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09-16-2018, 12:12 AM
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Join Date: Sep 2007
Location: Mesa Arizona
Posts: 608
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Most people who end up in cancer centers are going to be found to have cancer.
Polysomnography is done with over 30 digital channels of EKG, EEG, plus audio and infrared video. All studies are digitally recorded and if someone thinks that theirs has been ?faked? or predetermined, they can request a copy of the recording and take it to an independent expert for review. The largest payor for PSG?s is Medicare and Medicare fraud is prison time.
If one is diagnosed with OSA, they have it. The proof is irrefutable.
Where things turn Voodooey IMO is on the treatment side where there is a war between CPAP and surgery science of which both have success stories but neither has a spectacular track record. Even though skinny people can have OSA, the single most effective prevention and/or treatment for the masses is losing weight.
__________________
Myron Nelson
Mesa, AZ
RV-10 N24EV
KITPLANES Contributing Editor
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09-16-2018, 01:43 AM
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Join Date: Jan 2005
Location: 57AZ - NW Tucson area
Posts: 10,011
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Quote:
Originally Posted by woxofswa
Most people who end up in cancer centers are going to be found to have cancer.
Polysomnography is done with over 30 digital channels of EKG, EEG, plus audio and infrared video. All studies are digitally recorded and if someone thinks that theirs has been “faked” or predetermined, they can request a copy of the recording and take it to an independent expert for review. The largest payor for PSG’s is Medicare and Medicare fraud is prison time.
If one is diagnosed with OSA, they have it. The proof is irrefutable.
Where things turn Voodooey IMO is on the treatment side where there is a war between CPAP and surgery science of which both have success stories but neither has a spectacular track record. Even though skinny people can have OSA, the single most effective prevention and/or treatment for the masses is losing weight.
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I'm not a doctor, but like reading stuff with data...
If I'm reading this chart correctly, the data shows evidence as moderate for some treatments and the word insufficient appears in lots of places
http://annals.org/data/Journals/AIM/927677/7TT3.png
Even weight loss came out as "low" strength of evidence. By engineering standards it's awfully close to voodoo.
Quote - Overall, low-quality evidence showed that some intensive weight-loss programs may effectively reduce signs and symptoms of OSA in obese patients with or without diabetes.
The data source appears reputable.
http://annals.org/aim/fullarticle/17...-from-american
It makes for interesting reading.
As far as the testing goes, I'm not sure if I could get wired up like this and go to a strange bed in a strange building with technicians hovering around and sleep "normally"
Not me... a wiki pic.
__________________
Gil Alexander
EAA Technical Counselor, Airframe Mechanic
Half completed RV-10 QB purchased
RV-6A N61GX - finally flying
Grumman Tiger N12GA - flying
La Cholla Airpark (57AZ) Tucson AZ
Last edited by az_gila : 09-16-2018 at 08:57 AM.
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09-16-2018, 03:19 AM
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Join Date: May 2005
Location: Savannah, GA
Posts: 1,301
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Let's see how much I remember from 18 years ago...
* The interruption to breathing during the night I thought was called an hypopnea, but I see that it can also be called an apnea;
* Everybody has these. Everybody. Sleep apnea means that you have too many per hour;
* An apnea means that just when you're about to get to very deep sleep, you relax, the airway is obstructed, you quit breathing and then a jolt of adrenaline gets you breathing again... and keeps you from getting deep sleep;
* If you have dreams, you don't have sleep apnea. In my case, I'd gone decades without dreams;
* There are three mechanisms for sleep apnea: soft palate blocks the airway when relaxed, same for the tongue, or the airway collapses under suction. I had all three, with the first being predominant. Mine was successfully cured by surgery (UPPP - uvulopalatopharyngoplasty), with an extraordinarily painful two week recovery period. Two weeks to the day later, the pain turned off completely and life resumed. I don't think that insurance pays for UPPP any more...
* A common result of successful treatment is that people become nicer. Actually, what is going on is that chronically sleep derived people get grouchy. In my case, I observed that there was suddenly less heavy traffic in the area. You get the idea;
* Stats are that maybe 10% of the population has undiagnosed sleep apnea. But if the victim doesn't observe any symptoms, denial reigns;
* In my opinion, there's a strong case for everybody getting a sleep test at least once in their life. Certainly if an ATP requires five hours in a Cat D sim, a sleep apnea test ain't that big a deal;
* When I went to see the sleep doctor, I filled out a five or so page questionnaire. That gave a diagnosis that was confirmed by a sleep study at home with all the toys hooked up. C'mon guys, man up, it's not that big a deal;
* And some of the effects of long term untreated sleep apnea are ugly;
* One symptom of sleep apnea is that you fall asleep easily. Why? Because you're sleep deprived all the time. Falling asleep in a plane is obviously not good.
