FAA adds another hoop for medicals

[Gary F]

I do heart disease (and some Internal Medicine) for a living. My advice is for anybody with a BMI over 30 is to quityerbitchin and lose enough weight to get under 30. If you (any BMI) have symptoms of sleep disordered breathing including (but not limited to) excessive daytime somnolence and/or witnessed apneic spells during sleep talk to your physician to see if you need a formal sleep study. This is very important.

 

[flyingcheesehead]

Maybe the FAA could hire ESPN to do the analysis of BMI in pilots generally and in accidents specifically and see if there is correlation...

Certainly Tilton's position would be strengthened if the fat pilots were overrepresented in the accident population..... But I'm thinking it will not be statistically different.

Forget ESPN, just have *somebody* do it... And I agree with your prediction of the conclusion. Yes, I understand the BMI correlation, the cognitive impairment, and that most accidents are pilot error.

That last piece is merely an irrelevant correlation IMO, though. I can see fatigue causing a botched landing, for example, but the big accident causes aren't related to your reflexes being slowed - Even if no fatigued pilots are around, there's going to be people running out of gas, people buzzing their buddy's house, and people trying to get somewhere in marginal weather.

The OSA policy isn't going to make any dent in accident rates, or even fatigue. (See crew rest.) It's simply going to increase the cost of getting a pilot certificate to an unacceptable level for a significant portion of the population, which is eventually going to make things LESS safe as the smaller pilot population struggles with increased costs and becomes less proficient.

 

[weilke]

Here's an interesting perspective on BMI.

http://espn.go.com/blog/truehoop/post/_/id/23776/putting-the-nba-to-the-fat-test

Maybe the FAA could hire ESPN to do the analysis of BMI in pilots generally and in accidents specifically and see if there is correlation....

Nothing new here, tall individuals who are full-time athletes will have BMIs up into the low 30s without having an abnormal amount of body fat.

You and I are not athletes, if our BMI is over 25 we can lose a couple of pounds.

Now Shaq is just fat :wink2:

 

[Gary F]

Nothing new here, tall individuals who are full-time athletes will have BMIs up into the low 30s without having an abnormal amount of body fat.

You and I are not athletes, if our BMI is over 25 we can lose a couple of pounds.

Now Shaq is just fat :wink2:

I think Charles Barkley was really overweight at one time. During college basketball games the opposing spectators would wave empty pizza cartons to distract him when he shot free throws.

 

[weilke]

I think Charles Barkley was really overweight at one time. During college basketball games the opposing spectators would wave empty pizza cartons to distract him when he shot free throws.

Just the other day he was talking on one of the talk-shows about the diet he is on right now. I remember him saying something like 'yeah, the diet is great, the only problem is that I am so damn hungry all the time'.

 

[Gary F]

Just the other day he was talking on one of the talk-shows about the diet he is on right now. I remember him saying something like 'yeah, the diet is great, the only problem is that I am so damn hungry all the time'.

I know the feeling. It's better to stay busy so not to think about being hungry.

 

[bbchien]

Forget ESPN, just have *somebody* do it... And I agree with your prediction of the conclusion. Yes, I understand the BMI correlation, the cognitive impairment, and that most accidents are pilot error.

That last piece is merely an irrelevant correlation IMO, though. I can see fatigue causing a botched landing, for example, but the big accident causes aren't related to your reflexes being slowed - Even if no fatigued pilots are around, there's going to be people running out of gas, people buzzing their buddy's house, and people trying to get somewhere in marginal weather.

The OSA policy isn't going to make any dent in accident rates, or even fatigue. (See crew rest.) It's simply going to increase the cost of getting a pilot certificate to an unacceptable level for a significant portion of the population, which is eventually going to make things LESS safe as the smaller pilot population struggles with increased costs and becomes less proficient.

Shoe on the other foot. What's your evidence for that? Evidence, not suppositions.

....see, it cuts both ways, Kent......

Better yet, why don't you just google the answer. ...yeah, that's it.

...sigh.....

