All That's Trucking

Do Drivers With Sleep Apnea Have to Use a CPAP Machine?

October 13, 2014

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For patients with obstructive sleep apnea, a malady affecting many truck drivers, the standard treatment has long been the C-PAP device, a continuous positive airway pressure. But many find it cumbersome, and some companies market oral appliances to treat the condition. Will they meet new federal guidelines for treating apnea?

I asked David McKinney, founder of California Occupational Medical Professionals, who's very knowledgeable about the regulations on driver health qualifications. (He helped develop the National Registry of Certified Medical Examiners.)

The present situation, he said, is that if they work, they are acceptable treatment for obstructive sleep apnea. But the driver still has to be diagnosed and followed. In others words, they cannot just get an oral appliance and say "I'm treated."

However, if diagnosed with OSA and the condition is properly treated with the device, it is an option.

The present guidance suggests that compliance for treated OSA is that the driver be treated for at least four hours a night at least 70% of the time (seven out of 10 nights). Some of the companies producing the dental appliance have/are developing a compliance data chip, much like the ones present in the C-PAP machines currently available, McKinney says.

"It remains very important to note that treatment and compliance is the key, and that will be the real marker for continued commercial certification."

Oral appliances also have their own set of nuisances, he pointed out. They are definitely cheaper and less cumbersome, but as with any dental appliance, they constantly shift in your mouth and frequently require some adjustment.

"So again, since using the device is the key and a poorly fitting oral appliance may not be tolerated, making compliance a problem," McKinney told me. "In my experience, at least, I follow these individuals in the same way I follow anyone with OSA. In other words, they have to prove they are compliant."


  1. 1. Bob Stanton [ October 16, 2014 @ 10:14PM ]

    I am sorry to disagree with Mr. McKinney.

    All three sets of guidance to medical examiners on sleep apnea specifically reccomend not certifying a driver on oral appliances. We had Dr. Barb Phillips who was on the FMCSA MRB when the 2008 reccomdations were developed and was also on the 2006 Jtf committee on sleep apnea for cmv operators speak to our support group for truck drivers with sleep apnea about oral appliances for truck drivers. The conference call is archived at .

    We recently did a follow up call on the new Braebon compliance chip for oral appliance therapy. The conclusion was that it looked good that oral appliances would be included as an approved therapy in the rulemaking but for now they are not.

    Language in Public Law 113-45 about FMCSA reviewing alternative therapies was intended to force FMCSA to review oral appliances in any rulemaking on sleep apnea.

    A major problem with oral appliances is that they only reduce not eliminate apneas. Medically they are only suitable for mild to moderate OSA. They are not less expensive than a CPAP. Oral appliances suitable for a truck driver will cost upwards of $ 3,000 with all testing. They may depending on FMCSA rulemaking require an annual sleep study ($400 - 1,500) to ensure they are working right.

    Oral appliances are sensitive to heat and can melt if left in a truck parked in sun. (requiring a $ 1,000 replacement). Oral appliances may not be covered by insurance unless there is a documented failure to adapt to cpap.

    Cpap only require annual compliance data download and can cost $ 900 - 1,500.

    There are a host of vendors marketing everything from DOT approved sleep studies. ( DOT doesn't approve sleep studies). to herbal remedies guaranteed to cure sleep apnea (The FDA is working to shut that one down.)

    Drivers need to be very careful about this topic as there are not firm regulations on sleep apnea lots of misinformation is out there.

  2. 2. Dale newkirk [ October 20, 2014 @ 01:37PM ]

    Here we go again, more half truths and deception. Here are the facts
    1. There is not nor has there ever been any guidance nor any rule making formally created by fmcsa!!! As a matter of fact Landline just wrote an article about this. The deceptions and rumors surrounding get this subject have become so common place that two U.S. Senators have introduced legislation that would order the above mentioned "experts" to stop telling and training doctors for the new federal registry of certified medical examiners on this subject!
    Because there is no formal regulation regarding sleep apnea doctors are NOT allowed to force drivers to undergo any type of study based on neck size, weight, how much they snore or anything else.
    LISTEN CAREFULLY, THERE IS NO RULE ON SLEEP APNEA AT THIS TIME!!! The doctors involved in these rumors have made millions on sleep studies and selling cpap
    Machines. Stand up for your rights and demand that you be given a clean medical card and call your representative and Senator and make sure that your fellow driver's and yourself are treated fairly according to the law!!!

