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Q&A
Is sleep apnea a disqualifier?
What is EDS? Is EDS a disqualifier?
If I’m overweight do I have to have a sleep apnea test?
Is there a BMI limit for commercial drivers to pass the DOT physical?
What does neck size have to do with the DOT physical exam?
What does snoring have to do with the DOT physical exam?
I take Restoril for sleep. Will that be a problem for the DOT physical?
Is sleep apnea a disqualifier?
Sleep apnea does not necessarily disqualify you for medical certification. Treatment with a CPAP machine and some basic lifestyle changes can help you get a restful sleep and maintain your commercial driver’s license. Many drivers who have suffered fatigue for a long time , and then were diagnosed with sleep apnea and treated, report that they’ve felt like a new person since they’ve been on a CPAP machine.
You will need to bring a medical opinion letter from your treating physician before you can be considered for DOT medical certification.
Narcolepsy is a disqualifier regardless of treatment, because it poses a risk of EDS and may also bring on sudden muscular weakness.
What is EDS? Is EDS a disqualifier?
EDS stands for Excessive Daytime Somnolence or Sleepiness. Because fatigue and driver drowsiness are safety concerns, the medical examiner must rule out EDS before certifying. A driver who has EDS will be temporarily disqualified until the condition is being successfully treated. The medical examiner will want to see a medical opinion letter from the treating physician before issuing a medical card.
If I’m overweight do I have to have a sleep apnea test?
No. Being overweight, of itself, does not mean that you should be tested for sleep apnea. Overweight is an initial indicator for the medical examiner to make sure that other conditions aren’t present which may affect your ability to safely operate a CMV.
The medical examiner will evaluate your overall physical condition and health history. The medical examiner has a responsibility to have you tested for sleep apnea if he/she has reasonable suspicion that you may have sleep apnea. Many people suffer for years from sleep apnea and don’t know they have it until a doctor catches the symptoms.
Sleep apnea is not only associated with sleep deprivation. It’s also associated with an increased risk of cardiovascular disease, stroke, high blood pressure, arrhythmias, and diabetes. The most serious complication is a severe form of congestive heart failure. Sleep apnea sufferers also have a 30% higher risk of heart attack or premature death than those unaffected.
Is there a BMI limit for commercial drivers to pass the DOT physical?
There are currently no set specifics on BMI measurement in the DOT regulations. However, companies may set their own policies and have their own standards for these indicators, which may disqualify you to drive for that particular company.
What does neck size have to do with the DOT physical exam?
Neck size, weight, and BMI are all just indicators that the medical examiner looks at to determine if you may have a condition such as sleep apnea that would impact your ability to safely drive a commercial vehicle now or for the period for which the medical card may be issued. There are currently no set specifics on these measurements in the DOT regulations.
Other indicators of potential obstructive sleep apnea are enlarged tonsils and large tongue volume. Individuals with low muscle tone and soft tissue around the airway (e.g., because of obesity) and structural features that give rise to a narrowed airway, are at high risk for obstructive sleep apnea.
Because sleep apnea is associated with increased risk of other debilitating diseases, it’s the responsibility of the medical examiner to rule out suspicion of sleep apnea, for driver certification.
What does snoring have to do with the DOT physical exam?
Snoring, in combination with obesity, can be highly predictive of obstructive sleep apnea risk. That said, even the loudest of snorers may not have a breathing obstruction. The sign that is most suggestive of sleep apnea occurs when snoring stops. If both snoring and breathing stop while the person’s chest and body try to breathe, that is literally a description of an event called an ‘apnea’. When breathing starts again, there is typically a deep gasp and then the resumption of snoring.
For the DOT physical exam the medical examiner evaluates your overall physical condition and health history to determine if there are signs of a medical condition that may affect your ability to safely drive a CMV. If the medical examiner has reasonable suspicion that you have sleep apnea you may have to go for an overnight sleep test called a polysomnogram before you can be further considered for certification.
I take Restoril for sleep. Will that be a problem for the DOT physical?
The medication, Restoril, may cause side effects: Hangover effect, drowsiness, dizziness, nausea, and vomiting.
These will all be questions the medical examiner is going to ask you about. This medication is usually used on a short term basis and not for a long term sleep aid. So it will depend on the type of driver you are and would be a serious consideration within the DOT examination.