 

[jbarrass]

Just have an IT intern query the db for each pilots ht/wt & certificate number to determine the number of pilots by BMI

Then have them query the accident db by certificate number and find the rate of accidents by BMI.

An IT intern should be able to do it in a couple hours max.... easy

If there's a statically valid positive correlation, Tilton has a point and can connect the dots between BMI & Accidents. If not, move on..... I'm betting there's not a measurable correlation.

 

[ClimbnSink]

Just have an IT intern query the db for each pilots ht/wt & certificate number to determine the number of pilots by BMI

Then have them query the accident db by certificate number and find the rate of accidents by BMI.

An IT intern should be able to do it in a couple hours max.... easy

If there's a statically valid positive correlation, Tilton has a point and can connect the dots between BMI & Accidents. If not, move on..... I'm betting there's not a measurable correlation.

I bet there is, even if it isn't causal. Personal observation is pilots tend to be a hefty lot. You'd hurt the don't test for osa case just because pilots are a (mostly) old sedentary group. If you got the data crunched next the fatties would be crying about normalizing the rate against skinny pilots, etc. The excuses will never end, excuses is why these people are fat. I'm starting to think if you don't have the personal responsibility and self control to be <30 bmi you don't have mentally what it takes to be a safe pilot. Get your bmi under 30. Everything will get better from your knob being harder to being at a lower risk for everything but happiness.

 

[flyingcheesehead]

Shoe on the other foot. What's your evidence for that? Evidence, not suppositions.

I never suggested it's the absolute truth... Hence, the "IMO". In My Opinion.

....see, it cuts both ways, Kent......

I was not the guy who asked for the evidence of accidents caused by OSA... That was someone named "Cruiser":

I've scanned through all three pages of messages on this ...........
Please point me to the one that describes the AVIATION related issue.
Check the NTSB, can't find a "17" neck cause the plane to crash"
What is ACTUALLY going on here???????

I understand the high correlation. I understand that most accidents are pilot error. To say that B is caused mostly by A is a leap that I can't buy, and one for which there is no evidence on either side yet. I'd like to see the data mentioned above by jbarrass, as that is the missing piece of the puzzle.

I understand that strictly medically speaking, this is a good idea. I'm quite afraid of the long-term cost to GA, though. It seems that the ROI may not be there, and that this is just a politically easy way to say "we're doing something about pilot fatigue!" when in reality it'll help airline safety (which is what Joe Public actually cares about) only marginally if at all.

 

[flyingcheesehead]

The inexpensive way is a recording pulse-oximeter. Doesn't catch all of them, but if you are apneic enough to drop your oxygen saturation, it will pick it up.

What should be looked for using this method? I have a recording pulse-ox... It supposedly records pulse and SpO2 for 24 hours. What would happen to pulse during an apnea event? How much would SpO2 go down? How much does SpO2 vary normally?

 

[bbchien]

What should be looked for using this method? I have a recording pulse-ox... It supposedly records pulse and SpO2 for 24 hours. What would happen to pulse during an apnea event? How much would SpO2 go down? How much does SpO2 vary normally?

You really don't understand sleep apnea, do you.....why don't you just google us the answer.... sigh. We are not looking at the pulse. we are looking at the sat.

Two desaturations below 88 is abnormal.
One desaturation to 85 or less will interrupt REM sleep. There is a variable pulse increase just before the obstruction to breath is overcome (sometimes not seen) - that is the epinephrine surge that keeps you from asphyxiating- it stirs you up and you take a breath.

The cycle then restarts.

The correlations are in the last 20 years of sleep literature. It's between desats and EEG disturbance......

 

[JimNtexas]

Jim if you improve to the point where a sleep study shows no further OSA, and you can maintain the weight loss and show no desats buy sequential home overnight saturimetry recordings, after 3 years we can get you back in the regular issuance pool.

So, the answer is "yes".

I'll contact you directly when we get closer to my SI renewal, but I guess I'm on the SI bandwagon for three years. Sigh.

Jim, mnewb1's data do not serve your point...

