Day Studies/Commercial Truck Drivers

[Beachmeezer]

Hubby and I are both long time cpap users with good stats and totally compliant.

For his DOT physical hubby had to have another night study and the sleep doctor ordered a day study. It was the following day/morning after the night study and he failed it. He and I both sleep little during our night studies so it is no surprise that he failed the day study. As a result, DOT was notified.

Now he can't drive and we're suffering a loss of income. They have agreed to do another study but are requiring another night study immediately followed by a day study. Jeeze...he's going to fail the day study again.

Is that how it is always done? The day study always follows the next morning/day of the night study? He shouldn't even have to repeat the night study.

So frustrated.
Kim

[49er]

Hubby and I are both long time cpap users with good stats and totally compliant.

For his DOT physical hubby had to have another night study and the sleep doctor ordered a day study. It was the following day/morning after the night study and he failed it. He and I both sleep little during our night studies so it is no surprise that he failed the day study. As a result, DOT was notified.

Now he can't drive and we're suffering a loss of income. They have agreed to do another study but are requiring another night study immediately followed by a day study. Jeeze...he's going to fail the day study again.

Is that how it is always done? The day study always follows the next morning/day of the night study? He shouldn't even have to repeat the night study.

So frustrated.
Kim

Hi Kim,

The only time I have heard of a day study being done after a night one is to test for narcolepsy. Why did the doctor order one?

49er

[Beachmeezer]

We're not sure why he ordered a day study. It was out of the blue. We thought maybe all commercial truck drivers on cpap had to complete a day study. Even if you didn't have daytime wakefulness issues, with less than 6 hours of sleep a lot of people might have issues during a day study. He and his sleep doctor don't get along and it feels kind of personal. He has used the power to keep hubby off the road. 10 years of commercial driving with no incidents, cpap compliant and now grounded. We have appointments with two other practices to review his records and the issue. I think it's time to find a new doctor/practice. I use the same practice but see someone different and I'm not happy with my sleep disorder doctor either.

[49er]

We're not sure why he ordered a day study. It was out of the blue. We thought maybe all commercial truck drivers on cpap had to complete a day study. Even if you didn't have daytime wakefulness issues, with less than 6 hours of sleep a lot of people might have issues during a day study. He and his sleep doctor don't get along and it feels kind of personal. He has used the power to keep hubby off the road. 10 years of commercial driving with no incidents, cpap compliant and now grounded. We have appointments with two other practices to review his records and the issue. I think it's time to find a new doctor/practice. I use the same practice but see someone different and I'm not happy with my sleep disorder doctor either.

I am so sorry to hear that. I am glad you all are consulting with other doctors. Hopefully, they can help you out.

49er

[HoseCrusher]

Kim, This is the most ridiculous thing I have ever heard of. In the work place there is a practice called fit for duty. If you aren't fit for duty you inform people and by not working you improve the safety of everyone else. I believe something similar is done in medical testing. If you go in for a test and are not fit for the test the test is rescheduled.

At this point you need to contact legal help. You have been deprived of income because of a doctor that is not following best practices. Then you need to contact whoever regulates doctors in your area and file a complaint against this doctor. The sooner this doctor is removed from practice the better.

Take this weekend to do some research and Monday morning at 08:00 be on the phone. Make sure you have all the facts straight. This won't be an easy battle.

And what is a day time test?

[jencat824]

OMG! I think the DOT is getting out of hand! My hubby just had a DOT sleep related problem, but the opposite of your hubby's. Mine had his medical card pulled because he was on sleep meds (temezpam) & had been for 5 yrs. Now we find out NO sleep meds are currently approved, so they want him to just get poor sleep. He is CPAP compliant, with good numbers (I check his daily), & just recently found a great mask with NO leaks on his reports, but he suffers from familial insomnia, which make his sleep light, so he doesn't hit REM without sleeping meds. He is now back to work WITHOUT sleeping pills & is tired as hell during the day. His sleep Dr. thinks the DOT is crazy to have tightened the reg's like this, but I can understand they don't want sleepy drivers on the road.