You will need a medical opinion letter from your prescribing doctor explaining his reasoning for the use of this medication and why he feels it would be safe for you to drive a commercial motor vehicle OTR. Otherwise this could be a disqualifier for OTR drivers.
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I took my sleep study in August 2016. At the time I was skeptical that I had apnea, especially after the technician seemed to confirm my suspicion. Lo and behold, the doctor called me 2 weeks later to inform me of having “severe SA.” My problem is that I am up against the end of my second (and presumably last) extention but still can’t manage to keep the mask on for at least 4 hours a night. Is it possible to get another extention, or should I be re-tested?
@Patrick
Getting another extension will be up to the examining CME. And retesting is not going to work since you have to show 70% compliance for a thirty day period. Have you checked into a low profile mask? Check with your sleep doctor to see what options you may have. Good Luck.
I went down to get my DOT medical exam on 2-4-17, I’ve kept up on my CDL license and Medical certificate every year since not driving a commercial truck since 2011. On the exam theirs a question that says : Has your USDOT/FMCSA medical certificate ever been denied or issued for less then 2 yrs? I said “yes” and the Doctor who was doing my exam put down “NO”. I even told her in front of my girlfriend that my CDL was suspended once for not having a up to date medical card on file. In the note section on the physical exam, the doctor put down in her notes after i had already sign the certificate,that and I quote” he later reported in front of his girlfriend,PO,BM, and myself that he had his CDL suspended and has had to get his license renewed every year. He is aware that I called our medical director DR.Poon and that his license is being revoked” end Quote. She disqualified me for having OSA and C-PAP. She says I misrepresented myself on a federal form. I didn’t, she didn’t hear me correctly. They also asked me if I had a sleep study done and I said “yes, back in Dec 23,2016. The doctor asked why I had it done and I said cause I felt I wasn’t sleeping well enough. She asked what the report said and I told her I have a mild case of sleep apnea. She asked if I had a CPAP machine and I said “no” coz i didn’t know I had to say anything about it. Then she left the room and came back with another person and that’s when I told her that I had a CPAP machine at home. I feel like the examiner had it out for me from the beginning. Can the doctor put notes down on my exam report that is sent to DOT after I had already signed it? What Options do I have now,if any at all? I already called my primary care doctor to get a second exam done and for him to fill out the medical release form opinion that shows my use of the CPAP machine as I”ve only had it Since Jan 2017. I’m lost in what direction can I go. Thank you.
@Ronald
Sounds like you and the CME are at odds. Best bet is to get a medical release form from your doctor explaining your need for the CPAP machine, along with your most recent compliance report. Then go and get a second opinion somewhere else. The new medical certificate will over-ride the last one. That should do the trick, good luck.
Having similar problem. Medical card came due Jan 26-17. Went on Jan 27. First time asked about cpap machine.Reluctantly admitting to having one but explaining not much data on it cause of mask problems and loosing more sleep.Doctor still required 30 day read out. finally got appt with VET hospital on March 2. Got read out and fitted different masked,but not enough data on readout.Started using cpap on march 3 finally averaging 6hrs/night.Knowing this doctor is going to fail me called other doctors explaining situation and need time to comply cause my 45 days is running out.Can not find doctor to work with me on this problem.This is my third year having my cdl and the first time i am being asked about cpap machine.What rights do i have if any or what can I do?
@Tim
The FMCSA is holding pretty strict on this and has the CME’s between a rock and a hard place. Best bet is to learn from this experience and have the documentation ready before you go for the examination. Now that you are in the FMCSA database as a CPAP user, you should only need a read out just prior to doing your medical certificate examination. Good luck.
I have mild OSA. Prior to renewing my CDL last May I purchased a Resmed S9 variable with a nasel pillow mask. Three months later my medical provider, Kaiser, provided me with a Phillips cpap. I keep one machine in my truck and the other one at home. We very quickly discovered that the AHI number on the Phillips consistently runs three time higher that the Resmed. So I purchased another Resmed S9 identical to my first machine. I am set at 5.6 pressure and my AHI runs from 0.6 to 5.0 with the average under 3. I am 95% compliant with 4 hours or more.
