Confused about sleep apnea screening

Discussion in 'Medical Topics' started by I don't snore, Nov 7, 2019.

  1. I'm obese. Part of the reason I stopped flying and let my medical lapse was the talk going around in 2012-ish about requiring a sleep study for a BMI over 40. I'm a very light sleeper and a CPAP is a deal-breaker for me. Anyway, it appears requirement never happened, and now it's just "screening" if obese. What does this screening consist of? My spouse attests that I don't have sleep apnea, but I'm worried about proving that to the FAA.
     
  2. unsafervguy

    unsafervguy Pattern Altitude

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    No offense, but the health problems of sleep apnea should be more important than getting a medical. The effects of sleep apnea can be fatal. If you have sleep apnea and are avoiding the doctor because younfear a cpap you could be putting yourself in real danger.
     
  3. Like I said, I'm a light sleeper. Can't sleep with the noise of a CPAP - My housemate’s used to keep my up in the next room. If that shortens my life, so be it. So will getting zero sleep because of the noise and something on my face.

    Not sure how you can have sleep apnea without snoring or waking up gasping for air, though.
     
  4. TCABM

    TCABM Cleared for Takeoff

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  5. schmookeeg

    schmookeeg Pattern Altitude

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    I can save you having to look up how to score the berlin questionnaire or administer the slap-chop screening. If you show up for a medical, it will go like this:

    1. Are you a fat dude? -> Cannot issue, go get sleep study.

    Let me save you another bit of suspense. The sleep study protocol is like this:

    1. Did this person arrive for a sleep study? -> this person has sleep apnea.

    Let me save you a third bit of suspense.

    1. Did you post online asking about sleep apnea? -> Apnea is worse than a dozen September 11s and will kill you instantly and every hour thereafter, even if you are a vampire who does not sleep. The CPAP device is literally the second coming of the jeesus without the need to move furniture, it will add two inches to your gentleman's region, give you the energy of Richard Simmons, and is something you needed yesterday.

    ==

    Enjoy your new CPAP or Basic Med fellow 'dude of gravity' :)
     
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  6. So BMI is the sole criteria for referral? Obviously I missed something along the line. Thanks!
     
  7. schmookeeg

    schmookeeg Pattern Altitude

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    No. Being male is part of it. Being over a certain age is part of it. Neck circumference is part of it.

    Basically once you're in 'fat dude' territory, you're going to either tick 3 or 4 of the 8 boxes, even if you have zero symptoms.
     
  8. Morgan3820

    Morgan3820 Pattern Altitude

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    I’m in ‘fat dude’ territory. When it comes up, I just tell the AME that I am not tired and do not snore, and he moves onto the next topic. Never had a problem. I think the whole sleep apnea thing as it is related to flying is BS.
     
  9. I'm not a dude. I'm 25 and losing weight. My neck is 13 inches (I have no idea if that's big or not).

    I guess what I'm asking is, how do I know if I should lose more weight before I renew so I can pass the screening?
     
  10. Matthew

    Matthew Touchdown! Greaser!

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    FAA documentation says they use this chart:

    https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/BMI chart and formula table.pdf

    then apply it to this checklist:

    https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/AASM Tables 2 and 3.pdf

    then use this flowchart:

    https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/FAA OSA Flow Chart.pdf


    Here's the source:
    https://www.faa.gov/about/office_or...ices/aam/ame/guide/dec_cons/disease_prot/osa/



    edit: looks like the target BMI for losing weight is <= 35.
     
    Last edited: Nov 8, 2019
  11. gkainz

    gkainz Final Approach

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    I've been on CPAP for many years (more than 20?) and CPAP machines have improved to the point that they are nearly silent (and downsized to the point that traveling with one is a non-issue). Don't let that keep you from proceeding down this path. Honestly, no - not everyone who goes in for a sleep study gets a positive sleep apnea diagnosis. My son had a sleep study as a senior in high school, as we observed his sleep patterns on a summer camping trip. However, the severity of OSA was categorized as minor and that was that.

