because it was reported to her by a passenger that I was falling asleep behind the wheel. I made the mistake of talking to my coworkers who have decided that I have traditional Narcolepsy despite me telling them that was not the case. Anyways, I guess it got to the administrative level of my company and then I am assuming to the Medical Examiners office. The whole thing is a bit confusing. The point is I am not allowed to return to work until the Medical examiner gets information from my doctor about my condition. My neurologist is off until Monday and I have only seen him once, plus I’ve already had to call to up the medications as they are not effective. With the limited amount if information about CDL and Idiopathic Hypersomnia it is not looking like they will approve me to drive. Before my diagnosis my chief complaint was Excessive Daytime Sleepiness and i have had a history of lightheadedness and vertigo. Do you know of anyone else with Idiopathic Hypersomnia that has a DOT medical card?
@Amber
No, I do not.
Your condition is mostly a safety issue and once you have it under control you should be able to return to driving. But until it’s under control and your primary physician signs off that you are ready to return to work, you are not medically fit to do your job safely.
I just went in for my physical. I’ve been using a CPAP machine for over 10 years. The doc this time said I had to provide a readout to see that I’m in compliance. My machine is too old to provide this information. There is a port in the back where apparently you can plug into a device to get the info, but no one I’ve called and talked to have the equipment. There is no smart card in my machine. I’ve NEVER been asked for this information. This was a different doctor and a different clinic. He gave me a 3 month extension to provide information I am unable to provide. Any thoughts?
And they wonder why there is a driver shortage.
@John
Try getting your doctor to complete your medical release form explaining your compliance levels and if he can get a read out, then do so. If not the doctor’s explanation regarding your machine and your compliance levels should be sufficient.
I was required to take a sleep study and results said I need VPAP (bi-level w/ full face mask). Medical examiner requested 30 day compliance report, which showed 96% compliance, but an AHI reading of 13.6. This is down from about 2-3 times that before treatment. I am feeling better, but examiner says she needs to see 30 days average AHI <5 to re-certify, so she denied my card until that time. Is she within her duties to require the AHI number when I am in compliance for usage?
@Ed
She has the right, but you may want to have your doctor step in and fill out a medical release form stating that you are being compliant and that your numbers are looking good. This will be a big help here.
Did the sleep study in home, came back 17.9,,now the doctor wants me to come in to do lab study and to set the titration…Why? I have read <20 AHI, you are good for one year. Please help..testing is set for Monday in overnight. 1500 more dollars.
Hello, Okay took the sleep study test and the reading was 17.9 ahi. They now say i need to do overnight study to get the titration to get it set. What is up with this…What are the regulations on it. I thought it said 20? Please let me know…are they wanting me to wear that monkey mask? What steps do i take now? Thanks for all you do………..it is a rough world in truck drivers.
my pcp doctor told me i no loner have to use c-pap machine as i get less sleep using it. medical examiner issued a 3 month card and said i needed another sleep study done, what are my options ?
@Tom
Get a medical release form completed by your primary doctor and take that in when you go for the next DOT examination. If he feels that you do not need the sleep study, then have him say so in the release.
I have been using a cpap machine for the last 4 years and have not had a problem with getting my recertification. Went in this week and the Dr’s will not accept the printout from my machine now since it does not show “ahi” . Was there a rule change in the last year? I just bought a new machine just like my old one at the end of last year, if i would have known i needed a machine that tracked that i would have bought one. Now they won’t give me an extension to get enough days on a new machine that tracks the data they wanted.
@Jaydee
You could try having your primary doctor fill out a medical release form for you, stating that you show proper usage and good compliance with your CPAP. The waters a a bit muddy regarding some of the regulations and a lot of the new CME’s are not reading and understanding what their part of this process is.
Hi, need your help.
Went in for med card and they went 120% over the top and request that i have sleep test done.
