Third-Class Medical with Sleep Apnea?

[SpoilerFault]

Hello everyone, I have a question regarding a third-class medical for PPL. I have sleep apnea which requires the use of a CPAP machine and from what I've read it seems as though an AME alone can't issue the medical certificate but rather a special issuance must be obtained from the Feds under FAR 67.401. Have any of you guys had experience with getting such a waiver? Is getting a 3rd class with such a condition a terribly difficult process?

Thanks in advance for the info. I haven't encountered anyone yet who has actually attempted it. Also, my disclaimer is that I haven't actually spoken to an AME as I thought I would post here first in spite of the potential for a semi-public lamblasting ;-)

 

[guido411]

Can't help you a lot but I know a pilot that has sleep apnea and got a 1st class Special Issuance. I don't know much about the process but know he had to do a sleep study and his medical is only good for 1 year (will not revert to 3rd class). I would suggest a call to an AME and let him guide you through it. Getting the medical, with patience, shouldn't be a problem.

 

[JCJ]

Hello everyone, I have a question regarding a third-class medical for PPL. I have sleep apnea which requires the use of a CPAP machine and from what I've read it seems as though an AME alone can't issue the medical certificate but rather a special issuance must be obtained from the Feds under FAR 67.401. Have any of you guys had experience with getting such a waiver? Is getting a 3rd class with such a condition a terribly difficult process?

Thanks in advance for the info. I haven't encountered anyone yet who has actually attempted it. Also, my disclaimer is that I haven't actually spoken to an AME as I thought I would post here first in spite of the potential for a semi-public lamblasting ;-)

If you're an AOPA member use their aeromedical resources to guide you through. If you're not an AOPA member, you should be - the aeromedical assistance itself is worth the membership fee. www.aopa.org.

 

[JimNtexas]

I may in the same boat in the future so I've looked in to this a bit. I'm pretty sure that the rules for CPAP are the same for all classes of medical.

I think it will be a special issuance situation, and that you'll have to take a 'wakefulness test' (sort of the inverse of a sleep study) to hang on to your medical.

 

[SpyFlysDOTs]

I may in the same boat in the future so I've looked in to this a bit. I'm pretty sure that the rules for CPAP are the same for all classes of medical.

I think it will be a special issuance situation, and that you'll have to take a 'wakefulness test' (sort of the inverse of a sleep study) to hang on to your medical.

The "Wakefulness Test" was rejected by my insurance company.

There IS another way, that most AME's have no idea about.

Details:

First, please don't leave a paper trail regarding daytime sleepiness.
Your docs may have you fill in a questionnaire regarding sleeping and wakefulness. Some typical questions:
Do you feel drowsy while driving?
Do you feel drowsy while a passenger in a car?
Do you feel drowsy while watching tv on the sofa after a meal?

Who doesn't?

You have to deny daytime drowsiness. Very important or the FAA will deny your special issuance.

Now, re the Wakefulness test.

Unnecessary.

What my AME wanted was a SOLID MONTH with 6 hrs per night usage of Cpap documented by your DR, who can get that documentation from your sleep hardware supplier. The equipment keeps track of your usage and can either, via Cellular connection or by memory card, allow them to document your usage. There are about 5 other things your Dr will have to note when you walk into your AME.

Three pilots with recent OSA advised me I would need that test.
Multiple AME's also advised me I'd need it.

Suggest you google Dr Bruce Chien, of Peoria Il.
This AME is worth the travel. He is very communicative via Email and will answer your Email and questions initially at no charge. If you use him, his fees will save you hundreds plus save you from taking unnecessary and unproven tests.

If you have any further questions, PM me and I will be happy to dig into it with you.

One thing I would advise you of is not to ignore any symptoms.

 

[JimNtexas]

The "Wakefulness Test" was rejected by my insurance company.

There IS another way, that most AME's have no idea about.

Details:

First, please don't leave a paper trail regarding daytime sleepiness.
...

That's all consistent with my experience. Dr Chein performed my physical in June, and I walked out of his office with a 3d class SI for OSA.

I didn't have to take the wakefullness test.

Oddly, a month later I got a second certificate signed by an FAA doctor.

 

[11thHour]

I recently went through this process for a first class medical. I was shocked I had it, as I'm in good shape, active, eat well, am healthy, etc. I had the idea (as most do) that it's an issue the obese deal with. Well, it's true it can increase the likelihood of apnea, but they now think weight gain is a symptom of apnea, and not the cause. So maybe I caught it before the weight gain?

In any case, the FAA wants to see that the machine is working for you. They want to see the printout from the data card in the machine that shows you use it consistently for at least 6 hours a night..maybe 4, I don't remember. But you also have to show that it's bringing your AHI to 5 or lower. The AHI is the number of apnea events per hour. Well, it took me a few weeks to get used to the mask. I hated it. I hated the air pressure. Made me feel like I was choking. So for the first few weeks, my AHI hovered around 10. Too high. I was discouraged and thought this would mean no more medical for me! Well, suddenly, something clicked and I got used to it, slept soundly, and my AHI dropped and stayed around .2 per hour. Fantastic.

