Sleep Apnea MWT/How do I get one?

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motospeed9058

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rhall9058
Sleep Apnea MWT/How do I get one? (UPDATED, Jan 2012)

So, I had my physical back in July, and due to my sleep apnea treatment, the AME obviously had to send it to OKC for final decision. Took them some time, but they came back and asked for an updated report from my treating doc, only asking for compliance and a handful of other observations. After the appointment with my treating doc, we made sure that everything they asked for was satisfactorily addressed in the report and sent back to them. Here we are 45 days after the last report was submitted to them, and I get another request in the mail saying that the report they recieved was not satisfactory and they would need a Maintenance of Wakefulness Test (MWT).

I guess I shouldn't be shocked at this request since I've read enough here to know that that was a possibility. I guess what frustrates me the most is that they didn't just ask for this the first time around. All of the items they originally requested from my treating physician were well within any reasonable guidelines (i.e. heart rate, blood pressure, no heart issues, etc.) yet they continue to defer to the MWT. Why didn't they just ask for that up front instead of jerking my chain around.

I've now quit flying becuase I'm not so sure that I can continue to dump money into this not knowing whether or not it will have a positive outcome from the Regulatory side of things. SO FRUSTRATING!!!

Ok, now that I have my venting done. A question for the masses. Does the MWT have to be done by an AME? How do I find out about getting one of these done? and at what cost? My AME has not been the most responsive to these types of questions (so responsive, he hasn't bothered to return the phone calls and emails asking him what to do next), so I come to the all knowing body of knowledge to find out. What next? :dunno:
 
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motospeed9058 said:
Ok, now that I have my venting done. A question for the masses. Does the MWT have to be done by an AME? How do I find out about getting one of these done? and at what cost?
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Contact the sleep lab where you did your PSG and they'll tell you what it'll cost. Then get your PCP or ENT to order one. If they can work it properly, it might even be covered under your insurance. As to why FAA is requesting it, ???
 
AggieMike88 said:
Good info on OSA iS also on the AOPA board, including my experience with the MWT.
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Here's a link to a search on AOPA when I used "wakefullness" as the keyword.

My situation was that I desired my first issuance to be a slam dunk with no questions. I was fortunate that the previously adminstered sleep test tipped my medical deductible into the "the carrier will pay for nearly all of it" zone. And they did.

I'll echo Dr. Bruce's "Don't Fall Asleep!!" during the MWT.

In my research on what an MWT is and how it relates to the FAA, I discovered an airman who got hosed by the lab techs when they stacked the deck against him by (1) not adequately explaining what they were seeking, and (2) telling him to "try to go to sleep" after putting him in the bed comfy warm bed and shut out most of the lights. That's sorta like saying "it's okay if you go to sleep".

The object of the MWT is to determine if you can remain awake even if you are in a "sleep producing situation".

A fun way to pass the time? Visualize conducting a complete flight, from getting the keys, to the walk-around inspection, to taxiing, t/o, laps in the pattern, landing, etc.

In my situation, I never got past the 6th lap before the tech came back in to end that data round.
 
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Motospeed: I've posted multiple times on the red and (?) I think here that the MWT is not a requirement, but if your Doc's letter isn't tiptop and doesn't have things like epworth scales in it, the doc isn't walking the walk and talking the talk and FAA knows he's just "doing the best he can". I can tell, without the letterhead, in about 30 seconds if the letter was written by the correct specialist. "Treating doc" doesn't tell me if your guy was a pulmonary medicine specialist or a neurologist. Or maybe a family doc.

It also depends on how much CPAP pressure is being required to treat you.

MWT is necessary, however, in order to get a slam dunk first time issuance, which is WHAT MOST GUYS WANT. One poster- I can't recall if it was you probably wasn't), really wanted to keep costs down, and I respect that. But his family doc obviously muffed the letter and then he was back outraged by the situation.

He would have been better to just get the MWT out of the box. It boils down to how you value time vs. money. I do encourage a lot of guys to try to won their own medical, and give what nonbinding help I can from afar. But if you had hired one of the dozen or so GOOD certification specialists that do this sort of work, they could have looked at the letter BEFORE you tried, and told you that is would, or would not cut it.

MWTs are done by hospital accredited pulmonologists or neurologists, and they are 20 minute x 4 periods ten minutes apart in which you are given the opportunity to fall asleep, but do not.

Bottom line, you never get more than what you paid for. Now that the agency has decided it wasn't good enough, you have no choice but to go get the study. You might have succeeded, though, so on balance, you got "best economy" and didn't win. It's time vs. money, in the end. Sigh.

