Neck Size, BMI and your CDL. Drivers Beware You Might Be OOS Soon.

Drive for CDL

Ready to get your Medical Card updated?  Feeling healthy, and you cruised through your last exam? What’s to worry about?  Plenty.over


If your neck is bigger than 17 inches, or your BMI is 35 or greater, there might be a medical “out of service” in your future.  So let’s see how this can happen, what you need to worry about, and then in conclusion, what you can do to prevent an out of service.  Remember over 40% of drivers will meet one of these “criteria”.


The DOT does, and through regulations being promulgated by the FMCSA, DOT is going to have your neck size and body mass measured.  Turns out there is a statistical correlation between your neck size and / or your body mass index, and the likelihood of sleep apnea.


According to the National Institute of Health;

Sleep apnea (AP-ne-ah) is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.

Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into light sleep.

Sleep Apnea is only one problem.
Sleep Apnea is only one problem.

As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness.

Sleep apnea often goes undiagnosed. Doctors usually can’t detect the condition during routine office visits. Also, no blood test can help diagnose the condition.

This last part is most important, to reiterate, “sleep apnea often goes undiagnosed“.  Thus, the DOT is trying to find a way to flag CDL drivers who “might” have sleep apnea for further screening.  This is where neck size and the Body Mass Index (BMI) come into play.

According to WebMd;

More than half of people with obstructive sleep apnea are either overweight or obese, which is defined as a body mass index (BMI) of 25-29.9 or 30.0 or above, respectively. In adults, excess weight is the strongest risk factor associated with obstructive sleep apnea.

Each unit increase in BMI is associated with a 14% increased risk of developing sleep apnea, and a 10% weight gain increases the odds of developing moderate or severe obstructive sleep apnea by six times. Compared to normal-weight adults, those who are obese have a sevenfold increased risk of developing obstructive sleep apnea. But the impact of BMI on obstructive sleep apnea becomes less significant after age 60.

BMI isn’t the sole marker of obesity that’s important. Men with a neck circumference above 17 inches (43 centimeters) and women with a neck circumference above 15 inches (38 centimeters) also have a significantly increased risk of developing obstructive sleep apnea.


So as you will see, DOT is trying to screen CDL drivers by requiring doctors doing medical certifications to flag anyone with a large neck or high BMI for further testing of sleep apnea.

According to The Medical Examiner’s Handbook produced by the FMCSA:

Treatments for OSA [obstructive sleep apnea] include surgery and continuous positive airway pressure (CPAP). The successfully treated driver may be considered for certification following the recommended waiting period. You should not certify the driver with suspected or untreated sleep apnea until etiology is confirmed and treatment has been shown to be stable, safe, and adequate/effective.


Waiting period

Minimum — 1 month after starting CPAP

Minimum — 3 months symptom free after surgical treatment

NOTE: If more than one waiting period applies (because of multiple conditions or other comorbid diseases), examine the driver for certification after the completion of the longest waiting period.


Maximum certification — 1 year

Recommend to certify if:

The driver has:

  • Successful nonsurgical therapy with:
    • Multiple sleep latency testing values within the normal range.
    • Resolution of apneas confirmed by repeated sleep study during treatment.
  • Continuous successful nonsurgical therapy for 1 month.
  • Compliance with continuing nonsurgical therapy.
  • Resolution of symptoms following completion of post-surgical waiting period.

Recommend not to certify if:

The driver has:

  • Hypoxemia at rest.
  • Diagnosis of:
    • Untreated symptomatic OSA.
    • Narcolepsy.
    • Primary (idiopathic) alveolar hypoventilation syndrome.
    • Idiopathic central nervous system hypersomnolence.
    • Restless leg syndrome associated with EDS.


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). See Sleep Disorder Tests.

According to;

The current DOT regulations include BMI and neck size as key indicators for sleep apnea that medical examiners will be looking for during recertification physical exams. The DOT currently wants anyone with a BMI of 35 or greater to have a sleep study performed as well as anyone with a neck size of 17 inches or greater (for males) and 16 inches or greater (for females) to have a sleep study done. Drivers whose sleep study results are positive for sleep apnea and who have been set up on CPAP treatment, will have to meet certain compliance requirements when using their CPAP machines. To meet current DOT regulations, CDL holders must use their machines for 70% of the week which roughly equates to 4 hours a night for 5 nights a week.

The Federal Motor Carrier Safety Administration’s (FMCSA) goal is to reduce commercial vehicle related fatalities and injuries. A FMCSA study found is that an estimated 28% of Commercial driver’s license (CDL) holders suffered from some form of sleep apnea ranging from mild (17.6%), to moderate (5.8%) to severe (4.7%). 



