FAA Medical and pilots with Sleep Apnea

On 9/28/2005 12:19, Montblack wrote:

("Foster" wrote)
[snip]
I used the CPAP for about a year and probably lost as much sleep to it as
I had with the apnea. My doctor got offended when I suggested he try it
for a night.


Ahh, another 'at war' with his mask.

The leaking mask under the eyes is one nightly problem (eyelash flutter).
After a while you learn to flick your head a little, like a hound on the
front porch when flies are bothering him, and it usually seals back up.
Otherwise, you can (lightly) smack/tap the side of the mask, like
'fine-tuning' our old 1963 TV set - that will sometimes cure air leaks too.

Other nights you take it off. It wins that round.


Montblack


Sheesh, I thought I was the only one ;-)

When I first got the set-up, the technician showing me how to use it
said:

You can make this work, or you can do without. The choice is yours.

.... I got the impression that it wasn't going to do me any good to
complain.



--
Mark Hansen, PP-ASEL, Instrument Airplane
Sacramento, CA

On Wed, 28 Sep 2005 14:19:03 -0500, "Montblack"
wrote:

("Foster" wrote)
[snip]
I used the CPAP for about a year and probably lost as much sleep to it as
I had with the apnea. My doctor got offended when I suggested he try it
for a night.


Ahh, another 'at war' with his mask.

The leaking mask under the eyes is one nightly problem (eyelash flutter).
After a while you learn to flick your head a little, like a hound on the
front porch when flies are bothering him, and it usually seals back up.
Otherwise, you can (lightly) smack/tap the side of the mask, like
'fine-tuning' our old 1963 TV set - that will sometimes cure air leaks too.

Other nights you take it off. It wins that round.

Chacun a son gout. Foster's cure has the advantage of being a
one-shot permanent fix..

Don

On Wed, 28 Sep 2005 14:19:03 -0500, "Montblack"
wrote:

("Foster" wrote)
[snip]
I used the CPAP for about a year and probably lost as much sleep to it as
I had with the apnea. My doctor got offended when I suggested he try it
for a night.


Ahh, another 'at war' with his mask.

The leaking mask under the eyes is one nightly problem (eyelash flutter).
After a while you learn to flick your head a little, like a hound on the
front porch when flies are bothering him, and it usually seals back up.
Otherwise, you can (lightly) smack/tap the side of the mask, like
'fine-tuning' our old 1963 TV set - that will sometimes cure air leaks too.

Other nights you take it off. It wins that round.


Montblack


Yea, know what you mean about that Montblack.

After a while, you are able to adjust the mask on your nose by just
tilting your head a bit. And it becomes almost unconcious, you do it
without even waking fully.

Only problem I had with CPAP was my mouth kept falling open. First
time I had one on was in the sleep test. I woke up very slowly and
heard a tornado in the room. After a few more seconds, I realized it
was COMING OUT OF MY MOUTH! To use the CPAP, they gave me an extra
strap with a chin cup that held my mouth closed. Worked OK.


Chuck

"Don Tuite" wrote in message
...
What worries the FAA is narcolepsy caused by sleep apnea.

Narcolepsy is not caused by sleep apnea. Whoever told you that hasn't got
the slightest clue what they are talking about. That's like saying that
working too hard and not getting enough sleep causes narcolepsy. ??? Look
up the definitions, Don. I have sleep apnea too and never had narcolepsy. I
was simply not getting enough sleep, with the related consequences.

On Wed, 28 Sep 2005 16:00:07 GMT, Don Tuite
wrote:

SNIP

For the curious, a CPAP machine looks like a mini vacuum cleaner. Its
hose connects to either a mask that covers your nose or to what I
have, which is a snorkel-like contraption that ends in a couple of
buds that stick into your nostrils. (Not a cannula, they actually
close the nostrils.) Either way, it means the air pressure at your
nose is higher than the air pressure at your mouth, forcing you to
keep your mouth closed while you sleep and to breathe through your
nose. The result is no more snoring and none of the sudden
interruptions of breathig air that occur when your tongue or glottis
gets in the way of the air you'd be breathing through your mouth. And
those interruptions are the apneas that interupt your REM sleep, which
is what you need enough of in order to avoid narcolepsy.

For the really curious, yes you take the damned thing off for sex.

Alternative surgical approaches that don't involve CPAP include cuting
off your uvula and breaking your jaw and resetting it further forward.
I understand that some people actually opt for them. Go figure.

Don

Actually Don, you're using the headset they tell me is for people with
some clostrofobia. Two plugs in the nostrils and a small line that
goes up between the eyes to be less noticible.

The regular (note, I didn't say NORMAL) mask is a little trangular
thing that fits over just your nose and is feed by a plastic line
about an inch in diameter. I used one for five years and it does
work.

And then they make a full-face mask that fits over the nose AND mouth.
It has a quick release in case your stomache comes up while in the
mask. I tried one for a couple nights once and couldn't take it.
Made me feel like a scuba diver and was just TOO much all over my face
-- and I'm not clostrofobic at all.

