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-   -   Sleep Apnea-new FAA Guidelines - be prepared! (https://www.airlinepilotforums.com/pilot-health/87019-sleep-apnea-new-faa-guidelines-prepared.html)

Raptor 03-17-2015 07:45 PM


Originally Posted by sleepdoclv (Post 1844812)
The information that I posted is actually factual and based on information available to anyone at: Guide for Aviation Medical Examiners
Though mostly black and white, there are some ambiguities which I have taken the time to research and clarify with the FAA. The fact remains that this is not going to go away, many unsuspecting pilots will get caught in the cross-hairs, the qualifications for "high risk of OSA" may not be as difficult to meet as you once thought (http://www.faa.gov/about/office_org/...stionnaire.pdf), and many pilots will be at risk for a temporary lapse in the ability to fly. There are basically 2 options: 1) Roll the dice and hope for the best at your AME exam (to land in Group 3 or 4) and go through the motions as they have laid out if not, 2) proactively and truthfully screen yourself (using the same tools provided to the AME), make a plan for seeking diagnosis and treatment if indicated by the risk assessment, and find a way to do it in the least disruptive way possible to minimize down time. That being said, I will under no circumstance advise a pilot to continue flying once a true diagnosis (via sleep study) is found and prior to effective treatment. I will, however, inform pilots that there are many ways to get from point A (risk evaluation) to point B (treatment) and by doing a little research, finding a physician with knowledge and experience in this unique circumstance, and taking control of the potential problem before it becomes an actual problem; the process can be far less frustrating, smoother, more efficient, and with little to no disruption in the ability to fly.

I think it's been quite clearly established that you have violated the TOS on this forum by posting to promote your own business and line your pockets. You may claim an altruistic reason, but it just doesn't appear that way.

I posted that some information you had posted and provided on your website was wrong. I fail to see where you've provided information contrary to my assertion.

In my post #2 on this thread, I provided the reader the complete AME guide provided by the FAA and you discounted this information, yet you post the link to the overall Guide and ask people to drill down to get the information I've provided.

If one goes to the AME informed, there is no "roll the dice" as you propose. If you truthfully don't have reports of apnea symptoms, don't report that you snore, don't report less than restful sleep, and don't have a BMI over 35, you are most certainly in the clear. The STOP BANG sheet you provide does come from the FAA materials, but as everyone can see if you're male, over 50, you would almost certainly think you'd be selected. But you fail to mention that the triage process is much more complicated that the single self-serving form you present. A history is to be taken, clinical observations etc. The FAA specifically references tables to be consulted, and a lot more that you let on. That taken overall overrides the fear mongering you are trying to provoke.

Let's take your point that you think you can smooth the flow by having pilots go to your fly in program and do a sleep study prior to their AME visit. If they do that prior to an AME visit, they have to report it. They will have to provide your complete workup/report to the AME/FAA. Do you think any pilot is crazy enough to do that? For a simple cold, go to a nutritionist and they will find a food problem with you, an ENT will find you need sinus surgery, you'll find a sleep problem is causing the cold, etc. Pilots don't take treadmill stress tests unless they HAVE to. Pilots don't take sleep studies unless they HAVE to. Whether a pilot finds a problem prior to their physical or afterwards, the paperwork and the process is virtually the same. Why put yourself in career jeopardy with you before one has to?

You also conveniently fail to mention that being put in category 5 by one's AME is a process that COULD result in a sleep study, not a process that WILL result in a sleep study. There is a heck of a lot of stuff that goes into the determination of what is needed once a pilot is put in high risk/category 5. Being put in a high risk category by the AME flow chart is NOT a certain need for a sleep study--as much as you would like to convince potential clients otherwise. You fail to mention the Epworth Sleepiness Scale and the Berlin Questionnaire which often provide different results than the "Scary" STOP BANG assessment.

