The FAA's New Approach to Sleep Apnea

It's been almost five years since we talked about sleep apnea (September, 2011) and the FAA's approach to this problem has been updated. Obstructive sleep apnea (OSA) is very common. .It affects anywhere from 9% to 28% of adults. It happens when the upper airway becomes obstructed during sleep causing disruption of normal sleep patterns. It is usually caused by overweight. Fat tissue in the neck can block the airway, causing an interruption of air flow. It seems to occur more commonly in men but obese and post-menopausal women frequently are afflicted. Characteristically, as you slip off into sleep, your airway starts to close. Breathing slows down. It can even stop. Blood oxygen plummets. The brain gives a "wake up and breathe, buddy!" signal and you start from sleep, take some deep breaths, snore, snort and slip off to sleep again.

This cycle repeats again and again through the night. Not surprisingly, you wake up the next morning feeling like you've been hit by a truck. Alertness during the day suffers. You find yourself dozing off in conferences, even behind the wheel! Obviously this is not a good thing if you are proposing to fly an airplane.

This is where the FAA comes into the picture. In 2014 the NTSB issued a report linking OSA to a number of truck, railroad and aviation accidents. They noted that current screening procedures were, in many instances, inadequate to pick up this condition. They made comprehensive recommendations to tighten up examination techniques for safety-critical transportation personnel.

In response to this NTSB report, the FAA has revised the procedures used to screen and deal with OSA. It begins when the nurse measures your height and weight. This is used to calculate your Body Mass Index (BMI) which is essentially a ratio of your weight to your height. If your BMI is above 35 your AME will ask if you have any trouble with daytime drowsiness, snoring at night, irregular breathing patterns observed by your bedmate. If the answer to all this is "no" your AME will have a little chat about the risks of OSA-like killing yourself while flying-give you some educational materials, and issue your medical certificate. If, however, he/she feels there is a pretty good chance you have OSA he'll still issue, but with the condition that within the next 90 days your personal physician or a sleep medicine specialist evaluate you.

If it seems a sleep study is warranted and it's negative, you send it in to the FAA and go on your merry way. If, however, the sleep study is positive and you have OSA, you're grounded until you start the recommended treatment. You'll also need a statement from the treating doc that the therapy works and that you're taking it. You will have to sign a statement that you're a good boy and are complying with the prescribed treatment. The FAA may or may not ask for more information after they get this report.

On the other hand, if you are already diagnosed with OSA and want a medical certificate you'll have to convince the AME that you are doing OK and are using whatever treatment has been prescribed. If he feels that is the case and you don't fall asleep in the exam room, he can issue your medical if you are otherwise qualified. This also has the catch that you will have 90 days to send in a report from your treating physician along with your most recent sleep study and a certificate of compliance. Otherwise the Men in Black may show up at your door.

Of course if you come into the AME's office looking like Jabba the Hutt and behaving like the Drowsy Dormouse, chances are he'll defer you to the FAA's medical division for additional evaluation for OSA rather than issue a certificate. They will let you know what further testing and treatment is necessary to get you back to the Land of the Living and into the cockpit.

Treatment for OSA is geared to keeping the airway open during sleep. Sometimes a dental device does the trick. More frequently a respirator-like apparatus that delivers air under positive pressure is worn during sleep (CPAP, BIPAP of APAP). In some instances a surgical procedure to remove redundant tissue blocking the airway might be recommended. Whichever therapy is prescribed, it's frequently effective and can make a dramatic difference in your feeling of well-being as well as allowing you to be awake when you are up in the wild blue!

Fly wisely. See you next month.

As always, comments, questions and suggestions are welcome:

jdlakin@mnallergyclinic.com.