Sleep Apnea and 3rd Class medicals or BasicMed

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Leo Langston

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What are the new rules regarding sleep apnea and a 3rd class medical? Does it even apply? If yes, then why? Does FAA think you will fall asleep in the middle of a flight? I can see where it might affect airline pilots but not recreational ones.
 
U mean it doesn't matter if u fall asleep on your recreational flight and u r PIC?? ...

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No absolutely not. Just why does the FAA care about how much sleep I get on any given day?
 
I think it's related to if u don't get much sleep u will be tired and fatigue would come in and you won't function at your 100%. But, I will let an AME chime in

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The FAA is a reactionary group. There have been a few airliner incidents with undiagnosed (or perhaps diagnosed and disregarded) sleep apnea resulting in pilots falling a sleep. The most notable was the Go! (or as I call them, Wake Up!) airlines case in Hawaii. Some of the insiders also believe that a Delta/NW incident where the pilots went "off the air" for a while was a similar issue (though officially, they claimed they were involved in other non-aviation activities).

Anyhow, your doc on the third class is obliged to inquire about your susceptibility to sleep apnea. If you have such a diagnosis, you'll need to either prove you are getting sufficient sleep (sleep study) or go on CPAP with that SI.

As far as BasicMed goes. This isn't one of the major hot buttons. The statement to your doc that you are rested and alert and don't have problems staying awake will probably suffice.
 
I think that this is an area where the FAA goes overboard on the third class medical. Non-commercial pilots have the option of stopping for a nap when they get sleepy.
 
Leo, a few pieces you have not yet introduced into evidence so that we can properly answer your question as it applies to you and BasicMed:

1. Have you already been diagnosed with OSA and are using a CPAP machine?
2. Do you hold a SI for OSA?
 
AggieMike88 said:
Leo, a few pieces you have not yet introduced into evidence so that we can properly answer your question as it applies to you and BasicMed:

1. Have you already been diagnosed with OSA and are using a CPAP machine?
2. Do you hold a SI for OSA?
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Following this thread as I have a question regarding it also. Yes, I have been diagnosed w/ OSA and yes, I just recently got my SI for it. (Last week). I assume that since it does not specifically mention SI in the BasicMed description I am eligible to fly under BasicMed starting in May and will not have to jump through the SI hoops anymore. Am I correct?
 
The "SI Hoops" have always been an easy thing for me. If you read the SI letter, it specifically says what FAA Medical wants when you renew your medical. And it's something that your GP is able to do.

I always brought my GP a simplified punchlist from the SI letter, the printout from my machine for the compliance portion, then he did a simple exam, then wrote up a letter with the required items. This letter was presented to the AME during the flight physical, who reviewed it, filled out his section on the paperwork, and all was good.

The OSA SI is one of the easier ones to comply with, as it doesn't require expensive testing year after year.


But how this SI fits in with the new BasicMed system.... I'll defer to Dr. Bruce or Dr. Lou since I don't know.
 
My annual physical is tomorrow with my PC. I am working on printing out the report to take to my Primary Care doc as we speak. He will then put together a letter and fax that and the report to my AME. The AME will review the note and the report as well as cash my $75 check and send me new 3rd class card good for the next year in the mail.

I plan to take advantage of Basic Med so next year at this time when I go to do my annual physical I will just have the doc fill out the Basic Med form. I do not plan on printing reports with regard to compliance anymore and turning them in. I don't see the need and I don't suspect the doctor will either short of just asking me if I am using the machine. I will continue to use my CPAP when I am sleeping as I know it is good for me. On the other hand I won't be stressing out about making sure I get 6+ hours every day.

I realize it isn't hard to get 75% and I am generally in the mid 90%s but there are times when it just doesn't work like when you are sick a CPAP is a pain when you are drowning in snot. Last night I had a fire call just as I was going to bed and didn't get back in bed until around 2 AM. I get up at 6 so no way to get 6 hours there. There are times when I want to go camping and such and lugging a CPAP and a battery are just not an option. Or the times when you just wake up at 4:30 in the morning and can't fall back to sleep (welcome to being 50+) and have to lay there another hour or two just to get the time in.

The apnea SI is a one size fits all solution with the FAA. I fly for fun. I rarely go places in a plane. My flights are generally less than 2 hours and usually closer to an hour or so in length. It is pretty unlikely I would fall asleep for that one hour when I am doing the most exciting thing I will do all day. I suppose one could argue the other effects of apnea could have a long term detrimental effect that could cause a problem.

I know some people go on CPAP and it is life changing for them. I can't say that it has been. I was only rarely sleepy in the daytime not sure anymore than when using the machine and I just don't get as much sleep as I would like. Don't get me wrong I can take a nap with the best of them but I never just fell asleep.

All that to say I will no doubt still be in compliance but will worry about it less and have fewer hoops to jump through.