On the surgical solutions, there are two or three of them. As you
mentioned -- none of them sound appealing and NONE of them guarantee
to be effective. I told the doctor to forget it -- no surgery for me!

I have a friend who opted for the upper palet reduction (remove uvula
and some of that upper arch in the top back of the throat). He was
****ed afterwards. Not only did it NOT help his Apnea, he had to
learn how to eat & drink all over again. For the first couple years
after the surgery, he wouldn't eat out as he kept having liquids go up
his nose while he was drinking or swallowing.

In my case, my Obstructive Sleep Apnea is very position related. On
my back, its bad. On my side or front, it barely makes the cut to be
diagnosed as Apnea. So, while I used the CPAP for five years -- I
pretty much stopped about three years ago. I've taught myself to
sleep on my side and back and it works OK. Only time I have trouble
now is the rare occasions I turn on my back or I'm having a lot of
sinus trouble. Then I use CPAP.

Thanks for the info Don. I figure the more I can get, the better I
will come out in the end.



Chuck

Chuck,

I have sleep apnea too. Get the doctor to send you for a sleep study. The
first one confirms whether or not you have sleep apnea. I guess you had that
already. The second one determines the appropriate setting for the CPAP
machine that blows warm, moist air in your airway to keep it open. You WILL
notice the difference, it is like NIGHT AND DAY, guaranteed, my friend. The
mask takes a bit of getting used to, but you will feel SO much better.

Once you stabilize with the machine ask your doctor for a letter stating so
(30 days) and go back to the AME. A diagnosis of sleep apnea is not
disqualifying, the AME can review the doctor's documentation and issue it to
you right then and there. That's how well the FAA knows the CPAP machines
work to eliminate this problem.

Juan

"Chuck" wrote in message
...
Hi everyone,

I've run into a problem with renewing my medical because of a
diagnosis of Sleep Apnea. It didn't cause me to fail my medical, but
I didn't pass either.

Since the AME had never run into a pilot with Sleep Apnea before, he
wound up calling Oklahoma and talking to the FAA. The FAA person had
the doctor "defer" the medical and send the paperwork to them.

I spoke with the doctor for quite a while and he feels sure that the
FAA will eventually approve the medical and I'll be flying again. But
he thinks that the FAA will be asking for paperwork on my diagnosis
and test results. And he suggests I get together as much information
as possible -- for when the FAA does ask for it. I'm working on that.

But in the meantime, I was wondering if anyone out there has been in
the same situation before? Has anyone out there run into a medical
problem because of Sleep Apnea? Or does anyone know of a pilot with
the problem???

I'd really like to speak to anyone with similar experience. I'd like
to talk about how their situation resolved and any
suggestions/recommendations they might have in dealing with the FAA.

Having the FAA consider Apnea a problem is actually kind of curious.
Sleep Apnea isn't something that sneaks up on you like a stroke or
heart attack. Apnea just keeps you from sleeping correctly and if
you've had a problem while sleeping, you know it when you get up. So,
Apnea isn't something that should affect you while flying -- at least
I hope no one is sleeping at the controls.

And if you had a problem with Apnea the night before, you get up
tired and feeling bad -- and I'd really hope that someone in that
situation wouldn't get behind the controls!!! So, I'm a little
puzzled why the FAA consider it a possible flight problem -- but I'll
play along and supply anything they request.

Thanks for listening guys. And if anyone has any information, please
send it to me at or post it to this list.



Chuck
PA28-180

Chuck,

This is why you NEED AOPA.

Sleep Apnea is a disqualifying condition. Now you have to prove to the
FAA that you deserve a waiver, in the form of a special-issuance
medical.

What you should have done BEFORE going to your AME is get your paperwork
in order, then find an AME with experience doing SI medicals. The SI can
be done very quickly if you have the right stuff ready to go and an AME
who's willing to help get you issued.

The FAA wants to see that you are under treatment for sleep apnea and
that you will not fall asleep at the controls. There are different kinds
of S.A., the most common is obstructive. This is usually treated with
CPAP machine or some variant thereof. It is a condition where the throat
closes and stops your breathing. There are other kinds, like central
sleep apnea which is a central nervous system disorder.

Presuming you have obstructive sleep apnea, what you are going to need
for the FAA is your sleep studies, both before and after CPAP or
surgery. You are also probably going to need to take a daytime test
called a maintenance of wakefullness test or MWT. If you have all the
paperwork ready at your medical, your AME has to defer your medical to
the FAA. It is possible to get issued with a phone call, if your doc
knows how to get through. Most likely, the bundle of paperwork will need
to go in to Oklahoma or the Regional Flight Surgeon.

Once you get the SI, you'll most likely get a 1-yr renewal, requiring a
letter from your treating physician that you are compliant with
treatment and experiencing no daytime sleepiness. You'll probably have
to go back to the AME or send the letter in once a year and get your SI
renewed.

