FAA adds another hoop for medicals

Whole dang country is under a thumbscrew, this is small potatoes big picture, and a perfectly lovely sounding idea to our masters. I think it kind of funny, old fat white guys, the ones this affects, ran the country to this point let em get a taste of what they built before they pass.

I don't agree with much that you post but...That's some funny stuff right there. Fixed one thing for you.
 
[...]Dr. Chien says that he has no airmen that see him for their medicals that are skinny and in fact he reports that they are all over weight to some degree. That means that 90% of his airmen are likely suffering from OSA[...]
Incorrect conclusion. The 90% figure is those with BMI >= 40 and neck >= 17", which is morbidly obese. That is not the same as overweight, which has a much lower BMI threshold.
 
Dr. Chien says that he has no airmen that see him for their medicals that are skinny and in fact he reports that they are all over weight to some degree.
I don't recall Bruce saying that. I think what he said was that all of his OSA airmen were carrying extra weight.

It would indeed be surprising if of all the pilots using his services in person, us skinny types weren't represented at all. Possible, but still surprising.
 
All this parsing of what constitutes who is over weight and who is not, only strengthen the questions-

  • Is it wise to bring further obstacles to becoming, or continuing to be a pilot, at this point in time keeping in mind the ultimate goal is to screen everyone?
  • Is the reduction in pilot population and therefor GA revenues associated with this new screening, worth the potential unknown improvement in the accident record as it stands now? 1388 - ???
 
I don't recall Bruce saying that. I think what he said was that all of his OSA airmen were carrying extra weight.

It would indeed be surprising if of all the pilots using his services in person, us skinny types weren't represented at all. Possible, but still surprising.

Seriously, what the hell is the difference between "over weight" and "carrying extra weight"??!:rolleyes:
 
All this parsing of what constitutes who is over weight and who is not, only strengthen the questions-

  • Is it wise to bring further obstacles to becoming, or continuing to be a pilot, at this point in time keeping in mind the ultimate goal is to screen everyone?
  • Is the reduction in pilot population and therefor GA revenues associated with this new screening, worth the potential unknown improvement in the accident record as it stands now? 1388 - ???
All this "show me the proof" is asking for data that cannot exist.
90% of accidents are pilot error.
Untreated SA is cognitively as powerful as 0.080 alcohol.
The SA guys- most of them are Dead.

Even flown with a guy with SA? That describes my first FE. But Uncle finally got it fixed. V1 cut, failure to feather- Garys' nodded off. "Never mind, I got it". Awoke with a start and I had to remind him to not touch anything....I don't remember his height and weight but I'd guess BMI -36.

Now we call it "microsleep" like the trainman on the Hudson Line last weekend.

The problem with the "forced into rulemaking" approach is that when the prevalence is laid out, we will have to screen to BMI 36. Because that will have been a congressional act, the FAA will go back and request funding for screening to BMI down-to 36: so the agency just got bigger.

The reason we can't deal with lower than BMI 40 is, the wait is already up to 105 days....

...Maroons....

dav8or said:
Seriously, what the hell is the difference between "over weight" and "carrying extra weight"??!:rolleyes:
Nothing at all. But the prevalence of untreated SA is not related to whether we call an airman "carrying extra weight" or "over weight" or "obese". Those are just names. The LRPV is related to BMI. You're just diverting the focus.

The prevalence of untreated SA is correlated to BMI.
The prevalence of untreated SA is correlated to BMI.
The prevalence of untreated SA is correlated to BMI.
The prevalence of untreated SA is correlated to BMI.
 
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You guys don't understand, the world cares as much about GA vitality as the Audubon society cares about jetskis. Worse the default is no longer freedom, the default is safety at whatever it costs to feel good never mind the consequences.
 
Seriously, what the hell is the difference between "over weight" and "carrying extra weight"??!:rolleyes:
Not much. But there definitely is a difference between saying all airmen who have OSA and all airmen period which is what you posted.

Dr. Chien says that he has no airmen that see him for their medicals that are skinny and in fact he reports that they are all over weight to some degree.
 
Not much. But there definitely is a difference between saying all airmen who have OSA and all airmen period which is what you posted.
Indigo, he's trying to twist words to suit his case. It's unbecoming. I'd just let it be.

On a positive note, one of the airmen who flies corporate, who had called demanding a "right now" flight physical, came in for his routine December/June physical. He had lost 20 pounds since last summer.