Once I had a bout a months worth of good quality sleep with low AHI on the data, I had to see the doc and give him an update on daytime sleepiniess ( they have to see that you don't have it anymore), quality of sleep, energy levels, any memory issues, etc. Everything improved quickly and dramatically for me. Doc wrote a note, we submitted the data printout, and I got the special issuance. It took about 4 months to hear back though. Long wait. Like the others, no MWT was needed.

The biggest pain was the wait, getting used to the machine and giving it the time needed to work and for me to get used to it, and also having to go to the medical equipment company to get the printout. The docs office couldnt do it. ANd I cant see the data on screen. IT only shows the previous night. So I"d have to run in, get a week printed, saw it sucked, wait a week, do drive all the way out there again, another bad week, etc, until I saw the good numbers. Time consuming.

I'll have to provide such a printout every 12 months for the rest of my life, along with updated physicians notes, at each medical.

PS - I suspect A LOT of pilots have apnea and are scared of being tested. I have heard pilots snoring in the room next to me to the point it kept me up. Or they yawn all the time, no matter how long the overnight. Complain of being tired all the time, etc etc. Yeah buddy, go take the sleep study; your health is not to be toyed with.

The biggest problem with apnea is it is torturous on your cardiovascular system. It's not worth screwing around with, and can have serious negative health consequences if ignored. I think you're going to see more and more pilots, even at the airlines, dragging their machines around.

 

[SpyFlysDOTs]

I recently went through this process for a first class medical. I was shocked I had it, as I'm in good shape, active, eat well, am healthy, etc. I had the idea (as most do) that it's an issue the obese deal with. Well, it's true it can increase the likelihood of apnea, but they now think weight gain is a symptom of apnea, and not the cause. So maybe I caught it before the weight gain?

In any case, the FAA wants to see that the machine is working for you. They want to see the printout from the data card in the machine that shows you use it consistently for at least 6 hours a night..maybe 4, I don't remember. But you also have to show that it's bringing your AHI to 5 or lower. The AHI is the number of apnea events per hour. Well, it took me a few weeks to get used to the mask. I hated it. I hated the air pressure. Made me feel like I was choking. So for the first few weeks, my AHI hovered around 10. Too high. I was discouraged and thought this would mean no more medical for me! Well, suddenly, something clicked and I got used to it, slept soundly, and my AHI dropped and stayed around .2 per hour. Fantastic.

Once I had a bout a months worth of good quality sleep with low AHI on the data, I had to see the doc and give him an update on daytime sleepiniess ( they have to see that you don't have it anymore), quality of sleep, energy levels, any memory issues, etc. Everything improved quickly and dramatically for me. Doc wrote a note, we submitted the data printout, and I got the special issuance. It took about 4 months to hear back though. Long wait. Like the others, no MWT was needed.

The biggest pain was the wait, getting used to the machine and giving it the time needed to work and for me to get used to it, and also having to go to the medical equipment company to get the printout. The docs office couldnt do it. ANd I cant see the data on screen. IT only shows the previous night. So I"d have to run in, get a week printed, saw it sucked, wait a week, do drive all the way out there again, another bad week, etc, until I saw the good numbers. Time consuming.

I'll have to provide such a printout every 12 months for the rest of my life, along with updated physicians notes, at each medical.

PS - I suspect A LOT of pilots have apnea and are scared of being tested. I have heard pilots snoring in the room next to me to the point it kept me up. Or they yawn all the time, no matter how long the overnight. Complain of being tired all the time, etc etc. Yeah buddy, go take the sleep study; your health is not to be toyed with.

The biggest problem with apnea is it is torturous on your cardiovascular system. It's not worth screwing around with, and can have serious negative health consequences if ignored. I think you're going to see more and more pilots, even at the airlines, dragging their machines around.

Just had another long convo with my AME re OSA (Obstructive Sleep Apnea.)

There is NO NEED to wait months.

Go to your doc.
Get a script for sleep study with Cpap.
Get the Cpap.
Sleep with it for one month, 6 hrs a night.
Get your medical, with the right AME.
Many AME's don't have the right stuff.

There are other solutions:
Surgery (With not even close to 100% success rates.)
Oral Appliance.
Cpap.
Weight loss then another sleep study.

If you want to talk about it, send me a PM.
I have the special issuance.

 

[11thHour]

I'm confused why you quoted me, my post just detailed what I went through to get the SI for myself. The long wait was waiting for the SI letter after we submitted the documentation. Took them 4 months to approve the SI.

