Posted: 9 years, 2 months ago
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Finally, some professional logic.
The sleep Dr. has recommended no treatment and no follow up appointments. She simply suggests that I lose a few pounds and avoid sleeping on my back (you might recall that I had 18 minutes out of 9 hours where I slept on my back and apneas increased slightly). Without divulging the name of my health care organization, I will say that they are affiliated with one of the most respected Medical Universities on the cutting edge of medicine in the country. Conversely, the DOT certified Nurse Practitioner who did my exam, works for another, not so highly touted health care organization.
With no other symptoms beside BMI, and my low scores from the sleep study, she reports that while borderline Sleep Apnea exists (by the mildest of standards), my insurance company would not even consider me a candidate for CPAP.
Now waiting to see what the NP who did my exam does with this information. It should be interesting, but a 1 year card seems to be her only option at this point. I cannot imagine how she would be able to justify anything less.
The moral to the story: A diagnosis of OSA does not necessarily mean that CPAP is the answer, no matter how much they try and tell you it's the law!!! Don't let this happen to you if you can avoid it. Demand justification if your AHI proves to be fewer than 15. Know that the standards are being implemented in order to pay for their overpriced sleep study programs and not necessarily by what DOT/FMCSA recommends.
If particular companies have implemented their own standards, that is a different story. Drivers have no recourse there and must abide by company policy or move on. At least now, I have documentation to carry with me and an incredible motivation to lose weight a little faster.
Posted: 9 years, 2 months ago
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Going to meet with the sleep study MD today.
My diagnosis of OSA was made based on 5.8 apnea per hour. That is a very mild case when compared with the DOT/FMCSA panel of expert's "primary focus", to identify drivers with an AHI (apnea per hour index) of 15 or more. The focus is on those with "moderate to severe" apnea.
Unfortunately, the DOT examiner who did my physical, after having received a "diagnosis" of OSA, then demanded that I begin CPAP therapy. I nearly jumped through the phone while telling her she was misinterpreting this and other portions of her responsibility as a health care professional. I told her this is unacceptable and I would need to speak with her director.
To make a long story short, she decided that she needed to talk with her Director and would call me back. All the while, now agitated and calling me Mr. rather than Joe.
She called back finally and said that if the Sleep Dr. "prescribes" treatment that does not include CPAP (which they will), and sends her a letter stating such, she'll give me a 30 day card. I asked, then what? She replied, after 30 days, they will have to confirm that you have been compliant and then a 90 day card will be issued, etc. Just like the requirements for CPAP, but in human form and not via smart card.
So, in my meeting with the Dr. today, I will ask for a revision to the diagnosis and it should read "mild sleep apnea" and well under the standard definition of "moderate to sever" as is the focus of the DOT. No restrictions or specific treatment is warranted, only lifestyle changes (lose wt., stop smoking, exercise). Any responsible health care professional would issue a 1 year card, rather than going the typical route. We'll see.
Sleep apnea is a serious condition and should be treated as such! Just be careful that your examiner and subsequent sleep tech/MD is interpreting things correctly so that you are not subject to be tied to this machine for the rest of your professional lives, based on misinterpreted guidance, remembering that there is no legislation regarding truck driving and CPAP machines! The guidance however is somewhat clear, as you can see in the bulletin posted originally. On the other hand, take the treatment if you feel that you will benefit from it as so many have. I will not benefit from it. I sleep well and have absolutely no other symptoms.
I'll let everyone know what happens after my appointment today. One thing that is certain, I will not be purchasing any sort of machine.
Stay tuned..... Joe R.
Posted: 9 years, 2 months ago
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Is there a standard deduction for supplies?
Standard Meal Allowance
Generally, you can use the “standard meal allowance” method as an alternative to the actual cost method. It allows you to use a set amount for your daily meals and incidental expenses (M&IE), instead of keeping records of your actual costs. The set amount varies depending on where and when you travel. In this publication, “standard meal allowance” refers to the federal rate for M&IE, discussed later under Amount of standard meal allowance . If you use the standard meal allowance, you still must keep records to prove the time, place, and business purpose of your travel. See the recordkeeping rules for travel in chapter 5 .
