Misdiagnosed sleep apnea, do I need to do a sleep study for 1st class medical?

[ILS_PILOT]

A few years ago I talked to a primary care physician about a problem I experienced even a few more years before that. He poked around my chest and asked if I was ever tired during the day. I said yes a little because I work with computers and have to stare at a screen for hours everyday. He recommended a sleep study. This was not the cause of the problem I initiated the talk with him for.

I ignored that recommendation because I'm 22 BMI, no sleep issues, exercise, etc. Did not see a reason for a sleep study.

Cut to just a bit ago, I started learning about aviation and soon discovered that in my medical history, the doctor put that I have sleep apnea. I went back to the same hospital, but the 1st doctor was gone. The 2nd doctor said I'm not at risk for apnea, nor do I seem like one to have it based on body type, etc. He gave me a letter saying I'm no risk for it. Next year, the 2nd doctor is also gone, and 3rd doctor said exact same thing. They cannot remove that from my medical history, but also gave another letter saying I'm low risk for it, and so on. I asked if I should just go get a sleep study done, and he said you can't just go do that, I need a recommendation from him first.

My concern is if I do get a sleep study done, it'll be another point on my history about sleep apnea. Would these 2 letters be enough to get a 1st class medical? Or should I go to an AME, submit that it's a misdiagnosis with the 2 letters, and see what the FFA wants?

 

[TCABM]

Sleep study will definitively rule in or out the diagnosis, which was likely put in so your insurer could pay for the test.

Without ruling it out, the FAA will assume you have untreated sleep apnea.

 

[ILS_PILOT]

Sleep study will definitively rule in or out the diagnosis, which was likely put in so your insurer could pay for the test.

Without ruling it out, the FAA will assume you have untreated sleep apnea.

Ah insurance would make sense why the first doctor put it in history. Unfortunate. But is it fair to say the 2 letters the following doctors wrote are meaningless to the FAA?

 

[AvNavCom]

This stuff makes me really annoyed, and I hate that physicians do it. Medical conditions such as sleep apnea have specific diagnostic criteria, and "I feel tired during the day" doesn't meet criteria for that diagnosis. There are a hundred things that you can make you occasionally tired during the day. I'll give your primary care doc the benefit of the doubt that perhaps you provided more of a history than you've given here, and that perhaps he had you do an Epworth Sleepiness Scale or similar tool to guide his recommendations. Even so, he should have kept his diagnosis to something like "fatigue" or "daytime sleepiness" until such time as you had a sleep study done. The AAFP, which presumably your doctor belonged to, explicitly endorses nocturnal polysomnography as the diagnostic standard. Perhaps it was a billing thing, given the wildly broken American medical system which encourages such things, but it sure as heck has put you in a position to do some scrambling to clear the air.

 

[ILS_PILOT]

Unfortunately no, he didn't ask various questions that the Epworth scale shows online. He was more confused as to the other problem I was telling him about and trying to dig further into it. Now I have realized that the problem was completely unrelated and just some pinching pain that I feel when slouching forward too much. Goes away soon after, but didn't know it at that time. Not sure why he connected that to sleep apnea without asking any of those questions.

The following 2 doctors also get confused when they look at my medical history and then at me. It feels completely unrelated. So they always resort to a letter that says low risk for apnea, but they can't specifically say I do not have it without a sleep study. That is the frustrating part that I can be diagnosed with it without the study, but can not cleared of it.

 

[Jeff Oslick]

The concern here is expressly whether you would be put in a position to lie on a government form. I expressly do not endorse lying on a government form. However, you are asked specific questions on the medical form. You are only asked about visits to health care providers in the last three years. If the original visit was older than three years ago, it doesn't get mentioned. You have no reason to believe that declaring a diagnosis of sleep apnea is accurate to declare under 18(x). In fact, you have good reason to believe that declaring that on the form would be an inaccurate statement based on subsequent written professional opinions, and an understanding that the original doctor performed an inadequate assessment to make a determination. You are signing that the form is "complete and true to the best of my knowledge".

Do what you will with this interpretation.

 

[DJTorrente]

This stuff makes me really annoyed, and I hate that physicians do it.

One might hope (expect?) that a competent, thoughtful, professional who is elevated to the position of Federal Air Surgeon, or his duly authorized designee, might be able to work through all that on the record at hand and not choose to implement a policy that puts applicants through unnecessary time, expense, and mental anguish in order to disprove an errant "diagnosis" that was clearly taken with pecuniary motive.