My only disagreement is with the statement that having OSA means you are just as impaired as a drunk. That's just ridiculous. Having OSA doesn't mean you wake up drunk.

OSA or not, don't fly when you're sleepy. Period. If you think you have OSA you probably do, see your doctor.

If you are the FAA, get some input from stakeholders before you issue a sweeping dictate.

And Mr Administrator, if sleepy pilots are such a problem why didn't you tighten up the crew rest requirements for cargo operations as you did for passenger flights? The cargo guys are ones living in circadian nightmare.

 

[bbchien]

I'll contact you directly when we get closer to my SI renewal, but I guess I'm on the SI bandwagon for three years. Sigh.



My only disagreement is with the statement that having OSA means you are just as impaired as a drunk. That's just ridiculous. Having OSA doesn't mean you wake up drunk.

OSA or not, don't fly when you're sleepy. Period. If you think you have OSA you probably do, see your doctor.

If you are the FAA, get some input from stakeholders before you issue a sweeping dictate.

And Mr Administrator, if sleepy pilots are such a problem why didn't you tighten up the crew rest requirements for cargo operations as you did for passenger flights? The cargo guys are ones living in circadian nightmare.

Yeah, well ask the Senator from FedX. The Administrator only does what the congress authorizes/demands.

 

[denverpilot]

Shoe on the other foot. What's your evidence for that? Evidence, not suppositions.

....see, it cuts both ways, Kent......

Better yet, why don't you just google the answer. ...yeah, that's it.

...sigh.....

Kent didn't use the real stats. But I did. Top two: Fuel and VFR into IMC. 50% of an already bottomed-out, hasn't gotten significantly lower in four decades, accident record.

If there were any way to tie OSA to a *significant* percentage of those two, then it's reasonable to say the accident rate will go *significantly* down after this is implemented.

Kent's right Doc. An educated guess by the known numbers puts the highest number I can come up with for OSA-caused accidents in the single digit percentages, just by the law of averages.

Do the math. If even 10% of all of the top ten accident types are OSA induced, you're still roughly 40% below the top one. Fuel.

Lots of money and lots of time on a very marginal accident cause. I would have to crunch a spreadsheet to see how high the OSA causation against all of the top ten accident types would have to be, to hit double digit percentages of total accident causes.

If it isn't double digits, it's almost into the statistical noise floor.

 

[Henning]

Thing is Fuel issues as well as VFR into IMC are indicative of Poor Decision Making which is/can be part and parcel of fatigue. How many people who run out fuel do so because they forgot to look at the gauge or recalculate the time they'll be aloft due to unexpected head winds until it was too late? That's the deal, you can't discount OSA from those accidents any more than you can attribute them to it or anything else.

Personally I hope this all goes through if for no other reason than the 'unintended consequence' of the pilots whose lives will be improved by it. I have never heard a person complain about how crappy life was since they got on a CPAP. I have heard a lot of people say how much it's improved.

 

[denverpilot]

Thing is Fuel issues as well as VFR into IMC are indicative of Poor Decision Making which is/can be part and parcel of fatigue. How many people who run out fuel do so because they forgot to look at the gauge or recalculate the time they'll be aloft due to unexpected head winds until it was too late? That's the deal, you can't discount OSA from those accidents any more than you can attribute them to it or anything else.



Personally I hope this all goes through if for no other reason than the 'unintended consequence' of the pilots whose lives will be improved by it. I have never heard a person complain about how crappy life was since they got on a CPAP. I have heard a lot of people say how much it's improved.

You can't prove it, though. Not by a long shot.

The people who aren't working with their primary care Doc already chose their quality of life. Unless FAA can tie it to accidents (sorry a two pilot crew overflying an airport on autopilot at night isn't an accident, it's pilot error), their quality of life isn't your business or the government's.

If it is, FAA better start mandating that employers pay enough money only to all licensed pilots so they can maintain a better level of proficiency in their aircraft and enough time off to do it. If they can't afford at least 150 hours a year in both time and money, we'd better mandate a higher quality of life for them. Obviously the accident rate will go down considerably.

