Sleep Apnea - new FAA Guidelines to AME - be prepared!

GotWings? said:
Hmmmm...a buddy told me to take a look at this for some clarity regarding my upcoming exam, but it sounds like almost everyone is just as confused as I am. So, if I go to my physical and happen to be "labeled" high risk, I have 90 days to get a sleep study, but if it's positive I am grounded until I'm on treatment? How long is that?
If I go on my own and have a positive test and get treated BEFORE seeing the AME, I have 3-4 months to provide my test and treatment information with no down time?
Now I'm fairly new at this, but it seems pretty obvious which avenue the FAA wants us to take. Am I missing something here?:dunno:
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I'm not sure about the grounding part. From the flowchart, the only grounding happens if you are a clear and present danger.

I t sounds like - (a) if you see the AME AND you are labeled high risk, THEN you have 90 days to get evaluated (and are not grounded). (b) The flowchart also says, if you have tested positive for OSA AND don't already have an SI THEN you have 90 days to provide follow up info (and are not grounded).

It is not clear on what happens after (a), do you then have an additional 90 days for compliance reports or not, or does (b) only apply to pilots who got a sleep study on their own, prior to the AME visit? I'll pop over to the Red Board and ask

The video specifically says the high risk pilots are required to get an "evaluation", it says a sleep study is only required if the evaluation calls for it.
 
Bonanza said:
Also it beats me why they are putting so much effort into an issue that is not a problem.
There may be a few, but I can't recall a single accident report where on a private operation Sleep Apnea has been cited as a probable cause.
Pilots are not falling asleep at the controls and dropping out of the sky on a regular basis.
Sounds like someone at the FAA has a bee in their bonnet.
All the more reason to get rid of the third class medical all together.
Stephen.
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Because it's an incipient problem in that it leaves no evidence after an accident. If it causes a crash, you'll never know from direct evidence. Also most people with untreated sleep apnea do not even realize the degraded level of performance, and quality of life, they were experiencing until they get treated, because typically they know no other state of being to compare it to.

The NTSB thinks it's an issue due to findings with truck drivers who more often survive their accidents, the protocols are already in place there, and it is working out well. The drivers are not complaining because it really makes a marked improvement on their quality of life.

This is really one where people who are likely to have the condition would really benefit themselves by just cooperating. The FAA is making this as easy as possible, if you have it, just get treated, simple.
 
BMI, is a good correlation, but correlation doesn't equal causation. The general guidelines to easily determine BMI are usually "ball park" at best. I always register with a high BMI, I'm 6'3, 220lbs. By those numbers in any BMI calculator I'm obese. That doesn't match up with reality. I'm an ultra distance runner (50 mile race In a few weeks, 100 miler in October) and up until this year I competed heavily in crossfit competitions. I'm going to register as "at risk" because I can deadlift over 500lbs and run 30 or more miles. Last time I checked too my blood pressure was 100/60 and my resting heart rate was 50 bpm. I'm sure I'll have extra paperwork to do.

The army does the same thing to me though. I'm outside of Max weight so I have to have all these calculations done to show less than 20% BMI
 
Should add that the rules need-not be changed for me, there are always exceptions. It'd just be nice if the AME could apply some common sense in the review.
 
gitmo234 said:
BMI, is a good correlation, but correlation doesn't equal causation. The general guidelines to easily determine BMI are usually "ball park" at best. I always register with a high BMI, I'm 6'3, 220lbs. By those numbers in any BMI calculator I'm obese. That doesn't match up with reality. I'm an ultra distance runner (50 mile race In a few weeks, 100 miler in October) and up until this year I competed heavily in crossfit competitions. I'm going to register as "at risk" because I can deadlift over 500lbs and run 30 or more miles. Last time I checked too my blood pressure was 100/60 and my resting heart rate was 50 bpm. I'm sure I'll have extra paperwork to do.

The army does the same thing to me though. I'm outside of Max weight so I have to have all these calculations done to show less than 20% BMI
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That is why BMI is only being used as one factor, and only to establish risk at that. The doctors are being given latitude to make the determination of evidence, the compendium of which may throw out the BMI factor.

I think there are a lot of people who are afraid because they are afraid of everything that might ever happen. It's irrelevant to fear because it's going to happen regardless. Either you will be determined not at risk and issued, you will be determined at risk and issued, then you will be determined effected, treated and still issued; or unaffected and still issued.

Everybody keeps flying, and the people that undertook treatment for their condition experience a benefit in quality of life.

