Are strict medical requirements counterproductive?

gismo said:
Given the extremely low number of accidents attributed to falling asleep at the yoke, it doesn't seem to me that sleep apnea should really be much of a concern for GA.
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It's probably just as common from staying up late and partying the night before.
 
gismo said:
Given the extremely low number of accidents attributed to falling asleep at the yoke, it doesn't seem to me that sleep apnea should really be much of a concern for GA.
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On a personal note, what chaps me is that I'm subject to annual SI when I've got 15 years of demonstrated compliance with therapy... :mad2:
 
bbchien said:
b*tch b*tch b*tch
It's only going to get worse.

They are going to start screening airmen for sleep apnea by weight and weight, in 2014 (they have not yet published the spec), so get slender.
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Aviation isn't the only area of interest. The sleep apnea has been an item of interest for truckers and is getting worse. By 30 Jan 2014, anyone with a CDL must declare what kind of trucking they do. If you cross a state line even with your own product on your own rig, you must have a current medical on file. This is even if you cross a state line that is incidental to going directly between two places in the same state.

The commercial drivers license medical structure is becoming more like the AME.

So, it wouldn't look like aviation is likely to get any relief, rather the rest of the country will get more like aviation.

No doubt in my mind, Bruce is right on this.
 
DFH65 said:
You really can't assume just because someone falls asleep on the job that they have sleep apnea. Not saying it isn't a possible contributing factor but...zzz zzzzz zzzzzzz sorry dozed off for a bit there.
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I don't believe that and THAT IS NOT WHAT I SAID if you'd bother to read what I wrote. I said they FOUND that the sleeping pilot had undiagnosed sleep apnea.

So the whole reason for a copilot isn't so the other guy can take a nap?
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Unfortunately the FO fell asleep as well.
 
flyingron said:
I don't believe that and THAT IS NOT WHAT I SAID if you'd bother to read what I wrote. I said they FOUND that the sleeping pilot had undiagnosed sleep apnea.


Unfortunately the FO fell asleep as well.
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My use of the term YOU was meant more universally maybe I should have said WE or THEY shouldn't assume. It is not necessarily a fact that the guy fell asleep because he had sleep apnea. Sure it could have been the case. The fact they both fell asleep is interesting. Perhaps they ate a big meal. Perhaps they were out late the night before. Perhaps they had the heat turned up too high and the soft drone of the engines put them to sleep or maybe there was a low oxygen issue.
 
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Gary F said:
You are being at least a little absurd.

Please explain to me what is the purpose of the FAA medical certification process. Then you can explain if the current process serves the goal as intended? Is it possible that the process can be improved?

IOW, What is the FAA trying to achieve? Does it achieve it's objective(s)? Are there parts of the process that do not improve the outcome? Is it possible that the parts of the process that do not improve the outcome reduce the effectiveness of the necessary parts?
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How can you say that? Without medical standards airplanes would be falling out of the sky on a daily basis! Look at what happened when the FAA started to allow people to fly what are now LSAs without medicals! Why, the accident rate is, um, unchanged.

Annual_LSA_Accicent_Rates.jpg



More graphs here if you are bored.
 
I dislike the congresscritters as much as anyone but a simple look at the medical parts of the PBOR (passed unanimously), and the bureaucracy's reaction to it, makes me quite convinced the problem is more with entrenched bureaucrats protecting and expanding their fiefdoms....
 
bbchien said:
b*tch b*tch b*tch
It's only going to get worse.

They are going to start screening airmen for sleep apnea by weight and weight, in 2014 (they have not yet published the spec), so get slender.
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Whoa. Is this "screening" just going to be some mindless BMI calculation, or will it be by some other hopefully evidence-based method?

My own experience is that excess weight was a consequence of sleep apnea, not a cause of it, gaining 1-3 pounds a year over a few decades. I got on the blower, and I slowly shed, and am still shedding, the weight. And there are, of course, plenty of people under 150 pounds with sleep apnea out there. Congenital/hereditary defects in the jaw and airway seem to be the actual cause for a lot of people.

