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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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Doc,
I received a 2 yr DOT medical card from my personal doctor who is a DOT examiner. When I went to “blah blah” trucking for orientation I was required to have another DOT physical and that examiner stated that since my neck size was 17″ and I was overweight that I needed a sleep study done to get hired at the company and they sent me home. I don’t have any of the other symptoms; I don’t snore or stop breathing, I don’t have diabetes or High blood pressure nor do I smoke or drink. Also I do not have an enlarged tongue or swollen tonsils. How do I avoid this idiocy in the future? Would a letter from my personal doctor who is a DOT examiner help?
@Martin
Since there are NO NEW REGULATIONS regarding sleep apnea, the first question would be, is this a company policy?
If it is not company policy, then go through the FMCSA website and enter into conflict your opinion. FMCSA is very aware that the whole sleep apnea scam is taking good drivers off the road and they want to follow-up with regular reports that a CME is requesting expensive test when they are unnecessary.
Next time, if the CME starts in with the neck and BMI, get up and walk out, go somewhere else.
For more information on this misunderstood issue read our articles on Sleep Apnea Screening.
Can a trucking company out of Nebraska make me take a sleep study test. I past the physical an was certified for 2 years. There company policy states I have to take one. But I haven’t sign any papers agreeing to do the study.
@ Chadd
If it is a company policy and they are paying for it, then yes they can require it as part of their hiring policy.
How is the rate of compliance on the Cpap machine. I have been using it 4 hours a night the minimum, the clinic tells me i have to be at 70 to 80- percent compliance. What does that mean ?? How do they determine that ???
@John
Your cpap should be able to download a report of usage. In that report there should be a percentage of compliance. That is what the CME is going to be looking for.
See our article Commercial Drivers, Sleep Apnea for the compliance recommendations.
If a doctor suspects a CDL driver should be tested for sleep apnea can they certify the driver anyways? and then tell them they have three months to take the test and return? How many factors do they have to take in consideration to send someone for a test?
@Lisa
It is totally up to the examiner as to what he does and for how long he does it for. If he suspects sleep apnea, then there better be a number of things that have moved him toward that conclusion. You can Google sleep apnea and see how many things the examiner should be looking for.
Also read our series of articles on Sleep Apnea Affecting CDL Medical Certification.
I have an employee whose med card expires on in two days. He is doing the sleep study and taking it in tomorrow to see what the readings show. My question is, as an employer, what is my responsibility when I have an employee with an expired med card? Do I need to take him out of the truck immediately? or is there some grace period? I’m just trying to understand what all the ramifications are of any further delay in submitting his card – for whatever length of time it gets renewed for – or if it does not get renewed. Your help in understanding this is certainly appreciated.
@LaNelle
The medical card expires at midnight of its expiration date. Some states have a little leniency, but most don’t.
Your driver may ask for another short extension, because if he has to go on a CPAP machine he is going to have another waiting period to go through for compliance with the unit.
As an employer, you have to do what is right for you, the company and the driver. But you should not put the driver or the public at large at risk until your driver can and does pass the DOT examination for “medically fit for duty”.
Hello, I checked the box that says snoring, and I have no health insurance or a primary care doctor, I only snore after a long laborious day of work, and since I quit smoking I snore much less. The examiner says I need to get a sleep apnea blood test? can I just get a CPAP machine and go get my med card? im an owner operator and have been working for two years to get this business profitable. I would not be happy if I just wasted all that because I checked “snoring” on a questionnaire.
thank you
@John
Start with this series of articles on Sleep Apnea and the DOT physical to better understand this issue.
There are no new sleep apnea criteria. So unless you have a issue with excessive daytime sleepiness or many other circumstances that would point at the potential for sleep apnea, I would wait out the short medical card that you were given and then go to another CME for your DOT examination. Snoring is not sufficient to warrant a sleep study.
Now if you are on a CPAP unit, all you need is a medical release form from your doctor and a copy of your last compliance check and you should be good to go.
I was recently ordered to go take a sleep study after going in for my dot recert.. Went and done the sleep study which was a split study. But, the sleep tech said she didn’t have to try the mask as was initially planned. But, however they scheduled me for a 2nd study. She said the doctor would reveiw the initial study and may call and cancel the additional study. I’m confused here.. Either I have sleep apnea or don’t. If there was no need to put the mask on in the middle of the night. What are the chances that I don’t have sleep apnea? My insurance and employer do not cover the costs of any of this. I don’t have money for multiple tests..