I don't even much blame the first Doc. Hell, I'd bet s/he thought s/he was doing OP a favor by inducing the insurer to be willing to pay for the test. The coolest head in the room was OP, who declined to undergo a procedure for speculative and at most marginal benefit. In doing so, OP even saved his insurer some coin -- for all the gratitude it earned him.

On the other hand, if the government employee were instead primarily a self-interested a**-covering bureaucrat...

 

[Jeff Oslick]

On the other hand, if the government employee were instead primarily a self-interested a**-covering bureaucrat...

Even in the worst-case scenario where the FAA did manage to dig this up and make an issue out of it (unlikely), the OP could deal with getting a sleep study done at that point, paid for out-of-pocket, of course. The worst outcome of which would be to comply with the OSA treatment monitoring requirements done by many pilots. As I pointed out, if the MedExpress form is filled out truthfully, to the best of the OPs knowledge, there is no punishment to extract on that front.

 

[bbchien]

Sigh. the way around that is to order on your Visacard a $140 on line (it arrives in a box at your house), and if the AHI is <5 that's the end of it.

Crazy american system....

 

[Jeff Oslick]

Sigh. the way around that is to order on your Visacard a $140 on line (it arrives in a box at your house), and if the AHI is <5 that's the end of it.

Crazy american system....

I don't see how an at-home test would pass muster with the FAA. No proof of who actually took the test. It would be like taking a drug test at home.

 

[ILS_PILOT]

Thank you for all your comments. I'm getting a lot of insight here.

Researching a lot myself too. It looks like certain home tests are less accurate for people at low risk of sleep apnea, which is in a way good and bad for me if I need to be accurate for the FAA. I did worry about bad data which could be harmful in my situation. I'm also reading in places that sleep study isn't even recommended for people low at risk. So not sure what is happening or why that is said. I'm still thinking about how to proceed here, but I last year I did call an AME and asked for advice and he said to just do a sleep study. I might call a 2nd AME and see what they say about the 2 letters too. If they also recommend me having a test done just to be sure, I'll talk to the doctor and tell them to recommend me a sleep study. I just hate to have that on my record that I was recommended a sleep study.

 

[bbchien]

I don't see how an at-home test would pass muster with the FAA. No proof of who actually took the test. It would be like taking a drug test at home.

For most of these you need to upload your DL and your Visa card. So you get to document your felony……and Jeff, FAA accepts that all the time. But the real Ident. comes from the doctor's letter.

and to ILS pilot, the cat's meow is a class 2 study. This is the same one as in the hsoptial minus the video and can be had at home for $900 (which is off insurance, private and so controllable by you). But its' a bit steep. The Class 2 has all the wires on your head overnight.....so it can tell when you're in REM.

But I woudl also add, it appears if what you wrote is literally, "of record" accurate, you haven't been diagnosed. You're just "under suspicion". And if you BMI is what it is (thin!) what really matters is the SHAPE of your airway.

 

[4RNB]

I'm under the impression that sleep apnea does not keep. one from flying passengers for hire. I bought my first plane from a guy that used a machine at night.

 

[mryan75]

One might hope (expect?) that a competent, thoughtful, professional who is elevated to the position of Federal Air Surgeon, or his duly authorized designee, might be able to work through all that on the record at hand and not choose to implement a policy that puts applicants through unnecessary time, expense, and mental anguish in order to disprove an errant "diagnosis" that was clearly taken with pecuniary motive.

I don't even much blame the first Doc. Hell, I'd bet s/he thought s/he was doing OP a favor by inducing the insurer to be willing to pay for the test. The coolest head in the room was OP, who declined to undergo a procedure for speculative and at most marginal benefit. In doing so, OP even saved his insurer some coin -- for all the gratitude it earned him.

On the other hand, if the government employee were instead primarily a self-interested a**-covering bureaucrat...

Gibberish. The OPs medical records contain a diagnosis. On what basis should it be ignored? The second two doctors have an opinion without testing. All the OP has to do is a sleep study, which insurance will pay for.

Just do the study.

 

[Jeff Oslick]

Gibberish. The OPs medical records contain a diagnosis. On what basis should it be ignored? The second two doctors have an opinion without testing. All the OP has to do is a sleep study, which insurance will pay for.

Just do the study.

