undiagnosed sleep apnea/upcoming medical

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hey all, here is the situation. I just scheduled my 3rd class medical (first one, just about to get started as a student). My wife has told me that, aside from my snoring, I stop breathing for short amounts of time at night, leading me to suspect that I have sleep apnea. (Im also overweight, which makes me more at risk). I have not seen a doctor about it, and plan on doing so.

My question is, should I wait until after my medical exam to seek a diagnosis to avoid some of the red tape regarding an SI? or will the AME ask for a sleep study, so I should get going on it now? My exam isn until february and my PCP can see me right after christmas.

Thanks
 
If you get your 3rd class medical first, you'll have a few years to get your ducks in a row for the next one when you'll have to jump through the hoops...

(I'm sure someone will be along shortly to give you the "proper" answer.)
 
Since you have not been diagnosed, and you are not a physician yourself, you can right now honestly and legally answer "no" to the question of whether or not you have ever been diagnosed with sleep apnea. Beyond that, I'd suggest contacting Dr. Bruce Chien, MD, AME, ATP, CFI, for more information on how to handle this. You can reach him via his web site or on the AOPA Forums.

And for this and other reasons (like diabetes, joint problems, and cardiovascular issues), start working right now on a diet and exercise plan to lose that extra weight. That alone may make the problem go away.
 
dans2992 said:
If you get your 3rd class medical first, you'll have a few years to get your ducks in a row for the next one when you'll have to jump through the hoops...
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Not really, unless the OP chooses not to get this examined at all by a doctor. Even if the OP does get the medical now, any future diagnosis of sleep apnea, a disqualifying condition, 14 CFR 61.53 requires immediate self-grounding until either a SI is received or the condition is no longer present.
 
I definitely plan on seeing my doctor about it. and I am working on losing the weight and getting healthier. I didnt realize that I would have to self ground once I received a positive diagnosis. but it makes sense. thanks for the input.
 
Check with your dentist. He might be able to fit you with something that could help with the snoring problem that's keeping your wife awake. And he won't be doing any sleep studies or diagnoses.
 
Unregistered said:
I definitely plan on seeing my doctor about it. and I am working on losing the weight and getting healthier.
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Good. I got the wake-up call 15 months ago via my HbA1c going past 6.0 and my triglycerides over 400, despite my decades of good exercise, and largely due to poor dietary choices (spelled "carbohydrates"). Made some major changes to my diet, improved my exercise regimen, lost 15 lb, and Type II diabetes is no longer looming.

I didnt realize that I would have to self ground once received a positive diagnosis. but it makes sense. thanks for the input.
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No problem. And do give Bruce a shout for better long-term advice on these issues.
 
I lost over sixty pounds since January, and I was surprised to find that it was easier than I expected once I got past my (erroneous) belief that counting calories would be too much work. I used spreadsheet software to add it up every day, but I understand that there are apps for portable devices that make it even easier. I found a digital food scale very helpful. It also helped when I found out that limiting myself to 2000 Calories a day was sufficient to get the job done. (If anything, I lost weight too quickly. I'm told that one should not aim to lose more than 1.5 pounds a week on a sustained basis.) I'm currently maintaining a constant weight on 2600 Calories. I could stand to lose a little more weight, which I plan to start on after Christmas.

You may have to experiment to find the number of calories that give you a reasonable rate of weight loss. Of course, one needs to maintain a balanced diet as well.
 
Ron Levy said:
Not really, unless the OP chooses not to get this examined at all by a doctor. Even if the OP does get the medical now, any future diagnosis of sleep apnea, a disqualifying condition, 14 CFR 61.53 requires immediate self-grounding until either a SI is received or the condition is no longer present.
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Does 61.53 call out Sleep Apnea specifically or are pilots just supposed to "know" what constitutes self grounding and what doesn't?

I can party all day, then go out and fly all night and it's perfectly legal (ex AF447), but getting a good night's sleep hooked onto a CPAP is verboten absent the right paperwork.... Yes, I realize these are the regs, but they defy common sense.
 
dans2992 said:
Does 61.53 call out Sleep Apnea specifically or are pilots just supposed to "know" what constitutes self grounding and what doesn't?
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61.53 does not call out any specific conditions. It requires you to self-ground when you know or have reason to know that you have a condition that would make you ineligible for the medical certificate, so you have to refer to Part 67. Many conditions are specifically listed there, but not sleep apnea. That would fall under the catchall provisions, 67.113(b), 67.213(b), or 67.313(b). The conditions that the Federal Air Surgeon finds to be disqualifying under those sections of the regulation could probably be dug up on the FAA Web site somewhere.
 