And on a related note.. like I said in my post, we are definitely going see more pilots having to go through this process. BMI is now going to be used in FAA medicals and be used as a screening tool for referral to sleep tests. The FAA is very serious about not letting people flying with untreated OSA, whether diagnosed or not. (On a side note, like I noted in my post, I'm not overweight and my bmi is normal, so I would have fallen through the screening process had I not pursued testing myself).

http://www.avweb.com/avwebflash/news/FAA-Targets-Fat-Pilots-And-Controllers220978-1.html

Tilton says that while the initial action will target those with the BMIs above 40, his plan is to root out all sleep apnea victims and ensure they don't fly until they're treated. "Once we have appropriately dealt with every airman examinee who has a BMI of 40 or greater, we will gradually expand the testing pool by going to lower BMI measurements until we have identified and assured treatment for every airman with OSA," he wrote. That means even the moderately overweight (BMI of 30 or less) can likely expect the referral to a sleep specialist because Tilton says that up to 30 percent of those who carry an extra 20 or 30 pounds have OSA. For unknown reasons, pilots will be targeted first. There are "logistical details" to be dealt with before the rule is implemented for controllers but Tilton said the plan is to include them, too. National Air Traffic Controllers Association declined comment.

 

[JimNtexas]

After I started CPAP I lost almost 70 pounds in less than a year!

 

[RightPedal]

After I started CPAP I lost almost 70 pounds in less than a year!

Jim, with those results you almost make me want to give cpap another try.
What have you done to make friends with that machine?
I've tried both sleep and pain meds. I've tried whiskey; and I've tried drugs and whiskey. I put it on and watch TV during the day. I have all the different mask.
I put the thing in the closet about this time last year after my sleep dr gave up and canceled treatment. Told me to call him when I have a download with 45 days of cpap use. My gp and I fight about it every time we make contact.
I began walking in February and worked myself up to an hour every day. I then added light strength training. That is taking its toll on this old frame and I'm beginning to believe what the dr says that I will not be successful at weight loss until I get the apnea under control.
I would appreciate any input anyone may have on how you make friends with cpap.

 

[I Hate Freight]

I'm going through this now. I just had my sleep study, apnea is "severe" and I need a bipap machine that I am getting next week. My airline's medical dept has pulled me from the line and I have to jump through all the hoops to get the SI.

During the sleep study, the mask was extremely uncomfortable but I hope I'll get used to it but the fact that some can't worries me. Career is definitely on the line.

Stats: 49 year old, 5'9, 195 lbs (should be 170).

 

[SpyFlysDOTs]

Well, didn't know it was a wrong to quote someone. Many have their preferences for forum posting.

The past two posts asked about how to get comfortable with the mask.

I started with Nasal Pillows.
That didn't work for long cause if you open your mouth, all the air goes right out of same. The suggesting chin strap didn't help.
Switched to the Quatro FX mask. Reason I went with this one, I can actually wear my glasses to get tired either surfing or watching a bit of TV prior to bed.
Purchased a travel Cpap, the Transcend. While its lighter and easier to travel with, the A-pap wasn't available at time of purchase. Humidity is an issue with this machine, or I should say Lack of it.
In consulting with a buddy who instructs and has Apnea, he suggested I take my home unit on the road and try the pillows again.
Pillows failed, but the home unit is now allowing me to sleep 5-6 hrs a night on the machine. It's been nearly a year and I still don't enjoy sleeping with the mask on.
Ear plugs have helped. Took a few weeks to get use to sleeping with ear plugs.

Probably the hardest part is putting the mask back on once I wake in the middle of the night. Tend to want to take it off thinking I have had enough mask for the evening.

Another pilot I know sleeps without issue with the mask for close to 8 hrs a night.

My thought is, light sleepers will have issues and heavy sleepers, no issue.

Mask during sleep study with wires bubble gummed to your head in controlled sleep is understandable.

PS, I'm not a doctor but I do sleep at Holliday Inn Expresses a lot.

 

[I Hate Freight]

In any case, the FAA wants to see that the machine is working for you. They want to see the printout from the data card in the machine that shows you use it consistently for at least 6 hours a night..maybe 4, I don't remember. But you also have to show that it's bringing your AHI to 5 or lower.

Is that "5 or lower" figure an actual FAA requirement? I can't seem to find anything that tells me what numbers they're looking for.

After two weeks on the bipap, my AHI dropped dramatically from 89 to 6.8 and my AME sent everything to the FAA for an SI. My compliance is 100% averaging 6.5 hrs per night. I feel great!!

I hope that's enough because I my sick time has run out and I need to get back to work!!

IHF

 

[SpyFlysDOTs]

Apnea

IHF,

I'm hardly an expert, but I know more than most.

The FAA needs certain things documented in a letter from your sleep dr or gp.
The 4 items don't mention any range of AHI's.
I think the crux is that there is no daytime sleepiness along with compliance, no heart issues and records from the machine showing 6 hrs a night for the majority of nights in a 31 day period.

Post what you find out.

 

[JimNtexas]

My AME told me the CPAP usage requirement was:

CPAP report in the preceding 3 months ( covering more than 31 days, that show
(a) Greater than 75% of nights with >= 6 hours of usage.
(b) AHIs down below 6

I brought the CPAP printouts and letter from my family doctor. After the AME made a phone call to the FAA he was able to issue a certificate with an SI that day.

The SI (but not the whole physical) has to be renewed every year.