My dilemma is…only the combination of the two machines will show these numbers. Is that acceptable? Also, what exactly is the Fed DOT looking for? If they have the hours and the AHI number, are they looking for anything else?
My Kaiser doctor is giving me a hard time. I don’t fit his medical learning profile. He wants me to take another sleep study which will most likely show a higher pressure. I don’t tolerate pressure higher than 6.0 well. It suddenly involves mask leaking and difficulty breathing out. He refuses to accept the work I’ve done to minimize the pressure for minimal AHI numbers.
@Lee
You may want to get a second opinion from another CME. You numbers appear within normal limits and your usage/compliance are within the FMCSA requirements. Once those criteria are met, then the FMCSA is OK as long as everything else checks out satisfactory.
I was told by ME that because of my bmi I must take a sleep apnea test I have a pulmonary Dr that the Me sent me too for a pulmonary evaluation sign off and gave me an OK my primary doctor who I see 3 or 4 times a year signed off it but the ME still says because of my bmi I need the test.1 week left on my med card can I get a second opinion?
@Rochard
Go somewhere else for a second opinion. No new rules regarding BMI or neck size, so your best bet is to get a second opinion.
I am in a similar boat. I only have until the end of the month before my card runs out!
Original exam was told “too fat” and neck too big that I had to get sleep test done. Was told only to do that and bring results back within 90 days to centra care. Did that and saw a different doctor who lost his temper because even though I was never told to do so, said I should have already undergone treatment and been able to show compliance. He would only give me a 30 day extension. I takes 21-28 days just to make the device I’m seeking for treatment.
To that, I am claustrophobic and deathly afraid of cpap. There is an alternative called an Oral Devise but I am meeting with resistance to that. If centra care doesn’t agree to this treatment and my card runs out I will automatically lose my job on the 31st.
My company won’t let me go anywhere else to seek a second opinion.
What can I do? Do I have any options for some kind of appeal or anything? Doesn’t the ME have to help me if I’m seeking treatment l, even if it’s other than cpap?
If you have a mild case of sleep apnea can the medical examiner require you to use a cpap machine if your registration dr just told you to lose weight and quit smoking
I am very interested in becoming a OTR driver. I was recently told I have Sleep apena, was given a CPAP and I can not sleep with this thing. had it for 5 months and can Only sleep all night with it, if I take a sleeping pill. Other wise I wake up and freak out, rip the mask off and throw it. I’ve recently been in contact with a sleep center that offers sleep appliances. In hopes I can sleep with it and get some good sleep. Do you know if these are approved by the DOT, or does it have to be a CPAP machine? If it has to be a CPAP, then I’ll have to figure something out, the mask they said would fit me SUCKS!
@Cory
If you are working with a sleep facility, then anything that they finds that works for you and that they will provide a medical release for should be fine. Make sure you have the doctor sign off on a medical release form explaining his findings and what modifications he felt worked best for you.
Is a complete new DOT physical required after satisfying the sleep apnea testing?
@Judy
Yes, unless your previous medical examination was put in ‘pending’ status, and you were not issued another medical card. ‘Pending’ – it’s up to the discretion of the medical examiner.
I have printed out a “Compliance Summary” from my CPAP machine, regularly, with one going to our company doctor when it’s time for my CDL physical. What are the numbers on this report that the examining doctor looks at to see if I am “fit for duty”?
@John
CME and FMCSA want to see a medical release from your doctor and a 70% compliance of use with your unit.
I have a driver that is 5 feet three and weighs 305 pounds. BMI is off the chart and neck size over 16″. and is 42 years old femaleShe denies snoring, sleepy, tired, drowsy, etc. I sent her for a sleep apnea evaluation. Now she keeps calling telling me that I mis-read the FMCSA Medical review board sleep apnea Guidelines. Is she correct?
@Stuart
It’s a tough call. If all you use for the sleep apnea determination is BMI and neck measurements, then she is correct. FMCSA does not have any new guidelines regarding the use of these two measurements.
And at the same time you can’t find the FMCSA guidelines anywhere, since they are being revamped (for the last two years).
You need to be using other criteria to make your final decision. Drivers should be demonstrating a multiple of signs/symptoms before call for the testing. Do more research on the other signs and symptoms so you could make a better decision if the test is need for sure. FMCSA is looking at a list of about five things that must be considered before requesting the testing. But a good google search will be a huge help.
