Originally Posted by sleepdoclv (Post 1843559)

As a sleep physician (not an AME) who deals with pilots at all stages of the Special Issuance process. Let me explain the new Guidelines as best as I can. It is explained as well in detail at ZEE APPNEA ? Sleep Apnea Risk

The bottom line is that what is being written on the AOPA website is a little misleading.
It is very important to be aware of the implications of the new guidelines as it pertains to your next AME exam. The AME's now for the first time , is required to screen for sleep apnea (OSA) risk. Prior to these guidelines, this uncomfortable topic could be avoided by just ignoring it. Now it cannot!
My guess is a lot more Airman will be identified as high risk for OSA.

If you present to the AME and it is determined that you are at High risk of having OSA, you will be given Spec Sheet B, which will give you 90 days to get assessed and if required treated for OSA. But what needs to be made very clear is that once you do the sleep study, you cannot exercise your privileges of your medical certificate until you are deemed to be in compliance with treatment. The FAA now knows that you are in the process of being evaluated. Once your are in compliance with treatment, your medical certificate is valid.

I would strongly advise that prior to your next AME exam, predetermine if possible if you are at risk for OSA. Review Spec Sheet B carefully.
The new guidelines are definitely more lenient on those Airmen who have been evaluated prior to the AME exam. In these cases the Airman has 90 days + 30 days to get in compliance . See Spec sheet A. In this situation the Airman will be issued a medical certificate and will have 120 days to provide all information to the FAA.

Originally Posted by Billy32 (Post 1843606)

So now instead of BMI over 40 pretty much anyone with BMI 35+ is going to have to do an OSA assesment? Following the flow charts I don't see a way around it. What a bunch of crap.

Originally Posted by Billy32 (Post 1843606)

So now instead of BMI over 40 pretty much anyone with BMI 35+ is going to have to do an OSA assesment? Following the flow charts I don't see a way around it. What a bunch of crap.

Originally Posted by WARich (Post 1843610)

BMI is pretty crazy......as a healthy guy who is still higher on the charts than what they say is healthy, the BMI is out of control. Though dude, seriously over 30? Join a gym and stop eating the airport food.

Originally Posted by Raptor (Post 1843613)

Quick story: bmi > 35 (or other risk factors, but bmi > 35 is what will gather up 95%) will get you an assessment. If you need an assessment you will get spec sheet B. Read it and follow the instructions.

An assessment can be done by the AME (but the FAA doesn't recommend that), your PCP (personal care physician), or a board certified sleep specialist. The assessment will determine if you need a sleep study or not. Just because you are high risk and get spec sheet B doesn't mean you automatically get a sleep study. You only get a sleep study if the assessment finds you need one.

Only time will tell how well the FAA accepts assessments that determine one doesn't need a sleep study.

I have already heard about several AMEs who all are interpreting the guidance differently (and incorrectly), so it would be wise to be knowledgeable yourself by reading the AME guide linked above.

Originally Posted by Billy32 (Post 1843617)

So gym yes airport food no? Thanks for the hot tip dude. Maybe better just change my genetics not to be an endomorph.

Originally Posted by WARich (Post 1843621)

Get in contact with a good Naturopathic Doc. Seriously. The natural way is the best way. I know a great one in the Seattle area but that's it.

Originally Posted by Billy32 (Post 1843617)

So gym yes airport food no? Thanks for the hot tip dude. Maybe better just change my genetics not to be an endomorph.

Originally Posted by sleepdoclv (Post 1843643)

Can you explain what facts you feel are incorrect. Your link is just a pdf summary of all material provided by the FAA. BMI cannot be the only factor utilized in the assessment. Risk assessment is supposed to be based on a variety of factors, but BMI remains a major component. The most helpful document link is Guide for Aviation Medical Examiners
For what its worth I am a sleep doctor and I found these guidelines confusing.
The Spec sheets A and B are a link at the bottom of the document. Hope this helps. Also ZEE APPNEA ? Sleep Apnea Risk explains this somewhat.

Originally Posted by awax (Post 1843645)

Thanks for posting, I think the new guidelines will catch a lot of guys by surprise.

Originally Posted by forgot to bid (Post 1843663)

Sweet. the bmi chat doesn't include my height. :D


So the FAA is at it again age getting slapped down by Congress. Last time they were starting with high bmi and then were going to eventually test everyone.

The only people though I have ever seen have sleep trouble in cockpits were heavy drinkers. I wonder if they'll add alcohol to the mix regardless of bmi?

Originally Posted by rvr1800 (Post 1843670)

Alcohol prevents getting into deep sleep. But how would that ever be brought into the evaluation?