I would agree that some form of simple sleep apnea screening - a recording pulse-ox worn overnight showed an obvious problem - would actually be meaningful. If I'd had access to something like that 40 years ago when I first went to a doctor to find the cause of drowsiness way back in high school, my life would have been a bit different... as it turned out, as a lot of people do, I just compensated for it for a few decades until finally nearly hitting the wall a bit after age 50. I wasn't flying for the worst of it, perhaps that was just my body reflexively trying to preserve itself!
 
m_t_d said:
Whoa. Is this "screening" just going to be some mindless BMI calculation, or will it be by some other hopefully evidence-based method?

My own experience is that excess weight was a consequence of sleep apnea, not a cause of it, gaining 1-3 pounds a year over a few decades. I got on the blower, and I slowly shed, and am still shedding, the weight. And there are, of course, plenty of people under 150 pounds with sleep apnea out there. Congenital/hereditary defects in the jaw and airway seem to be the actual cause for a lot of people.

I would agree that some form of simple sleep apnea screening - a recording pulse-ox worn overnight showed an obvious problem - would actually be meaningful. If I'd had access to something like that 40 years ago when I first went to a doctor to find the cause of drowsiness way back in high school, my life would have been a bit different... as it turned out, as a lot of people do, I just compensated for it for a few decades until finally nearly hitting the wall a bit after age 50. I wasn't flying for the worst of it, perhaps that was just my body reflexively trying to preserve itself!
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The cost of screening is usually not covered by insurance.
 
jbarrass said:
?.........l.:yeahthat: the problem is more with entrenched bureaucrats protecting and expanding their fiefdoms....
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:yeahthat:

The nature of bureaucrats and bureaucracies is to preserve and enlarge their little empires.
 
Gary F said:
The primary symptom is excessive daytime somnolence, especially falling asleep during the day. http://www.mayoclinic.com/health/sleep-apnea/DS00148/DSECTION=symptoms
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Lots of good info on that link:
  • Excessive daytime sleepiness (hypersomnia)
  • Loud snoring, which is usually more prominent in obstructive sleep apnea
  • Episodes of breathing cessation during sleep witnessed by another person
  • Abrupt awakenings accompanied by shortness of breath, which more likely indicates central sleep apnea
  • Awakening with a dry mouth or sore throat
  • Morning headache
  • Difficulty staying asleep (insomnia)
  • Attention problems
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Pretty common for a spouse/significant other to tell you there's a problem. Loud snoring including "snorting" or catching your breath while asleep. I'm pretty sure that a sleep study is needed for definitive dx. Some providers are trying to get away with "in home" studies; basically giving you an APAP device for a couple nights. That's like throwing you in the deep end to teach you to swim.

One thing you can try is a recording pulse oxymeter. Here's one for an example. If your O2 sat stays above 90%, you prob'ly don't have a problem.

I'm not a doctor, so I'm sure those in attendance will correct me where I'm wrong.
 
Doctors or other apnea experts. What would cause a person to have a relatively high apnea/hypopnea index lets say 35 but an "Oxyhemeglobin saturation such that 1.3% of sleep was spent with a saturation below 90%. "

If the person slept 325 minutes that would mean they had an apenea/hypopnea approximately once every 2 minute but they were below 90% for only a hair over 4 minutes total. While I am sure anytime under 90 is probably not good for you and certainly 4 minutes straight would be bad but over the course of several hours this doesn't seem like much when they consider an apnea not breathing for at least 10 seconds which if totaled in this case would be about 15 mins.

This doesn't make a lot of sense to me.
 
DFH65 said:
Doctors or other apnea experts. What would cause a person to have a relatively high apnea/hypopnea index lets say 35 but an "Oxyhemeglobin saturation such that 1.3% of sleep was spent with a saturation below 90%. "

If the person slept 325 minutes that would mean they had an apenea/hypopnea approximately once every 2 minute but they were below 90% for only a hair over 4 minutes total. While I am sure anytime under 90 is probably not good for you and certainly 4 minutes straight would be bad but over the course of several hours this doesn't seem like much when they consider an apnea not breathing for at least 10 seconds which if totaled in this case would be about 15 mins.

