Third Class Medical and Sleep Apnea – Questions

[Weebs]

I have decided to pursue my PPL training after flying with a friend of mine and getting bit by the “bug” again. It’s been on my list since I was a kid and used to go to EAA every year.

I’ve had a few flights with a CFI and am ready to contact an AME for my Third Class Medical. I had a physical this spring and passed with flying colors so I thought this should be a piece of cake. Luckily I did some research on a Third Class Medical and Sleep Apnea and found this forum.

This has brought me to a screeching halt. I do not treat my OSA with a CPAP. Instead I use a dental device through my sleep clinic. My understanding is that since I cannot prove compliance with the dental device I will have to use the CPAP. I have gone back on the CPAP but only have a week of data.

So how much data do I need before I contact an AME (30, 60 days)?

How often would I need to prove compliance?

Would I have to do a WMT (Wakefulness and Maintenance test)?

It seems a good AME is a must if I don’t want this to get bogged down at the OKC office. Any recommendations for a good AME in the Atlanta area?

Any advice to move this along quickly would help. I am looking at buying a Cessna 140a. The seller is offering instruction (he’s a commercial pilot, part time CFI, has great references from 2 friends that have trained with him, plane is his baby not his trainer). The first buyer with the cash will own it but I sure don’t want to commit until I am comfortable with obtaining and keeping my Third Class.

 

[bbchien]

I see my email corespondence wasn't convincing. This does however, require a Madatory Watchfulllness test. Then the only way to prove compliance is by the Sleep doc's current status assessment letter- there are four items required in that letter.

If you have that, the AME of record, if he has the wherewithall, can get you issued on a phone call at time of exam.

 

[gkainz]

Hey Weebs ... whatever Dr. Bruce gave you, follow it. That is all.

 

[AggieMike88]

Hey Weebs ... whatever Dr. Bruce gave you, follow it. That is all.

As a holder of an SI for Sleep Apnea, I followed Dr. Bruce's directions and it made obtaining the SI a very simple thing.

 

[Weebs]

Sorry Dr. Bruce I checked and rechecked my email and spam filter with no luck. I'm not sure where your email response went.

I figured everybody takes a vacation now and then

Could you resend?

 

[bbchien]

This can be published w/o giving anything away. You need a Mandatory Watchfullness Test, with the device in. Compliance is addressed in the sleep doc's current status essay which has to say,

(1) Appears well rested
(2) historically compliant.
(3) No tendancy to fall asleep than the normal.
(4) No gross right heart failure on exam.

With the letter and the MWT, a good AME can get you approved same day. But choose the AME carefully. If you choose one that won't call it in to the Federal doc, nobody else can push your case except that guy.

 

[Weebs]

This can be published w/o giving anything away. You need a Mandatory Watchfullness Test, with the device in. Compliance is addressed in the sleep doc's current status essay which has to say,

(1) Appears well rested
(2) historically compliant.
(3) No tendancy to fall asleep than the normal.
(4) No gross right heart failure on exam.

With the letter and the MWT, a good AME can get you approved same day. But choose the AME carefully. If you choose one that won't call it in to the Federal doc, nobody else can push your case except that guy.

I am concerned about the burden of maintaining the SI and wondering if the MWT is a one time test or must it be repeated? Is proof of compliance (as in CPAP data) an annual event?

Since I have just switched back to CPAP I am unsure of how many days I will need on the machine to satisfy compliance and take my trip to the sleep doc. 30 days?

Although I probably know the answer to this one, is there any way I could use my dental device instead of the CPAP?

Thanks for your support. I think I am almost there

 

[bbchien]

Whoa whoa whoa whoa whoa.

Everything is about your stable state. Switching back and forth will just ground you for "stability periods", e.g, longer. You are about to become every AME's nightmare.

You either use the appliance or use CPAP or both, you do not switch back and forth.

The minimum stability period is 30 days of recording (or of use of the appliance, or of both). In fact you can do what you want but if you do that, it will be a very long time until you see a medical certificate.