But to keep your husband off the road because he CAN'T SLEEP DURING THE DAY!!! This is just stupid. I am researching the process for an exemption for my hubby, you might want to consider the same. The risk for mine is that they could pull his med card again until a decision is rendered. While its only a chance, we are trying to decide whether or not to risk it. Since your hubby is currently off because of a stupid Dr. you don't have anything to lose.

I will warn, however that the exemption process is only for hypertension & diabetes as far as I can tell. If you want an exemption for other reasons, I'm still waiting for an email back from an examiner in the state of KY, his license is in IN, but his employer is in KY, so his med card is from KY as well. Depending on what state you are in, you might get a state examiner to explore an exemption, especially since you have nothing to lose. The exemption process is kind of gray area, some med examiners will be open to this, as I was advised by an attorney, some will not. Its kind of an 'ask & see' as far as I've been able to determine.

DOT regulations regarding sleep are murky from what I've been able to tell. I've read hundreds of pages & still had to get an attorney to tell me that 'its complicated' which I already knew. Regulations regarding hours on the road would seem to be cut & dried, but this past July the 60 hr rule was changed to add lunch hours, making the actual work week for local drivers 57.5 hrs. Kinda stupid too, since that makes logging an exception rather than the rule for locals as well.

For anyone who followed me to this point, my hubby is a LOCAL driver, meaning that comes under the rules for driving & being at home every night, i.e., not an OVER THE ROAD driver. Why the differences, I have no idea, but that has been this way for years, or so I am told.

Beachmeezer, I will share with you any further research I'm able to do. I currently have some family crisis (MIL in rehab & had an amputation, also BIL went to rehab today for pulmonary rehab due to airway burns caused from smoking while on O2), so my research time has been cut significantly. Other than sharing info, all I can do is pray your new sleep Dr. won't be such an a$$.

Hang in there,
Jen

[robysue]

But to keep your husband off the road because he CAN'T SLEEP DURING THE DAY!!! This is just stupid.

I think you misread the original post.

The daytime sleep test is a measure of how sleepy you are during the day. You fail the test because you fall asleep too quickly when sitting doing nothing. And the OP's hubby failed the daytime sleep test because he got so little sleep during the night time part of the test that he had trouble staying awake during the day test.

And since the OP's hubby usually gets a full night's sleep with CPAP when at home or on the road, the OP is asking why the heck is he required to take this daytime test when he's not reporting any problems with daytime sleepiness in his normal life.

[chunkyfrog]

I could possibly imagine the day study to rule out narcolepsy if it can be caused by using sleep meds or sleeping too lightly.
--but how does one define "adequate sleep"? Maybe an alertness or judgement test?
--but why single out truck drivers, and let surgeons off?

[Todzo]

Hubby and I are both long time cpap users with good stats and totally compliant.

For his DOT physical hubby had to have another night study and the sleep doctor ordered a day study. It was the following day/morning after the night study and he failed it. He and I both sleep little during our night studies so it is no surprise that he failed the day study. As a result, DOT was notified.

So are you saying that he had a Polysomnogram (in lab sleep study likely while using CPAP as proscribed) followed by a Multiple Sleep Latency Test (MSLT)? This would make sense as he does need to be free from too much sleepiness to drive safely.

Now he can't drive and we're suffering a loss of income. They have agreed to do another study but are requiring another night study immediately followed by a day study. Jeeze...he's going to fail the day study again.

Is that how it is always done? The day study always follows the next morning/day of the night study? He shouldn't even have to repeat the night study.

So frustrated.
Kim

People are beginning to wake up to the safety issues involved with Sleep Apnea and that is good.

Sleep testing and CPAP therapy management is in a sorry state. That is hard on everyone!!!

I am frustrated along with you!

[Todzo]

--but why single out truck drivers, and let surgeons off?

A surgeon has people supporting them during a procedure who can call the person on thier current state if necessary.

A truck driver is alone with thier very boring road. Nothing is more dangerous for those with untreated or under treated with Sleep Apnea!

I think the only thing more dangerous would be to be a train engineer. Recently proven!!!

[chunkyfrog]

Some surgeons cannot take criticism. This is when they lose patients.

[jencat824]

But to keep your husband off the road because he CAN'T SLEEP DURING THE DAY!!! This is just stupid.

I think you misread the original post.