This doesn't make a lot of sense to me.
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I'm neither a doctor nor an expert; just an OSA sufferer. I think the issue is the cumulative effect of not sleeping plus repeated O2 deprivation. You body must keep waking you up to breathe, so you never get to REM sleep.
 
bbchien said:
b*tch b*tch b*tch
It's only going to get worse.

They are going to start screening airmen for sleep apnea by weight and weight, in 2014 (they have not yet published the spec), so get slender.
...
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How could they 'screen for sleep apnea'? Are they going to make every chubby pilot take an overnight sleep study?

Certainly a pilot wanting to hide his OSA would claim to be wide awake all the time, if just asked about it.
 
JimNtexas said:
How could they 'screen for sleep apnea'? Are they going to make every chubby pilot take an overnight sleep study?
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Pretty sure that's what they're aiming for. Above a certain BMI, pay out of pocket for a sleep study. Guilty until proven innocent...
 
Papa Foxtrot said:
Pretty sure that's what they're aiming for. Above a certain BMI, pay out of pocket for a sleep study. Guilty until proven innocent...
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Doesn't apply in administrative law. You must demonstrate you're qualified before the agency will give an authorization.
 
Papa Foxtrot said:
Sleep study for the dx and minimum 30 days confirmed compliance. So, if you're ATP and suspect you have a problem, it could mean about a 2 month vacation...

That's sorta' the point of this thread. "Undiagnosed" sleep apnea because the heavy metal drivers know what will happen if they do what they should for their own health.
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And so, one of the SWA guy who overflew MSP for 45 minutes, who was supposed to stay away, that's okay with you?
BTW - if you've got it, weight loss most likely won't make it go away...
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Lotta misinformation here.Not true. about 80% of it is associated with obesity and there is really really good data for this.

The 20% we don't know much about. But in that 80 if you lose the weight, the SA goes away. Most of my bariatric surgery patients have come off of it.

If you're an ATP and get it together I have gotten guys certified in 34 days. Such that the captain never missed but the one month of ops auction on the 25th.

Cert is simple: copy of the original sleep study, Current status letter from the doc, and 31 day CPAP chip report. Annuallly, the doc's letter and the CPAP report and it's an AME assisted SI, so no call to the agency is needed for six years after.

The SI is gotten on the phone. It's only hard if your AME is missing in action.

for Jim, the screening is an overnight recording oximetry, which is Not a sleep study, it's done in your bed unassisted. It's proposed one time, for some BMI above ~30, IIRC and then 35 if you climb that high. Just the overnight rental of a machine from the wheelchair store. This can be had for about $200 and always insured. But Dr. L_m_ng_no faces pretty stiff opposition as to being "paternal" within the division. We'll see.
 
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DFH65 said:
Doctors or other apnea experts. What would cause a person to have a relatively high apnea/hypopnea index lets say 35 but an "Oxyhemeglobin saturation such that 1.3% of sleep was spent with a saturation below 90%. "

If the person slept 325 minutes that would mean they had an apenea/hypopnea approximately once every 2 minute but they were below 90% for only a hair over 4 minutes total. While I am sure anytime under 90 is probably not good for you and certainly 4 minutes straight would be bad but over the course of several hours this doesn't seem like much when they consider an apnea not breathing for at least 10 seconds which if totaled in this case would be about 15 mins.

This doesn't make a lot of sense to me.
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Fro this one, understand it takes about 10 minutes to drop back into REM sleep. So six events an hour pretty much guarantees you get no REM sleep. If your CPAP setup isn't working, get to someone who can make the "ramps" work for you. It's not adjusted correctly.

ANYONE who has had it successfully treated swears they'll never stop using CPAP. Oddly enough, for some, when the SA is well treated, energy comes back and the weigh starts to reduce.
 
douglas393 said:
How does the medical certification for GA in other countries compare to the FAA's process?
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I have done medicals here and in Australia and here is a cakewalk, no bloodwork, no Audio box, no 4 hr eye exam, no x-rays, all requiring trips to different service providers, total cost, $600. My cousin goes through same in Germany.
 
