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Trucking Laws

DOT Sleep Apnea Regulations: What You Need To Know

DOT Sleep Apnea Regulations: What You Need To Know

There are no DOT sleep apnea regulations that address if or when a truck driver with this medical condition can continue to drive a commercial motor vehicle. Also, there are no regulations for how medical examiners should screen, diagnose and treat trucker drivers who have obstructive sleep apnea.

The lack of specific DOT sleep apnea regulations from the U.S. Department of Transportation and the Federal Motor Carrier Safety Administration stands in stark contrast to the serious and now well-known safety dangers that this medical condition can pose for truck drivers.   

Driver sleepiness is the cause of nearly 30% of truck crashes in the U.S. This sleep disorder compounds the dangers of drowsiness and is believed to increase truck drivers’ risk of being involved in a truck accident by 250% compared with well-rested truck drivers. (FreightWaves, January 2, 2020) 

Nearly one-third of U.S. truckers on the road today are estimated to have this medical condition. 

The Federal Motor Carrier Safety Administration (FMCSA), which is part of the U.S. Department of Transportation, is responsible for using regulations and safety rules to reduce crashes, injuries and fatalities involving large trucks in order to improve the safety of commercial motor vehicles and to save lives.

There are no DOT sleep apnea regulations

Despite acknowledging the prevalence and dangers of sleep apnea for truck drivers, the FMCSA is surprisingly quite open about its lack of safety regulations to protect truckers and the public:

  • “FMCSA regulations do not specifically address sleep apnea . . .” (2014)
  • “FMCSA’s physical qualifications standards and advisory criteria do not provide OSA [obstructive sleep apnea] screening, diagnosis or treatment guidelines for medical examiners to use in determining whether an individual should be issued a medical certificate.” (2015)
  • “With regard to identifying drivers with undiagnosed OSA [obstructive sleep apnea], FMCSA’s regulations and advisory criteria do not include screening guidelines.” (2015)
  • The FMCSA’s “regulations and advisory criteria do not include recommendations for treatments for OSA [obstructive sleep apnea] . . .” (2015)
  • “[T]here are no FMCSA rules or other regulatory guidance . . . with guidelines for screening, diagnosis, and treatment of OSA in CMV drivers. Medical certification determinations for such drivers are made by the examiners based on the examiner’s medical judgment rather than a Federal regulation or requirement.” (2017)

What is the DOT sleep apnea definition?

The DOT sleep apnea definition explains that “obstructive sleep apnea” is a “respiratory disorder characterized by a reduction or cessation of breathing during sleep,” which causes sufferers to wake up “gasping and choking as they struggle to breathe.” 

The pauses or interruptions in breathing that are caused by this “breathing-related sleep disorder” can “last at least 10 seconds or more and can occur up to 400 times a night.”

What is the prevalence of this medical condition among truck drivers?

Nearly one third (28%) of truck drivers in the U.S. have mild to severe sleep apnea, according to research sponsored by the FMCSA and the American Transportation Research Institute of the American Trucking Associations.

It has also been estimated that up to 30% of truck crashes are caused by driver sleepiness, which is significant given that obstructive sleep apnea is the most frequently diagnosed cause of “excessive daytime sleepiness.” 

What are the dangers that a DOT sleep apnea rule would help prevent?

Through notices and bulletins issued by the FMCSA, it is clear that a DOT sleep apnea rule would help prevent the very real and deadly danger that sleep-deprived truck drivers pose to themselves and to the rest of the driving public. Here are a few of the FMCSA’s observations:

  • “[S]tudies show that people with untreated sleep apnea have an increased risk of being involved in a fatigue-related motor vehicle crash.” (2014) 
  • Obstructive sleep apnea (OSA) “may culminate in unpredictable and sudden incapacitation (e.g., falling asleep at the wheel), thus contributing to the potential for crashes, injuries, and fatalities.” (2015)
  • Because of this medical condition interrupts and disrupts sleep, “eight hours of sleep [for a person with obstructive sleep apnea] can be less refreshing than four hours of ordinary, uninterrupted sleep, posing serious cognitive and neuropsychological risks. Moreover, someone without enough restorative sleep is often unaware of impairments to a range of cognitive abilities such as vigilance, reaction time, attention span, memory, learning, problem-solving, decision making, and multi-tasking. OSA can also lead to mood swings and difficulty controlling inappropriate feelings.” (2015)
  • “In driving simulations, OSA patients were more likely to unintentionally swerve and strike objects – a serious and dangerous outcome for the transportation industry.”
  • “Undiagnosed or inadequately treated moderate to severe [obstructive sleep apnea] can cause unintended sleep episodes and resulting deficits in attention, concentration, situational awareness, and memory, thus reducing the capacity to safely respond to hazards when performing safety sensitive duties,” such as driving semi-truck, tractor-trailer or other commercial motor vehicle. (2016 and 2017)
  • Obstructive sleep apnea “is a critical safety issue that can affect operations in all modes of travel in the transportation industry.” (2016)

What are the DOT sleep apnea risk factors?