This is a good thing.
 
I don't agree with many of the requirements imposed by the FAA medical department but this one where there is an easy out. Lose enough weight to get under a BMI of 40. If you are way over 40 then getting a sleep study is probably the least of your concerns. If you are reasonably close to the limit losing the weight is no big deal.
 
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Agree. This is our Aeromedical top expert saying, "men, SHAPE up!".

Those of you who had to serve, understand this phenomenon well. Those of you that haven't, well it'll be a first time. There always is a first time.
 
...If you snore or have BMI >34 and a neck >16", go get yourself checked out and get on CPAP if you need it." ... and then pilots actually went out and did it!

I had a BMI > 34 and neck >16", so I got a sleep study and then a CPAP machine. Nine months and 70 pounds latter my BMI is 28 and my neck is right at 16. So it's possible I might not be the only one who went out and did it.

It would be a waste of time as is obvious right now, the answer would be a giant "No, We don't wanna!!!!" Why waste the time? :dunno:


Maybe you'd say "I don't wanna", but I wouldn't say that. I would want to have a discussion about the best way to encourage pilots who might have OSA to get evaluated without forcing large numbers of pilots to pay thousands of dollar for a full overnight sleep study on your hunch. Remember, the decree just starts with the really fat guys, and then gathers in thousands more as time passes.

One obvious solution is to let the airman's general practitioner decide if a sleep study is warranted, and to accept the results of the much cheaper take home sleep study.

I don't think it's unreasonable to to ask what specific safety trends are driving the need for the decree.

I'd like to know why the same standard should apply to all classes of medicals. As a private pilot, I don't have to fly if I didn't get a good night's sleep for whatever reason. Maybe I don't need to be held to the same standard as the FedEx pilot doing an approach to mins at 3am.

My point is that it's border line un-American to just have one guy, no matter how well intentioned, simply impose such an expensive and intrusive requirement on a huge group of Americans.

But then, I one of those wackos who thinks that the government works for us, rather than the other way around.
 
I had a BMI > 34 and neck >16", so I got a sleep study and then a CPAP machine. Nine months and 70 pounds latter my BMI is 28 and my neck is right at 16. So it's possible I might not be the only one who went out and did it.




Maybe you'd say "I don't wanna", but I wouldn't say that. I would want to have a discussion about the best way to encourage pilots who might have OSA to get evaluated without forcing large numbers of pilots to pay thousands of dollar for a full overnight sleep study on your hunch. Remember, the decree just starts with the really fat guys, and then gathers in thousands more as time passes.

One obvious solution is to let the airman's general practitioner decide if a sleep study is warranted, and to accept the results of the much cheaper take home sleep study.

I don't think it's unreasonable to to ask what specific safety trends are driving the need for the decree.

I'd like to know why the same standard should apply to all classes of medicals. As a private pilot, I don't have to fly if I didn't get a good night's sleep for whatever reason. Maybe I don't need to be held to the same standard as the FedEx pilot doing an approach to mins at 3am.

My point is that it's border line un-American to just have one guy, no matter how well intentioned, simply impose such an expensive and intrusive requirement on a huge group of Americans.

But then, I one of those wackos who thinks that the government works for us, rather than the other way around.

No, I wouldn't, but we have them right here in this thread that already have. Like most rules, we enact them for the those who won't do the right thing on their own. Also, all pilots in the US are hardly a "huge group", and the morbidly obese even less so.

As Bruce points out, OSA is equivalent in cognitive impairment to .08BAC, do we defend the right to operate drunk? This is the government working for you. You want the guy to pull out on the runway as you're coming into the flare because he didn't manage to see you or whatever?
 
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As Bruce points out, OSA is equivalent in cognitive impairment to .08BAC, do we defend the right to operate drunk?

There's more to being drunk than cognitive impairment, isn't there? If so, that seems like kind of an exaggerated comparison.

By the way, what severity of OSA equates to that?
 
Remember, the decree just starts with the really fat guys, and then gathers in thousands more as time passes.

Maybe. Maybe the accident rate goes on unaffected. If catching the worst cases (>40 BMI criteria) doesn't solve the problem, why continue to the lesser suspects?

I'd like to know why the same standard should apply to all classes of medicals. As a private pilot, I don't have to fly if I didn't get a good night's sleep for whatever reason. Maybe I don't need to be held to the same standard as the FedEx pilot doing an approach to mins at 3am.