Hello I recently was in an inpatient drug rehabilitation program for 30 days and while I was there they suggested that I should get a sleep test sleep study. It was a 30 day inpatient facility and while there I went and got the sleep study done. I was there at the treatment center to get off of a prescription drug that I had been taking for a while. Back to the sleep study the first night when I was there I guess it was to check if I had sleep apnea which I did not. So the following day they did the five nap sleep study 20 minutes for each nap and told to try to fall asleep. Well each nap for 20 minutes only I did fall asleep before the Time was up. I am a UPS driver and have been for almost 13 years. I started at 21 and 35 now. The sleep study results from the naps said the “The findings are suggestive of a diagnosis of narcolepsy”. Now being told to try to fall asleep I found that seems to be now unfair. I went to my doctor to get my DOT physical and was just trying to be honest and I guess I offered to much information about my sleep study and the results were temporarily not fit for duty. What do I need to do to get that stupid narcolepsy word to go away. I don’t fall asleep when I’m walking or anything I do get tired and fatigue at times but not nothing to wear I would be endangering The lives of the people in public. I have never had an accident zero in 13 years while being employed there. I am a little lost on what I need to do to try to get this issue resolved. I’m reaching out and looking for some help but I think when you are told to try to fall asleep which I did but the results say I have narcolepsy. And now I can’t drive which is bullshit. I feel like I was being too honest and now I’m paying the price but any help from here and from what I’ve gathered from this site it seems to be a lot of great help for drivers.
@Jesse
Go get a second opinion from another CME or another doctor. Somehow you have been tagged and are having difficulty overcoming the earlier findings so see if you can start fresh with a second opinion.
Can you go out medically with sleep ampnia from the georgia department of corrections?
@Brian
Only GDC can answer this.
Does mild OSA (found out because I was snoring), that is treated with an Oral Appliance require a retest every year? My last sleep study was great, and the examiner said he could only give me one year card. I am not overweight 5’9″, 185# (workout 3-4 days a week), and my neck is not too big.
@Jesse
If the oral device is working and you can support the findings with a medical release from your primary physician, then you should not need to redo the testing each year.
I was diagnosed with sleep apnea and had to get the CPAP machine. I can’t sleep with it. I went through another state and another company got approved for med card for one yr. I did not tell them of the sleep apnea test. I can’t sleep with it. It makes me sleep worse. Am I good to go. Or will they find out about previous test.?
@Davey
Your last medical card over rides the previous medical certificate, but now you have not provided correct and truthful information on a federal form. It could be found out and then what????
Had Dot physical 7/13/2016. Got 3 month card so I could get sleep apnea test and equipment. Doc told me to come back within 3 months with my printout and if compliant a year card would be issued. Went back 9/22/2016 with my printout that shows 80% time useage of greater than 4 hours. Had to have an new complete DOT physical (with the accompanying full physical fee) before PA would issue new card. Why complete physical?
@Bonnie
The new FMCSA forms require the CME to redo the exam with a new set of forms. There is no longer the option to update a previous exam. The new medical certificate overrides the previous one.
if im on the cpap machine and my med card expires do i have to take the sleep study test everytime i recertify or just show that im using the cpap machine
@Carlton
You just need a recent print-out to show proper compliance with your unit.
You do not need any such thing. Fact: FMCSA does not require any specific treatment or equipment in its regulations and Advisory Criteria. This may be a standard of practice in the medical community, but it isn’t an FMCSA requirement.
I went for dot today. My cpap printout states as follows.
77% of days used overall. 219/240
62% of days greater than 4 hrs use
14% of days lesser than 4 hours
Is this in compliance? My NRCME wasn’t even sure so he gave me a 2 month MedCard too keep me going. He it’s to follow up and let me know and explained if he made mistake, he will issue me a new one for a year. If it’s not in compliance, he was nice enough to give me an extension of a 30 day CPAP report and if it’s satisfactory with 70% of days greater than 4 hrs, he will extend my expiration to a year. I use this machine all the time, even during short naps, I get better rested. I don’t understand why it’s lower. I don’t however use if when I get home, but Im only home 2 days a month on average.
