Health Watch: Could Sleep Apnea Be Keeping You Awake at Night?

By ALPA Staff

Do you snore loudly at night and wake up in the morning feeling tired? If so, you may suffer from obstructive sleep apnea (OSA), a chronic disorder characterized by intermittent obstruction of the upper airway when sleeping. The muscles in the back of the throat relax excessively, reducing or blocking airflow to the lungs and disrupting sleep. The Mayo Clinic observes, “People with [OSA] may not be aware that their sleep was interrupted. In fact, many people with this type of sleep apnea think they slept well all night.”

The Aviation Medicine Advisory Service (AMAS), ALPA’s Aeromedical Office, in its latest Quarterly Aeromedical Newsletter, reports, “The prevalence of OSA in adults is estimated to range from 2 percent to 25 percent, with a male preponderance.” In addition, there’s a strong link between obesity and OSA. The report’s “Ask the Doc” section adds, “Over 90 percent of individuals with a BMI [body mass index] of 40 or greater have OSA requiring treatment. Up to 30 percent of individuals with OSA have a BMI less than 30.” BMI is a person’s weight in kilograms divided by the square of their height in meters.

If left untreated, OSA can lead to a variety of ailments including heart disease, strokes, depression, cognitive impairment, and diabetes. In the cockpit, this potentially serious sleep disorder can impact your ability to concentrate and typically induces excessive daytime sleepiness, i.e., hypersomnolence.

The good news is that both U.S. and Canadian medical certification can be approved once effective treatment is demonstrated. Sleep studies record the number of episodes of interrupted breathing and the total number of occurrences observed in an hour. These studies also verify whether oxygen levels in the blood are affected to determine if OSA is present and if treatment is effective.

In January 2015, the FAA issued guidance to aviation medical examiners (AMEs) outlining how they should evaluate OSA based on guidelines from the American Academy of Sleep Medicine. Once a pilot’s OSA is properly treated, AMEs are instructed to approve medical certification unless the condition poses an immediate risk to aviation safety.

Prior to this guidance, the FAA had proposed mandating a costly evaluation for airline pilots with a BMI greater than 40 before a medical certificate could be issued. However, ALPA played a pivotal role in convincing the FAA to modify the earlier guidance to AMEs.

Possible treatments for OSA include the use of a continuous positive airway pressure device, an automatic positive airway pressure device, a bilevel positive airway pressure device, or a dental block device. Alternatively, your physician may recommend various surgical procedures. The bottom line is that both U.S. and Canadian ALPA members with concerns about possible OSA should seek evaluation and treatment, if diagnosed.

AMAS advises, “This is one of the few health conditions for which the FAA will allow a pilot to return to work while awaiting special issuance once effective treatment has been documented.” A pilot can submit evidence of effective treatment with a completed FAA OSA compliance statement and proof of at least one week’s compliance to the agency for an initial review, if the applied therapy is deemed effective with no symptoms of OSA. In addition, pilots using a breathing device need to submit the entire 12 months of compliance data each year to demonstrate that the device is being used at least six hours a night and more than 70 percent of the time. Make sure your device has tracking-data capability.

Getting a good night’s rest isn’t a luxury, so talk to your AME if you’re having trouble sleeping.

Read the FAA’s Pilot Safety Brochure on Obstructive Sleep Apnea.

This article was originally published in the May 2018 issue of Air Line Pilot.