Sleep Apnea and AHI events

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Guest

Guest
Does anyone have the acceptable parameters for someone with sleep apnea? Specifically the AHI (Events per hour). I am on a CPAP machine but still seem high?

Thx
 
Guest said:
Does anyone have the acceptable parameters for someone with sleep apnea? Specifically the AHI (Events per hour). I am on a CPAP machine but still seem high?

Thx
Click to expand...
From what perspective are you asking?
  1. In a general want to be healthy? Or,
  2. What the FAA is looking for when you apply for or are possessing an FAA medical certificate?

The Special Issuance (SI) for Obstructive Sleep Apnea does not have a specification for AHI. The criteria include (and I might be incorrect or lacking one or two):
  1. Initial issuance requires your sleep study results. Best if it is interpreted by a board certified sleep doctor. (This doctor might comment on the AHI, using it to determine your level of OSA, from mild to severe)
  2. The data from your CPAP recording chip shows compliance with therapy.
    • Compliance is defined (Initial) 90 days of a at least 6 hours of continuous use over 75% of nights, (Renewal) 1 year of data showing at least 6 hours of continued use over 75% of nights
  3. No Daytime sleepiness beyond the normal
  4. No visible evidence that you are lacking sleep (aka fatigued) during the exam
  5. No damage to the right side of your heart on exam by the doctor.

If you think your AHI is high, consult the physician monitoring your therapy not SGOTI's.

Your health is more important than flying. So if your treatment/therapy isn't working, seek the help of your doctor to make the appropriate adjustments.

(Edit to add). The details on Obstructive Sleep Apnea can be found at this FAA.gov page: Decision Considerations Disease Protocols Obstructive Sleep Apnea (OSA)
 
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Agree with @AggieMike88 if you're looking for the FAA perspective and if you're concerned, definitely check in with the doc that prescribed CPAP . That said, If it was me, I wouldn't be concerned if on CPAP my AHI was < 5. But after 6 years of CPAP I average < 1 so YMMV...
 
Two words for AggieMikes condition #2 (if you've previously had a medical): BASIC MED.

The FAA Sleep Apnea guidance for third class is ludicrously insane and counterproductive.
 
Guest said:
Does anyone have the acceptable parameters for someone with sleep apnea? Specifically the AHI (Events per hour). I am on a CPAP machine but still seem high?

Thx
Click to expand...

I’m pretty sure that >5 = OSA, so anything <=5 is acceptable. But <1 can many times be attained.
 
Google fu found...
  • AHI = < 5. Normal range.
  • AHI = 5 to 15 Mild sleep apnea.
  • AHI = 15 to 30 Moderate sleep apnea.
  • AHI > 30. Severe sleep apnea
This is "general knowledge" and may not reflect what the FAA is looking at or considering.
 
flyingron said:
Two words for AggieMikes condition #2 (if you've previously had a medical): BASIC MED.

The FAA Sleep Apnea guidance for third class is ludicrously insane and counterproductive.
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I agree. Especially if the pilot has no need of a Class 2 or Class 1 medical and the BasicMed limitations fit his flying needs.
 
I am original poster. I need to keep my first class medical. Been on cpap for 4 months and still average 14 on ahi events. Been through 2 sleep studies and they want a third more in-depth study. Just wondering what will limit the first class.
 
14 AHI is pretty high, that's above the level of what's considered (medically, I don't know about FAA) OSA, which is 5. I think the desired level will be <5, and a lot of people aim for < 1. There are a number of different CPAP settings that can help, most machines have at least some user settings. The sleep studies that use a CPAP will generally raise the air pressure until they find the sweet spot and that becomes your prescription setting. That sweet spot is only valid for that one night, though. At home you may have a different pillow, different sleep pattern, different mattress, whatever, and that can change your throat positions and affect AHI events. Some CPAPs are auto-PAP and will automatically adjust between a low and high limit until they find the best setting on their own. Those CPAPs can accommodate night-to-night changes in your body - they start at a setpoint and then adjust up or down. If it sees AHI events, it will slowly raise pressure until they go away, then slowly lower pressure again. Different brands have different algorithms. If you have a fixed pressure machine, your pressure setting may be too low. Your doc and your previous sleep test should have some info on why they decided on the pressure that's prescribed.