Incidental expenses. The term “incidental expenses” means fees and tips given to porters, baggage carriers, hotel staff, and staff on ships. Incidental expenses do not include expenses for laundry, cleaning and pressing of clothing, lodging taxes, costs of telegrams or telephone calls, transportation between places of lodging or business and places where meals are taken, or the mailing cost of filing travel vouchers and paying employer-sponsored charge card billings. Incidental-expenses-only method. You can use an optional method (instead of actual cost) for deducting incidental expenses only. The amount of the deduction is $5 a day. You can use this method only if you did not pay or incur any meal expenses. You cannot use this method on any day that you use the standard meal allowance. This method is subject to the proration rules for partial days. See Travel for days you depart and return , later in this chapter.
Posted: 9 years, 2 months ago
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Posted: 9 years, 2 months ago
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Is there a standard deduction for supplies?
There is a standard deduction for food while on the road, but as far as I can tell, you will need to claim everything else individually and yes, keep all receipts, although for the standard food deduction, just being able to prove that you were truly on the road for the days being claimed is all that is required. You'll have to look up the standard deduction. It's between $50 and $60 per eligible day on the road (typically meaning 'full days').
This is all off the top of my head, so please don't consider this to be sound advice from any sort of tax professional - please do your official research.
An OTR driver can claim nearly everything from glass cleaner and paper towels to beets and burgers. Yes, even company drivers! Just be sure that what you claim is not reimbursed in any way. You cannot claim clothing that can be easily utilized as civilian clothing either. You can however claim uniforms (if they are not provided, but required).
Posted: 9 years, 2 months ago
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Another Standard they use is a neck measurment of 17" or larger as a reason to have the test. They told me I had a 17" neck and might need a test, I pulled out a string that was cut to fit my neck, had the put around my neck (which fit properly) and measure it,, 16 3/4",, they had to change there findings,, just saying. Research " Sleep Apnea.Org" much info,, they ask you Questions like Do you fall asleep watching a movie? if you answer yes, then your going to need a sleep test,, just saying. also the stereo type of a fat old guy is just Prejudice,,, a skinny teen age Girl can have Sleep Apnea to, so the Standards are not an exact science,, Just Saying
Exactly, and my neck size is 16 1/4. I was sent to sleep study based solely on BMI with zero other symptoms. While I appreciate knowing now, that I get higher quality rest by sleeping on my side rather than on my back, there is hardly justification for strapping myself to a $3000 machine for the rest of my professional life. In fact, my BMI was recorded at 33.8. .2 below the threshold. She simply determined that it was borderline and close enough to cause concern. With that, she is holding my medical card. I am sure they were surprised and disheartened to learn that I took my sleep study business elsewhere.
Posted: 9 years, 2 months ago
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You're right. There is the notion of a scam. The truth is, these organizations developed their huge sleep study programs after the the FMCSA announced the initiative back in 2000. The idea was this mandate would be a cash cow in coming years. Unfortunatly for them, the legislation never happened as promised. There are now sleep study programs all around the country that need to be paid for. Hence, the tighter standards were imposed on providers by thier respective organizations. They use the FMCSA as an excuse and manipulate the information provided in order to coerce drivers into believing that they have no options. That is wrong and will almost certainly be dubbed illegal at some point in the future. There will be litigation.
I don't have the answers, but the solution to sleepy driving will not be resolved in this way. It is rather interesting that the "panel's" baseline for determining whether sleep apnea's severity is at a level which may affect a person's major wake time is equal to or greater than 15 apnea or hypopnea per hour. The sleep doctors are closer to 5 or more before diagnosing OSA. The point is, many more drivers are being diagnosed than even the panel of experts recommend. Who knows how many?
