Sleep apnea

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I'm in my twenties. I suspect I might have sleep apnea (I have a deviated septum that generally obstructs nasal breathing, I tend to feel a lot more tired during the day than I did a year or two ago, my wife reports that I snore all night in between gasps).

Before I go see a specialist (or a GP for a referral to a specialist, I guess), what do I need to know to minimize aeromedical consequences? I have a third-class and would like to keep it, preferably without a special issuance. I might like to get a second-class someday to do a little flight instruction on the side. I am not a career pilot and don't anticipate ever needing a first-class cert.
 
The experts will be around shortly, but wanted to add that it's my understanding that you only need a 3rd class for PPL or better CFI duties.
 
treated Sleep Apnea requires SI ... I have both. My 2 cents is - get it treated! Ok, actual proper order is 1. get it evaluated and diagnosed (sleep study), then 2. get it treated (C/Bi/APAP).

I had a deviated septum repaired, turbinate reduction, and sinus polyps removed, not as an attempt to treat Obstructive Sleep Apnea (OSA) but just because it needed treatment. I think it did make the CPAP more effective, in my opinion. Nasal obstruction removal made it easier to breathe, sinus polyps removed I believe reduced susceptibility for sinus infections.

The SI requirements are relatively benign and compliance is easy. Besides, you'll feel SO much better!
 
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As Greg said, OSA does require a Special Issuance (SI). But it's one of the easiest ones to obtain and comply with.

Do get evaluated and start therapy if needed. You'll feel much better, and you will forestall many other ailments including heart disease.

Evaluation usually is in the form of a "split study" where you're wired up for cable, sattellite, WiFi in addition to EEG's, sound, eye movement, leg movement, and more. You are allowed to sleep for the first half of the night so they can get a baseline of what's going on and how bad is your apnea.

Then you're fitted with a CPAP mask and sent back to sleep. While you're sleeping, they run the air pressure back and forth to find what range is best for you and keeps you from having apnea events.

If the sleep doc says, "yup, you've got OSA" then you need to obtain the following to bring to the AME:

1) A copy of the study and the doctor's interpretive notes.
2) A letter from the doctor saying that you do not have right heart failure on exam.
3) Add to the letter a statement from the doctor that you do not have any tendency to fall asleep beyond what is normal (Epworth Score)
4) 60-days minimum data from the CPAP machine (paper report from the download of the onboard history chip).

So, if you're dx'd with OSA, you're down for 60 days. Then bring all of this to your AME. The good and proactive AME's should be able to send this data to OKC in advance of your visit, and then get telephonic approval to issue the SI. The not so good and lazy one's will put you into the deferral queues.

Future compliance is simple. Just visit your regular PCP, and get him to write a status letter saying that he examined you, the data from your CPAP, and states that you are complying with therapy by being on the blower for at least 6hrs a night, and no removing the mask during the night. Also in the letter, you repeat the "no tendency for daytime sleepiness beyond the norm."

If you have questions about CPAP machines, Matthew and I have some good recommendations on vendors and models.
 
A word about obtaining the machine.

DO NOT get railroaded into purchasing a machine from your insurance companies or the doctor's "preferred" vendor. This is a bit of a racket where you might get sold a machine that isn't the best choice and it's sold to you at a massively inflated price, with you paying more than you should beyond the deductible.

You do have a say in both the brand/model and the vendor. Again, come back to us for recommendations when you're ready for them.
 
AggieMike and the others have it. OSA will be a SI, but it's really pretty simple to deal with. Once you get the initial SI you see your pcp once a year (a good excuse for an annual physical) and get your status report. You can mail that to OKC and wait, or go to your AME and let him renew it while you wait. Depending on your FAA medical schedule, the AME will also do his exam.
 
Unreg, it's an SI but a pretty easy one. Annually, you only need a letter and a 31 day download of your usage that shows ?75% of nights with >6 hours of usage.

The initial is:
31 days of CPAP report (Aggie, the target keeps moving)
Doc's letter saying 4 things: (1) complaint, (2) Appears well rested (3) No tendancy beyond nml to fall asleep, (4) No exam Rt. Heart failure.
Copy of original sleep study.

I get these on the phone just before exam.

No SI = no flying. SI is same for all classes of certificates.
 
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Unregistered said:
I'm in my twenties. I suspect I might have sleep apnea (I have a deviated septum that generally obstructs nasal breathing, I tend to feel a lot more tired during the day than I did a year or two ago, my wife reports that I snore all night in between gasps).

Before I go see a specialist (or a GP for a referral to a specialist, I guess), what do I need to know to minimize aeromedical consequences? I have a third-class and would like to keep it, preferably without a special issuance. I might like to get a second-class someday to do a little flight instruction on the side. I am not a career pilot and don't anticipate ever needing a first-class cert.
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If you're carrying any extra weight, consider losing that first. The sleep issue may go away. Plus it will be an additional health benefit either way.
 
LDJones said:
If you're carrying any extra weight, consider losing that first. The sleep issue may go away. Plus it will be an additional health benefit either way.
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Agree with this.
Also, the OP should read about OSA complications (which occur even in young folks in their 20's) if he has not already done so. It is not just passing a medical he should be concerned about.
 
LDJones said:
If you're carrying any extra weight, consider losing that first. The sleep issue may go away. Plus it will be an additional health benefit either way.
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Its not that simple. Sleep deprivation causes increased stress, and increased stress hormone secretion.. (corticosteroids..).

That, in and of itself, can cause elevated glucose levels and weight gain, even in the presence of weight loss attempts.

If you have sleep apnea, get it treated and THEN work on any correctable causes in a healthy manner. Weight loss may very well be the solution, but its easier to achieve with proper treatment of the sleep apnea.

