Sleep Apnea Recommendations for Drivers

by Wally Parke

First off let me state there are no sleep apnea regulations for commercial drivers and their Department of Transportation (DOT) physicals. Nor are there any rules for roadside checks of driver’s neck sizes. The Federal Motor Carrier Safety Administration may choose to address the issue with a rule in the future, but at this point there is no time frame for such to be done.

Sleep Apnea in regard to commercial drivers has been a somewhat controversial and often misunderstood issue. On the controversial side for drivers is the cost of sleep studies, sometimes as high as $3500 with the median cost in the $2000 to $2500 range. Insurance won’t always cover sleep apnea studies or devices, and if it does there are high deductibles to deal with drivers say. And many drivers perceive sleep study recommendations when getting their DOT physical as nothing but a way for doctors to support expensive sleep study facilities they may have ties with. Add to that the pictures they see of a driver sleeping with a mask strapped on to their head – it doesn’t look all that pleasant.

In contrast though on the misunderstood side is the benefit drivers realize when sleep apnea is properly diagnosed and treated. Many drivers have tried to tell other drivers their stories of how it helped them, often to closed ears. Drivers who have benefited from the treatment say they were previously always tired, never felt like they got a good night’s sleep, would doze off during the day, and just overall lacked energy. After getting the proper diagnosis and then finding an airway device that is comfortable for them (which can be a daunting task with lots of trial and error) they are thrilled. They say sleep apnea is real, and can be treated. Even though they were skeptical in the beginning that it was a real problem.

The Medical Review Board of the Federal Motor Carrier Safety Administration (FMCSA) put forth this week their official recommendations to the agency on sleep apnea criteria, for screening and driver disqualification.

Again, these are only recommendations and the Medical Review Board itself has not yet adopted them. If it were to move further they would encourage the FMCSA require a commercial driver to be screened if he or she:

  • has a body mass index greater then 40, or
  • has a body mass index (BMI) greater than 33 and meets three of the following: is older than 42, is male, is a postmenopausal female, has diabetes, has high blood pressure, has a neck size greater than 17 inches for males or 15.5 inches for females, has a history of heart disease, snores loudly, has witnessed apneas, has a small airway, has untreated hypothyroidism or has micrognathia or retrognathia (jaw and mandible conditions).


Male drivers 42 or older who also have a BMI of 33 would automatically qualify for screening if that they had one other criteria along with the age and BMI thresholds. Also if there was a sleep apnea diagnosis drivers would only qualify for a one year DOT physical instead of the standard every other year certification. A 90-day certification would be issued to drivers with a sleep apnea diagnosis and during that time would have to be tested and begin their treatment to get an extension of their DOT physical.
So the board would recommend the FMCSA require drivers to only be allowed to continue to operate if they are being treated effectively as determined by a certified sleep specialist.

The recommendations by the board will be addressed again at future meeting for finalizing them, but as of yet there is no date set for that meeting.

The recommendations were based on various public meetings which took place this year, and testimony was heard from drivers as well as advocacy groups and medical professionals.

The FMCSA is under no legal requirement to implement any of the board’s recommendations. But if they did decide to develop a sleep apnea rule in the future, the suggestions could be a foundation for it.