Let's take a look at the process--taken directly from the AME guide:

The AME while performing the triage function must conclude one of six possible
determinations. The AME is
not required to perform the assessment or to comment on

the presence or absence of OSA.
Step 1 -
Determine into which group (1-6) the airman falls.

Applicant Previously Assessed:
Group 1:
Has OSA diagnosis and is on Special Issuance. Reports to follow.

Group 2:
Has OSA diagnosis OR has had previous OSA assessment. NOT on

Special Issuance. Reports to follow.
Applicant Not at Risk:
Group 3:
Determined to NOT be at risk for OSA at this examination.

Applicant at Risk/Severity to be assessed:
Group 4:
Discuss OSA risk with airman and provide educational materials.

Group 5:
At risk for OSA. AASM sleep apnea assessment required.

Applicant Risk/Severity Extremely High:
Group 6:
Deferred. Immediate safety risk. AASM sleep apnea assessment

required. Reports to follow.
Step 2 –
Document findings in Block 60.

Step 3 –
Check appropriate triage box in the AME Action Tab.

Step 4 –
Issue, if otherwise qualified.

In assessing airmen for groups 4 and 5, the AME is expected to use their own clinical
judgment, using AASM information, when making the triage decision.
Some AMEs have voiced the desire to perform the OSA assessment.
While we do not recommend it, the AME may perform the OSA assessment provided that it is in

accordance with the clinical practice guidelines established by the American Academy
of Sleep Medicine.*
*If a sleep study is conducted, it must be interpreted by a sleep medicine specialist.

************************************************** ************************
Group 5 is what MAY lead people to a sleep study. Let's see what the FAA directs for those in group 5:

OBSTRUCTIVE SLEEP APNEA SPECIFICATION SHEET B
ASSESSMENT REQUEST
Due to your risk for Obstructive Sleep Apnea (OSA), and to review your eligibility to
have a medical certificate, you must provide the following information to the Aerospace Medical Certification Division (AMCD) or your Regional Flight Surgeon’s Office for review within 90 days:
•
A current OSA assessment in accordance with the American Academy of Sleep

Medicine (AASM) by your AME, personal physician, or a sleep medicine
specialist.
•
If it is determined that a sleep study is necessary, it must be either a Type I

laboratory polysomnography or a Type II (7 channel) unattended home sleep test
(HST) that provides comparable data and standards to laboratory diagnostic
testing.
It must be interpreted by a sleep medicine specialist and must

include diagnosis and recommendation(s) for treatment, if any.
If your sleep study is
positive for a sleep-related disorder, you may not exercise the privileges of your medical certificate until you provide:

•
A signed Airman Compliance with Treatment form or equivalent;

•
The results and interpretive report of your most recent sleep study; and

•
A current status report from your treating physician addressing compliance,

tolerance of treatment, and resolution of OSA symptoms.
If you are
not diagnosed with a sleep-related disorder or the study was negative

for a sleep-related disorder
, you may continue to exercise the privileges of your

medical certificate, but the evaluation report along with the results of any study, if
conducted, must be sent to the FAA at the address below. All information provided will
be reviewed and is subject to further FAA action.
In order to expedite the processing of your application, please submit the
aforementioned information
in one mailing using your reference number (PI, MID, or

APP ID).
************************************************** ******
How does your personal physician determine if a sleep study is needed:
History of findings that suggest increased risk of OSA include:
Hypertension requiring more than 2 medications for control or refractory hypertension

Type 2 Diabetes

Atrial fibrillation or nocturnal dysrhythmias

Congestive heart failure

Stroke

Pulmonary hypertension

Motor vehicle accidents, especially those associated with sleepiness/drowsiness

Under consideration for bariatric surgery

Symptoms that suggest an increased risk of OSA include:
Snoring

Daytime sleepiness

Witnessed apneas

Complaints of awakening with sensation of gasping or choking

Non-refreshing sleep

Frequent awakening (sleep fragmentation) or difficulty staying asleep (maintenance insomnia)