Is there any reason given for another sleep study? They already know you have OSA.
 
Guest said:
I am original poster. I need to keep my first class medical. Been on cpap for 4 months and still average 14 on ahi events. Been through 2 sleep studies and they want a third more in-depth study. Just wondering what will limit the first class.
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Pinging @bbchien for his input. Dr. Bruce to the white courtesy phone!
 
The reason for wanting another study is because of the high ahi. Some nights have seen average of 40 plus, a few nights later 2 or 3. That have changed the pressures, had me change temp and humidity but nothing seems to work solid?
 
Ouch. That’s almost as if it isn’t doing anything at all.

There’s a pretty knowledgeable crowd at the apneaboard.com forum. If you have sleepyhead detailed data charts I suspect they’ll be able to help a lot.
One thing to consider, the pressure settings are technically a prescription. If you want to change them, i’d get a new scrip, just in case FAA raises an eyebrow about changing the settings on your own.
 
Any update on this? I’ve been following as I’m also holding a 1st class and have recently started on an auto CPAP machine.
 
Jdm said:
Any update on this? I’ve been following as I’m also holding a 1st class and have recently started on an auto CPAP machine.
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JDM: all they want from the report is the use bar graph. Get to Sleepyhead.com and get the graphing program that allows you to create the use graph, which one guy did here. That's all that the agency wants. Take CONTROL.
 

Attachments

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Thanks! I’ll get the sleepyhead program, but I’ve already got a month of sleep logged on my machine. It’s a ResMed 10 AutoSet with SD card. Will the sleepyhead program allow me to upload my 1 month of progress?? ResMed has it’s own program as well, but I don’t know how well it works for the FAA.
BTW, I couldn’t get your attached file to open from 2 different devices.
 
Jdm said:
ResMed has it’s own program as well, but I don’t know how well it works for the FAA.
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The ResMed program doesn’t allow you to edit the recording parameters to show you meet the 6 hours of sleep FAA requirement.

That’s why everybody uses Sleepyhead.
 
the S8 does.....you'll have to put it into clinical mode. It's all there by day, week, month.....but, unless you have the data card it resides in the machine.
 
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Excellent. Thanks. I’ll try to access the file from a windows computer.
If anyone is putting off getting a sleep test because of the faa medical I would strongly advise otherwise. I’m an avid cyclist, not over weight, no blood pressure issues, nothing. Tested severe! My AHI was 36. Now, with the machine, I’m averaging 3.0 per hour. I have had 2 nights out of of my 1st month that got up to 5 but the remainder were very low.
The machines they have now are amazingly silent.
I tried 3 masks with my initial order. They were all ok but the nasal pillow type worked best for me. Very light weight and comfortable.
Overall I’m extremely satisfied with the progress, just have to figure out the data retrieval and FAA stuff. Going for my 1class renewal next week. My doctor was on board prior to testing so I’m expecting it to go well.
 
Fearless Tower said:
The ResMed program doesn’t allow you to edit the recording parameters to show you meet the 6 hours of sleep FAA requirement.

That’s why everybody uses Sleepyhead.
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Ahh, great info! Thank you
 
Sleepyhead development has been shut down. The replacement is OSCAR. It’s a direct replacement that also supports CPAP brands and models that Sleepyhead never did. OSCAR also has better Mac support. Use either one, they both do the same thing, work the same way, and generate the same reports.
 
I found out that even if your Resmed machine says 6 hours when you wake up then when you pull the data into sleepyhead, or OSCAR it will show 5.57 minutes be sure you go at least 30 minutes over 6 hours on those days where you might come up short on sleep hours.
 
Not a doctor, not a sleep specialist and did not stay at a Holiday Inn last night but...Check your results are these obstructive apneas or central apneas. I don't believe CPAP can do much about Central Apneas as they are brain controlled not obstruction related.
 
DFH65 said:
Not a doctor, not a sleep specialist and did not stay at a Holiday Inn last night but...Check your results are these obstructive apneas or central apneas. I don't believe CPAP can do much about Central Apneas as they are brain controlled not obstruction related.
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And I think FAA treats them differently, too. The SI is for OSA, not CA.
 