So getting sleep apnea treated can save your life, both in the sense of keeping your pulse going longer and in the sense of allowing you to enjoy life without being a sleep-deprived grouch.
__________________
RV-9A at KSAV (Savannah, GA; dual G3X Touch with autopilot, GTN650, GTX330ES, GDL52 ADSB-In)
Previously RV-4, RV-8, RV-8A, AirCam, Cessna 175
ATP CFII PhD, so I have no excuses when I screw up
2020 dues slightly overpaid
Retired - "They used to pay me to be good, now I'm good for nothing."
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09-16-2018, 07:13 AM
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Join Date: Jan 2005
Location: SC
Posts: 12,887
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A friend was diagnosed with sleep apnea and the FAA contacted him for the data his machine recorded.
It turns out that when he goes on vacation he has to rent a battery powered machine to keep the FAA happy.
What BS!
__________________
Bill R.
RV-9 (Yes, it's a dragon tail)
O-360 w/ dual P-mags
Build the plane you want, not the plane others want you to build!
SC86 - Easley, SC
www.repucci.com/bill/baf.html
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09-16-2018, 08:43 AM
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Join Date: Jun 2010
Location: Sunman, IN
Posts: 2,189
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yep
Don't do the sleep study! It is pseudo science. There are about 20 items on the sleep apnea checklist that they are supposed to check LONG before a sleep study is recommended...
Notably, they look first and foremost at your BMI...and, as we all know, your BMI tells you ABSOLUTELY NOTHING about your health. Don't believe me? Here is an example:
Two men, exactly 6 feet tall. Both weigh exactly 200 pounds. Both have the EXACT same BMI...27.12. According to the FAA BOTH of these men are OVERWEIGHT.
Now a description of the men:
The first one is an olympic gymnast.
The second one is a couch potato, laying on the couch, watching TV, and eating a bag of chips.
So what does BMI tell you? NOTHING. Unfortunately, most doctors seem to look at BMI as the primary indicator of sleep apnea.
Next, you go to the sleep study, in a strange room, strange bed, they wire you up, turn on the cameras, and say, "OK, get a good night's sleep"...yeah, right.
Then, after a crappy night's sleep, the diagnosis is sleep apnea...thank you, that will be $6000. Now go get a CPAP machine for $1200...
Then after a couple of weeks, you find it near impossible to sleep. You go back and they say that you need to try a BiPAP instead...
Meanwhile, you have to list all of these visits and diagnosis on your medical, where they stay FOREVER...and it is within the FAA's authority to REQUIRE you to wear the machine, and submit the recorded data.
Sound like a nightmare? I am not making it up, it happen to one of my best friends...
Oh, he still doesn't sleep well...
__________________
Bob
Aerospace Engineer '88
RV-10
Structure - 90% Done
Cabin Top - Aaarrghhh...
EFII System 32 - Done
297 HP Barrett Hung
ShowPlanes Cowl with Skybolts Fitted - Beautiful
Wiring...
Dues+ Paid 2019,...Thanks DR+
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09-16-2018, 08:52 AM
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Join Date: Aug 2005
Location: Atlanta, GA
Posts: 4,219
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Health issues and aviation create a fine line to walk. Try not to lose your medical. But absolutely do everything you can to maintain your health. You can't fly from 6' underground in a pine box.
I'd have a low key discussion with a GP, and see what s/he thinks.
__________________
Kyle Boatright
Marietta, GA
2001 RV-6 N46KB
2019(?) RV-10
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09-16-2018, 08:56 AM
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Join Date: Jan 2005
Location: 57AZ - NW Tucson area
Posts: 10,011
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Quote:
Originally Posted by Ed_Wischmeyer
Let's see how much I remember from 18 years ago...
* The interruption to breathing during the night I thought was called an hypopnea, but I see that it can also be called an apnea;
* Everybody has these. Everybody. Sleep apnea means that you have too many per hour;
* An apnea means that just when you're about to get to very deep sleep, you relax, the airway is obstructed, you quit breathing and then a jolt of adrenaline gets you breathing again... and keeps you from getting deep sleep;
* If you have dreams, you don't have sleep apnea. In my case, I'd gone decades without dreams;
* There are three mechanisms for sleep apnea: soft palate blocks the airway when relaxed, same for the tongue, or the airway collapses under suction. I had all three, with the first being predominant. Mine was successfully cured by surgery (UPPP - uvulopalatopharyngoplasty), with an extraordinarily painful two week recovery period. Two weeks to the day later, the pain turned off completely and life resumed. I don't think that insurance pays for UPPP any more...