More importantly how far do we allow the FAA to go with this nonsense? Why would they ever get more restrictive with medical requirements? When was the last time a pilot in poor health created any problem greater than the other pilot could handle by there self? Has it ever happened? We shouldn't even be required to get medicals. It's just something we accept because it's the way it has always been.

And no this new rule will not effect me. This stuff just bothers me.

Originally Posted by forgot to bid (Post 1843663)

The only people though I have ever seen have sleep trouble in cockpits were heavy drinkers. I wonder if they'll add alcohol to the mix regardless of bmi?

Originally Posted by ShyGuy (Post 1843690)

Pilot eating habits are surprising. Our job is tough on our circadian rhythms and eating patterns/habits. We are sedentary due to the nature of flying. But that having been said I still can't believe there are grown men in their 40s and 50s who will down 2-3 cans of Coke a day in flight. I'm sorry, that is waaay too much sugar at that age! That omelet breakfast looks fantastic, but did you read the menu where it said that they use 3 full eggs to make it? IIRC one egg yoke has ~80% of your recommended cholesterol intake for a day. etc. etc. It starts with good eating habits and a regular exercise routine.

Originally Posted by ShyGuy (Post 1843690)

Pilot eating habits are surprising. Our job is tough on our circadian rhythms and eating patterns/habits. We are sedentary due to the nature of flying. But that having been said I still can't believe there are grown men in their 40s and 50s who will down 2-3 cans of Coke a day in flight. I'm sorry, that is waaay too much sugar at that age! That omelet breakfast looks fantastic, but did you read the menu where it said that they use 3 full eggs to make it? IIRC one egg yoke has ~80% of your recommended cholesterol intake for a day. etc. etc. It starts with good eating habits and a regular exercise routine.

Originally Posted by dogpilot (Post 1843709)

You need to take a look at what the French eat, tons of cholesterol, yet they have a heart disease rate much smaller than the U.S. Cholestrol is not the problem, hydrogenated oils and processed foods are the real heart killers.

Originally Posted by vroll1800 (Post 1843735)

Requiring AME to delve into factors "other than BMI" may well be more insidious to more airmen than the BMI alone.

Originally Posted by Sink r8 (Post 1843758)

No kidding. I can definitely see how a BMI of 35 should be a red flag. I ran my numbers through. I'm the fatest I've ever been, and I still would need to be 50 lbs higher to reach 35.

Some of the other factors feel a bit like a witch-hunt. I'm surprised that frequently having to sit, and resorting to rollaboards to carry a load, are not listed as risk factors.

Originally Posted by Sink r8 (Post 1843757)

You guys didn't think Age 65 was going to come without more rigorous medical standards, did you?

This rule feels like it was written by people like the OP, and I think it's designed to force most people into sleep studies, and treatment. How lucrative that must be!

On the other hand, it's an issue worth considering. I'd be curious to hear from someone that isn't a sleep specialist telling us what experiences they've had in this regard, whether it is indeed better to get out in front of this, and where the facilities are that will provide good treatment without artificially forcing pilots into treatment purgatory, etc.

Originally Posted by TurboDog (Post 661962)

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 showed 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 whole 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 (BMI 30). 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?

Originally Posted by forgot to bid (Post 1843762)

When this came up a while back there was a pilot posting in a thread here who gave a real life experience. The problem seemed to be that the treatments the FAA wanted were not what a sane doctor would want you to do and the FAA didn't/doesn't consider losing weight a solution- they wanted surgery.

....

Here I found his post:

Originally Posted by ShyGuy (Post 1843724)

Mine wasn't an all inclusive list, I just listed a few examples. Yes certain oils and processed foods are worse.

Originally Posted by forgot to bid (Post 1843769)

You're right. Processed foods are probably the vast majority of the problem. Especially when they start making the fat free stuff or the stuff they're trying to make last a long time. Even what seems to be good for you stuff can be stripped of the good for you stuff in processing.

There is a local Doctor here in Atlanta that has a radio show that is pretty interesting to listen to the science of nutrition and he's a chiropractor so all of that witch doctory stuff. :D I'll look for his podcasts....

But he made it kind of simple, more than 3-4 ingredients then it's probably not good for you. I looked at a bag of nuts one time at the airport that had like 10 ingredients. How do they do that? Then I looked at a rice krispies treat, it was like 2 paragraphs of science words. :eek:

Originally Posted by NERD (Post 1843760)

No kidding. I'm actually the same weight as high school but it's shifted:eek: But according to the chart I need to gain 55 lbs to reach a BMI of 35. Guess I can stop at cinabon today:D