FAA adds another hoop for medicals

[Matthew]

What I really dread is a possible diagnosis of "mild" OSA. That's the worst of all. If your problem is more severe, you get a CPAP and you get your SI. If they don't decide it's bad enough for the machine, you get to do the maintenance of wakefulness test like one friend of mine. He described it to me, and it sounds like even someone with no OSA at all who got a great night's sleep would have trouble staying awake!

Not a doc - my understanding: a sleep study will count apneas (among other things). An apnea is a breathing episode that lasts > x seconds. For a diagnosis of OSA, you need > y apneas per hour. I don't remember what x and y are, but it should be easy enough to Google. Doc Chien can answer this - I think FAA sees any OSA diagnosis as something that must be treated and doesn't differentiate between mild or otherwise. The treatment also has to have some way to record compliance, so you need a recording CPAP. FAA doesn't like dental devices that hold your jaw just right or tennis balls sewn into the back of a t-shirt so you are forced to side-sleep because there is no way to record that you actually are using those methods.

 

[bbchien]

Hmm.

My BMI is currently 37.7, down from a high of 39.6.
For me, a 40 BMI (Morbidly Obese) = 329 lb.
35 BMI (Severely Obese) = 288 lb.
30 BMI (Moderately Obese) = 246 lb.
25 BMI (Merely Overweight) = 205 lb.

Best shape I've ever been in my life at this height was when I first reached this height and was on tour with a drum and bugle corps the entire summer, rehearsing and performing. Heckuva great workout, and we were fed healthy food. At that point - Again, *just* having grown to my adult height - I weighed 180, for a BMI of 21.9. I had so little body fat, you could see the blood vessels standing out on my arms, and you could see my ribs too. But, if I'd lost another 28 lbs. I'd have still been considered healthy.

I've suspected some possible issues with OSA in the past when I was at my peak weight - But that's because I was told I snored a lot, and occasionally, I'd snort and wake myself up as I was falling asleep. I've never felt really tired during the day, and can easily go for 20 hours after a good night's sleep before I start to feel tired.

What I really dread is a possible diagnosis of "mild" OSA. That's the worst of all. If your problem is more severe, you get a CPAP and you get your SI. If they don't decide it's bad enough for the machine, you get to do the maintenance of wakefulness test like one friend of mine. He described it to me, and it sounds like even someone with no OSA at all who got a great night's sleep would have trouble staying awake!

I also don't look forward to the time, cost, and hassle of getting the study done - I just happen to have an 18" neck, so despite my BMI being a few points lower than they're casting the net right now, I'm gonna have to do it. This really does seem like a witch hunt.

MWTs are hardly ever done for FAA stuff, Kent.

Read the sheet again. It's straight BMI> 40.

 

[flyingcheesehead]

Not a doc - my understanding: a sleep study will count apneas (among other things). An apnea is a breathing episode that lasts > x seconds. For a diagnosis of OSA, you need > y apneas per hour. I don't remember what x and y are, but it should be easy enough to Google. Doc Chien can answer this.

And I hope he does... Bruce?

Also, are you allowed to sleep on your side for a sleep study? I sleep on my side every night, for two reasons: 1) I'm less likely to snore, and 2) I injured my back several years ago and on the rare occasions that I fall asleep on my back (usually because I'm dog-tired and doing something in bed on my back and accidentally fall asleep) I end up with a major backache the next day.

I don't need a tennis ball or a retainer, but I can't sleep on my back.

MWTs are hardly ever done for FAA stuff, Kent.

That's good news... Kinda. But a friend of mine, whose wife suggested he visit the doctor because he snored a lot, has to do the MWT every year for his medical. Or, I should say "had". He's pretty much quit flying because of the hassle, expense, and BS factor it takes to fly.

Read the sheet again. It's straight BMI> 40.

Oh... I thought I was gonna get hit 'cuz my neck is about 18.5-19 inches. Sounds like it's BMI>40 AND neck>17", not or.

Still seems like they're going to cast a very wide net eventually.

 

[bbchien]

And I hope he does... Bruce?