Now go get 'em.

http://www.pilotsofamerica.com/forum/showthread.php?t=721&highlight=watchfullness
 
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bbchien said:
Motospeed: I've posted multiple times on the red and (?) I think here that the MWT is not a requirement, but if your Doc's letter isn't tiptop and doesn't have things like epworth scales in it, the doc isn't walking the walk and talking the talk and FAA knows he's just "doing the best he can". I can tell, without the letterhead, in about 30 seconds if the letter was written by the correct specialist. "Treating doc" doesn't tell me if your guy was a pulmonary medicine specialist or a neurologist. Or maybe a family doc.

It also depends on how much CPAP pressure is being required to treat you.

MWT is necessary, however, in order to get a slam dunk first time issuance, which is WHAT MOST GUYS WANT. One poster- I can't recall if it was you probably wasn't), really wanted to keep costs down, and I respect that. But his family doc obviously muffed the letter and then he was back outraged by the situation.

He would have been better to just get the MWT out of the box. It boils down to how you value time vs. money. I do encourage a lot of guys to try to won their own medical, and give what nonbinding help I can from afar. But if you had hired one of the dozen or so GOOD certification specialists that do this sort of work, they could have looked at the letter BEFORE you tried, and told you that is would, or would not cut it.

MWTs are done by hospital accredited pulmonologists or neurologists, and they are 20 minute x 4 periods ten minutes apart in which you are given the opportunity to fall asleep, but do not.

Bottom line, you never get more than what you paid for. Now that the agency has decided it wasn't good enough, you have no choice but to go get the study. You might have succeeded, though, so on balance, you got "best economy" and didn't win. It's time vs. money, in the end. Sigh.

Now go get 'em.

http://www.pilotsofamerica.com/forum/showthread.php?t=721&highlight=watchfullness
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Thanks for the notes Doc. I like to save a dollar as much as the next guy, but medical is one area I don't skimp. My letter was prepared by a neurologist that is also my treatment doc, through a Comprehensive Sleep and Neurology Center. I would have thought those credentials would have helped. He had the epworth scales, he had the required heart readings, we even included the past years worth of treatment/compliance progress. Still, the MWT was requested.

So in your opinion, do I go back to this doc and request the order for the MWT at the hospital sleep center?
 
motospeed9058 -

Is this for a first-time SI? Or was this for a renewal?

If it's a first-time (and it sounds like it is since you said your AME deferred it to OKC): With the info you said you had sent in, I wonder if FAA is starting to get a little tighter on their requirements than in the past?

If it's a renewal, then I don't know what happened.
 
motospeed9058 said:
Thanks for the notes Doc. I like to save a dollar as much as the next guy, but medical is one area I don't skimp. My letter was prepared by a neurologist that is also my treatment doc, through a Comprehensive Sleep and Neurology Center. I would have thought those credentials would have helped. He had the epworth scales, he had the required heart readings, we even included the past years worth of treatment/compliance progress. Still, the MWT was requested.

So in your opinion, do I go back to this doc and request the order for the MWT at the hospital sleep center?
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I would retain the services of an AME who specializes in difficult certifications and go from there. He will know the right questions to ask, and determine if your neurologist is qualified enough to render the needed data and interprettions, as well as ensure submitted materials will satisfy what the FAA is looking for.
 
Matthew said:
I wonder if FAA is starting to get a little tighter on their requirements than in the past?
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I had something occur that leads me to beleive they are.

My initial medical was 2010. The SI letter included my OSA SI and specs, and the directions for the next status letter to be submitted in 2012.

This month, I'm renewing the medical and forwarded the status letter my primary doc prepared for my pill controlled Diabetes 2 to my AME's office so he could review before I travelled there. I got a call from him soon after and was told all looked good but where was the status info for the OSA?

After a brief discussion, he said he did call his contacts at OKC and OSA now has an annual reporting requirement no matter what.

So they are tightening up on this.
 
Matthew said:
motospeed9058 -

Is this for a first-time SI? Or was this for a renewal?

If it's a first-time (and it sounds like it is since you said your AME deferred it to OKC): With the info you said you had sent in, I wonder if FAA is starting to get a little tighter on their requirements than in the past?
Click to expand...

I would also agree with AggieMike above in that they are tightening up. This is my first time through this process. Not a renewal. Before I started down this road, I had done some previous research and provided what everybody had said previously worked plus other materials which weren't required. I meticulously made sure that I had all bases covered as did my neurologist. We went line by line in the initial request for an updated report and made sure to include documented eveidence to each an every item they requested.