We've read about plenty of BS diagnoses on this forum before, but this is a very rare one where the OP has not just one, but two doctors confirming in writing it was an incorrect/unjustified diagnosis. The original doc didn't do any testing either, so there is nothing other than the first docs "opinion" to disprove.

 

[ILS_PILOT]

and to ILS pilot, the cat's meow is a class 2 study. This is the same one as in the hsoptial minus the video and can be had at home for $900 (which is off insurance, private and so controllable by you). But its' a bit steep. The Class 2 has all the wires on your head overnight.....so it can tell when you're in REM.

But I woudl also add, it appears if what you wrote is literally, "of record" accurate, you haven't been diagnosed. You're just "under suspicion". And if you BMI is what it is (thin!) what really matters is the SHAPE of your airway.

Am I able to take any type of sleep study to the AME as evidence?

Also, I did ask the 3rd doctor if what was on my record was an actual diagnosis. After starting at my history for a while with a stern expression, he did tell me in the end that it is a diagnosis. And I read on the website in the history that it says "Obstructive sleep apnea (adult) (pediatric)". I will ask about my airway shape next time too, that might be a good one to know. And yes, 5'7" at 141 lbs. I gotta work out now!

Another thing, and I know these things are more toys than medical devices, but I bought a fitbit charge 6 to track my sleep. For over a year, I am seeing good results in rem, deep, and light sleep.

What would be annoying is I have to do a sleep study and get back false data/someone just wants to sell me a cpap machine and I get stuck with that forever.

 

[Matthew]

I don't know how those DIY home tests work - do you do multiple nights and take an average? Is it just one night? Can you repeat the test until you get a negative?

--

As a guy with an OSA SI: It sounds like you're going to have to take the test. Best case: It's negative and you never have to worry about it again. Worst case: You're out $140, you'll have to get a CPAP and the SI, and you'll either be out of pocket for the CPAP or the deductible, and then you look into Basic Medical.

 

[ILS_PILOT]

and then you look into Basic Medical.

Can you expand more on this? If my goal is 1st class medical for career flying, and even if someone has sleep apnea and uses cpap machine, they can still get the medical without having to be stuck with basic med, right?

 

[flyingron]

Can you expand more on this? If my goal is 1st class medical for career flying, and even if someone has sleep apnea and uses cpap machine, they can still get the medical without having to be stuck with basic med, right?

You get a few months of reports from the machine that you're using the CPAP regularly, and it is a non-issue.

 

[Matthew]

Can you expand more on this? If my goal is 1st class medical for career flying, and even if someone has sleep apnea and uses cpap machine, they can still get the medical without having to be stuck with basic med, right?

Ahh… yeah. If you’re looking for a class I then Basic Med won’t work.

With sleep apnea you’ll get a Special Issuance. Like @flyingron said, get CPAP reports plus a status report from your treating doc saying you’re being treated, and turn that in to your AME every year to keep it renewed. That first-time SI is where I’m not familiar with the process. But I think it really is pretty simple. Ask your AME how to handle that, or take the advice from the AMEs here.

Once you’re in the system with a sleep apnea SI, it’s pretty simple to handle every year.

 

[AvNavCom]

Am I able to take any type of sleep study to the AME as evidence?

Also, I did ask the 3rd doctor if what was on my record was an actual diagnosis. After starting at my history for a while with a stern expression, he did tell me in the end that it is a diagnosis. And I read on the website in the history that it says "Obstructive sleep apnea (adult) (pediatric)". I will ask about my airway shape next time too, that might be a good one to know. And yes, 5'7" at 141 lbs. I gotta work out now!

Another thing, and I know these things are more toys than medical devices, but I bought a fitbit charge 6 to track my sleep. For over a year, I am seeing good results in rem, deep, and light sleep.

What would be annoying is I have to do a sleep study and get back false data/someone just wants to sell me a cpap machine and I get stuck with that forever.

I don't like to give medical advice over the internet but I hate seeing you feeling like you're stuck in a corner. So this is with the caveat that I'm not your doctor, should be considered SGOTI regarding reliability, and that this situation is best discussed with your PCM and in consultation with your AME

All that said, I see a couple of options for you. The first is to contact the original physician who placed the diagnosis in your record. You can explain the issue it's causing, and that putting the diagnosis without diagnostic certainty is something you need corrected. It's possible that he may be willing to write something to the effect that the diagnosis was entered in error and should have been "fatigue" or something similar. Such a correction, included as an addendum to the original diagnosis, would be best as it avoids any further testing since there's no actual diagnosis at that point.

