Airline Pilot medical and OSA

[WingNut]

I've just recently been diagnosed with OSA and I'm an airline pilot. Haven't told my designated medical examiner yet but plan on calling him this week.

I have had two sleep studies and have now been using a CPAP machine for a week now and it's all good. No problems with getting used to the mask, I used to wear a mask flying in the military anyway.

Has anybody here gone down this path lately? What ramifications are there with the pilot medical? What are your experiences with officialdom?

[deltadave]

I've just recently been diagnosed with OSA and I'm an airline pilot. Haven't told my designated medical examiner yet but plan on calling him this week.

I have had two sleep studies and have now been using a CPAP machine for a week now and it's all good. No problems with getting used to the mask, I used to wear a mask flying in the military anyway.

Has anybody here gone down this path lately? What ramifications are there with the pilot medical? What are your experiences with officialdom?

You're probably going to need another test (Maintenance of Wakefulness Test) (MWT) to objectively determine that it is working correctly.

[mayondair]

I assume you'll need a first class medical, you'll need a maintenance of wakefulness test, and compliance records. Shouldn't be any problem. .AOPA or one of the other pilot groups can help get the right format if your designated medical examiner isn't familiar . Kathy ( single engine, land and sea, insurment )

[JohnO]

Has anybody here gone down this path lately? What ramifications are there with the pilot medical? What are your experiences with officialdom?

Wingnut -- Run, don't walk, over to the AOPA Medical forum, search for notes on Sleep Apnea. You'll need to be an AOPA member to get in.

Here is a link to one pertinent thread: http://forums.aopa.org/showthread.php?t ... +apnea+FAR

Read what Dr. Bruce Chien has to say on the matter. I'm going down this path right now. Sleep Apnea invalidates your medical certificate, once you have been officially diagnosed. You need to ground yourself until you get a special issuance (SI). [See FAR 61.53 and
67.113 - being sleepy enough to fall asleep at your job is what triggers it here - even though we don't all suffer to that level]

Are you part of ALPA, or similar? Many of those organizations have doctors that specialize in getting their members back in the air as soon as possible.

The good news is that this SI is one of the easiest to get. Some doctors can issue "same day" medicals so you don't have to wait the typical 45-60 days after your AME mails the paperwork to FAA. Dr. Bruce Chien is one of those guys. I'm heading down to see him next week.

What you will need is:

1) A Compliance report from your CPAP machine showing compliance (Dr. Chien suggested 30 days of data) showing 75% of nights with more than 6 hours of usage.
2) A copy of your full sleep study report
3) A note from your doctor describing the following:
Letter from the treating doc whcih has to have four components:
(1) Appears well rested
(2) Complaint with therapy
(3) No apparent tendancy to fall asleep > normal.
(4) No findings of gross right heart failure.

A MWT will typically NOT be required if you work through an AME who understands how to work the system. The current language from the FAA suggests an MWT will be required if there is some question about the rest of your data.

John

[deltadave]

A MWT will typically NOT be required if you work through an AME who understands how to work the system.

What does "knows how to work the system" mean?

[-tim]

You do not want to take the MWT (Maintenance of Wakefulness Test) unless your into Zen calmness. You end up in a dark room in a bed and not go to sleep for hours while you can't do anything.

I think the test was created by a priest that used to run detention hall in a school I went to. They tortured the kids by getting them to do nothing but watch a clock for an hour in an empty room. If you fell asleep, you did it for another hour. The message was never try the patience of a monk or they might try yours. My friends who suffered through it said if felt like hours or days.

[JohnO]

A MWT will typically NOT be required if you work through an AME who understands how to work the system.

What does "knows how to work the system" mean?

It means, a doctor who meets regularly with the FAA to determine their current interpretation on the ways of the Aeromedical branch. So, for example, Dr. Chien sits on a number of panels with the FAA doctors, and understands the FAA thinking about many processes that many AMEs (Aviation Medical Examiner) do not.

