CPAP frustration - pulling my medical!

[Palmpilot]

I think it measured reaction times. I thought I found it once, about a year ago. I'll look again.

edit:

Pretty easy to find this one, but I don't know if it's the only one:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1739867/

Thanks. Looks like my hunch was right, at least as far as this study is concerned, in that it focuses on performance, which is a different issue than the lowering of inhibitions.

An important implication of this is that declining to fly while impaired could be more likely for a person suffering from sleep deprivation than it is for someone who is inebriated.

 

[Matthew]

Thanks. Looks like my hunch was right, at least as far as this study is concerned, in that it focuses on performance, which is a different issue than the lowering of inhibitions.

An important implication of this is that declining to fly while impaired could be more likely for a person suffering from sleep deprivation than it is for someone who is inebriated.

I see where you are going with that. Yeah, BAC impairs your decisions in ways OSA doesn't.

Trying to be devil's advocate on this: You are clear headed and feeling rested prior to the flight so you give yourself a passing score on the IMSAFE checklist. You get into some nice, smooth air, the engine is droning on, the afternoon sun is nice and warm, you get a case of the drowsies and miss a FF traffic warning and don't see the other plane because your eyes are focused on infinity for a few seconds. You yawn, shake your head, and realize that tail number in your headset is yours, asking how you read.

Could that happen to anyone? Sure. FAA might have reason to believe that statistically it happens to someone with OSA more often.

I understand why it's a deal. And I think the new rules allowing AMEs to issue are a really good step to keep people flying instead of grounding them for a deferral that first time. Maybe someday it won't be an SI (once > 50% of pilots are on CPAP?), that would be nice. I think it would also be a good compromise if FAA dropped the SI after the airman showed compliance for a few years and showed he could be trusted to stay complaint.

 

[Fearless Tower]

I knew I had sleep apnea. I'd "worked around" it for years. But the narcolepsy first manifested itself for me without other warning at freeway speed on the interstate in heavy traffic conditions.



Its not about documenting SA as a cause of the crash. Its about the real risk of SUDDEN incapacitation. Like seizures... like living with an implanted defibrillator... Like every other licensing and regulatory body, the FAA is not about protecting pilots or their right to fly. Its about protecting the public and managing manageable risk.

BUT, the big point is that you knew you had an issue before it got to that point.....and as you said yourself, you "worked around it".

 

[Palmpilot]

I see where you are going with that. Yeah, BAC impairs your decisions in ways OSA doesn't.

Trying to be devil's advocate on this: You are clear headed and feeling rested prior to the flight so you give yourself a passing score on the IMSAFE checklist. You get into some nice, smooth air, the engine is droning on, the afternoon sun is nice and warm, you get a case of the drowsies and miss a FF traffic warning and don't see the other plane because your eyes are focused on infinity for a few seconds. You yawn, shake your head, and realize that tail number in your headset is yours, asking how you read.

Could that happen to anyone? Sure. FAA might have reason to believe that statistically it happens to someone with OSA more often.

It's possible that I could have had undiagnosed OSA before I lost sixty pounds, but I never fell asleep without feeling drowsy first, so there was always the opportunity to pull the car over and take a nap, or land the plane somewhere (or not take off in the first place).

The thing that concerns me about the study citations is the implication that OSA is as bad as being inebriated, which appears to be an exaggeration.

I understand why it's a deal. And I think the new rules allowing AMEs to issue are a really good step to keep people flying instead of grounding them for a deferral that first time. Maybe someday it won't be an SI (once > 50% of pilots are on CPAP?), that would be nice. I think it would also be a good compromise if FAA dropped the SI after the airman showed compliance for a few years and showed he could be trusted to stay complaint.

I don't understand why the focus on treatment compliance for THIS condition and not all the rest, especially when people who are successfully treated are said to love their CPAP or APAP machines because they feel so much better. I'm not one to go on about "the nanny state," but this sure seems like an example.

 

[saddletramp]

So how late was your response?

My sleep study & all other paperwork arrived certified to The FFA at 10:30 the morning of the 6th. The non-compliance letter was mailed be the FFA on the 8th. I doubt they got it before the letter went out.

