Sleep Apnea For Truck Drivers - The Complete Guide

What New Truck Drivers Need To Know About Sleep Apnea:

  • Whether a driver gets tested for sleep apnea is a decision made by the trucking companies themselves, and the criteria that cause this are different.
  • Sleep apnea can cause worrying side effects for drivers, including daytime fatigue, vision problems, and slower reaction times.
  • Sleep apnea is a treatable condition; drivers can usually manage it effectively and reduce their risk of drowsy driving.
  • Sleep apnea will not prevent a driver from getting medically certified if managed and treated correctly.
  • The FMSCA offers no specific guidelines on who must get tested for sleep apnea or what specific measurements should prompt a Medical Examiner to recommend testing.
  • Drivers previously diagnosed, at risk of, and treated for sleep apnea may still be required by a prospective company to be tested. The cost of the test, and any necessary treatment, can be covered by the company. Yet, sometimes these costs may be charged to the driver through payroll deductions.

What Is Sleep Apnea?

Sleep apnea (specifically, Obstructive Sleep Apnea) is a physical disorder in which patients have involuntary pauses in breathing or shallow breaths during sleep. It is a widespread condition that 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. A typical patient can have up to 30 such disruptions per night.

In obstructive sleep apnea, the airways become blocked or collapse during sleep which causes the pauses and shallow breathing. Sleep Apnea is a chronic condition that will require ongoing management. It will not go away on its own.

Who Is Most at Risk for Sleep Apnea?

Medical examiners will take into consideration medically accepted symptoms such as:

Those That Are Overweight:

Two-thirds of people with sleep apnea are overweight. This is due to fat deposits around the airways that obstruct breathing. A higher Body Mass Index (BMI) may prompt the medical examiner to order a sleep apnea test.

Those With a Thick Neck:

Having a thicker neck is associated with an increased risk of sleep apnea, as it may narrow the airway. A neck size of 17 inches for men, and 16 inches for women, is generally used as a guideline for testing.

Drivers with High Blood Pressure or Hypertension:

High blood pressure is widespread in people with sleep apnea. Because of this, blood pressure is considered a leading indicator of the condition. Luckily, sleep apnea treatment also can help to lower blood pressure.

Those With Chronic Nasal Congestion:

Sleep apnea occurs twice as often in those who report being consistently congested or stuffed up at night.

Drivers with a Narrow Airway:

For some, a narrow throat is inherited through genes. Other reasons for a narrow airway include due to enlarged tonsils or adenoids, which can constrict the airway.

Those Older in Age:

Sleep apnea is reported to occur more in older adults, especially those over 60.

Other risk factors that have been associated with sleep apnea:

Additionally, statistically, males are more likely to have sleep apnea than females, and African Americans are more likely to have it than other demographics.

BMI Calculator:

BMI Calculator


Symptoms Of Sleep Apnea:

Many who have sleep apnea often don't even realize it. This is because, unless apnea is being tested for, a routine doctor visit usually won't detect it. There is no simple diagnostic test to diagnose it. Add to that the fact that most people tend to be asleep when symptoms occur (it is "sleep" apnea, after all), making it difficult to self-diagnose. The condition can go unnoticed indefinitely without another person nearby to witness an event.

  • Excessive daytime sleepiness
  • Frequent nighttime urination
  • Loud snoring
  • Difficulty staying asleep
  • Displaying difficulty holding attention and memory problems
  • Abrupt awakening with shortness of breath
  • Morning headaches
  • Waking up with sore or dry throat
  • Fatigue (or a general lack of energy)
  • Mood changes
  • Impotence

The FMCSA Position on Sleep Apnea:

FMCSA regulations do not specifically touch on sleep apnea. The FMCSA states that existing regulations “prescribe that a person with a medical history or clinical diagnosis of any condition likely to interfere with their ability to drive safely cannot be medically qualified to operate a commercial motor vehicle (CMV) in interstate commerce.”

See Also: The FMCSA Guide to Driving When You Have Sleep Apnea

However, in early 2015, the FMCSA issued a bulletin to medical examiners and training organizations outlining their position on the subject. Several studies 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 relying 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.