@Michael
Looks like you have started a process that now needs to run its course. So get back with the sleep study folks and get an answer now for the yes or no of sleep apnea.
There were no new rules or regulations regarding sleep apnea, so you may have been taken for a money ride. But get your answer from the sleep study folks.
If a nurse practitioner performs my DOT Physical says I need to have a sleep study done but my Dr who is also FMCSA certified says different can my Dr do another Physical on me
@Tank
Yes, you may go to another certified medical examiner.
I have a diagnosis of obstructive sleep apnea and have vocal fold paralysis after surgery for thyroid cancer. Because of the vibration of the lax vocal fold in my throat from the CPAP, I am unable to use the machine until “if and when” the nerve damage to my vocal cord/fold recovers. My 12 weeks of FMLA are about to run out. I work intrastate (SC) only as a yard switcher, regular day hours, home every night. Can I get an exemption to not use the machine under these circumstances? If so, who do I contact at the federal and/or state level?
@DirtTracker
Most of the new regulation and guidelines are aimed at the long haul OTR drivers. Since you are intra-state only and work locally, you should not have to meet the interstate guidelines. Have your doctor fill out a medical release form for you and take it into the your state DLD. That should answer any questions. And when you have to go for your medical certificate, the same medical release form should work with the examiner.
Please also keep in mind that “inter-” vs. “intra-” is about more than where the driver drives. If the vehicles you are moving around ever haul anything that has crossed, or will cross, state lines, the feds may consider your work to be involved with interstate commerce. We had this specific question come up with our mechanics, who only take unloaded trucks out for test drives during repair & maintenance. That being said, if you never leave your employer’s property and do not ever otherwise operate a CMV on a public road, your company has complete discretion.
I wanted to keep my card and license current and went for a DOT. Because I marked “snoring” the physician’s assistant said I have to have a sleep test. The PA said my throat had the typical formation of sleep apnea sufferers and she was doing me a favor. After checking with my wife and reading up on sleep apnea, I contacted the office and have told them the sleep test is not needed. I am 5 foot 7 and 153 pounds, healthy, non-smoker, rested after sleeping, etc. My wife said I snore once a month maybe and she was teasing me. The doctor’s office is dragging their feet to get this changed. This is a private pay as currently I am not driving for a living. What are my options, please? Currently residing in Tennessee and thank you for your time.
@Sam
You might try getting a note from your primary doctor stating that you do not have any sleep apnea symptoms and take it back to the DOT examiner. That should help expedite your situation.
I have been driving for ten years and have narcolepsy since I was 15. I got diagnosed with it back in 2010 And have held Bern able to recertify every 2 years up until last year. I have never had an episode and take medicine to control it. Even with medical letters and forms I may still not get it. Exactly why is that?
@Jason
FMCSA has a real hard time with the potential safety issues that narcolepsy presents.
With a medical release form from your primary doctor, explaining you condition and situation, you may be able to continue driving. But you are going to have to explain yourself, with medical support and a medical release, before any CME is going to work with you. It’s a FMCSA safety issue.
hello I’m trying to help my friend. He is a new driver and at his orientation said he had sleep apnea. Didn’t know about the compliance % that was needed. He has not been using his machine correctly for a while. He was wondering if he decided to go to another company will they know about his first orientation. Aren’t his medical records private?
Thanks for your help.
@Georgia Girl
It does not matter if someone knows or not. You / he signs the federal forms stating that all of the information is correct and true. Lie on the form, lose your driving privileges.
Sleep apnea has a set of regulations that must be adhered to, for a reason of safety.
Just tell the truth and use the cpap as prescribed and he’ll do fine.
What if it is found that the driver has been non-compliant in using the CPAP machine? Can he get a 30 day card to come into compliance? Or what can happen?
@Kristine
Try to keep your eye on the whole picture. If the driver is out of compliance and is exhibiting EDS symptoms, then no, you want him in compliance before he gets behind the wheel, because he is unsafe.
If the driver is just under his given compliance levels, but appears to be doing OK with no signs or symptoms, then yes, give him a short card to get his numbers back in line. It’s all about safety and you are the one calling the shots.
