- Part 1 – Can A DOT Medical Examiner Refuse You A Medical Card Unless You Have A Sleep Study Done?
- Part 2 – DOT Physical And Sleep Apnea Testing: Are Medical Examiners Caught Between A Rock And A Hard Place?
- Part 3 – Commercial Driver Awareness About The Sleep Apnea Issue
- Part 4 [You Are HERE] – OSA: How To Know If You Have It
- Part 5 – Commercial Drivers Can Manage Sleep Apnea And Maintain Their CDL
Long-haul drivers can suffer from obstructive sleep apnea for years and not know that they have it.
Commercial drivers do whatever it takes to stay on the job. As a professional driver, you may have gotten used to masking symptoms by using stimulants such as sugar and caffeine.
If you’ve had symptoms for some time you may have become conditioned to feelings of fatigue and not realize that they’re associated with sleep apnea.
If you think about it, though it’s not a thought any driver wants to entertain: If you experience restless sleep and feel sleepy during daytime hours, you may suspect yourself of having sleep apnea.
The question then, is …
What is obstructive sleep apnea?
How can you know if you have it?
Start With These Signs For Obstructive Sleep Apnea
The following are possible indicators of sleep apnea.
- Snoring
- Deep, gasping breaths while sleeping
- Pauses in breathing while sleeping
However, these factors alone cannot diagnose obstructive sleep apnea. Even the loudest of snorers may not have breathing obstruction.
Check with someone you trust! A sleeping partner can check to see if you experience breathing interruptions while you’re sleeping.
This is what to check for:
In adults, a pause in breathing must last 10 seconds to be scored as apnea.
Clinically significant levels of obstructive sleep apnea are defined as five or more of these 10-second episodes per hour.
- 5 – 15 episodes indicate mild sleep apnea
- 15 – 30 episodes indicate moderate sleep apnea
- More than 30 episodes indicate severe sleep apnea
Investigate Further. What Else To Check For…
If you have sleep apnea (even undiagnosed), here are some of the symptoms you may have been noticing:
- Excessive snoring or snorting
- Restless or interrupted sleep
- Frequent headaches or waking up with headaches
- Feeling more tired when you wake up than when you went to bed
- Daytime drowsiness
- Excessive nighttime urination
- Erectile dysfunction
- Family history of sleep apnea
A number of health issues potentially head you toward sleep apnea. These factors are even more likely to indicate sleep apnea if there is a combination of two or more.
- Obesity (indicated by weight, neck size, BMI)
- Small upper airway (check throat area by sticking tongue out, whilst in a seated position)
- Age increases potential risk
- High stress levels
- Other diagnosed medical conditions, such as:
- High blood pressure
- Diabetes
- Hypothyroidism
- Arrhythmia
- Cardiovascular disease
The work stresses and challenging lifestyle of long-haul commercial drivers has led to a higher inclination for these adverse conditions, which contribute to obstructive sleep apnea. This is not your fault, but it is the reality that you must deal with.
It is a combination of these conditions that a medical examiner will be looking at, to assess your overall risk of sleep apnea.
How Can You Be Sure You Have Sleep Apnea?
An overnight sleep test called a polysomnogram, or a “sleep study” is the most accurate way to diagnose, or rule out, many types of sleep disorders.
As the word ‘poly’ suggests – ‘many’ factors are scored in this test. A polysomnogram records your brain waves, the oxygen level in your blood, your heart rate and breathing, as well as eye and leg movements during the study.
A sleep physician interprets the data in conjunction with your medical history, a complete list of drugs you are taking, and any other relevant information that might impact the study. A report is sent to your referring physician, usually with specific recommendations based on the test results.
Undiagnosed Obstructive Sleep Apnea (OSA).
Where Are You Headed?
OSA can be life threatening. OSA is not only harmful in itself, but is correlated with many serious and potentially fatal illnesses and complications.
Obstructive sleep apnea is associated with increasing the risk of cardiovascular disease, stroke, high blood pressure, arrhythmias, diabetes, and sleep-deprived driving accidents. The most serious complication of OSA is a severe form of congestive heart failure. Sleep apnea sufferers also have a significantly higher risk of heart attack or premature death than those unaffected.
