Sleep Apnea v. Time v. New Rules v. Insurance Requirement

[Ventucky Red]

Hi,

Two questions....

Just today I got a diagnoses of sleep apnea.. (sorry the wife was insistent on it.. ) I will not get my CPAP for another three to four weeks... I have my CLIII due on 3/1/2017, and this will not give me enough data for them to considers a SI... Not to mention this will raise the cost of the physical from $125.00 to $500.00 from my local AME.. My inclination is to wait it out until May 1st, and then go from there.. thoughts from the group?

Second question... the place I rent from is checking with their insurance company to see what they are going to require for the renters... we actually pay them for the insurance as their way of making sure we're covered... (its kosher, I had an attorney look at the policy). I and they are thinking that with the change the insurance may still require a Class I, II, III FAA exam... if that is the case what is the process of the SI, that is what do I need to bring when I go in for a physical?

Thanks

John

 

[gkainz]

pre-BasicMed, the last FAA documents I saw had a one time waver for 1 year of CPAP data. Talk to your AME about providing the report for actual use, plus a letter explaining new diagnosis, just starting CPAP etc ... as well as a letter from your Primary about the efficacy of CPAP dated about as close to your AME appointment as possible ...

or, like you noted, wait until May 1st but you now have a known medical disqualifying condition against your 3rd class medical starting from the day you got the official diagnosis, I believe ... but that's just my speculation and I'll defer to others on this.

re: second question - I posted something here in the last week or two from EAA, whereas they said in an article that they had polled insurance companies and brokers who all claim "no change in insurance practices after BasicPlus"... for whatever that's worth.

 

[azure]

or, like you noted, wait until May 1st but you now have a known medical disqualifying condition against your 3rd class medical starting from the day you got the official diagnosis, I believe ... but that's just my speculation and I'll defer to others on this.

While that's true, I'm pretty sure it's not one of the conditions that requires an SI before being BasicMed eligible. So the OP may be grounded for now, but should still be able to get a BasicMed signoff once he's treated, and assuming he can find a doctor who is willing to give it.

 

[JimNtexas]

If you are new to CPAP I'm pretty sure the faa will happy with 90 days of data showing 6 hours of use per night.

Do what I did, call Dr. Bruce Chen, pay him the cost of one hour of renting a C172, and get the most current and correct information.

Only trust Dr. Bruce! He almost certainly knows more current information than your AME.

You can still get your medical with your regular AME, but Dr Bruce will make sure you have all your ducks in a row before you do the physical.

 

[Ventucky Red]

I am thinking this is a situation where taking the high road may be the better option... How does one contact Dr. Bruce?

Thanks everyone for your input... most helpful.

 

[bobmrg]

I'm a CPAP user, not a doctor or seller, just passing on my experience: Look for a ResMed AirSense 10. Much smaller and easier to use than my first machine.

Bob Gardner

 

[Matthew]

Insurance companies want to see 4 hrs per night for something like 80% of the nights. The machines generally default to report these compliance numbers.

FAA wants to see 6 hrs per night for something like 80%.

Download Sleepyhead software and configure it for the 6 hr settings. You can generate all your compliance reports yourself by copying data from the cpap sd card.

Generally, you need a report with as many days of data as necessary (the first time). After that, you need a 1 year record. Also, you need a letter from your treating doc saying you are compliant and treatment is working (no excessive daytime sleepiness.) I think the AME should be able to issue in office. As far as his costs go, that's between the two of you.

Doc Chien will have more details.

I do NOT know how the new medical will work.

 

[bbchien]

The AME has the authority to issue the FIRST SI for Sleep Apnea out of his office (if he's got the memo). But I would be very hesitant to commit you until you have had a month of figuring out how to get the CPAP device compatable with your sleeping. Some fellows adapt right away...others need work on the zero Pap ramp, the face vs a nasal pillow mask, and just how the machine recognizes that you have fallen asleep, so that you don't fight it. A lot of docs forget the finer settings which make ALL THE DIFFERENCE IN THE WORLD to the user. It is where the rubber meets the face, as it were.

