Membership Services
FAA’s position on sleep apnea
Sleep disorders continue to be high on the FAA’s radar, so we’ll devote some time in this issue to review the FAA’s position on Obstructive Sleep Apnea (OSA). But first, a little background on the history that is driving the FAA’s focus on sleep disorders and pilot fatigue in general. The Department of Transportation, the FAA, and the National Transportation Safety Board have a long standing interest and concern in the broad subject area of pilot fatigue and aircraft accidents. Many NTSB accident investigations conclude that a causal factor for the accident was “pilot error,” but that term doesn’t necessarily refer to stick and rudder flying techniques, but about the more elusive problem of cognition, judgment, and executive function that can be compromised by overtaxing the nervous system beyond “normal operating limits.”
Probably by now everyone is aware of the two high profile incidents in 2008 and 2009 involving Part 121 air carriers in which the flight crews overflew their destination airports in Hawaii and Minnesota. The resulting investigations suggest that both flight crew members on both aircraft simply dozed off for more than just a few minutes before being aroused by ATC.
Fatigue has many contributors that slowly whittle away at a pilot’s alertness during the course of the day. These include, for airlines and many other Part 91 or 135 commercial operators, long duty days, “jet lag” associated with disruption of circadian rhythms, and sleep deficit prior to reporting for duty.
The FAA is concerned about another potential contributor to fatigue that many people don’t realize they have, and that’s obstructive sleep apnea. In our population that has a high prevalence of obesity, sleep apnea is becoming more frequently diagnosed, and the biggest problem for people who suffer from the condition is not the snoring that keeps their bed partners awake, but the periods of airway obstruction that cause a reduction or complete cessation of breathing that can occur hundreds of times during the night. Fortunately, those periods of hypopnea, when the airway is partially obstructed, or apnea, when there is complete airway obstruction, are brief, but the accumulated loss of quality sleep caused by the interruptions throughout the night result in the person waking up tired and fatigued. When we start out the day with that much sleep deficit, it can only go downhill from there.
OSA is diagnosed with a sleep study in which the patient is monitored during a sleep session and the quality and quantity of sleep is measured. Although the range of treatment options is fairly broad, CPAP, Continuous Positive Airway Pressure, seems to work best for many people.
The FAA medically certifies pilots under a special issuance authorization, but in order to obtain the special issuance, a Maintenance of Wakefulness Test (MWT) is required after treatment has been started to establish that the treatment option is effectively maintaining an open airway. Most sleep specialists agree that the MWT is a less than optimal demonstration of adequacy of control; however, there aren’t any other tests that are considered to be better than the MWT, so for now, that’s what we’re stuck with.
Technology may come to the rescue, though, in the form of sophisticated CPAP machines that include computer chips that record data to confirm compliance and effectiveness. Compliance is a big problem among CPAP users because the face masks and hoses are cumbersome to wear while sleeping. That, too, is improving, as the masks are getting more compact and comfortable to wear.
The FAA policy is still evolving on OSA, and although the MWT is currently required, that could change as the recording capabilities of the CPAP machines enter the marketplace. Complete information on sleep apnea special issuance can be found here.
January 13, 2011