* A common result of successful treatment is that people become nicer. Actually, what is going on is that chronically sleep derived people get grouchy. In my case, I observed that there was suddenly less heavy traffic in the area. You get the idea;
* Stats are that maybe 10% of the population has undiagnosed sleep apnea. But if the victim doesn't observe any symptoms, denial reigns;
* In my opinion, there's a strong case for everybody getting a sleep test at least once in their life. Certainly if an ATP requires five hours in a Cat D sim, a sleep apnea test ain't that big a deal;
* When I went to see the sleep doctor, I filled out a five or so page questionnaire. That gave a diagnosis that was confirmed by a sleep study at home with all the toys hooked up. C'mon guys, man up, it's not that big a deal;
* And some of the effects of long term untreated sleep apnea are ugly;
* One symptom of sleep apnea is that you fall asleep easily. Why? Because you're sleep deprived all the time. Falling asleep in a plane is obviously not good.
So getting sleep apnea treated can save your life, both in the sense of keeping your pulse going longer and in the sense of allowing you to enjoy life without being a sleep-deprived grouch.
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For most of the population, falling asleep at the wheel on a long drive would be a more common effect, and usually could be self-diagnosed before actual sleep and an accident occurred.
Perhaps a better survey question may be "Can you drive for xx hours on a freeway non-stop?"
__________________
Gil Alexander
EAA Technical Counselor, Airframe Mechanic
Half completed RV-10 QB purchased
RV-6A N61GX - finally flying
Grumman Tiger N12GA - flying
La Cholla Airpark (57AZ) Tucson AZ
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09-16-2018, 10:22 AM
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Join Date: Jan 2013
Location: D.C.
Posts: 303
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Quote:
Originally Posted by rocketman1988
It is pseudo science.
So what does BMI tell you? NOTHING. Unfortunately, most doctors seem to look at BMI as the primary indicator of sleep apnea.
Oh, he still doesn't sleep well...
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1. It is well established through repeated meta analysis. It's solid science.
2. It is misunderstood by most. "Sleep apnea" is best thought of as an umbrella term. Is it obstructive, central? Both? (Its not just old, fat, men.)
3. BMI is not a diagnostic criteria for sleep apnea, obstructive or otherwise. It is, however, a risk factor.
4. If you thought a medical was hard to get with OSA on your record, try getting one after a stroke, or cardiac event.
Avoiding a potential diagnosis because one is fearful of loss of a medical can seriously shortchange a person in the long run. It always amazes me that some pilots will pull a cylinder at the first symptom (couldn't resist), yet not treat their bodies with the same abundance of caution.
__________________
Paul M.
Fayetteville, NC
Airport Bum
RV-4 / PA28-180
Last edited by Icarus : 09-16-2018 at 10:46 AM.
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09-16-2018, 10:57 AM
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Join Date: May 2012
Location: Ga
Posts: 662
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Data needed to help them make a decision about your safety...
I'm not a doctor and don't offer advice proposing to be a doctor but I do know a little bit about government bureaucracy and the need to keep you "safe", so I would suggest that you don't do the sleep study.
That being said, if you feel you need better sleep, just purchase a machine without the govt knowing about it. If it helps, then great. If it doesn't help, then sell it and move on.
Hope all works out well for you and that you fly many more years.
__________________
Craig
RV-3 Sold
RV-4 Sold
RV-6a Sold
RV-9 IO-360 CS, Built and Flying
Aerostar 600A, Family Hotrod
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09-16-2018, 10:58 AM
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Join Date: Jan 2005
Location: 57AZ - NW Tucson area
Posts: 10,011
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Quote:
Originally Posted by Icarus
1. It is well established through repeated meta analysis. It's solid science.
.....
3. BMI is not a diagnostic criteria for sleep apnea, obstructive or otherwise. It is, however, a risk factor.
.....
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As an engineer I would read the medical report as far less than "solid science"
http://annals.org/aim/fullarticle/17...-from-american
Read it completely, it's interesting.
If BMI is a risk factor, lowering should be more effective...
Quote - Overall, low-quality evidence showed that some intensive weight-loss programs may effectively reduce signs and symptoms of OSA in obese patients with or without diabetes.
IIRC the FAA obsession with BMI and sleep apnea a few years ago came about from a few serious accidents involving profession vehicle drivers/train drivers who were on long variable shifts, often at night.
Just checked - It was 2013 -
http://www.vansairforce.com/communit...d.php?t=106736
http://www.vansairforce.com/communit...d.php?t=107787
I don't remember it being linked to accidents involving pilots with Class III medicals.
By definition this group is not professional. If you feel tired, land - you are in charge 
__________________
Gil Alexander
EAA Technical Counselor, Airframe Mechanic
Half completed RV-10 QB purchased
RV-6A N61GX - finally flying
Grumman Tiger N12GA - flying
La Cholla Airpark (57AZ) Tucson AZ
Last edited by az_gila : 09-16-2018 at 11:01 AM.
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