You need:
a One month minimum record (graph) of 75% compliance at >6 hours per night.
Copy of the original sleep study
Letter from your doc (the one managing you on the machine) after the first month of treatment, saying that:
you appear well rested
you are compliant with CPAP
You have no complaint of daytime sleepiness
You have no findings of rt. Heart failure.

Then you sign a "treatment affidavit". When you have all that, it is clear that you will be able to sustain the SI. If an AME issue you in the office prior to having this, it's a gamble if you will be able to comply with all the reuqests in the 90 days they give you---->until they retract the certificate, a "denial".

You can still make 3/31/2017.
Attached is how a Resmed report appears you need the 4th graph as seen on the smaller attachment)....the fellows here will tell you how to use the SD card data (make SURE you don't get a dumbed down base machine) so that you can create your reports with Sleepyhead Software, by yourself. You might need an SD card USB "dongle" reader ($10.00).

If you plan to renew (many don't if your Basic_Med docs are amenable) you will need a whole year's data (that graph is attached, and is a sleepyhead graph).

My email form this site is turned off. Email me via the link in my signature line. Many here have thrown me gratuitous abuse. (flyingriki most notably)

 

[DFH65]

BY the way if your AME is charging you that much for a apnea SI find another AME.

 

[AggieMike88]

Curious... why the long delay to get the machine? If you VP can get the prescription written to tomorrow, we know of a good supplier who can have your machine of choice by the end of the week.

 

[gkainz]

... Not to mention this will raise the cost of the physical from $125.00 to $500.00 from my local AME..

BY the way if your AME is charging you that much for a apnea SI find another AME.

adamantly concur on that point! My last SI AME renewal cost me less that $200 (full physical year)

... you now have a known medical disqualifying condition against your 3rd class medical starting from the day you got the official diagnosis, I believe ... but that's just my speculation and I'll defer to others on this....

While that's true, I'm pretty sure it's not one of the conditions that requires an SI before being BasicMed eligible. So the OP may be grounded for now, but should still be able to get a BasicMed signoff once he's treated, and assuming he can find a doctor who is willing to give it.

Yep - that was my point (not well made) ... grounded for now, until ... what? deemed compliant with CPAP by his AME? That's the part I wasn't sure about ... the "grounded until ... what/when?" Concur on your point about should be ok on BasicMed.

 

[bbchien]

adamantly concur on that point! My last SI AME renewal cost me less that $200 (full physical year)



Yep - that was my point (not well made) ... grounded for now, until ... what? deemed compliant with CPAP by his AME? That's the part I wasn't sure about ... the "grounded until ... what/when?" Concur on your point about should be ok on BasicMed.

That's not how the approval works. The SA program was designed to not get people grounded. the AME office issuance is basically a 90 ay temporary until you get the necessary stuff. I would NEVER commit an airman to getting it all worked out in 90 days, however, unless:

(1) I know it's already worked out.

 

[gkainz]

Thanks for sticking with this thread, Doc. Have I mis-understood the process here, though? I assume when we discover a grounding medical condition, we are grounded until we work through the SI process? (Pre BasicMed, of course).

So if I follow what you're saying, our OP has a valid 3rd class medical, is then diagnosed with sleep apnea, ... here's where I fall apart - should he self ground until he sees his AME who can in-office issue the SI for OSA?

 

[RJM62]

The AME has the authority to issue the FIRST SI for Sleep Apnea out of his office (if he's got the memo). But I would be very hesitant to commit you until you have had a month of figuring out how to get the CPAP device compatable with your sleeping. Some fellows adapt right away...others need work on the zero Pap ramp, the face vs a nasal pillow mask, and just how the machine recognizes that you have fallen asleep, so that you don't fight it. A lot of docs forget the finer settings which make ALL THE DIFFERENCE IN THE WORLD to the user. It is where the rubber meets the face, as it were.

