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-   -   FAA to require testing for Sleep Apnea (https://www.airlinepilotforums.com/pilot-health/42954-faa-require-testing-sleep-apnea.html)

TurboDog 08-14-2009 06:58 AM

FAA to require testing for Sleep Apnea
 
The FAA is moving forward with an NTSB recommendation to require additional sleep study testing for a medical certificate if you have a history of sleep apnea, and/or if you meet certain criteria that would increase the likely hood of you having the disorder. I would imagine the additional criteria would be in the form of height and weight standards. Pretty much anyone over 200lbs would be a candidate for such testing.

I am a victim of sleep apnea myself and I have been through the entire process and I can tell you that it is a royal pain in the arse. First an initial sleep study would be required. If the initial study showd signs of sleep apnea you would be required to seek further treatment. Types of treatment include surgical procedures to remove your tonsils(if you still have them,) septoplasty, removal of your uvula, removal of a portion of your upper pallet, a procedure where they break your lower jaw and place steel extenders in it to move your lower mandible forward, implants put into your tongue to pull your tongue away from the back of your throat and a few others. Most often times one of the above procedures is coupled with the use of a mouthpiece worn while sleeping, or the use of a CPAP or BIPAP machine that goes over your face while you sleep. It usually takes a multiple approaches and even then, usually the Apnea doesn't go away completely. Cure rate is usually around 33-40% in adults. Losing weight also helps, but losing weight as a single solution is not an approved therapy per the FAA.

Once one of the above treatments is complete the pilot must undergo a follow up sleep study to determine the effects of the procedure. After my procedure, I am still required to use a CPAP machine and I have to undergo annual Maintenance of Wakefulness Testing to make sure I don't get sleepy during the daytime.

The MWT is an all day test that usually starts around 6:30am. They hook a bunch of wires up to your head and chest(similar to the sleep study) and put you on a bed in the sitting position in the dark. The room looks like a hotel, or bedroom. They close the door for 30-40 minutes and you have to sit there in the dark and not fall asleep. You just sit there. They watch you on camera the hole time to. You can't do anything to keep yourself awake either. No singing, humming, slapping yourself in the face etc. You have to sit still. Once you come out of the dark room you are confined to their clinic. You cannot leave the hospital. With about 2 hours in between tests, you go back into the bedroom and do it again. You repeat this process until approximately 5:00pm. This test flat out sucks.

Here are my thoughts....

I am a young man of about 225lbs and I am 6' tall. I am willing to bet that nearly 75% of the guys I fly with are shorter and much bigger than me and all suffer from Obstructive Sleep Apnea. It goes undiagnosed because the tests are expensive and you have to have a reason to get tested for it. Do you snore at night? Chances are, if you snore, you will be one of the FAAs prime suspects when you get your medical. Question is, will guys near 60 years old, or between 60 and 65 be willing to go through all of this just to be able to fly for a few more years. My quick answer is no.

Any thoughts?

xtreme 08-14-2009 09:04 AM

So what you're saying is, not only will we have a fed ride the jumpseat, he will also follow you to the overnight? Hmm. Interesting.

GRpilot 08-14-2009 11:33 AM

Hey Turbo,
So, by using a CPAP and an acceptable MWT, satisfies the feds, for your medical certificate?

SkyHigh 08-14-2009 08:49 PM

My thoughts
 
Turbodog,

My thoughts are if you are a young person who has already been diagnosed with sleep apnea what do you think the future holds for you and your career? I would not be counting on attrition from older pilots. If I were in your shoes I would be worried about myself. As people age they gain weight and things like that usually do not get any better. What would happen if you exceeded sleep apnea limitations and lost your medical?

Could you still fly with a third class medical? Is the FAA going to make everyone pass apnea tests?

Skyhigh

TurboDog 08-14-2009 09:26 PM


Originally Posted by GRpilot (Post 662164)
Hey Turbo,
So, by using a CPAP and an acceptable MWT, satisfies the feds, for your medical certificate?

Not exactly. I had to undergo surgery first. Then the use of CPAP and annual MWT tests with a passing result will allow me to get a special issuance medical. The FAA will not accept weight loss and CPAP as a therapy to combat the issue. They want to see something that produces better results, because they cannot tell if you are actually using the CPAP.