Also, are you allowed to sleep on your side for a sleep study? I sleep on my side every night, for two reasons: 1) I'm less likely to snore, and 2) I injured my back several years ago and on the rare occasions that I fall asleep on my back (usually because I'm dog-tired and doing something in bed on my back and accidentally fall asleep) I end up with a major backache the next day.

I don't need a tennis ball or a retainer, but I can't sleep on my back.



That's good news... Kinda. But a friend of mine, whose wife suggested he visit the doctor because he snored a lot, has to do the MWT every year for his medical. Or, I should say "had". He's pretty much quit flying because of the hassle, expense, and BS factor it takes to fly.



Oh... I thought I was gonna get hit 'cuz my neck is about 18.5-19 inches. Sounds like it's BMI>40 AND neck>17", not or.

Still seems like they're going to cast a very wide net eventually.

Impossible. When the response time goes up from 105 days to 168 days the OKC folk will say to leadership: "we will now send our overflow to you directly in Washington...." and it will all stop there.

But it looks like there is going to be some legislation to force this through rulemaking. If it succeeds, it'll be 2 years before implementation.....

 

[weilke]

But it looks like there is going to be some legislation to force this through rulemaking. If it succeeds, it'll be 2 years before implementation.....

That is what the trucking industry did.

As the numbers support what the air surgeon proposes, I dont see how the rulemaking process is going to change the outcome (it didn't for the trucking industry). A two year 'reprieve' but in the end a process with less flexibility for the AME or subsequent air surgeons to modify the policy. Lets say they write polysomnography as the only acceptable means into the regulation and in 3 years someone comes up with a tamper-proof portable throw-away monitor that reduces the cost for the test to $25. As the PSG requirement is carved in stone in the reg, people will still be stuck with PSGs for a very long time.

 

[Jeff Oslick]

I dont see how the rulemaking process is going to change the outcome

At the least it could force a rational discussion of the difference between the risks to the paying public vs. recreational/personal business uses, and why we have 3 different classes of medical certification.

 

[weilke]

At the least it could force a rational discussion of the difference between the risks to the paying public vs. recreational/personal business uses, and why we have 3 different classes of medical certification.

If you have ever looked at nprms and the final rules, you will notice that it has very little to do with a rational discussion.

'One commenter stated that the proposed rule will cause the rotation of the earth to cease and everyone to be flung into space. The agency disagreees with the commenters statement and the rules on being flung into space will remain unchanged from the draft regulation.'

But yes, there should probably be a difference between some old guy who flies his 182 to a pancake breakfast on saturday mornings and a commercial pilot who flies single pilot at night shipping parcels to Memphis. The better solution would be to do away with the third class for all flying in ac with 4 seats, less than 250hp weight < 3000lbs and which are flown for strictly recreational purposes.

I attended the NTSB hearing on the Ted Stevens crash. A very experienced pilot deviated from the safe route through a pass and flew a perfectly good plane into the side of a mountain. The probable cause was found to be: The pilot's temporary unresponsiveness for reasons that could not be established from the available information. So, dozing off while flying a plane full of people is a bad thing, whether it is for 'reasons that could not be established' or due to excessive daytime sleepiness from OSA.

 

[denverpilot]

I
Maybe that's part of the problem. On my driver's license, I can't drive trucks above a certain number of axles (and/or weight?), even if it's for non-commercial purposes.

What is: A type rating is triggered by what criteria...?, for $500, Alex.

 

[Matthew]

Also, are you allowed to sleep on your side for a sleep study?

In my case, I was, and am, a side sleeper. During the study they did ask me to sleep on my back a couple times during the night. I must have managed to doze off just enough to give good data. The report did give an apnea result for side vs back.

 

[Capt. Geoffrey Thorpe]

Hmm.

My BMI is currently 37.7, down from a high of 39.6.
For me, a 40 BMI (Morbidly Obese) = 329 lb.
35 BMI (Severely Obese) = 288 lb.
30 BMI (Moderately Obese) = 246 lb.
25 BMI (Merely Overweight) = 205 lb.

Best shape I've ever been in my life at this height was when I first reached this height and was on tour with a drum and bugle corps the entire summer, rehearsing and performing. Heckuva great workout, and we were fed healthy food. At that point - Again, *just* having grown to my adult height - I weighed 180, for a BMI of 21.9. I had so little body fat, you could see the blood vessels standing out on my arms, and you could see my ribs too. But, if I'd lost another 28 lbs. I'd have still been considered healthy.