I'll try to get through by phone tomorrow. I did call late in December asking for the 30 day extension but was told they couldn't do that over the phone. I did request the extension in my letter with my new cpap info.

I'm hoping I don't have to send in my medical certificate as they requested within 14 days!

I'll report on how this plays out.

 

[Let'sgoflying!]

Maybe, Mari.
But if so, it is amazing to me that the FAA would come down so hard on it based upon a 'hunch' that it might be involved in accidents.

Wouldn't that be pretty hard to prove one way or another?

Again, has a crash ever been attributed to S.A.?

 

[Everskyward]

Maybe, Mari.
But if so, it is amazing to me that the FAA would come down so hard on it based upon a 'hunch' that it might be involved in accidents.

I think the impetus has come from other transportation accidents that have been linked to people falling asleep. If you fall asleep for a minute while flying in cruise on autopilot, nothing is likely to happen. The same could not be said for truck and bus drivers and probably for train engineers.

 

[JimNtexas]

Self ground. Do CPAP for enough time (60 days?) to demonstrate compliance, obtain status letter from doc, send sleep test results, sleep doc reading, status letter, and CPAP download.

Additional detail in AME guide.

I think that has changed very recently.

 

[Let'sgoflying!]

I think the impetus has come from other transportation accidents that have been linked to people falling asleep. If you fall asleep for a minute while flying in cruise on autopilot, nothing is likely to happen. The same could not be said for truck and bus drivers and probably for train engineers.

Regrettably, in their attempt to be proactive, it appears there is a negative outcome from what I am reading.

 

[Brad Z]

My sleep study & all other paperwork arrived certified to The FFA at 10:30 the morning of the 6th. The non-compliance letter was mailed be the FFA on the 8th. I doubt they got it before the letter went out.

I'll try to get through by phone tomorrow. I did call late in December asking for the 30 day extension but was told they couldn't do that over the phone. I did request the extension in my letter with my new cpap info.

I'm hoping I don't have to send in my medical certificate as they requested within 14 days!

I'll report on how this plays out.

Things can be a little slow around the FAA the first week of January as that's the last opportunity to take "use-or-loose" annual leave. I'm certain things got crossed, as a letter dated the 8th was likely drafted on the 7th.

Also, wait until Tuesday to call; Monday is a federal holiday.

 

[Everskyward]

Regrettably, in their attempt to be proactive, it appears there is a negative outcome from what I am reading.

I agree that it appears they are targeting too wide a population. I haven't paid much attention but it seems that if you are over a certain BMI and neck size you are suspect. I have had other pilots tell me that when they go to the AME they are quizzed about snoring. The same AME has never brought it up with me but I am not that big.

On the other hand, I think people who have an actual diagnoses of sleep apnea need to submit their sleep studies. It would be nice if it was a simple process so that people would not be reluctant to get treatment.

 

[AggieMike88]

I think that has changed very recently.

Oh? Please share...

 

[bflynn]

See post #18. IMHO do not push deadlines. You can always get extensions ... and such a request takes it from bureaucracy and allows the OKC medical officers 2 stay in the loop.

My point was that the FAA gave a deadline, but then didn't honor their own date. When they failed, they immediately put the burden on the airman to fix their failure in their process.

I agree, pushing deadlines is a bad idea. But when you make deadlines, you should have an assurance that they're not going to suddenly change the rules on you.

 

[flyingron]

Not a crash and I have not seen anything documented, but Bruce has mentioned before that the Northwest Airlines overshoot of Minneapolis was related to undiagnosed OSA.

I believe those guys were playing with their computers trying to understand the new bid scheduling.

It was the Go! (aka Wake Up!) guys in Hawaii that both pilots fell asleep. The Captain had undiagnosed sleep apnea. The first officer broke the cardinal rule: It's his job to stay awake when the Captain sleeps.

 

[Matthew]

.
I don't understand why the focus on treatment compliance for THIS condition and not all the rest, especially when people who are successfully treated are said to love their CPAP or APAP machines because they feel so much better. I'm not one to go on about "the nanny state," but this sure seems like an example.

