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In This Article:
- FMCSA: What Is Currently Required For CDL Medical Certification Regarding Sleep Apnea?
- FMCSA: Future Guidelines and Rules on Sleep Apnea
- Obstructive Sleep Apnea Concerns For Commercial Drivers
- Obstructive Sleep Apnea: Do You or Don’t You Have It?
- How Do You Recognize Obstructive Sleep Apnea Symptoms?
- Obesity: How Can BMI or Neck Size Affect Your CDL Medical Certification?
- How Can You Be Sure You Have Sleep Apnea?
- What Is The Treatment For Obstructive Sleep Apnea?
- You Can Manage Your Obstructive Sleep Apnea and Maintain Your Commercial Drivers License!
- Commercial Drivers – Are You At Risk?
FMCSA: What Is Currently Required For CDL Medical Certification Regarding Sleep Apnea?
FMCSA: Future Guidelines and Rules on Sleep Apnea
The Federal Motor Carrier Safety Administration is expected soon to issue more explicit guidelines for CDL medical certification that would significantly raise the bar on DOT physical screening, and treatment for obstructive sleep apnea. However – as far as changing the rules – the FMCSA wants to verify that sleep apnea affects trucking safety before they change the rules, which may be another two or more years in process.
Not all parties agree on the relationship between sleep apnea and safety. The National Transportation Safety Board is one of the parties alleging a clear connection between driver sleep apnea and safety. In response to such concerns, the American Sleep Apnea Association, the American Trucking Associations and the FMCSA are co-sponsoring a national conference, Sleep Apnea & Trucking Conference 2010, in May about sleep apnea’s effect on truckers.
Obstructive Sleep Apnea Concerns For Commercial Drivers
As a commercial driver, your concerns are twofold: Your livelihood and your life.
1. Repercussions that sleep apnea issues will have on your livelihood.
Under current CDL medical restrictions, drivers with moderate to severe sleep apnea that interferes with safe driving can be disqualified for a DOT medical card if a state-licensed medical examiner determines they should not drive. Commercial drivers, in general, support safe driving. What concerns some is that guidelines and rules based on a single factor like BMI or neck size, will create sleep tests which will be costly in dollars and downtime, and where sleep apnea may not be a factor.
2. Consequences that untreated sleep apnea could have, leading to life-threatening health issues.
The lifestyle of commercial drivers leading to a higher rate of obesity has contributed to a higher rate of sleep apnea among truckers than in the general population. Obstructive sleep apnea is associated with an increased risk of cardiovascular disease, stroke, high blood pressure, arrhythmias, diabetes, and sleep deprived driving accidents. 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.
Obstructive Sleep Apnea: Do You or Don’t You Have It?
People can suffer from obstructive sleep apnea for years and not know they have it.
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 apneas 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.
How Do You Recognize Obstructive Sleep Apnea Symptoms?
- A sleeping partner may witness you experiencing difficulty breathing while you are sleeping. In adults, a pause in breathing must last 10 seconds to be scored as an apnea. Clinically significant levels of sleep apnea are defined as five or more episodes per hour of apnea.
- You may have other health problems such as high blood pressure, diabetes, arrhythmia, or cardiovascular disease, for which sleep apnea is a risk factor. People with diabetes or “borderline” diabetes have a higher risk of having obstructive sleep apnea.
- You may suspect you have it because you’ve experienced restless sleep, and you feel sleepy during daytime hours. If you’ve had these symptoms for some time you may have become conditioned to feelings of fatigue and not realize that they’re associated with sleep apnea. You may also have gotten used to masking symptoms by using stimulants such as sugar and caffeine.
- Excessive snoring or snorting
- Restlessness or interrupted sleep
- Workday drowsiness
- Excessive nighttime urination
- Erectile dysfunction
- Hypertension
- Diabetes
- Smoker
- Obesity
Obesity: How Can BMI or Neck Size Affect Your CDL Medical Certification?