    I snored a little, I stopped breathing (which freaked my wife out) and then would sometimes gasp for air, sometimes just start breathing again. For many years, I did not wake myself up. I self-diagnosed (ok, confirmed my wife's positive diagnosis) OSA when it exhibited in the dentist' chair when they tipped me nearly prone and pried by jaw down to my ankles to work on my wisdom teeth. I simply could not exhale through my nose... no matter how much tried to force it. I came upright fast, pushing hands and tools out of my way. I have a very understanding dentist now and he and the techs know if I wave my hands, clear the area because I'm sitting up. It's a lot like being water-boarded (thanks, SERE school). Dentist visits for me, even routine cleanings, are torture.

    But, as I explained to my GP who ordered my sleep study, before CPAP I felt like I was running a marathon all night long, only to cross the finish line to be hit by a bus as the alarm went off. I used to have nightmares about eating something and have it grow and grow and grow in my mouth and choke me.

    Since starting CPAP, I cannot imagine life without it. I had a couple of occasions of overnight power outages (resolved with a battery backup) and one business trip where I forgot to put my mask in the travel case. My local Respiratory Therapist found me a mask near me and I only spent one night of torture on that trip.
     
    Last edited: Nov 8, 2019
  12. Jeffythequick

    Jeffythequick Pre-takeoff checklist

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    Amen, brother. I did the sleep study as shown above, and since then, my blood sugars have been more stable (T1D), and the days (I think 10 over the last 10 years) that I haven't used it have been disasters. Even 5 hours of sleep with the CPAP on is better than 10 hours without it, and here's why:
    To the OP, the light sleeper. If you have Sleep Apnea, you are, by definition, a light sleeper. The charts they showed me said that I stopped breathing 40-50 times per hour while sleeping, and that I'd nearly wake up each time, then go back to sleep.
    Day #1 with a CPAP - couldn't stand it. I felt like I was being buried alive.
    Day #5 with a CPAP - could tolerate it, and fell asleep with melatonin
    Day #30 with a CPAP - Didn't hear it, slept through the night
    Day #3650 with a CPAP - Now it's Pavlovian. When I put the mask on, my body says, "He's going to sleep, let's knock him out with natural melatonin." and I'm out in like 4 minutes.
    The morning after: I wake up, ride my bike for 8-13 miles, and am awake the whole day.

    Sending the information to the FAA: No worries. I used that open source CPAP reader and had my doctor pull his reports. I also wrote a letter explaining how I got the pretty charts, and got my SI.

    The diabetic stuff was in the letter too, so it was a harder SI than all y'all have.
     
  13. Maybe so, but I'm breastfeeding, which means there's another biological explanation for light sleep in my case. I was trying to be private about that detail, but I think that also explains why a sleep study within 90 days of an FAA request isn't possible (and why I'd likely fail one even without OSA). I'm not tired during the day, don't have any symptoms of OSA, but based on the reaction here, it looks like I'll be losing weight before trying to renew.
     
  14. Crashnburn

    Crashnburn Line Up and Wait

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    A sleep study is no big deal. They instrument you up like an astronaut, and go to sleep. You turn the machine in the next day (if you didn't do a monitored study). If you have symptoms, but fewer than 5 events/hour, you don't have sleep apnea. If you have symptoms, and between 5, and I think 15 events/hour. You have it. If you have more than 15, regardless of symptoms, you have it.

    I have a Resmed 10 CPAP. It is absolutely silent. My wife says my breathing is loud, and sounds like Darth Vader, but with the machine, my events have gone from about 5.5 to a max of 1.5/hour. Also, before the machine, I felt fuzzy, but after several months, I feel a lot sharper. Also, I went from being sleepy and tired all the time, to being awake and not usually tired. If I don't get enough sleep, I feel sleepy, but not as tired as I would have w/o the CPAP.

    If I remember right, I don't think the instrument rigging will interfere with breast feeding, and if you tell the specialist when you pick up the sleep study machine, I'm sure they'll be able to show you how to wear it without problems.

    I didn't believe I might have sleep apnea until my wife told me I actually stopped breathing at night. Then I had the survey done. My BMI is well south of 35, too.

    An interesting factoid: When I exercise, I usually have fewer events than when I don't.
     
