CMV Drivers

A Commercial Motor Vehicle (CMV) is any motor vehicle used on a highway in interstate commerce to transport property or passengers when the vehicle:

• Has a gross vehicle weight rating (GVWR) of 10,001 pounds or more

• Is single or combination of vehicles with a gross vehicle weight rating (GVWR) of 26,001 pounds or more

• Is designed or used to transport more than 8 passengers (including the driver) for compensation; or more than 15 passengers if not receiving compensation for the transportation.

• Any size vehicle that transports hazardous materials that require federal placarding

The Federal Motor Carrier Safety Administration (FMCSA) requires CMV drivers to hold a Commercial Driver's License (CDL) and to pass a Department of Transportation (DOT) physical. A DOT physical  must be conducted by a licensed "medical examiner" listed on the Federal Motor Carrier Safety Administration (FMCSA) National Registry. Upon passing this physical you receive your Medical Examiner’s Certificate, Form MCSA-5876, which confirms that you are healthy enough to safely perform the demanding job of a CMV driver. This testing is to ensure the safety of the public.

You will be asked questions about your medical history including whether you have “ Sleep disorders, pauses in breathing while asleep, daytime sleepiness, loud snoring Have you ever had a sleep test (e.g., sleep apnea)?” and “ Have you ever had a sleep test (e.g., sleep apnea)?”

During the physical your body mass index (BMI) will be calculated. Your neck circumference and the space at the back of your throat will also be assessed. You are at a higher risk for Obstructive Sleep Apnea (OSA) if you have three or more of the following:

S Do you snore loudly?

T Do you often feel tired, fatigued, or sleepy during the daytime?

O Has anyone observed you stop breathing during sleep?

P Do you have (or are you being treated for) high blood pressure?

B BMI  >35

A Age > 50

N Neck circumference (inches): >15.5 in females/ >17 in males

G Gender- male or post menopausal female

The degree of your upper airway narrowing as assessed your Mallampati score can also predict for risk for OSA:

According to the American Academy of Sleep Medicine (AASM) Obstructive sleep apnea affects nearly 30 million Americans. Approximately 17% to 28% of CMV drivers have OSA.

So what exactly is OSA?

OSA stands for Obstructive Sleep Apnea. It is a medical condition where you stop breathing during sleep. Your upper airway becomes blocked repeatedly during sleep causing less air to reach your lungs. The narrowed airway causes snoring by making the tissue in the back of the throat vibrate as you breathe. Your brain detects that there is less oxygen and awakens you so that you can breathe. This may occur several hundred times a night. 

As a result of being awakened multiple times from your sleep you may feel tired or unrefreshed after waking up even though you have had a full night of sleep. Patients with sleep apnea may not be aware that they awaken multiple times during the night as this wake time may be for only a few seconds. During the day, however, you may feel fatigued, have difficulty concentrating or may even unintentionally fall asleep. In addition to snoring and daytime sleepiness, patients with OSA may experience choking in their sleep, multiple awakenings from their sleep to urinate, racing heart beats in their sleep, memory loss, decreased sexual desire, difficulty maintaining an erection, and irritability.  

How is OSA diagnosed?

OSA can only be diagnosed definitively by a sleep study. A polysomography (PSG) is the gold standard for diagnosing this condition. A PSG is sleep study which is done in the sleep lab under the care of a sleep technician or technologist. A Home Sleep Apnea Test (HSAT) may also be used to diagnose OSA and is done from the comfort of your home. Once OSA is confirmed, it should be treated.  Untreated OSA may result in worsening hypertension and is associated with an increased incidence of stroke, heart failure, atrial fibrillation, and coronary heart disease. The gold standard for treatment of OSA is Positive Airway Pressure (PAP). Other treatment options include:  oral appliance, nerve stimulator and newly FDA approved medication - Zepbound. 

What is PAP?

PAP (positive airway pressure) is the first-line therapy for OSA. PAP may be supplied in a continuous mode - CPAP or bilevel PAP- BiPAP.  In some cases you may need a PAP titration study prior to starting PAP treatment. During a PAP titration study the pressure is incrementally increased until the pressure(s) to reduce and/or eliminate obstructive events during sleep.  This pressure is provided by a machine (CPAP or BiPAP machine) connected to a mask. The pressure supplied helps to keep your airways open while you sleep. 

What is a PAP compliance download?

A PAP download sometimes referred to as a compliance report is downloadable data from PAP devices that provide objective data to facilitate further management. Stored data can be downloaded using various methods, such as secure digital cards, modems, and wireless transmission.  Most devices provide information on amount of usage (ie, compliance), effectiveness, airway leak, and details on respiratory events during sleep, usually reported out as a summary of events over a specific period (eg, 30, 90 days or one year).  CMV drivers diagnosed with OSA and being treated with PAP usually are required to show at least a minimally acceptable compliance -defined as greater than 4 hours of use for at least 70% of the days.