The FAA's New Obstrucitve Sleep Apnea Policy

FAA Surgeon General Dr. Fred Tilton M.D. has waged war on undiagnosed Obstructive Sleep Apnea (OSA).  The research was actually done by Dr. Nick Lomangino over some years (Tilton, F. 2014).  The new OSA rules were initially invoked as a simple FAA medical reinterpretation of the existing regulations (ergo avoiding the notice of proposed rulemaking (NPRM) process) but once the word got out, virtually every aviation organization started screaming bloody murder.  Organizations that are often at odds with each other were in a united opposition to Dr. Tilton's reinterpretation of the FAA's medical standards as it was seen as administrative overreach.  AOPA, ALPA, ATA, various aviation periodicals and many in the flying community were activated.  They were motivated by 3 things. 

1. The biggest complaint was that the FAA was instituting what was obviously a major rule change as a simple interpretation that required no outside oversight.  The attempt was thwarted by congress and the entire thing went through the NPRM process.

2. Dr. Tilton's insistence that any pilot with a BMI over  40 or neck size of 19 or higher were to be denied issuance of a medical certificate until they had completed a sleep study (at their own expense) and received FAA approved treatment (if it was deemed required).  

3. Some are arguing that it serves only a political purpose, not a practical one and it doesn't cost the government money since the airmen have to foot the bill. (Stanton, 2014).

After some changes made during the NPRM process the rule came into effect.  The main adjustment is that the FAA aviation medical examiners (AMEs) can issue the medical certificate but airmen with BMIs over 40 will or neck size over 19" have 90 days to do the sleep study and, if required, receive treatment. The deadline can be extended another 90 days at the airman's request.

Another change is that the airman can exercise the privileges of his certificate until such time as the (and if) the sleep study requires treatment.  As soon as the treatment begins and the airman is content that the issue has been properly addressed, they may self-release back to flying but the results of all tests must still be submitted to the FAA by the 90 day deadline.  If the treatment is not working then the airman may not exercise the privileges of their medical certificate until a satisfactory treatment is underway.

An example is thus:  The airman has a 19 inch neck and the doctor says take a sleep study.  The sleep study tells them they have severe OSA.  At this point the airman is grounded (much the same as if they had a cold or any other temporary condition that would ground them).  A second sleep test is done with a constant pressure air pump (CPAP) and the results show the OSA is adequately addressed by its use.  The pilot gets their home CPAP unit and uses it for a few nights to make sure all is well.  The pilot may now self release to resume flying but the doctor will want to see the results of longer term use of the CPAP.  The airman takes the computer chip to the doctor who collects the data and from longer term use (usually 30 days or so) and writes up a report that goes to FAA Aeromedical.  Once they look at it and decide the OSA is under control they will issue a waiver.  The pilot may have to have it renewed annually, possibly via a download from the CPAP or just a declaration on the medical form.  

FAA Aeromedical may continue to pursue more OSA requirements on the aviation community possibly even making sleep studies a requirement for all airmen certificates.  This will be likely justified by the data showing that 30% of all people have undiagnosed OSA.  This is on all of the associated documents and correspondence to AMEs (Tilton, F. 2014).  

Tilton, F. (2014). New obstructive sleep apnea policy. retrieved from web link.                        https://www.faa.gov/other_visit/aviation_industry/designees_delegations/designee_types/            ame/fasmb/media/201304_editorial.pdf

Stanton, B. (2014). Sleep apnea testing in transportation, it's not medical guidance anymore, it's               full blown politics now. retrieved from web link.

            http://www.sleepscholar.com/sleep-apnea-testing-in-transportation-its-not-medical-            guidance-anymore-its-full-blown-politics-now/