In short, the FMSCA states that the issue of sleep apnea screening, treatment, and management is best left to medical examiners. And treatment should be provided by healthcare professionals. And as with other medical issues, the medical examiner will take into consideration many factors regarding potentially disqualifying conditions.

Sleep Apnea Treatment Options:

Continuous Positive Airway Pressure (CPAP) Therapy:

With a diagnosis of sleep apnea, drivers may be required to carry and use continuous positive airway pressure (CPAP) machines on the road. A CPAP machine connects to a mask that covers the nose or the nose and mouth. This machine increases air pressure in the throat to prevent the airway from collapsing when breathing.

Research and studies have shown that CPAP decreases daytime drowsiness, as well as lowering blood pressure and the risk of heart failure. For most, CPAP is the best non-surgical method for sleep apnea treatment.

In addition, those using CPAP to treat the condition generally experience better quality sleep. This brings correlated benefits to drivers such as increased energy and alertness, lower stress levels, a more robust immune system, and even a longer life expectancy.

Exercise and Weight Loss:

Like it or not, a driver's BMI will help determine whether a trucking company has them tested for sleep apnea. This makes lowering BMI the best way to avoid apnea testing. There are exceptions, but losing weight generally lowers a driver's BMI. This will also often have the knock-on effect of improving your overall health.

Drivers who must use CPAP (or any other method) to treat their sleep apnea will need follow-up testing. When this happens, lowering BMI will help take some drivers out of the risk pool for sleep apnea testing.

Oral Appliances:

Simpler devices (such as mandibular advancement devices, mouth guards, and tongue retainers) are also available to help drivers that suffer from sleep apnea. Such instruments are inserted into the mouth before heading to bed. These dental appliances are designed to help keep airways open during sleep and maintain positive airway pressure. Such solutions are lesser used than CPAP and not as effective. They may be more comfortable and easier to use for some people.


Finally, there are also surgical solutions for those suffering from sleep apnea. They are usually explored as a last resort after other options have shown to be inadequate.

Will a diagnosis of sleep apnea keep me from being able to drive?

A sleep apnea diagnosis will not necessarily keep a driver from being able to work. Sleep apnea won't necessarily disqualify a driver from getting their CDL when adequately managed. 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?

Many medical treatments and homeopathic management options are available for truck drivers. Most commonly, drivers must have a CPAP machine in their trucks. This machine is a small electric device that helps pump oxygen while sleeping.

Those looking to improve their health should consider DIY interventions such as weight loss programs that have shown promise in reducing instances of sleep apnea. Even decreasing body weight by 10-15% can reduce the severity of sleep apnea by 50% in moderate cases.

What are the laws on truck drivers and sleep apnea?

Generally, there are no specific laws outlining trucker-specific sleep apnea issues. The rules that govern drivers with sleep apnea are imposed by employers.

Can CMV drivers be qualified while being prescribed Provigil (Modafinil)?

Some drivers may choose to take medication to help treat their sleep apnea. Provigil (Modafinil) is a common medication used for treating sleep disorders. It won't resolve the underlying issues that cause sleep apnea. But still, drivers can use medicine to treat excessive sleepiness caused by certain sleep disorders. These sleep disorders are narcolepsy, obstructive sleep apnea, hypopnea syndrome, and shift work sleep disorders.

Drivers considering Provigil should be aware of several concerning side effects. This includes chest pain, dizziness, difficulty breathing, heart palpitations, irregular or rapid 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. In addition, Provigil may affect concentration and function or may hide signs that an individual is tired.

Also, many drugs interact with Provigil. This can include common over-the-counter medications, prescription medications, nutritional supplements, herbal products, alcoholic beverages, and caffeine. This means that the use of Provigil should take place under your physician's careful supervision and guidance.

It is recommended that until individuals know how Provigil affects them, they may not drive, use machinery, or do any activity that requires mental alertness.

Straight From the Trucker's Mouth: Advice Found in the Trucking Truth Forums

User Mountain Girl from Rocky Mountains, CO, on what being diagnosed with sleep apnea is like:

I know of a retired physician who apparently had it for years & had no idea he had it. He was recently diagnosed in the past couple of months. Since getting treatment, his life & health have improved drastically.

