Sleep Apnea

I have had a sleep study completed on me, and have been diagnosed with sleep apnea. I have a Bi-PAP machine. I can't get used to it. I've tried it on and off for 6 months. I also have sinus problems so it is hard for me to breath through my nose anyway (I've had 3 operations on my nose), that makes using the Bi-PAP machine even harder, you must breath through your nose. I've also been told that operations for sleep apnea are only about 40% to 60% successful with a chance for some really bad side affects.

I work 60-80 hours a week every week, and I never fall asleep during the day. Sure I'm tired but who wouldn't be with those hours.

Has anyone gone through this with the FAA and got your medical back with a Special Issuance?
What is required, and what is the cost?

I could use some advice on who to talk to and, the steps to take.
Right now my medical is just expired.

I'm literally sick to my stomach that my flying days could be over, and may never fly my RV-8.

I just had sinus surgery a few weeks ago. I can now breathe through my nose.

My doctor told me If I would lose about 40 pounds it would make an even more dramatic improvement.

If you're carrying any extra weight, get rid of it. It may not completely solve the problem, but it may save your medical.

Has anyone gone through this with the FAA and got your medical back with a Special Issuance?

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Look Here This is an AOPA members section web page so you will probably need to sign in.

My suspicion is that your diagnosis will not be a big issue re your medical certificate.

I do not know your age weight or other predisposing features but if you are a youngster (<60) find a good pulmonologist and get this problem fixed. As mentioned above obesity is the major cause of sleep apnea and the cure is weight loss. Sleep apnea does it's damage over 20-30 years and the consequences at that point are irreversible.

Your most pressing and important issue is your sleep apnea not your medical certificate nor your RV 8. Go see a Doctor!

Until then get used to CPAP it needs to become your most intimate and best friend.

Advice

Yes indeed your health is more important than your flying. Sleep Apnea is nothing to take lightly, it can kill. I have a history of it in my family so I am somewhat familiar with this issue. You can get a full face mask for your CPAP by the way. You will get used to it and it will help so don't abandon it just it.

What you will have to do to get your medical is have your specialist (probably your ENT) address the issue and then report that it has been addressed. Your ENT will have to write a letter stating that you have been diagnosed with sleep apnea and that it has been "successfully" addressed via surgury/cpap/both. Your ENT will have to perform a before and after sleep study or at a minimum a before sleep study and an after daytime sleepiness test. These are well documented and accepted studies for this disorder and will prove to the Feds that your issues have been addressed.

As you know, the sleep study involves a stayover at the hospital or sleep center and you are monitored through the entire night. Once the extent of the condition is known and a course of action taken, a second study will determine how effective the treatment was. As an alternative the "after" test can be a daytime sleepiness test. You go to your ENTs office and they put you in a room and monitor your vitals while they turn the lights down very low. They do this for 3 or 4 - 20 minute periods over the course of 3 hours. During these 20 minute periods, you are required to sit quietly in a comfortable chair and remain quiet. The idea is that you should be able to stay awake and alert for these 20 minute periods unless you are excessively sleepy.

The deal breaker will be the letter your ENT submits. The letter will have to state that you are under his/her care, you have been diagnosed with sleep apnea, the condition has been treated by ..., and this is the most important part, the letter must state that, "I [the doctor] consider XYZ [the patient] to be an acceptable risk to pilot an aircraft and is an acceptable risk to the general aviation community."

You will in all likelihood also need to produce a second letter from your general practicioner stating that you are seeing him/her on a regular basis and that you are in generally good health. Sleep Apnea can lead to an enlarged heart and to other cardiovascular issues so you will probably be asked to provide a resting EKG and a cardiac history questionaire signed by your doctor stating that you are "an acceptable risk" and that you are taking steps to improve your overall health. The questionaire asks you to list any cardiac history in your family and to rate yourself on other cardiac risks such as smoking, etc. Your doctor will also have to list your BP from your last 3 visits over a period of time, so visit your doctor quarterly to establish this history. Losing weight is a big part of addressing sleep apnea and the Feds like to see that you are taking an active role in improving your health through diet and exercise.

Your application will have to go to Oklahoma City for approval so expect a several month delay. You do not want to get into a back and forth tit-for-tat scenario so do your homework ahead of time and be prepared to supply the documentation when you go to your FAA medical examiner. If everything goes in at the same time and you have crossed all of your "T's" and dotted all of your "I's" you can reduce the processing time considerably.