If you think you have OSA, you should not ignore the signs.
If you have been diagnosed with obstructive sleep apnea, you livelihood doesn’t have to be threatened. There are ways to manage this condition and still drive commercially.
Put In A Nutshell
- A combination of symptoms, health issues, and previously diagnosed medical conditions point to the need for a sleep study test to diagnose OSA.
- People with a combination of conditions have a much higher likelihood of sleep apnea.
- If a Medical Examiner thinks you are at reasonable risk, your DOT medical certificate may be temporarily disqualified while you get a sleep study done for proper diagnosis. If you have to start CPAP treatment, then you will have a conditional period of 30 days, before your next evaluation for a medical card.
If you have reasonable suspicion that you have sleep apnea, it’s recommended that you investigate it further, before you end up in a situation where your medical certificate is put on hold. See your primary doctor and do a sleep test if necessary — BEFORE it becomes an issue for your medical card.
Remember – You can manage sleep apnea and maintain your CDL!
Thanks to Trucker Docs expert panel doctor, Dr. Kenn Seals, for contributing to this article.You can find Dr. Seals at Chiro Stop in Salt Lake City, UT.
My husband is 56, and has his Class B CDL in Kentucky. He went in for his physical, and was told that because his neck size is 17, he has to have a sleep apnea test. He does have heart disease, so he complied, but he only has a mild AHI score, which from what I read, that is not treated with cpap machines. His doctor at Concentra is requiring him to get a cpap machine before he will renew his medical card. Does he have any options, as he really doesn’t want to have to mess with a cpap machine when it doesn’t appear to be needed?
@ Kallie B
Class B cdl’s are not under the federal DOT/FMCSA guidelines. He falls under the states guidelines and variances. The medical examiner at the facility you are using is holding your husband to a class A cdl standard, which he is not. Go get a second opinion from a CME that knows the difference between state and federal guidelines.
My sleep apnea is not moderate but it’s minimal, will this stop me from getting qualified ?
@ K.C.
No, just make sure you bring a medical release form from your sleep doctor. And, if possible, a copy of your last test results.
I want to know if one doctor says you hsvebsleep apnea on home test results only and puts you on machone, then later you have a real sleep study some at faculty and those results show no, does the first dr. have to accept favorable results.
@ET
Yes. Home studies are very inconclusive with no major supportive information. FMCSA does not accept those types of results.
is all this worth the effort to have an Arizona Departnent of Public Safety highway patrol officer who states that the highways is his and that he is granting his permission for me to drive on his freeway. Then escorts me home using his patrol vehicle. Is this how things are being done? In Tucson and Casa Grande this happends more every day.
I’m 52 years old 5’11” 285lb.neck size 17″ I was sent for a sleep study I was I have a mild case of apnea I purchased a cpac machine I used it for 30 days took the results to concentra.I Only sleep 4 to 5 hrs a night they won’t renew my dot card till I get number of hrs of use at night up I go sleep around 11:30 pm or 12:00am IWAKE 4:15 or so every day and done so most of my life do not use alarm clock to wake me I drive local in MI.I have cdlwithAT endorsement do u have advice for me not that it maters but I’m a non drinker or smoker and I don’t bleave in pills I less antibiotics thank u Dennis
@Dennis
It’s either: Get the numbers that your CME is requiring, or see if there is a difference between your driving intra-state only vs interstate. Some states have different rules for intra-state only.
I am a new cdl holder. I am a 49yr old female. I graduated from a top 100 driving school and preformed every medical procedure that the CME told me I was ‘required’ to. This included a 4 1/2 hr functional capacity test, a pulmonary function test and sleep studies. Infact I was required to do two of each of these. The first ones at the CME’s office and the second ones at the local hospital and the functional capacity test was done at the local rehabilitation center even though my physician had cleared me specifically for this type of work. The sleep study was the last of the tests done. This first report said that I ‘showed symptoms of sleep distress but only in REM sleep’. They did not put me on oxygen as was stated in the the procedure guidelines for the study, so I was made to do another one wearing oxygen through the whole study. That report said ‘Patient titrated at 6 cm but findings are inconclusive because she never entered REM sleep. We suggest another sleep study be preformed’. My doctor said forget it..if that’s what they said you titrated at I’ll just write you for it.