For example, many AMEs assume an MWT is required, when it is usually not. Also, many AMEs will gather the required documentation and mail it to the FAA for review, which could take 45-60 days, depending on FAA backlog. Dr. Chien is able to greatly reduce that time -- so much so that many patients with the proper documentation can get their FAA medical during their FAA exam with Dr. Chien.

http://www.faa.gov/about/office_org/hea ... eep_apnea/

John

[RandyJ]

I would guess a chat with your union rep should happen ASAP to be assure that your rights are protected as you navigate through the process of being certified as fit to work.

[mayondair]

JohnO, thanks for a good tip, don't want unnecessary tests! Kathy

[chunkyfrog]

Also best not to get eaten up by the paper mill.

[WingNut]

Thanks to all that have replied.

My issue was whether I would have to be grounded prior to proving ongoing treatment to the regulator, or whether I can keep flying (earning income) whilst gathering the required info.

My diagnosis of OSA was a side issue whilst seeing an ENT surgeon investigating sinus pain, (all clear there), rather than the classic diagnosis of falling asleep in the afternoons/at the wheel/drowsy during the day etc. I have a low Epworth score, and thus a mild case of OSA so apparently I can keep flying whilst undergoing treatment - CPAP trials etc.

My local DAME (Designated Aviation Medical Examiner) said I would have to provide the paperwork from my sleep specialist at medical renewal time to the regulator, CASA (I'm Australian and CASA is our regulator), and that they will probably want proof to confirm compliance with my treatment. Pretty much all the info what JohnO has articulated in his post above.

As my OSA is a mild case, suspension of my medical is not warranted because I can still function to a high level.

I spoke to my company's DAME and he agrees with my own DAME's opinion, so I've covered myself with a second opinion, most importantly, one from my employer.

So now I have to lug around a CPAP when I travel. Luckily they aren't that heavy and easily portable. I suppose that is a whole thread in itself.

[chunkyfrog]

Several!

[JohnO]

My local DAME (Designated Aviation Medical Examiner) said I would have to provide the paperwork from my sleep specialist at medical renewal time to the regulator, CASA (I'm Australian and CASA is our regulator), and that they will probably want proof to confirm compliance with my treatment. Pretty much all the info what JohnO has articulated in his post above.

As my OSA is a mild case, suspension of my medical is not warranted because I can still function to a high level.

I spoke to my company's DAME and he agrees with my own DAME's opinion, so I've covered myself with a second opinion, most importantly, one from my employer.

That is fantastic that the Australian rules seem to have more wiggle room that the FAA. Here in the US, you need all the stuff I mentioned to prove to the FAA that your case is mild. In my case, I had an Epworth score of 3, but that, plus a $1.00 would get me a cup of coffee, and not get me out of the hoop jumping.

John

[deltadave]

You do not want to take the MWT (Maintenance of Wakefulness Test) unless your into Zen calmness. You end up in a dark room in a bed and not go to sleep for hours while you can't do anything.

This is not so. In between naps, there are few limitations:

A light breakfast is recommended at least 1 h before the first nap trial, and a light lunch is recommended immediately after the second (noontime) nap trial. Smoking should be stopped at least 30 min before test initiation. In addition, stimulating activities should be stopped 15 min before each nap. The use of caffeine, tobacco, or other medications should be discussed and decided on before the test day. Exposure to bright sunlight is discouraged on the testing day.

The nap attempts are only 40 minutes long with a total of 4 during the day, spaced at 2 hour intervals (although apparently FAA will also allow 20 minute protocols, but you need to find a rogue lab to do that).

The nap attempt may also be terminated if you fall asleep, so theoretically you might only need to spend about 6 minutes in nap attempts.

Course, a MWT Score like that would certainly result in a new career.

[deltadave]

In my case, I had an Epworth score of 3, but that, plus a $1.00 would get me a cup of coffee, and not get me out of the hoop jumping.

Because ESS has no predictive value for sleepiness.