CPAP frustration - pulling my medical!

[saddletramp]

When I received my second class medical in September I told the flight physician that I had been using a cpap for 12 years. I was unable to get my old records so I ordered a in-home sleep study & after the study was read by a Dr I ordered a new machine.

I sent the info certified to the FAA & they received it on January 6, 2016. Today, I received a certified letter from them dated January 8th that I have 14 days to return my medical to them for non-compliance.

I realize my sleep study had arrived 2 days before their letter of non-compliance was sent out. I'm sure it takes time to process.

When you call the medical certification number you get put on hold & the phone is never picked up.

I emailed AOPA for help this evening.

Any other ideas? I really don't want to surrender my medical since I complied with their requests.

 

[AdamZ]

The only other thing I can think of is to contact Dr. Bruce Chein at aeromedicaldoc.com

 

[Greg Bockelman]

Yeah, that. And be 100% honest and forthright with him. He can smell BS from clear across the country.

 

[Matthew]

FAA just started letting AMEs issue the SI for sleep apnea sometime last year. They might still be working out the bugs in the processing system. Doc Chein is the guy.

 

[SCCutler]

Definitely call Bruce; he has the direct-dial numbers.

 

[Let'sgoflying!]

Remind me how the use of a cpap machine affects flying?
Has anyone had an incident from this? Hope it's not excessive governmenting.

 

[SkyHog]

Remind me how the use of a cpap machine affects flying?
Has anyone had an incident from this? Hope it's not excessive governmenting.

It is. It is another example of "we would rather you remain undiagnosed and die from health issues."

CPAP Should be seen as a sign of a safer pilot, if the FAA had any intelligence. CPAP means you won't be narcoleptic.

 

[DFH65]

I use a CPAP and not sure it matters that much. The reason I had the test was because of snoring not because of daytime tiredness. I average about 7 hours a night and use my machine 95%+ of the time. What I hate is the days when I wake up after sleeping 5 hours am rested and have to lay there an hour to get the 6 hours in.

 

[write-stuff]

Now I wonder. If this third-class medical reform goes through and you get on CPAP therapy after that, do you have to report it or self-ground?

 

[AggieMike88]

Self ground. Do CPAP for enough time (60 days?) to demonstrate compliance, obtain status letter from doc, send sleep test results, sleep doc reading, status letter, and CPAP download.

Additional detail in AME guide.

 

[Whiskey Romeo]

I use a CPAP and not sure it matters that much. The reason I had the test was because of snoring not because of daytime tiredness. I average about 7 hours a night and use my machine 95%+ of the time. What I hate is the days when I wake up after sleeping 5 hours am rested and have to lay there an hour to get the 6 hours in.

Been there, done that. I use a CPAP. My normal sleep duration is around 6 hours. Lately, I just get up when I wake up. I've noticed the usage works out to be acceptable anyway. I don't usually get concerned until just before compliance reporting is due. Hated just laying there.

 

[lbfjrmd]

sounds like you missed some FAA deadlines. Always respond to their letters ... and you can always get 1 extension for time. This can be easily fixed ... but my advice is to follow FAA instructions, hook your star to AOPA. Dr Bruce or your union ... pick one and stay with them and re-apply. Your AME should be able to handle this issue too.

 

[Archammer]

Sorry you're having to experience the useless portion of the FAA.

 

[Kiddo's Driver]

The issue isn't so much sleep apnea or the machine. It is that you have not proven compliance. Also, it would have gone smoother if you would have gone through someone like Dr. Bruce for the big reveal to the FAA.

Remind me how the use of a cpap machine affects flying?
Has anyone had an incident from this? Hope it's not excessive governmenting.

It doesn't. If you don't use the machine it affects your sleep quality...just like eating too much...noisy neighbors...a sick baby...life in general. It wasn't really an issue until a commercial flight flew past its destination in Minnesota (?) because both pilots were asleep. One of them had sleep apnea and used it as his excuse. Now we all have to prove therapy compliance.

