FARGO - In May, Joey Romero went in for his annual physical, as truck drivers are required to do once a year. He didn't realize this time would result in a $2,500 expense.

Romero, an owner-operator with Fargo Cargo, was diagnosed with mild sleep apnea, a condition in which breathing stops and starts during sleep, causing sleepiness the next day.

But even after purchasing an AutoPAP machine and a "highly uncomfortable" mask that is supposed to regulate his breathing, Romero doesn't feel any different.

"Whenever I first started using it, I was hoping that it would do something for me, but it hasn't, so now I just see it as a waste of money," the 26-year-old said.

He's one of many frustrated local truck drivers who've had to undergo costly sleep studies due to a federal policy change last year.

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"This affects every trucking company," said Arik Spencer, executive vice president of North Dakota Motor Carriers, which represents truckers in the state.

It might affect others, too, given that at least one of Fargo's sleep centers is now more crowded, though the Sanford Health clinic attributes that to a growing population and not directly to trucker regulations, said Kevin Faber, medical co-director of the center.

Last year, the Federal Motor Carrier Safety Administration established a medical examiner registry, a list of doctors who have taken an online course and are therefore certified to conduct physicals for truck or bus drivers.

Spencer believes many of these doctors are recommending sleep apnea tests based solely on the driver's neck size. Romero was recommended for a study after his neck was measured at 18.5 inches. The cutoff is 16, 17 or 18, depending on who you ask.

"A number of factors increase the likelihood of someone having sleep apnea," not just neck size, Spencer said. "Unfortunately, I think a lot of clinics are using the training to try to generate additional profit."

Tests in a sleep center can be expensive, sometimes costing up to $3,000, which is enough to rile local trucking companies.

The safety manager for Midwest Motor Express, an Upper Midwest trucking company with a site in Fargo, said 15 to 20 percent of their 365 drivers have had to take sleep apnea tests this year - "more than ever," Tyler Skoglund said. And not one has been diagnosed with sleep apnea.

"I am not a doctor by any means, but I do question some of the times when they are required to take a sleep apnea test," Skoglund said.

FMCSA spokesman Duane DeBruyne has heard similar complaints, but he defended the practice.

"Previously, there were some medical examiners that maybe certified some drivers unknowingly in error, because the medical examiner was not familiar with the rigors or the lifestyle of a truck driver," he said.

And if a driver has sleep apnea, that is a danger for the trucker or anyone else on the road.

"Patients with undiagnosed/untreated sleep apnea are at higher risk for a motor vehicle accident due to decreased alertness, prolonged reaction times and dozing off behind the wheel," said Faber, the Sanford sleep specialist, in an email.

Romero isn't buying it.

"I don't even see how the machine works. It doesn't seem to have any effect on me," he said. "They say that it's supposed to make me not tired or whatever in the morning when I wake up. I feel the same way with or without the machine."

Plus, he theorizes that the uncomfortable mask could be damaging for drivers.

"It takes a while to get used to them, so people aren't getting enough sleep when they first start," Romero said. "I think that's a hazard."

Not all of the feedback has been negative, though.

Karla Bancroft, safety director at Holland Enterprises, said their drivers who were recommended for sleep studies had a positive experience.

"Initially, we run into frustration, but then those who have ended up with the machines, it's helped them," she said. "Their lives are better. They're rested better."