Apnea and DVLA (UK) experience

Hi all,

First post on this board so I'll fill you in on my background.

Im 40, unfit largely due to being on the road daily for my job (I am a field based network engineer) and pretty much everyone on my dad's side of the family snores and stops breathing, even my little nephews.

My partner had pointed out that she was concerned about me stopping breathing but to be honest, it has never been a problem. I just dont get tired at all.

So I started with banging headaches almost daily and when my OH was at the doctors, I used one of those Blood Pressure monitors in the waiting room.

It turns out my BP isnt even on the charts, so the doctors put me on Ramipril and Amlodipine and things went back to a sane level.

During my BP consultation, my OH let slip about my apnea and the Dr said he'd refer me to a sleep clinic for tests, so I was hooked up to various monitoring devices, all the time with me protesting that there wasnt anything wrong with me.

The results showed an AHI of 18 apnea events per hour.

So an appointment was made and an official diagnosis was made of Sleep Apnea....

Then the bomb shell - "We'll have to inform the DVLA...."

Crap.

He gave me an SL1 form to fill in declaring my condition, but there is no entry on there for whether you are tired or not, ONLY whether it is "Controlled".

As I hadnt yet had my CPAP consultation, I had to answer "No" to that question.

Result? Licence revoked - Stop driving, return your licence, we dont care how well you drive or that you arent sleepy, you have sleep apnea so you cant drive until you have been compliant with treatment.

The CPAP isnt so bad, it is a Resmed 10 with 3g reporting to the sleep centre. The CPAP is like being outside in a breeze so I am ok with that (But I dont like the "Big Brother is watching you" element).

So I was diagnosed mid August, licence revoked mid September, 1 month consultation 28th September and now my licence reapplication went in early October. This consisted of a D1 "standard application" form, an updated SL1 declaration form, and a REAPP form that was sent to me with my letter of revokation. This form seems to cut out the whole "DVLA will send your Dr a form and he sends it back" part of reapplying, so hopefully, the DVLA should have everything they need now.

I will be updating this post as and when things start to happen.

So I have some questions for those who have gone through this:

How long did it take you to get your licence back?
What hoops did you have to go through?
Did you guys get a REAPP form also?
Or did they have to speak to your Dr?

My big fear is that my employer is going to let me go because at the moment, I am neither use nor ornament, despite volunteering to do "local" jobs or work remotely by logging into devices from home.

Just to add - My AHI according to the machine is now less than 1 event per hour

Most of the people here are in the US or Canada, though there's a sprinkling of others from all over the world and a few from the UK - I suggest you PM Rick Blaine who's over there and really knowledgable about how things work... our systems and laws are different. Good luck and let us know how it all goes.

burnt_toast wrote: My AHI according to the machine is now less than 1 event per hour

Thanks for your message on my thread. My letter from the hospital saying I had to tell the DVLA came once I'd been diagnosed but my APAP collection appointment was within a couple of weeks. So I filled in the form saying I *will* be on treatment on that date, which is now a week ago (ie I've been on APAP a week today). I haven't heard back from DVLA yet.

I hope your license is soon restored.

Best Wishes.

Hi burnt_toast,

You raise a lot of points. I'll try to be succinct, as well as respond to most of them.

1. You don't say which part of the UK you're from. Treatment varies from area to area and from foundation trust hospital to foundation trust hospital. It can make a difference on what information and/ or advice to give you.

2. Your main point seems to be: 'When do I get my driving licence back?' Before I get to that, I hope you'll let me respond to a few of your other comments - if not for you, then for the general reader.

3. a. You say you didn't get tired - just got banging headaches. One way to over-ride tiredness is to 'gee up' your state with a controlled amount of your body's own adrenalin. It's a trick people with high-pressure jobs learn to do.

But there's a cost. Hypertension, or raised blood pressure. Which can show itself in ... headaches.

b. You say you didn't get tired - but your system was reacting in one very clear way to the sleep apnea. One frequent consequence of untreated sleep apnea is ... high blood pressure.

And if you add that to (a) above ...

c. You say you didn't get tired. There's research which shows that many drivers with untreated sleep apnea have 'mini-sleeps' - sometimes as brief as three seconds.

And a key additional finding is that some of those mini-napping drivers don't even notice. When they come fully awake again, they have amnesia for the downtime.

A lot can happen on the motorway in three seconds.

4. You may not realise it but you've already done better than most NHS patients. NICE guidelines are that, if your job involves driving, you must be fast-tracked - that is, from GP referral to start-of-treatment should be under four weeks.

There are NHS patients who don't drive for a living (or who don't fly airplanes, or who don't have certain medical conditions) who are on the waiting list for three months or more before they're seen. From what you say, your treatment did start within four weeks. And you've had a one-month follow up.

It doesn't get much better than that.

4. Now, about the DVLA (the Driver and Vehicle Licensing Agency; the UK's equivalent to the DMV). The reason your doctor(s) informed the DVLA is because the General Medical Council tells them to. This is quite a recent change. Before that, the responsibility to inform the Agency lay solely with the drivers. And lots of them didn't.

Now, both you and your doctor have a separate duty to inform. Which means your statement -"This form seems to cut out the whole "DVLA will send your Dr a form and he sends it back" part of re-applying' - is a mis-perception on your part.

Your doctor will have to sign off on your re-application.