How about the guy with a 3rd Class with OSA that has to get home for work tomorrow?

I rode to Sun-N-Fun with a guy (>40 BMI) that had severe OSA. His CPAP broke while there. He had to get home for work the day after we left. He couldn't stay awake while flying home. I had to keep waking him and he was obviously behind the curve on VFR landings. Glad it wasn't IFR.

But then, I one of those wackos who thinks that the government works for us, rather than the other way around.

My initial reaction was the same. But I now think Government IS working for us on this one. Once I got passed being offended I have to agree that there is strong evidence linking BMI to OSA to the GA accident rate.

My BMI is 33. I have mild/moderate OSA and use a CPAP. It makes a difference in energy and alertness. I didn't realize how OSA was affecting me until it was treated. Now I am focused on weight loss.
 
All this "show me the proof" is asking for data that cannot exist.
90% of accidents are pilot error.
Untreated SA is cognitively as powerful as 0.080 alcohol.
The SA guys- most of them are Dead.

Even flown with a guy with SA? That describes my first FE. But Uncle finally got it fixed. V1 cut, failure to feather- Garys' nodded off. "Never mind, I got it". Awoke with a start and I had to remind him to not touch anything....I don't remember his height and weight but I'd guess BMI -36.

Now we call it "microsleep" like the trainman on the Hudson Line last weekend.

The problem with the "forced into rulemaking" approach is that when the prevalence is laid out, we will have to screen to BMI 36. Because that will have been a congressional act, the FAA will go back and request funding for screening to BMI down-to 36: so the agency just got bigger.

The reason we can't deal with lower than BMI 40 is, the wait is already up to 105 days....

...Maroons....

Nothing at all. But the prevalence of untreated SA is not related to whether we call an airman "carrying extra weight" or "over weight" or "obese". Those are just names. The LRPV is related to BMI. You're just diverting the focus.

The prevalence of untreated SA is correlated to BMI.
The prevalence of untreated SA is correlated to BMI.
The prevalence of untreated SA is correlated to BMI.
The prevalence of untreated SA is correlated to BMI.

I've stayed out of this as it is as much if not more political/emotional then a rational discussion of the statistics and science behind the policy. And, I admit I have not read every post here, but Bruce has it on the nose.
 
That's BS.
We see this in cogscreens and psychometric evals routinely.

I had a guy who jumpseated into DC to see the "father of metric psychology", was up late, scored poorly. Turned out his son had just been injured in a car wreck and he had been up the night before at the hospital.
Sleep deprivation.

Three weeks later when we could convince him that he would never fly with scores like that (it was a special issuance), he scored in the normal ranges.

"Yeah, it's all BS".
"Jim, it's real."
 
That's BS.

few examples of the research:

Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication
A M Williamsona, Anne-Marie Feyerb
+ Author Affiliations

aSchool of Psychology, University of New South Wales, Sydney, Australia, bNew Zealand Occupational and Environmental Health Research Centre, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
Dr A M Williamsona.williamson@unsw.edu.au
Accepted 15 June 2000
Abstract
OBJECTIVES To compare the relative effects on performance of sleep deprivation and alcohol.

METHODS Performance effects were studied in the same subjects over a period of 28 hours of sleep deprivation and after measured doses of alcohol up to about 0.1% blood alcohol concentration (BAC). There were 39 subjects, 30 employees from the transport industry and nine from the army.

RESULTS After 17–19 hours without sleep, corresponding to 2230 and 0100, performance on some tests was equivalent or worse than that at a BAC of 0.05%. Response speeds were up to 50% slower for some tests and accuracy measures were significantly poorer than at this level of alcohol. After longer periods without sleep, performance reached levels equivalent to the maximum alcohol dose given to subjects (BAC of 0.1%).