You need:
a One month minimum record (graph) of 75% compliance at >6 hours per night.
Copy of the original sleep study
Letter from your doc (the one managing you on the machine) after the first month of treatment, saying that:
you appear well rested
you are compliant with CPAP
You have no complaint of daytime sleepiness
You have no findings of rt. Heart failure.

Then you sign a "treatment affidavit". When you have all that, it is clear that you will be able to sustain the SI. If an AME issue you in the office prior to having this, it's a gamble if you will be able to comply with all the reuqests in the 90 days they give you---->until they retract the certificate, a "denial".

You can still make 3/31/2017.
Attached is how a Resmed report appears you need the 4th graph as seen on the smaller attachment)....the fellows here will tell you how to use the SD card data (make SURE you don't get a dumbed down base machine) so that you can create your reports with Sleepyhead Software, by yourself. You might need an SD card USB "dongle" reader ($10.00).

If you plan to renew (many don't if your Basic_Med docs are amenable) you will need a whole year's data (that graph is attached, and is a sleepyhead graph).

My email form this site is turned off. Email me via the link in my signature line. Many here have thrown me gratuitous abuse. (flyingriki most notably)

Just out of curiosity, Doc, how would someone like me who rarely sleeps more than five hours be handled? I wake up raring to go after five hours these days. (When I was younger, not so much.)

I have no sleep apnea issues. I'm just curious.

Rich

 

[bbchien]

Thanks for sticking with this thread, Doc. Have I mis-understood the process here, though? I assume when we discover a grounding medical condition, we are grounded until we work through the SI process? (Pre BasicMed, of course).

So if I follow what you're saying, our OP has a valid 3rd class medical, is then diagnosed with sleep apnea, ... here's where I fall apart - should he self ground until he sees his AME who can in-office issue the SI for OSA?

The AME can issue a 90 day temporary for this one condition alone- so it has essentially been demoted to a "between pilot and AME" condition, until the SI authorization is issued. And that SI is nearly ALWAYS a 6 year auth, so it continues in that manner. This is UNLKESS the a/m falls asleep in the AME office, the AME checks box 5 and he is down. This has happened to me ONCE.

For RJM 62, it'd be a disaster. There always is a work around to the cookie cutter but those are never warm nor fuzzy.

 

[RJM62]

The AME can issue a 90 day temporary for this one condition alone- so it has essentially been demoted to a "between pilot and AME" condition, until the SI authorization is issued. And that SI is nearly ALWAYS a 6 year auth, so it continues in that manner. This is UNLKESS the a/m falls asleep in the AME office, the AME checks box 5 and he is down. This has happened to me ONCE.

For RJM 62, it'd be a disaster. There always is a work around to the cookie cutter but those are never warm nor fuzzy.

Thanks Doc.

Rich

 

[MD11Pilot]

RJM 62 and Dr. Chien
Both of your comments just further intensify my loathing of the FAA. So rare are the days that I sleep more than 5 - 6 hours that I can count them on both hands. I have been that way since I was a small child. Storey Musgrave, Astronaut on several missions sleeps three to a max of four hours a day, yet NASA deemed him acceptable for space flight. I know that both of your know that each and ever person is different and yes I understand the FAA bureaucracy is self limited to a cookie cutter mentality, but at least allow the local AME more latitude in certification without the automatic, expensive and intrusive medical testing that seems to always come around to "see, I told you so" from the pilot.
I went to bed last night about 10:30 and got up at 3:47 AM. Am I sleepy? A little but I have a trip in the morning and I KNOW how to prepare for it. On paper it may not look good but it works for me. My company makes me commute on the airlines and be at the hotel a minimum of 18 hours before showtime. I prefer to commute in with about six hours in the hotel and take a nap. When I get there early I now have to fight two sleep cycles and when I am supposed to show up, my body is telling me to go to sleep....which is safer? Me KNOWING my needs or some dr in OKC that has never had to work under the conditions that the FAA allows.