The DOT sleep apnea risk factors include: (1) obesity; (2) male gender; (3) advancing age; (4) family history of obstructive sleep apnea; (5) large neck size; (6) a small throat; and (7) smoking and alcohol use.

What are the symptoms of this medical condition?

Symptoms include: (1) excessive daytime sleepiness; (2) disturbed sleep; (3) loud snoring; (4) gasping or chocking while sleeping; (5) morning headaches and nausea; (6) loss of sex drive/impotence; (7) irritability and/or feelings of depression; (8) concentration and memory problems; and (9) frequent nighttime urination.

Is there any DOT sleep apnea policy?

Based on FMCSA notices, bulletins and information on its website, it appears that the DOT sleep apnea policy is to put the burden of identifying truck drivers with sleep apnea on the medical examiners whose job it is to determine whether a truck driver meets the FMCSA’s “physical qualifications” to drive.

In a 2015 Bulletin, the FMCSA stated:

“FMCSA relies on medical examiners to make driver qualification decisions based on their clinical observations, findings and standards of practice. The current regulations and advisory criteria do not include guidelines concerning OSA screening, diagnosis and treatment.”

Under the FMCSA’s rule for the “physical qualifications for drivers,” 49 CFR § 391.41(b)(5), a person is qualified to drive a truck so long as he or she “[h]as 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 “advisory criteria” issued in 2000 and reaffirmed in the 2015 Bulletin, the FMCSA explained that if a “medical examiner detects a respiratory dysfunction” such as “sleep apnea” 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.”

Whether a truck driver with sleep apnea is ultimately cleared to drive and issued the necessary medical certificate is left to the medical examiner’s “medical judgment,” “medical training” and “expertise.”

Does the policy prevent a truck driver from ever driving again?

No. In order to “regain [his or her] ‘medically-qualified-to-drive’ status,” a truck driver with with this medical condition must undergo and successfully complete treatment and a “medical examiner must qualify and determine [the] driver’s medical fitness for duty.”

Is the DOT sleep apnea policy adequate to promote safety?

Arguably, the FMCSA does not think so. Although the FMCSA has not created any specific DOT sleep apnea regulations or rules, it has expressed its own lack of confidence in its own policy.

The FMCSA stated in a 2016 notice that “the current guidance is not helpful if the ME [medical examiner] does not have sufficient experience or information to suspect the driver may have OSA, or the driver does not share with the examiner any previous diagnosis that he has the condition.”

In other words, if the truck driver does not report any symptoms or if no symptoms are detectable by the doctor and/or if the truck driver fails to disclose that he has been diagnosed with sleep apnea, then the condition will undiagnosed and untreated and the truck driver will continue to pose a danger to himself and others.

Why isn’t there a formal, official DOT sleep apnea regulation?

This is a great question.  Unfortunately, as of today there is no great answer. 

In March 2016, the FMCSA announced that in light of the “prevalence of moderate-to-severe obstructive sleep apnea (OSA) among individuals occupying safety sensitive positions in highway . . . transportation,” it was considering passing a regulation that would require truck drivers “who exhibit multiple risk factors for OSA [obstructive sleep apnea] to undergo evaluation and treatment by a healthcare professional with expertise in sleep disorders.”

Strangely, in August 2017, the FMCSA abandoned the idea of creating a DOT sleep apnea regulation, explaining that “current safety programs . . . are the appropriate avenues to address OSA [obstructive sleep apnea].

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(Sources: “How sleep apnea causes trucking accidents?,” FreightWaves, by Dean Croke, Chief Analytics Officer, January 2, 2020; FMCSA, Proposed Sleep Apnea Rule, March 10, 2016 notice; FMCSA, Proposed Sleep Apnea Rule, August 8, 2017 notice; FMCSA “Bulletin to Medical Examiners and Training Organizations Regarding Obstructive Sleep Apnea” (January 22, 2015); FMCSA, “Driving When You Have Sleep Apnea,” website page (February 19, 2014); “Obstructive Sleep Apnea in North American Commercial Drivers,” Industrial Health Journal, National Institute of Occupational Safety and Health, published January 2014)

DOT Sleep Apnea Regulations