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FMCSA updates guidance for truck driver medical examiners

New handbook could be used to launch rulemaking on sleep apnea risks

New guidelines issued for truck driver medical qualifications. (Photo: Jim Allen/FreightWaves)

For the first time in seven years, physicians have reliable guidance they can use to help determine if commercial truck drivers are physically fit to operate their vehicles.

The Federal Motor Carrier Safety Administration on Tuesday published a draft of its new Medical Examiner’s Handbook (MEH). The handbook provides information on driver health requirements and guidelines used by medical examiners (MEs) listed on FMCSA’s National Registry of Certified Medical Examiners to interpret regulations on physical qualifications for commercial drivers.

An ME is licensed, certified, and/or registered in accordance with state laws and regulations to perform physical examinations and must also be knowledgeable of the physical and mental demands associated with operating a truck.

“Other health care professionals, such as treating providers and specialists, may provide additional medical information or consultation, but the ME ultimately decides whether the driver meets the physical qualification standards of FMCSA,” according to the agency.

FMCSA also emphasized that, unlike regulations, the recommendations and guidance in the handbook “do not have the force and effect of law and are not meant to bind MEs, drivers or the public in any way. Rather, such guidance itself is only advisory and not mandatory.”

FMCSA first posted the MEH on its website in 2008 but had to withdraw it in 2015 because some of the information was “obsolete or was prescriptive in nature,” according to FMCSA, and therefore MEs and training organizations were told not to consider the MEH as guidance to interpret federal regulations.

Potential for sleep apnea rulemaking

While federal regulations do not include specific requirements related to testing drivers for obstructive sleep apnea (OSA), “the big question is whether FMCSA will use [the MEH] as a potential launchpad for a formal rulemaking on OSA,” P. Sean Garney, co-director of Scopelitis Transportation Consulting, told FreightWaves.

To address the issue, FMCSA would have to go through a formal rulemaking process, Garney noted. In 2016, FMCSA and the Federal Railroad Administration (FRA) issued an advanced notice of proposed rulemaking on OSA, but the Trump administration withdrew the proposal in 2017. “The agencies believe that current safety programs and FRA’s rulemaking addressing fatigue risk management are the appropriate avenues to address OSA,” the agencies stated at the time.

Over the last decade, however, “there is a lot more data available on [OSA], and the industry’s take on the issue has evolved as well. The time could be right,” Garney said.

FMCSA addresses OSA in the handbook by providing a link to recommendations made in 2016 by the Medical Review Board, an advisory committee to the agency. It includes suggestions on risk factors, screening, testing and medical certification of drivers with OSA.

Comments on the draft handbook must be received on or before Sept. 30.

Click for more FreightWaves articles by John Gallagher.


  1. G.S

    during the hight of covid I took a year off and voluntarily went and took the sleep test, mostly just to get it out of the way to prove before I was told to get one that I didn’t have it.
    but yes ofcourse it came back mild sleep apnea. I was actually shocked, then a nurse at my regular clinic told me that it probably really isn’t accurate due to me being off duty so long and staying in to avoid covid.. and she’s correct..all we were all doing was laying around all the time and sleeping too much to stay ofcourse my sleep would be off.. anyone who has slept ‘too’ much will know if you sleep too much your quality of sleep will deminish.
    anyways now that my sleep is back to normal and back at work I hafto kiss up to sleep clinic and stress that the examiner is going to take my career. 16yrs on the road.. spotless tickets no accidents.. perfect. over a million and a half miles n nothing is unsafe about me. I sleep fine ‘though it is harder with a mask on my face for the last year…I’m scared..just bought a house.. finally, my career takes care of 3 grand kids, a disabled son and my elderly mother in law, myself and wife..if they take it from me we will all have nowhere to go… absolutely nowhere, but the illegal migrants can go live in motels, cruise ships on our dime!
    the Dr. says he will say I’m compliant. but his notes describe the opposite. in 06 a guy I let drive me in my car to visit my son (he was driving because I had worked all day and it was supposed to be safer) anyway he fell asleep at the wheel and hit a gaurdrail. well before a appointment during small talk I told Dr about it, (stupid of me)..he put it in my permanent medical record that I was in a accident involving a pedestrian.. really?! but he acts like he’s helping.. something.. yeah something has to be done, this is wrong and reeking havac and poverty on top of everything else we hafto fear.
    mild sleep apnea and still I hafto comply.
    at sleep study I flexed my leg before I was even asleep, they tagged it rapid leg syndrome and I was awake..I turned over they tagged it something I can’t even pronounce. they said I sat up and counted to 3 and flopped back down on bed.. another tag there.
    don’t they know I been sleeping with my wife every night for thirty years,, we’d known if stuff like that was going on. not to mention the wise cracks the teeny bobber twenty something year old girls were giggling about as I left. the Drs hide behind a two way mirror so you don’t even know who they are..
    I know this is way too long but I, every day am so frustrated and stressed I secretly just want to cry due to what they are doing and yes I’m a well adjusted big guy.. for them to jeopardize and scandalize my career and record really really should be criminal..I’d rather be beat down..truly.
    anyways there’s a lot more to this story as it has been going on for over a year. I haven’t even gotten to what the machine has done to my sleep and health..down to actually distorting my facial structure and more serious things than that.
    but hafto save the rest for next time as this is already very long.
    thank You to all fellow drivers out there and all who do or may be willing to voice your experience with CPAP and the crookedness of this injustice.