There is a statistical and direct relationship between neck circumference, snoring, and apnea (the absence of breathing). The patient breathes and snores to the point where breathing stops for moments at a time. The brain then wakes the patient into conscious or semi-consciousness to start breathing again. The patient then falls back to sleep. Still, after a few minutes, they will likely wake up again to take a sufficient breath.

With the sleep study, using electrodes on the head, specialists can see (and prove) where the patient has woken. Sometimes it can be as many as 300-600 times (not uncommon) in one night's "sleep." Therefore, the patient hasn't really "slept" at all.

This can cause a person to fall asleep unexpectedly for unknown periods of time while driving. The retired physician I know had done just that a few times. He finally "turned himself in" to his own doctor to start the study process. He no longer naps during the day nor falls asleep at the wheel. It's a serious disorder and causes a plethora of secondary health problems, as you can imagine, after years and years of never getting enough REM sleep. Many patients have reported phenomenal improvements in health, including weight loss, once using a CPAP (continuous positive airway pressure) machine.

User G-Town from Lewes, DE, on Being Tested for Sleep Apnea Without Displaying Symptoms:

With that said, what is bothersome for me, having never exhibited any symptoms of SA, is my age (57), my neck size, and my BMI. Years of athletic training left me with an above-average size neck and muscle mass. Body fat percentage, waist size, and resting heart rate are also indicators being ignored.

If I had SA and didn't know it, I'd want to get treated for it. But like [others] suggests, there may be more to this. We should all start investing in companies manufacturing CPAP devices. It looks like we'll help drive up their sales.

User guyjax(Guy Hodges) from Pine Bluff, AR, on Driving While Using a CPAP or BiPap:

Many drivers use a CPAP or BiPap machine depending on what their doctor says. [If] you comply with the rules, you should be OK. I know you will have to have the memory card read every so often, so they know you are using it. Or you will have to get one with a removable memory card so they can track its use.

User Ken C from Huntsville, NC, on breaking into the trucking industry with sleep apnea:

Having Sleep Apnea is not a deal killer. I have it but had to get a newer machine with a memory card and a small wifi modem attached so they can see my usage.

Join the crowd; Prime Inc will even pay all the upfront costs and then take $40 a week out of your checks until paid for.

User Fatsquatch from Tacoma, WA, on being flagged for sleep apnea testing:

It's not your weight per se that they're going by. It's your BMI, which is based on your weight in relation to your height. If your BMI is over 35, they'll measure your neck, and if it's over 17" around, you'll be recommended for a sleep study to see if you have sleep apnea.

As for what will happen after that point, that varies wildly from one company to the next. Some companies won't even consider a driver who needs a bi-pap or c-pap machine. Others will allow it as long as you actually use it. It's by no means an automatic disqualification to getting your medical card or CDL like insulin-dependent diabetes would be. The best advice is to contact the companies you're interested in and ask what their policy is regarding sleep machines, just in case.

Sources to Incorporate

Cleveland Clinic Guide to Managing Diabetes

The Sleep Apnea Witch Hunt

How Weight Affects Sleep Apnea

Pathophysiology of Sleep Apnea


Commercial Driver's License (CDL)

A CDL is required to drive any of the following vehicles:

  • Any combination of vehicles with a gross combined weight rating (GCWR) of 26,001 or more pounds, providing the gross vehicle weight rating (GVWR) of the vehicle being towed is in excess of 10,000 pounds.
  • Any single vehicle with a GVWR of 26,001 or more pounds, or any such vehicle towing another not in excess of 10,000 pounds.
  • Any vehicle, regardless of size, designed to transport 16 or more persons, including the driver.
  • Any vehicle required by federal regulations to be placarded while transporting hazardous materials.

Commercial Motor Vehicle:

A commercial motor vehicle is any vehicle used in commerce to transport passengers or property with either:

  • A gross vehicle weight rating of 26,001 pounds or more
  • A gross combination weight rating of 26,001 pounds or more which includes a towed unit with a gross vehicle weight rating of more than 10,000 pounds
  • CSA:

    Compliance, Safety, Accountability (CSA)

    The CSA is a Federal Motor Carrier Safety Administration (FMCSA) initiative to improve large truck and bus safety and ultimately reduce crashes, injuries, and fatalities that are related to commercial motor vehicle


    Federal Motor Carrier Safety Administration

    The FMCSA was established within the Department of Transportation on January 1, 2000. Their primary mission is to prevent commercial motor vehicle-related fatalities and injuries.