Palmpilot said:
61.53 does not call out any specific conditions. It requires you to self-ground when you know or have reason to know that you have a condition that would make you ineligible for the medical certificate, so you have to refer to Part 67. Many conditions are specifically listed there, but not sleep apnea. That would fall under the catchall provisions, 67.113(b), 67.213(b), or 67.313(b). The conditions that the Federal Air Surgeon finds to be disqualifying under those sections of the regulation could probably be dug up on the FAA Web site somewhere.
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So, if I was a "normal" pilot who did not read PoA, or hear the news about the latest sleep apnea kick the FAA is on, how would I realistically know that sleep apnea is disqualifying?

After all, it seems like a pretty minor ailment. Not like a stroke/heart attack, seizure, etc.
 
I am no doctor but I do have a sleep apnea SI

If you are diagnosed right now I would be concerned that you wouldn't have the data you need for your exam in February. You would need to be diagnosed get the machine be on it for a period of time 30-60 days or some such and then after proving compliance find an AME that can and will issue the SI in the office or you could be waiting for the FAA to get through the paperwork.

Unless your wife is a doctor, you don't know if you have anything other than an annoying snore diagnosis. Everyone has apneas and up to five an hour is considered normal. Not saying don't get tested you absolutely should if you think you have it (are you sleepy in the daytime?, Wake up with headaches?) but timing is everything.
 
Therer are 15 disqualifing conditions in regulation:
  1. Angina pectoris
  2. Bipolar disease
  3. Cardiac valve replacement
  4. Coronary heart disease that has been treated or, if untreated, that has been symptomatic or clinically significant
  5. Diabetes mellitus requiring hypoglycemic medications
  6. Disturbance of consciousness without satisfactory explanation of cause
  7. Epilepsy
  8. Heart replacement
  9. Myocardial infarction
  10. Permanent cardiac pacemaker
  11. Personality disorder that is severe enough to have repeatedly manifested itself by overt acts
  12. Psychosis
  13. Substance abuse
  14. Substance dependence
  15. Transient loss of control of nervous system function(s) without satisfactory explanation of cause.

If you have one of these you are probably required to ground since you know you have a condition that is disqualifying, regardless of a "formal" diagnoses.

Beyond these, the bureaucracy has added an unknowable and undocumented number of conditions that require deferral and issuance under an SI. Things like Sleep Apnea and Prostate cancer fall into this class. They are not disqualifying but will prevent a normal issuance. Whether this requires you to ground in the interim is debatable. Those close to the bureaucracy say you should (if you know). Some say you should, out of fear of awakening the wrath of the bureaucrats and their unfettered control of the issuance process.

Others say follow the published regulations, answer the questions honestly, and deal with it at the next medical. Congress was clear earlier this year, if they want to add Sleep Apnea to the list of disqualifying conditions, they should follow the rule making process. Seems like a good idea to me.
 
Half the American population would be diagnosed with sleep apnea if they were all tested. Unless you feel tired every day, etc. just forget this. Especially don't put this "diagnosis" from your wife on your medical application.
 
Google sleep apnea quiz if you're curious. Even if you answer yes to all the questions it's still not a diagnosis until a sleep study and analysis confirms it. Do you fall asleep face first in your spaghetti?? Not since I was 2. Do you fall asleep at red lights? Just the red lantern inn. :) not quite the questions on the quiz. :)

My wife did diagnose my OSA. Other than the obligatory "told ya so" her diagnosis held no weight.
For the record, I have a SI for OSA for many years now.
 
I got my OSA diagnosed prior to flight training, so I didn't really have any timing to deal with. It was pretty obvious in my case, I'd wake myself up with a gasp whenever I dozed off in my recliner in front of a Sunday afternoon ball game. I think that if you have OSA you will snore, but if you snore you don't always have OSA.

My explanation of of apneas to anyone that wonders: breathe through your nose, then on an inhale, close your throat like you are swallowing. Hold that for about 10 to 20 seconds, then open your throat. You'll inhale with a gasp. Now repeat that every couple minutes during the night and you have OSA.

If you don't think you have OSA, you might not. This is why I suggested talking with your dentist first. If you can stop your snoring that way, you won't have a diagnosis to deal with.
 
Oh....
yawn.gif
 
Capt. Geoffrey Thorpe said:
It's all about plausible deniability.
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...and ignorance of the law is no excuse. Any time you discover you have some medical condition, it's on you to determine whether it's an aeromedical issue or not. Consultation with an AME or the Regional Flight Surgeon is the best way to find out.
 
