CPAP to Oral Appliance - Study Requirements

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SleepQuestion

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About four years ago I was diagnosed with moderate OSA in a lab study with AHI of about 17. I did the study based my AME's recommendation based on BMI etc rather than any perceptible symptoms. Got a CPAP and have been on SI ever since (currently 2nd class medical, but 3rd would be fine).

The CPAP is fine at home but I travel to back country areas a lot where it is very hard to stay compliant.

Worked my weight down from 170+ to 155 to get my BMI down to 24 and have held it there for about a year, started competitive running, and recently got fitted with an oral appliance. Because of Covid I opted for a home study this time (Alice NightOne device) via an online service to evaluate my progress.

The report came back with an AHI of 2 and a conclusion that "The study does not demonstrate sleep apnea."

However, it also notes:
  • "This home sleep study was technically limited by intermittent pulse oximeter signal loss and signal characteristics suggesting a high degree of sleep fragmentation and wakefulness during the recording." (I wake up tangled in wires several times, although it also seemed that the pulse ox lost signal a lot even when I was holding still just looking at it)

  • "There was limited time spent in the supine position which may have led to an underrepresentation of the degree of sleep disordered breathing." (I had about 57 mins of the study supine with 9 events vs several hours on left and right with only a couple events total in those positions. I rarely sleep on my back.)
The recommendation is "If a high degree of clinical suspicion remains for sleep apnea, a repeat sleep study is suggested."

I'm trying to figure out what to do with this result from an FAA standpoint before I talk to my sleep doctor. Given my prior history, will the FAA assume a "high degree of clinical suspicion"? Is the fact that I'm at an AHI of ~9 in one position going to be problematic as long as the average is << 5?

I can certainly spend the $ and do another lab or home study to try to get a stronger result. On the other hand, I don't want to inadvertently do something that will complicate my situation.

Any advice greatly appreciated.
 
First, congrats on loosing weight and getting in shape!

Second, do you fly for hobby or business? You said a 3rd class would be fine, so I'm guessing you now fly for "hobby".

If you fly for hobby perhaps just go Basic Med and let your family doctor determine if your apnea is an issue. There is a new thread on this topic that popped up just the other day.

Suggest read that thread, think about what medical you need, and sleep on it.

.......
( "sleep on it" .... anpea.... :D )
 
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OP here. Great point on BasicMed - I have considered that path but my flying does take me into the flight levels and occasionally across the Canadian border.

There's plenty of great flying to do below FL180 in the CONUS but I'm hoping not to close the door on going farther and higher just yet.

If it's a matter of losing another 10 lb or jumping through a few more hoops to get a standard medical certificate I'd rather try that first.
 
SleepQuestion said:
OP here. Great point on BasicMed - I have considered that path but my flying does take me into the flight levels and occasionally across the Canadian border.

There's plenty of great flying to do below FL180 in the CONUS but I'm hoping not to close the door on going farther and higher just yet.

If it's a matter of losing another 10 lb or jumping through a few more hoops to get a standard medical certificate I'd rather try that first.
Click to expand...
Get a Braebon or a somnodent (recording jaw advancement devices, battery powered) and then get another home sleep study. Of get a denal jaw advancement device but for SURE go through a sleep doc, not a dentist for your annual evaluations.
 
Thanks for the suggestion!

Went in for a proper lab study. My (board certified) sleep doc subsequently told me I have an AHI of 2 when when wearing the appliance (which does have the Braebon recording chip). Gave me a copy of the report and a letter attesting that the apnea is resolved by the appliance.

Do I just send this in to the FAA with a nice letter asking that my SI be updated to include oral appliance therapy in addition to CPAP?
 
Send both the printout that gave the AHI to be 2 (at home sleep study?), and your sleep doc's letter.
If all is properly written they will revise your SI letter to reflect the jaw advancement device.
 
Thanks so much - glad to have this in progress!

It was an overnight in-lab study with all kinds of wires. So hopefully the gold standard.

In reading through the report it seems that although my AHI is 2 I still had an RDI of 13.

The doctor didn't mention this at all when we talked nor in the letter he gave me. Is that something the FAA is likely to want more information on?
 
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