What New Drivers Need To Know About Sleep Apnea:
The decision on who, if anyone, should be tested is made by the trucking companies themselves, and they may all have different criteria.
Sleep apnea can cause daytime fatigue, vision problems, and slower reaction times. All important concerns for someone driving a 40-ton truck.
Sleep apnea is a treatable condition, and drivers can usually manage it effectively and reduce their risk for drowsy driving.
Having sleep apnea will not prevent you from getting your medical certification, if managed and treated properly.
The FMSCA offers no specific guidelines on who should be tested for sleep apnea , or what specific measurements should prompt a Medical Examiner to recommend testing.
Drivers previously diagnosed and treated for, or at risk of, sleep apnea , may still be required by a prospective company to be tested. The cost of the test, and any necessary treatment, may be covered by the company, but may also be charged to the driver, usually through payroll deductions. Every company has different policies on this. It is important to ask them individually.
What Is Sleep Apnea?
Sleep apnea (specifically, Obstructive Sleep Apnea), is a physical disorder in which you have pauses in your breathing, or take shallow breaths, during sleep. It affects about 18 million people in the U.S.
These pauses can last anywhere from a few seconds to a few minutes. Normal breathing will usually resume, sometimes with a loud choking sound or snort.
In obstructive sleep apnea, your airways become blocked or collapse during sleep, causing the pauses and shallow breathing.
It is a chronic condition that will require ongoing management.
Who Is Most At Risk For Sleep Apnea? It should be noted that ANYONE can develop sleep apnea. For better or worse, the FMCSA has identified certain conditions as possible symptoms for further testing.
Medical examiners will take into consideration medically accepted symptoms such as:
Obesity/Overweight: By most accounts, a BMI in the range of 36-41 will prompt a sleep apnea test, depending on the company.
Two-thirds of people with sleep apnea are overweight. Fat deposits around your airways may obstruct breathing. A higher Body Mass Index (BMI) may prompt the medical examiner to order a sleep apnea test.
A thick neck is typically associated with an increased risk of sleep apnea, as it may narrow the airways. A neck size of 17 inches for men and 16 for women is generally used as a guideline for testing.
High Blood Pressure/Hypertension:
High blood pressure is very common in people with sleep apnea, and is considered a possible indication of the condition. Sleep apnea treatment has been shown to lower BP.
Chronic Nasal Congestion:
Sleep apnea occurs twice as often in those who report being consistently congested (stuffed-up), especially at night.
Whether a narrow throat inherited through your genes, or due to enlarged tonsils/adenoids which can block your airway.
Sleep apnea is reported to occur more in older adults, especially those over 60.
Other risk factors that have been associated with sleep apnea:
- Someone else in your family having it.
- Alcohol drinkers.
- Statistics show more males with sleep apnea than females.
- Some studies have shown that African-Americans are more likely to have it.
Symptoms Of Sleep Apnea:
Many people who have sleep apnea don't realize it. Routine doctor visits won't usually detect it, and there is no blood test to diagnose it. Add to that most people would tend to be asleep when symptoms occur, ("sleep" apnea), and without another person nearby to witness an event, the condition can go unnoticed.
- Excessive daytime sleepiness.
- Frequent night-time urination.
- Loud snoring.
- Difficulty staying asleep.
- Attention/Memory Problems.
- Abrupt awakening with shortness of breath.
- Morning headaches.
- Waking up with sore or dry throat.
- Fatigue/Lack of energy.
- Mood changes/Impotence.
The FMCSA and Sleep Apnea:
The FMCSA regulations on the physical qualifications of drivers addresses obstructive sleep apnea in this way: "Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his/her ability to control and drive a commercial motor vehicle safely;"
In early 2015, they issued a bulletin to Medical Examiners and training organizations outlining their position on the subject.
Several studies compiled by a group of doctors offered guidance to the FMCSA regarding sleep apnea as it applies to truck drivers. In response, the U.S. Congress passed a bill requiring that if any action is to be taken by the FMCSA on sleep apnea, it must establish formal rules rather than rely on "guidance". The bulletin officially leaves the decision to the medical professionals, while still including "reminders" of what would typically indicate a need for further testing. Any decision about whether sleep apnea will keep a driver off the road will come from the medical examiner, rather than the FMSCA itself.
In a nutshell, the FMSCA states that the issue of sleep apnea screening, treatment, and management is best left to the medical examiner and treating healthcare professionals. As with other medical issues, the Medical Examiner will take into consideration many factors regarding potentially disqualifying conditions. The DOT and the FMSCA do not issue specifics on whether sleep apnea will keep you off the road. It will be up to your doctor and the Medical Examiner, depending on the severity of your condition and treatment.
Sleep Apnea Treatment Options:
Continuous Positive Airway Pressure (CPAP) Therapy:
With a diagnosis of sleep apnea, drivers may be required to carry and use CPAP machines on the road. A CPAP is connected to a mask that fits over your nose (most commonly), or your nose and mouth, and and increases air pressure in your throat to prevent your airway from collapsing when you breathe in.
Research and studies have shown that CPAP decreases daytime drowsiness, as well as lowering blood pressure and the risk of heart failure. It has been shown to be the best non-surgical method for sleep apnea treatment.
In addition, people using CPAP to treat the condition generally experience better quality sleep, reaping the benefits such as increased energy and alertness, lower stress levels, stronger immune system and longer life expectancy.
Exercise and Weight Loss:
Like it or not, your BMI will help determine whether a trucking company has you tested for sleep apnea. There are exceptions, but generally, losing weight will lower your BMI, and improve your overall health.
As drivers who are required to use CPAP (or any other method) to treat their sleep apnea will be required to do follow-up testing, lowering your BMI in the meantime will help take you out of the risk pool for sleep apnea testing.
A device that you put in your mouth before going to sleep that is designed to help hold your airways open. Lesser-used than CPAP, and not as effective, they may be more comfortable and easier to use for some people.
Usually used as a last-resort, after other options have been proven to be inadequate.
Questions About Sleep Apnea and Truck Drivers:
Will a diagnosis of sleep apnea keep me from being able to drive?
Not necessarily. Properly managed, sleep apnea won't necessarily disqualify you. The Medical Examiner (ME) will make recommendations based, in part, on the severity of your condition, and risk factors.
What sleep apnea treatments are available for truck drivers?
Most commonly, you will be required to have a CPAP machine in the truck, which is simply a small electric device that helps pump oxygen to you while you sleep.
What are the laws on truck drivers and sleep apnea?
Generally, there are no specific laws outlining trucker-specific sleep apnea issues. The laws for truckers are the same as for pedestrians.
Can CMV drivers be qualified while being prescribed Provigil (Modafinil)?
Provigil (Modafinil) is a medication used to treat excessive sleepiness caused by certain sleep disorders. These sleep disorders are narcolepsy, obstructive sleep apnea/hypopnea syndrome and shift work sleep disorders. Provigil has several concerning side effects such as chest pain, dizziness, difficulty breathing, heart palpitations, irregular and/or fast heartbeat, increased blood pressure, tremors or shaking movements, anxiety, nervousness, rapidly changing mood, problems with memory, blurred vision or other vision changes to name a few.
Many drugs interact with Provigil which include over-the-counter medications, prescription medications, nutritional supplements, herbal products, alcohol containing beverages and caffeine. The use of Provigil needs careful supervision. Provigil may affect concentration, function or may hide signs that an individual is tired.