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

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Sleepdoc

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Sleepdoc
As a sleep physician who deals with pilots at all stages of the Special Issuance process, let me explain the new Guidelines as best as I can.
It is explained in detail at www.zeeappnea.com

The bottom line is that what is being written on the AOPA website is a little misleading.
It is very important to be aware of the implications of the new guidelines as it pertains to your next AME exam. The AME now for the first time , is required to screen for sleep apnea (OSA) risk. Prior to these guidelines, this uncomfortable topic could be avoided by just ignoring it. Now it cannot!
My guess is a lot more Airman will be identified as high risk for OSA.

If you present to the AME and it is determined that you are at High risk of having OSA, you will be given Spec Sheet B, which will give you 90 days to get assessed and if required treated for OSA. But what needs to be made very clear is that once you do the sleep study, you cannot exercise your privileges of your medical certificate until you are deemed to be in compliance with treatment. The FAA now knows that you are in the process of being evaluated. Once your are in compliance with treatment, your medical certificate is valid.

I would strongly advise that prior to your next AME exam, predetermine if possible if you are at risk for OSA. Review Spec Sheet B carefully.
The new guidelines are definitely more lenient on those Airmen who have been evaluated prior to the AME exam. In these cases the Airman has 90 days + 30 days to get in compliance . See Spec sheet A. In this situation the Airman will be issued a medical certificate and will have 120 days to provide all information to the FAA.
 
Welcome.

Thank you. We need good info.

The fact that this just pizzes me off no end is no reflection on your assistance.

This really, really, really makes me mad.

There are no accidents, incidents, or other indication of anything ever related to sleep apnea to pin this on, but the FAA, not elected representatives have shoved this down our throat(no pun).

Remember, N Korea has a perfect GA accident record.
 
I thought all of the implementation of screening for sleep apnea was killed!
Time to start reading again.
 
BillTIZ said:
I thought all of the implementation of screening for sleep apnea was killed!
Time to start reading again.
Click to expand...

Went into effect March 1. What was killed was the talk of automatically requiring a sleep study based on BMI and neck size only. Those are still screening points, but there is at least one questionnaire that gets used now in addition.
 
Matthew said:
Went into effect March 1. What was killed was the talk of automatically requiring a sleep study based on BMI and neck size only. Those are still screening points, but there is at least one questionnaire that gets used now in addition.
Click to expand...

So what are the numbers that kick off the screening?
 
BillTIZ said:
So what are the numbers that kick off the screening?
Click to expand...

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.
 
Here's the FAA AME protocol. There some PDFs linked.

https://www.faa.gov/about/office_or...ices/aam/ame/guide/dec_cons/disease_prot/osa/


>>>
"AME Actions - On every exam, the Examiner must triage the applicant into one of 6 groups:

..."
<<<

Note that in 5 of the 6 categories the AME will issue (but you may have to come back with further info). The 6th category is the one where the AME feels you are at an immediate risk to others. In that case, the AME must defer.
 
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On reviewing the information provided by the FAA extensively and having discussed points of ambiguity with the FAA directly, it appears that the AME is going to have a significant amount of discretion as to whether he classifies an airman as being at high risk for OSA.
Information has been provided to the AME to help determine risk of OSA, but it is by no means clearly defined. Some of the information is actually confusing, the guidelines could be interpreted as high risk for OSA only if symptoms of OSA are present. But in other supporting documentation provided to the AME's it provides very defined screening tools that determine high risk based on objective features only. For example high risk could be an airman who is over 50, BMI 35 with a neck circumference of 17 inches. It is all going to boil down to how the individual AME interprets the FAA guidelines. Further info is available at www.zeeappnea.com . This website will be updated as more information becomes available.
 
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.
 
I don't see where there is a problem. If you have it, you get treated, you keep flying the whole time, you feel a ****load better in general nearly immediately. Where is the problem?:dunno: Heck, you can pre-empt everything if you suspect you have OSA by seeking treatment before your next medical. "Currently under treatment" bypasses everything.
 
Henning said:
I don't see where there is a problem. If you have it, you get treated, you keep flying the whole time, you feel a ****load better in general nearly immediately. Where is the problem?:dunno: Heck, you can pre-empt everything if you suspect you have OSA by seeking treatment before your next medical. "Currently under treatment" bypasses everything.
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The problem is if you are screened as "high risk" but don't have it. Proving a negative to the FAA can be expensive......and take a long time.
 
jbarrass said:
The problem is if you are screened as "high risk" but don't have it. Proving a negative to the FAA can be expensive......and take a long time.
Click to expand...

