[Diagnosis] Maintenance of Wakefulness Test

[Ockrocket]

In New South Wales- Australia, it is a requirement to pass the MWT if you hold any form of commercial driving licence ( in my case I hold Heavy Combination truck and Driver Authority for passenger/hire car/taxi, and am a professional hire car driver at present )

The way the test is done in NSW can't be cheated on to pass.. fully monitored by IR camera and you are hard wired to the recording machines. 
At the times between each test period you are to stay within the facility, and not allowed any soft drinks or caffeine based drinks or products, and you are still wearing the monitoring machine that continues recording even though it is disconnected from the main computers for a period of time.

My test was done at the same time as I was being tested for SA, so spent a full 24 hours in the hospital where the MWT was done. 
I also underwent a whole raft of other tests to check brain function- heart- and other things that had to be cleared before I got my licence reinstated to commercial status. 
The whole problem came up when I fell asleep and crashed my work vehicle I was driving at the time ( took out a small tree and two wheelie bins, no one else involved or injured )

I still have doubts my sleep apnoea diagnosis is correct, and my wife says I don't stop breathing when I'm asleep, and I feel more rested after 7-8 hours of sleep without CPAP than I do over the same period sleeping with it.  

The true cause of my accident I feel was just sheer fatigue, for the preceding ten years I had been averaging 4-5 hours of sleep per night.. 
I was in to my fourth long day at work, and had been awake for about 17 hours at the time I crashed.

For me, the real benefit of being forced to use CPAP to keep my commercial driving licence is that now I make a diligent effort to get a full night's sleep, so it has been valuable for me.

[Sleeprider]

Sidesleeper, have you ever considered that you could simply transfer your sleep apnea care to your primary physician and avoid the specialist. You have a diagnosis in hand, and are managing to comply with using the CPAP. Your primary physician could review your CPAP use and ask a few questions regarding how it is going, and if needed sign sign off on your DL.

I would think after 3-years of CPAP therapy this accident should not be following you. Does the Oregon DMV require an annual review, or is that your doctor's thing to keep you coming back?

[SideSleeper]

Interesting information--thanks, members! I did a lot of reading online about it. My doctor has you come in and be ready at 8 a.m. This means I must get up at 6 a.m.--I'm not even functional at 8! They called me to set up the test and I declined. Right now I'm fighting two different spine problems--lumbar and cervical--and not certain I can sit up on a bed for the 40 minutes required. I told his tech I am not a candidate for it a this time--possible lumbar surgery in July. I'm just going to let this ride for now. My doctor is a good one--think he was using this before he could sign me off permanently from yearly visits. I'm OK until next April--have time to talk more bout it to him. Not certain my PCP would sign off on it--he and the sleep doctor are friends--sleep doc worked in the same clinic before he had problems with sleep apnea himself and was talked into changing specialties by HIS sleep doc.

[dwd1249]

In New South Wales- Australia, it is a requirement to pass the MWT if you hold any form of commercial driving licence ( in my case I hold Heavy Combination truck and Driver Authority for passenger/hire car/taxi, and am a professional hire car driver at present )

The way the test is done in NSW can't be cheated on to pass.. fully monitored by IR camera and you are hard wired to the recording machines. 
At the times between each test period you are to stay within the facility, and not allowed any soft drinks or caffeine based drinks or products, and you are still wearing the monitoring machine that continues recording even though it is disconnected from the main computers for a period of time.

My test was done at the same time as I was being tested for SA, so spent a full 24 hours in the hospital where the MWT was done. 
I also underwent a whole raft of other tests to check brain function- heart- and other things that had to be cleared before I got my licence reinstated to commercial status. 
The whole problem came up when I fell asleep and crashed my work vehicle I was driving at the time ( took out a small tree and two wheelie bins, no one else involved or injured )

I still have doubts my sleep apnoea diagnosis is correct, and my wife says I don't stop breathing when I'm asleep, and I feel more rested after 7-8 hours of sleep without CPAP than I do over the same period sleeping with it.  

The true cause of my accident I feel was just sheer fatigue, for the preceding ten years I had been averaging 4-5 hours of sleep per night.. 
I was in to my fourth long day at work, and had been awake for about 17 hours at the time I crashed.

For me, the real benefit of being forced to use CPAP to keep my commercial driving licence is that now I make a diligent effort to get a full night's sleep, so it has been valuable for me.

Unless it has changed in the 3 years since my retirement I never had to have a MWT to drive a school or passenger bus in NSW. I was required to get signed off by a sleep doctor every year.

[Ockrocket]

Unless it has changed in the 3 years since my retirement I never had to have a MWT to drive a school or passenger bus in NSW. I was required to get signed off by a sleep doctor every year.

MWT was to get my HC endorsement back, and to keep my Driver Authority to drive passenger buses and hire cars.
I also have to be cleared by my sleep specialist every year to keep my licence at a professional level. 
These are requirements stipulated by the RMS for professional drivers in situations like mine ( post accident, rather than just a diagnosis by a GP/doctor )

The alternative was to forego the various tests, wait out 6 months to get my car driver's licence back ( 6 months without another "blackout" ).. then sit out another 5 years, again without a repeat "blackout" event, to get my HC truck endorsement and passenger Driver Authority reinstated to my driver licence.

[dwd1249]

I forgot that you were post accident Ockrocket. With me it was just a regular physical once a year with GP and once a year with the sleep doctor.
We had 3 drivers suffer blackouts driving. All of them had to wait months and see specialist to get their car license back. Only one ever got his Driver Authority back.