ETA: Just got the report done 93% > 6 hours.
 
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wilzup said:
Following this thread as I have a question regarding it also. Yes, I have been diagnosed w/ OSA and yes, I just recently got my SI for it. (Last week). I assume that since it does not specifically mention SI in the BasicMed description I am eligible to fly under BasicMed starting in May and will not have to jump through the SI hoops anymore. Am I correct?
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Yes you are eligible for BasicMed and can skip the SI renewal as long as you can find a doctor willing to sign you off.
 
Can anyone refer to where in the new BasicMed program Sleep Apnea is covered? I have a 2nd class, obtain an SI annually, so this would be totally helpful. However, everything I'm reading is kind of vague and doesn't specifically state Sleep Apnea is covered.
 
TJ Reid said:
Can anyone refer to where in the new BasicMed program Sleep Apnea is covered? I have a 2nd class, obtain an SI annually, so this would be totally helpful. However, everything I'm reading is kind of vague and doesn't specifically state Sleep Apnea is covered.
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It isn't covered, that's the point. If your doc signs you off, fly.

Will Basic Med be good enough for your Class 2 requirements?
 
TJ Reid said:
Can anyone refer to where in the new BasicMed program Sleep Apnea is covered? I have a 2nd class, obtain an SI annually, so this would be totally helpful. However, everything I'm reading is kind of vague and doesn't specifically state Sleep Apnea is covered.
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It's not mentioned by name. The "way it's covered" is by not being on the list of items that are immediate disqualifying. You still need to declare that you are diagnosed with OSA and are being treated with CPAP therapy. But it's to the doctor conducting the BasicMed exam to determine that you are compliant with therapy and meet his standards for appearing alert and well rested. So bring your SleepyHead reports with you showing compliance with therapy, and get a good night's rest before the exam.
 
"Compliance" isn't something basic med deals with anywhere. All you need do is convince your phsyician that you are getting enough sleep. There's a quicky little survey many uses where you identify how likely you are to fall asleep during a dozen listed activities. Of course, it's pretty reliant on self-assessment and you can just check NEVER on each column. My ENT was a bit disinclined to do anything further (including a sleep study) though he suggested I try losing weight.
 
flyingron said:
There's a quicky little survey many uses where you identify how likely you are to fall asleep during a dozen listed activities
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See attachment for the Epworth Sleepiness Scale Ron is referring too.
 

Attachments

  • Epworth[1].pdf
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Palmpilot said:
I think that this is an area where the FAA goes overboard on the third class medical. Non-commercial pilots have the option of stopping for a nap when they get sleepy.
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Falling asleep in flight is only one part of the issue. Sleep apnea resulting in insufficient sleep/rest is directly linked with impaired cognitive functions. In other words, you might be able to stay awake, but if you are sleep impaired, there is an increased likelihood of error.

So, yes, they see this as a safety of flight issue for pilots in general rather than just commercial pilots.

This is one of those things where I think we should be thankful that the FAA has an actual path/process for special issuance that allows OSA diagnosed pilots to keep flying unlike the folks that have an ADHD diagnosis.
 
Before I lost enough weight to get rid of my OSA I found that using CPAP for four hours a night was OK, but for whatever reason keeping it on for six hours every night, like the FAA wants, was just torture. I think that my GP would still have signed off on my basic med based on 4 hours a night even if I still needed to use a CPAP device.
 
JimNtexas said:
but for whatever reason keeping it on for six hours every night, like the FAA wants, was just torture
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Was this due to the mask becoming uncomfortable? Or the machine ramping up the pressure?

For me, I'm good for all 8hrs plus on the hose. Using the Aloha nasal pillow mask and an auto-PAP
 
Anyone that tries to use BasicMed to hide sleep apnea, well let me put it nicely and say they aren't wise. If one truly has uncorrected sleep apnea you have NO business flying. I have corrected sleep apnea and have a SI. I remember what it was like before I got the cpap. I definitely would have killed myself (and maybe others) in a plane if I had flown before it was corrected. True sleep apnea is a serious impairment.
 
BrianNC said:
Anyone that tries to use BasicMed to hide sleep apnea, well let me put it nicely and say they aren't wise. If one truly has uncorrected sleep apnea you have NO business flying. I have corrected sleep apnea and have a SI. I remember what it was like before I got the cpap. I definitely would have killed myself (and maybe others) in a plane if I had flown before it was corrected. True sleep apnea is a serious impairment.
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The great thing about Basic Med is that there is no reason to hide OSA. With the class III I know there was the temptation to not report it or to pretend you didn't have it because your medical would be deferred until you got the SI. A couple years ago they changed the rules so you could get the medical first, then fly while the SI was being processed. With Basic Med, there isn't even that to worry about.

If you suspect OSA, get it checked.
 