Looks comfortable doesn't it.
Looks comfortable doesn’t it.

Well summarizing, if you have a BMI above 35 or a neck above 17 inches for a male, or 16 inches for a female, the DOT registered Medical Examiner “has” to test you for Sleep Apnea.  The definitive test is a sleep study, which is essentially an overnight visit, that can’ be done on the spur of the moment, and if you are unlucky enough to “fail” only a month of successful treatment (best case scenario) will ensure your Medical Card is issued.

Even worse, Overdrive Magazine has reported that:

Drivers who walk in to a medical examiners office with any of the above will be told they need to be tested for sleep apnea, McDermand said, and he’s hearing frequently from drivers who say the examiners aren’t renewing med cards if they haven’t been tested.

So drivers need to be proactive.  If your BMI is above 35 (Calculate your BMI here) or your neck is over 17 inches (16 for woman), you should get a sleep study at least three months before your Medical re-certification is required.  Because if you test positive for sleep apnea you will have time to get treatment and prove the treatment was effective at the time of re-certification.

Unfortunately this is the new reality of regulation in truck driving.  CDL drivers need to be vigilant, both when they drive and when they negotiate the maze of regulations inherent to the industry.   Make sure you pass this information along to fellow drivers,  as a medical out of service can break most peoples finances.  They’ll be sure to thank you.


Yes they did, forbidding any new guidance on sleep disorders, and requiring FMCSA to use the rule making process only.  But the net effect is not to stop this issue of BMI and neck size from interfering with your medical certification.

 “Rulemaking will take at least two and possibly four years on a contentious topic like sleep apnea. In the meantime the “no rule – rule” of informal guidance to medical examiners will be in place. This informal guidance is that all drivers with a Body Mass Index (BMI) over 35 be required to get tested for sleep apnea. If positive for OSA, treatment with a Continuous Positive Airway Pressure (CPAP) machine would be required for DOT medical certification.” –


Since there is no FMCSA regulation regarding sleep apnea evaluation and the basic parameters are subject to interpretation, then be aware of the Medical Examiner’s position.

  • The medical examiner’s job is not to diagnose. It is to assess the driver’s medical fitness to determine if any safety risk issues exist.
  • If there is a reasonable chance of risk then the examiner will request that a specialist in that field provide a proper diagnosis and treatment if necessary.
  • If you’ve been diagnosed with sleep apnea, then another set of regulations apply.

By being proactive, you get to manage this before it becomes an issue. –







33 thoughts on “Neck Size, BMI and your CDL. Drivers Beware You Might Be OOS Soon.”

  1. Anyone of any size can have sleep apnea. Anyone who Snores is a very good canidate for having Sleep Apnea . So the DOT is discriminating against all larger drives. (Harassment) That in my book needs to be stopped. I have a CDL and have Sleep Apnea and have a CPAP machine and I do great when it comes time for my certification and pass with flying colors because the Doctor knows I use my machine all the time by the card that records everything.

      Get out of my truck!
      Get out of my Kitchen!
      Get out of Bed!
      Let go of my Clock so I can do my job!
      Get out of my Wallet!

  2. Ok.who is paying for the sleep study.
    Who is paying for the 2000.00 machine.
    If having to use the machine gor work does this mean we will be getting payed.
    If we pass the sleep study who pays for the down time.
    Lost pay.
    Is there going to be job fairs if you cant get a medical card.
    Sounds like invation of privencey.

  3. What my question to all of this is…. Who is paying for all these tests that some doctor is saying the driver will need? The driver will. A sleep study test is expensive and also takes 24 hr period to complete. So then the driver has to take off of work to do this. I was an over the road driver for more years than I can count. When I needed only one day off, I usually had to take about 3 to 4 off, because of the load schedule. So now the driver is out of pocket all this money. I think its crazy!! I can understand if a morbidly obese driver comes in to the doctors office and is out of breath just walking in to the place, yes… that driver needs some testing done. All I can say is when over half the truck drivers are out of service for a couple of months, lets see how the government takes that when nothing gets delivered on time. They are already saying that we have a driver shortage.

  4. This is discrimination and profiling I know plenty of drivers with sleep apnea that are NOT overweight and some that are that don’t have sleep apnea or have a neck size of 17 or BMI 35 or greater. If they are requiring that sleep apnea be a part of the medical certification then every person that holds a CDL or is just getting it for the first time needs to be tested.




