Obstructive Sleep Apnea: Commercial Driver Risk?

In This Article:

The effects of obstructive sleep apnea (OSA) on trucking safety has become a contentious issue for the Federal Motor Carrier Safety Administration.
Drivers are confused and concerned about what to expect during their DOT physical exam and how this will affect their CDL medical certification.

FMCSA: What Is Currently Required For CDL Medical Certification Regarding Sleep Apnea?

At the time of writing this article, March 2010, the DOT physical exam required for commercial driver license holders includes only brief questioning regarding sleep apnea. Examiners are not required to screen for the condition if drivers respond that they are symptom-free.  However, this current approach is ineffective if the driver intentionally fails to reveal a clinical diagnosis or intentionally avoids identifying such signs and symptoms during their DOT physical exam.

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

Fatigue is a significant issue, and driver drowsiness has been cited in a high number of fatal truck-related crashes. Current road safety concerns are that many cases of sleep apnea are undetected and may be a safety issue.

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.
Here are some sleep apnea symptoms you may recognize:
  • 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?

Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram, or a “sleep study”. Clinically significant levels of sleep apnea are defined as five or more episodes per hour of apnea measured by the polysomnogram.

What Is The Treatment For Obstructive Sleep Apnea?

Depending on the level of the problem, here are some things you could try, to find relief and get a more restful night’s sleep.
  • 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.

Leave a comment


  1. Dot

     /  July 30, 2015

    My husband has this he has been using that mask for several years and he cant get use to it . The mask is preventing him from getting any sleep at all! And the mask is expensive. I now know why companies cant find people to drive. you have to be in perfect health. I see why the trucking industry is going down no one wants to truck drive . If he does not use the mask you cant drive and you are monitored every month you have to have so many hours of using that horrible dumb mask!

  2. I’ve been dealing with sleep apnea for years. It’s a bigger problem than most people realize. It’s best to get properly tested and discuss with your physician on how to help correct the problem. Being overweight, I’ve dropped about 35 pounds and that by itself has made a big difference in how I sleep.

  3. Trucker Doc

     /  February 2, 2015

    Here are a number of articles on our national website that will answer your questions on this Sleep Apnea Screening issue.

  4. Mongo

     /  February 1, 2015

    I have a CDL and work in the public sector, I drive a truck only during my 9 hour day time job for the City I live in. Yes, I am 6′ 5″ and weigh 280lbs (borderline from what the Doc said) and have been told I need to lose weight or do the Apnea test but I have also heard that this law is unconstitutional and has been rescinded, is this true or not. I can’t find any information on it.

  5. Trucker Doc

     /  December 29, 2014

    No, sleep apnea screening is not a regulation. This is a much misunderstood subject which we explain on our blog in a series of Sleep Apnea articles.

  6. Chris Hayward

     /  December 29, 2014

    I need to get my new dot med card in the next 2 weeks my bmi is over 35 and my neck is over 17. I get a good night sleep 7+ hours and only wake up to pee once in the night. I do snore Called my primary to ask if he new anymore and sent me a question air for a sleep test. I feel well rested and could fall asleep in the day if tried. Is it mandatory to have a sleep ap test with your bmi over 35,17+ neck and over age 40 ? Or is it depend on the doctor. I work in locally excavation. thanks

  7. Trucker Doc

     /  December 22, 2014

    The doctor may be reading a little to much into the FMCSA guidelines. I would have your primary doctor complete a medical release form for you before returning to the DOT examiner. It needs to state on the release that there is proper compliance with the CPAP and that there are no additional signs or symptoms. Your primary may require some additional testing before hand, just to support his findings.

  8. Rene Pearson

     /  December 18, 2014

    My husband went to renew his CDL (he is an equipment operator for the Ashley NF), he has a hazardous material endorsement, he completed TSA required paperwork (fingerprints, etc). He does have sleep apnea but has been on a cpap machine for over 6 years. When did this requirement to have a sleep study done every year become effective? No one at work knew of this restriction. Appreciate your advice. Thanks – Rene’

  9. Billy

     /  November 12, 2014

    You should not have to wait to drive you can be monitored remotely. Also i see alot of folks complaining about the cost there is a company out there doing free OSA testing.
    We dont have to go broke trying to keep our FEDMED cards.