    Remember "The only thing needed for evil to thrive is for Good Men to do nothing".
    Truck safe and God Bless

  3. 3. Pat Sonier [ January 04, 2015 @ 03:16PM ]

    I would like a firm answer on the rule or law if any on the sleep apnea deal. I got a job with a good trucking outfit, however it was rough getting in because of the sleep apnea deal. I have the machine and the expensive supplies that go with it it, and all I get out of it ( not) is not getting proper rest. I didn't and don't have a problem with sleeping, and if I get tired, then I pull over and take a nap. Since having this so called therapy, I lose 4 hrs of sleep a night. I guess that makes the roads safer though, right? I feel someone has put their noses in where it doesn't belong. Perhaps if companies hire drivers with common sense, rather than a 98 degree piece of meat known as a steering wheel holder, and if they got tired ( regardless of the freight, nothing in or on a truck is worth anyone's life) and they told dispatch they can't make it, perhaps there would be less accidents. I could go on an on, but I need a real answer, cuz it's not helping matters any, thxs

  4. 4. jim fraser [ February 11, 2015 @ 07:19AM ]

    WhAt are regulation for Arkansas today . I'm being held up pending a 30 day study right now for sleep apnea ? Need to go to 2/16/15 but can't get med card !

  5. 5. Wes Huffey [ July 16, 2015 @ 06:50PM ]

    I've goten into this mess now tried to renew my physical in November was given a 3 month physical card to get a sleep test got that done but my insurance changed so had to wait till this May for the cpap machine that fulls my lungs with mucus and cough like I have lung cancer I've never smoked but wore the thing for 4hrs a day for 10 days guess what that is not 70% 70% was for the time I was diagnosed till May so I'm unemployed and my employer fought unemployment and won so I'm on welfare waiting for a disability claim to go through that I will not win and after 27yrs of driving this is my life now

  6. 6. Debra Hughes [ April 14, 2016 @ 09:04AM ]

    I would hope that the transportation industry would not worry about what are the regulations, let's use common sense. Obstructive Sleep Apnea effects 1 in 3 men and 1 in 6 women nationally. The effects of driving with sleep apnea are equivalent to driving with a blood alcohol level of 0.5, which is not legal in any state. As humans we can make our bodies go without proper sleep but that doesn't mean it is safe. CMEs, Physicians, CPAP sellers and the whole sleep community need to look at everyone - CDL holders, soccer Moms, Physicians, RNs, etc. Everyone of these people hold the lives of others in their hands, whether behind a steering wheel or over an operating table, sleep apnea is real and it is dangerous to not only the person going without proper sleep but everyone around them. I am a Clinical Sleep Educator, and I work closely with CDL drivers to make sure they are getting results if they are placed on CPAP therapy, stop making it about MONEY - make it about SAFETY and the health and welfare of EVERYONE!!!! My company provides drivers with home sleep studies - results in 2 days for $260.00, and then we provide them with wireless connected APAP devices that we can monitor anywhere in the US and we call and we coach and we replace masks and we monitor pressures and make sure they are TREATED not just given machine and a huge bill. I am sad that everyone wants to make a buck, when it should be about health and safety, if didn't have CDL drivers we wouldn't be able to function in our world, everything we have was once on a truck being driven by a driver that deserves to be treated fairly and given tools to protect their health, not just given a machine that makes your company CEO able to afford his next beach house of expensive vacation.