There is no real good reason to fight on this one. Don't just fight a fight to resist change, fight the fights that bring positive change. This change is only positive, there is no reason to fight it.
 
gitmo234 said:
Should add that the rules need-not be changed for me, there are always exceptions. It'd just be nice if the AME could apply some common sense in the review.
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It sounds like you (and many others) will fall into one of these categories:

>>>

  • If the applicant does not have an AASI/SI or has not had a previous assessment, the AME must:
  • If the applicant is at high risk for OSA, the AME must (Group/Box 5 of OSA flow chart (PDF)), select Group 5 on the AME Action Tab:
    • Give the applicant Specification Sheet B (PDF) and advise that a letter will be sent from the Federal Air Surgeon requesting more information. The letter will state that the applicant has 90 days to provide the information to the FAA/AME;
    • Notate in Block 60; and
    • Issue, if otherwise qualified
<<<

AME needs to calculate BMI and then apply tables 2 and 3.

It does say: "If the applicant is at risk for OSA but in the opinion of the AME ..." It does seem like the AME can use some judgement. But, since this is all new to everyone, will the AME be willing to give the pilot the benefit of the doubt or just check the box that says "high risk" and cover himself?
 
gitmo234 said:
Should add that the rules need-not be changed for me, there are always exceptions. It'd just be nice if the AME could apply some common sense in the review.
Click to expand...

They can, they have latitude, it's not a single factor determinant.

There are visible/noticeable symptoms of the results of sleep apnea as well. I've lived/worked close quarters with sufferers on boats, and when we started working on this in the marine sector years ago, you could see the physiological change in them when they started treatment. Not to mention the noise level in the crew cabin went down from the reduction in snoring.

People who are suffering sleep apnea typically have been doing so all their lives and have no clue because they know nothing else. Their entire recallable life experience has been in this degraded state. If the AME says to you, "You need to get checked out, consider it a favor.
 
Matthew said:
It sounds like you (and many others) will fall into one of these categories:

>>>

  • If the applicant does not have an AASI/SI or has not had a previous assessment, the AME must:
  • If the applicant is at high risk for OSA, the AME must (Group/Box 5 of OSA flow chart (PDF)), select Group 5 on the AME Action Tab:
    • Give the applicant Specification Sheet B (PDF) and advise that a letter will be sent from the Federal Air Surgeon requesting more information. The letter will state that the applicant has 90 days to provide the information to the FAA/AME;
    • Notate in Block 60; and
    • Issue, if otherwise qualified
<<<

AME needs to calculate BMI and then apply tables 2 and 3.

It does say: "If the applicant is at risk for OSA but in the opinion of the AME ..." It does seem like the AME can use some judgement. But, since this is all new to everyone, will the AME be willing to give the pilot the benefit of the doubt or just check the box that says "high risk" and cover himself?
Click to expand...

This is where your choice of, and relationship with, your AME come into play. Not all AMEs are the same, but in general, they are more prone to be practical and liberal in their determinations to keep the airman flying. There are plenty of AMEs out there who 'pencil whip' medicals too, just like mechanics.:lol:
 
Matthew said:
Ptetty sure it's still 40 BMI and 17" neck, plus results of the questionnaire. I don't know if AME has the ability to use discretion based on in-person observation.
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Thank goodness it's AND. I'm 23.1 BMI and 17" neck. :\ Shesh.
 
Reedster said:
Just had my medical this past week. I was surprised when he said he was going to screen for sleep apnea. He asked if I had ever been told I snored, stopped breathing in my sleep, or fell asleep during the day (all no's). We talked about my BMI (27). That was about it.
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I was asked the screening question, but there was no mention of BMI.
 
Matthew said:
I'm not sure about the grounding part. From the flowchart, the only grounding happens if you are a clear and present danger.

I t sounds like - (a) if you see the AME AND you are labeled high risk, THEN you have 90 days to get evaluated (and are not grounded). (b) The flowchart also says, if you have tested positive for OSA AND don't already have an SI THEN you have 90 days to provide follow up info (and are not grounded).

It is not clear on what happens after (a), do you then have an additional 90 days for compliance reports or not, or does (b) only apply to pilots who got a sleep study on their own, prior to the AME visit? I'll pop over to the Red Board and ask

The video specifically says the high risk pilots are required to get an "evaluation", it says a sleep study is only required if the evaluation calls for it.
Click to expand...

I asked over on the Red Board: If you see the AME and he determines you are high risk, and you get the eval, sleep study, OSA diagnosis and CPAP, you have 90 days (plus a 30 day extension if needed) to get it all done. Otherwise the clock runs out and you get a denial and are grounded until you complete all the requirements. You then have a denial on your record.