The medical division can do it under their legal authority since stress is not conducive to good health and there's piles more evidence that stressed out pilots make awful decisions. Probably way way more than OSA afflicted pilots.

I'm glad you care for your fellow pilots well-being so much you've offered to pay for the whole proficiency program via your taxes.

It's about the IMSAFE checklist. If you're tired you shouldn't be flying. You failed F.

Like someone pointed out, if they're driving their cars that way...

Here's the real litmus test. Any insurers planning on raising fat pilot's rates? They have the data and actuaries. They can tell you exactly how many more fat pilots make bad judgement calls in airplanes. And they know if it adds significant risk of a major payout.

Same thing with fat car drivers. They have the data from DMV records.

 

[ClimbnSink]

Long past due for fat people to pay more for insurance. Same problem as here, fatties are weak and have been coddled so no company has yet to stand up to the 'fat victim' cries of outrage.

 

[weilke]

Here's the real litmus test. Any insurers planning on raising fat pilot's rates? They have the data and actuaries. They can tell you exactly how many more fat pilots make bad judgement calls in airplanes. And they know if it adds significant risk of a major payout.

Fat chance of that happening. Not even the multi-billion health insurance industry dares to go against the fat lobby, look at the outcry every time an airline tells someone to buy two tickets.

 

[flyingcheesehead]

You really don't understand sleep apnea, do you.....why don't you just google us the answer.... sigh. We are not looking at the pulse. we are looking at the sat.

No, I don't, or I wouldn't be asking. I know that if you hold your breath your pulse can go down... So I was wondering if that's something that occurs during an apnea event or not.

Two desaturations below 88 is abnormal.
One desaturation to 85 or less will interrupt REM sleep. There is a variable pulse increase just before the obstruction to breath is overcome (sometimes not seen) - that is the epinephrine surge that keeps you from asphyxiating- it stirs you up and you take a breath.

The cycle then restarts.

Thank you - That's good information, exactly what I was after.

Now, I just need to see if my pulse oximeter's battery will last 8 hours, and if I can go a whole night without knocking it off my finger.

 

[flyingcheesehead]

Personally I hope this all goes through if for no other reason than the 'unintended consequence' of the pilots whose lives will be improved by it. I have never heard a person complain about how crappy life was since they got on a CPAP. I have heard a lot of people say how much it's improved.

Meh... If I'm wide awake to be hating life because I can't afford to drop $2K/year on my medical, I'm not going to be happy!

 

[Gary F]

No, I don't, or I wouldn't be asking. I know that if you hold your breath your pulse can go down... So I was wondering if that's something that occurs during an apnea event or not.



Thank you - That's good information, exactly what I was after.

Now, I just need to see if my pulse oximeter's battery will last 8 hours, and if I can go a whole night without knocking it off my finger.

Who will watch the O2 sat readings while you are asleep or does it have a recording function?

 

[flyingcheesehead]

Who will watch the O2 sat readings while you are asleep or does it have a recording function?

This:

I have a recording pulse-ox... It supposedly records pulse and SpO2 for 24 hours.

 

[Dav8or]

Long past due for fat people to pay more for insurance. Same problem as here, fatties are weak and have been coddled so no company has yet to stand up to the 'fat victim' cries of outrage.

You certainly seem to be a perfect human being and your compassion is overwhelming.

 

[Dav8or]

Fat chance of that happening. Not even the multi-billion health insurance industry dares to go against the fat lobby, look at the outcry every time an airline tells someone to buy two tickets.

Could it be that large numbers of the American public are over weight, including members of the insurance industry? In this CDC report, they found that 35.7% of Americans were obese between 2009 and 2010. They define obesity as any adult with a BMI of 30, or over. If you were in business, would you really want to alienate this many potential customers? If they were going to charge extra for fat people, does that mean skinny people get a discount? Do we really want to create yet another reason to discriminate and hate people?