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  15. bobmrg

    bobmrg En-Route

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    Could it be that your experience is with an older-technology CPAP? My ResMed AirSense 10 makes no noise....none. When i take it off in the morning I can hear the air rushing through the mask (in my hand) but it quits in about ten seconds. If your doc wants a sleep test, you will go to a place with a bedroom and get hooked up. While you sleep, interruptions in breathing will be recorded...I was shocked to hear that I stopped breathing 144 times during the night. ,,and I nver woke up gasping. My CPAP keeps a record of mask time, mask fit (leakage), and several other parameters. I use mine religiously and it still records a dozen or so stoppages during the night.

    You are fooling yourself.

    Bob
     
  16. Brad Z

    Brad Z Final Approach

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    OP, when was your last medical? Have you applied for an been denied a medical? Are you planning to fly commercially? You might qualify for BasicMed, which doesn't involve an exam by an AME.
     
  17. Crashnburn

    Crashnburn Line Up and Wait

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    The FAA didn't require me to have a Sleep Survey, but I'm a lot healthier for it. I don't know about the rest of the members of this board, nor the pilot population, but I think the FAA screening us for Sleep Apnea above a certain BMI is actually helping us be healthy, even if against our "better" judgement.

    One more thing. Even though I don't have an current medical, and am not actively flying, because of the requirement to have at least 6 hours of CPAP sleep 75% of the time, I've boosted my nightly average from about 5 hours to around 6 hours, and the additional hour makes a big difference.
     
  18. bobmrg

    bobmrg En-Route

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    I was telling my wife about your CPAP-phobia and she reminded me that when I was originally diagnosed in the late 1990s the machine was indeed loud...but that was more than 20 years ago. Sleep science has advanced by leaps and bounds. When I lay down to sleep, my head is about 18 inches from the CPAP...it has a six-foot hose, so I can roll over without disconnecting anything and still be within 30 inches of the machine and I do not hear a thing. Get the test.

    Bob
     
  19. Fearless Tower

    Fearless Tower Touchdown! Greaser!

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    That’s not how it works....
     
  20. Terry M - 3CK (Chicago)

    Terry M - 3CK (Chicago) Pre-takeoff checklist PoA Supporter

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    I’ve been on a CPAP 11 months. I was totally against it. It’s a Resmed 10 something.

    Unless I pull the mask off it is absolutely silent.

    Its been a big positive for me.
     
  21. Rushie

    Rushie Pattern Altitude

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    OP if I had to bet, you do not have OSA. You have no symptoms, your spouse hasn’t noticed you not breathing, and you’re a light sleeper because you’re a young mother. I don’t think I’d worry about it. I don’t think I’d delay renewing if the only reason is you’re fearing the study.

    But before renewing: Go to the AME for a consult only! Find out if a sleep study is going to be required before giving them the number to make it go live. That way if he says you’re going to need the study, you have the option of waiting if you don’t want to do it while nursing.
     
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  22. Interesting thread. And encouraging!

    I’m soon turning 45, so my 3rd class will convert from the 5-yr plan. I plan to renew it on my birthday. My wife is an FNP and says I have occasional apnea. It seems like it comes and goes and I haven’t figured the trigger yet.

    What’s the process? Do I need an SI? Am I jeapardizing my 3rd class by getting the study done now? Can I just do it now and bring the results with me when I see the AME in 3 months? My health is important to me but I also want to keep my medical as long as I can.

    PS- I’m not in “fat dude” territory, but I do plan to trim a few pounds (15-30) for overall health and feeling good.
     
  23. Half Fast

    Half Fast Final Approach

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    Do you really need class 3? You could go Basic Med and avoid the FAA requirements. Or you could use Basic Med until you’re ready and confident you can pass the screening.
     
  24. jjflys

    jjflys Pre-takeoff checklist

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    I’m a bigger dude and was not happy when I was sent for a sleep study. Of course the test said I had sleep apnea, so the next step was picking up the machine.

    I remember the day I picked up the machine (a Resmed Autoset 10 APAP) vividly- they let us “test” it for a few minutes to see what it was like and to fit us with our masks. I remember almost walking out right then and there thinking there was no way in hell I could ever wear this thing much less sleep at night.