In 2008, a health panel recommended to the Medical Review Board that CDL medical certification be conditional based on body mass index (BMI). BMI is a statistical measure which compares a person’s weight and height. Though it does not actually measure the percentage of body fat, it is used to estimate a healthy body weight based on a person’s height. For more information on BMI and height weight charts, see this Wikipedia article.
The panel recommended that truckers with a BMI of 30 or higher should be required to be tested for sleep apnea. It is not yet clear how strict a criteria FMCSA will give BMI in the DOT physical exam process in the future.
Currently fleet owners use a BMI of 39 or higher to screen and disqualify driver applicants.
Other indicators of potential obstructive sleep apnea are neck size, enlarged tonsils and large tongue volume. Large neck circumference is measured at 16 inches in women, 17 inches in men. 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.
High BMI or large neck size are indicators of possible obstructive sleep apnea. Additional factors that predict obstructive sleep apnea are diabetes and high blood pressure. A driver presenting a combination of these conditions is likely to trigger suspicion of sleep apnea and the need for a sleep study in order to rule it out, to complete the DOT physical exam process for CDL medical certification.
How Can You Be Sure You Have Sleep Apnea?
What Is The Treatment For Obstructive Sleep Apnea?
- Some treatments involve lifestyle changes, such as avoiding alcohol or muscle relaxants, losing weight, and quitting smoking.
- Many people benefit from sleeping with their upper body elevated, like sleeping in a recliner.
- Sleeping on your side, as opposed to sleeping on your back, is also recommended as a treatment for sleep apnea.
- Dentists who specialize in obstructive sleep apnea can prescribe various kinds of mouthpieces to keep the airway open during sleep.
- The treatment used by most doctors is the continuous positive airway pressure (CPAP) machine or the BiPAP machine. The CPAP assists only inhaling, whereas the BiPAP is used in more severe cases for inhaling and exhaling.
- There are also surgical procedures to remove and tighten tissue and widen the airway.
If you have reasonable suspicion that you have sleep apnea, it’s recommended that you investigate it further, see your physician and do a sleep test if necessary. Obstructive sleep apnea is a medical condition that can have serious consequences if not treated.
You Can Manage Your Obstructive Sleep Apnea and Maintain Your Commercial Drivers License!
Obstructive sleep apnea does not necessarily disqualify you for CDL medical certification. Treatment with a CPAP machine and some basic lifestyle changes can help you get a restful sleep and maintain your commercial drivers 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.
Commercial Drivers – Are You At Risk?
You may be reading this article because you’re concerned about your livelihood – how sleep apnea could affect your CDL medical certification and that your CDL is at risk.
If that’s the case, then you should be concerned about your health too – that your life is at risk.
You don’t have control over the forthcoming FMCSA rules and regulations to get your DOT medical card. But you can manage your health so that those rules and regulations are not a problem for your CDL.
Commercial driving is a challenging lifestyle. Will it control the way you live, or will you manage the way you live, within its constraints? By knowing what the problems are, you can take action to make the outcome different, and pass your DOT physical exam with flying colors.
Martha
/ May 16, 2012I have driven a school bus for 29 years, I also have been using a cpap for 15 years of that time. I found myself trying to doze off while driving so went next day asked my doctor to be tested for sleep apna. Had test, got cpap and could not believe how much better I felt.
Trucker Doc
/ February 24, 2012@Jim
Well to answer the question, ” Can he do that? ” Yes, he can. He is basing his findings on experience and the guidelines set forth by the Guide for evaluation of the commercial drivers.
But you also have choices. He is looking out for you, the driver, and the safety of the public at large. You are looking out for your family and the ability to continue doing your job. All the signs are there to warrant a study, overweight, out of shape, large neck, etc. If you have not had any difficulty during your driving career, then I would go to someone else for a second opinion, but be aware the guidelines are still just that, guidelines for all the DOT examiners.