Matthew said:
The great thing about Basic Med is that there is no reason to hide OSA. With the class III I know there was the temptation to not report it or to pretend you didn't have it because your medical would be deferred until you got the SI. A couple years ago they changed the rules so you could get the medical first, then fly while the SI was being processed. With Basic Med, there isn't even that to worry about.

If you suspect OSA, get it checked.
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Absolutely.
 
Don't hide OSA! If you suspect you have OSA discuss it with your doctor, get a sleep study if that's what she recommends. If you and your doctor decide you need a cpap machine then get one and use it. When you go in for your BasicMed exam report it and discuss how your are using it, bring in a current cpap print out, describe your general sleep quality, and the type of flying you are doing. Your doctor will probably sign you off with no problem.

Keep in mind that the FAA has one standard for OSA, they treat each and every pilot as if he or she is flying single pilot night cargo from LAX to JFK in the middle of the night. Perhaps you don't fly that way. The FAA doesn't care.

Suppose you wake up after four hours of CPAP and have trouble getting back to sleep because of the discomfort associated with CPAP. Maybe you taking the mask off after four hours results in you getting better rest than if you toss and turn with your mask for two more hours. After all, the standard recommendation for CPAP use is four hours a night.

To the FAA everyone is identical wrt OSA. But in reality that's not the case. BasicMed allows the pilot and doctor to use judgement.
 
Matthew said:
The great thing about Basic Med is that there is no reason to hide OSA.
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This.

This is a prime reason why Basic Med is a good idea. Better to get an ongoing relationship with a PCP and get these things addressed without fear of unwarranted groundings or excessive paperwork. The way the Sleep Apnea SI is currently implemented is an actual discouragement for people to address their problem.
 
AggieMike88 said:
It's not mentioned by name. The "way it's covered" is by not being on the list of items that are immediate disqualifying. You still need to declare that you are diagnosed with OSA and are being treated with CPAP therapy. But it's to the doctor conducting the BasicMed exam to determine that you are compliant with therapy and meet his standards for appearing alert and well rested. So bring your SleepyHead reports with you showing compliance with therapy, and get a good night's rest before the exam.
Click to expand...

Thank you AggieMike88 for the input. Will do on my next exam!
 
TJ Reid said:
Can anyone refer to where in the new BasicMed program Sleep Apnea is covered? I have a 2nd class, obtain an SI annually, so this would be totally helpful. However, everything I'm reading is kind of vague and doesn't specifically state Sleep Apnea is covered.
Click to expand...

Its not "covered" as you put it.. It is NOT specifically EXCLUDED as other disqualifying conditions are. So by being NOT EXCLUDED, you dont have to worry about sleep apnea specifically, only that your endorsing physician is comfortable that you are safe enough to pilot knowing you are treated for sleep apnea.
 
Sorry to reopen this thread, but, how does this relate to first-time pilots who have apnea? I've been considering training, but was diagnosed with mild OSA and I was prescribed a dental appliance to handle it (which has been working great). Trouble is, when I look at the forms for getting an SI (which, I assume you have to do when you get your initial 3rd class), it seems that this requires compliance monitoring (see https://www.faa.gov/about/office_or...ia/OSA Spec Sheet A - Information request.pdf). My device doesn't have support for this (no built-in chip) and I really don't feel like paying to have a new one fabricated (they're not cheap). Am I out of luck?
 
Sorry Bob90.... if you want to play with the FAA while diagnosed with OSA, you're gonna need a machine with long term data logging capability. It is extremely difficult to get the initial SI without compliance data.
 
bob90 said:
Sorry to reopen this thread, but, how does this relate to first-time pilots who have apnea? I've been considering training, but was diagnosed with mild OSA and I was prescribed a dental appliance to handle it (which has been working great). Trouble is, when I look at the forms for getting an SI (which, I assume you have to do when you get your initial 3rd class), it seems that this requires compliance monitoring (see https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/OSA Spec Sheet A - Information request.pdf). My device doesn't have support for this (no built-in chip) and I really don't feel like paying to have a new one fabricated (they're not cheap). Am I out of luck?
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You might be able to get by with this, but you probably will need good, regular, followups and an understanding PCP that will continue to monitor and convince FAA that the device is working.
 
Hello -- reopening the old thread again. :)

I just went through the FAA SI mill for OSA. My sleep study was mild (AHI 5.5) but they required compliance with the CPAP machine anyway.

My second class was issued a few weeks ago after 3 months of BS, with a new 1 year term. The SI letter is good until 2023.

My question:

I sleep worse with the CPAP than I do without it. I am not a commercial pilot, and I have no mission that would require me to fly while tired. I have never had symptoms of OSA, my factors are all circumstantial (fat, treated hypertension, male)

I am currently looking to convert to basic med. In the meantime, I will need to renew my 2nd class in December.