Sleep apnea can wreak havoc on your heart and vascular system if untreated.
 
Thanks very much for the info and advice, everyone. I'm lucky enough not to be overweight. I've made an appointment with a sleep study center.
 
Unregistered said:
I've made an appointment with a sleep study center.
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If possible, select a doc that will take the time to review the results with you in person. Makes a big difference to help you understand what's going on, and gives you the chance to ask for the required letter in person.

PS. I would suggest handing the doc something close to a "fill in the blank" template. Plain language is best and some doctors like to use their medical thesaurus.
 
I would like to bump this because I am a student pilot in a similar situation.

I was diagnosed with OSA back in December 2012 and have been on the CPAP since the first week in January 2013. I am on my 6th-7th lesson with my CFI and had an exam with an AME scheduled for Tuesday next week. When I mentioned to him that I had been diagnosed with OSA, he suggested we cancel the physical until I can get the correct documents from my doctor.

It looks like the 4 items ((1) complaint, (2) Appears well rested (3) No tendancy beyond nml to fall asleep, (4) No exam Rt. Heart failure.) are relatively cut and dry, but as far as a copy of the original sleep report, I did a home sleep study in which they sent me home with some apparatus to put on while I slept. Does that method of sleep study and the resultant report provide the needed information?

Also, I have heard 60 days of CPAP history is required, but a few posts above it looks like 31 days. I'd just like to verify that it is indeed/still 31 days.

How long can I expect this to delay my medical? I anticipate solo in 5-6 more hours and I'm trying to decide if I need to (as much as I'd hate to) temporarily suspend lessons....
 
if you have sleep apnea or any other unusual medical condition I strongly urge you to contact Dr Chien to get his advice on how to proceed with your medical. He knows the rules inside and out.

If you don't want to wait months for the FAA to approve your medical go see Dr Chien in person it's, worth the trip.

Contact him in advance he will help you get all the paperwork for OSA exactly correct and you will be able to walk out of his office with your special issue updated medical certificate.

I know because I did that yesterday!! :D
 
I'm a bit far from Texas LOL.

Anyways I gathered the required documentation as stated above. The Dr. deferred to the FAA. Now I get to wait... crap
 
fiveoboy01 said:
I'm a bit far from Texas LOL.
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Dr. Bruce Chien is in Peoria, IL. And has the reputation of being the airman's advocate to FAA medical. He will do his best to avoid putting an airmen into the deferral queue.

Anyways I gathered the required documentation as stated above. The Dr. deferred to the FAA. Now I get to wait... crap
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That is unfortunate. Because if he was the AME he should be, this is an SI that he could have gotten telephonic approval to issue in the office. Bruce is one who does it this way.

During Sunday Brunch at Gaston's, Bruce told me that he and many of the harder working AME's like him are petitioning Dr. Tilton to put OSA into the CACI program.
 
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AggieMike88 said:
Dr. Bruce Chien is in Peoria, IL. And has the reputation of being the airman's advocate to FAA medical. He will do his best to avoid putting an airmen into the deferral queue.



That is unfortunate. Because if he was the AME he should be, this is an SI that he could have gotten telephonic approval to issue in the office. Bruce is one who does it this way.

During Sunday Brunch at Gaston's, Bruce told me that he and many of the harder working AME's like him are petitioning Dr. Tilton to put OSA into the CACI program.
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...got two of 'em this month.... :) :)
 
I really think the FAA is acting counter to safety by making OSA a special issue. No doctor is ever going to just tell you that you have sleep apena. It's something you have to realize for yourself.

I bet there are hundreds, maybe thousands, of professional pilots who strongly suspect they have OSA but don't want to ask the question because they can't stand the answer from the FAA.

Untreated OSA can directly lead to weight gain, high blood pressure, heart problems, and a general feeling like poo-poo. It's a bad thing that isn't hard to fix.

If the FAA really wanted to put safety ahead of CYA they would reward pilots who are getting treatment for their OSA by extending their medical intervals, not cutting it back or making them wait for months.

The current FAA policy concerning sleep apnea is insane.
 
Hi. I have sleep apnea. Dr. Chien in Peoria is my AME. He told me what I needed to get in advance- basically a read out of my logged machine usage and other data over time. My advice:
1. Call Dr Chien for a consult- different than an exam
2. Get a study and if you have SA, immediately get it treated. Forget about the flying aspects for a moment as your health is at risk if you don't. Not to mention safety.
3. Go to a respected health device dealer. You need them initially for mask fitting I have a Resmed S9 which is good for reporting.
4. After you are experienced you can go to CPAP.com for masks supplies etc.
5. Use machine religiously. S9 will log usage
6. Dr Chien will ask for report. You will need provider to download from machine. You can't do it. That's why u need to establish a relationship with a good provider. See bullet 3 above.
7. Schedule an appointment with Dr Chien. He asks for a lot of data, but he is thorough and will not be a waste of your time.

Good luck! If you wish to communicate privately my email is asgpiper@comcast.net.
 
As an aside, my personal feeling is that Dr. Chien is a true professional who knows his stuff, is responsive and gets things done. And he is a caring individual. I couldn't have been happier with my selection of an AME. I wish he was closer than an hour away via Cherokee, but glad he is not in another state. Think about this one... I recommended my sister goes to him for her exam. And she lives in Florida. He's the best.
 
I did forget to add that my doctor whom did my exam said he would wait about 1 week and call OKC and see if the process could be expidited because I was almost ready to solo.

Apparently he did, because my medical/student pilot certificate showed up in the mail today. That was much faster than I thought it would be.. my exam was on the 13th of this month.

I do appreciate the suggestions though guys :)
 
That just goes to show what a difference a helpful AME can make. You might have found a good one.
 
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