The FAA flight surgeon is tasked with protecting the public from potentially dangerous pilots. Well actually, they are tasked with covering themselves so if anything happens they can say, "Hey we did our part to keep an unsafe pilot out of the skys." As such, they are going to error on the side of caution. However, they are not unreasonable either. If they have documentation that states you have addressed your medical issues, are actually working to improve your health, and that other doctors are willing to go out on a limb and accept some of the risk of putting you in the cockpit, then you will probably prevail.

Good luck!

I was diagnosed with obstructive sleep apnea in October, and I have similar worries about flying, although I'm cautiously quite optimistic.

I've been using a CPAP since December, and I've noticed several improvements (I no longer nap, I'm more active, I'm actually smarter - - or less-non-smart, my b.p. is dropping nicely, and I'm finally able to get into some pretty decent physical condition.) All due to 100% compliance with CPAP!

Poster Maxwell had some excellent advice about trying different kinds of masks. To that I would add the consideration of a heated vaporizer attachment. I don't use one, but from what I read, those with sinus issues can benefit from them.

I grounded myself last year, and I feel that I'm just about ready to undergo the whole mish-mash for the re-establishment of my medical. Even though I just hate going to Dr.s, being poked and prodded, etc, if that's what I need to do to get back in the sky where I belong... then bring it on.

Best of luck getting used to your PAP. Once you finally get accustomed to it, you actually learn to like the darned contraption (even though you look like an alien and if you open your mouth, Hurricane Rita does a U-turn on your tonsils.)

Oh, this is my first posting here. Hope I wasn't too wordy.

Shannon Evans

Take your sleep apnea seriously. I was diagnosed 4 years ago, I am 40 years old & the C-pap machine has been great. No longer tired in the morning, not tired when I wake up, & blood pressure is under control. I took a long time to find a mask that did not irritate my skin, but feeling better was worth it. This was not an issue at my last flight physical. By the way I lost 50 pounds last summer & that helped also.

I am watching my dad battle congestive heart faliure due to High Blood Pressure, Sleep Apnea, & Weight. That & not being able to fly is enough incentive to USE THE MACHINE & LOSE WEIGHT.

By the way I am a new member, but I took the Vans tour in Aurora in Jan 06. Did the demo ride in an RV9, & bought the plan book.

AND THE T-SHIRT.

I had no idea.

I had no idea that the FAA would take my medical away for Sleep Apnea. I should have thought about that, but I haven't been thinking clearly until recently. (I have not been flying anyways, I am still building my shop)

I was diagonsed in December and got my CPAP in January. It took a long time to get used to it. When I first got it I thought I would go to bed early, sleep all night and get caught up on my sleep all at once. I went to bed at 8, woke up at midnight and was WIDE awake. It seems that 4 hours of GOOD sleep is far better than a whole night of tossing, turning, and gasping for air.

Only now, 4 months later I can sleep a full 8 hours with the CPAP. It has made a tremendious difference. In fact, recently I had a cold and a stuffed up nose and could not use my CPAP. The next morning I felt like I had not slept a wink.


Well, now that I have gotten used to a good nights sleep, looks like I need to start working on losing the extra weight.

Chofrock said:

I had no idea that the FAA would take my medical away for Sleep Apnea. I should have thought about that, but I haven't been thinking clearly until recently. (I have not been flying anyways, I am still building my shop)

I was diagonsed in December and got my CPAP in January. It took a long time to get used to it. When I first got it I thought I would go to bed early, sleep all night and get caught up on my sleep all at once. I went to bed at 8, woke up at midnight and was WIDE awake. It seems that 4 hours of GOOD sleep is far better than a whole night of tossing, turning, and gasping for air.

Only now, 4 months later I can sleep a full 8 hours with the CPAP. It has made a tremendious difference. In fact, recently I had a cold and a stuffed up nose and could not use my CPAP. The next morning I felt like I had not slept a wink.


Well, now that I have gotten used to a good nights sleep, looks like I need to start working on losing the extra weight.