Thanks for the question. Trucker Doc
Jim
/ February 23, 2012I went in today to get my new medical card, as a dot requiement,
The Doctor asked if i snore i ansered yes. he measured my neck and then
looked down my throat he then told me that i probably have apena, and that I need
to be tested, and that he would give me a 30 day medical card ? I told him that
I needed this card for this new job, he basiclly stated not his problem,
can he do this just on a hunch ? aperatlly so. I dont think I have apena,
but I dont have 2 or 3 thousand to prove him wrong, no insurance, no job,
I don’t have any history of diabetes, high blood presure or getting tierd while driving, no sighs at all,
but I am over wieght, doc says I have a 17 1/2 ” neck a swollen touge and a BMI of
39. and that all he needs to suspect i have apena. I am 52 and 6 foot tall 286 pounds. been driving for 30 years. personally I think that the goverment has found a way to but drivers on a diet. or else . you can find statistics on both sides of this issue. both interesting reading.
Trucker Doc
/ January 23, 2012@Sue
The testing for sleep apnea makes sense, if the driver finds himself feeling sleepy during the day following a night’s rest.
The rest of the test battery is the doctors choice and is not a required series, unless the examiner feels there may be other health issues regarding the driver and his safety.
As a diabetic and a little overweight, the doctor’s concerns are for the overall health of the driver and for his safety and the publics’. Thanks for the question. Trucker Doc
Trucker Doc
/ January 23, 2012@Linehaul driver
Well, lets think this through!
You drive a commercial motor vehicle, weighing 80,000 pounds and you fall asleep while driving. HMMM, should I pull your medical card for that?
The purpose for the medical examination and certificate is to make sure you are safe to yourself and the public.
I would recommend that you go back to your primary physician and have him check you out again and see if there are any modifications to be made regarding your cpap and your level of restfulness following a nights sleep.
Otherwise, yes, they will pull your medical certificate until you get this issue corrected and rightfully so.
Thanks for the question. Trucker Doc
Linehaul driver
/ January 22, 2012I sleep with a cpap and still don’t feel rested after a whole night of sleep and still doze while driving will the dot doctor pull my medical card if I was to tell him I’m still falling asleep even with the cpap
sue
/ January 11, 2012My husband holds a cdl in the state of mn. Just because he got pneumonia on the road and went in for that, now he’s been tested for sleep apnea, hepatitus c, stress test, which is walking on a treadmill for 15 minutes. Is this all necessary?
He is a diabetic with numbers under control, weighs about 265, and has been a owner operator for 37 years. He is our only income and now they threaten that they will take his card away if he don’t do the stress test on the treadmill? He has agreed to the sleep apnea test in Febuary. Is this necessary to keep his cdl?
Trucker Doc
/ January 2, 2012@mkgc59
It is unfortunate that it happened this way.
If it is company policy, then it’s company policy. But there is no ruling about how long to issue a medical certificate for sleep apnea, only a guideline.
So answer a few questions.
1. When was his condition diagnosed?
2. Does he use a CPAP machine?
3. For how long has he used it?
4. When was the last testing and what were the results.
If the job is still available, all he should have to do is demonstrate his willingness to get things right and go from there.
Thanks for the question. Trucker Doc
mkgc59
/ December 29, 2011My husband gave notice and was due to start his new job next week. Went for the DOT physical and the questionaire asked him whether he had sleep apnea or not. He said “YES”….because he’s honest. So, they would only give him a 3 month DOT card. The new co called him to say they cannot hire him without at least a 6 mo card. This is utter BS in my opinion, he left a job to take the new job—with only a few days they change their minds stating “co policy”..
truckers wife
/ December 28, 2011My husband went for his medical card today ,The doctor was rude did not ask him if he has problems sleeping .He is 5’9 310 he feels great ! This physican referred him to a test center for sleep test WTH! a million miles driven with no problem . So on top of that this doctors says to him you are more likely to kill some one before a drunk driver could who says that.so go to say he has to go be checked another way just for people to get money if you ask me these drivers have been driving for years with out these test .Maybe they should worry about the ones that cheat on their logs and drive with three hours of sleep .
Trucker Doc
/ December 27, 2011@David
Here you can read our summary of FMCSA Rules and Regulations.
Here is the link for the long, legal version FMCSA Part 391.41
Thanks for the question. Trucker Doc.