In that case, much simpler to fake having it, buy a cheap machine and be "under treatment" Learn to play the game, reality is irrelevant to bureaucracy as long as the paperwork completes. Complete the paperwork by the most expeditious method possible.

But there is no evidence that the simple single cycle automated study results wouldn't be acceptable.
 
jbarrass said:
The problem is if you are screened as "high risk" but don't have it. Proving a negative to the FAA can be expensive......and take a long time.
Click to expand...

I haven't downloaded all the FAA AME documents yet. How easy is it to get screened into the high risk category is you don't have it? I don't know - the screening test is, hopefully, thorough enough to catch that case. But it's still a screening, the sleep study is the final word on if you have it and how bad it is. If you fail the screening, there is probably a good chance you have it.
 
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.
Click to expand...

I've known 12 yr old string bean kids that snore.
Snoring is not associated with him BMI numbers.
 
BillTIZ said:
I've known 12 yr old string bean kids that snore.

Snoring is not associated with him BMI numbers.
Click to expand...

But there are also people with OSA that are string beans. My boss fits that description. BMI in the low-mid 20s and has OSA.

Snoring by itself is not a diagnosis, but just one potential indicator to be taken with other signs.
 
Yep. The issue is a physiological blockage of the airway. Being overweight is only one cause. Your natural physiology can also create the situation regardless weight. Snoring is a sign the physiological conditions exist regardless the cause.
 
Matthew said:
One of the risk factors on the AME guide is jaw structure.
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I bet, "Do you sleep on your back?" Is in the questions as well. All the horrible snorers I have met, all sleep on their back while snoring, you roll them out of their bunk and they quit.
 
Henning said:
I bet, "Do you sleep on your back?" Is in the questions as well. All the horrible snorers I have met, all sleep on their back while snoring, you roll them out of their bunk and they quit.
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I didn't see that on the PDF.

I know that FAA doesn't accept sewing tennis balls into the back of a t-shirt as a way to force you to sleep on your side (I remember reading that on their website somewhere - maybe it was on AOPA medical.)
 
Sleepdoc said:
As a sleep physician who deals with pilots at all stages of the Special Issuance process, let me explain the new Guidelines as best as I can.
It is explained in detail at www.zeeappnea.com
Click to expand...
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.
 
timwinters said:
Sidetrack...

I've seen this a lot in the interwebs...when did the "less than" symbol (<) become the "greater than" symbol (>)?
Click to expand...

Perhaps he thought the magic happened when you were less than 35 BMI. I can't imagine anyone would think getting snared by this useless screening would find the experience magical.

Is the BMI calculation fairly standard or is it too subjective? Can I google up any old random BMI calculator and learn if I'm eating veggies tomorrow, and for the 18 months before my next renewal? :D
 
schmookeeg said:
It doesn't matter which one I use, it matters which one my AME uses. :)

I'd hate to eat a few bushels of broccoli only to learn the FAA uses some other metric to calculate the thing.
Click to expand...

BMI is a standard universal metric. The FAA doesn't have any special sauce.
 
I can't lose weight by diet alone. I have to exercise to make any progress.
 
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:
 
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.
Click to expand...
Bonanza~I feel ya, but it is what it is. (Pretty sure the questionnaire wasn't created by Sleepdoc. It is one of the few "additional resources" in the FAA document.) If your screening was positive there it will be positive at your exam too! You may want to look further into that. Not going to be hard to meet the high risk criteria when you only need 3 symptoms and gender and age are both factors! Sucks.
 
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.
 
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.
Click to expand...

I think the closest it has come was an article linking a FLIGHT CONTROLLER related accident to untreated sleep apnea. If there has been any pilot related incidents, they do a good job of keeping that out of the records. Nonetheless, doesn't seem like the process is getting any better. Or that we can avoid it. I think I liked the previous BMI related guidelines better. At least it was pretty black and white and everyone knew what they had to do to avoid problems. Don't want a sleep study? Diet! Now, with this new policy, I'm not so sure. Last time checked, I couldn't un-male myself!
 
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