Morning headaches

Decreased concentration

Problems or difficulty with memory or memory loss

Irritability

Physical/clinical findings that suggest increased risk of OSA include:
High score on an OSA screening questionnaire (e.g., Berlin, Epworth)

Increased neck circumference (>17 inches in men, >16 inches in women)

A Modified Mallampati score of 3 or 4 (assessment of the oral cavity)

Retrognathia

Lateral peritonsilar narrowing

Macroglossia

Tonsillar hypertrophy

Elongated/enlarged uvula

High arched/narrow hard palate

Nasal abnormalities such as polyps, deviation and turbinate hypertrophy

Obesity (AASM guidelines)

And he will use the information in the AASM tables 2 and 3.

All a lot more complicated that you would lead people to believe. If you have a BMI of 35 or above and don't have hardly any of the findings above, your PCP may determine you don't need a sleep study. If you have a BMI of 35 or above, and you snore or have other major indicators, then you'll get a sleep study. But, in any case, either through what you propose prior to or after the AME visit, the result and process will be the same. So why take a chance on seeing you prior to the AME....it would be foolish!

coopervane 03-17-2015 11:48 PM

I love lamp

surfnski 03-18-2015 12:25 AM


Originally Posted by coopervane (Post 1844900)
I love lamp


Loud noises!!!

MikeF16 03-18-2015 04:53 AM

I am torn on the subject. On the one hand I don't like BMI since it does not account for muscle mass. I gave myself a good body for my 40th birthday -- over a year of intense workouts and diet. At the end of the year I had the least body fat I'd had since college (wrestled intramurals in college, so I wasn't a fatty then). I was muscular to the point where my wife didn't want anymore, and according to BMI charts I was overweight with a BMI of 28. 4 years later and even though I've backed off the gym a bit I've still got much of the same muscle with a little more fat around the waist and my BMI is now 29. I don't snore and certainly don't have sleep apnea, this would be a ridiculous intrusion for me.

Then there is the flip side. One of my roomates in my crash pad sounds like he dies about every 30 seconds while he sleeps. Very fat, looks like shlt, and probably at the high end of obese to low end of extremely obese. He snores like a chain saw, and literally stops breathing every 30-40 seconds. It was scary listening to him. I wouldn't want this guy flying my family around, would you?

I honestly don't have a good answer -- something should be done but this feels like your typical stupid government program that has good intentions but goes about it the wrong way (TSA anybody?). We should do something about people with sleep apnea, but casting a massive net over droves of pilots feels like the wrong approach.

rvr1800 03-18-2015 05:08 AM


Originally Posted by MikeF16 (Post 1844932)
I am torn on the subject. On the one hand I don't like BMI since it does not account for muscle mass. I gave myself a good body for my 40th birthday -- over a year of intense workouts and diet. At the end of the year I had the least body fat I'd had since college (wrestled intramurals in college, so I wasn't a fatty then). I was muscular to the point where my wife didn't want anymore, and according to BMI charts I was overweight with a BMI of 28. 4 years later and even though I've backed off the gym a bit I've still got much of the same muscle with a little more fat around the waist and my BMI is now 29. I don't snore and certainly don't have sleep apnea, this would be a ridiculous intrusion for me.

Then there is the flip side. One of my roomates in my crash pad sounds like he dies about every 30 seconds while he sleeps. Very fat, looks like shlt, and probably at the high end of obese to low end of extremely obese. He snores like a chain saw, and literally stops breathing every 30-40 seconds. It was scary listening to him. I wouldn't want this guy flying my family around, would you?

I honestly don't have a good answer -- something should be done but this feels like your typical stupid government program that has good intentions but goes about it the wrong way (TSA anybody?). We should do something about people with sleep apnea, but casting a massive net over droves of pilots feels like the wrong approach.

