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CPAP Compliance in relation to DOT.
#1
There is a lot of anxiety surrounding positive airway pressure by many of patients. This certainly applies to the trucking industry when it comes to being tested for sleep apnea and the treatment options based on those test results. If you are doing your research there is definitely a lot of information available about the testing options and the lack of instruction from the Federal Motor Carrier Safety Advisory. I'm going to be up front with you. I don't want to discuss the qualifications needed for a diagnosis of sleep apnea in comparison to the guidelines and suggestion in place with the FMCSA. I want to provide information to the patients that have completed their sleep studies and have decided to initiate CPAP therapy. I have found a lot of information readily available when searching for the guidelines; however, I did not find much information for patients that have already followed through with testing and reached their diagnosis. So, with that - let's talk about positive pressure therapy (CPAP) compliance with the department of transportation!


Even though CPAP is meant to be accommodating, let's be honest with one another - sometimes it isn't. You have to go to sleep with a mask placed on your face while breathing in pressurized air throughout the night, it simply with some patients - is - not - accommodating. However, CPAP is not meant to entirely alter your lifestyle in this manner, it is made to fit into your lifestyle and enhance your health! So, one of the fears when it comes to truck driving and positive pressure therapy is the CPAP adapting into the lifestyle. Whether you are driving across the country (over the road), running single deliveries (hot shots) or any other commercial driver license holder. Your CPAP device is meant to slide into your lifestyle, not for you to completely alter yours to accommodate the therapy. Slight alterations in your lifestyle are typical as you will have to acclimate to wearing the therapy at night as you sleep. If your CPAP device is causing such a problem that you are having to alter so much of your sleeping habits without a guidance then there is likely something not working correctly. Do some research or speak with your provider. Do not settle for sub par positive pressure therapy.


The reasoning behind my push of the proper mind set to have is that you must meet compliance. Regardless if you are CDL holding patient or not, compliance will be something that is mentioned several times by every provider and health care professional you encounter. The question is, what is compliance? Compliance is a measurement that shows if you are wearing your CPAP machine and how well it is working for you. n regards to the transportation industry DOT and FMCSA physicians will be looking for patients to wear the CPAP machine 4 hours each night for 70% of the nights. This is measured out of thirty consecutive nights. If the machine is used for over 4 hours a night with 22 nights meeting this criteria out of 30 nights then you have met compliance. Even though this task can seem lenient, it can be very strict. If the CPAP machine is utilized for 3 hours, 59 minutes, 59 seconds, well - this means that the patient is now non-compliant and failed that particular night. And if problems cannot be resolved and one night of non-compliance turns into 9 nights or greater, then the patient is now dubbed "non-compliant" by failing to meet the guidelines. There is an aid with the "30 Day Rule". A patient will typically have between the 30th day and the 90th day after initially starting your CPAP therapy to prove compliance. Within the first thirty days it is understandable that a patient can be still acclimating to the CPAP machine and mask. In overall a patient has at least 90 days from the start of therapy to meet this requirement and allows some time for problems to rise and be resolved.


Compliance does not only encompass the use of the CPAP machine, it also requires a visit to the physician. DOT/FMCSA wants the CPAP machine to accurately indicated that the patient is utilizing the therapy and that a certified physician has reviewed this data and annotated that the CPAP machine is in fact working with the patient compliant. Some physicians are able to download CPAP units in office, but unfortunately a great many are not able to do so. Then the patient must visit the DME (durable medical equipment) company for a download of the information to be completed and provided to the physician for review. A call to the physician ahead of time can help to assure whether the machine must be downloaded before the appointment. It is also important to note that not every physician is certified to read these downloads per DOT/FMCSA standards, so assure this with the assigned physician through DOT/FMCSA first of what physician to use, then assure that this physician can download the CPAP unit and if not schedule a download from the DME provider and ultimately follow up with the physician for the download to be reviewed and noted within the patient chart.