 

[Matthew]

FAA may look at this as: in one case it's your choice to get <6 hrs sleep and you self evaluate prior to flight. In the other case (OSA), it is not your choice to miss out on sleep because the condition has control. And it's not just sleep hours that matter, it's sleep quality that OSA affects.

The OSA SI 6 hr compliance requirement doesn't say 6hrs sleep. It says you need to be plugged in for 6 hrs most days.

 

[RJM62]

FAA may look at this as: in one case it's your choice to get <6 hrs sleep and you self evaluate prior to flight. In the other case (OSA), it is not your choice to miss out on sleep because the condition has control. And it's not just sleep hours that matter, it's sleep quality that OSA affects.

The OSA SI 6 hr compliance requirement doesn't say 6hrs sleep. It says you need to be plugged in for 6 hrs most days.

It's not so much a choice as simply the way it is. I almost never bother setting my alarm clock because I wake up on my own feeling fully-rested long before I have any actual need to be awake.

Lying fully awake in bed staring at the ceiling seeming a rather pointless use of my time, I get up, have a cup or two of coffee, read the news, and go to work. The hours between 5:00 and 8:00 are some of my most productive because I'm not interrupted by telemarketers or technologically-challenged clients who've forgotten their passwords and locked themselves out of their email accounts for the thousandth time.

I think it's age-dependent. I used to need a lot more sleep than I do now.

Rich

 

[Matthew]

^^^

OK, not so much a choice, I could have used a better phrase, but normal and without any medical cause for gettingng less sleep. But quality is a huge factor. You may be getting better sleep in 4 hrs than someone with untreated OSA does in 8.

 

[bbchien]

It's not so much a choice as simply the way it is. I almost never bother setting my alarm clock because I wake up on my own feeling fully-rested long before I have any actual need to be awake.

Lying fully awake in bed staring at the ceiling seeming a rather pointless use of my time, I get up, have a cup or two of coffee, read the news, and go to work. The hours between 5:00 and 8:00 are some of my most productive because I'm not interrupted by telemarketers or technologically-challenged clients who've forgotten their passwords and locked themselves out of their email accounts for the thousandth time.

I think it's age-dependent. I used to need a lot more sleep than I do now.

Rich

You're probably getting good quality sleep. If you're getting good quality sleep you don't need as much of it...e.g no sleep apnea.

 

[Anonymous]

Thanks Dr. Bruce and all for the great information/discussion in this thread so far.

I recently went to renew my third class medical that expires at the end of the month, and the AME deferred my application and told me to go get a sleep study on BMI > 40 alone (which I thought they weren't supposed to do but they did it anyway and even pretty much said as such). So while I try to deal with the BMI issue (working on it), I guess I am in for some SI "fun" with the FAA. AME didn't provide any other information or help beyond giving me the Spec Sheet B and telling me the FAA would send a letter with what they need.

My insurance company/sleep medicine provider only does a type 3 home study and only sends you to the sleep lab if the home study fails or is inconclusive twice. If it's positive the way I have read everything is that I need to get on treatment, get compliance data for 30 days, sign the affidavit and have my doc that prescribes the treatment attest to those things Doc Bruce mentions above.

Question: Is that it or will it be different since the AME deferred it vs. issuing the certificate and starting the 90 day clock? I'm worried the FAA is going to give me a tougher deadline (somewhere I read 30 days) once they do send me a letter...

I already have the sleep study scheduled so I am trying to get things in motion before getting any sort of letter from the FAA.

Thanks!

 

[bbchien]

No functional difference. He had to put a sleep apnea assessment on his side of the application; with BMI~=40 you likely have it (95% sez so).

The only thing he could have done better was
No exam
Send you for the stuff
Wait for you to demonstrate able to use CPAP
Then issue the cert, the doc's letter (favorable) after 30 days of CPAP is a near certainty.