What is sleep apnoea?

Sleep apnoea means your breathing stops and starts while you sleep. The most common type is obstructive sleep apnoea, where the airway briefly closes over.

Each time it happens, your body wakes itself just enough to start breathing again. You will not remember it, but it can happen dozens of times an hour.

The result is that you spend eight hours in bed and wake up as though you had four.

Common signs are loud snoring, waking with a dry mouth or headache, a partner noticing you stop breathing, and feeling sleepy during the day no matter how long you slept.

Why does it matter for driving?

Because sleepiness at the wheel is dangerous in the same way alcohol is. It slows reactions, narrows attention and affects judgement.

The specific risk with sleep apnoea is the microsleep. This is a brief lapse of a few seconds where you are effectively asleep with your eyes open. At 100 kilometres an hour on the M1, four seconds is more than 100 metres travelled with nobody driving.

People often do not notice they are having them.

Do I have to tell Transport and Main Roads?

It depends on your situation.

In Queensland you must tell Transport and Main Roads (TMR) about any permanent or long-term condition likely to affect your ability to drive safely.

You do need to report it if you have sleep apnoea along with significant daytime sleepiness, if you have been falling asleep or feeling drowsy at the wheel, or if you have had a crash caused by inattention or sleepiness.

You may not need to report it if you have been diagnosed, your treatment is working, and you have no daytime sleepiness. Ask your doctor. They are the one who decides whether it meets the threshold, and they will tell you.

If you do need to report, you can:

• Report online through the TMR medical condition notification service

• Email Form F4355 to mcr@tmr.qld.gov.au

• Report in person at a Transport and Motoring Service Centre

See Reporting a Medical Condition to Queensland Transport.

What do the rules actually say?

Queensland uses the national standards published by Austroads. The same rules apply everywhere in Australia.

For a private licence, you are generally not fit to hold an unrestricted licence if any of these apply:

• You have sleep apnoea confirmed on a sleep study, together with moderate to severe daytime sleepiness

• You regularly feel sleepy or drowsy while driving

• You have had a crash caused by inattention or sleepiness

• Your doctor believes your sleep disorder makes you a significant driving risk

The important word is "unrestricted". This is not a permanent ban. It usually means a conditional licence with review while your treatment gets sorted out.

The rules are considerably stricter for truck, bus and taxi drivers, and screening is routine at commercial medicals.

What happens once I am treated?

This is the good news part.

For most people, treatment works. CPAP is the usual option, and where it is used consistently, daytime sleepiness typically improves within weeks.

Other options include a mandibular advancement splint fitted by a dentist, weight loss, positional therapy, and in some cases surgery.

Once your doctor is satisfied that your sleepiness has resolved and your treatment is being used properly, they can certify you as fit to drive. Many people go back to an unrestricted licence.

Your doctor may want evidence, such as CPAP usage data from your machine. This is why using it every night matters, not just most nights.

Do I need an OT driving assessment?

Usually not, and it is worth being clear about that.

Sleep apnoea is mostly a medical question, answered by your GP and sleep physician. An OT driving assessment looks at how you drive, and untreated sleepiness is not something that shows reliably in a two-hour assessment.

An OT assessment is worth doing when:

• You have another condition on top of the sleep apnoea, such as stroke, dementia, diabetes or reduced neck movement

• Long-term untreated sleep apnoea has affected your memory and concentration, and your doctor wants that checked

• You are an older driver and your doctor has broader concerns about your driving

• Your treatment is working but you or your family are still not confident about your driving

If sleep apnoea is your only issue and your treatment is working, the answer is generally treatment and a review with your doctor, not an assessment with me. I would rather tell you that than take your money.

Practical things that help

• Use your CPAP every night, including naps

• Take your machine when you travel

• Do not drive if you feel sleepy, no matter how short the trip

• On long drives, break every two hours

• Be aware that alcohol and sedating medication make apnoea worse. See Driving and Medications

• If you feel drowsy at the wheel, pull over somewhere safe and have a short nap. Winding the window down and turning the radio up does not work

Common questions

Will I lose my licence if I report sleep apnoea? Very unlikely. Most people are given a conditional licence while treatment is set up, then return to normal driving.

Do I have to report it if my CPAP is working? Ask your doctor. If your sleepiness has resolved and treatment is effective, it may not meet the reporting threshold. Your doctor makes that call.

What if I cannot tolerate CPAP? Tell your doctor rather than quietly stopping. There are alternatives, and mask and pressure problems are usually fixable.

Can my doctor report me without telling me? Health professionals in Queensland can notify TMR where they believe a driver is a serious risk. In practice they will normally discuss it with you first.

What about my insurance? If you have not reported a condition you were required to report, an insurer may decline a claim. This is a good reason to be upfront.

I only feel tired sometimes. Is that a problem? It depends on when. Feeling sleepy at the wheel, at any level, is the specific thing the rules are concerned with. Mention it honestly to your doctor.

Ready to book an OT driving assessment on the Gold Coast? Steer Driving is a mobile assessment service covering the Gold Coast and surrounding areas. Whether you already have a referral or you're just getting started, get in touch and we'll guide you through the next steps.

This article was written by Elise, an AHPRA-registered Occupational Therapist and driver assessor. Elise is the founder of Steer Driving, a mobile OT driving assessment practice.

References

Austroads. (2022). Assessing fitness to drive for commercial and private vehicle drivers: Sleep disorders. Austroads. https://austroads.gov.au/publications/assessing-fitness-to-drive/ap-g56/sleep-disorders/medical-standards-for-licensing-9

Queensland Government. (2024). Reporting your medical condition. Department of Transport and Main Roads. https://www.qld.gov.au/transport/licensing/healthy-to-drive/report-medical-condition