[SideSleeper]

Oregon puts you in the "At Risk Driver Program". The last question the sleep doc must answer on the form is:
"Do you recommend that DMV require the patient to reestablish eligibility for a driver license in the future? Yes, No or Unknown. If yes, when? in 6 months, in 12 months other." He has checked yes and 12 months for the past two years (it was 6 months the first time after the suspension). He is also under the impression that Medicare requires a yearly visit--but said he would check on it when I asked about this. I was under the impression that he would cut me loose if I was successful on the MWT. I didn't ask if Medicare paid for this or if I was being volunteered for a study--this I will do later. I certainly appreciate the information you all have shared.

[KSMatthew]

Oregon puts you in the "At Risk Driver Program".  The last question the sleep doc must answer on the form is:
"Do you recommend that DMV require the patient to reestablish eligibility for a driver license in the future?  Yes, No or Unknown.  If yes, when?  in 6 months, in 12 months  other."  He has checked yes and 12 months for the past two years (it was 6 months the first time after the suspension).  He is also under the impression that Medicare requires a yearly visit--but said he would check on it when I asked about this.  I was under the impression that he would cut me loose if I was successful on the MWT.  I didn't ask if Medicare paid for this or if I was being volunteered for a study--this I will do later.  I certainly appreciate the information you all have shared.

I don't know anything about Oregon law.

Have you asked the doc why he still insists on keeping you monitored?

From what I read: You had an accident when you fell asleep at the wheel.  Then you got CPAP (did you know you had OSA prior to the accident?)

Since then, 2.5 yrs, you've been compliant and show good AHI numbers.

Now he still wants you monitored and do a MWT?

Is he thinking there may be something else wrong, besides the OSA?  You'll only know if you ask.

Can you change docs?

[SideSleeper]

Oregon puts you in the "At Risk Driver Program".  The last question the sleep doc must answer on the form is:
"Do you recommend that DMV require the patient to reestablish eligibility for a driver license in the future?  Yes, No or Unknown.  If yes, when?  in 6 months, in 12 months  other."  He has checked yes and 12 months for the past two years (it was 6 months the first time after the suspension).  He is also under the impression that Medicare requires a yearly visit--but said he would check on it when I asked about this.  I was under the impression that he would cut me loose if I was successful on the MWT.  I didn't ask if Medicare paid for this or if I was being volunteered for a study--this I will do later.  I certainly appreciate the information you all have shared.

I don't know anything about Oregon law.

Have you asked the doc why he still insists on keeping you monitored?

From what I read: You had an accident when you fell asleep at the wheel.  Then you got CPAP (did you know you had OSA prior to the accident?)

Since then, 2.5 yrs, you've been compliant and show good AHI numbers.

Now he still wants you monitored and do a MWT?

Is he thinking there may be something else wrong, besides the OSA?  You'll only know if you ask.

Can you change docs?

I intend to talk with him at some point about why he continues to monitor.  I didn't know I had sleep apnea when I had my accident.  I have wonderful numbers--under 1.0 since January 2018--AHI 0.3 when I saw him (30 day).  He brought up the MWT when I asked him if he could sign off on my mandatory 12 month re-certifications.  He is under the belief that Medicare requires a yearly visit--I told him that wasn't true and he said he would check on it.  I'm putting this behind me for awhile until I get two spinal problems taken care of--couldn't do this test for some time anyway.  He is rally a good doctor--easy to talk to, doesn't care if I change my settings, friendly.... He did give me another 12 months so I'll deal with it before next visit in April 2019.

[KSMatthew]

Oregon puts you in the "At Risk Driver Program".  The last question the sleep doc must answer on the form is:
"Do you recommend that DMV require the patient to reestablish eligibility for a driver license in the future?  Yes, No or Unknown.  If yes, when?  in 6 months, in 12 months  other."  He has checked yes and 12 months for the past two years (it was 6 months the first time after the suspension).  He is also under the impression that Medicare requires a yearly visit--but said he would check on it when I asked about this.  I was under the impression that he would cut me loose if I was successful on the MWT.  I didn't ask if Medicare paid for this or if I was being volunteered for a study--this I will do later.  I certainly appreciate the information you all have shared.

I don't know anything about Oregon law.

Have you asked the doc why he still insists on keeping you monitored?

From what I read: You had an accident when you fell asleep at the wheel.  Then you got CPAP (did you know you had OSA prior to the accident?)

Since then, 2.5 yrs, you've been compliant and show good AHI numbers.

Now he still wants you monitored and do a MWT?

Is he thinking there may be something else wrong, besides the OSA?  You'll only know if you ask.

Can you change docs?

I intend to talk with him at some point about why he continues to monitor.  I didn't know I had sleep apnea when I had my accident.  I have wonderful numbers--under 1.0 since January 2018--AHI 0.3 when I saw him (30 day).  He brought up the MWT when I asked him if he could sign off on my mandatory 12 month re-certifications.  He is under the belief that Medicare requires a yearly visit--I told him that wasn't true and he said he would check on it.  I'm putting this behind me for awhile until I get two spinal problems taken care of--couldn't do this test for some time anyway.  He is rally a good doctor--easy to talk to, doesn't care if I change my settings, friendly.... He did give me another 12 months so I'll deal with it before next visit in April 2019.

OK - too many people simply take their doctor's word without asking for an explanation.  Sounds like you like your guy is just being cautious.  As long as that isn't getting in the way of you living your life, that's not necessarily a bad thing.  Good luck on getting things fixed until then!