Has he passed his FAA checkride? Then hell yes I'd be fine with him flying my family around. Are you serious man? You're just as bad as the Feds with a comment like that. He snores so all of a sudden he's an unsafe pilot? GMAFB

N9373M 03-18-2015 05:20 AM


Originally Posted by rvr1800 (Post 1844937)
Has he passed his FAA checkride? Then hell yes I'd be fine with him flying my family around. Are you serious man? You're just as bad as the Feds with a comment like that. He snores so all of a sudden he's an unsafe pilot? GMAFB

He's not just snoring, he's suffering from hypopnea/apnea every 30-40 seconds. He needs to see a sleep specialist. OSA messes with REM sleep, causes low O2 sats, and is stressful on cardiovascular system.

He's failing 2 of the IMSAFE criteria (Illness and Fatigue).

Billy32 03-18-2015 05:30 AM

I think we should take all of this to it's conclusion. Can't be too safe right? Give everyone 1 calendar year to get their stuff straight then go full bore. BMI less than 30, liver enzymes, cholesterol tests, treadmill stress tests, MRI to check for hidden tumors, neurological testing, psychiatric exam, alchoholism screening, no nicotine allowed, dig deep to find any unknown potential health issue. You never know, might have some pilot out there flying with an undiagnosed illness. Never mind shuting down the air transpoortation system, gotta be safe. Oh yeah, why not a skills test too. I could be dead asleep and outfly some of the idiots I have flown with. I recommend a certain score on an AFOQT and TBAS.

rvr1800 03-18-2015 05:57 AM


Originally Posted by Billy32 (Post 1844946)
I think we should take all of this to it's conclusion. Can't be too safe right? Give everyone 1 calendar year to get their stuff straight then go full bore. BMI less than 30, liver enzymes, cholesterol tests, treadmill stress tests, MRI to check for hidden tumors, neurological testing, psychiatric exam, alchoholism screening, no nicotine allowed, dig deep to find any unknown potential health issue. You never know, might have some pilot out there flying with an undiagnosed illness. Never mind shuting down the air transpoortation system, gotta be safe. Oh yeah, why not a skills test too. I could be dead asleep and outfly some of the idiots I have flown with. I recommend a certain score on an AFOQT and TBAS.

Don't forget to add skin cancer screening for all fair skinned pilots. Ever had a tattoo or piercing? Better add proof you're hepatitis free. What about chicken pox? Well we all know the shingles virus is inside you right. Well you better demonstrate that you don't have shingles. Ever take Advil for a headache? Probably brain tumor.

inline five 03-18-2015 05:58 AM


Originally Posted by Billy32 (Post 1844946)
I think we should take all of this to it's conclusion. Can't be too safe right? Give everyone 1 calendar year to get their stuff straight then go full bore. BMI less than 30, liver enzymes, cholesterol tests, treadmill stress tests, MRI to check for hidden tumors, neurological testing, psychiatric exam, alchoholism screening, no nicotine allowed, dig deep to find any unknown potential health issue. You never know, might have some pilot out there flying with an undiagnosed illness. Never mind shuting down the air transpoortation system, gotta be safe. Oh yeah, why not a skills test too. I could be dead asleep and outfly some of the idiots I have flown with. I recommend a certain score on an AFOQT and TBAS.

So, basically the old AA medical :D

rvr1800 03-18-2015 06:00 AM


Originally Posted by N9373M (Post 1844942)
He's not just snoring, he's suffering from hypopnea/apnea every 30-40 seconds. He needs to see a sleep specialist. OSA messes with REM sleep, causes low O2 sats, and is stressful on cardiovascular system.

He's failing 2 of the IMSAFE criteria (Illness and Fatigue).

BS. How do you know? Maybe he's adapted to this type of sleep and feels fine. He's passed all his check rides. Maybe won't live as long as the rest of us but seriously we're going to also threaten his career? I'm am vehemently against this big brother type medical exam. Billy32's tongue in cheek response illustrates where this is headed if we allow this nonsense to continue.


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