TurboDog 08-14-2009 09:31 PM


Originally Posted by SkyHigh (Post 662561)
Turbodog,

My thoughts are if you are a young person who has already been diagnosed with sleep apnea what do you think the future holds for you and your career? I would not be counting on attrition from older pilots. If I were in your shoes I would be worried about myself. As people age they gain weight and things like that usually do not get any better. What would happen if you exceeded sleep apnea limitations and lost your medical?

Could you still fly with a third class medical? Is the FAA going to make everyone pass apnea tests?

Skyhigh

I am fine. I have already gone through the procedures, I am not overweight and the CPAP therapy provides a good night sleep. I am just wondering how the senior folks will do with it. There are tons of them that will blow a study and lots of them probably no that they will. So will they do it and spend the money on the surgery, or just hang it up. Most people are fine with surgical procedures, but there are also lots of people who are afraid of going under the knife. I can't tell you how many flights I have flown when the guy next to me can barely read the displays at night. I think the AMEs are going to start paying attention to this stuff now with all of the focus on pilot health. No more "Go stand over there and tell me if you can hear me whisper" type stuff.

rickair7777 08-14-2009 11:32 PM

I hope this is being overblown. I don't think I would have a problem, but I would quit immediately if they told me I had to have surgery based on BMI. I am not running around tired, I have plenty of energy and would have already done something about it if that was the case.

navigatro 08-15-2009 12:01 AM

why do they remove your vulva?

beech_nut 08-15-2009 09:31 AM

sleep apnea
 
Turbodog, what is the source for this rumor?

papa77 08-25-2009 07:34 PM


Originally Posted by beech_nut (Post 662765)
Turbodog, what is the source for this rumor?

Not so much the FAA is, more like the NTSB says they should.

http://www.ntsb.gov/recs/letters/2009/A09_61_66.pdf

Hacker15e 08-26-2009 01:55 PM

The NTSB sez:


FAA is not yet formally considering such changes

KC10 FATboy 08-30-2009 07:34 PM

I think there would be a pandora's box if they made this a requirement. Could you imgaine how many of the overnight box haulers who would suddenly not be medical cleared?

rickair7777 08-31-2009 06:55 AM

This is one of those occasional pie-in-the-sky NTSB ideas that will not pass muster in the real world.

74plb 08-31-2009 09:56 AM


Originally Posted by rickair7777 (Post 670747)
This is one of those occasional pie-in-the-sky NTSB ideas that will not pass muster in the real world.

You maybe right about this type of testing being used in the real world, but the JCAB does this testing if you tell the medical examiner that you snore, sleep often during the day, and if you feel fatigued during normal wake hours.
One of the Syd based guys at JAL told the Doc that he snored and the medical dept put him on the beach for about 6 weeks until he *passed* all of the requirements to come back. Several years ago a train crashed in Tokyo and the driver had a history of sleep apnea. Killed a bunch of people and the government took action.
When the Doctor asked if I snored, the answer was no. If he asked my wife he might have gotten a different answer. :)

rickair7777 08-31-2009 12:26 PM


Originally Posted by 74plb (Post 670827)
You maybe right about this type of testing being used in the real world, but the JCAB does this testing if you tell the medical examiner that you snore, sleep often during the day, and if you feel fatigued during normal wake hours.
One of the Syd based guys at JAL told the Doc that he snored and the medical dept put him on the beach for about 6 weeks until he *passed* all of the requirements to come back. Several years ago a train crashed in Tokyo and the driver had a history of sleep apnea. Killed a bunch of people and the government took action.
When the Doctor asked if I snored, the answer was no. If he asked my wife he might have gotten a different answer. :)

Medical standards are much higher in europe and asia.

I don't expect to see that here...if you tighten up our standards to theirs, we would lose half of our pilot force overnight. That really would cripple the economy.

vtailpilot 09-07-2009 01:16 AM

Hey guys, it seems kinda strange seeing this brought up on here. I have asked some questions on here and got a lot of responses and advice, so now its my turn to help anyone out that I can. In my previous posts I said I was leaving my medical career for a flying career, well in my medical career the last 5 years was spent in this field which is why I added an endorsement to my license for sleep disorders specialist. I am a Registered Respiratory Therapist with a Sleep Disorders Specialist endorsement. If your curious you can go to our licensing board www.nbrc.org and read up on the credentials. I know all about the testing procedure, how the sleep report is scored, CPAP/BiPAP or Bi-Level Ventilation and the machines used for treatment, and the surgical procedures that are used. You would have a diagnosis of either Obstructive Sleep Apnea (OSA) or Central Sleep Apnea (CSA). If you have it it will most likely be OSA, hopefully it would be OSA because CSA is central or nervous system caused and the treatments are a lot more complex and a FAA 1st class medical would probably be over. Luckily there is not nearly as many cases of CSA as OSA tho. Well I just wanted to volunteer my assistance to anyone that I can help on here. Feel free to pm me with any questions and I will be glad to help if I can.