CONCLUSIONS These findings reinforce the evidence that the fatigue of sleep deprivation is an important factor likely to compromise performance of speed and accuracy of the kind needed for safety on the road and in other industrial settings.

another excellent study:

Am J Respir Crit Care Med. 2006 August 15; 174(4): 446–454.
Published online 2006 May 11. doi: 10.1164/rccm.200408-1146OC
PMCID: PMC2648121
Impaired Performance in Commercial Drivers

Role of Sleep Apnea and Short Sleep Duration
Allan I. Pack, Greg Maislin, Bethany Staley, Frances M. Pack, William C. Rogers,* Charles F. P. George, and David F. Dinges

In conclusion, there are daytime neurobehavioral performance impairments that are found commonly in commercial drivers, and these are more likely among those with durations of average sleep less than 5 h/night and those with severe obstructive sleep apnea. These results suggest that strategies employed by the Federal Motor Carrier Safety Administration to reduce sleepiness, and potentially crash risk, in commercial drivers include plans to (1) develop and implement approaches to identify “impaired” drivers by objective testing, (2) implement and ensure quality programs to identify and treat individuals with severe sleep apnea as well as monitor adherence to therapy, and (3) introduce approaches to assess and promote increased sleep durations among commercial drivers.

I would invite you to look at the entire study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2648121/

here is a further list of research articles cited in the above work, granted most of these relate to driving incidents but that, with a much larger population of drivers then pilots is where the problem has been most pronounced.