Don't other conditions require some form of compliance? All I know is the OSA SI.

Are there other conditions that require some kind of test results, but don't get an SI?

 

[Fearless Tower]

I believe those guys were playing with their computers trying to understand the new bid scheduling.

That is what they claimed. I don't think that anyone believed it.....everyone knows damn well that they were asleep. Whether it was OSA that caused them to fall asleep, I don't really know. That is just what Bruce claimed a while back.

 

[AggieMike88]

Are there other conditions that require some kind of test results, but don't get an SI?

Type 2 Diabetes fits that question if you're extremely well controlled and can remain in the pre-diabetes range (A1C less than 6.5 and FBG 125 or less). The only way the applicant can tell the FAA he's been a very good boy/girl is from lab results ordered by his/her primary doc.

 

[flyingron]

That is what they claimed. I don't think that anyone believed it.....everyone knows damn well that they were asleep. Whether it was OSA that caused them to fall asleep, I don't really know. That is just what Bruce claimed a while back.

While there was conjecture that the were sleeping (mostly BEFORE the rest of the reports came out), the NTSB never gave that any credence (which given their propensity to trumpet fatigue/sleep apnea issues, you'd thing they would).

Here's the entire docket: http://dms.ntsb.gov/pubdms/search/h...dRow=15&StartRow=1&order=1&sort=0&TXTSEARCHT=

The captain actually had a sleep study that concluded he didn't have sleep apnea but he was using a CPAP anyhow to make his wife happy (snoring). There was definitely much analysis of crew duty times and such looking to make that connection, but it doesn't seem to have gone anywhere.

But in the Go! 1022 case there was very much notice taken of the pilot's undiagnosed and severe sleep apnea. In fact, it's pretty much the NTSB poster child for such. I still believe you're confusing the incidents. It was Bruce who pointed me to the apnea issue on the Go! case.

The NTSB doesn't have the docket for the Go! investigation on line, but here is the factual
http://www.ntsb.gov/_layouts/ntsb.aviation/GeneratePDF.aspx?id=SEA08IA080&rpt=fa

 

[Fearless Tower]

I still believe you're confusing the incidents. It was Bruce who pointed me to the apnea issue on the Go! case.

No. Not confusing anything. I wasn't aware of the Go! incident. I was referring to this post from Bruce back in 2013:

http://www.pilotsofamerica.com/forum/showpost.php?p=1331993&postcount=19

 

[flyingron]

Well that's still hardly definitive. But of course, Doc Bruce knows better than the FAA nad the NTSB.

He was right about the tower controller. Here's the report on that one:
http://www.ntsb.gov/safety/safety-recs/recletters/A09_134_136.pdf

 

[Lindberg]

My point was that the FAA gave a deadline, but then didn't honor their own date. When they failed, they immediately put the burden on the airman to fix their failure in their process.

I agree, pushing deadlines is a bad idea. But when you make deadlines, you should have an assurance that they're not going to suddenly change the rules on you.

I don't see where the OP has said exactly what the deadline was. But he did say he got the medical in September and he had 90 days to send the requested information. That would have been sometime in December.

 

[saddletramp]

Okay fellow airmen I did make contact with the FAA today after holding 19 minutes.

After explaining my situation to the very nice lady that took my call she put me on hold for a few minutes. After coming back on the line she found my cpap test results & other documents I sent to the certified. She said she couldn't make a decision herself but she would expedite my scanned doc's where the decisions are made. I still have to return my second class medical since when my documents are approved I will be issued a new medical. She also advised me call in a week to check status. So I'm grounded for a bit. It does **** me off a bit since I've used a cpap since 1998!

The ironic thing is I'm in the process of trying to put a deal together on a 182 I found.

 

[Whiskey Romeo]

I'm still waiting since first of December, even after all the calls to check status. Checked yesterday and was told the same thing as before.... "its on the reviewer's desk".

It is what it is. It will happen when it happens. (sigh)

 

[Matthew]

I'm still waiting since first of December, even after all the calls to check status. Checked yesterday and was told the same thing as before.... "its on the reviewer's desk".