So, this does seem simple. Wear your machine for at least four hours a night and schedule to see your physician approved through FMCSA/DOT within 2-3 months after you receive your machine. I want to warn you of you one major finding. Some patients will turn the machine on and allowing it to run all throughout the night without ever applying the mask resulting in "fake compliance". This is obviously, ludicrous. The CPAP cannot help you if you are not wearing it, but some patients - especially employees in the shipping industry - are forced into sleep therapy to assure public safety. Here is the warning. The modern style of CPAP machines can tell if the patient is breathing or not. This can become an issue depending on the physician that interprets your download and/or the department of transportation. So do not try this, wear the CPAP. It is not worth the risk as this could lead to severe problems that contain your approval for commercial drivers license and health. If problems arise with the therapy think about what the problem is and do some research or communicate it to your providers. Get an answer and solve the issues to assure that your compliance criteria will be satisfied.


I know this is a brief explanation. A large portion of this compliance can be also transcribed to insurance coverage with a few changes. This information is strictly what typical department of transportation/FMCSA is looking for when approving the use of the CPAP therapy as I have encountered in my home state of Oklahoma.

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#2
It's always interesting to hear different definitions of "compliance." My insurance's definition of compliance was 4+ hours of usage on average over a 90-day period, and the compliance "spec" was 80%. It seems to me that DOT's definition is fairly lax, considering how important sleep is to the performance and safety of the long-haul truck driver, but I suppose 4 hours of high quality sleep is better than 7-8 hours of low quality sleep, without therapy
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#3
(01-19-2016, 02:03 PM)thecpapguy! Wrote: I know this is a brief explanation.

I found it neither brief nor an explanation. What is your purpose?
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
(01-19-2016, 10:10 PM)Sleepster Wrote:
(01-19-2016, 02:03 PM)thecpapguy! Wrote: I know this is a brief explanation.

I found it neither brief nor an explanation. What is your purpose?


Good morning Sleepster! I don't know if I have to reply if you are a moderator or not? I usually try not to reply unless it is a question that I feel I can offer knowledge for or if there is something I can learn from as well. So, I'm responding to assure if there are any rules I meet them and to be friendly!
My purpose, well that is a broad question. I have worked with several driving patients and helped them with compliance for their DOT physical. They were confused and one said he could not find any information online about what compliance is needed. So I thought I would offer some information if I could. Just simply to help for anyone that is interested. Sorry if I caused a problem or offended in any way.
I did feel that I explained what compliance is and how it is related to a physician follow up up. I'm sorry that you don't feel I explained well - I will try harder in the future to be more clear and even more concise as I can. Thank you for the criticism and contrast!

You're right, if your reading the thread it does seem somewhat long - but compliance can be so complicated and I felt that this was very concise when I could have elaborated greatly. That is why I felt it was brief for patients that understand compliance can be very complicated.
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#5
Compliance is pretty simple. You just use the machine for the required number of hours per day and for the required number of days. That's two numbers. For example, it's usually 4 hours per night for 70% of the nights. Like you said, it varies from state to state and insurance company to insurance company so I guess I don't see the need for being any more specific than that. Unless, of course, someone asks.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
Sleepster, and CPAPguy, the Federal Motor Carrier Safety Administration (FMCSA) https://www.fmcsa.dot.gov/regulations/medical issued new regulations that requires that interstate commercial motor vehicle drivers maintain a current Medical Examiner’s Certificate to drive. This certificate includes, for drivers with obstructive sleep apnea, that they demonstrate compliance in using a CPAP device. This is completely apart from any insurance requirements. The driver's job literally depends on him maintaining his medical certificate, of which CPAP compliance may be a part. Drivers must use certified examiners, who must sign off on compliance records.

In 2014 the FMCSA established the National Registry of Certified Medical Examiners, a program that has minimum training and testing requirements for healthcare professionals who perform qualification examinations for drivers to ensure that examiners fully understand the medical standards in the Federal Motor Carrier Safety Regulations and related guidance applicable to OSA. As a result, better trained examiners will and have been screening and identifying more drivers at risk for OSA.

Where CPAPguy's article falls down is it fails to reference the regulatory requirements and references to FMCSA and the resources for drivers to use in complying with the requirement...it is more of an insurance compliance article. I think it would be great for someone to take the time to compile useful information for motor carrier driver's to use in complying with these sometimes difficult requirements. I took the time to read the first post, and unfortunately it doesn't seem to have been well researched for its intended purpose.

I think it would help CPAPGUY to know that he may in fact use government and non-commercial hyperlinks to assist in identifying requirements and resources to make his article more meaningful to those affected. In most cases I would think the company Human Resources departments should also have this information and a list of physicians and examiners they use to maintain compliance..
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