Failing that, you're in the position of disproving the diagnosis, which is harder. I would caution you against being too cynical regarding polysomnography tests. The physicians doing (or supervising) the tests are not making money on the equipment; it's just a further referral if the diagnosis is confirmed. A home test (as explained by a Sleep Medicine colleague some time ago) is not overly sensitive, so if it's positive then you almost certainly have the diagnosis, but if it's negative (and there's sufficient suspicion due to symptoms), then a formal "sleep lab" polysomnography is indicated to confirm. In your case, you can just run with the negative study.

Given the above, you could do the home test with the reasonable certainty that the test will be negative unless you genuinely have significant OSA. Alternatively, you could go directly to a reputable Sleep Medicine clinician (referral may be required for insurance purposes, but isn't mandatory if you're self-paying) to request the overnight sleep study.

So, either get the original diagnosis amended, or get a test done to prove/disprove. I don't see any other path. Good luck.

 

[Lindberg]

A few years ago I talked to a primary care physician about a problem I experienced even a few more years before that. He poked around my chest and asked if I was ever tired during the day. I said yes a little because I work with computers and have to stare at a screen for hours everyday. He recommended a sleep study. This was not the cause of the problem I initiated the talk with him for.

I ignored that recommendation because I'm 22 BMI, no sleep issues, exercise, etc. Did not see a reason for a sleep study.

Cut to just a bit ago, I started learning about aviation and soon discovered that in my medical history, the doctor put that I have sleep apnea. I went back to the same hospital, but the 1st doctor was gone. The 2nd doctor said I'm not at risk for apnea, nor do I seem like one to have it based on body type, etc. He gave me a letter saying I'm no risk for it. Next year, the 2nd doctor is also gone, and 3rd doctor said exact same thing. They cannot remove that from my medical history, but also gave another letter saying I'm low risk for it, and so on. I asked if I should just go get a sleep study done, and he said you can't just go do that, I need a recommendation from him first.

My concern is if I do get a sleep study done, it'll be another point on my history about sleep apnea. Would these 2 letters be enough to get a 1st class medical? Or should I go to an AME, submit that it's a misdiagnosis with the 2 letters, and see what the FFA wants?

What's your exact issue at this moment? You have been told by two doctors, in writing, that you don't have sleep apnea. The doctor that put it on your chart did so conditionally in order to order a test. Are you concerned that you have to tell the FAA that you have sleep apnea even through you don't? I don't think it works that way. But if you're super concerned, take all these records to the senior AME you're having your consult with (you are planning to have a consult before your first flight physical, right?) and all him what he thinks. I have a guess.

 

[ILS_PILOT]

Given the above, you could do the home test with the reasonable certainty that the test will be negative unless you genuinely have significant OSA. Alternatively, you could go directly to a reputable Sleep Medicine clinician (referral may be required for insurance purposes, but isn't mandatory if you're self-paying) to request the overnight sleep study.

So, either get the original diagnosis amended, or get a test done to prove/disprove. I don't see any other path. Good luck.

Yeah I think that might be what I will have to do. I thought maybe someone might have had this experience with these letters doctors gave and somehow it'd be enough for the FAA.

What's your exact issue at this moment? You have been told by two doctors, in writing, that you don't have sleep apnea. The doctor that put it on your chart did so conditionally in order to order a test. Are you concerned that you have to tell the FAA that you have sleep apnea even through you don't? I don't think it works that way. But if you're super concerned, take all these records to the senior AME you're having your consult with (you are planning to have a consult before your first flight physical, right?) and all him what he thinks. I have a guess.

Is your guess that the AME will look at the letters from 2 other doctors and say I don't have sleep apnea? As I mentioned in the above message, my goal is definitely that the AME takes those 2 letters. But my worry is that the letter do not explicitly state that I don't have sleep apnea. Because there is no proof that I don't have it. The letters only state I'm at low risk, not necessary for test, etc. That is where I think the AME/FAA might get tripped up on where the medical history says I am diagnosed with it, but no proof that I don't have it.

 

[AvNavCom]

Yeah I think that might be what I will have to do. I thought maybe someone might have had this experience with these letters doctors gave and somehow it'd be enough for the FAA.