AOPA's medical resources have the full details of the required protocols
the FAA is looking for. Get a copy and bring them to your regular doctor
who is treating you for apnea.

It's a PITA, but that's what you gotta do.


In article ,
Chuck wrote:

Hi everyone,

I've run into a problem with renewing my medical because of a
diagnosis of Sleep Apnea. It didn't cause me to fail my medical, but
I didn't pass either.

"nolan void" wrote in message
...
Chuck,

This is why you NEED AOPA.

Sleep Apnea is a disqualifying condition. Now you have to prove to the
FAA that you deserve a waiver, in the form of a special-issuance
medical.

NO, it is NOT a disqualifying condition, and NO you don't have to do the
special-issuance dance. This is just like hypertension, you just need to
show that you are under treatment and a letter from your doc saying it
works.

VERBATIM from the AOPA web site:

Sleep Apnea

At the time of your next examination, you will need to provide your aviation
medical examiner with a current status report from your treating physician.
If the information is acceptable to the AME and you are found otherwise
qualified, your AME may issue your medical certificate at that time.

The report should include:

A current status report that mentions the present treatment and whether it
has eliminated symptoms. The report should also include specific comments
about daytime sleepiness. If there is any question about treatment
compliance, a Maintenance of Wakefulness Test (MWT) will be required.

The AME should defer the application to the Regional Flight Surgeon or
Aerospace Medical Certification Division if:

1. There is any question concerning adequacy of treatment.
2. There is evidence of non-compliance with therapy.
3. The Maintenance of Wakefulness Test is positive (abnormal).
4. Development of associated illness, such as right heart failure, is noted.

Juan,

The information on AOPA has changed since my last medical, but only a
little. What you linked to is misleading. That is the protocol for a
*re-issuance*, not a first report issuance.

First issuance requires deferral and FAA decision, no matter what.

Read page 22:

http://www.faa.gov/about/office_org/...s/offices/aam/
ame_guide/media/secaasi.pdf

An initial determination requires more paperwork. The MWT is the
gold-standard for successful OSA treatment. They may authorize on less.
If this is your first report, you can make it easier for them to say yes
by having the MWT in addition to polysomnographs from the sleep study.

Re-issuance with the condition only requires current report from your
treating physician along with the authorization letter from the FAA from
your initial issuance at first report.

Trust me, it *IS* a disqualifying condition. I have been through the
whole process. I get an authorization letter that's good for a year,
then I have to send in a report, then I get another year authorization.




In article ,
"Juan Jimenez" wrote:

"nolan void" wrote in message
...
Chuck,

This is why you NEED AOPA.

Sleep Apnea is a disqualifying condition. Now you have to prove to the
FAA that you deserve a waiver, in the form of a special-issuance
medical.

NO, it is NOT a disqualifying condition, and NO you don't have to do the
special-issuance dance. This is just like hypertension, you just need to
show that you are under treatment and a letter from your doc saying it
works.

VERBATIM from the AOPA web site:

Sleep Apnea

At the time of your next examination, you will need to provide your aviation
medical examiner with a current status report from your treating physician.
If the information is acceptable to the AME and you are found otherwise
qualified, your AME may issue your medical certificate at that time.

The report should include:

A current status report that mentions the present treatment and whether it
has eliminated symptoms. The report should also include specific comments
about daytime sleepiness. If there is any question about treatment
compliance, a Maintenance of Wakefulness Test (MWT) will be required.

The AME should defer the application to the Regional Flight Surgeon or
Aerospace Medical Certification Division if:

1. There is any question concerning adequacy of treatment.
2. There is evidence of non-compliance with therapy.
3. The Maintenance of Wakefulness Test is positive (abnormal).
4. Development of associated illness, such as right heart failure, is noted.

"nolan void" wrote in message
...
Juan,

The information on AOPA has changed since my last medical, but only a
little. What you linked to is misleading. That is the protocol for a
*re-issuance*, not a first report issuance.

The same thing applies to hypertension. It's not a disqualifying condition,
it just requires the FAA to know that you are under treatment. Sleep Apnea
is even simpler than that... what does it require as treatment? Warm, moist
air down your airway when you go to sleep. A mask that makes you look like
one of Sigourney Weaver's acid-for-hemoglobin buddies. Doesn't even require
medication! And as a bonus, most people get their dreams back. Such a deal.

First issuance requires deferral and FAA decision, no matter what.

That doesn't mean that it is a disqualifying condition that requires a
special issuance medical. What you get after that is not a special issuance
medical. That's an entirely different animal.

Trust me, it *IS* a disqualifying condition. I have been through the
whole process. I get an authorization letter that's good for a year,
then I have to send in a report, then I get another year authorization.

Then you have another condition that has nothing to do with sleep apnea. If
you have to go through the special issuance process every year, what you get
when you get a special issuance is a medical certificate, but from the FAA
in OKC. I've never had to tell the FAA anything further about my sleep
apnea, but I have had to tell them about other issues.

Juan