Regarding FAA medical issuances
Subject: sleep apnea
Most pilots think very lightly of the event that could end their career’s which is known as the FAA Medical. The thought is “I’ll always be okay and it’ll be fine”, however nothing could be farther from the truth. Since 2008 the FAA has been set on task to cure us of the very ambiguous condition called OSA (Obstructive Sleep Apnea). I speak from personal experience and the experience isn’t a walk in the park. The trip down OSA lane is full of tests, appointments, sleep studies, more appointments defining what level you are at. After it is decreed that you have OSA and what at what level, it is treatment time with more appointments with adjustments if required. Finally, it is time to send in the paperwork to the FAA and see what the “ruling” is going to be. Mind you all the while you can NOT exercise the privilege of your medical certificate. This process could take weeks….to date I set the average between 5-7 weeks of NOT working, not making money, yet still having to pay required bills and paying out extra on doctor and sleep study bills along with any needed equipment.
First and foremost, in my opinion that this is a witch hunt by the FAA and AME’s that subscribe to this “means justify the end”
The seemingly benign and often misunderstood so called condition is really a ticking time bomb for all in G.A., Corporate and charter operations and pilots.
I have searched both NBAA and AOPA and found their information to be quite lacking in regard to exactly how this affects an airman and the process that is involved as well as the financial hardship it imposes with little or no consideration for those that do this for a living. I know for I just got tagged with it from an overzealous AME who used data from one group zone and applied it to another and bingo, your guilty during a so called screening process.
The reality of this OSA letter from the FAA is guilty until proven innocent with little or NO help from either some AME’s or FAA as how to proceed rather just “comply”. TO make matters worse, the medical community is grossly underinformed to the schedule of a piot and have no real sense of urgency in this matter. One would think it would be the opposite for the FAA has determined that it is so called “life threating” yet, unless you have a severe case, the push for any treatment devices is put through normal channels IE: slow. I guess it isn’t as “severe “as the FAA and NTSB have led us to believe, then is it?
The FAA increased it’s screening from what I can tell starting in February of 2015. (see FAA.gov fact sheet print date 02/02/2015) We can all thank the airline crew who in 2008 over flew their destination while BOTH were asleep. However, with the help of ALPA, they “shifted” (the word I’ll use) attention to the sleep problem being due to Sleep apnea. Since then and with this new smoking gun, the hunt is on to best this dreaded cause of overflying destinations. Most of the so-called DATA from the aforementioned government agencies is unsupported and at best extrapolated. This touted “hard” data is Pushed home by words like “suggested and estimated” phrases like “thought to be contributing” or “could have been a factor”. Most of the data they lay claim to have come from the DOT. This data collected on truck and auto accidents and again is THOUGHT to be a contributing factor. I can’t be that people are just driving tried, there must be a root cause. It just can’t be lifestyle choices, it must be a condition, it can’t be their fault.
Below are most of the key Factors they look for during a medical exam and is part of the so called screening during said exam.
1) BMI of 30 or more is considered “Obese” (see below)
(*note BMI is an outdated, flawed, accepted official method to calculate one’s fat levels or should I say level of Heath?? IF one is a body builder or weight lifter, he or she will NOT have a normal BMI, but will have very low fat percentage. It should be BFI, body fat index as under this current government and intuitional accepted formula, most all navy seals, delta force, army rangers and Green berets would be overweight and most NFL players and body builders would be Obese. A 6ft male would have to be under 180 pounds to “normal” So, if you look like Bruce Lee, you’re okay)
Underweight = <18.5
Normal weight = 18.5-24.9
Overweight = 25-29.9
Obesity = 30 or greater
3) age over 40
4) large neck size 16-17 and over (inches)
5) Enlarged tonsils or tongue
6) Snoring….OF ANY KIND FOR ANY REASON.
7) Any sleep deprivation you have for any reason. (never mind 14-hour duty days with a so called 10-hour rest back to back and sleeping on command)
Note: you don’t have to be overweight to have OSA. I know of several that have it and are young, fit and a low BMI.