FAA just started letting AMEs issue the SI for sleep apnea sometime last year. They might still be working out the bugs in the processing system. Doc Chein is the guy.

A couple of years ago at least. Nearly the same issue for me back in 2010. I had been using one for 10 years, but not flying. I went back to get my medical and they had changed the form. It included a change in question wording that keyed me into asking if this was going to be an issue. I did some research, contacted Dr. Bruce and then went from there. It is a relatively small issue to get it renewed.

Dr. Bruce is definitely worth the relatively small fee. He absolutely knows what he is doing.

 

[Let'sgoflying!]

It doesn't. If you don't use the machine it affects your sleep quality...just like eating too much...noisy neighbors...a sick baby...life in general.

That's disgraceful. A bureaucratic over-reach imo.
Deserves repealing.

 

[soarohio]

Is this your first medical in the last 12 years? If no, did you report your sleep apnea on your prior medicals?

 

[Matthew]

Is this your first medical in the last 12 years? If no, did you report your sleep apnea on your prior medicals?

This might be why you got some special attention.

 

[saddletramp]

sounds like you missed some FAA deadlines. Always respond to their letters ... and you can always get 1 extension for time. This can be easily fixed ... but my advice is to follow FAA instructions, hook your star to AOPA. Dr Bruce or your union ... pick one and stay with them and re-apply. Your AME should be able to handle this issue too.

I had 90 days to comply but I wasted most of them waiting to get into a local sleep clinic. Thanks to info obtained on this board I got smart after 60 days had elapsed & did the home study thing. I should have made that decision much sooner.

 

[saddletramp]

This might be why you got some special attention.

I haven't flown for 22 years. So yes, this was my first medical since then. I got a second class so I could reinstate my CFII.

The good news is...I'm not flying for income.

 

[Matthew]

OK, makes sense.

There is a simple flowchart for the AME. It sounds like that was followed and the only problem now is a paper trail.

Once this gets straightened out, all you will need is a yearly status report from your doc and a report from the machine showing use >6 hrs/night @ >75% nights.

You can go to an AME and get it done in-office for his fee, or mail to FAA for free and wait however long their turnaround is.

 

[bbchien]

Logged in just for this. This is painful for me to see.

Saddletramp, the basic requirements are pretty simple.
CPAP compliance report, 30 days showing 75% (23) of nights with >6 hours' usage.
Current letter from a doc saying 4 things: (1) Appears well rested, (2) Compliant by Hx with CPAP, (3) No complaint of daytime sleepiness, (4) No stigmata of right heart failure on physical exam.
Signed CPAP use affidavit (there have been a few guys who use it for 30 days prior to their renewals, agency wants that to STOP, and many machines can't hold 365 days of data.

If you have all that, then call 405-954-4821 on MONDAY, and ask the call center on WHAT DAY your package was scanned. If it was scanned anytime after Jan 4, it could have overlapped.

If not, one of your components is either missing or not right.
Don't fall afoul of the enforcement mechanism- if you get on their enforcement list, the medical officers promptly go quiet.

No way to get your Blue Ribbon record short 14 days (to see what's really there), so if you didn't have any of the components, turn the thing in (yeesh) and start correcting what's missing. If it was an overlap, they'll flag it for a supervisor and a medical officer, so check:
(1) Whether you had everything I listed and
(2) If it really was overlap.

If not, send it in and get moving on the 4 things the doc's letter must say, or on improving the compliance report (whichever wasn't quite to snuff).

 

[Flymeariver]

Bruce,

Thanks for being so awesome to still come and give helpful advice. It would nice to see you on here more often.

 

[Greg Bockelman]

I haven't flown for 22 years. So yes, this was my first medical since then. I got a second class so I could reinstate my CFII.

The good news is...I'm not flying for income.

For what it's worth, you do NOT need a Second Class medical to instruct. A Third Class will do.