BMI numbers should be corrected for your frame size to get a less unrealistic value. Hand / wrist measurements are used to determine the correction.

 

[Palmpilot]

What is: A type rating is triggered by what criteria...?, for $500, Alex.

You can get a type rating without getting a second class medical. Can you get a commercial driver's license, and/or exercise the privileges of one, without meeting the medical standards that are applicable to commercial drivers?

 

[ClimbnSink]

Picking on bmi is funny. Wonder the percentage of bmi > 40 chaps that are hardcore bodybuilders. I think fat pilots should be treated the same as pilots with a dui. Both show a lack of self discipline, self control, irresponsibility, and willingness to take excessive risk for immediate gratification.

 

[Palmpilot]

But it looks like there is going to be some legislation to force this through rulemaking.

Are you basing that on the fact that they did it for truckers, or has Congress actually started moving in that direction for pilots?

 

[Palmpilot]

BMI numbers should be corrected for your frame size to get a less unrealistic value. Hand / wrist measurements are used to determine the correction.

And something should be done about the fact that the BMI formula and table assume that muscle and bone mass are zero.

 

[DFH65]

I think fat pilots should be treated the same as pilots with a dui. Both show a lack of self discipline, self control, irresponsibility, and willingness to take excessive risk for immediate gratification.

Now there is a slippery slope. So lets see who might fit in to the category of lack of self discipline and willingness to take excessive risk for immediate gratification. Who should we ground lets make a list I will start.

Smokers?
Liberals?

 

[Unregistered]

If you find cracks in structure when inspecting an airplane you don't wait until the wing falls off before issuing an AD.

The issue a few years ago where the NW pilots slept through the final approach step down was such a crack in structure...
It is my understanding that both pilots would have been subject to OSA screening given the proposal...

The fact that OSA causes drowsiness is undisputed.
The fact that Neck size over 17" and BMI ove 40 are significant risk factors for OSA is undisputed... (note its BMI not fat percentage)

Suppose OSA is a real problem with today's pilots, what sort of evidence would you expect to see?

With access to the data one could compare the overall pilot population BMI against the
BMI for all night time single pilot CFIT accidents.....

If your confident that OSA is not an issue then get that study done and if there is no difference between BMI in the overall pilot pool and the pilots that CFIT at night you have a strong case to crush the proposed rule. If the study shows correlation between BMI and night CFIT... then maybe its a reasonable rule.

 

[Palmpilot]

Now there is a slippery slope. So lets see who might fit in to the category of lack of self discipline and willingness to take excessive risk for immediate gratification. Who should we ground lets make a list I will start.

Smokers?
Liberals?

People who eat hamburgers and fries?

 

[Jeff Oslick]

Now there is a slippery slope. So lets see who might fit in to the category of lack of self discipline and willingness to take excessive risk for immediate gratification. Who should we ground lets make a list I will start.

Smokers?
Liberals?

Why not anyone with a high-pressure job? Or a difficult family situation, or any other of a myriad of life circumstances that we know can lead to poor decision making, fatigue, get-home-itis, etc? This one isn't a slippery slope folks, it's the edge of the cliff.

 

[Henning]

Why not anyone with a high-pressure job? Or a difficult family situation, or any other of a myriad of life circumstances that we know can lead to poor decision making, fatigue, get-home-itis, etc? This one isn't a slippery slope folks, it's the edge of the cliff.

We already test for the negative effects of that with blood pressure/hypertensive screening.

 

[flyingcheesehead]

Picking on bmi is funny. Wonder the percentage of bmi > 40 chaps that are hardcore bodybuilders. I think fat pilots should be treated the same as pilots with a dui. Both show a lack of self discipline, self control, irresponsibility, and willingness to take excessive risk for immediate gratification.

As does the dick who spouts this kind of crap on message boards to shore up his own self-esteem.

One of my old fraternity brothers eats like a pig. Breakfast for him is a pound of bacon, and then a dozen eggs cooked in the bacon grease. He's skinny as a rail. Maybe we need to look at calorie intake to find the "lack of self discipline, self control, irresponsibility, and willingness to take excessive risk for immediate gratification."