29.5 bmi, neck>18. 218 weight 6’1. I do not have it and my wife says she does i do not snore. GAVE ME 3 MONTH MED CARD….. Anyway, went in to see Sleep Dr and he said I dont think you have it …But, we have to prove to DOT. So, he issued me to go to get home study test. I go to pick up the home machine and the gal said…500.00 bucks is your cost and since the dr did not code it ..for med we can not run thur insurance. So..i paid half. Then she gets the last only only machine and said to do this and that …and the finger probe was not connected correctly ..and just to wiggle it and put tape around it … Ok..so i go home with machine that night my wife could not get the lights to work correclly per paper. The amber light would not stop blinking and green was blinking never went solid. The next day i drop the machine off and told the gal the machine was junk…she laughs and said i will send it in. 2 days dr office calls and says you need to go in for lab study ..i think you osa.. It has been 40 days since my dot examine..so i just go to anotther dr and tell him and he says it is a money scam..and gives me a 1 year card because of bp pills.. Is this okay? or what do you think i should do? Thanks for your help…Seems to me that this is a mess with fmca and osa.
@Sam
You’re good at this point. Proper for the one year with the bp meds.
The sleep apnea stuff is a money scam, in most cases.
I am currently up for recertification of my medical card. I am only 33 years old but I am overweight. I have perfect blood pressure, no medical problems to speak of and do not snore or have any problems sleeping. All of this was discussed or noted with the physician doing my recert exam. She asked if I snored and I stated I did not. She asked if there was anyone in my home that could prove that, I stated no, not really. (My husband and I have been living apart for 6 months.) She said because my BMI was over 35 I would have to do an at home sleep study and if I failed it I would have to do a formal sleep test, and in the mean time I could not renew my card. I did the at home test. I ripped it off in the middle of the night because I couldn’t sleep with the darn thing on. However, after I returned the test, a man from the hospital called and said that everything checked out and looked fine. Even though I only kept it on for three hours, the data they collected showed no problems. Then today I get a call from the physician’s nurse stating I have to retake the at home test because they only were able to record 1 1/2 hours of sleep and they have to have at least 2 hours of study recorded. I am livid! I didn’t want to take this in the first place but I did. I DO NOT snore or have problems sleepings and feel that I am just being given the run around by this lady. I told the nurse I’m not doing it, that even if I did I couldn’t be sure I’d even keep it on again. She said that the doctor would be willing to give me a sleeping pill. Really? Why? I don’t need help sleeping if not I’m not being forced to wear some sleep testing machine! Was it even necessary for me to be forced to do this test in the first place? This doc is known for jerking people around but I am not able to go to my primary due to my employer. Any help would be appreciated to fight this.
@carrie S
After thirty days from the original test, you have the right to go to anyone you want to to do your DOT medical examination. So go somewhere else.
Do I need to provide a past 90 day printout from my cpap machine’s memory card to the medical examiner for a requirement to get my medical card?
@steve.
It would be helpful and a medical release form from your doctor will be a huge help to the examiner also
CDL requirement is 70% usage for 4 hours per night for a 2 week period. The download will provide the data needed. I hope the CPAP is beneficial to you.
I had a 3mon card on my last dot exam and was told I needed to have a sleep apnea study from Concentra Health Care. I made an appointment with my primary care and and got a referral for sleep study. They asked the list of preliminary questions yes i am overweight, have a large neck and high blood pressure( being treated and well controlled),but I do not ever fall asleep during the day,dont take naps, never fall asleep when I am a passenger in a car, not a big snorer,and do not fall asleep after eating. The sleep study center said that our insurance would probably not approve a in center sleep study which they did not. Well they would approve a home study. Meanwhile the 3mon was up on my card went back to Concetra to renew my card got a different examiner who gave me a one year card. Got called back to the clinic the next day by first examiner who took my DOT card away. Now I cant work. Did the home sleep study and they say I have sleep apnea have to get CPAP machine and be compliant for 30 days before I can go back to work. Can I get and pay for my own DOT exam from a private place if ok with my employer ?
@bob
Well it really looks like they have placed you between a rock and a hard spot. If your information went into the FMCSA data base as temporarily disqualified then you would be considered doctor shopping by the FMCSA and they are not real keen on this type of activity. If you wait thirty days before going else where then you would be OK to go to the doctor of your choice. And by then you are past the wait period for your CPAP. If the second doctor put your information in as a one year, then you are good to go while you are adapting to the CPAP. At this point, until you know where your medical card is in the FMCSA system, you probably will have to wait the thiry days and then go somewhere else if you can.
How can I find out my status. Does this mean I will have to use CPAP. Thanks
@bob
You should be able to check with FMCSA to see what your status is. And if you do have sleep apnea and the unit works for you, then yes you would have to use it. If you don’t then be aware that there are no new laws or regulations regarding sleep apnea.