 

[Doggtyred]

Remind me how the use of a cpap machine affects flying?
Has anyone had an incident from this? Hope it's not excessive governmenting.

Having experienced narcolepsy from severe untreated sleep apnea in my past I can say I could barely stay awake during sudden nap-attacks while driving.. they came on without warning... and was the impetus for me to finally get treated. I'd have hated to have been in hard IMC on approach. Its incredibly distracting.

Yes there are severe long term insidious consenquence to untreated sleep apnea, but the sudden incapacitation risk is real... and I'm a data point.

 

[Let'sgoflying!]

Having experienced narcolepsy from severe untreated sleep apnea in my past I can say I could barely stay awake during sudden nap-attacks while driving

Hm good to know. Still, is it not true that a person becomes aware of this problem well before being anywhere near an airplane? I mean if the average pilot flies 100hrs per year that's likely maybe 1% of their waking hours and it oughta show up well before airplane time.
Again, has a crash ever been attributed to S.A.?

 

[Fearless Tower]

Hm good to know. Still, is it not true that a person becomes aware of this problem well before being anywhere near an airplane? I mean if the average pilot flies 100hrs per year that's likely maybe 1% of their waking hours and it oughta show up well before airplane time.
Again, has a crash ever been attributed to S.A.?

Not a crash and I have not seen anything documented, but Bruce has mentioned before that the Northwest Airlines overshoot of Minneapolis was related to undiagnosed OSA.

 

[bflynn]

sounds like you missed some FAA deadlines. Always respond to their letters ... and you can always get 1 extension for time. This can be easily fixed ... but my advice is to follow FAA instructions, hook your star to AOPA. Dr Bruce or your union ... pick one and stay with them and re-apply. Your AME should be able to handle this issue too.

Sounds to me like he didn't miss the deadline, the FAA did. They had his test in hand but did not process it in a timely manner

 

[lbfjrmd]

Sounds to me like he didn't miss the deadline, the FAA did. They had his test in hand but did not process it in a timely manner

See post #18. IMHO do not push deadlines. You can always get extensions ... and such a request takes it from bureaucracy and allows the OKC medical officers 2 stay in the loop.

 

[Let'sgoflying!]

Not a crash and I have not seen anything documented, but Bruce has mentioned before that the Northwest Airlines overshoot of Minneapolis was related to undiagnosed OSA.

Thanks. I naively believed the NTSB report which does not mention sleeping although it certainly makes sense. However if they were sleeping, did both have S.A.? Begs the question if they were just overworked.

 

[Everskyward]

Again, has a crash ever been attributed to S.A.?

Wouldn't that be pretty hard to prove one way or another?

 

[Kiddo's Driver]

Not a crash and I have not seen anything documented, but Bruce has mentioned before that the Northwest Airlines overshoot of Minneapolis was related to undiagnosed OSA.

My personal opinion on this is that you need to self assess before you fly. Being tired from poor sleep quality is being tired from poor sleep quality. "Did I get enough sleep?" is just one of the many things that you need to ask yourself before you fly. You don't need the government to attach a sensor to you to do what is right.

Do we need to attach sleep monitors to all new fathers to document that they got enough sleep before they go flying? How about we attach sleep monitors to ALL pilots to ensure they are getting enough sleep? The pilots who overflew Minneapolis were looking for anything they could find to cover their butts for not doing their jobs. OSA just happened to be handy.

 

[Fearless Tower]

My personal opinion on this is that you need to self assess before you fly. Being tired from poor sleep quality is being tired from poor sleep quality. "Did I get enough sleep?" is just one of the many things that you need to ask yourself before you fly. You don't need the government to attach a sensor to you to do what is right.

I completely agree.

 

[Doggtyred]

Hm good to know. Still, is it not true that a person becomes aware of this problem well before being anywhere near an airplane? I mean if the average pilot flies 100hrs per year that's likely maybe 1% of their waking hours and it oughta show up well before airplane time.
Again, has a crash ever been attributed to S.A.?

