The National Highway Traffic Safety Administration attributes 2.2% of all traffic accident fatalities to drowsy driving. People who drive tired, a symptom of sleep apnea, may not realize how much their lack of sleep affects their driving, which is why undiagnosed sleep apnea is a major concern for the Federal Motor Carrier Safety Administration (FMCSA).
Currently, federal law does not require testing, but testing and treatment for sleep apnea can improve productivity and save lives. If you suspect you have sleep apnea or are you ready to renew your Commercial Drivers license (CDL), keep reading to learn more about the Department of Transportation (DOT) and CPAP compliance requirements.
1. Does sleep apnea disqualify you from CDL?
While FMCSA regulations do not currently address sleep apnea specifically, the FMCSA does state an individual with a clinical diagnosis or medical history of any condition that could interfere with their safe driving ability can’t be medically qualified to operate a commercial motor vehicle (CMV) in interstate commerce.
However, once they receive successful treatment, they can then qualify for “medically-qualified-to-drive” status. It’s important to know most sleep apnea cases can be successfully treated.
2. Does DOT or FMCSA require sleep apnea testing?
There are currently no laws requiring a Department of Transportation (DOT) physical for sleep apnea. However, DOT does require a medical examination for truck drivers to receive and maintain a CDL license as well as obtain DOT medical cards.
During the examination, a medical practitioner will determine if you require sleep apnea testing. DOT states it’s up to the medical practitioner to determine whether or not your health condition can interfere with your driving.
3. Can I lose my license if I test positive for sleep apnea?
FMCSA has concluded that moderate to severe sleep apnea levels (per sleep study diagnosis) interfere with safe driving. If you are diagnosed with moderate to severe sleep apnea, you’re considered unsafe for driving a CMV and will lose your CDL. Once you begin treatment and are approved by your medical examiner, you will be able to reapply for your CDL.
Apnea-Hypopnea Index (AHI)
If the results of your sleep study indicate moderate to severe (Apnea-Hypopnea Index (AHI) greater than 20), then you will need to show adequate compliance with your recommended therapy, according to the FMSCA, and report your sleep apnea is being effectively treated.
Drivers who have recently been diagnosed with sleep apnea may continue to drive conditionally for one month while simultaneously beginning CPAP therapy. At the end of that month, drivers can be certified conditionally for three months if there is documented CPAP compliance in the previous two weeks. Drivers should be reevaluated at three months, and if they are compliant with their CPAP therapy, they can be certified for one year
4. What are the symptoms of sleep apnea?
Symptoms medical examiners can take as suggestive of sleep apnea include:
- Daytime sleepiness
- Loudly snoring on a chronic basis
- Witnessed pauses in breathing or apneas
5. What are the risk factors for sleep apnea?
Here are seven risk factors that may indicate sleep apnea:
- BMI greater than or equal to 28.
- Small jaw
- Advancing age
- Family history of sleep apnea
- Small airway
- Neck size greater than or equal to 17 in males
- Neck size greater than or equal to 15 in females
The medical expert panel for the FMCSA states that drivers with a BMI greater than or equal to 33 may be conditionally certified to drive depending on a sleep study.
If you have diabetes, high blood pressure or previously suffered a stroke; You should consider talking with your doctor about a sleep study before your DOT physical exam. By being proactive, you’ll eliminate any unnecessary delays in your certification.
If you have a BMI of 35 or higher, it may be time to consider bringing up sleep apnea with your doctor.
If you have a BMI of 35 or greater, you should be proactive and get yourself tested.
Not sure what your BMI is? Find out with the National Heart, Lung, and Blood Institute’s free BMI calculator.
6. If I have moderate to severe sleep apnea, how can I prepare for my DOT medical exam?
If you have a current sleep apnea diagnosis, make sure you stay compliant with your treatment by meeting the FMCSA’s compliance standards. Be sure to print a copy of your CPAP compliance report to bring with you to your exam. If you have more than one machine and mask, you’ll need to bring a copy of each compliance report.
7. What does CPAP compliance mean?
CPAP compliance is the measurement of how many hours and nights you’re using your therapy, and if you’re using it enough for treatment to be effective. When you’re noncompliant, it means you don’t use your CPAP device as often as you should be or you’re not using it long enough while sleeping.
The FMCSA describes compliance as therapy usage for an average of four hours each night for a minimum of 70 percent of the nights.
Devices today can determine if you actually wear your mask or simply turn the machine on but don’t wear your mask. This measurement helps with assessing compliance and is usually a factor insurance providers measure for purposes of coverage. DOT may also use your CPAP compliance report to prove you’re treatment is successful.
8. What are some tips on getting started with CPAP therapy?
If you think you may have sleep apnea, we recommend speaking with your doctor first. Below are a few steps you can take in order to advocate for yourself to ensure you get the care you need :
- Get a sleep study. The first step to CPAP therapy is to receive your official diagnosis from the doctor. To do this, you’ll need to undergo a sleep study. This is also known as polysomnography and is the gold standard for diagnosing various sleep disorders, including sleep apnea.
- Undergo a titration study if indication. If your sleep study results indicate you have sleep apnea, you’ll need a “titration study” next for the doctor to decide on the accurate pressure level you require for maintaining your airway while you sleep. You may have the titration study the same night you have your sleep study, or the doctor may schedule it for a later date. While in your titration study, a sleep technician will monitor you while you’re sleeping and gradually increase your CPAP machine’s air pressure until you can sleep with few or no sleep events (hypopneas and apneas). Throughout the night, your pressure requirements will vary; therefore, an overnight sleep study is needed so the doctor can prescribe the proper pressure to you.
- Get a prescription. You will need a prescription to start CPAP therapy and purchase a CPAP mask, humidifier, or mask. This is because these machines are FDA classified as Class II Medical Devices, and they can’t be sold legally without a valid prescription.
Be Proactive With Your CPAP Treatment
You need to stay proactive in your treatment. Learn all you can about sleep apnea and your treatment options. If you experience problems or side effects, seek out solutions the minute they become a problem. Get an understanding of the way the equipment works and what your part is in the process and what you should expect.
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David Repasky has been using CPAP treatment since 2017 and has first-hand experience with what it’s like to live with Sleep Apnea. He brings the patient’s perspective to the CPAP.com blog and has received formal training in CPAP machines, masks, and equipment.