It is what it is. It will happen when it happens. (sigh)

The story I've been told is to call on non-consecutive days. This is supposed to move your paperwork to the top of the stack. Since you called yesterday, call again tomorrow.

Maybe "moving to the top of the stack" takes the same amount of time if you call or if you don't.

 

[Whiskey Romeo]

Thanks Mathew. I've done that. Actually called 5 or 6 times on non-consecutive days. I've come to expect the unexpected from OKC.

 

[saddletramp]

Update.

As hard as it was to do I sent in my Second class medical. It killed me to do it because I use a cpap everyday & have since 1998. It works for me.

I received a certified letter Monday the 25th from an MD from the FAA & it requested that I send in current data from my new apap machine. The letter listed that it had to show at least 75% usage & that I had to use it at least 6 hours per night. My report for the last 30 days shows 83% usage & that I never had a night with less than 7 hours usage. I should be alright. I sent my current 30 day sleep study in on Wednesday the 27th two day after receiving their request.

Now sitting here without a medical awaiting their decision. I'm hoping it will come in the form of a revised medical.

I plan to call at the end of next week to confirm their receipt of my study.

 

[Matthew]

dang. Good luck. I'm sure it will come through, but it sucks you had to go through this.

 

[AggieMike88]

I know you already sent it... but for future and for anyone else monitoring this thread, anytime you're sending stuff to FAA, always do it CMRRR so you have record of when the mail room gets it. Then you can give them 5-ish days to get it scanned into the system, and then start your non-consecutive calls.

Also make sure each page you send has name, DOB, pilot license number, and the "control number" (I forget the actual name of it) that is on the correspondence they sent to you. All of that helps to identify your paperwork to the system and reviewers. Having it there can help speed things up. Not having it will slow it down big time.

 

[gprellwitz]

I know you already sent it... but for future and for anyone else monitoring this thread, anytime you're sending stuff to FAA, always do it CMRRR so you have record of when the mail room gets it. Then you can give them 5-ish days to get it scanned into the system, and then start your non-consecutive calls.

Also make sure each page you send has name, DOB, pilot license number, and the "control number" (I forget the actual name of it) that is on the correspondence they sent to you. All of that helps to identify your paperwork to the system and reviewers. Having it there can help speed things up. Not having it will slow it down big time.

A trick I have seen Dr. Bruce do to get that information on all of the pages is to put it on one blank page at the top, put that in the photocopier, put all of the papers that you want it printed on into the paper source for the copier and then copy them right onto the pages.

 

[bbchien]

Update.

As hard as it was to do I sent in my Second class medical. It killed me to do it because I use a cpap everyday & have since 1998. It works for me.

I received a certified letter Monday the 25th from an MD from the FAA & it requested that I send in current data from my new apap machine. The letter listed that it had to show at least 75% usage & that I had to use it at least 6 hours per night. My report for the last 30 days shows 83% usage & that I never had a night with less than 7 hours usage. I should be alright. I sent my current 30 day sleep study in on Wednesday the 27th two day after receiving their request.

Now sitting here without a medical awaiting their decision. I'm hoping it will come in the form of a revised medical.

I plan to call at the end of next week to confirm their receipt of my study.

SaddleT, call 405-954-4821 on M, W, and F, and become an "interested airman". I'll bet they reissue you shortly after Valentines' day, if you do this.
It has to be on three nonconsequtive days- Friday and Monday ARE consequtive (in the federal brain) to ge labeled "interested airman". If you have >75% of day I showing >6 hour's use, extending over >30 days, and the affidavit (see attached) submitted, and ANYTHIGN from your doc saying that you are (1) well treated, (2) no daytime sleepiness, (3) complaint, (4) no right heart failure on exam, this can be issued by the mid level minion at the agency with just the sprinkling of the "holy water" from above.
It moves pretty good. You'll be back up before the upcoming cold snap is over.

 

[saddletramp]

Thanks! I will make the calls.