    1. Well you’re not correct here. But hey we’re open. Show us where this was “thrown out”. Notice we cited the FMCSA doctor’s manual, WebMD, the NIH, and OverDrive Magazine…

  6. This is total bullshit!! Fuck the Dot and the fmcsa!Truck Drivers are not the cause of all the accidents.It is the dumb asses in the damn four wheelers cutting us off,turning in front of us. I truly believe they think we can stop on a dime. Screw this it time to put the damn government in their place and people take this country back!Go ahead dot and fmcsa keep it up it is all your dumb ass rules and regulations is what is wrong with the trucking industry!

  7. Some of the information that is posted in this article is not 100%. For example, in the article it is stated “The current DOT regulations include BMI and neck size as key indicators for sleep apnea that medical examiners will be looking for during recertification physical exams.” The main idea to notice is this is an indicator or a recommendation, it doesn’t say that this being a requirement, yet in another section of the article it says

    Well summarizing, if you have a BMI above 35 or a neck above 17 inches for a male, or 16 inches for a female, the DOT registered Medical Examiner “has” to test you for Sleep Apnea.” This is simply not true. Recommendation yes, requirement NO!!! Questions answered on the Epworth Sleepiness Scale can also resolve some of the sleep apnea issues without the need for a sleep study. I am a certified medical examiner and it saddens me that there are some drivers that have given up on getting their medical card as they have been told by uninformed individuals, both at the driver, management and examiner level that they have to go for a sleep study when in fact they may not. Check out my website at You can also see and there is listing for certified examiners in each state. On the home page is a booklet, about taking the stress out of the DOT physical that can be very helpful. You can download a copy for yourself. It also has information about the individual state requirements that can be helpful as well. I hope that this information helps because I want to see all of you drivers continuing to work.

    1. Well doc, let us see what the manual says (as I quoted in the article): “According to The Medical Examiner’s Handbook produced by the FMCSA: Treatments for OSA [obstructive sleep apnea] include surgery and continuous positive airway pressure (CPAP). The successfully treated driver may be considered for certification following the recommended waiting period. You should not certify the driver with suspected or untreated sleep apnea until etiology is confirmed and treatment has been shown to be stable, safe, and adequate/effective. (my emphasis)…

      And here’s what the drivers are saying on FB:

      “They got me all ready…. I lost my medical card. And since i have no insurance or 10 grand for trsting, cpat machine i no longer can drive after 25 years of driving accident free. But im unsafe….. Its not right”

      ” I have been put on a 90 probation til I get a test all because I said I snore when I’m tired. He said I am too big. Oh did I mention I used to play semi pro football and I used to cage fight.”

      “Too bad the apnea study has to be prescribed by your “family” physician, in order for insurance to cover some of the cost of this. A Oc-health physician is not recognized by “our” insurance company to advise such a test. Wife learned this the hard way on her last physical.”

      I appreciate your statement ” I am a certified medical examiner and it saddens me that there are some drivers that have given up on getting their medical card as they have been told by uninformed individuals, both at the driver, management and examiner level that they have to go for a sleep study when in fact they may not.” – but let’s face facts, he may still have to go.. you just said that. So hence our warning… We are not telling people not to drive, but giving them a road map to hurdle this obstacle…

      You shouldn’t wait until your DOT physical, you should get a family doctor referral way in advance, both so you don’t go out of service, and further because of possible insurance issues.

      But on a different note, thanks for the helpful links, and for being a “driver friendly” doctor.

    2. Well trust me it’s no joke I just did my dot physical and they only gave me a 3 month card but my bmi was 36 and my neck size was 17 1/2 …..but the funny thing is last year I weigh in at 259 and my neck was a 16 this time I was 284….but I’m also 6ft4 common sense my neck got bigger do to weigh gain but the only option I have is to loose weight or do the sleep study so far I’ve lost 10 pounds and my card expire next month… do what you can to shed the pounds drivers

  8. Biggest crock of shit..they said I had sleep apnea & I got a 2nd opinion..turns out I didn’t have it..doctors & the government is full of shit..
    My grandpa & great grandpa didn’t need this..
    So why the hell do we need it now…????
    Killing more American jobs..assholes

  9. Ok. What about all these over weight officers and postal workers? They only targeting CDL drivers. Harassment and discrimination.

  10. So let’s c I’m 6’5 1/4 and weigh 300 pounds. my neck is bigger than 17 inches, I have no gut and lift weights regularly. so by there definition I’m obese and should weigh 205 pounds. Lmao. But yet i bet I’m in better shape than about 95 percent of dot officers and cops

  11. I was nailed a year ago. I was sent to a medical equipment vendor, where they sell wheelchairs and such. I was given a “home test.” It’s cheaper than the overnight test, you take it home with you, and bring it back the next morning, and your results are supposedly emailed to a doctor and he gives you your diagnosis without ever laying eyes on you. Don’t fall for this. Most of the large carriers are sending their drivers to these “clinics” to save money. You WILL fail. And you will walk out of that medical equipment vendor with a $1500 CPAP machine. They monitor it, it has a cellular modem on it that sends data to their company, and they will report you and your medical card will get suspended for seven days.