    The first night I forced myself to try it knowing without it I wouldn’t be able to fly. I ended up having one of the best nights of sleep ever, and I haven’t looked back since.

    OP, this is so worth it and you will feel so much better getting treated.


    Sent from my iPhone using Tapatalk
     
  25. Jaybird180

    Jaybird180 Final Approach

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    If apnea is well controlled with CPAP, is it possible to get and retain a 1st class medical?
     
  26. GMascelli

    GMascelli En-Route

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    Here was the process when I had it done in 2015. I do not recommend the "take home" sleep study, go to the professionals to knock this out.

    Taken from my Flight Journal September 2015

    The Sleep Study (Updated)

    I gave this a lot of thought about posting but since I'm confident my results will free me I decided to help any of my readers that may be facing the same path to travel, a chance to hear what the study is all about.

    Getting hooked up.

    At about 10:30PM it was time to begin attaching all the sensors that would take readings of what seemed like every brain, breathing, facial expression and leg function one could imagine or dream up.

    Plug me in!

    I had two electrodes on the outside of each calf muscle to measure for Restless Leg Syndrome. Two more electrodes on my chest and one on my back for measuring heart rate. These electrodes snapped into connectors located on the elastic straps across my chest and abdomen in order to measure my breathing. All of these electrodes were all attached with sticky pads after a light scrub with what I thought was a scotch pad, ok it FELT like a scotch pad, then they were each secured with medical tape. Each individual connection had a long thin wire that plugged into a box to transmit the data to a computer in the monitoring room, which was just outside of my room.

    Next, the tech measured my skull so she would know where to place the next electrodes.
    These were metal discs connected to a wire and were eventually attached to my scalp with Conductive Paste. Yes, it's a nasty sticky glue. After marking certain spots on my head with a wax pencil the tech used a cotton swab stick an antiseptic gel to clean the target area, I mean location, for the sensor.

    Next up was the face sensors. Three were placed across my forehead. one at the corner of each eye to monitor eye opening and three across my chin to measure jaw clenching.

    The last sleep test accessory was the nasal tubing, not quite the typical oxygen cannula we use for flying but very similar. The cannula has a port in each nostril with the tubing wrapping around each ear to hold it in place. There was a small loop under my nose as a part of the cannula that hangs down and gently sits on my upper lip to monitor breaths in and out of my mouth. Finally, the pulse oximeter for measuring oxygen levels in my blood was placed on my left thumb.

    When I first crawled into bed, the tech had to run a baseline test including the video and audio monitoring equipment. I would be given several commands to follow; without moving my head move my eyes right and left ten times each, move my eyes up and down ten times each. Move each foot like I was stepping on the gas pedal in a car, then move them both at once. I had to take a deep breath and hold it, cough, and clear my throat, clench my teeth and finally blink my eyes ten times. Base line numbers complete, time to sleep!

    I slept fairly well all things considered. I had one nature call around 3ish (I'm guessing since she said see you in a couple of hours)and finally woke up around 6am. The first process was to unhook all of the spaghetti wires from the machine then begin pulling off the sticky pads. The goobs of glue would need plenty of hot water when I shower after getting home.

    My follow up appointment with my sleep doctor is scheduled for September 16th and my Flight Physical is following three days later on the 19th. I'll be armed and ready to knock this out.

    UPDATE:

    I followed up with the sleep doctor and my in hospital results were very good. I do NOT have sleep apnea. During non-REM sleep my AHI was 3 and RDI 4. In REM stage sleep both AHI and RDI were 4. Average Oxygen Saturation was 94%.

    [​IMG]

    My advice - Don't waste your time or money on a take home, go to a sleep certified doctor and check yourself into the hospital for the real deal sleep study.


    My flight physical a few days later was a non-event. I went in armed with the report and my certification number from the online med-express form. Typical procedures; height, weight, eye test, color blind test and sample in a cup. My BMI was an instant flag (requiring a sleep study) and my response was to hand over the report. The good doctor read through it and said I was good to go.



    Good Luck!!
     
  27. MarkH

    MarkH Pre-takeoff checklist

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    Sleep Apnea is not limited to overweight individuals, but it is made worse by excess weight.