    What Does The FMCSA Do?

    • Commercial Drivers' Licenses
    • Data and Analysis
    • Regulatory Compliance and Enforcement
    • Research and Technology
    • Safety Assistance
    • Support and Information Sharing


    Department Of Transportation

    A department of the federal executive branch responsible for the national highways and for railroad and airline safety. It also manages Amtrak, the national railroad system, and the Coast Guard.

    State and Federal DOT Officers are responsible for commercial vehicle enforcement. "The truck police" you could call them.


    Commercial Motor Vehicle

    A CMV is a vehicle that is used as part of a business, is involved in interstate commerce, and may fit any of these descriptions:

    • Weighs 10,001 pounds or more
    • Has a gross vehicle weight rating or gross combination weight rating of 10,001 pounds or more
    • Is designed or used to transport 16 or more passengers (including the driver) not for compensation
    • Is designed or used to transport 9 or more passengers (including the driver) for compensation
    • Is transporting hazardous materials in a quantity requiring placards

    Interstate Commerce:

    Commercial trade, business, movement of goods or money, or transportation from one state to another, regulated by the Federal Department Of Transportation (DOT).


    Commercial trade, business, movement of goods or money, or transportation from one state to another, regulated by the Federal Department Of Transportation (DOT).


    Abnormally high blood pressure.

    Sleep Apnea:

    A physical disorder in which you have pauses in your breathing, or take shallow breaths, during sleep. 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. It affects about 18 million people in the U.S.


    Body mass index (BMI)

    BMI is a formula that uses weight and height to estimate body fat. For most people, BMI provides a reasonable estimate of body fat. The BMI's biggest weakness is that it doesn't consider individual factors such as bone or muscle mass. BMI may:

    • Underestimate body fat for older adults or other people with low muscle mass
    • Overestimate body fat for people who are very muscular and physically fit

    It's quite common, especially for men, to fall into the "overweight" category if you happen to be stronger than average. If you're pretty strong but in good shape then pay no attention.

    Body Mass Index:

    Body mass index (BMI)

    BMI is a formula that uses weight and height to estimate body fat. For most people, BMI provides a reasonable estimate of body fat. The BMI's biggest weakness is that it doesn't consider individual factors such as bone or muscle mass. BMI may:

    • Underestimate body fat for older adults or other people with low muscle mass
    • Overestimate body fat for people who are very muscular and physically fit

    It's quite common, especially for men, to fall into the "overweight" category if you happen to be stronger than average. If you're pretty strong but in good shape then pay no attention.


    Constant Positive Airway Pressure

    CPAP is a breathing assist device which is worn over the mouth or nose. It provides nighttime relief for individuals who suffer from Sleep Apnea.


    Dispatcher, Fleet Manager, Driver Manager

    The primary person a driver communicates with at his/her company. A dispatcher can play many roles, depending on the company's structure. Dispatchers may assign freight, file requests for home time, relay messages between the driver and management, inform customer service of any delays, change appointment times, and report information to the load planners.


    Drive-A-Check Report

    A truck drivers DAC report will contain detailed information about their job history of the last 10 years as a CDL driver (as required by the DOT).

    It may also contain your criminal history, drug test results, DOT infractions and accident history. The program is strictly voluntary from a company standpoint, but most of the medium-to-large carriers will participate.

    Most trucking companies use DAC reports as part of their hiring and background check process. It is extremely important that drivers verify that the information contained in it is correct, and have it fixed if it's not.


    Transportation Worker Identification Credential

    Truck drivers who regularly pick up from or deliver to the shipping ports will often be required to carry a TWIC card.

    Your TWIC is a tamper-resistant biometric card which acts as both your identification in secure areas, as well as an indicator of you having passed the necessary security clearance. TWIC cards are valid for five years. The issuance of TWIC cards is overseen by the Transportation Security Administration and the Department of Homeland Security.


    Hours Of Service

    HOS refers to the logbook hours of service regulations.


    When a violation by either a driver or company is confirmed, an out-of-service order removes either the driver or the vehicle from the roadway until the violation is corrected.

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