Sleep Apnea, Policy or Not!

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

There’s been a lot of fuss in the past few months over a proposed change in FAA aeromedical policy regarding “sleep apnea” and I’m not going to weigh in on the pros and cons of that. Regardless of FAA policy, it’s not good for you in general, and I cannot imagine that disordered sleep makes anybody a better pilot. So, here goes.

Does your snoring frighten small children?

Does your spouse or 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)?

If your answer to any of the above is yes, then you may have sleep apnea.

There are two kinds of sleep apnea. 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 apnea,” which is related to neurological abnormalities. By far the most common is OSA, and I’ll discuss that here.

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, un-interrupted 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 nasti-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 This is a questionnaire that scores for Snoring, Tired (daytime), Observed apnea, High Blood Pressure, Body mass index (BMI) over 35 (about 245 pounds for a 5’ 10” person), Age over 50, Neck size over 17” and male Gender. And, by the way, it’s not just being out of shape and obese – 34% of NFL linemen have OSA.

Note that even if you have a valid medical certificate and have not been officially diagnosed with OSA, if you do have OSA you are not flying legally, or for that matter, as safely as you might. 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 (see Not a cure-all, but it will sure as heck help.

And if you still have symptoms, then get it treated. An aviation medical examiner (AME) can get you through the certification process, and you’ll be safer for it.

Whether a result of sleep apnea or a lack of sleep, FAA publication AM-400-10/1 notes an incident involving an airline crew that fell asleep which could have ended in disaster.

“One February day in 2008, a commercial aircraft with three crew-members and 40 passengers flew past its destination airport after both the captain and first officer fell asleep.”

The moral of that story is, get plenty of rest before flying, and if you suspect you have sleep apnea, seek treatment.

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