(see Guide for AME, Decision Considerations Disease Protocols-Obstructive Sleep Apnea (OSA) at FAA.gov, and AASM tables at www.aasmnet.org/Resources/clinicalguidelines/OSA)
From the AME, comes several guide lines in which to follow. Some AME’s follow it, others take from one group and add it to the other to get their “findings” as I mentioned above.
Group 1-6 thus far is the accepted number, with Group 1-2 being already diagnosed and addressed with either a special issuance or restrictions and Group 3 being you don’t “seem” to have it/don’t fit the profiling they are currently using. Group 4 is your assessment is close and we will make a note here for next time (means lose some weight and or have your neck stretched) Group 5 is we think you may have it, so we will issue you your medical but send all information to the FAA so they can issue you a letter of compliance and make it official and placed on your record and give you 90 days from printing of said letter to comply. Groupe 6 is severe, usually associated with heart conditions or other documented issues. (accidents, overflying your destination perhaps?)
I am most familiar with Group 5. Where it seems that you are guilty until proven innocent and proven on your dime. You are so called screened by a series of questions and a neck measurement is done (if you don’t know yours) with the rest of the medical data taken for your class of medical, you are now in the zone. Meaning, you may have it or “may” just be a candidate for it. IF the AME is not acting in your best interest, he/she will send off the letter of what I call is the letter of employment suspension or termination to the FAA without, I say again WITHOUT any further testing as that comes later, to prove or not prove you have OSA. The meaning of this screening is, we suspect your guilty of OSA yet we have ZERO proof of it, so, prove you don’t have it. Once the FAA receives this letter, they in turn send off a computer-generated form letter to the airman. It states that you have 90 days FROM THE PRINTING of the letter, not receipt of it, to comply with the following testing.
Visit with a OSA specialist approved by American Academy of Sleep Medicine (usually a pulmonologist MD) and be checked. This checking involves blood pressure and height and weight with a host of questions. Then heart rate is checked with a few other neck/throat tests/checks and if further thought is that you may (yes MAY) have it, a sleep study is ordered. IF he says by some act of the almighty that it is his professional diagnosis that you don’t have any key symptoms, then you send in that information with the form you received from the FAA and it “should” be okay. Otherwise it’s the below;
Sleep study home test (2 nights)
In lab testing usually 1 overnight stay.
Interesting that the FAA and other medical government types tell you NOT to take sleep medication or alcohol as it will increase your chances of OSA. Yet, while in said sleep study, they offer you sleep aid, because you might not be used to all those wires and things hanging off you while you sleep. One would think it would rather help to push you over the threshold to test positive? Your choice whether to take it or not.
Once the results are studied they will determine whether you have light, moderate or severe OSA. The next step is to treat said OSA. IF a CPAP machine is the course of treatment (Continuous Positive Airway Pressure) there are several different ones to choose from as well as masks. The one to get is the one that transmits daily the condition of sleep and hours AND has a SD card slot. This machine will store the data when cell service is not available of which I’m told it only works in the US. This is approved for DOT and Insurance companies so it should be (should being the operative word) acceptable to the FAA. The phrase “it’s no big deal or issue” to have OSA offers little comfort for what I’ve discovered. They have created this white whale and now must feed it. Truth is one can just read the FAA “Obstructive Sleep Apnea Specification Sheet B, Assessment Request” and get a very different legal view which states;
IF your sleep study is positive for a sleep-related disorder, YOU MAY NOT EXERCISE THE PRIVILEGES OF YOUR MEDICAL CERTIFICATE UNITL YOU PROVIDE” and by provide they mean the sleep study, the doctors report, the 7 days’ minimum of data from the CPAP machine and 3 Blood pressure readings sent into them all the while, you can’t work. To the best of my calculations it could be an average of 5-7 weeks from sleep study review to a reply from the FAA. Everything takes time, you must make appointments, you have to work with the medical community’s schedule not yours.
