Sleep Apnea

by Dr. John Beasley, M.D.
Aviation Medical Examiner
Professor Emeritus and Clinical Professor
Department of Family Medicine
University of Wisconsin – Madison

Does your snoring frighten small children and cause dogs to cringe? Does your spouse/partner consider homicide in the wee hours of the morning? Does he/she report that sometimes during the night you stop breathing and then almost wake up and gasp? Are you sleepy during the day and have a problem with dozing off (other than when you are reading dull articles on sleep apnea)?

You might have sleep apnea. There are two kinds. One is obstructive sleep apnea (OSA), which is related to the anatomy of the tongue and pharynx (the area of the throat behind the mouth). The other is central sleep apnea (CSA), which is related to neurological abnormalities. By far the most common is OSA, and I’ll discuss that here.

So what does OSA cause?

FAA publication AM-400-10/1 notes an incident: “One February day in 2008, a commercial aircraft with three crewmembers and 40 passengers flew past its destination airport after both the captain and first officer fell asleep.” Sleep apnea can lead to difficulty in thinking, sleepiness and fatigue, irritability, and short attention span. There is a greater probability of task-saturation when things get busy. Good, uninterrupted sleep does matter.

Back in the days I was taking night calls, an FAA-designated examiner giving me an Instrument Proficiency Check (IPC) commented, “You’re not so bad when you’ve had a good night’s sleep.”

I got a bit of an awakening (sorry!) regarding the fed’s concern with OSA when an applicant showed up in my office who had special issuance permission for OSA. As far as I was concerned, he was doing just fine with a continuous positive airway pressure (CPAP) machine and no daytime fatigue. I documented this, certified him, and sent the stuff off to the FAA only to get a nasty-gram from them a couple of months later. (No, it wasn’t really nasty, but it was a bit embarrassing.) They were asking for more information. They needed more recent documentation of his current status, the use of his CPAP machine, and the rest. After a bit of hassle for both of us, we got it cleared up. The take-home for me was that the FAA is pretty concerned about this and, while we can get you certified, it’s not trivial.

Are you at risk? Well, check out “STOP-Bang” at  http://www.thesleepmd.com. This is a questionnaire that scores for Snoring, Tired (daytime), Observed apnea, high blood Pressure, BMI over 35 (about 245 pounds for a 5-foot, 10-inch person), Age over 50, Neck size over 17 inches, and male Gender.

The FAA probably will be coming out with a new standard that pilots with a BMI over 40 (280 pounds for our 5-foot, 10-inch person) will need to be screened for OSA, and they may go to even lower values. And it’s not just being out of shape and obese… 34 percent of NFL linemen have OSA.

Note that even if you have a valid medical certificate and have not been officially diagnosed with OSA, that if you do have OSA, you are not flying legally, or for that matter, safely. All pilots are prohibited from “operations during a medical deficiency.”

Now the good news is that most OSA is preventable.

At a recent FAA seminar I attended, it was pointed out that a patient with multiple issues (including diabetes, hypertension, and OSA) can often get rid of the conditions entirely by simply maintaining a reasonable body weight and a high level of physical fitness.

What does that take? Probably at least 45 minutes a day of some modest aerobic exercise, some resistance training, and avoiding being sedentary (https://www.midwestflyer.com/?tag=sedentary-death-syndrome). Not a cure-all, but it will sure as heck help.

And if you still have symptoms of OSA, then get it treated. We’ll get you through the certification process, and you’ll be safer for it.

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This entry was posted in Aug/Sept 2013, Columns, High On Health and tagged , , , . Bookmark the permalink.

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