 

[flyingcheesehead]

You can get a type rating without getting a second class medical. Can you get a commercial driver's license, and/or exercise the privileges of one, without meeting the medical standards that are applicable to commercial drivers?

Yes, but the license will be limited to intra-state operations only. At least, that's how it is here in Wisconsin.

 

[Henning]

Yes, but the license will be limited to intra-state operations only. At least, that's how it is here in Wisconsin.

I think Farm Tag also gets an exemption even for interstate. I don't know if they have changed the rule in the mean time, but I could run the Farm Truck on farm business anywhere regardless of GW on my regular TX drivers license.

 

[bbchien]

Are you basing that on the fact that they did it for truckers, or has Congress actually started moving in that direction for pilots?

Nah, Richard you have it backwards.
If you get the EAA and AOPA bulletins, you'd see the pushback has already begun.

AOPA e-pilot from 11/21/2013:

There are more affordable and less intrusive options for addressing sleep disorders, the letter notes, including a provision in the AOPA/EAA Third-Class Medical Petition that would require pilots to participate in a recurring educational course that would teach them how to better self-assess their medical fitness to fly. The letter points out that pilots determine their fitness to fly every time they get in the cockpit, while they visit the medical examiner only periodically.
AOPA's position received support from Congress on Nov. 21, when a group of House General Aviation Caucus members introduced legislation to require the FAA to go through the rulemaking process before implementing policy changes related to sleep disorders.
The measure is sponsored by Rep. Frank LoBiondo (R-N.J.), chairman of the House aviation subcommittee; Rep. Rick Larsen (D-Wash.), ranking member of the aviation subcommittee; Rep. Sam Graves (R-Mo.), co-chair of the House General Aviation Caucus; Rep. Dan Lipinski (D-Ill.); Rep. Larry Bucshon (R-Ind.); Rep. Richard Hudson (R-N.C.); and Rep. Pat Meehan (R-Pa.).

 

[Jeff Oslick]

We already test for the negative effects of that with blood pressure/hypertensive screening.

1) We test everyone for that, not just a select group that has a cut off for selection based on an arbitrary number.

2) Are you implying that everyone, or even most people with a lot of stress in their lives has hypertension above the FAA screening criteria? I'd love to see that study.

 

[tmyers]

Hmmmmm, taking risks for gratification pretty well describes a pilot!!!

 

[ifconfig]

Now there is a slippery slope. So lets see who might fit in to the category of lack of self discipline and willingness to take excessive risk for immediate gratification. Who should we ground lets make a list I will start.

Smokers?
Liberals?

Serial philanderers? Speeders? Motorcycle drivers? Parachute jumpers?

 

[Palmpilot]

DFH, did you know that just last month I got a guy's record straight and got him on the Sleep Apnea SI. The AME in Georgia had been telling airmen,
(1) do you still have sleep apnea?
(2) Well, it's treated, isn't it?
(3) So do you still have it?
No, I don't think they're going to let the AMEs do it.

I've been thinking about this, and I'm wondering how much effort FAA Medical has been putting into educating AMEs on this. If AME's are not up to the task, which makes more sense, bringing them up to speed, or making potentially thousands of pilots wait months for an SI?

 

[Henning]

1) We test everyone for that, not just a select group that has a cut off for selection based on an arbitrary number.

2) Are you implying that everyone, or even most people with a lot of stress in their lives has hypertension above the FAA screening criteria? I'd love to see that study.

I imply that in the slightest, that's why it's called 'screening'. Since this screening is simple and low cost, we do it to everyone, that fact that there is no overt appearance associated with a stressful life that may lead to hypertension, is another reason we screen everyone. With OSA though there is an overt appearance that we can easily recognize that is associated with it, so we begin screening there. Notice that the FAA intends to broaden the screening, they just don't have the resources to do it in one fell swoop, no matter that it wouldn't particularly make sense.

 

[flyingcheesehead]

I think Farm Tag also gets an exemption even for interstate. I don't know if they have changed the rule in the mean time, but I could run the Farm Truck on farm business anywhere regardless of GW on my regular TX drivers license.