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My OSA became very apparent to me in the dentist chair. They tipped me back to do some work and I couldn't exhale.
 
gkainz said:
Google sleep apnea quiz if you're curious. Even if you answer yes to all the questions it's still not a diagnosis until a sleep study and analysis confirms it. Do you fall asleep face first in your spaghetti?? Not since I was 2. Do you fall asleep at red lights? Just the red lantern inn. :) not quite the questions on the quiz. :)

My wife did diagnose my OSA. Other than the obligatory "told ya so" her diagnosis held no weight.
For the record, I have a SI for OSA for many years now.
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My wife also "diagnosed" sleep apnia based on watching Opra. Bought a $500 CPAP machine and found out it wasn't an issue.

I suggest loosing 15-20 lbs and being done with it.
 
Personally, I would do it in this order:

1. Get your medical. Be honest, by which I mean say nothing. You haven't been diagnosed, and you're not a doctor. Unless of course you are.
2. Buy some earplugs for the wife.
3. Lose a whole bunch of weight.
4. Take away the earplugs.
5. Ask the wife if you're still doing that thing at night.
6. Repeat steps 2 through 5 until the wife's answer is "no."
7. If you reach the point of emaciation and are still doing that thing, then see a doctor about it.

The chances are good that all you have to do is lose weight. Personally, I'd try that before (literally) making a federal case about it.

But that's just me.

Rich
 
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All OSA is not weight related. I have a large neck. I've had OSA even as a junior in high school wrestling at 165 pounds.
 
Unregistered said:
hey all, here is the situation. I just scheduled my 3rd class medical (first one, just about to get started as a student). My wife has told me ...
My question is, should I wait until after my medical exam to seek a diagnosis to avoid some of the red tape regarding an SI? or will the AME ask for a sleep study, so I should get going on it now? My exam isn until february and my PCP can see me right after christmas.

Thanks
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There is no question on the medical form about what your wife says! Unless your wife is an MD her opinion isn't relevant.

I'm assuming that you don't feel especially sleepy when you go flying, that you don't see a risk of falling asleep while flying or driving.

Fill out the form, get your medical. Once you have your medical THEN make an appointment with your family doctor to discuss your sleep issues.

I have an SI for sleep apnea. Going on CPAP was a big help to me in losing about 70 pounds over about 8 months.

But really, the Sleep apnea Special Issuance is medium to large sized hassel. Unless your AME is an expert (like Dr Chien) an apnea diagnosis can delay your medical for months.

It takes a few weeks just to get your sleep study accomplished and the results back. A short delay won't make any real difference.

In my case I don't think I even have apnea any more, so I hope to get 'undiagnosed' before my next physical. I'm keeping my fingers crossed.

[edited to add:]

. It was pretty obvious in my case, I'd wake myself up with a gasp whenever I dozed off in my recliner in front of a Sunday afternoon ball game
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That was my problem. This would happen to me. I'd doze off, head would go forward, and I'd wake up gasping for breath. Now that I've lost weight that has stopped happening.

You can snore and not have OSA, and not snore but have it. Weight is a cause, but not the only cause.
 
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Ron Levy said:
...and ignorance of the law is no excuse. Any time you discover you have some medical condition, it's on you to determine whether it's an aeromedical issue or not. Consultation with an AME or the Regional Flight Surgeon is the best way to find out.
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I have a hang-nail.... I'd better get ahold of these guys right away!
 
Unregistered said:
I definitely plan on seeing my doctor about it. and I am working on losing the weight and getting healthier. I didnt realize that I would have to self ground once I received a positive diagnosis. but it makes sense. thanks for the input.
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Personally, if you're serious about the diet and exercise plan I'd let that work first BEFORE raising the issue with your doctor. Once you've seen a doctor for it it's in your records and needs to be disclosed.

Weight loss cures a multitude of bad things. I'm restarting my diet after tomorrow. :wink2:
 
Unregistered said:
hey all, here is the situation. I just scheduled my 3rd class medical (first one, just about to get started as a student). My wife has told me that, aside from my snoring, I stop breathing for short amounts of time at night, leading me to suspect that I have sleep apnea. (Im also overweight, which makes me more at risk). I have not seen a doctor about it, and plan on doing so.

My question is, should I wait until after my medical exam to seek a diagnosis to avoid some of the red tape regarding an SI? or will the AME ask for a sleep study, so I should get going on it now? My exam isn until february and my PCP can see me right after christmas.

Thanks
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You'd do well to engage an AME who's a pilot advocate and get some real guidance. If you lived in Alaska I could send you to a couple of them. Ask your local pilot friends who they use in your area. If you're uncertain or reluctant to move forward consider spending the $100 fee to enroll in AOPA's pilot protection services. They'll advise you about how to navigate your particular issues and will help guide your file through special issuance process if it comes to that.