Posted: 9 years, 2 months ago
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I just want to clarify that I started this thread with the intent for it to be informational, rather than a rant. I read some of what I wrote earlier and realized it was beginning to sound like ranting. I apologize for that!
In the end, to all those affected, try not to fold under the pressure and ask questions if/when you are ordered to a sleep study. Consider referring to your primary physician if you have one, but at the very least, question the person performing the exam and making the decisions on your medical card. This is an ongoing issue with the FMCSA and others. Until it is resolved, drivers and prospective drivers will be caught in the middle. For us, it is a game changer and is having an impact on thousands individual livelihoods.
Personally, I don't take medications or therapies unless I've exhausted all other remedies. I will not be forced by any government entity to alter that standard.
Oh, and by the way Rick, the magic BMI number is actually 34 (although it may be 33 now). I have never seen a number like 39 in all my research. Similar to many other discrepancies within this mandate, however, there could be dozens of BMI standards floating between providers; I don't know.
I'll let the forum know how this turns out, just in case anyone finds themselves in a similar situation.
I'm waiting to hear back from the nurse in terms of how she will interpret the results of the sleep study. In the interim, I will try to get my physician to prescribe "position therapy" and I'll simply wear a fanny pack sort of thing to keep me from rolling onto my back. That should be considered appropriate treatment. There isn't now and never will be legislation that demands CPAP treatment for every trucker diagnosed with a mild case of sleep apnea - ever!
Posted: 9 years, 2 months ago
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Trust me Rick, I am the first to admit that I'm not at my prime wt. at 228 lbs and 5' 9" even though, up until nearly 2 years ago, I was a complete gym rat and my muscle far outweighs the average 48 year old dude as compared to the fat. I have put on some unwanted pounds, but I don't fall into the "typical category" and I am by far, not the only one. The concerns are genuine and deserve a look! While everyone cowers away from the issue, drivers are being cheated from the truth.
Here is the latest: I just received my results from the sleep study. To make it short, MY sleep doctor considers my apnea a mild case. In fact it recorded only 5.7 apneas per hour. Those who want to dig can look-up the DOT's so called recommendations to see how low that truly is in their minds. For 18 minutes, I was on my back and recorded an average of 45 apneas per hour!!! Wow!!
Now, while CPAP is the standard "go to" for even my case, there is also the recommendation for "positional therapy" - I think that describes itself (no machines, just maybe a device that keeps me from rolling onto my back).
The million dollar question: Once I report this to the DOT certified Nurse Practitioner who is awaiting the results and holding my med card; how will she react? Will she sign off? 1 month? 3 months? 1 year? Hmmm.... DOT and FMCSA doesn't tell her whether that's acceptable. How will she be able to monitor this therapy for compliance?
My guess is that she'll try and force the CPAP on me to protect herself and I'll have no other choice but to comply. Well, there is one other choice, but not going through with my plans to drive OTR is unacceptable to me.
More than one driver has compared it with being raped. I'm not sure I would categorize in that way, but it sure feels like we're governed by juveniles.
Posted: 9 years, 2 months ago
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Directions to Marshfield Wisconsin
Hey Mike:
This is just an observation. I was born and raised in the Chicago area but have been long gone from there since 1988.
I visit there and northern Indiana frequently. Two things: First, you mention that you'll be traveling on Sunday afternoon. Drive through town and enjoy! It's Sunday, my friend. While there are no guarantees in that fine city, I doubt that you'll encounter anything too significant.
Even if you were traveling during the morning rush on Monday, if this is intimidating in your 4 wheeler, what will you do when you get into a truck? Unless you get extremely lucky, you will almost certainly find yourself navigating through much worse traffic than in Chicago. Despite what you hear, Chicago traffic is very navigable for a responsible driver in any sized vehicle.
I wish you the best at Roehl. They are in fact on my short list of companies for when I finish private CDL school.
Joe