If you are dreaming you must be making it to REM sleep at some point correct?
 
Henning said:
I have done medicals here and in Australia and here is a cakewalk, no bloodwork, no Audio box, no 4 hr eye exam, no x-rays, all requiring trips to different service providers, total cost, $600. My cousin goes through same in Germany.
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Is their accident rate any better?
 
DFH65 said:
If you are dreaming you must be making it to REM sleep at some point correct?
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Usually but not necessarily true. In fact if you get rem-stopped at the hypnogogic stage (lighter than REM) you will think you dreamed a lot- but you got zero rest. One really needs a substantial amount of REM time to really get rested. We can measure it the next morning in cognitive performance scores.

When you do a sleep study they are not just watching your airways- they are watching your closed eyes.
 
Capt. Geoffrey Thorpe said:
How can you say that? Without medical standards airplanes would be falling out of the sky on a daily basis! Look at what happened when the FAA started to allow people to fly what are now LSAs without medicals! Why, the accident rate is, um, unchanged.

Annual_LSA_Accicent_Rates.jpg



More graphs here if you are bored.
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That's accidents per year, not accidents per 100,000 hours flown. The LSA accident rate is really quite a bit taller than the rest of aviation.....per hour. Say whatever you wish to forward you cause but recognize that it doesn't make it true.
 
bbchien said:
That's accidents per year, not accidents per 100,000 hours flown. The LSA accident rate is really quite a bit taller than the rest of aviation.....per hour. Say whatever you wish to forward you cause but recognize that it doesn't make it true.
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I doubt that it is due to pilot incapacitation but it would be good to review the data if available. Has anybody on the ground been injured by a LSA?
 
Gary, that's useless. The agency has already drawn the line at "Weeee think that level won't do harm to anyone significant on the ground..." WE dont' want to re-open that.

Yes, there are 4. It was an LSA crash over a high school football game, and he just missed the stands.
 
bbchien said:
And so, one of the SWA guy who overflew MSP for 45 minutes, who was supposed to stay away, that's okay with you?
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Nope - not my intent at all. I think the problem is that the heavy metal drivers avoid getting necessary treatment because of the impact a dx will have on their income. That goes well beyond OSA...

bbchien said:
Lotta misinformation here.Not true. about 80% of it is associated with obesity and there is really really good data for this.
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Well, my statement was based on what I was told by my pulmonologist when I was diagnosed. His observation was that weight loss wouldn't "cure" most OSA patients as aging causes "sagging" of the soft tissue in the throat. Also what I've seen in various OSA forums, where members who lost the weight grumbled that they weren't even able to reduce pressure; much less get off the machine. I yield to your data....

bbchien said:
ANYONE who has had it successfully treated swears they'll never stop using CPAP.
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That's me - at least until medical science comes up with a better way for me to get the same quality sleep that I get with the machine. The machine can be a PITA, but it's soooo much better than sleeping(or trying to sleep) without it! :yes:
 
bbchien said:
Gary, that's useless. The agency has already drawn the line at "Weeee think that level won't do harm to anyone significant on the ground..." WE dont' want to re-open that.
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So, why is the agency so intent on gathering data on LSA accidents if the genie is out of the bottle? It would seem(at least to this outsider) that they might be looking to tighten standards on LSA. Or are they building a case to fight back on any loosening of Class 3 standards?
 
Papa Foxtrot said:
So, why is the agency so intent on gathering data on LSA accidents if the genie is out of the bottle? It would seem(at least to this outsider) that they might be looking to tighten standards on LSA. Or are they building a case to fight back on any loosening of Class 3 standards?
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Because we asked them to. There are no NTSB funds to do so.

You can't ask for an extension of medical-less flight to other categories without having the data, now can you?