It seems as though none of it worked and the FAA has decidedly started to get "sticky" with their approvals. Like I said though, this is my first time, so I'm not in the right shoes to compare against anything other than the previous research that I had done. I could be way off base.
 
Ahh yes. ISO 9000.

The, "We can't tell you if we do anything right, but we can prove we know how to absolutely do it wrong every time with consistency!", Certification.

The Firestone plant that made all those (very consistent) deadly tires for Ford a few years back, was ISO 9000 Certified.

I have a photo of it shuttered and closed forever with the "proud to be ISO 9000 certified" sign still hanging out front. I pull it out and tell the tale any bored middle manager starts rumbling about getting "ISO Certified".

"Sure boss. We'll be so busy for a year documenting all the business rules that we won't make any forward progress on anything, and then we'll probably implement ISO wrong and tie it to our change-control process so tightly that we won't be able to approve our own change requests. It's easily the most common mistake of first-time ISO qualification documentation. This will cost us so much time and money we'll be on the street within 3 years, max. I'll happily start tomorrow both working on this project (since there's some nice ISO training courses in sunny climates with beach bars, I hear), and I'll get reasy to polish up the resume' for about 24 months from now. As long as we agree that's the plan... Or would you rather I fixed X today?"

:lol: :rofl:
 
motospeed9058 said:
Thanks for the notes Doc. I like to save a dollar as much as the next guy, but medical is one area I don't skimp. My letter was prepared by a neurologist that is also my treatment doc, through a Comprehensive Sleep and Neurology Center. I would have thought those credentials would have helped. He had the epworth scales, he had the required heart readings, we even included the past years worth of treatment/compliance progress. Still, the MWT was requested.

So in your opinion, do I go back to this doc and request the order for the MWT at the hospital sleep center?
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Yup. no choice.

Is you CPAP level about 8cms?
 
UPDATE:
So I got my special issuance this weekend. A question for those that have been through the sleep apnea drill before and even Doc. The special issuance had the same instructions that I mentioned above in the original letter. Submit annual treatment report with a handful of statistics and compliance notes; however, again, there was no mention of an annual MWT that needs to be submitted. Do I take the proactive route and get one done annually? Or now that I've proven my worth, they will trust the treating physician and I only REALLY need to submit a report from the treating doc on my CPAP compliance ensuring we only provide the information they have requested. What have you guys done? what's the expectation here?

On a side funny note; the process has taken long enough that my next annual is due in 6 months. HA!! :mad2: :mad2:
 
My most recent visit to my AME was late November for the AME assisted renewal (the off year where I don't fill out the full 8500-8 form). I had called his office in advance to review what I needed to bring for my SI's to ensure I had it all and ready. For sleep apnea, all that was needed and was accepted by him was a letter from my PCP containing the items stated in the SI specs page, the summary print out from my CPAP chip, and I tossed in an Epworth score for good measure.

I asked of he needed anything different for the next time and he said what I brought this time was good.

If you check your SI letter again, you should see that a MWT is only required if there is doubt your current therapy is doing its job. Typically your physician will make that call.
 
And the agency will make that call if the doc isn't competent enough to report your epworth score, etc. as to "lack of tendancy to fall asleep", etc. They reserve the right if the letter from the doc doesn't reflect expertise.
 
Dr. Bruce in a earlier post in this thread you mentioned the Epworth scale. My doctor indicated in the prognosis letter to the FAA I scored a 3 out of a possible 24 on the Epworth Scale. His specialty is sleep management which is the area I failed the test. I have Obstructive sleep apnea. I also passed the MWT which the FAA told me to get with 0 sleep out of 4 periods tested. Additionally, he told the FAA that my compliance with the BI-Pap is 100% and machine records indicate I use the machine 8 hours, 4 minutes nightly.

Any guesses if I will get my medical approved?
 
You'll pass on the sleep apnea part, but on the underlying diagnoses behind the 3 prohibited meds- that may be another story.
 
bbchien said:
You'll pass on the sleep apnea part, but on the underlying diagnoses behind the 3 prohibited meds- that may be another story.
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Went cold turkey on those three meds three months ago. They are colonozapan, Mirapex, and Edular. Doctor reported that without the meds I am fairing quite well and have 92% compliance with the BI-Pap machine sleeping over 8 hours nightly. Was working one night so did not rack up more than 4 hours sleep. Passed the MWT with 0 portions of sleep out of the 4 sessions.

I have another question that with your permission, I will send via a email tomorrow.

Thank you so much for your efforts to the flying public.
 
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