I'll try to explain briefly a couple of issues that you guys have already brought up. If you get tested, then you will most likely be diagnosed. Its sad to say that the legalities of US healthcare makes almost everyone qualify for the diagnosis because of the possible law suits from guys like pilots and semi-truck drivers. Actually, several truckers have been sued because they fell asleep at the wheel as well as their company so airlines may make it a requirement even if the FAA doesn't just to cover theirself. Sleep is a relatively new field so there are still many variables at this point even in the medical practice of it.

The other thing that has been brought up is just beating the system by saying that you don't snore because the doctor isn't going to bed at night with you to say otherwise, and saying no to the other questions that would lead them to want to test you for Sleep Apnea like answering no to "do you get tired during the day? or Do you fall asleep easily during normal awake hours?" The actual questions may be worded slightly differently but you get the point. The truth is you probably would not pass the test without getting the diagnosis (or at least most people would not), you probably can get away with denying it by answering the questions, unless you have severe Sleep Apnea, like the people whose eyes are always bloodshot looking or the white area looks yellowish like someone who is extremely tired. The problem with denying it will catch up with you later tho. Just to explain what happens with the body in someone who has Sleep Apnea so you have a very general understanding of the long term effects. Apnea is spells of not breathing, when your sleeping and not breathing for periods of time throughout the night, your blood oxygen level goes down and the heart rate and blood pressure increase to compensate for the lack of oxygen in the bloodstream. This will lead to future heart conditions because the heart is over worked during the night when it is supposed to be resting like the rest of your body. Sorry for the long post, just sharing what I can with people who have helped me.

By the way, I'm still waiting on the regionals to hire so hopefully I can be on your side of things someday ;)

rickair7777 09-07-2009 05:11 PM

Thanks for the info. I probably don't have to tell you that you should keep your medical qualifications current if you get into aviation...

jedinein 09-08-2009 04:37 PM


Originally Posted by 74plb (Post 670827)
You maybe right about this type of testing being used in the real world, but the JCAB does this testing if you tell the medical examiner that you snore, sleep often during the day, and if you feel fatigued during normal wake hours.

Remember to answer the question without considering the fact that in the previous two days you were on duty for 28 hours, had min rest and a 2 hour wait for the hotel shuttle, and it was a 45 minute ride to the hotel as the shuttle stopped at every bloody two-bit wide spot in the road before getting to the hotel and it took 3 tries to get an unoccupied room. :cool:

trigg41 09-13-2009 01:06 AM


Originally Posted by jedinein (Post 675251)
Remember to answer the question without considering the fact that in the previous two days you were on duty for 28 hours, had min rest and a 2 hour wait for the hotel shuttle, and it was a 45 minute ride to the hotel as the shuttle stopped at every bloody two-bit wide spot in the road before getting to the hotel and it took 3 tries to get an unoccupied room. :cool:

Right on,
The FAA should be much more concerned with the current regs reguarding rest. The current structure is much more dangerous, IMHO, than the chance I may be tired from snoring at night. I grew up in the regionals and now doing international with major frieght. And I can tell you I have been way more fatigued from my schedule than from snoring. The feds and the ame better get with it or the like of BUF will continue. whinning over...

dtw757 09-22-2009 10:36 PM


Originally Posted by navigatro (Post 662619)
why do they remove your vulva?

Because they want you to buy American...a Ford or a Chevy, not one of them swedish cars:D

Pitbull 10-23-2009 03:07 AM

Falling asleep is a physiological response. If the airline blames you, then there are a few avenues to pursue. Is it your fault ? Did you not go to bed and sleep, were your overworked and not allowed to sleep? Were you out drinking all night? As a physician I know that falling asleep can not be prevented by the individual, the causes are the problem. I know that the flight time restrictions do not include the transport time of the flight crew from their original destination and I think this is the real problem. If the FAA wants to test everyone for sleep apnea, then they will get rid of everyone, because the more sleep deprived you are, the more you will have sleep apnea. It is physiological. So sleep deprive me and test me for sleep apnea, then fire me. Sounds like a plan..