How many days can be missed in a 90 day CPAP test before my license will not be renewed. I just got a 90 day temp ME card ( I drive a school bus) and am going on vacation and will be in an airplane one night out and one night back.
@Diane
All that is being looked for is a 70% compliance when you are using the unit. Like most of the drivers that have sleep apnea, “they won’t leave home without it.” But to miss one or two days while you are gone is no big issue as far as the report is concerned.
I went for pre-employment DOT physical, at Concentra, for an employer that I applied to, I was told at the examination that my BMI was 37 and my neck size was 17.5 in, all questions pertaining to sleep apnea we’re answered no. I was recommended to get a sleep study and was only given a 90 day medical card. What should I do?? Can I just go to another doctor? What are my options? Please help!!
@Josh
You can go somewhere else and get it done, just wait 30 days or so before you do that.
Here we go, I do not have OSA…But, the DOT Dr wanted me to do study because i am 6ft1 and 209 pounds. No daytime sleepiness..He says i am overweight and need massive weight weight loss. My neck is 18 inches from lifting weights years ago. I sleep fine, no sorning and if i do it does not bother my wife. My question is…I did the study and Sleep dr signed off because i was 17 AHI and per guidelines..no treatment needed. SO, now when i have renewal I will go to different dot examiner ( this one is CrAzY) but do i need to be tested again for OSA or just go with new DOT doctor and his test. This other DOT doctor says what this office of examiners are doing is over the top! They are OSA people at 19 years old and weight lifters. So yes, the word is out to stay away from this place. Thanks for your help.
All DOT doctors do what they want. Truck drivers are men tall short skinny fat it takes a man to drive truck do not take sleep test walk out then sue them for none existing LAW any trucking company that goes with fake law made up by doctors should have their DOT # taken away CONCENTRA is a big scam go to your on doctor for a DOT physical
I take Ambien in conjunction with my CPAP therapy. Will that disqualify me for a CDL?
@Warren
You are going to need a medical release form from your doctor describing your need and usage of the medications. That will answer some of the CME’s questions. If you have been doing this regiment for some period of time, make sure the prescribing doctor explains that in the release form.
I recently took my cdl med physical. My BMI was over 35. So I was given a 6 month extension on my medical card. The doctor told me I needed to get checked for sleep apnea or I could just lose the weight. Well I have lost the weight and my BMI is under 35 now. I wanted to know if I’m in the clear next time I take my physical or if I still need to take a sleep apnea test. Can you just lose weight and not have to take a sleep apnea test? Thank you.
@Mitch
Considering that there are no new laws or regulations regarding sleep apnea and that the BMI and neck measurements are only one or two steps in a list of 7 or 8 things, you will probably do fine. There must have been other indicators for the CME to request to the test initially. Weight loss is a big help. But if you do not have any day time sleepiness and all that was needed was to lose some weight, then you should be home safe.
How long is the sleep study good for. I have a bmi over 60 and on near perfect health.
@Esther
A BMI of over 60 and on near perfect health? These two things don’t really add up to the picture of near perfect health. Or, I’ll ask, what is “on near perfect health?”
As far as the sleep studies, each time you return to do a DOT medical examination you need to bring a medical release form from your sleep doctor and a readout indicating your levels of compliance with your unit.
Near perfect health:
OK. No high blood pressure (Low at times)
Heart rate normal
Normal vision
Normal Hearing
Able to swim 1 kilometer without a problem
I am able to move around, I drive a Wheel Chair accessible vehicle and have no problem loading/unloading and restraining wheelchairs.
According to my husband, I don’t snore at night or wake up from not being able to breathe.
During my sleep test, I only got three hours of sleep.
Has the law changed that drivers who have been diagnosed with OSA and are under going treatment and exceed the compliance guidelines, Are they required to get a new sleep study done annually for re-certification of their medical card?
@Jim
It’s a gray area generally speaking. The way the FMCSA has written the guidelines, it looks like you have to take multiple sleep studies.
In reality, if you can bring a medical release form in with your readout showing better than 80% compliance, then you should be good to go. All the CME has to do is enter that information, along with his / her findings to support the decision making process and they should be able to get you a one year card. You will need to do this each time you do your DOT examination.
I have 70% usage on my cpap download report is this sufficient to pass D.O.T regulations?
@Rodney
It should be. But you would be better of with an 80% compliance.