  7. 7. John [ April 27, 2016 @ 08:16AM ]

    Debra Huges can you give me the name of your company that does the home sleep studies for 260 $ s

  8. 8. Johnny Layton [ July 10, 2016 @ 03:24AM ]

    Well I'm sorry to say but this thing bout to kill me , I'm not going to make it with it , guess I'm going to loose my lic ,start checking on disability ,I'm 57 been driving truck 30 yrs or more high school dropout not going to get luckey enough to find another job not much choice for me , going to loose what I got ,my home ,stuff ain't rite ,is what it is ,what did we do twenty yrs ago ?

  9. 9. Frank Sinacore [ July 12, 2016 @ 09:59AM ]

    Debra Hughes im interested in finding out more about your company can you email me please

  10. 10. Chris [ September 19, 2016 @ 08:54PM ]

    Stevens Transporr at home test is 100 or less.

  11. 11. Doug [ December 02, 2016 @ 07:28AM ]

    I have been driving truck for the last 15 years no problems getting sleep. I am 5' 10" weigh 265. I workout at the gym continuously and I am in very good shape. I bench over 350. I go get my physical renewed and they tell me I need to take a sleep apnea test because of the size of my neck. I have no problem sleeping whatsoever. I am now required to take a sleep apnea test. The test shows I have mild sleep apnea. Now I am required to have a CPAP machine strap to my face to be in compliance. it is the most God awful thing I have ever experienced in my life. Now I am told that even on vacation which I do a lot of backpacking and hiking in the upper Lakes I am supposed to remain 70% compliance. My company that I work for says I have no choice or I will be put out of service until I get to 70% compliance. When I go on vacation I don't hang out at motels are usually go to the backwoods and enjoy backpacking and hiking. So why am I subject to any DOT regulations whatsoever on my vacation. If I am in compliance when I leave why doesn't it start like my logbook as a clean slate when I get back . Now the government is trying to dictate what I can and can't do on my own personal time and how I choose to spend it . Myself I cannot find any standard operating procedures on any DOT regulations regarding sleep apnea . Or any studies pertaining to accidents were sleep apnea is involved . To me it's another intrusion on my personal life . I am 56 years old love the outdoors so I guess I will be put out of service for a week every time I get back from vacation . this my friends is the biggest crock of crap that DOT has reached into our own personal lives where I cannot find a sleep study that proves anything at all it's all Theory. I just talk to my manager and he said we have no choice it is DOT regulations. But I cannot find but I cannot find any standard operating procedures any regulations that have been passed by law to show that I have to be on a CPAP machine because of the size of my neck. I cannot wait to retire take that CPAP machine to the rifle range and make mincemeat out of it. i'm sure I'm not the only one in this predicament

  12. 12. De [ January 31, 2017 @ 10:23AM ]

    Couldn't have said it any better myself!! It's not CPAP it's CRAP.

  13. 13. Jo [ March 10, 2017 @ 01:09PM ]

    Same problem here. I slept good before but not any more. I would never drive fatigued before but now I have to to keep my job. I am 59 so another job is kind of out of the question. Also the machines are not cheap and you have to buy replacement parts all the time. I believe someone is getting a kickback as it can't be for the good of the drivers and the public.

  14. 14. Lyle [ May 26, 2017 @ 09:42AM ]

    I'm actually getting less sleep trying to comply . So what's the real safety issue?

  15. 15. Dewey [ July 19, 2017 @ 06:27AM ]

    I went from having no problem sleeping to struggling to get 4 hours a night its not right

  16. 16. Laural [ August 08, 2017 @ 03:09PM ]

