Question about sleep aid/limited SSRI use.

[Alec357]

I'm a first responder with a private/instrument rating.

Last July I went back to night shift on a permanent basis after having not worked night shift in about a decade.

I had trouble adjusting to the sleep schedule (now 40 years old). After a couple months of struggling to sleep, I went to the doctor. We tried a few different prescription sleep aids. Ambien and Lunesta. They kind of worked, but I still struggled to sleep and the stress from the fatigue and schedule change was only making this worse.

My Doc put me on sertraline, thinking it may help with the stress and anxiety from the situation. I took the medication for 3 months, before discontinuing. It didn't help, infact I think it made it worse! (insomnia is a side effect of ssri)

I've been off the sertraline for three months, still on night shift, and I've NEVER had an issue with anxiety or depression in my life.

I still take Lunesta up to twice a week, but not every week to help with my sleep schedule. I work 4 shifts on overnights with 3 days off. So my sleep schedule is all jacked because of the constant back and forth day v. night sleep schedule. If I can get back to a more normal day schedule then I won't need the sleep aids at all.

I'm at 150 hrs and want to start getting ready for commercial training stuff, but I also want to get my class 2 medical. Should I wait until I can get off the sleep aids completely before going for my class 2, or will I be okay going for it now.? I'm not sure whay the best route is. I'd like to avoid a deferment if possible. Any advise or experience here? Thanks!

 

[Half Fast]

Paging @lbfjrmd @bbchien @WingmanMed Doctors, your assistance is needed.

 

[dbahn]

The sleep experts believe that it's impossible to fully adjust to a night shift schedule.

I'm not sure what the best pathway is at this point, but I suspect it will involve time and money and will ultimately be doable. There are several knowledgeable docs here who I believe will provide more useful information, but while that gets sorted out and before it's put in the hands of CAMI I would consider continuing your training under Basic Med.

 

[Alec357]

The sleep experts believe that it's impossible to fully adjust to a night shift schedule.

I'm not sure what the best pathway is at this point, but I suspect it will involve time and money and will ultimately be doable. There are several knowledgeable docs here who I believe will provide more useful information, but while that gets sorted out and before it's put in the hands of CAMI I would consider continuing your training under Basic Med.

Like I said... if I can get back to a normal day shift, I won't need the slep aids at all. It could happen within the next 6 to 12 months.

 

[Alec357]

Like I said... if I can get back to a normal day shift, I won't need the slep aids at all. It could happen within the next 6 to 12 months.

The sleep experts believe that it's impossible to fully adjust to a night shift schedule.

I'm not sure what the best pathway is at this point, but I suspect it will involve time and money and will ultimately be doable. There are several knowledgeable docs here who I believe will provide more useful information, but while that gets sorted out and before it's put in the hands of CAMI I would consider continuing your training under Basic Med.

If I'm going to get deferred either way then I'd like to start that now rather than waiting

 

[dbahn]

Like I said... if I can get back to a normal day shift, I won't need the slep aids at all. It could happen within the next 6 to 12 months.

That's in the future. The FAA will focus on what's already happened.

 

[Alec357]

That's in the future. The FAA will focus on what's already happened.

Yes... but what im saying is... would it be a better choice to wait until I'm on a normal shift and OFF any precription sleep aids, regardless of the frequency of use, and THEN apply for the medical? Therefore it would not be "in the future" like you said. I know the AME will still look at the past occurrence, but if it has already resolved itself then it seem like that would be viewed in a more positive light? I guess I'm just going to call my AME and find out.

 

[bbchien]

I think training under Basic Med is a very very good idea. Evenatully your doc wil lhave to decalre that his use was "off label" for shift work and that you never had a psychiatry diagnosis.

 

[dbahn]

My Doc put me on sertraline, thinking it may help with the stress and anxiety from the situation. I took the medication for 3 months, before discontinuing. It didn't help, infact I think it made it worse! (insomnia is a side effect of ssri)

I've been off the sertraline for three months, still on night shift, and I've NEVER had an issue with anxiety or depression in my life.

Do you see a problem with those two statements? The FAA will. The doctor treated you for anxiety but you believe you've never had an issue with it in your life. You probably haven't, or if you did it could very well have been situational and transient. But the process with the FAA involves proving to them that sertraline wasn't necessary and wasn't for treatment of an underlying mental health condition, and you'll need medical documentation for that.

Again, I'd continue your training under Basic Med while you wait to get off the night shift, assemble the documentation to convince CAMI that you qualify for medical certification, and then hit the ground running when that occurs. If you have unused sertraline or unfilled prescriptions for it, see if the pharmacy can document their return.

Talk to your AME about this before you initiate the certification process.

And as an aside, I think night shift work is similar to sleep apnea with respect to flying. Both create "sleep debt", or lack of adequate REM sleep, which can hava a signficant effect on performance in activities requiring a high level of alertness.