 

[Henning]

Could it be that large numbers of the American public are over weight, including members of the insurance industry? In this CDC report, they found that 35.7% of Americans were obese between 2009 and 2010. They define obesity as any adult with a BMI of 30, or over. If you were in business, would you really want to alienate this many potential customers? If they were going to charge extra for fat people, does that mean skinny people get a discount? Do we really want to create yet another reason to discriminate and hate people?

The two ticket rule isn't "paying extra", it's paying for what they use rather than imposing their girth into the neighboring seat which someone else paid for. I personally think that if the people that can't be contained within the width of one seat don't want to buy a second, we should take all those people and group them into their own rows so they all get to experience what everyone else gets to experience sitting next to them.

 

[weilke]

Could it be that large numbers of the American public are over weight, including members of the insurance industry? In this CDC report, they found that 35.7% of Americans were obese between 2009 and 2010. They define obesity as any adult with a BMI of 30, or over. If you were in business, would you really want to alienate this many potential customers? If they were going to charge extra for fat people, does that mean skinny people get a discount? Do we really want to create yet another reason to discriminate and hate people?

If you buy a a car with an above average loss history, you are going to be charged a higher rate, even though you haven't gotten into any accident yourself. Doesn't mean that the insurance company hates you.

Being obese is just like smoking, it is related to ones choices. This is different from other insurance risks, e.g. being female or old, something you can't really do much about.

 

[weilke]

The two ticket rule isn't "paying extra", it's paying for what they use rather than imposing their girth into the neighboring seat which someone else paid for. I personally think that if the people that can't be contained within the width of one seat don't want to buy a second, we should take all those people and group them into their own rows so they all get to experience what everyone else gets to experience sitting next to them.

I actually think they should be denied boarding, two tickets or not.

Airline seats are designed for a particular weight, if cargo beyond that limit is strapped into the seat, it puts the people in the row in front at risk in case of an accident. Also, if a non-spec passenger is put in the aisle seat, the passengers in the middle and window seats are put at the risk of remaining trapped in the plane in case of an accident.

 

[timwinters]

I personally think that if the people that can't be contained within the width of one seat don't want to buy a second, we should take all those people and group them into their own rows so they all get to experience what everyone else gets to experience sitting next to them.

helluvan idea!

 

[AggieMike88]

Two desaturations below 88 is abnormal.
One desaturation to 85 or less will interrupt REM sleep. There is a variable pulse increase just before the obstruction to breath is overcome (sometimes not seen) - that is the epinephrine surge that keeps you from asphyxiating- it stirs you up and you take a breath.

The cycle then restarts.

This is likely a very good description of what happens to me (as dx'd with OSA) when I made the decision to sleep without using my CPAP.

And it happened over the weekend. I decided to try and watch a late movie ("Akira" on Toonami), but was warm and comfy enough in my barca-lounger that I conked out before the end. When I did wake up, the movie was over and I decided that I was warm and cozy enough to just stay there versus move to the bedroom and my CPAP machine.

Stupid mistake as I really slept lousy. I recall waking up at least 6 maybe 8 times before I got up for the day. Had a slight headache and felt crummy for the first hour of being up. The headache I attribute to accumulated CO2, and feeling crummy to not getting the right sort of rest. All of this reminded me why I am glad I got dx'd correctly and use the CPAP. I never have nights this bad when I'm on my blower.

My anecdotal evidence is that I am much more alert and productive when I get 7-8 hours rest while compliant with CPAP therapy. I don't have pulse-ox data, but my apnea events per hour recorded by my CPAP machine are lower than when I first started therapy and if I do wake up in the middle of the night, it's usually for bladder relief and never because I got hit with a big apnea event. Most nights it's straight through with no wakefullness or at worst, once to change positions, or go potty.

When I don't comply with CPAP therapy, I am not as alert and productive as when I am. And because I want to be alert and productive, then I willingly comply.

I know much of our debate here is about airmen being broadbrushed into a particular category and then "forced" to substantiate that they have or do not have OSA with an expensive sleep study. And that if we give the authorities this inch, what mile are they going to take next? I get that. But my personal opinion is that if you are likely in this category, and do have concerns about your quality of sleep, then get tested.