I have a current medical card valid for another 14 months. My PCP recently ordered a sleep study and diagnosed me with sleep apnea. Do I need to report the change or can I wait until my next physical?
@nicholas
Just wait for your next DOT examination. When you go for your next DOT, make sure you have all the information regarding your compliance and a medical release form completed by your primary doctor.
If a driver is already using a cpap machine and goes in for an updated physical and tells the medical examiner that he/she is using the cpap unit, how does the driver prove to the M.E. that this is really being done?
@Michael
Your CPAP should provide a read out to demonstrate proper compliance, and your primary doctor should fill out your medical release form for you to demonstrate proper usage.
My ahi is 8.8 what is the limit amd how long will my medical card b good for thanks Randy
@Randy
Looks like you will be in the one year range if there is nothing else.
Was diagnosed with COPD/sleep apnea. Currently on cpap, with 1yr med card.Issued by work Dr.
Was just informed that my pulmonary Dr. wants to add oxygen to cpap.
My primary Dr. DOT certified, says that he believes this disqualifies me.?
@Ron
Have him read up on this issue, or check with the FMCSA guidelines and see what they say, but the issue is more of a “physically fit for duty” question rather then an oxygen question.
What about FEV spirometry test? My primary Dr. says i have to have 65%, am at 57%
@Ron
These are indicators for additional testing. Obvious difficulty breathing in a resting position is an indicator for additional pulmonary function tests. If the forced expiratory volume in the first second of expiration (FEV1) is less than 65% of that predicted, arterial blood gas measurements should be evaluated.
So check with your primary physician and also have him complete your medical release form for you before you go for your next DOT examination. This will answer many of the questions that the medical examiner will have.
Hi, mike again, I didn’t make my #s plain on cpap >4hrs night 39%, I wore my machine 86% of the time, but I was just wearing it 3.45 hrs a night so I wasnt getting any credit for the 4 hours, I let taking it off during the night, is this right why I was not meeting the 70%? Thanks
Hi, I work for utility company and drive a bucket truck 4hrs 39%, well I was using it on nights before work and not n weekends, for this truck I’m not required CDL but I do drive interstates and cross state lines, can they denie my card for this type truck with no CDL, my card runs out dec31, went to see sleep dr, he says come back jan 12, my card will be out then, whi should I ask for maybe 30day extension, I’ve worked with this company 37 years, thanks
@Mike
This is a state related question, so check with your state DLD to find out for sure.
You do not fall under Federal FMCSA rules and regulations on this matter.
I have read every post to this point and apparently it is impossible for someone diagnosed with narcolepsy regardless of symptoms/treatment to be approved for a CDL. Further, I was left confused by the three posts dealing with driving jobs that do not require a CDL (smaller non passenger box truck crossing various state lines, no CDL required but has narcolepsy) where the employer indicates you must pass a DOT physical. I have heard you say consistently that DOT physical is not required when a CDL is not required and that you have to contact the state… so will the state (NY, NJ) accept/approve/deem satisfactory a DOT physical for someone diagnosed with narcolepsy?
Or what I am hearing is someone with narcolepsy should not be driving a vehicle for a living regardless of CDL or DOT physical, period?
does this mean someone with narcolepsy can not drive any vehicle for a living under any circumstances?
I can understand not being approved for a CDL but to be eliminated from all driving jobs doesn’t seem American.
Help make this crystal clear for us, thanks.
@sk8trek
Nothings impossible, and some things are more time consuming than others.
First determine what type of driving you are going to be doing. Does that type of driving require a commercial drivers license?
If not then you need to know if the type of driving is going to require a medical card. (fit for duty as a driver).
If you need a medical card to drive whatever you are going to drive, then you will need to take as much information from your treating doctor about your condition and his treatments and a medical release form explaining your situation.
With all this information in hand when you go for the medical certification, the CME now must understand what type of driving you are going to be doing. At this point, if all looks logical and the safety issues have been addressed by both the CME and your medical doctors information, the CME will make his final decision based on all the available input. That’s how it is supposed to work.
And besides you are probably driving some type of vehicle anyway, so you still may want to check with your local drivers license department and see what they have to say about narcolepsy and driving, while under the treatment of your PCP.
Hey, I am impressed that you answered and pretty happy with the scope and clarity too. Yes, I drive my own van delivering car parts, no requirements.
