I've been on CPAP since 2017 with great compliance. I feel so much better with it, it's not an issue to never be without it. In 2017, I was handed the machine which was set to Auto (APAP). The numbers were essentially checked only twice a year by my sleep doc and once a year during the flight physical. The biggest box checker was the 75% compliance of 6 hours/night of usage. My AHI's have never been great...more than 5, but less than 10. I had nasal surgery to remove part of the deviated septum, reduce nasal turbinate size, and install valves to hold things open. In the absence of daytime sleepiness, mental fog, or any other symptoms that would be attributed to OSA, no one ever had any issues. I was doing everything possible to do everything the right way. No hassles from my sleep doc or from the FAA...
UNTIL...
I received a letter of investigation regarding my "high" AHI (7.08)at my last physical, which was last July. They just want a letter of explanation from my doctor, essentially saying that yes, I'm compliant, yes, the treatment is, in their eyes, effective, and that I'm no danger to aviation safety.
I downloaded my SD Card into Oscar and whoa...my AHI's have steadily climbed over the past year. My Obstructive Apneas (OA's) have remained low...(.5 - 1.5). But the central apneas have been climbing. I reached out to my doctors and to a sleep tech for help. The sleep tech made the recommendations of putting the machine into CPAP mode with a fixed pressure, not auto.
By simply doing that, the AHI's immediately dropped to between 2 and 4. His thoughts are that the poor mask seal/high leak rate was allowing the machine to adjust pressure all night long, which 'helped' my body to blow off CO2, thus causing the central apneas. I've read up on the theory of treatment-emergent central sleep apnea, and what he's saying makes perfect sense. Additionally, by addressing the mask leakage and changing the settings as he recommended, the AHI's dropped immediately. I have not had one night of AHI's over 5 since. However, while my OA numbers are still low, my CA (clear airway or central apneas) haven't completely disappeared.
My doctor recommended moving me to a Bi-Pap ASV machine to essentially totally remove all of the central apneas. The primary diagnosis remains Obstructive Sleep Apnea, and with the ASV machine, my total AHI's have been as low as .5, and as high as 3.
All that said...
Does anyone have experience with the FAA seeing Obstructive Sleep Apnea treated with CPAP/APAP/Bi-Pap that evolves into Complex Sleep Apnea? I've only been on my new machine for a week. The average AHI is 2 during that time. Does the FAA just want to see the AHI's less than 5? What is the likelihood that they'll just say, yep, you were goofed up, but now you're fixed. Keep on keeping on (but don't let the AHI number get away from you this time. What I don't want to do is to send the FAA something that shouldn't have...like anything mentioning central sleep apnea. I don't have an issue with CSA, but a by-product of long-term APAP usage is the emergence of the occasional central apnea event. Will the new ASV machine be enough for the FAA? If an airman uses an ASV machine to treat the combination of OSA and the emergent CSA (possibly meets the definition of Complex Sleep Apnea) is that a disqualifier for the special issuance?
I feel that, surely with all of the airmen who are on special issuance authorizations for OSA, someone has also received the letter, "Your AHI is too high, we need a letter from your doctor."
Sorry this is such a long post...and my first one here, at that. I'd appreciate any helpful insight.
UNTIL...
I received a letter of investigation regarding my "high" AHI (7.08)at my last physical, which was last July. They just want a letter of explanation from my doctor, essentially saying that yes, I'm compliant, yes, the treatment is, in their eyes, effective, and that I'm no danger to aviation safety.
I downloaded my SD Card into Oscar and whoa...my AHI's have steadily climbed over the past year. My Obstructive Apneas (OA's) have remained low...(.5 - 1.5). But the central apneas have been climbing. I reached out to my doctors and to a sleep tech for help. The sleep tech made the recommendations of putting the machine into CPAP mode with a fixed pressure, not auto.
By simply doing that, the AHI's immediately dropped to between 2 and 4. His thoughts are that the poor mask seal/high leak rate was allowing the machine to adjust pressure all night long, which 'helped' my body to blow off CO2, thus causing the central apneas. I've read up on the theory of treatment-emergent central sleep apnea, and what he's saying makes perfect sense. Additionally, by addressing the mask leakage and changing the settings as he recommended, the AHI's dropped immediately. I have not had one night of AHI's over 5 since. However, while my OA numbers are still low, my CA (clear airway or central apneas) haven't completely disappeared.
My doctor recommended moving me to a Bi-Pap ASV machine to essentially totally remove all of the central apneas. The primary diagnosis remains Obstructive Sleep Apnea, and with the ASV machine, my total AHI's have been as low as .5, and as high as 3.
All that said...
Does anyone have experience with the FAA seeing Obstructive Sleep Apnea treated with CPAP/APAP/Bi-Pap that evolves into Complex Sleep Apnea? I've only been on my new machine for a week. The average AHI is 2 during that time. Does the FAA just want to see the AHI's less than 5? What is the likelihood that they'll just say, yep, you were goofed up, but now you're fixed. Keep on keeping on (but don't let the AHI number get away from you this time. What I don't want to do is to send the FAA something that shouldn't have...like anything mentioning central sleep apnea. I don't have an issue with CSA, but a by-product of long-term APAP usage is the emergence of the occasional central apnea event. Will the new ASV machine be enough for the FAA? If an airman uses an ASV machine to treat the combination of OSA and the emergent CSA (possibly meets the definition of Complex Sleep Apnea) is that a disqualifier for the special issuance?
I feel that, surely with all of the airmen who are on special issuance authorizations for OSA, someone has also received the letter, "Your AHI is too high, we need a letter from your doctor."
Sorry this is such a long post...and my first one here, at that. I'd appreciate any helpful insight.