Dakota 10-23-2009 05:13 AM

Just say NO!
 
Don't tell the FAA anything. Are you doing your job safely? If so, then they don't have a need to know. I can't believe this bureaucracy isn't sued more often because of their discriminatory practices.:mad:

Pitbull 10-25-2009 12:58 AM

As an Anesthesiologist before becoming a pilot, I can tell you with certainty that everyone has sleep apnea. The more fatigued you are and sleep deprived, the deeper you fall into sleep and thus have apnic episodes. This is physiologic. The sleep apnea business is different. They want everyone to get CPAP machines etc, just a scam. If you don't get enough slep, you will have sleep apnea, 140 lbs, or 240 lbs, its all the same. If they use this against you it is just a tool to remove you without fair scientific judgement and I would pursue this to the top if it was me they were after.

FGHJKL 05-04-2010 01:53 PM

Has anybody with a Class 1 actually dealt with this recently? The ALPA docs say it's actually not a big deal to get a waiver after treatment...they claim to have consulted hundreds of cases and few cases resulted in lost medical certificates. ...wouldn't make much sense for the FAA to encourage folks to hide it. If anybody has gone through the diagnoses/treatment/waiver process recently please post some info.

SkyGayle 05-12-2010 07:43 AM

Funny I should find this thread today. I have an appointment with the sleep Dr. in about 2 hours. I am applying for my 1st class for the first time. I had a medical procedure done a few years ago that prompted me to get records together before I went to see the AME. Well when I got the surgical records its listed on there that I had OSA. I was diagnosed with it like 8 years or longer ago with it and then I lost over 125 lbs and it became a none issue for me, so I forgot I even had it. Now I donít snore, wake up at night ect. and I never fall asleep during the day. The FAA says weight loss is not enough, but if I donít have it now what the heck am I to do? Get surgery and wear a CPAP? I am hoping that I can have another sleep test done and a daytime test and hope that all comes out clear. So my question is, if it does come out clear and I donít have it even though the treatment doesnít satisfy their criteria of approved treatment what are they going to do? Will I get a waiver or special issuance or should I just give up now?

USMCFLYR 05-12-2010 07:49 AM


Originally Posted by SkyGayle (Post 810368)
Funny I should find this thread today. I have an appointment with the sleep Dr. in about 2 hours. I am applying for my 1st class for the first time. I had a medical procedure done a few years ago that prompted me to get records together before I went to see the AME. Well when I got the surgical records its listed on there that I had OSA. I was diagnosed with it like 8 years or longer ago with it and then I lost over 125 lbs and it became a none issue for me, so I forgot I even had it. Now I donít snore, wake up at night ect. and I never fall asleep during the day. The FAA says weight loss is not enough, but if I donít have it now what the heck am I to do? Get surgery and wear a CPAP? I am hoping that I can have another sleep test done and a daytime test and hope that all comes out clear. So my question is, if it does come out clear and I donít have it even though the treatment doesnít satisfy their criteria of approved treatment what are they going to do? Will I get a waiver or special issuance or should I just give up now?

SkyGayle -

In my opinion your question is far to intricate in the details to hope of getting, and then taking, advice over an internet forum.
I usually refer users to the Virtual Flight Surgeon website for more detailed information or I understand that AOPA has AME services (Q&As) available for members.

Virtual Flight Surgeons Inc. -- Your One Source for FAA Medical Certification Waiver Assistance!

Good luck in your search.

USMCFLYR

mdojet 11-09-2011 08:04 AM

I just called the FAA regarding Sleep Apnea which I have. I am furloughed and thought I'd jump threw the hoops before I get recalled. Last Summer I did a sleep study and confirmed I do have sleep apnea. I was issued a CPAP and the Sleep and Lung clinic monitored me threw a wireless device on the CPAP machine itself. My numbers are back in the normal range. I have to supply the FAA with all the paperwork of the Dr's findings from the sleep study plus the records of them monitoring me. They also said that when I got to my doctor for my 1st class physical, present these items to him and he can get an over the phone temporary approval to issue me the 1st class.
If you are a person that gets sleepy during the day, which I'm not, then there is that 'Daytime wakeful sleepiness' test but not everyone has to do it. All depends on the results of the sleep study and there after.
Hope this helps.

VanceJayhawk 12-09-2011 12:05 PM

Did you receive the temp class 1?

HercDriver130 12-10-2011 04:11 AM

I know a guy with a 1st class who carries a CPAP machine on overnights.


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