To show compliance for the SI letter, I had to maintain 75% use of the machine for 6 hours per night. I turned in numbers at 100%. I frequently sleep with the machine for 6 hours, then go back to sleep for another 3-4 without it just to feel refreshed. This is a stupid situation for me.

My question: When I renew in December, what compliance will I need to show (I assume the same), and for HOW LONG looking back will I need to show it for?

I think for my own sanity, I'd like to secure basicmed and throw this CPAP in the neighbor's hedge. I am still actively searching for a doc who will do it in my area. I am thinking about "should I need to renew the second class again", so I am hesitantly remaining CPAP compliant.

Thanks for any insights into the renewal process.
 
schmookeeg said:
My question: When I renew in December, what compliance will I need to show (I assume the same), and for HOW LONG looking back will I need to show it for?
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Check your SI letter. The information required for the renewal of your medical and the SI is there.


And I would not give up on the CPAP therapy just yet. You might be "mild" now, but it could progress to "moderate" and you won't know it until you submit to a polysomnogram again.

Your discomfort with using It could be because you have 1) the wrong mask, 2) the wrong machine, 3) or a combination of both.


I wasn't happy with my first machine because it was a Constant pressure machine and would have too short of a ramp period and would always go to too high of a pressure for comfort.

I now have an AUTO PAP machine that I really like. It constant monitors the pressure I need on each breath and makes adjustments on the fly. Read outs show good nights where I just need 6cm H2O. And they show rough nights where I needed 11. But on the long average my AHI is down considerably from where I started when I was diagnosed.

The machine also keeps more than 1 years worth of information on the SD card. And it is super simple to grab the compliance data and stuff it into Sleepyhead software to generate reports.


I know you're frustrated with the therapy, but I encourage you to not give up.
 
I can't even keep my night guard in for my jaw clenching. I don't know how you sleep with those things on.
 
This is the mask I use, called "Aloha"

https://www.cpap.com/productpage/devilbiss-aloha-nasal-pillow-cpap-mask.html

aloha_nasal_pillow.jpg


To prevent air leaking through my mouth, I've sorta trained myself to keep my tongue on the roof of my mouth. Works great. Mask is super comfy and I don't notice it.
 
AggieMike88 said:
Check your SI letter. The information required for the renewal of your medical and the SI is there.
Click to expand...

Here is what is in my letter about the renewal:

"A copy of the cumulative annual PAP device report which shows actual time used. Target goal should show use for at least 75% of sleep periods, and an average minimum of 6 hours per day"

This leads me to believe that 75% is for the entire preceding year. In my case, starting the "treatment" in June, this is not a full year, so there are clearly some guidelines an AME will need to follow prior to issue. For example, I may have been in Tibet, at a monastery with no electricity, learning to meditate for 9 months. Surely that is not cause to deny a renewal? :)

As a practical matter, I assume an AME can issue with the last X months of reports from a machine. X might be 12. X might be 3. I am trying to solve for X. X might be 0 with a dose of "just make sure his BS story makes sense and he's using the thing now"

SO If I show up in December, and I have my Sleepyhead reports for Oct/Nov/Dec at 100%, and claim the dog ate my other months -- is he able to issue? I would think yes.

...

Yes I have a noncompliant attitude. But I still like to know where the goalposts are so I can comply to a letter, if not a spirit of what I perceive to be a cash-grab nuisance requirement.

Yes I understand that my OSA may get worse (particularly if I reverse my weight loss successes of late), and having a machine around may be "neato"

Yes I understand "stick with it" would be a prudent thing to do if I had problems before this mess. Which I didn't.

Since I'm still using the rotten thing, my noncompliance is only theoretical at the moment. I want my 3-4 hours per day spent "sleeping for real" back. The years of my life the CPAP is theoretically saving me -- is being taken out of me today. It's like a reverse mortgage on my health.

---

Appreciate any practical insight into the "lookback period" required. Or if these guidelines are public somewhere, some google keywords I can hunt up. :)
 
Is there such thing as a false positive diagnosis from a sleep study? It found you had "mild" OSA but is that a real thing, or is that like "mild" ADHD when you're really just bored at school? I don't know much about the results of sleep studies except your blood oxygenation has something to do with it and how often you stop breathing.
 
schmookeeg said:
SO If I show up in December, and I have my Sleepyhead reports for Oct/Nov/Dec at 100%, and claim the dog ate my other months -- is he able to issue? I would think yes.
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I'm sorta thinking that once you're issued with the SI, 90 days worth of compliance history is no longer enough.... @Matthew had posted the information not that long ago... perhaps he can copy/paste.

I don't look at CPAP compliance as a cash grab. I had sea container loads of anecdotal data that indicated I likely had OSA before I was officially tested. And once I was used to the machine, the difference in quality of life was remarkable.

But if you wish this to be an equine anti-hydration problem, then I'm down with that.
 
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