Your medical record currently reflects that you have been diagnosed with sleep apnea, although the legitimacy of that diagnosis is in question. Two later physicians disagree, but it doesn't remove or nullify the fact that you have indeed been diagnosed with the condition at some point. Thus, you can either get the original physician to write something to the effect of "my bad, guys" or empirically disprove the diagnosis through testing. If the original diagnosis was indeed an erroneous entry (as stated by the diagnosing physician), then I think you can truthfully say that you've never had the diagnosis. However, if the diagnosis is in your record and has not been stated as an erroneous entry by the diagnosing physician, I suspect that would cloud the picture enough that the FAA would want a definitive answer. Again, best to discuss this in consultation with your AME prior to any formal FAA medical assessment, and were I in your shoes, I'd be calling the original physician first thing on Monday to get it corrected or find out how he justifies the diagnosis.

 

[Lindberg]

Two later physicians disagree, but it doesn't remove or nullify the fact that you have indeed been diagnosed with the condition at some point. Thus, you can either get the original physician to write something to the effect of "my bad, guys" . . . .

The original physician saying "my bad, guys" wouldn't alter what happened in the past any more than the two doctors who disagree does. So why would it alter your reasoning? What if the three doctors had all examined the OP at the same time? What if they'd all examined him on sequential days? Not all molehills must be made into mountains.

 

[Lindberg]

Is your guess that the AME will look at the letters from 2 other doctors and say I don't have sleep apnea?

My guess is he'll talk to you, look at you, and conclude that you don't have sleep apnea. You should ask him.

As I mentioned in the above message, my goal is definitely that the AME takes those 2 letters. But my worry is that the letter do not explicitly state that I don't have sleep apnea. Because there is no proof that I don't have it.

There's no proof that you didn't have a lot of things. That's not the standard.

The letters only state I'm at low risk, not necessary for test, etc. That is where I think the AME/FAA might get tripped up on where the medical history says I am diagnosed with it, but no proof that I don't have it.

Are you under the impression that you're required to submit your entire medical records to the FAA?

 

[DJTorrente]

As a guy with an OSA SI: It sounds like you're going to have to take the test. Best case: It's negative and you never have to worry about it again. Worst case: You're out $140, you'll have to get a CPAP and the SI, and you'll either be out of pocket for the CPAP or the deductible, and then you look into Basic Medical.

Oh, yeah OP would also have to sleep attached to a respirator for a maladady he barely suffers from if at all, in order to show the FAS (OKC) a record of "compliance" to attain that SI.

 

[AvNavCom]

The original physician saying "my bad, guys" wouldn't alter what happened in the past any more than the two doctors who disagree does.

Certainly it would. If the original physician says "hey, this diagnosis was entered in error due to administrative reasons and he never actually met criteria, so I'm amending that note" then it nullifies the diagnosis. It quite literally revises the medical record to remove the original diagnosis. At that point, it never happened and as far as I'm concerned the FAA wouldn't even need to hear about it. The two subsequent physicians agreeing that he's at low risk for same is just icing on the cake. On the other hand, if the original guy sticks to his guns for some weird reason, then the diagnosis remains in the record (appropriately or not) and OP is stuck proving that it isn't a thing.

 

[Jon Wilder]

There's no proof that you didn't have a lot of things. That's not the standard.

Tell that to the FAA. All it takes is an anonymous tip to be received that the OP has sleep apnea, and they’re gonna send him a letter requesting a sleep test.

Once something is mentioned…even if this doctor amends the OP’s records, the FAA will still make the OP prove he doesn’t have it solely because they will take no one at their word, especially not the word of a non-aeromedical doctor who has “made a mistake”.

Get the study done and remove all doubt.

 

[Matthew]

Oh, yeah OP would also have to sleep attached to a respirator for a maladady he barely suffers from if at all, in order to show the FAS (OKC) a record of "compliance" to attain that SI.

I did say that was worse case.

If he “…barely suffers from if at all…” there’s likely no need for the SI. But the sleep study sounds like the only way now to clear the diagnosis.

I can’t remember the allowable apnea events. I think >= 5 per hour is the line for a diagnosis and the CPAP treatment level of <= 3 is the target? I check mine every morning and am typically <= 1. I also lost 40 pounds over the last 4 years and have kept it off. I didn’t know about those DIY sleep studies until this thread. Now I’m thinking about doing one. If I’m <5 then I can look into getting out of my own SI.