  10. Trucker Doc

     /  September 13, 2014

    Once you show compliance and the unit is dialed in for you, you should get a 30 to 60 day card to let you drive, but all parties involved want to see how you do on a longer term.
    After the short card you should get the remainder of your one year card.
    From this point on your medical card will be for one year and you will need to have your medical release form completed by your primary doctor done before each new DOT exam.

  11. I am a trucker recently diagnosed with mild sleep apnea. I am currently off work. Just started my CPAP machine. I see referring doctor in a week… 10 days on machine. If I am in compliance and seem to check out ok, how long will I have to be off work? I am domiciled in Iowa. Other health conditions are good. I have been OTR for 25 years.

  12. Trucker Doc

     /  August 5, 2014

    Thank you for your comments.
    For more information on this sleep apnea issue see our national website – DOT Physical DOCTORS Sleep Apnea

  13. Lori

     /  August 5, 2014

    My husband has been driving tractor trailer for 33 years with no accidents or anything. Clean MVR.

    He is obese and he does have hypertension but is controlled with medication. He does snore but not excessively. He does not stop breathing nor does he snort. He is a local driver. He is very worried about his livelihood because of this new Sleep Apnea deal.

    The tiredness of the drivers, for the most part, is not due to Sleep Apnea. Its due to the hours that they are required to drive. If they would cut the hours down to 60 working hours for the drivers there wouldn’t be near the accidents caused by sleep. 70 hours is way too much and now they want to jack it up to 82? Get real!!! Talk about fatal accidents then!

    I believe that drivers that have driven for many years without any accidents should be exempt from this craziness. They need to be “grandfathered” in. The government makes enough money off the truckers and everyone else. Why are they singling out truckers? Why not the people that drive regular four wheeled vehicles, train operators and air plane pilots?

    I guess the drivers that get their CDLs taken from them need to sign up for disability and have the government pay them. There are a lot of drivers that cannot afford to take these tests and cannot get another job because that’s all they know is driving a truck. So if you have sleep apnea I guess you would be qualified for disability.

  14. Trucker Doc

     /  July 23, 2014

    Sounds like a bounce around or worse.
    Suggest you search the FMCSA website and try to enter into conflict with your past examiner. There is a way to stop this, but you have to initiate it. It won’t be easy. FMCSA knows there is a problem, but you will have to do some searching to find it. Good news is, the FMCSA will be helpful, once you get to the conflict resolution stage.
    For more info on this Sleep Apnea issue see the blog posts on our other website.
    Post your comment on our FAQ – Sleep Disorders forum. It will be helpful to other drivers.

  15. chris skinner

     /  July 23, 2014

    i have been out of service for three weeks now due to a d .o.t doctors diagnosis of sleep apnia.. just got my results from the the sleep study. i passed no apnia. guess what. i have hypoxamia. have to stay on oxigen for one more week to satisfy the asshole doctor that my oxtgen blood levels are up to snuff.. what a scam… bmi is good blood presure perfect didnt measure my neck am i just an asshole being bounced around

  16. Trucker Doc

     /  March 31, 2014

    Sounds to me like a run around. If you have been diagnosed with sleep apnea, unless it is some type of company policy, there isn’t any real time frame for restricting your driving. It is nice to have the test results in hand, but you will need to adjust to the mask and machine. I would find out if it is a company policy, because it is not a DOT policy.


     /  March 29, 2014


  18. John valley

     /  March 21, 2014

    I am currentky studying for my Class C Cdl in NEW YORK,but i just found out about the Sleep Apnea issue as I have beeb mmmmmr

  19. Trucker Doc

     /  August 15, 2013

    @Iowa Driver

    Well all I can say about this is the DOT examiner is doing what he believes is correct.

    There is no regulation regarding neck size and sleep apnea, there are guidelines about this issue. In most cases there needs to be more than one thing going on with you to move the DOT examiner to do a neck measurement and base the need for a sleep study.

    If you could check with another examiner, he may have a better understanding of the rules, regs, and guidelines. Hope this might help. Thanks for the question. Trucker Doc

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