Due to the local clinics not being able to fit me in for a sleep study I did a home study from a company in California.. The 30 day compliance report came from them & showed my numbers far above what the FAA considered minimum. I don't have anything from my regular physician or by the AME who issued my medical. The AME that issued my medical is a pilot though & was so concerned about me showing compliance he brought the forms to my house a few days after my exam. I know if I need a Dr's statement he would help. Super nice guy.

I'll call & report back.

 

[saddletramp]

Update. After calling the FAA medical dept every two to three days since my original post on January 15, 2016 I finally got some good news today. The nice gentleman that answered after only waiting 3 minutes informed me that a new medical was mailed out yesterday. I am ecstatic!

I don't yet have it in hand but al least I know its on its way.

I figured since I sent in a sleep study that had numbers way beyond their minimums for compliance I didn't think it would be an issue.

So it took nearly 7 weeks to get my sleep study through the system.

Thanks for all your helpful suggestions & encouragement.

 

[midcap]

Bruce,

Thanks for being so awesome to still come and give helpful advice. It would nice to see you on here more often.

Dr. Bruce is definitely the man when it comes to these things.

 

[saddletramp]

My second class medical is in hand & after the long ordeal I couldn't be happier.

My FFA issued medical does stipulate that it's not valid for a lower class after 9/30/16. This is the date of my original medical. I assume this is normal after being issued special issuance due to the sleep apnea.

Can't wait to get airborne again!

 

[Matthew]

Good!

Yeah, the medical is always dated frome the day of the exam.

 

[Jay Honeck]

So, to sum up...

If you are diagnosed, and are using a CPAP machine to treat sleep apnea, you are legally grounded by the FAA?

But...

If you are symptomatic, undiagnosed, and are not being treated for sleep apnea, you're legal to fly?

Oh, my...

 

[jsstevens]

So, to sum up...

If you are diagnosed, and are using a CPAP machine to treat sleep apnea, you are legally grounded by the FAA?

But...

If you are symptomatic, undiagnosed, and are not being treated for sleep apnea, you're legal to fly?

Oh, my...

Not a lot different from all sorts of other diseases, really. If you feel bad (IMSAFE) you're supposed to self-ground.

I could have undiagnosed artery disease, be asymptomatic and fly legally. I could also keel over in the pilots seat. If I'm having symptoms, it's up to me to self-ground until I get checked out.

If you are diagnosed, you have to jump through the hoops to prove you're safe to fly.

Probably the biggest problem with sleep apnea is that it's insidious. You are cognitively impaired (due to fatigue/lack of sleep) without even realizing it.

John

 

[Jay Honeck]

Not a lot different from all sorts of other diseases, really. If you feel bad (IMSAFE) you're supposed to self-ground.

I could have undiagnosed artery disease, be asymptomatic and fly legally. I could also keel over in the pilots seat. If I'm having symptoms, it's up to me to self-ground until I get checked out.

If you are diagnosed, you have to jump through the hoops to prove you're safe to fly.

John

The difference is, the diagnosed guy using the CPAP machine is verifiably safe to fly, while the unreported guy is not.

This seems almost perfectly backwards, to me, and almost certainly results in pilots with sleep apnea hiding their condition -- but what do I know? I'm not a doctor, I'm a hotelier, dammit!

 

[Matthew]

The difference is, the diagnosed guy using the CPAP machine is verifiably safe to fly, while the unreported guy is not.

This seems almost perfectly backwards, to me, and almost certainly results in pilots with sleep apnea hiding their condition -- but what do I know? I'm not a doctor, I'm a hotelier, dammit!

Probably a big reason behind the push to triage pilots at their AME visit.

 

[jsstevens]

The difference is, the diagnosed guy using the CPAP machine is verifiably safe to fly, while the unreported guy is not.

This seems almost perfectly backwards, to me, and almost certainly results in pilots with sleep apnea hiding their condition -- but what do I know? I'm not a doctor, I'm a hotelier, dammit!

If you're diagnosed and using the CPAP machine, once you've got it under control (i.e. have the 30 day history and a Dr's note), you're no longer grounded.

A few years ago I had a heart scare. It turned out to be completely unrelated, thankfully. But at the time, I would have been able to fly only after undergoing a treadmill test-in other words proving the condition didn't cause issues.