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I had a tendency toward the problem as well and managed to lose around 50 pounds (could stand another 50). My wife says that it has made a world of difference. I also noticed that if I would refrain from even the tiniest of snacks within 5 hours (literally) of bedtime, the apnea was significantly reduced.
-mike

Thanks for your responses.

Mr Mikey, I too could lose some weight, I have already started a new life style change including exercise and diet. I'm 42 years old 6'6" 245 lbs. I'm hoping to get down to 200lbs.

Seaplaner, please let us know how everything comes out with your medical.
I for one would like hear about what your experiences.

I was wondering if a person has to have a sleep study or a daytime sleepiness test every year, or will a check up and a letter from my doctor/ENT satisfy the FAA?

My sleep study test was over $3000.00.

I would hate to have to add that to my yearly flying costs.

If I end up going the surgery route and it's successful does the FAA even have to know about it?

Does anybody have any experience with the surgeries available?

Followup

rv8tr said:

Thanks for your responses.
I was wondering if a person has to have a sleep study or a daytime sleepiness test every year, or will a check up and a letter from my doctor/ENT satisfy the FAA?

My sleep study test was over $3000.00.

I would hate to have to add that to my yearly flying costs.

If I end up going the surgery route and it's successful does the FAA even have to know about it?

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1) No you do not have to have a sleep study every year/medical period. You will have to make a visit to your ENT prior to every renewal and get a letter that you continue to be "an acceptable risk. The key is to get the condition addressed and to have your ENT verify that it is truly addressed and continues to not be an issue. A history of visits to your ENT is a good thing!

2) Yes the FAA does need to know about it. In fact if you read the medical questionaire, there is a question or a statement that requires you to list "every visit you have made to a doctor." Not listing something as significant as Sleep Apnea and surgery would be withholding pertinent information and subject to stiff fines and penalties.

The surgery can be minor or quite complicated. At a minimum, the doctor will use a laser to remove the soft tissue in the back of your throat. More serious surgery includes removing the soft pallet, the tonsils, and other soft tissue in the throat. In addition, it may be necessary to remove tissue in your nasal and sinus areas. If your nose has been broken and is displaced, the doctor may end up re-breaking your nose and resetting it to lesson the obstruction of your nasal passages.

The whole roto-rooter work is in-patient surgery and is quit an ordeal. You can expect to be in intensive care for at least one day and possibly more following the surgery. They will put you in ICU to monitor you closely in case your airway decides to swell shut or you have serious bleeding issues. You may go home in a day or remain in the hospital for 3 or more days. Reasonable recovery will take about 10-14 days unless complications occur. The first 5-7 days will be difficult as you will not be able to lie down and will be quite sore and swollen. Your first few days and nights will be spent spitting blood and catching small cat naps.

Surgery is not a guarantee so you may end up still requiring a c-pap following the surgery. You may want to consider trying the c-pap for several months before you go in and demand that your Dr. perform the surgury. Many do just fine on a C-PAP and never have to have the surgery. IMO, your best bet is to first try the c-pap along with weight loss and if that doesn't solve the problem, then think about the surgery. If you have severe allergies which can contribute to difficult breathing, you should also consider seeing an allergist and addressing the issues with injections. The FAA is not real friendly towards over the counter allergy medications.

I don't mean to discourage you from surgery and it may very well completely cure your symptoms. But it is significant surgery and may not be the panacea cure all that you might think it is. There can be complications and there is no gurantee. To me it makes sense to be a little on the conservative side in treating this issue prior to opting for surgery. But if it comes down to a surgery/suffer decision, the surgery is worthwhile.

Good luck!

Hey RVers,
I too suffer sinus problems and use a CPAP every night. May I recommend using a "neti pot" for helping sinus problems. Go to netipot.com for a video of its use and purchase. It is a nasal douche. Fill the pot with warm water and 1/4 teaspoon of sea salt (non-iodized). Place head over sink and pour through one nostril and blow out water. Then do the other nostril.

I know it sounds horrible but it isn't. You can breathe while pouring and it is painless. The warm salt water soothes the sinus and washes out crud. You can use as many times per day as you wish or is required. Is cheap, painless and provides immediate relief.

Think this is a bad joke? Ask your Doctor about it, try it and you'll be angry that he didn't tell you about it to begin with.

Good luck and best to all.

Deal Fair
George West, TX
RV-4 flying
N34CB