The daytime sleep test is a measure of how sleepy you are during the day. You fail the test because you fall asleep too quickly when sitting doing nothing. And the OP's hubby failed the daytime sleep test because he got so little sleep during the night time part of the test that he had trouble staying awake during the day test.

And since the OP's hubby usually gets a full night's sleep with CPAP when at home or on the road, the OP is asking why the heck is he required to take this daytime test when he's not reporting any problems with daytime sleepiness in his normal life.

Ahhhhhh..... I'm having a "I'm a little stupid today' kind of day. So sorry. I don't see any reasons for a daytime test, especially one that causes a CPAP user to take a daytime test after being deprived of your CPAP the night before. Now I'm catching on. Even worse than the way I read it. Wow - one thing I got right, the DOT is really not making sense these days.

[houndlover]

The DOT standards have not changed...it is just now the DOT is requiring providers that do the exam to take classes on the standards and pass a certification test in order to be able to do the exams.

Basically...they are making us actually learn the rules. The rule book is about 300 pages and before, many providers follow it (they were supposed to). But now the DOT is tracking providers, who they do physicals on, and we have to report who passes and fails. Basically, there can be repercussions on medical providers who pass drivers who otherwise should not be driving a truck.

Now, I have no idea why the sleep doc required a day test after the PSG. The DOT leaves it up to a providers discretion based on the history they get from the patient as far as any "extra" testing. Compliance data and an overnight test are required yearly for the DOT. You could just take the compliance report that PSG report to the physical, of course if your husband can't sleep for the overnight test there is little you can do until he can sleep long enough to show his OSA is controlled.

[jencat824]

The DOT standards have not changed...it is just now the DOT is requiring providers that do the exam to take classes on the standards and pass a certification test in order to be able to do the exams.

Basically...they are making us actually learn the rules. The rule book is about 300 pages and before, many providers follow it (they were supposed to). But now the DOT is tracking providers, who they do physicals on, and we have to report who passes and fails. Basically, there can be repercussions on medical providers who pass drivers who otherwise should not be driving a truck.

Now, I have no idea why the sleep doc required a day test after the PSG. The DOT leaves it up to a providers discretion based on the history they get from the patient as far as any "extra" testing. Compliance data and an overnight test are required yearly for the DOT. You could just take the compliance report that PSG report to the physical, of course if your husband can't sleep for the overnight test there is little you can do until he can sleep long enough to show his OSA is controlled.

Houndlover,

Did I understand you to say the PSG must be repeated yearly? Even if compliance has been established by loads of great data? This will get expensive if every driver has to repeat the PSG. See what I mean about the DOT getting out of hand? I too want to be safe on the roads driven daily by truckers, but I feel that repeating a PSG yearly is overkill. Likewise, I think having drivers with untreated insomnia on the road is dumb too, but its in the DOT regs.

Jen

[houndlover]

Yep, that is correct. A patient needs some sort of objective test to show that not only are they complaint with CPAP therapy (which can be downloaded from the machine) but that the CPAP therapy is working. A provider can require a MWT, MSLT (which for those, you generally must do a PSG the night before). The place I know of that does DOT physicals is only requiring compliance data and a PSG while on PAP dated within the last year.

If sleep apnea is even suspected a provider is to "not certify" a driver until it can be checked. Then, if they have sleep apnea there is a one month waiting period after starting PAP before they can be eligible to pass their physical and of course we all know that everything doesn't go smoothly and one month may not actually be long enough. If you search around on trucker forums like this one...most are encouraging everyone to lie when asked or screened for snoring or sleep issues. The DOT tried to issue guidelines on who to screen but last year that was thrown out in court so now they are working on actual laws. Which means anyone (say anyone with a BMI that puts them in the obese category if that is what they decide) who falls into the 'screening group' they make will have to have a sleep study no matter if they have symptoms or not.


Truck drivers tend to be older, male, have higher rates of obesity, high blood pressure and every other health issue out there. It is hard to be a provider these days. I hate this part of my job because I know I am basically costing people their jobs and livelihood. However, I won't go against standards because if I do that it could be MY license and job.

http://nrcme.fmcsa.dot.gov/mehandbook/r ... ep_ep.aspx