5. The Agency's rules say you get your licence back "when the condition is controlled, sleepiness is improved, and treatment is complied with."

Unfortunately, the Agency gives no hard definitions of what those words mean.

In practice, "controlled" seems to be: "if the degree is 'severe' (ie, untreated AHI is 30 or above), then the target is < 10. If the degree is 'moderate-to-severe' (ie, untreated AHI is 15-to-30), then the target is < 5."

"Sleepiness is improved" - ostensibly, this refers to a reduction in score on the Epworth Sleepiness Scale (which notionally the patient is asked to fill in on first visit, and then on each follow-up visit). But I have a hunch that sleep service staff also rate this by the general look of you.

And "complied with" means "at least four hours a night". On the theory that that's just about three REM-sleep cycles.

6. Anyway, these rule-of-thumb numbers aren't enough on their own. You also have to convince your sleep service staff and consultant that you will comply in the long-term - because many of them were taught from text books which said long-term compliance is only about 40 per cent.

Now, that maybe was true in the very early days of CPAP - and masks are lighter now, and tolerated more, and the equipment is quieter and more effective now. But there are still enough patients who give up after a few months, saying the treatment isn't for them, to make some doctors want to err on the cautious side.

So the answer to "How long did it take you to get your licence back?" is: it can vary.

I can tell you about the motor mechanic in Dorset who got the OK to drive again after four weeks, using the 'good faith argument'. I can tell you about someone in the north-east of Britain who got his licence back after three months.

And I could point you to the sleep service department in my area who like to see six months of 'much improved' before they sign off on it.

You need to find out what 'the time frame your consultant is convinced by' is. So by all means press your case, and do tell them about your work situation. But remember, these are very busy and overworked people. So be nice to them. Genuinely nice to them.

7. Oh, and take the time to thank your wife - by speaking up for you the way she did, she's kept you alive.

One of the most stunning things about all the sleep deprivation studies that various armed forces have done, is that nearly everyone insists that they are not that tired and that sleep deprivation does not affect their ability. Even when tests prove them otherwise they will deny the facts. Sleep deprived driving is the same as drunk driving when tested.

Thanks for the replies.

When I got my DVLA letter telling me not to drive, they also sent a REAPP form for the consultant to fill in.

This form had to be accompanied by an invoice for £40 odd.

The form was filled in by the consultant which stated that I had complied and the consultant basically green lit my return to driving.

Question - Was this form an attempt to cut out the waiting time between initial processing of the D1 driving license form and contacting the consultant?

The sleep centre staff looked as though they hadnt seen one before, so is this a new approach from the DVLA?

Thanks

Laws everywhere "can be" continually changed to "keep up with the times".
You are fortunate it is the rule where you live.
I would not dare to expect such forward thinking in my state.
I would be quite surprised.

I'll say it again - PM Rick Blaine for answers to the UK's systems, rules, etc... or else call the specific agency there and ask them for the answers.

Thanks, Julie. You're very kind.

To burnt_toast: It appears I mis-read part of your first post and was mis-led by the first of your four questions at the end. If - as I now understand you - you did get the re-application form signed by your consultant, then the 'in good faith' advice from the DVLA applies.

The 'in good faith' argument is this: if you know that your doctor approves, you can start driving again right away - even though the paperwork will take some time to complete.

(About six weeks, the uk.gov website says.)

The 'in good faith' line isn't that new - the Agency's being saying it to people with existing medical conditions for years when their licence is reviewed - which it has to be, every three years.

Purples wrote:Thanks for your message on my thread. My letter from the hospital saying I had to tell the DVLA came once I'd been diagnosed but my APAP collection appointment was within a couple of weeks. So I filled in the form saying I *will* be on treatment on that date, which is now a week ago (ie I've been on APAP a week today). I haven't heard back from DVLA yet.

Update: The DVLA didn't like the fact that I didn't strictly answer the questions on the form (There's no option for "will be controlled by dd-mm--yy", you have to say "is controlled" or "is not controlled". So they've sent me my form back and I have to "fill it in properly" within 21 days or my licence will be revoked.

I have my APAP follow-up on Tuesday so will check that the hospital agrees that I can send the form back saying "is controlled".

Will update at next step in case useful to others.

Julie wrote:I'll say it again - PM Rick Blaine for answers to the UK's systems, rules, etc

What???

That's not the way the forum works, Julie. The discussion should be out in the open. With all the time you spend here, you should know at least two reasons for this:

1. The information will be available for others who may have the same question in the future and can use the search function.

2. The forum does a fairly good job of group editing - if someone posts something that is wrong, it's usually not long before others chime in to correct it or offer a dissenting view.

In this case, Rick had already posted in the thread and would be likely to watch for any followup questions.

He needed quick answers and most of us don't have them for UK stuff... was just trying to move things along.

Hang Fire wrote:

Julie wrote:I'll say it again - PM Rick Blaine for answers to the UK's systems, rules, etc

What???

That's not the way the forum works, Julie. The discussion should be out in the open. With all the time you spend here, you should know at least two reasons for this:

1. The information will be available for others who may have the same question in the future and can use the search function.

2. The forum does a fairly good job of group editing - if someone posts something that is wrong, it's usually not long before others chime in to correct it or offer a dissenting view.

In this case, Rick had already posted in the thread and would be likely to watch for any followup questions.

Good catch.