Sleep and Safety
Emphasis on DOT guidelines
Christopher M Nolte, MD, MS
Comprehensive Sleep Wellness Center
Knoxville, TN
Upcoming Change
May 21, 2014
Federal Motor Carrier Safety Administration
(FMCSA) requirement
all DOT exams must be performed by providers
certified and listed on National Registry of
Certified Medical Examiners
http://nrcme.fmcsa.dot.gov/documents/National_Registry_FAQ.pdf
FMCSA ‘Best Practices’
Medical Examiner should:
– ask the driver about sleep disorders
– ask about such symptoms as daytime sleepiness,
loud snoring, or pauses in breathing while asleep
http://nrcme.fmcsa.dot.gov/mehandbook/respiratory4_dis_secondary_sleep_ep.aspx
FMCSA ‘Best Practices’
If the patient uses CPAP or oral appliance
• Waiting period
• Minimum — 1 month after starting CPAP
• No mention of oral appliance
• Recommend to certify if:
• Continuous successful nonsurgical therapy for 1 month
• Resolution of apneas confirmed by repeated sleep study during
treatment
• Multiple sleep latency testing values within the normal range
• Compliance with therapy
http://nrcme.fmcsa.dot.gov/mehandbook/respiratory4_dis_secondary_sleep
_ep.aspx
FMCSA ‘Best Practices’
Patients undergoing sleep apnea surgery
• Waiting period
• Minimum — 3 months symptom free after surgery
• Recommend to certify if:
• Resolution of symptoms following completion of post-surgical
waiting period.
http://nrcme.fmcsa.dot.gov/mehandbook/respiratory4_dis_secondary_sleep
_ep.aspx
FMCSA ‘Best Practices’
The driver who is being treated for sleep
apnea should remain symptom free and agree
to:
• Continue uninterrupted therapy
• Undergo yearly objective testing (e.g., multiple sleep
latency test or maintenance of wakefulness test)
http://nrcme.fmcsa.dot.gov/mehandbook/respiratory4_dis_secondary_slee
p_ep.aspx
DOT Medication Policy
modafinil/armodafinil (Provigil, Nuvigil)
• driver is disqualified until completion of:
• Waiting period
• Minimum – 6 weeks of close monitoring
• Treating physician and the Medical Examiner should
agree that the medication is effective in preventing
daytime somnolence and document that no untoward
side effects are present.
www.gpo.gov/fdsys/pkg/CFR-2011-title21-vol9/pdf/CFR-2011-title21-vol9-sec1308-11.pdf
DOT Medication Policy
amphetamine, narcotics, or sodium oxybate
(Xyrem)
• The driver is medically unqualified unless:
• the prescribing doctor can write that the driver is
safe to be a commercial driver while taking the
medication.
www.gpo.gov/fdsys/pkg/CFR-2011-title21-vol9/pdf/CFR-2011-title21-vol9-sec1308-11.pdf
Narcolepsy and DOT
“Narcolepsy and sleep apnea account for about 70% of EDS. “
The examiner should consider general certification criteria at the initial and
follow-up examinations:
• Severity and frequency of EDS
• Presence or absence of warning of attacks
• Possibility of sleep during driving
• Degree of symptomatic relief with treatment
• Compliance with treatment
http://nrcme.fmcsa.dot.gov/mehandbook/respiratory4_dis_secondary_sleep_ep.aspx
Other transportation modes
• Rail http://sleepapnea.org/assets/files/2011%20Conference/Wednesday/BJ%20Arsene
au.pdf
• Air http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame
/guide/special_iss/all_classes/sleep_apnea/
• Sea –
http://www.uscg.mil/hq/cg5/nvic/pdf/2008/NVIC%200408%20CH%201%20with%20Enclosures%2020130607.pdf