Sorry, you're too fat to be a pilot. Love, FAA

[annken100]

Hey folks, just read on Avweb that the FAA will soon deny medicals to people who are obese. If you have a Body Mass Index (BMI) of 40 or greater and a neck 17 inches or greater in circumference you are assumed to have Obstructive Sleep Apnea (OSA) and therefore disqualified. If you exceed the BMI and neck circumference values you must go to a doctor that is a board certified sleep specialist to either prove you don't have OSA or get treated. This applies to both pilots and controllers. Eventually the criteria will be lowered to affect all those with a BMI of 30 or greater. I'm curious to see what, if any, evidence they produce that shows that the above criteria decreases the overall safety of the national airspace system. I've read many accident reports over the years but don't recall obesity or sleep apnea being listed as a cause or contributing factor. Here is a link to the Federal Air Surgeon's medical bulletin introducing the concept: http://www.faa.gov/other_visit/aviation_industry/designees_delegations/designee_types/ame/fasmb/media/201304.pdf

[Hal Bryan]

We are fully aware of this, and are working with AOPA on this sudden and unjustified policy shift. You'll be hearing more from us, hopefully tomorrow - keep an eye on http://www.eaa.org.

[Frank Giger]

Don't forget the tongue measurements. An overly long tongue is also a medical barrier to obtaining a pilot's license according to the notice.

We're looking at you, Gene Simmons.

Somebody ask me again why I chose to be a Sport Pilot even though there's nothing physically wrong with me and how I've short changed myself as an aviator. Please.

[zaitcev]

Being tall I noticed long ago how bogus BMI formula becomes once you hit 6 ft. My BMI is 27.3 and I am as skinny as you can get. It's ridiculous.

[Mike Switzer]

Physical trainers have been saying for years that BMI is flawed. When I was in college & lifting weight we used to strap weights to our heads & do exercises to make our necks bigger. I haven't worn a 17" collar since sometime early in high school.

[WLIU]

I know very little about the topic but a quick search came up with the info that the US average is 27.something and the statement, from Wikipedia, that seems to make sense to this engineer

"The medical establishment has acknowledged major shortcomings of BMI.[26] (http://en.wikipedia.org/wiki/Body_mass_index#cite_note-26) Because the BMI depends upon weight and the square of height, it ignores basic scaling laws whereby mass increases to the 3rd power of linear dimensions. Hence, larger individuals, even if they had exactly the same body shape and relative composition, always have a larger BMI."

Given the amount of medical research that goes on, I am actually pretty surprised that a better formula that takes into account the issue in the quote has not been developed. This looks like a fatal flaw if the calculation is to be applied to individuals for regulatory purposes rather than to populations for general estimates.

I see that both EAA and AOPA are against this policy.

Best of luck,

Wes

[s10sakota]

Come on guys you all forgot one very important detail! Don't you know........ The gov't knows best! HAHAHA

[Hal Bryan]

We are fully aware of this, and are working with AOPA on this sudden and unjustified policy shift. You'll be hearing more from us, hopefully tomorrow - keep an eye on http://www.eaa.org.


Here's our first published response:

http://www.eaa.org/news/2013/2013-11-19_faa-sleep-apnea-policy-would-set-a-dangerous-precedent.asp

Full text:

November 19, 2013 - EAA is joining other general aviation organizations urging an immediate and indefinite hold on the FAA's just-announced aeromedical guidelines on sleep apnea (https://www.faa.gov/other_visit/aviation_industry/designees_delegations/designee_types/ame/fasmb/media/201304.pdf).

The protocol, announced by Federal Air Surgeon Dr. Fred Tilton, would initially require all applicants with a body mass index (BMI) of 40 or greater and a neck size of 17 inches or greater to be evaluated by a sleep specialist prior to receiving a medical certificate. Those who are diagnosed with obstructive sleep apnea (OSA) would need to be treated prior to issuance. Dr. Tilton noted that OSA is "almost universal" among this group.

"The FAA has not presented nor have we seen any evidence of aeronautical hazards or threats based on sleep apnea in general aviation," said Sean Elliott, EAA's vice president of advocacy and safety. "To enter into the realm of predictive medicine based on no safety threat or symptoms - at a significant cost to individual aviators and the GA community - is not only a reach beyond FAA's mission but a serious hurdle to those who enjoy recreational aviation. The FAA's special issuance process would also be overwhelmed by this unneeded policy, creating even further delays and bureaucracy."

Elliott also notes that while this newly announced FAA policy is clearly unjustified, a greater threat looms in subsequent plans outlined by Dr. Tilton, that "once we have appropriately dealt with every airman examinee who has a BMI of 40 or greater, we will gradually expand the testing pool by going to lower BMI measurements until we have identified and assured treatment for every airman with OSA."

The Pilot's Bill of Rights passed by Congress and signed by the president in 2012 required that the FAA thoroughly evaluate the medical certification process and supply medical science and justification to support its policies. Any sleep apnea requirements or policy should also meet this requirement. To date, the FAA has not undertaken such an evaluation.

"We are joining in the call for an immediate suspension of this policy and thorough review of its need and justification," Elliott said. "There has been no evidence of sleep apnea as a cause or factor in more than a decade of general aviation accidents reviewed by FAA's own General Aviation Joint Steering Committee, in which EAA participated."