Re: the advice about plausible deniability or to not report your condition. All pilots who have FAA medicals are required to comply with medical certification guidelines and are required to self ground when we aren't in conformance with them. Those conditions of issue are printed on the back side of every airman's medical certificate. But don't let that scare you off. Seek out a good AME and get your med cert.
 
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thanks for all the input! I sent an email to Dr. Bruce, who was very helpful. He recommended that I get started with my doctor right away. I havent started my flight lessons yet, but I plan to soon, so the less time I have to go without a medical, the better. by the time I get the sleep study done and get on a CPAP for 30 days (assuming I have OSA), and wait for the deferral, I should be close to soloing, hopefully. that sounds better than getting neck deep in lessons, then taking a 2 month vacation from it while I work out an SI. I drive for a living, and dont feel like exhaustion affects my job, but I do feel tired often, and I wake up with headaches more mornings than not.

I would never use a "diagnosis" from my wife on a legal document. Thats foolish and dishonest. but it made me realize I should do something about it. if my quality of life (and my wife's) improves by taking care of it now, its worth the slight delay to handle it.

I still have my medical mid feb, and Im going to see my PCP tomorrow, so there is even a chance I can have the paperwork all together for the AME to send in then.


Again, thanks for chiming in!
 
dans2992 said:
I have a hang-nail.... I'd better get ahold of these guys right away!
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If you can't figure that one out yourself, you're not smart enough to be allowed to fly alone. As the commander of the 27th TFW once told his aircrews, "you gotta be smarter'n a box o'rocks".
 
Ron Levy said:
If you can't figure that one out yourself, you're not smart enough to be allowed to fly alone. As the commander of the 27th TFW once told his aircrews, "you gotta be smarter'n a box o'rocks".
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If I know I have sleep apnea, but am not tired and feel fine, the only way I'd know to self ground would be reading stuff on these forums, or diving into the minutia of the FARs. Most pilots do neither.

Not that it makes it right, mind you, but a "reasonable person" would not assume sleep apnea would disqualify them, assuming they do not feel tired.
 
Everyone has apneas. To have a diagnosis of OSA you need a certain number of apneas per hour.
 
dans2992 said:
If I know I have sleep apnea, but am not tired and feel fine, the only way I'd know to self ground would be reading stuff on these forums, or diving into the minutia of the FARs. Most pilots do neither...
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It's not even in he FARs. The only thing that covers it is the following, from 67.113, 67.213, and 67.313:

(b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds—

(1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges...
​
 
Isn't an SI by definition a statement from FAA that you aren't qualified to hold a medical? They are making a special case for you.
 
I consider my SI as a conditional issuance based upon my current health status and my maintenance of it. My SI medical status is subject to a higher level of scrutiny than a standard pilot would expect but other than that it's no big deal. Every one of us has a conditional issuance. Some of us just have to prove up more regularly than others.
 
My SI letter for OSA says:

vvv
...
You are ineligible for medical certification under Title 14, Code of Federal Regulations (CFRs) revised part 67; specifically under paragraph(s) or section(s) 67.113(b)(c), 67.213(b)(c) and 67.313(b)(c). I have determined, however, that you may be granted an Authorization for special issuance of the enclosed third-class airman medical certificate as provided for in Title 14 of theCFRs, Section 67.401.
...
^^^

Highlighted section is in the letter that way.

That reads to me to mean that OSA is a disqualifying condition - but the FAA will let it slide if you follow the rules.
 
The weird thing to me is that the FAA's requirements for OSA are the same for all classes of licenses.

I can kind of see requiring the SI for class I or II medicals. For class III I think the SI is overkill unless the pilot is experiencing significant sleepiness during his or her normal day.

A professional pilot has to fly when told, a GA pilot does not.
 
The FAA has a burr up their ass about OSA since a few pilot dozing incidents (including the one from Wakeup! airlines where both pilots fell asleep). It hasn't further been helped by having a train driver fall asleep and run off the tracks as well.
 
The FAA is part of DOT. DOT has been targeting sleep disorders for a few years and they've already successfully applied aggressive regulations to commercial truck drivers. This isn't an FAA thing, it's a DOT thing.
 
Agreed...hits a little close to home as two of my daughter's friends were killed when a dozing dump drunk driver slammed through them at a red light. I don't think this idiot had OSA, just working too long hours.
 
Stewartb said:
The FAA is part of DOT. DOT has been targeting sleep disorders for a few years and they've already successfully applied aggressive regulations to commercial truck drivers. This isn't an FAA thing, it's a DOT thing.
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So we should be expecting to see mandatory apnea treatment for non-commercial drivers soon? :)
 
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