    The regulations that were implemented only benefited the sleep apenea Doctors and the CPAP machine!
    My horror story: I am a day driver, class B with air brakes, M-F 7am to 3:30.
    I have to have a DOT medical card. One day a few years back, it was time for the physical. At the clinic, a girl comes in, puts a tape measure around my neck, on the outside of my shirt collar. I had no idea what this new thing is for, obviously she didn't know how to measure inside a shirt. The Dr comes in, says won't give me a med card until I go get tested for sleep apnea, shock to me, I have always slept great, never nap during the day. But ok, a test will show I don't have sleep apnea. But NO, apparently many "Sleep Doctors" are aware of the new regulations! Guess what, not covered by insurance, because my personal Dr did not request it, a person at a walk in clinic did. So I have to pay $1500 to get the test, The sleep Dr says I do have it! I could not believe it. So more money for the machine. I have not had a good nights sleep since. I was in the SYSTEM. I still did not think I had a sleeping problem, so I paid for a second test, different Dr, guess what, he says I do not have sleep apnea, I go to the DOT clinic with my new test results, sorry mam, once your in the system, we can't take you out of it. I go back to the first sleep Dr, of course angry, his exact reply to me, "SLEEP APNEA HAS BECOME A VERY LUCRATIVE BUSSINESS SINCE THE NEW REGULATIONS, MANY OF MY FRIENDS HAVE CHANGED TO SLEEP STUDY MEDICINE, I HAVE NOT HAD ONE SINGLE PATIENT WHO HAS NOT HAD SLEEP APNEA.!
    No matter what I have tried or done, I can not get out of THE SYSTEM!
    It was always about money, I pray my company will drop this stupidity! I want to sleep at night again!

  17. 17. Michelle smith [ August 14, 2017 @ 03:14PM ]

    @Laural wow that's so screwed up. They're trying to get my bf to get a CPAP sleep test done

  18. 18. Curtis Roberts [ August 14, 2017 @ 05:17PM ]

    Crete Carrier Corporation told me that I was required to take the test to gain employment I to believe that this is a scam between companies and government because I was told that companies get a tax break when they have head counts for taking sleep apnea tests furthermore if diagnosed with sleep apnea they get points for safety with Department of Transportation of course these are all rumors and hearsay however I've been doing a lot of research and found that these rumors are most likely truthful I too have not had a good night's rest since the machine except for when I refuse to use it my air flow seems more restrictive now than ever before and they refused to even talk about any other options besides changing masks which I have tried one other mask and still could not sleep. I have been told by another company that they also believe that this is a scam and that I should seek an attorney.

  19. 19. Forrest [ August 29, 2017 @ 11:03PM ]

    I unplug the mico wave and plug in the cpap in the sleeper and it sends a message through the satellite to my doctor and if my heart is good and there are no episodes then cpap is doing a great job and I dodged a bullet had I chosen to be untreated. I do feel much better and use my cpap every nite.

  20. 20. Doug [ October 07, 2017 @ 07:13AM ]

    I've been driving big truck for 40 some years. I have been chosen by "the powers to be" a recipient of this joke.
    I have working sometimes long hours each day with no cpap machine. I'm a very light sleeper, and very sensitive to touch. So I use Trazadone to keep me calm through at least six hours.
    I cannot stand anything on my face while sleeping. It's a natural resistance I believe in everyone.
    Someone is making millions of this, which is a forced equation added to my life.
    I spend very little time on my back because of injuries, but have been tested while being made to sleep on my back.
    This is a bunch of crap.
    Think of the billions of dollars spent on testing, studies, appliances, employing people, writing mandates, hiring counsel and doctors.
    I will fight this, and get a mouth piece, or laser surgery.

  21. 21. Theresa [ November 17, 2017 @ 02:54PM ]

    I was tested on the sleep apnea test and had mild sleep apnea, my trucking company iDrive for says I must use a CPAP machine which they sold me, I cannot use it because it causes fluid in my lungs, I am prone to pneumonia and I have had legionnaires disease so my lungs did not like having fluid in them what can I do to stay compliant And have an appliance I can use, what are my options


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Deborah Lockridge

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All That's Trucking blog is just that – the editor's take on anything and everything related to trucking, with the help of guest posts from other HDT editors. Author Deborah Lockridge's career as an award-winning trucking journalist started in 1990.


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