I knew I had sleep apnea. I'd "worked around" it for years. But the narcolepsy first manifested itself for me without other warning at freeway speed on the interstate in heavy traffic conditions.

Its not about documenting SA as a cause of the crash. Its about the real risk of SUDDEN incapacitation. Like seizures... like living with an implanted defibrillator... Like every other licensing and regulatory body, the FAA is not about protecting pilots or their right to fly. Its about protecting the public and managing manageable risk.

 

[Lindberg]

I had 90 days to comply but I wasted most of them waiting to get into a local sleep clinic. Thanks to info obtained on this board I got smart after 60 days had elapsed & did the home study thing. I should have made that decision much sooner.

So how late was your response?

 

[DFH65]

I knew I had sleep apnea. I'd "worked around" it for years. But the narcolepsy first manifested itself for me without other warning at freeway speed on the interstate in heavy traffic conditions.

Its not about documenting SA as a cause of the crash. Its about the real risk of SUDDEN incapacitation. Like seizures... like living with an implanted defibrillator... Like every other licensing and regulatory body, the FAA is not about protecting pilots or their right to fly. Its about protecting the public and managing manageable risk.

I just don't buy that your experience is at all common.

My only apparent symptom was snoring I was rarely if ever "too tired" to function during the day. Suddenly falling asleep when you are engaged in an activity is not just being overly tired.

 

[Matthew]

I don't know how the "behind the scenes" decisions were made. But Dep of Transportation (which FAA is a subset) has been working problems with OTR truck drivers for years: falling asleep behind the wheel, even if it's just for a fraction of a second, kills people.

Fatigue can also make you goofy. Slow responses and poor decision making can result. Somewhere there is a study that shows a certain amount of sleep loss is equivalent to a certain blood acohol level.

I don't know if OSA has caused an aircraft accident, maybe fatigue because of poor sleep quality was a factor. But OSA is recognized as a valid diagnosis that has a simple treatment. And a commercial airline crew falling asleep and overflying their destination didn't help PR.

FAA medical has control on medical diagnoses, so they took it in the case of OSA. If you pulled an all nighter at work, or because of a baby, you self evaluate for that flight or circumstance. With OSA it's an "always" thing so to FAA you either treat it and fly, or don't and don't.

I wish they'd remove the SI. Maybe report it like anything else that requires ongoing treatment.

 

[AggieMike88]

I wish they'd remove the SI. Maybe report it like anything else that requires ongoing treatment.

I do remember seeing various items discussing making OSA part of the CACI program. Which would be a good thing for CPAP users by making it simpler to get the medical done. And shift some of the OK to issue burden off of the already overwhelmed reviewers at OKC.

 

[Palmpilot]

...Somewhere there is a study that shows a certain amount of sleep loss is equivalent to a certain blood acohol level...

I wonder if that study has been accurately quoted. I can believe that sleep apnea reduces performance in various ways, but I have a hard time believing that it lowers inhibitions like alcohol does.

I wish they'd remove the SI. Maybe report it like anything else that requires ongoing treatment.

I agree. And the insistence on monitoring compliance with the treatment plan strikes me as obsessive. For most conditions, the FAA takes our word for it when we say that we have been successfully treated.

 

[Matthew]

I wonder if that study has been accurately quoted. I can believe that sleap apnea reduces performance in various ways, but I have a hard time believing that it lowers inhibitions like alcohol does.

I think it measured reaction times. I thought I found it once, about a year ago. I'll look again.

edit:

Pretty easy to find this one, but I don't know if it's the only one:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1739867/

 

[flyingron]

For what it's worth, you do NOT need a Second Class medical to instruct. A Third Class will do.

You don't need a medical at all to instruct unless you have to be a crew member (either your student can't be PIC or you are putting him under the hood or such).