David
/ December 25, 2011I have been useing a cpap for 3 years and it helps. I only drive on my cdl a couple of times a month, may be for 30 min. or 4 hours. Where can I find the rules on drivers w/ sleep apnea by the DOT?
Trucker Doc
/ December 24, 2011@Wilson
It’s tough that good people are being squeezed more and more as the economy gets worse.
My suggestion is that you start to take actions that vest your life in YOU, not in any company.
Do whatever you can to start taking your life into your own hands. That could mean addressing some of this problem with the HR department in the Company. It could also mean understanding any health challenges you may be headed towards, and finding ways to address those. It may mean looking for alternatives in your work environment. YOU are the best course of action to make this problem go away!
Hope this helps. Trucker Doc
Wilson Hardy
/ December 22, 2011i have not been examined yet for sleep apnea but i’m being treated like i have it already my employer is trying to get rid of me after years of service to the company. i have my whole life vested in this company and now i’m about to lose everything over something i haven’t been diagnosis with by any doctor. What’s the best course of action for me to take in making this problem go away ?
Trucker Doc
/ December 13, 2011@Joe
Well the examiner is following the new recommendations, they are just recommendations not law.
Also the examiner has the responsibility to look out for your safety and the public’s safety.
Be aware that the examiner may request a new AHI test to determine the overall effectiveness of your unit.
Thanks for the question. Trucker Doc
joe
/ December 12, 2011been using c-pap for 5 years, just renewed med card and was given a 1 year card, the p/a said new rules say 1 year only for sleep apnea sufferers in ca
Trucker Doc
/ November 29, 2011@andrea
Dealing with sleep apnea is not an issue unless it is untreated. If the condition is treated correctly, then it should not have any effect regarding the hazmat endorsement. Thanks for the questions. Trucker Doc
andrea
/ November 28, 2011I was curious. If someone has sleep apnea does that affect getting a hazmat endorsement? And if he already has the endorsement, does that matter?
Trucker Doc
/ November 18, 2011@Valerie
His condition will need to be supported with some level of documentation in that his condition is stable and he does wake well rested and that his oxygen levels are within normal limits. But no, it will not be a limiting factor unless his condition is unstable.
Thanks for the questions. Trucker Doc
Valerie
/ November 18, 2011My husband has severe sleep apnea but it is being treated with a cpap machine will this disqualify him from getting a cdl?
Trucker Doc
/ August 11, 2011@Kenny
Well it isn’t that you are automatically disqualified, but you must consider the side effects of the medication that your doctor has you using.
Dextroamphetamine SIDE EFFECTS: Constipation, diarrhea; dizziness; dry mouth; headache; loss of appetite; mild weight loss; nausea; restlessness; trouble sleeping; unpleasant taste; upset stomach.
It will be things like dizzyness while driving a commercial motor vehicle, that will get you disqualified.
Have your doctor check you out on the CPAP machine to determine the underlying cause of the sleepiness while at work and then go for the CDL.
Thanks for the questions. Trucker Doc
Kenny
/ August 10, 2011I have been using a Cpap machine for 7 years and definetly feel well rested in the morning having used it versus the few times I haven’t. Problem is I get to work and cannot stay awake. Doc has me on 10mg dextroamphetamines. Am I automatically disqualified from getting my CDL.
Trucker Doc
/ August 4, 2011@Ricky
Well getting the CPAP out of the way and using it routinely would be a great start. Sleep apnea is not the issue for the long haul driver, it’s the tiredness that works against them.
Having sleep apnea does not limit your qualifications, unless the company has some standard about it.
Your examining DOT doc will ask you some questions about your sleep habits, because it determines how safely you will be as a driver, safe for yourself and the public. So go for it, you should not have problems.
Thanks for the questions. Trucker Doc
Ricky
/ August 3, 2011I am interested in getting into the industry, however I know I have sleep apnea. I am 6 feet tall and weigh between 390 and 420lbs. However I have no insurance and am having a hard time finding a decent job that has insurance. Since I know that alot of companies do have good benefits, I was wondering if I went and got a CPAP on my own if that would stop me from being licensed. I have no other health issues other than the sleep apnea, my bp is fine and my sugar is good… so I guess the question is… should I go for it?