References
1. Center for National Trucking Statistics. THA facts 1999. Ann Arbor, MI: University of Michigan Transportation Research Institute; 2000.
2. National Transportation Safety Board. Factors that affect fatigue in heavy truck accidents. Vol. 1: Analysis safety study. Washington, DC: National Transportation Safety Board; 1995.
3. AAA Foundation for Traffic Safety. A report on the determination and evaluation of the role of fatigue in heavy truck accidents. Washington, DC: AAA Foundation for Traffic Safety; 1995.
4. Dinges DF, Pack F, Williams K, Gillen KA, Powell JW, Ott GE, Aptowicz C, Pack AI. Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4–5 hours per night. Sleep 1997;20:267–277. [PubMed]
5. Belenky G, Wesensten NJ, Thorne DR, Thomas ML, Sing HC, Redmond DP, Russo MB, Balkin TJ. Patterns of performance degradation and restoration during sleep restriction and subsequent recovery: a sleep dose–response study. J Sleep Res 2003;12:1–12. [PubMed]
6. Van Dongen HP, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose–response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep 2003;26:117–126. [PubMed]
7. Mitler MM, Miller JC, Lipsitz JJ, Walsh JK, Wylie CD. The sleep of long-haul truck drivers. N Engl J Med 1997;337:755–761. [PMC free article] [PubMed]
8. Howard ME, Desai AV, Grunstein RR, Hukins C, Armstrong JG, Joffe D, Swann P, Campbell DA, Pierce RJ. Sleepiness, sleep-disordered breathing, and accident risk factors in commercial vehicle drivers. Am J Respir Crit Care Med 2004;170:1014–1021. [PubMed]
9. Stoohs RA, Bingham LA, Itoi A, Guilleminault C, Dement WC. Sleep and sleep-disordered breathing in commercial long-haul truck drivers. Chest 1995;107:1275–1282. [PubMed]
10. Pack AI, Maislin G, Staley B, George C, Pack FM, Dinges DF. Factors associated with daytime sleepiness and performance in a sample of commercial drivers [abstract]. Sleep 2001;24:A427.
11. Maislin G, Hachadoorian R, Dinges DF, Pack AI. Apnea and sleep behavior co-determine sleepiness and alertness in commercial truck drivers [abstract]. Sleep 2002;25:A119.
12. Gurubhagavatula I, Maislin G, Nkwuo JE, Pack AI. Occupational screening for obstructive sleep apnea in commercial drivers. Am J Respir Crit Care Med 2004;170:371–376. [PubMed]
13. Gislason T, Almqvist M, Eriksson G, Taube A, Boman G. Prevalence of sleep apnea syndrome among Swedish men: an epidemiological study. J Clin Epidemiol 1988;41:571–576. [PubMed]
14. Maislin G, Pack AI, Kribbs NB, Smith PL, Schwartz AR, Kline LR, Schwab RJ, Dinges DF. A survey screen for prediction of apnea. Sleep 1995;18:158–166. [PubMed]
15. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 1991;14:540–545. [PubMed]
16. Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 1992;15:376–381. [PubMed]
17. Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea: the Epworth Sleepiness Scale. Chest 1993;103:30–36. [PubMed]
18. Johns MW. Sleepiness in different situations measured by the Epworth Sleepiness Scale. Sleep 1994;17:703–710. [PubMed]
19. Gottlieb DJ, Whitney CW, Bonekat WH, Iber C, James GD, Lebowitz M, Nieto FJ, Rosenberg CE. Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med 1999;159:502–507. [PubMed]
20. Carskadon MA, Dement WC, Mitler MM, Roth T, Westbrook PR, Keenan S. Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness. Sleep 1986;9:519–524. [PubMed]
21. Dinges DF, Powell JW. Microcomputer analyses of performance on a portable, simple visual RT task during sustained operations. Behav Res Methods Instrum Comput 1985;17:652–655.
22. Doran SM, Van Dongen HP, Dinges DF. Sustained attention performance during sleep deprivation: evidence of state instability. Arch Ital Biol 2001;139:253–267. [PubMed]
23. Powell NB, Riley RW, Schechtman KB, Blumen MB, Dinges DF, Guilleminault C. A comparative model: reaction time performance in sleep-disordered breathing versus alcohol-impaired controls. Laryngoscope 1999;109:1648–1654. [PubMed]
24. Moskowitz H, Burns M. The effects of alcohol and valium, singly and in combination, upon driving-related skills performance. In: Huelke DF, editor. Proceedings of the 21st Conference of the American Association for Automotive Medicine. Morton Grove, IL: American Association for Automotive Medicine; 1997. pp. 226–240.
25. George CF, Boudreau AC, Smiley A. Simulated driving performance in patients with obstructive sleep apnea. Am J Respir Crit Care Med 1996;154:175–181. [PubMed]
26. Middelkoop HA, Knuistingh Neven A, van Hilten JJ, Ruwhof CW, Kamphuisen HA. Wrist actigraphic assessment of sleep in 116 community based subjects suspected of obstructive sleep apnoea syndrome. Thorax 1995;50:284–289. [PMC free article] [PubMed]
27. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307–310. [PubMed]
28. American Academy of Sleep Medicine. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research: the Report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:667–689. [PubMed]
29. Cochran WG. Survey sampling. New York: John Wiley & Sons; 1977.
30. Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry 2002;59:131–136. [PubMed]
31. Edwards D, Berry JJ. The efficiency of simulation-based multiple comparisons. Biometrics 1987;43:913–928. [PubMed]
32. Kish L. Survey sampling. New York: John Wiley & Sons; 1965.
33. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230–1235. [PubMed]
34. Bearpark H, Elliott L, Grunstein R, Cullen S, Schneider H, Althaus W, Sullivan C. Snoring and sleep apnea: a population study in Australian men. Am J Respir Crit Care Med 1995;151:1459–1465. [PubMed]
35. Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A. Effects of age on sleep apnea in men. I. Prevalence and severity. Am J Respir Crit Care Med 1998;157:144–148. [PubMed]
36. Vgontzas AN, Bixler EO, Tan TL, Kantner D, Martin LF, Kales A. Obesity without sleep apnea is associated with daytime sleepiness. Arch Intern Med 1998;158:1333–1337. [PubMed]
37. Heitman SJ, Atkar RS, Hajduk EA, Wanner RA, Flemons WW. Validation of nasal pressure for the identification of apneas/hypopneas during sleep. Am J Respir Crit Care Med 2002;166:386–391. [PubMed]
38. Van Dongen HP, Baynard MD, Maislin G, Dinges DF. Systematic interindividual differences in neurobehavioral impairment from sleep loss: evidence of trait-like differential vulnerability. Sleep 2004;27:423–433. [PubMed]
39. Leproult R, Colecchia EF, Berardi AM, Stickgold R, Kosslyn SM, Van Cauter E. Individual differences in subjective and objective alertness during sleep deprivation are stable and unrelated. Am J Physiol Regul Integr Comp Physiol 2003;284:R280–R290. [PubMed]
40. Stoohs RA, Guilleminault C, Itoi A, Dement WC. Traffic accidents in commercial long-haul truck drivers: the influence of sleep-disordered breathing and obesity. Sleep 1994;17:619–623. [PubMed]
41. George CF, Nickerson PW, Hanly PJ, Millar TW, Kryger MH. Sleep apnoea patients have more automobile accidents. Lancet 1987;2:447. [PubMed]
42. Findley LJ, Unverzagt ME, Suratt PM. Automobile accidents involving patients with obstructive sleep apnea. Am Rev Respir Dis 1988;138:337–340. [PubMed]
43. Young T, Blustein J, Finn L, Palta M. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep 1997;20:608–613. [PubMed]
44. George CF, Smiley A. Sleep apnea and automobile crashes. Sleep 1999;22:790–795. [PubMed]
45. Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. N Engl J Med 1999;340:847–851. [PubMed]
46. Horstmann S, Hess CW, Bassetti C, Gugger M, Mathis J. Sleepiness-related accidents in sleep apnea patients. Sleep 2000;23:383–389. [PubMed]
47. Connor J, Whitlock G, Norton R, Jackson R. The role of driver sleepiness in car crashes: a systematic review of epidemiological studies. Accid Anal Prev 2001;33:31–41. [PubMed]
48. Sassani A, Findley LJ, Kryger M, Goldlust E, George C, Davidson TM. Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. Sleep 2004;27:453–458. [PubMed]
 