Like the discussions on hypertension and diabetes, and how uncorrected adds to the ticks of the eventual health timebomb, the same applies to OSA. There are many conditions, especially cardio, that are aggravated with untreated OSA. So I say that it's worth being checked out if you are at risk, and then comply with CPAP therapy if so proscribed.

And I agree with Gary F. when he said, quityerbitchin and get busy getting healthier and get your BMI to 30 and below. It's a goal of mine I hope to achieve and maintain this next year.

 

[Henning]

Even without having OSA, I doubt I could do the waking restful ness test lol. 25+ as a captain (you think truckers and pilots had crappy rest rules, you wouldn't believe what seamen get put through, and yes, it is high on the list of accident causes especially when you're on a 6 on 6 off rotation) my body has become accustomed to taking advantage of any period of calm to get in a nap.

 

[Matthew]

Even without having OSA, I doubt I could do the waking restful ness test lol. 25+ as a captain (you think truckers and pilots had crappy rest rules, you wouldn't believe what seamen get put through, and yes, it is high on the list of accident causes especially when you're on a 6 on 6 off rotation) my body has become accustomed to taking advantage of any period of calm to get in a nap.

heh - that's like telling the cop, "Officer, I couldn't do that test sober!"

 

[Palmpilot]

Now, I just need to see ... if I can go a whole night without knocking it off my finger.

I asked about this on another board, and a couple of people who have OSA and are being treated said that people have been successful by criss-crossing a couple of pieces of surgical tape to hold it on.

 

[Palmpilot]

...There are many conditions, especially cardio, that are aggravated with untreated OSA...

Along those lines, according to WebMD, there is a significant correlation between ED and OSA. That might be an incentive for some.

http://blogs.webmd.com/sleep-disorders/2011/06/erectile-dysfunction-and-obstructive-sleep-apnea.html

So I say that it's worth being checked out if you are at risk, and then comply with CPAP therapy if so proscribed.

Now if we could just get the FAA to stop penalizing people who get treated...

 

[EdLarkin]

Do you know of anyone who has had a sleep study who didn't come away with a prescription for a CPAP machine?

 

[Matthew]

Do you know of anyone who has had a sleep study who didn't come away with a prescription for a CPAP machine?

Yes..

 

[AggieMike88]

Now if we could just get the FAA to stop penalizing people who get treated...

What is this penalty you speak of? The Special Issuance?

If yes to that, it's an easy SI to obtain and comply with if you are already diagnosed, being treated, and work with a top AME like Bruce.

IIRC, there is a push amongst the top AME's to get OSA under the CACI realm if issuance like DM2(pill) and others were done this year.

 

[flyingcheesehead]

Along those lines, according to WebMD, there is a significant correlation between ED and OSA. That might be an incentive for some.

http://blogs.webmd.com/sleep-disorders/2011/06/erectile-dysfunction-and-obstructive-sleep-apnea.html

Well, I have an idea for a much cheaper test now.

 

[bbchien]

Well, I have an idea for a much cheaper test now.

Well, the way the FAS is going to do it will allow the sleep specialist to order an overnight home recording and if that screen is negative, he'll then write "this man does not have Sleep Apnea".

B.

 

[denverpilot]

I could care less what truckers rules are.



In aviation, transportation to and from hotel is not considered as rest.

You missed the point. Unless airlines changed their ways, and maybe they did... let's do a simpler example.

Say your crew van gets caught in a 3 hour traffic jam on the way to the crew hotel for your rest period. The entire crew lost three hours of rest time and the flight back into the hub is scheduled at exactly the second they'd have gotten the legal rest time to depart in the morning. There is no other crew. You're at an out station.

Is the crew going to be able to not show until three hours later and have it backed by law the next morning?

How many airlines will fly a reserve crew out to an out-station or postpone the flight departing back into the hub the next morning if the above scenario occurs?