I would be willing to bet you are mouth breathing. This is common during sleep and you won’t typically know it because...you’re asleep. Your mouth droops open, the cpap air goes out your mouth, and your airway doesn’t stay open. Try using tape to keep your mouth closed, or a double sided boil&bite mouthguard, or a neck buff pulled up over your head and under your chin. Put your pressure at 8cm of water pressure and see how you do. Mouth breathing is a common issue and only gets worse as your doc prescribes higher pressures because “therapy isn’t working”.

try the 8cm of water pressure for a few nights. Then dial things in a bit from there. You may need to go up or down just a bit. And turn off ramp settings and all the other ********.
 
flybill said:
I would be willing to bet you are mouth breathing. This is common during sleep and you won’t typically know it because...you’re asleep. Your mouth droops open, the cpap air goes out your mouth, and your airway doesn’t stay open. Try using tape to keep your mouth closed, or a double sided boil&bite mouthguard, or a neck buff pulled up over your head and under your chin. Put your pressure at 8cm of water pressure and see how you do. Mouth breathing is a common issue and only gets worse as your doc prescribes higher pressures because “therapy isn’t working”.

try the 8cm of water pressure for a few nights. Then dial things in a bit from there. You may need to go up or down just a bit. And turn off ramp settings and all the other ********.
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I just sleep with full face mask my mouth doesn't stay closed. Also had to shave off facial hair get a good seal unless you tighten it up makes my jaw hurt. Mine is set to auto pressure I think it's 6-20 it goes up to 8 psi. CPAP's are a hassle many can get rid of them if they dump the weight I have extreme OSA. My BMI is 34 I think if I can get it down to BMI of 20 might be able to get rid of the CPAP. My sleep doctor says my BMI is below the average person they see who usually have BMI of 37 and up. Oddly my AHI was lower when I had more mask leaks once I shaved off the facial hair which I had since my 20's made a seal and my leakage went way down my AHI went from 1.4 to 2.8 still not really a big deal under 5. I think the AHI is accurate when the mask makes a seal.
 
Ive been on one since April 1. I’m in awe with how much better I feel sleeping with it. I do t snore anymore and wake up rested each morning. I have a Philips Dreamstation. I haven’t had to travel with it yet so not sure how well that will work out.

I had tried like 3 masks before I found one I like. I use the resmed p10 and it’s like not wearing anything at all. Aside from the hose it’s comfortable and seals fine without having to shave. On occasion I have a mouth leak, but it doesn’t really impact my numbers much.

I tried the tape thing, it works but is a pain.

I’ve finally gotten to the acceptance phase, I’ve been busting my butt literally to lose weight to hopefully get off of it, been riding a bike about 60-75 miles a week, adjusted my diet etc. while I feel much better over all, it would be nice to not have to sleep with a machine.
 
Beaker’s Flyin said:
Ive been on one since April 1. I’m in awe with how much better I feel sleeping with it. I do t snore anymore and wake up rested each morning. I have a Philips Dreamstation. I haven’t had to travel with it yet so not sure how well that will work out.

I had tried like 3 masks before I found one I like. I use the resmed p10 and it’s like not wearing anything at all. Aside from the hose it’s comfortable and seals fine without having to shave. On occasion I have a mouth leak, but it doesn’t really impact my numbers much.

I tried the tape thing, it works but is a pain.

I’ve finally gotten to the acceptance phase, I’ve been busting my butt literally to lose weight to hopefully get off of it, been riding a bike about 60-75 miles a week, adjusted my diet etc. while I feel much better over all, it would be nice to not have to sleep with a machine.
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When I was first diagnosed I was able to get down from 225 to 178 which put my BMI just below the obese range doctor ordered an oxygen monitor said to sleep without the CPAP. He showed me the results I would drop into the 70% 02 range he said weight loss for me might not change anything. He also said it takes more weight loss to remove the fat deposits in the upper respiratory tract that narrows the airway. I really needed to get down into the normal BMI range. I got discouraged gained the weight back eventually got used to the CPAP. American's always figure out ways to get around weight loss. I had gotten down to the 180's when covid hit and quit going to the gym now I'm back up again. I'm ready to start again I'm a month past my 2nd covid vaccine now that the CDC says I can go without a mask I can get back in there.
 
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