If you are worried about it, do an evaluation on your own first. If no OSA, keep the report. If OSA, deal with it. Or, do a consult with the AME - in this case, your medical might expire while you comply with whatever requirements are necessary, but you won't have a denial.
 
what happens if someone takes care of their OSA when in between medicals? Will the pilot need to self ground while on treatment, go to an AME to get an SI and wait on the ground for the several months it takes, or what is the process? I bet the red tape and the wasted time for an SI is preventing a lot of people to get the appropriate treatment when the reality is that once you are on the machine the improvements are immediate.
 
gitmo234 said:
BMI, is a good correlation, but correlation doesn't equal causation. The general guidelines to easily determine BMI are usually "ball park" at best. I always register with a high BMI, I'm 6'3, 220lbs. By those numbers in any BMI calculator I'm obese. That doesn't match up with reality. I'm an ultra distance runner (50 mile race In a few weeks, 100 miler in October) and up until this year I competed heavily in crossfit competitions. I'm going to register as "at risk" because I can deadlift over 500lbs and run 30 or more miles. Last time I checked too my blood pressure was 100/60 and my resting heart rate was 50 bpm. I'm sure I'll have extra paperwork to do.

The army does the same thing to me though. I'm outside of Max weight so I have to have all these calculations done to show less than 20% BMI
Click to expand...

Based on 6'3" and 220 you'd have a BMI of 27.5 or 27.6. Obese starts at 30. Between 25 and 29.9 IS considered overweight.

I'm at 29.9 currently. But I'm not 6'3". I'm 6'. (And I can walk 10+ miles in a day no problem. But I can't run 30 miles. Not no way. Not no how.)

John
 
Matthew said:
I asked over on the Red Board: If you see the AME and he determines you are high risk, and you get the eval, sleep study, OSA diagnosis and CPAP, you have 90 days (plus a 30 day extension if needed) to get it all done. Otherwise the clock runs out and you get a denial and are grounded until you complete all the requirements. You then have a denial on your record.

If you are worried about it, do an evaluation on your own first. If no OSA, keep the report. If OSA, deal with it. Or, do a consult with the AME - in this case, your medical might expire while you comply with whatever requirements are necessary, but you won't have a denial.
Click to expand...


so if you go on your own to get a study and end up having an OSA diagnosis do you have to immediately ground yourself, get treatment and go to your ame to get a special issuance? or can you continue flying even if the treatment is working perfectly fine?
 
cirrusmx said:
so if you go on your own to get a study and end up having an OSA diagnosis do you have to immediately ground yourself, get treatment and go to your ame to get a special issuance?
Click to expand...

Check with Dr. Bruce Chien via the AOPA Forums, but I believe the answer is yes. See FAR 61.53(a)(1), Prohibition on operations during medical deficiency.

An OSA diagnoses requires obtaining the SI to regain your PIC privileges. That will require some downtime while you build compliance data on your CPAP machine.
 
Stewartb said:
Lots of guys are quick to complain but it doesn't seem most are aware of the screening rules. I wasn't. Here's the best info I found when I went looking. it doesn't seem very threatening to me. http://www.faa.gov/tv/?mediaId=1029
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It's not! I was amazed they actually implemented the way I suggest during the comments after their first withdrawal. They have set it up so it is as painless as possible and encourages people to seek help.
 
Sac Arrow said:
I was asked the screening question, but there was no mention of BMI.
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I watched as my AME filled out my form on the computer. After entering height and weight, the BMI appeared in the next field automatically.
 
6'3" 200lbs. been skinny all my life. Blood pressure of an athlete.

I can wake the dead snoring if I've had beer, or very physically tired after a hard day of work and sleeping on my back.

Recently passed my third class medical with flying colors. Doc asked me all those silly questions. .... I won't incriminate myself on a public board, I'll just say seeya in two years. ;)
 
cirrusmx said:
so if you go on your own to get a study and end up having an OSA diagnosis do you have to immediately ground yourself, get treatment and go to your ame to get a special issuance? or can you continue flying even if the treatment is working perfectly fine?
Click to expand...

You can check with Doc Bruce in your own, but I just asked him because I was curious, too.

If you are a CFI, you are grounded until you get an SI.

If not, you self ground until you have a 30 day record of treatment and the ability to show it's working. Then you can fly until your next AME appointment. He recommends - since you need thirty days of good data, you might as well see an AME and get issued then, get it over with, and avoid the possibility of FAA saying that all your status reports and other paperwork are too old (depending on your next medical schedule) and want you to repeat some things that your insurance won't want to pay for again.

If you want to hear it straight from him, check on the red board where I asked, or ask him directly.
 
Bonanza said:
This is a crock of sh*t.
I did the questionaire at this website and with a BMI of 24, no snoring or other indications but a neck size over 15" and no other negative indications it predicted a HIGH likelihood of OSA and said I should immediately come to them for an evaluation. At 6'2", if I had a neck size under 15" I should be denied a medical on the basis of malnutrition.
I have seen some great spam posts, but Sleepdoc should really declare his financial involvement with zeeappnea,com and we should recognize this as the confidence trick that it really is.
Stephen.
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Doesn't look like Sleepdoc has been back since 3/15. I'd be interested in his response to your post.
 
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