From the Guidelines
Commercial drivers with obstructive sleep apnea must demonstrate a minimum CPAP compliance of 70% usage to meet Department of Transportation (DOT) medical certification requirements. This means using the CPAP machine for at least 4 hours per night on 70% of nights, with compliance documented over a period of at least 30 days 1. The DOT requires this level of compliance because untreated or poorly managed sleep apnea significantly increases the risk of drowsy driving, which poses serious safety concerns for commercial drivers. Key points to consider include:
- Untreated OSA is linked to a higher risk of crashes in both passenger car and commercial truck drivers, with treatment reducing this risk 1
- CPAP therapy can lower crash risk to the same level as that seen in individuals without OSA, improving sleepiness and performance on a driving simulator 1
- Drivers who do not meet the PAP adherence criterion have a crash rate that is five-fold higher than those who do meet the criterion 1
- Adequate CPAP usage helps ensure that drivers remain alert and safe on the road by effectively treating their sleep apnea. Drivers should maintain detailed usage records from their CPAP machines, as medical examiners will review this data during DOT physical examinations to determine certification eligibility. If compliance falls below the required threshold, drivers may face restrictions or denial of their medical certification until adequate compliance is demonstrated.
From the Research
CPAP Compliance for DOT
- The Department of Transportation (DOT) requires commercial motor vehicle drivers to adhere to certain standards for treating obstructive sleep apnea (OSA), including the use of Continuous Positive Airway Pressure (CPAP) therapy.
- According to a study published in the Journal of Clinical Sleep Medicine 2, the proportion of participants adherent to CPAP therapy was 68.0% at 1 week, decreasing to 39.6% at 1 year.
- Another study published in Sleep 3 found that "Full Adherence" to CPAP treatment (defined as using the device for more than 5 hours per night) was associated with a significantly lower risk of preventable Department of Transportation-reportable crashes.
- The Federal Motor Carrier Safety Administration (FMCSA) requires commercial drivers to have a minimum of 4 hours of CPAP use per night to be considered compliant 2.
- A study published in Chest 4 found that patients who used CPAP for more than 5 hours per night tended to have better compliance and outcomes.
- The American Academy of Sleep Medicine recommends that adults with OSA use CPAP for at least 7 hours per night 5.
- However, the specific percentage of CPAP compliance required for DOT is not explicitly stated in the provided studies, but it is generally recommended that drivers use CPAP for at least 4-7 hours per night to be considered compliant 3, 2.