John
/ July 6, 2011My family is struggling financially and I have already been bused to a potential employer 1000 miles away only to have this sleep study and the 9″ skirt clearance (new aerodynamics) send me back home even more broke than when I left. Can anyone tell me what companies I can look into so that I can get a paycheck coming in? I’m 6’4″ and 350 – yes, a bit overweight, but played football for a long time. Any help appreciated. Thanks.
Trucker Doc
/ July 5, 2011@Trucker Wishbone
The FMCSA did not pass any new rulings regarding BMI or sleep apnea.
What I am seeing mostly is doctors who invested in these sleep study clinics and weight loss clinics trying to recoop their money. THIS IS A CONFLICT OF INTEREST issue.
The company you try to hire on with may have this as a policy, but the DOT has made NO ruling regarding these issues.
Thanks for the heads-up.
Travel Safely, Trucker Doc.
Trucker Wishbone
/ July 4, 2011Just had a dot physcial at valley occupational medicine roanke va going for a new job passed road test back ground etc dr powledge informed me they now have new protocol for screening drivers they took my height weight and said my bmi was 39 measured my neck it was 18″ asked me if i snored i said no they did not believe me so they would only certify me for 3 months until i go and get a sleep study done dr powledge went to a conference in may 2010 sponsored by fmcsa and the ata so they anticipate the osa sleep disorder will be updated more frequently in the next few years in the meantime there going by this now to screen drivers on ther dot physcials the day i was there i so at least two drivers that did not qualify at all i have been driving for 10 years no accidents on my record i cant say i havent been tired driving i have but i know when its time to shut it down and i do and i have been this will cost alot of drivers out there when this goes into full effect if it does i know it cost me a chane at a good job no co out there will hire you on a 3 month med card i just wanted to let other drivers know that some places are going by this some are not i just had a dot phy where i work at now they never even talked about bmi neck size or osa they did ask me if i snored what do you think i said?
Anonymous
/ June 5, 201141 bmi 18 ” neck i have sleep apnea, bought my cpap on craigslist, no insurance. I sleep great with the cpap, but now i have 90 days to take a sleep study to tell me what i already know. then i will have to buy a cpap at full cost. 800,000 miles no tickets, violations or accidents, this sucks
Trucker Doc
/ May 5, 2011@Bryce
The Federal DOT has not set any standards regarding weight, BMI, or body measurements. There were no law changes on the DOT physical.
So unless this is a company policy, you could pass the examination. Yes you are overweight, and so are 80% of the senior drivers in America. So, if not company policy, go somewhere else to test for you medical card.
Bryce
/ May 4, 2011I just received my new DOT physical. Im 6″1′ and 270 lbs. They told me im overweight which I already knew. Whipped out a tape measure and measured my neck. Told me i was disqualified until I receive a sleep test. Now out of work and gotta wait 3 mths to get into a sleep facility.
Trucker Doc
/ April 7, 2011@Randy
There was a lot of discussion regarding possible changes using neck size measuremments and snoring as a precursor for determining sleep apnea.
Some of the trucking companies started adopting these, but DOT did not make any changes with the CSA 2010.
Thanks for the question. Dr. Kenn
Randy Day
/ April 6, 2011has a new reg for sleep apnea been issued
Trucker Doc
/ January 24, 2011@Greg
The CSA does not really have anything to do with sleep apnea per se.
If you needed the unit and it’s working well for you, there is no concern. It’s noted on your medical examination and should have been a point of question with the DOT examiner during the exam. But the use of the CPAP unit has nothing to do with CSA 2010. It’s a question only if the company has questions, or there is a question as to whether you are fully rested following a night of sleep with or without the unit. Thanks for the question. Dr. Kenn
Greg
/ January 21, 2011I have been driving over the road for 39 years. I think I am in good health. However, I have been on a CPAP for the past year. Do I feel better? I think I so.
But I am concerned about the MCSA 2010 and my ability to hold a CDL. Just think 39 years of HWY miles accident free and I am worried!
Greg
/ January 21, 2011I have been on a CPAP