That's different - That's driving a CMV without a CDL. I was talking about getting a CDL without a FedMed card.

 

[Henning]

That's different - That's driving a CMV without a CDL. I was talking about getting a CDL without a FedMed card.

Ahhh, gotcha.

 

[ifconfig]

For y'all fat FAA-targeting S.O.B's, lose weight. And try these:

Throat exercises to reduce sleep apnea

Studies show that throat exercises may reduce the severity of sleep apnea by strengthening the muscles in the airway, making them less likely to collapse.

Try these exercises:

• Press your tongue flat against the floor of your mouth and brush top and sides with a toothbrush. Repeat brushing movement five times, three times a day.
  
• Press the length of your tongue to roof of your mouth and hold for three minutes a day.
  
• Place a finger into one side of your mouth. Hold the finger against your cheek while pulling the cheek muscle in at same time. Repeat 10 times, rest, and then alternate sides. Repeat this sequence three times.
  
• Purse your lips as if to kiss. Hold your lips tightly together and move them up and to the right, then up and to the left 10 times. Repeat this sequence three times.
  
• Place your lips on a balloon. Take a deep breath through your nose then blow out through your mouth to inflate the balloon as much as possible. Repeat this five times without removing balloon from your mouth.

And then lose weight.

Good luck, and may your BMI go the way of America's future, down the drain.

 

[bbchien]

....And then lose weight.

Good luck, and may your BMI go the way of America's future, down the drain.

Before my dad got senile he used to say, "What this country needs is a good......famine"

I've been thinking about this, and I'm wondering how much effort FAA Medical has been putting into educating AMEs on this. If AME's are not up to the task, which makes more sense, bringing them up to speed, or making potentially thousands of pilots wait months for an SI?

The delay is not at the AME level, Richard. It's in OKC.
A good AME however can circumvent nearly ALL the delays.

Look at the AME count. FAA simply is decertifying those guys.

 

[Palmpilot]

The delay is not at the AME level, Richard. It's in OKC.

That's why I was suggesting that the FAA cut OKC out of the loop by letting AMEs handle it instead of having it be a special issuance.

A good AME however can circumvent nearly ALL the delays.

Even the 105 day backlog?

 

[Henning]

It could actually be a 'value added' AME service to provide the studies.

 

[weilke]

It could actually be a 'value added' AME service to provide the studies.

Already keeping my eyes open for an office suite that would work for this .

You still have to hire a sleep medicine guy to do the interpretation, but they are available for rent by the hour.

 

[PilotAlan]

So, when does this new standard take effect? Immediately on announcement?

 

[bbchien]

That's why I was suggesting that the FAA cut OKC out of the loop by letting AMEs handle it instead of having it be a special issuance.



Even the 105 day backlog?

Yup. I think removing uncertainty is why I am successful in what I do.

So, when does this new standard take effect? Immediately on announcement?

Well, with the legislative effort underway, zero to two years.

Since the "rules" never specify who gets screened for what, if it gets done through rulemaking it will be a blanket for ALL.

Be careful for what you wish....

 

[Palmpilot]

Yup. I think removing uncertainty is why I am successful in what I do.

You're doing God's work, that's for sure.

Well, with the legislative effort underway, zero to two years.

Since the "rules" never specify who gets screened for what, if it gets done through rulemaking it will be a blanket for ALL.

Be careful for what you wish....

That reminds me, I noticed that the AOPA letter included a reference to their previous proposal for getting more pilots out of third class medicals. I'm hoping that the new guy has or will become aware of the possibility that lobbying for the Australian model might be a better approach going forward.

 

[bbchien]

You're doing God's work, that's for sure.



That reminds me, I noticed that the AOPA letter included a reference to their previous proposal for getting more pilots out of third class medicals. I'm hoping that the new guy has or will become aware of the possibility that lobbying for the Australian model might be a better approach going forward.

Which is what I proposed, in 2011. Which Craig said, "wasn't good enough". F-head.

 

[Kelvin]

Which is what I proposed, in 2011. Which Craig said, "wasn't good enough". F-head.

Is it too late to say it to the new guy Dr. Chien?