  2. Scott Wooley

    I have had 3 sleep studies done due to an ME saying I have OSA but they come back negative. I find it funny that the ME always knows the exact place you should go to have one done. I always find my own.

  3. Joseph H Zaniewski

    Just the fact that the Dr’s assistant puts these masks on us says the Dr. Is not putting their reps. On the line. That says alot!

  4. David Kulesavage

    One of the reasons I retired the other was ELD s. Nothing worse than lying in bed unable to sleep waiting to hit 4 hours of compliance so I could rip the mask off and sleep normally. When I could sleep with the mask I would wake up with a dry mouth probably not good for the gums

  5. CBanks

    I think the idea of requiring drivers to wear a cap is ridiculous. Truck drivers go through enough bullcrap as it is without all the extra nonsense. It’s funny that they claim there’s a shortage in drivers, but how will the fill the gap. Adding more restrictions only adds to the problem.

    1. Rick Smith

      Most federal regulations are nothing but money grabbers they treat drivers and companies like slot machines let’s see how much we can get out of them this year hmmm well that wasn’t enough so let’s change things around and get more.

  6. Wendy Porche

    My mother thought she had a loss of sleep due to sleep apnea, what’s the doctor gave her a sleep study and decided that she had apnea. Put her on a CPAP machine. Then her nose dried out, she got bronchitis, then she got pneumonia, and then they had to add oxygen to the CPAP machine. As the future would hold for my mother her lungs got so dependent on that CPAP machine pushing air into her lungs that she grew into not being able to breathe on her own. Now my mother who was a nurse all of her life is disabled completely at home sitting on portable oxygen machines while she’s just sitting in the living room she can’t beg to have enough air in her lungs independently just to walk to the restroom. We’re talking about a completely independent woman who is now due to Big Pharma some guys invention of a CPAP machine and lobbyists in Congress goddess machine on the market now he’s pushing it on everyone else so if everyone has to have one he’s a billionaire and we’re all dependently strapped to machines in order to get a breath of life. So before we go making any rash decisions we may have to look at the overwhelming evidence that the CPAP machines have been recalled all over the nation drivers and people sitting at home all alike are facing chronic lung diseases and needs for transplants of lung surgeries that are overwhelming selfish public will not vow to be an organ donor for these people or any others. So before you try to make choices with an American Life think about what they did in the old days you lived you breathe and you died just like everyone else the way God intended. Maybe government and man should stand aside and let God decide it’s time we all let God decide

  7. JT

    To me I think using a cpap machine would cause a person to get less sleep. Having something on face would drive me crazy and I probably just end of ripping it off in the middle of the night.

Comments are closed.

John Gallagher

Based in Washington, D.C., John specializes in regulation and legislation affecting all sectors of freight transportation. He has covered rail, trucking and maritime issues since 1993 for a variety of publications based in the U.S. and the U.K. John began business reporting in 1993 at Broadcasting & Cable Magazine. He graduated from Florida State University majoring in English and business.