Can't have it both ways!
 
bbchien said:
That's accidents per year, not accidents per 100,000 hours flown. The LSA accident rate is really quite a bit taller than the rest of aviation.....per hour. Say whatever you wish to forward you cause but recognize that it doesn't make it true.
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1) What does the fact that people wreck little lightly loaded aircraft more than larger, more stable, aircraft have to do with medicals? You have to look at the same population of aircraft with and without the medical requirement to factor out the airplane size effect. The data I plotted was for the same population of aircraft before and after the sport pilot rule.

2) Nobody really knows how many hours these aircraft are flown. And, no one really knows how many Private and "better" pilots are now flying under the sport pilot rules. How do you determine how many hours these aircraft are flown?

3) Unless people suddenly stopped flying these aircraft when the requirement for a medical went away, then the accident rate per 1000 hours did not go up.

Say whatever you want, but this is the only apples to apples comparison you can make. Looking at the accident rate for aircraft that didn't exist before the LSA rules tells you nothing WRT the effect of the medical and not that former Bo drivers wreck light airplanes.

Other factors i n these numbers are economic - how much do people fly. Also you can see shifts between different types of aircraft. If you look at the Cessna 172 vs. the Cessna 150/152 you can see the shift from the 150/152 to the 172 in popularity.The accidents in 172's did not decline with the 150/152 as the economy tanked. You should see a similar thing with implementation of the sport pilot rules as a lot of people have come out of the woodwork and started flying again (like myself). It would be reasonable to expect the accident rate per year to go UP for the "traditional LSAs" as they get pulled out of the corners of hangars and put back in the air (this trend is also reflected in the prices of similar LSA vs. not LSA aircraft).

So, there is every reason to expect that for a given LSA, the number of accidents per year would increase just because of improvements in the economy and the increase in hours per aircraft flown as the geezers get back in the game. And, since we really don't see any statistically significant increase even with those factors, it's really hard to claim that the lack of a medical has any statistical significance in the accident rate for these aircraft no matter how you measure it.

Are pilots flying under the sport pilot rules having medical issues and even accidents related to those issues? No doubt. But so are airmen with valid medicals.

Is the LACK OF A MEDICAL resulting in a significant increase in the number of accidents in the same population of aircraft? If so, it can't be seen in the data.

Trying to guess how many hours these aircraft are flown isn't going to change the results unless you try to claim that before the sport pilot rules they were flown X hours per year and after they are flown X/2 hours per year - which would be contrary to any reasonable analysis.
 
bbchien said:
Because we asked them to. There are no NTSB funds to do so.

You can't ask for an extension of medical-less flight to other categories without having the data, now can you?

Can't have it both ways!
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OK - I'll buy that. I just have a visceral distrust of bureaucracy that makes me quick to ascribe mal intent...
 
Let's say you are an active GA pilot and fly 100 hours per year. There are 8760 hours in a year. So a 1.14% chance of having an acute medical condition strike you while flying. Of that percentage what are the chances the issue will be so instant and debilitating that you will be unable to land the plane? Infinitesimal. How many of these potential situations will come with some warning, previous history, etc.? Many I would think. Of the remaining issues, which will be stopped by having a current (1-3 year old) medical? Not many.

Lawmakers need to grow a pair when questioned about aviation accidents. If they really want to increase the public safety, push to outlaw texting and driving, I see that everyday and it scares the crap out of me.
 
Alexb2000 said:
Let's say you are an active GA pilot and fly 100 hours per year. There are 8760 hours in a year. So a 1.14% chance of having an acute medical condition strike you while flying. Of that percentage what are the chances the issue will be so instant and debilitating that you will be unable to land the plane? Infinitesimal. How many of these potential situations will come with some warning, previous history, etc.? Many I would think. Of the remaining issues, which will be stopped by having a current (1-3 year old) medical? Not many.

Lawmakers need to grow a pair when questioned about aviation accidents. If they really want to increase the public safety, push to outlaw texting and driving, I see that everyday and it scares the crap out of me.
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That is worst case and assumes that you will have an event that year. Only a small percentage of my patients with heart disease will have an incapacitating event any given year including those who have no chance of getting an FAA medical certificate.
 
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