Some further sources


1) NASA Aviation Safety Reporting System 1995-2007
Inadvertent in-flight sleep
17 reported incidents; 5 with both pilots asleep

2) Brain activity research (UK Civil Aviation Auth 2005)
Inadvertent sleep/reduced alertness
10 episodes in 400 person hours

3) 1999 NASA Survey of 26 regional airlines
80% of respondents admitted to having ‘nodded off’ during flight

4) OSA reported in US pilots
First Class: 0.5%
Second Class: 0.6%
Third Class: 0.3%
Obesity: 15-24% of civil pilots have BMI ≥ 30kg/m2
75% of persons with BMI > 32 kg/m2 have OSA
 
Maybe. Maybe the accident rate goes on unaffected. If catching the worst cases (>40 BMI criteria) doesn't solve the problem, why continue to the lesser suspects?

I thought the thread had started going in circles, so it's surprising to see someone come up with an aspect of this that hasn't been brought up before.
 
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All this "show me the proof" is asking for data that cannot exist.

People keep saying that, but no one has explained why the methodology suggested in the DOT link I provided wouldn't work.
 
"Yeah, Jim, it's all BS".

....sigh.

As I said, the science is very good.
When we get done with rulemaking, we will be screening down to BMI=36.
You asked for it, you got it.
 
few examples of the research:

'Facts' don't matter in this discussion. This is about being overweight as an expression of freedom. With your 'facts' you are just a part of the oppressive regime ;-)
 
'Facts' don't matter in this discussion. This is about being overweight as an expression of freedom. With your 'facts' you are just a part of the oppressive regime ;-)

you're right, which is why I've tried to stay out of it...
 
Although me and my Barney Fife neck don't have a dog in this fight, I do believe in slippery slopes and, "Beware what you ask for, lest you get it."

I don't doubt the science behind OSA causing drowsiness, nor the effects of drowsiness. Making a few flights on the back side of the clock is all it took to convince me. If "drowsiness" is the villain, though, where do we draw the line? It occurs to me that the same folks wih fat necks probably also eat a lot of high glycemic foods (http://en.wikipedia.org/wiki/Postprandial_somnolence):
"Insulin stimulates the uptake of valine, leucine, and isoleucine into skeletal muscle, but not uptake of tryptophan. This lowers the ratio of these branched-chain amino acids in the bloodstream relative to tryptophan (an aromatic amino acid), making tryptophan preferentially available to the large neutral amino acid transporter at the blood–brain barrier. Uptake of tryptophan by the brain thus increases. In the brain, tryptophan is converted to serotonin, which is then converted to melatonin. Increased brain serotonin and melatonin levels result in sleepiness."​
Is it a matter of time until the "real" cause of falling asleep in the cockpit is discovered to be what was eaten? Do we then regulate a minimum time frame "from carbohydrate to carburetor", like we do with alcoholic beverages?

Just sayin'...

dtuuri
 
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I just want to add that I really appreciate the patience of our medical professionals in dealing with all these questions and concerns.
 
The rest of the population over which you fly doesn't care what the **** you think, and they think you can get the test or sit on the ground. THAT my friend is the reality of freedom.

Reality of the Tragedy of the Commons, you mean. There's no freedom in that.
 
When we get done with rulemaking, we will be screening down to BMI=36.

The folks who looked at this for the motor carrier side of DOT pulled the relevant studies and did a ROC analysis on it. The best tradeoff when using BMI as a criterion for OSA is at 33.