My problem is that (1.) I had problems getting the machine (2.) When i used it, it bruised my lungs so bad after wearing it for only 2 1/2hrs it felt like I had been kicked in the chest by a mule (3.) When I told my Dr. about it he told me not to used it until it had been properly adjusted because it could actually DAMAGE my lungs. He faxed an order to the company that supplied it to lower the pressure setting to 4 cm to which they never responded. A week later I called them and they said they never received the order. I called my Dr again and he refaxed the order. Same responce. I called them AGAIN a week later to be told the never received it. I WENT to my Dr’s office and physically WATCHED him fax the order. They still did not respond. Infact, they never did a follow up to see how or IF the machine was functioning! During this time I graduated from driving school, was recruited by a large trucking company and went to their facility for training. THEIR M.E. sent me back home to get 30 days compliance on my machine even tho my DOT card is good till August. She said that she read my sleep study report and that it was barely borderline that I even needed the cpap but that once an order was written she HAS to have 30 day compliancy, her hands were tied. Upon getting home I went to the place that sells and services the machine and they gave me a whole new machine and completely different mask. STILL having nothing but problems with it! Monday I have a consultation appointment for an oral device and hope to aleviate the need for the whole contraption! I really just want to go to work!!! The thing that got me going about all of this is that their M.E. told me this..I have stage 1 lipedema and my bmi is 37 (my neck is 13.25) I plan on having the surgeries to correct it..’after you have your surgery you probably won’t even be required to have a cpap’. Is this whole thing based on my weight ? And once I’ve had a sleep study do I have to have one every year? I’ve also been told they can make you take up to 6 sleep studies a year.
@Tami
You appear to be being jerked around. Since we don’t have access to your medical records, it is hard to say why they are doing this to you. BMI and neck measurement alone are not grounds enough to warrant a sleep study.
So what prompted the first sleep study? Once that is answered then you might know where to go next.
If you need the CPAP, then you won’t leave home without it. If you don’t need it then it is nothing but a problem. Once you have a unit and it is working correctly and as needed, then the CME has to have a 30 day with 70% compliance to move on with the certification process. Your medical card will be limited to one year at the time and once on the unit, you only need to show compliance, not re-take this test over and over.
Someone needs to tell Concentra about BMI and neck size not being sufficent grounds for a sleep study. I lost out on two job offers based soley on those two items.
Your not alone. I also lost a job. He gave me 3 months and the job didnt hire me. I pass everthing with flying colors. So now how do i go get a another phiscal. Will the new one overide that one.
@Roxy
Yes, a second opinion that clears you to drive does over-ride the last medical certificate.
Seems to be a common thing with Concentra. Sounds like discrimination on their part
I had a mini stroke last month, one of my doctors said according to the DOT I can not drive for a year even though I am fully capable. Is this true?
@Alvin
That is true. What you want to do is to check with your local drivers license department and see if you would be qualified to drive intra-state only during your waiting period. Good Luck.
So if I have my medical card good for 3 months while I do the sleep apnea study and so happens it will go over the 3 months because getting appointments and study back takes time and if diagnosed with sleep apnea that will take time to schedule and another month with treatment the 3 months are not suffiecient to finish the treatment when you get an extension until treatment is complete? (maybe one more month). The question is can you get an extension while your doing the treatment?
@Laura
That would fall into the CME’s discretion as to whether or not he feels this is acceptable or not.
Hi I have a regular driver license I drive a twelve passengers van 3hours in the am and 3hour in the afternoon if I’m diagnosed with sleep apnea and get treatment wil that affect me get my medical physical card to drive
@Marie
No, it will only be affected by the fact that you will need to bring documentation and a medical release from you primary doctor and/or sleep doctor.
Be aware that your medical card will go to once-a-year renewal.