    I am overweight. I don’t snore. I don’t have sleep apnea. I have been wearing this thing for the better part of a year now, it has not improved my sleep, only hindered it. I have missed delivery appointments because I have tore it off in middle of the night, and woken up at 5am, ready to roll, and now I have to lay there until 8am wide awake with this mask on my face because I only wore it one hour out of the required four. I have to carry it around with me, wherever I go, making sure it’s plugged in so they can read the data on it.

    This is a crony capitalist SCAM. It’s not a coincidence that the same “doctor” responsible for making these decisions at the FMCSA is also the man in charge of General Electric’s medical equipment division. That is FACT.

  12. So, here we go having to dance around like puppets trying to lose weight for the government to keep our jobs.
    Ever wonder why people go postal?

  13. So Admin, when was this policy made a rule and mandated? Last I heard it had to go through Congress for that to happen. So maybe you need to reread the book. If your Dot or FMCSA or a wanta be maybe you need to proove it the the trucking community and inform us of the policy or rule statue number. For those having been told to test have the doc show you the policy. They can’t because it doesn’t exist. But your government is doing what they have regulations on and that coursing the medical community into testing you. Wow sounds like another law suit in the making for the FMCSA.

  14. My doctor told me that your insurance will not pay for your physical or any other test you need. Comes out of your pocket. Maybe we should have make the DOT CONFORM TO THESE SAME RULES.

  15. This is nothing short of another way to harass hard working truck drivers. The doctors and bureaucrats involved on this are getting big financial rewards every time you buy one of those machines. Do the math.
    40% of say 4 million truckers times 1500 to 2000 dollars per machine. Then you add doctors fees etc.
    Somebody’s getting filthy rich by this little move. By our hard ass sweat.
    I just don’t know what is gonna take to get truckers to stand together as we used to 30 + years ago. We can stop this darned abuse.
    But we must stand together first.

  16. F*** you DOT !!!!! This is discrimination!!!
    Wtf??? And wt bout your f***ing fat a**es officers??? They f***ing worse!!!

  17. It is sad this country discriminates against overweight people worse than sex,color,and religion. How can you pick one industry and single out overweight workers and take away THEIR lively hoods,and say it’s not profiling and discrimination.i’ve had a big neck all threw school because of weightlifting and sports.even at 167 wrestling weight , I could not button the top button on ANY size shirt. So exactly WHOS gonna support my family when they put me out of work because of my neck size? My exemplary driving record should say it all…. Not the size of my neck…..

  18. To bad congress said no. To bad the govt. cut funding to fmcsa because of this supposed rule. It won’t happen relax..

    1. Here is another rediculous law they are trying to pass. Whoever is in charge of making the DOT laws needs to go bc i am sure they have never been in a truck or have any knowledge of the trucking industry. When hiring whoever is going to make these decisions needs to have some trucking background. I was hit by a tractor-trailer in ’92 & i married a truck driver in ’07. My knowledge in ’92 had me angry & scared but my knowledge soon after my husband & i got together has changed drastically. I have worked for a trucking company for 2 & a half years now & it sickens me with alot of these laws. I am sorry but i can not force someone to rest or sleep & u can not discrimanate against weight, unless you take everyone & make them rest before they leave their job & get on the road after working 8 or more hours & what do you do with someone overweight that does not work in the trucking industry & they have sleep apnea & do not sleep properly & works 8 or more hours & gets on the road tired. We need to stop making these rediculous laws for truckers if we are not going to inforce them on people who do not drive truck. Lets come together & stop blaming all accidents on truckers (ecspecially in the news) & start looking at ways for everyone that drives on the roads to be safe. Lets make laws that make since for all drivers & lets better educate all drivers

  19. please, the government needs to stop, I had to start taking insulin back in march 2010, lost my job driving truck. I had 1 million miles safe driving no accidents. They were doing this BMI crap then too. Its wrong! government needs stop there crap. I mean really? They train a driver for 3 weeks and hand them a lic. to 80 ton truck and wonder why there are accidents? Lack of training, and take the lic. away from damn good drivers ?? Come on america, this is medical discrimination!

  20. If I lose my card and job then before I turn in my keys I’ll crash the bitch on the White House lawn. Fuck em

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