For example, you can’t just pick up a CPAP machine, you must be fitted for one and if insurance doesn’t pick up the cost, it isn’t cheap. Keep in mind that once you are issued the CPAP machine, you must have at a minimum at least 7 days/nights of data with at least 4 hours a night minimum while using the machine. In addition, you must have 3 blood pressure readings taken in that week, by whom it does not say nor does it say when. Those items along with the sleep study and attending physician’s report are sent in to the FAA. They, the FAA, state that they can take up to 10 business days to “review” this data. However once mailed or faxed they have to receive it, process it AND then scan it to be viewed. That can take 5-7 business days just for that and no medical person has seen it. SO, it is unclear if the 10 business days includes that process of scanning or is AFTER it has been scanned. Once viewed and judgement rendered, they mail it back via regular mail. (more time) Now you can call and check the status of your medical, however all they will provide you with is approved, denied and pending and any comments they are seeing on the computer screen under your file….that is IF you can get through to them.
Once the required data is reviewed they (the FAA) can require more data (testing) or deny your medical application or approve it under a special issuance. Meaning under a special issuance you will have to go through this data collection once a year for the rest of your flying career for those seeking a first, second or third class medical unless it either magically cures itself or you have surgery and it helps not hinders the current OSA. (yes, there have been cases where it has worsened the OSA condition)
Keep in mind this testing is on YOUR dime, that’s right…you pay for it, you prove your innocence. If you have been given a CPAP machine, don’t worry, it’s only the size of a briefcase and has been approved for airline carryon. Think of it as your forever pilot man purse. You’ll not want to place it in checked luggage, the cost is hard to eat if lost or taken and if you do for some reason place the machine in checked baggage, take the SD card out and carry that with you. That way you have that data that they will require you to show for compliance up to that date the machine was lost.
I would say to avoid all this unpleasantness it is my opinion to find an AME that is knowable in this process of OSA and who will work WITH you on this. In addition, when asked, (it is entirely up to you) state NO for snoring, No for any and all questions relating to anything to do with sleep problems. IF you suspect you have it (OSA), do the testing away from your AME and get on a treatment plan or schedule. Then when you have your next medical go and submit all data at the time of the exam when you’re sure it’s a solid deal. It’s a lot easier and much less time OUT OF WORK and out of money as it will more than likely be approved under special issuance straight away with no 90 day letter.
So, let’s assume that you have OSA and have complied with all the requests of the FAA and submitted all data. They review it and send you their letter. It will say (if approved) that you are Ineligible for a medical certification under title 14, Code of Federal Regulations (CFRs) revised part 67; specifically, under paragraphs or sections 67.113 (b) (c) and 67.313 (b) (c). (Keep in mind it says Medical certificate…meaning ANY.) It then says that it is granted under an Authorization for special issuance under title 14 of the CFRs section 67.401. Then it says; This Authorization shall be effective until withdrawn by the agency and supersedes any previous grant of the Authorization. IT is valid for one year (meaning you will have to comply with the data stated by said FAA annually no matter what medical you have) So forget trying to let it down grade to a third class and stretch it out for a few years. In addition, the FAA requires 6 (six) hours of verification of CPAP machine use per sleep period. That means per 24 hours. Good luck getting that in a charter and or international environment. The FAA also requires a years worth of data, so, print it off the SD card when you can, less you lose some data...and I have no clue what one does then.
If you’re in the Milwaukee area, I can recommend an office that is now up to speed on the process. Dr. Olafsson and his nurses of the St. Joseph’s Health Center in West Bend. He and his staff are great to work with and have pushed things as fast as they could once they understood the gravity of the situation. One finial note, if your insurance company doesn’t approve you for a CPAP machine or you don’t want to wait the up to 15 business days, you can rent them. Speeds up the process by a few weeks then submit it to the insurance company later.
PS: IF by some reason, you don’t comply with the 90 day FAA letter, on the day of the 90 days, if they have not heard from you, they will send out yet another form letter, this one being a little harsher. Words like legal action and denial. Also, this letter is sent out via registered mail with return receipt so they know exactly when you received it. This letter gives you 30 days from the date of the letter being printed.