I have new health card that is only a month old. I went to a trucking company and they diagnosed me with sleep apnea during a new dot health screening. I did not take the job or their health card. I am going to get me a CPAP machine at a dot certified sleep doctors office tomorrow. If the doctor that diagnosed me said he was faxing the results to the dot, will that affect my current health card while I am in the process of getting my CPAP machine, I have a job that I applied for and got before I was diagnosed with my month old 2 year health card and at the time I was not diagnosed. like I said I made an appointment and I am getting the machine but can I drive until it comes in. my employer doesn’t pay for health cards I had to get it my self. pre diagnoses ?
@Matt
If you did not get a long form from the last CME that stated you were disqualified or gave you a short term card to get the cpap in order, then it would seem that a ‘complete’ exam was not done. Results are not ‘faxed’ to DOT, they are entered into an online database.
Check with your local DMV to find out which medical card they have on file.
Does the DOT have any regs on which CPAP machines are acceptable or will any machine be ok as long as the driver can get a reading from it for compliance? Thanks again..
@Employer
As long as the machine can give a reading to show compliance, that’s okay.
I took a sleep study on my own and it was determined that I have sleep apnea. I was placed on a cpap machine. Am I under any violation
@Kelcey
No, but now you need to show compliance on the cpap.
I have a driver who tested positive for OSA and now has a machine and is doing well with his compliance 10 days in. Unfortunately due to financial hardship it took a while to get a machine organized for him. His DOT expired on 8/11 after a 3 month cert. We work with a sleep specialist and in the past we have provided weekly downloads of CPAP compliance to enable our drivers to stay on the road. The ME’s we have worked with seem to be happy with this arrangement so long as we send the downloads regularly every Friday for the week. This drivers ME will have non of that and just wants to see 30 days. My question is, are we able to send him to another doctor as his cert has expired. We will of course disclose whats been happening with our driver and all relevant medical records. There may be another ME out there who will work with us to try and keep our driver on the road or he will suffer further financial hardship. Thanks for a fantastic website, we need you guys every day….
@Employer
You are welcome to send your driver to any NRCME examiner.
Also explain to the driver that FMCSA guidelines do request a thirty day on the unit compliance report, but your input should be taken into consideration.
We did send this driver to another facility and he has been given 3 months to produce his 30 day compliance (of which he is almost halfway there) he will then get his years cert. He keeps his job, we keep our driver safely on the road. Thanks again!!
@Employer
You are welcome. Thanks for keeping your drivers safely driving.
I have a driver who went to a Concentra for his DOT. He was told he needed a sleep study but that they would not accept a home test. We work closely with a company who does a great job with our drivers. They do 2 home sleep tests, unless the first one is totally conclusive as positive for OSA. Concentra told me that the DOT will no longer accept home studies. I can’t find anything to support this can you clarify for me please? My driver (and many others) simply cannot afford a lab test, he is struggling to afford the home test. I feel my only option is to ask if I can refer him to somewhere that will accept HST. I was wondering if anyone else was having the same issues with Concentra, could it be a new’ Company policy’ we have to deal with?
Thanks again..
@Employer
It falls in a very gray area.
FMCSA stated that the home studies were not as accurate as the lab studies.
Now, if you are working with a company and the overseeing doctor can and will support the finding, then the CME should be able to accept the results.
The CME just needs supporting information to be able to provide the best decision about the drivers safety.
Some of the ‘doc in a box’ facilities are tied together with sleep study companies and will not budge on the issue: follow the money.
But good supporting information from the study with a medical release from the provider should be all you need. If the driver is found to have OSA, then he would want to move forward with whatever the doctor is recommending.
I have a current fed med card without the diagnosis of sleep apnea.
I have taken upon myself to go have a test taken to find out if I have it.
I was scared about having my fed med card revoked till the study took place so i told the doctor i didn’t have a cdl not knowing the seriousness of my actions.
What do I have to worry about taking a test on my own free will?
I had to schedule months in advance for the test also
@John
You have not had the test and there is no functional diagnosis to worry about at this time. Once you get your test results back, there may be a thirty day waiting period, if you test positive for OSA. That waiting period is for you to get accustomed to the new device. Then you need to redo your fed med card.