FMCSA: Expect sleep apnea guidance proposal in near term

| October 28, 2012

Elaine Papp, chief of the Medical Programs Division of the Federal Motor Carrier Safety Administration, reiterated that the agency continued to make progress in developing official guidance on screening and treatment for obstructive sleep apnea for driver medical certification purposes. Speaking at the 2012 Truck Driver Social Media Convention in Kansas City, while she didn’t specify an exact timeline for the official notice, she urged drivers to utilize the federally mandated public comment period to propose alternatives specifications when the guidance was ultimately released. Barring a shift in priorities with a change in administration after the election, drivers could be expected to anticipate the guidance within months.

“It is absolutely imperative that you participate in this rulemaking,” Papp said. “If you don’t like something in there, or do like it, you better tell us.” That imperative is underscored by regulation that prevents FMCSA from changing an official rulemaking or guidance after it has released official proposed stage unless their are compelling reasons to do so specified in comments.

As for what the guidance will look like, during her talk Papp referenced the recommendations made at the combined meeting of the Motor Carrier Safety Advisory Committee and Medical Review Board in February, which in April themselves were erroneously released as proposed guidance prior to undergoing full agency review. Those recommendations notably didn’t fully endorse dental appliances as an allowed treatment or home-based apnea tests as allowed diagnostic testing. (You can access the language of the recommendations here.)

Papp, in her remarks, however, spoke favorably of both as lower-cost possibilities for diagnosis and treatment of apnea. Several years ago, when Papp herself underwent a sleep study to determine if she had the condition herself, it cost her arond $4,000. She cited an average cost figure for a full in-lab sleep study today at more like $1,800-$2,000. “The agency has also sponsored studies … of in-lab sleep studies compared to home studies. There’s a huge cost difference,” she added, and the studies found the home tests to be as effective as overnight sleep studies, generally.

About dental appliances as alternatives to continous positive airway pressure (CPAP) machines for treatment, Papp noted the FMCSA had seen their effectiveness recently in meetings with a dentist who utilizes mechanical devices with technology embedded that can allow for proving compliance with treatment.

Ultimately, she added, the agency must consider less-costly diagnoses and treatment options in order to pass the regulatory smell test. By law, “We have to make sure that what we write [as proposed guidance] is in the framework that will be an acceptable economic burden.” Then, she asked, “If sleep apnea affect 2 million drivers,” and it will cost $2,000 for every one of those drivers to get tested, “do you think they will let us put that kind of economic burden into rulemaking?”

National Registry of Certified Medical Examiners update
Responding to a dynamic Trans Products Trans Services Regulatory Manager Richard Wilson noted in his talk earlier in the day relative to unprofessional practices from certain clinics and doctors around the country cashing in on the gray area that currently is the sleep apnea regulatory situation, Papp said, the new National Registry of Certified Medical Examiners would give the agency a tool to act on driver whistleblowers against examiners. For the first time, the FMCSA will have an easy method of identifying and tracking the up to 40,000 total registered examiners they feel they will need nationwide to meet drivers’ needs.

The date on which thereafter you will have to utilize a medical doctor in the registry when getting your DOT physical is May 21, 2014. As of now, said Papp, the agency has received about 4,000 registrations of doctors all awaiting finalization of the agency’s exam for approval. They’re averaging an addition of 150 daily.

  • Richard M. Gaskill

    I have heard nothing about compensation for drivers that were referred for testing but found not to have sleep apnea .
    There have to be some out there and we need to hear from them . They need to be compensated for expenses and lost wages resulting from being subject to an unneeded sleep study .

  • Don Lanier

    Its time they recognized the Dental Appliance as a tried and true medical solution, many guys cant sleep with air being forced down there throats and hoses attached to there face, say what you will its Obtrusive and can actually cost a driver sleep…I think they are making a molehill out of this issues anyway and no where near the 2 million drivers have this issue, Its another costly and intrusive forced regulation that will cost trucking many many safe drivers who arent going to be forced to undergo the expenses and testing to keep the CDL they worked and paid for. Look on the board of this rulemaking and youll find stockholders of the manufactureres of these devices, as she said 2000.00 x 2 million is going to make someone VERY VERY RICH,

  • Marty Marsh

    The only thing obstructing a drivers sleep is the company and FMCSA with all of their rules and regulations. First I would like to say,although I have said it a thousand times already, YOU CAN NOT REGULATE SLEEP. You are nothing but a gold digging idiot if you think you can. Also the money that is in this is why they are going to keep trying. It is also funny how the feds want to regulate the industry only to the point they make money, but not how much a truck or driver gets to haul a load.
    The reason these drivers can’t sleep is because they are being told when to do it, and life simply don’t work that way, of course unless there is money in it. These people are nothing but crooks practicing corruption, this is not about safety it is about money, LIARS.

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  • trockens

    My last physical was done at Concentra in Ft. Worth, TX, they asked me if I had sleep apnea and I said NO, they then told me I had it and gave me 3 mo. to get sleep studies done as well as a machine. The part of this that infuriates me is that they gave me a Sleep Study Co. that I would have to go to get the study done….it was in Houston (5 hrs. away) and the Sleep Study Co. would ALSO furnish me the machine……Looks like Colusion to me!!!! Concentra, just happened, to own the Sleep Study Co.

    I went to my own personal Dr. and got my physical redone and she didn’t agreed with the sleep apnea diagnosis of Concentra. My Dr. agree with me, Concentra has a racket going and they are out to make money!!!

  • trockens

    I’m telling all you drivers out there, please join OOIDA, they are the only organization that is fighting for us drivers. They fight these silly regulations in the courts and they are winning!! They also testify before Congress and they are always on our side. I can’t tell you how many times I have called them for advice and information and they always get me to the right people in their organization who KNOW what they are talking about. In the next few years, trucking is going to become a nightmare if the Government has its way and owner/operators are going to be squeezed out. If we don’t have Strong Representation, we are going to be eliminated, therefore, I strongly recommend supporting OOIDA in order to have our voice heard or we will come to the day when we won’t have ANY voice to raise.

  • Todd Dills

    John, Thanks for telling your story — I’ve heard, as has FMCSA, of this sort of thing going on. If you could email me at tdills [at] I’d love to hear more of your story in a phone conversation.

  • E.F.

    I want to say WOW, but no, if you follow the money you’re bound to see this kind of predatory activity against drivers Mr. trockens… Anyway excellent article, about time FMCSA started seeing the light on oral appliances! I suspect they’re trying to avert legal challenge…

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