companies that do not require sleep study

Hence the primary issue. The FMCSA took all these things down. Today there is not a single mention anywhere of neck sizes or BMI measurements anywhere in title 49 CFR. The medical examiners are making this up. I am not saying your statement is wrong, it is right, but it speaks to how crooked these people have become.

 

Good companies will send you to a clinic that doesn't hassle prospective driver candidates. Of course, a lot of it depends on you not getting flagged by falling within the guidelines. The BMI is a load of crap for the most part, but if you can lose some weight do it by cutting out junk food and carbs a few months before you have a DOT physical. Remember that this job is contingent on your good health, just like an airline pilot. Good health is money in the bank no matter what.

 

I wholeheartedly agree. I have written many comments on these boards and others about drivers and their health. Most drivers once they lose some weight, limit the junk they eat, AND get plenty of exercise will see physicals getting easier. But this still does not change the simple fact much of this OSA thing is coming from crooked greedy people.

 

As a side note, I'll give up some personal info regarding my last DOT physical last year. I took the urine test and I was surprised by the physicians assistant confronting me about high levels of ketones in my urine. I explained to him that I had no food intake in over 24 hours. He asked, me "Why?", I told him that I wanted to weigh in as low as possible. Of course, high ketone levels in a urine sample can by a sign of diabetes, so that was a bit scary, but no harm no foul!

It should also be known that if you are into vitamin and mineral supplements, it can have an effect on your urine readings, specifically blood and ph. I consume at least 1000 milligrams of vitamin C everyday. Also, for those that have been flagged as a "negative dilute", just take a B complex vitamin to negate that.

 

So that's a no, you have no source.

Simple fact is that fmcsa still "suggests" apnea be looked for. It's not a requirement as congress has told them they must follow the rule making process to make it a requirement. They sidestepped congress by simply suggesting apnea be tested for.

 

This is what the FMCSA puts as guidance to Medical Examiners!

Sleep Apnea

49 CFR 391.41(b)(5) requires that an individual must have no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with the ability to safely drive a CMV interstate commerce. The Medical Advisory Criteria (Appendix A to Part 391 Section E), identifies sleep apnea as one of several respiratory dysfunctions that may be detrimental to safe driving as this condition may interfere with driver alertness and may cause gradual or sudden incapacitation.


FMCSA reminds medical examiners that the Agency has no rules or regulatory guidance or criteria specifically on OSA screening, testing, and treatment beyond the existing requirements in 49 CFR 391.41(b)(5) and the 2000 medical advisory criteria which is not mandatory. The Agency relies on the use of sound screening approaches by certified medical examiners to identify which individuals are at greater risk for OSA and to refer only those individuals for diagnostic testing. In screening for OSA during the medical certification process, medical examiners may rely on their medical judgment and may consider relevant medical best practices, and expert recommendations. Medical examiners may confer with treating specialists, and request additional and current information to inform their medical certification determinations. FMCSA urges medical examiners educate CMV drivers regarding their risk factors and the health and safety impact of moderate to severe OSA during the medical certification process to explain clearly to drivers the basis for their medical certification decisions.


Key points to aid a medical examiner’s decision on safe driving ability include using best practice methodology through experience and research to ensure driver and public safety:


· Symptoms associated with sleep apnea include but are not limited to:

o Loud snoring

o Episodes of stopping to breath during sleep

o Gasping for air during sleep

o Awakening with a dry mouth

o Morning headache

o Insomnia

o Excessive daytime sleepiness

o Difficulty paying attention while awake

o irritability

· Are there multiple risk factors? A high BMI by itself may not be sufficient to order a sleep study

· Risk factors include:

o Hypertension (treated or untreated)

o Type 2 diabetes (treated or untreated)

o History of stroke, coronary artery disease, or arrhythmias

o Rheumatoid Arthritis

o Hypothyroidism (untreated)

o Micrognathia or retrognathia

o Loud Snoring

o Small airway (Mallampati Classification of Class III or IV)

o Neck size > 17 inches (male), >15.5 inches (female)

o Age > 42 or male or post-menopausal female

o BMI of 33 and above

· A medical examiner may certify a driver with an OSA diagnosis if the driver is being treated effectively

· A driver determined to be at risk for OSA may be certified for 90 days pending sleep study and treatment (if diagnosed with OSA) at the medical examiner’s discretion

· To requalify, drivers must show effective treatment and compliance. Use of APAP for a minimum of 4 hours per night with 70% nightly usage is a recommended standard from the Medical Review Board. Trucking companies have the option of using their own standards.

 

Just a word about 49 CFR 391.41(b)(5) AND Appendix A to Part 391 Section E

LOOK at the wording of section E,
E. Respiratory Dysfunction: § 391.41(b)(5)
1. A person is physically qualified to drive a commercial motor vehicle if that person: Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with ability to control and drive a commercial motor vehicle safely.

2. Since a driver must be alert at all times, any change in his or her mental state is in direct conflict with highway safety. Even the slightest impairment in respiratory function under emergency conditions (when greater oxygen supply is necessary for performance) may be detrimental to safe driving.

3. There are many conditions that interfere with oxygen exchange and may result in incapacitation, including emphysema, chronic asthma, carcinoma, tuberculosis, chronic bronchitis and sleep apnea. If the medical examiner detects a respiratory dysfunction, that in any way is likely to interfere with the driver's ability to safely control and drive a commercial motor vehicle, the driver must be referred to a specialist for further evaluation and therapy. Anticoagulation therapy for deep vein thrombosis and/or pulmonary thromboembolism is not medically disqualifying once optimum dose is achieved, provided lower extremity venous examinations remain normal and the treating physician gives a favorable recommendation.

Nowhere does it say a ME should go on fishing expeditions in regard to OSA. (If the medical examiner detects a respiratory dysfunction,) a dysfunction is NOT just having a high BMI or a large neck. It means taking the actual time to discuss with the driver the answers to the questions asked on the medical form. I have had MEs look inside my throat and ask me how are you sleeping. They would ask about morning headaches etc. This is how it is supposed to be done.

What is happening is some MEs are invested in sleep labs and accept gifts from drug and CPAP makers reps. This MUST be stopped!

 

As far as kick backs go I am sure it happens some how, but with the strict anti kickback laws it might not happen as much as you think. I work for the number 2 DME company in the country (Friday is my last day) and they are publicly traded. We are not writing checks to Dr. offices for referrals of cpap supplies or equipment.

With that being said I have seen that some of the Megas have Sleep Centers and require drivers to get studies done for various criteria. In that case that whole thing screams all kind of wrong. Makes no sense that you have a valid medical, they want you to get another from one of their Drs. That Dr. decides you have the makings of OSA and send you to an in house sleep lab who then in turn tells you that you have OSA and then sell you (or bill insurance) for a Cpap and supplies. All sorts of SHADY there if you ask me .

 

It's happening all the time. I stand by that statement. I might also add that CPAP reps are only part of it. MEs are also invested in sleep labs. It's a large multifaceted problem.