I want to drive something that requires a CDL which offers frequents stops/deliveries as I do now (dump truck would be cool). I would not do well driving day in day out on the open road without taking a break every 100 or 200 miles. Being a UPS, FedEx or box truck driver for example (no cdl but dot physical) is a great fit for me and agree that as you described anything is possible, in fact, highly probable.
Thanks for your time and giving me a bit of hope.
I have very mild case of sleep apnea. My doctor said if I choose to use cpap I could. I tried hard to use. Woke up with it off my face every time. I told him I wasn’t using it . Now he won’t give me a release saying I don’t need it. It was my decision to go on it. Shouldn’t it be the same to drop off if I have mild sleep apnea. Were are the guidelines saying ruling for mild sleep apnea. Ah1 was 7.2 per hour. In rem it was 25.9. Sleep specialist called this very mild case. What is required for cpap ? Diane
@Diane
If you do not have a functional diagnosis of sleep apnea, then go somewhere else and take your DOT examination there.
Otherwise, explain to your doctor that he is mis-reading the federal rules and there is no new rulings about sleep apnea on the books. No diagnosis, then no new laws.
Read our articles on Sleep Apnea Screening to better understand where you fit in to this scenario.
I just received an offer of employment. They said I had to go for a DOT physical even though my current physical hasn’t expired. The doctor said that because I do snore and my BMI is 31.5 vs my neck size of 17, I have to be tested within 30 days.I don’t know what the requirement is but I’m guessing my BMI has to be under 30. I don’t have the money to go for a sleep study and I don’t start work for 2 weeks. Wouldn’t It be better to lose 5 pounds?
@Nick
There is no new FMCSA laws/rules or guidelines (like BMI and neck size) requiring you to do anything regarding sleep apnea. If the doctor cannot show you the law, then get up and leave. Go somewhere else for your DOT examination.
Read our articles on Sleep Apnea Screening to better understand your position on this issue.
Upon trying to return to work following breast cancer surgery and a diabetes diagnosis, My employer had me do a physical. They made me see 3 doctors, one of which was a sleep doctor.
Although I did not answer their questions negatively, as I had no daytime sleepiness, nor was my neck size huge. My BMI was just over requirements The first test showed an AHI of 3, but my RDI was 14.5.
The sleep center told me I did not have sleep apnea, but the doctor insisted I did and put me on a cpap at a 6 setting. I was able to use it to get back to work, but the machine does absolutely nothing for me and in fact causes headaches and dark circles under my eyes. I quit using it.
I had to go back out of work for breast reconstruction and know they will require me to get another physical. How can I prove that I do not need this CPAP any suggestions.
Also, I never saw the doctor that ordered the cpap. I only spoke to him on the phone. I saw his PA, I know they lied to get the insurance to pay for a test that I didn’t need. There was so much trouble with this you would not believe.
Thanks
@Angela
Get your primary doctor to review your sleep study records and have him complete a medical release form for you before you go back for your next DOT examination.
And go somewhere else for your next DOT physical.
I am a bus driver and I seen a dot examiner for renewal who request sleep study because if my BMI and High Blood pressure, was also given 90days which will expire in three weeks. I went to primary Doc she ordered test, my results were moderate. I have absolutely no problem using machine if it helps but, between funds and appointments to get started with machine my expiration day is near, and the DOT require I be on machine for 30days. I’m soo confused what to do, because my card will expire before I’m finished. I don’t want to lose my home,job, etc, I’m a single parent. Can I get Disabilty benefits?..but will the DOT/primary Dr. Give me the time off, until I’m finished?…please help!
I’m caught in this sleep apnea trap. I had an AHI OF LESS THAN 20/ my BMI suggested a sleep study. I took it. The recommendation is AHI<20, DOES NOT have daytime sleepiness.. Can be certified for 1 year. MES are confusing the words AND &OR
It clearly states that AHI less than 20 AND does not have day time sleepiness OR
has OSA and is being effectively treated
should be certified for one year.
I fall into this category. Yet I was still put out of service pending the doctor reviewing this recommendation or (standard). This is what's going to cause major lawsuits, forcing companies to pay drivers for every day they were out of work. I'm losing money every day in spite these recommendations. If it's not a rule, regulation, nor law, then no one should be out of service. It's a recommendation.