Is OSA one of the SIs the AME can issue ? With the flood of SIs this is bound to generate after the rulemaking is done, it may be worthwhile to re-vamp the SI process to cut headquarters out of the loop for most of the cases.

Well, this morning I made it to just below 200lbs for the first time in many years. It requires conscious effort to get and stay there.
 
The folks who looked at this for the motor carrier side of DOT pulled the relevant studies and did a ROC analysis on it. The best tradeoff when using BMI as a criterion for OSA is at 33.

Is OSA one of the SIs the AME can issue ? With the flood of SIs this is bound to generate after the rulemaking is done, it may be worthwhile to re-vamp the SI process to cut headquarters out of the loop for most of the cases.

Well, this morning I made it to just below 200lbs for the first time in many years. It requires conscious effort to get and stay there.

This is where the focus of the debate should be, controlling the process to be as time/cost effective as possible, not on denying it from happening. One major factor I would consider throwing into the mix is exempting those who are already on the CPAP of their own accord when they bring in the tracings or whatever from their machine; simple. Since the CPAP is the method of compliance for the SI and treatment in the medical community, then it can be assumed that any pilot already on CPAP is not affected by the attributes of OSA. If you know you have OSA (very likely with obesity & snoring) you can probably forego the whole sleep study thing and just get on a CPAP saving that as well.
 
The most amazing thing about this, is the well treated SI, is ROUTINELY given on the phone. It's EASY!!

We've been repeatedly told on this thread that it's super-easy to get the tests and get a medical. This does NOT sound "easy" to me: (It's the story of someone who has an SI for apnea)

Pilots with Apnea Face Lifelong Struggle

It also wouldn't be easy at all for me to drop $2K on the sleep study to begin with... I'm spending enough AMU's on, well, maintenance!
 
We've been repeatedly told on this thread that it's super-easy to get the tests and get a medical. This does NOT sound "easy" to me: (It's the story of someone who has an SI for apnea)

Pilots with Apnea Face Lifelong Struggle

It also wouldn't be easy at all for me to drop $2K on the sleep study to begin with... I'm spending enough AMU's on, well, maintenance!

Linky no worky. Do you have to get a $2000 sleep study to get a $350 CPAP machine?
 
"Yeah, Jim, it's all BS".

....sigh.

As I said, the science is very good.
When we get done with rulemaking, we will be screening down to BMI=36.
You asked for it, you got it.

Dr Bruce, please don't but words in my mouth. I didn't say "it's all BS".

It is BS to say that "OSA is like driving with .08". That's simply not true. Flying while fatigued can be even worse than driving with .08, and it is true to say that the danger of flying while tired is greater for a person with OSA. We know that lots of pilots have had fatigue issues, but lots of those pilots don't have untreated OSA.

If you drive or fly with a blood alcohol level of .08 or more you will be impaired, there's no question about it.

If you drive or fly with untreated OSA you MIGHT be affected, but you might not.

Untreated OSA != 'driving drunk'!!!

As I've said a number of times, if you suspect you have untreated OSA you need to talk to your doctor about it and do what she says. You'll be glad you did.

If pilots with OSA are really a safety issue then the FAA should come up with a way to identify these pilots and see that they get treatment.

That doesn't mean that is OK for one government employee to issue a sweeping and expensive decree with no discussion or input from the affected stakeholders!!!!!!

This 'rule by decree' business is getting way out of hand.
 
Linky no worky. Do you have to get a $2000 sleep study to get a $350 CPAP machine?

It is possible to get a fairly good test for OSA with a take home device, that would only cost about $300. But the decree doesn't seem to allow that, if I read it correctly every pilot with a BMI >= 30 is going to have to spring for the full monty overnight sleep lap study. Those do indeed cost thousands of dollars, and are no fun either.
 
It is possible to get a fairly good test for OSA with a take home device, that would only cost about $300. But the decree doesn't seem to allow that, if I read it correctly every pilot with a BMI >= 30 is going to have to spring for the full monty overnight sleep lap study. Those do indeed cost thousands of dollars, and are no fun either.

That's why I think the FAA would be wise to issue a "pre-emptive exemption", I.e. if you already know you have it and are on CPAP, you are exempt from doing the sleep study because it will yield no result since getting you on the CPAP IS the result they will use anyway.

Just have a check box "TAC", treated and compliant, for the OSA issue same a "PRNC" "previously reported, no change." Elsewhere on the form for other issues.
 
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