    Technically it is an SI, but (as I understand) it is a "will issue" SI, if you have been diagnosed and are being treated. You will need to show documentation of the treatment every year, but it's not a huge inconvenience. Having said that, talk to your AME about what you need, if I recall correctly, my AME told me he needed at least 2 months of treatment history. So if you can get your Sleep Study done quickly you should have enough treatment data in 3 months. Either way now may be a good time to go BasicMed to bridge the gap until you have enough treatment data to get a new medical.

    My experience was, I declared sleep apnea on my medical application, I brought in treatment data, and I was issued my medical in office. The only issue was because the government shut down twice right after I received my medical, I had to resubmit the sleep treatment data 6 months later because OK City lost the data before they reviewed it. My AME handled all of this.
     
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  28. 3393RP

    3393RP En-Route

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    The OP seems to be engaging in rationalization and denial instead of simply facing facts.

    This statement is indicative of that behavior. Wishing away the problem isn't a viable solution.

    My spouse attests that I don't have sleep apnea, but I'm worried about proving that to the FAA.

    The spouse's opinion has no validity. If the protocol indicates testing is required, the only way to satisfy the FAA is to undergo a sleep study.
     
    Last edited: Mar 9, 2020
  29. wrbix

    wrbix Pattern Altitude

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    In my 30+ years as a physician, I NEVER saw a NEGATIVE sleep study come out of any of the three sleep study clinics in the area. Cannot help but think there are a lot of false positives.
    Some patients report benefit from CPAP, some do not. Never quite knew what to think of the whole sleep apnea conundrum
     
  30. Jaybird180

    Jaybird180 Final Approach

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    Now THATS interesting!
     
  31. steingar

    steingar Taxi to Parking

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    Last time I did a Medical with the dishy AME they were looking for sleep apnea. I'm male and over 50, which checks 2 of the boxes. When asked if I snore I said no, since I've never once heard myself snore. Mrs. Steingar might beg to differ, but she wasn't there.

    Thankfully the guy who does my Medicals now has a lick of common sense and doesn't worry about it.
     
  32. Jaybird180

    Jaybird180 Final Approach

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    I have a buddy flying for American who says they can still keep their Medical with positive treatment results. There is no more reason to obscure your health. The Government is only trying to help (/sarcasm (LoL)...but I wasn’t kidding about what my friend said)
     
  33. schmookeeg

    schmookeeg Pattern Altitude

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    To whom? The people who got steamrolled by this requirement? Yeah. Problem is, the "this changed my life" crowd are very loud, and honestly, if they're sincere -- it's sort of "correct" to have thousands with "life changing increase in life quality" at the expense of a few hundred with "great I get to suck air through a hose at night for no discernible benefit". It gets a little grating when the thousands assume the hundreds are in denial, but.. well.. perspective and all that. :D
     
  34. Jaybird180

    Jaybird180 Final Approach

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    Come to think...there is a negative report in THIS thread?
     
  35. You’re all - except maybe one poster - missing the point. I can’t do a sleep study right now, unless they’re ok with me waking up every two hours for at least 20 minutes, which I assume they are not. So, how do I know if the FAA will require a sleep study? That was the question no one ever answered.

    Anyway, I’ve decided against applying until I lose weight just in case, but seriously, the old fat man assumptions and accusations of rationalization without reading the entire thread need to stop.
     
  36. MarkH

    MarkH Pre-takeoff checklist

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    Sleep studies (both in office and at home) can be performed around intermittent sleep.

    Having said that, are you flying light sport right now? Do you plan to?

    Whether or not your AME requires you to get a sleep study will be based on these factors (link).
    I would recommend finding an AME that will do a consult, in the consult, the AME will tell you if they think you should be referred for a sleep study.

    Personally, I would not recommend putting off your medical to loose weight unless an AME has told you that you cannot qualify. With Basic Med, a medical now will be good until you have major health issues, don't give up time flying based on anything less than an expert opinion.
     
  37. NoHeat

    NoHeat En-Route

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    Just curious ... did they have a financial incentive to give a positive diagnosis? For example, did they also sell CPAP machines, or get free stuff of value from the CPAP manufacturer?