Example: vision. If a pilot needs near vision "granny" glasses to pass the eye exam, we certify him in that combination and his medical specifies that he must possess grannies...

If the airman uses CPAP, we are interested in his compliance with CPAP and the resultant stable state evaluation. If he uses a dental appliance, we are interested in that resultant stable state evaluation. If he uses both, we test him in that state.

But if you switch back and forth it will be multiple periods obtaining demonstrated stability, and the "stable state" Doc's evaluation letter.

HYPERTENSION is the same way. 2 weeks is the traditional period that physicians use to determine if the sodium balance disruption created by an antihypertensive is stable and the situation is good (3 half lives of salt, renin, and angiotensin adjustment). If the doc keeps changing the meds, we keep piling up the two week periods.

30 days is the acceptable minimum period for mucking with Sleep Apnea Rxs. I have gotten airmen certified on a 30 day record. But it's a minimum. A rock bottom minimum.

With regard to annual events:

On the appliance, the MWT is discretionary annually to the physician writing your letter.

On the CPAP, the repeat sleep study +/-MWT is discretionary annually to the physician writing your letter.

This is about as long a comprehensive a post as I have time to create. Much more and you really, really need document review and a consult to get this right because going in multiple directions is not productive.

The BOTTOM LINE: Choose what works for you and then document it. the burden is nearly identical. Since appliances don't have recording devices, you depend much more on the ability of the Doc to write a letter that addresses all 4 items in my prior post (#6).

 

[Weebs]

I certainly am not trying to become an AME's nightmare

I have been working on the assumption that I could not use the dental device so would have to go back to CPAP to obtain a SI. I could see now why you thought I was going in multiple directions.

That is good news. Your response to mine and other posts on this website are the only resources that I could find on this subject. My hat is off to you sir!

 

[ja_user]

Hey Weebs, where do you live?

 

[bbchien]

I certainly am not trying to become an AME's nightmare

I have been working on the assumption that I could not use the dental device so would have to go back to CPAP to obtain a SI. I could see now why you thought I was going in multiple directions.

That is good news. Your response to mine and other posts on this website are the only resources that I could find on this subject. My hat is off to you sir!

You can be certified in any combination which is successful. But the combination has to be stable and the outcome verified.

 

[Skip Miller]

You need a Mandatory Watchfullness Test

Bruce, is this the correct terminology for MWT? I thought it was a Maintenance of Wakefulness Test? Or is that something different?

-Skip

 

[Weebs]

Hey Weebs, where do you live?

I am in the Atlanta area.

 

[bbchien]

Bruce, is this the correct terminology for MWT? I thought it was a Maintenance of Wakefulness Test? Or is that something different?

-Skip

This is like potato and potatoe. Maintainence of Wakefullness if the HCFA descriptor. Mandatory Watchfullness Test is the DOD descriptor IIRC..... sigh.

Weebs, see your email, I made an AME suggestion. Say "hi" from me if you use him

I would not go to any AME until you have all your documents together. Seriously.

 

[Weebs]

You can be certified in any combination which is successful. But the combination has to be stable and the outcome verified.

The initial verification is then backed by a sleep doc visit and MWT. How about the SI (not sure this is annual) renewal and Third Class re-cert down the road? I interpret this as MWT's each time for dental device. Ouch

This is like potato and potatoe. Maintainence of Wakefullness if the HCFA descriptor. Mandatory Watchfullness Test is the DOD descriptor IIRC..... sigh.

Weebs, see your email, I made an AME suggestion. Say "hi" from me if you use him

I would not go to any AME until you have all your documents together. Seriously.

I received your email. Thanks a bunch. Will say "hi" when I make the visit. Everybody's help here has been priceless. Thanks again.

 

[bbchien]

M__t: see post #8

On the appliance, the MWT is discretionary annually to the physician writing your letter.

On the CPAP, the repeat sleep study +/-MWT is discretionary annually to the physician writing your letter.