The new policy grew out of a 2009 NTSB recommendation that the FAA change the airman medical application to include questions about any previous diagnosis of obstructive sleep apnea as well as the presence of risk factors for the disorder. The recommendation also asked the FAA to implement a program to require pilots at high risk for obstructive sleep apnea to be evaluated and, if needed, treated before being granted medical certification.

EAA, in consultation with the Aeromedical Advisory Council composed of aviation medical examiners, will be sending specific recommendations to the FAA in the days ahead. EAA is also carrying opposition to lawmakers on Capitol Hill who have already called for a review and evaluation of the aeromedical process under the Pilot's Bill of Rights.

[Jim Hann]

Thank you EAA.

[TedK]

Thank you EAA.


+1

[CDS]

The FAA has already announced that they're just starting at a BMI of 40 and higher, then they'll work their way down to lower BMIs. They haven't said where they'll stop.
There are some people with high BMIs who are very fit. A lot of muscle is heavy. BMI is a poor choice for a measurement.

If not challenged here, then what's next?

[Bob Dingley]

I've got a different take on this.


Notice that this is starting in commercial aviation. For as long as I remember, FAA has been requesting comments for one NPRM after another.The subject: "crew rest regs." FAA pulls one way, the carriers yank the other way, the crews are in the middle and every one files comments. This popped up as a factor in the Colgan accident in NY a few years ago. Sure, that crew had their issues with training and pilot error. The thing that scandalized the public the most (IMHO) was when the press reported that the crew spent most of their "rest time" the night before their flight in a travel status. They did get a few hours snooze on a sofa before preflight.


So now, FAA no longer wants to wrestle in the mud with pigs over crew rest regs, but now tries a different tack. They just have their AMEs check the applicants collar size. Its now handled at the local level and the suits in Oke City don't break a sweat. You working pilots know I'm right.


Bob

[martymayes]

The FAA has already announced that they're just starting at a BMI of 40 and higher, then they'll work their way down to lower BMIs. They haven't said where they'll stop.
There are some people with high BMIs who are very fit. A lot of muscle is heavy. BMI is a poor choice for a measurement.

If not challenged here, then what's next?

If one is healthy, I don't see anything to worry about.

[I_FLY_LOW]

Question is, if they go by bmi, and neck size, and, according to your doctor, you're healthy, vs the FAA's definition, how is adding a special waiver a good thing?

[Bob Dingley]

If one is healthy, I don't see anything to worry about.

Not as simple as it sounds. Airplanes are easy. The wear is either within tolerances or its not. The computer printout says the component has another 98.4 hrs until retirement or it doesn't. Cut and dry. Many more variables with people. Just because a pilot no longer takes his meds doesn't mean he is no longer bipolar.


The bulletin talks of sleep studies. ($3K to $4K). Untreated, OSA is disqualifying. Buy a medical device (< $3K) and presto, its treated. All because your neck is too big.They plan to "work" the limit down to 20 bmi.


I stand by my previous post that there is a lot of fatigue in cockpits. Some may be caused by too much snoring (OSA). Much more by long hours.


Bob

[Zack Baughman]

More here: http://www.eaa.org/news/2013/2013-11-20_eaa-medical-council-pans-faa-sleep-apnea-testing-proposal.asp

And here's a link to EAA's letter to Administrator Huerta: http://www.eaa.org/news/2013/releases/2013-11-20_eaa-sleep-apnea-letter.pdf

[pacerpilot]

"If one is healthy, I don't see anything to worry about."

Marty, I'm 5' 10" (I used to be 6' but squashed a vertebrae and a couple discs doing manly things) 210lbs. That equates to a BMI of 30.1. According to the FAA, I'm fat. I am not. I have a 52" chest, 32" waist, run, lift (a lot) and, have a very low body fat percentage. The boobs in Ok city don't care. My doc has gone around and around with them. Still, I can only get 1 year special issuance medicals because of a minor pre-existing condition which has never-nor ever will-pose a problem and they say due to my presentation of diminished physical condition. I don't know what they consider to be in "good shape" but I'd be afraid of that dude! This is another tactic to reduce and eventually eliminate GA and put the government in control of all aviation, plain and simple. I've quit getting medicals. I've found it really hasn't diminished my ability to fly whatever airplane I want!

[skeeter_ca]

The bulletin talks of sleep studies. ($3K to $4K). Untreated, OSA is disqualifying. Buy a medical device (< $3K) and presto, its treated. All because your neck is too big.They plan to "work" the limit down to 20 bmi.


Bob

Those Medical devices know as a CPAP machine have a recorder inside that logs your usage every night and monitors your sleep habit. That data has to be turned into your doctor. I used one for awhile but found i couldn't sleep with it on because it bothered me so much. From what i was told by the FAA you have to have 6 months of good monitored sleep to qualify as ok and i would bet it has to be turned in everytime you renew your medical. I asked about it when i was speaking with the FAA at Oshkosh 2012 about retesting for my color blindness. They had brochures at the desk about sleep apnea. Wish i hadn't because he probably put it in my file. And yes i'm fat. According to one BMI calc i am at 37.59 (obese class 2).

skeeter

[1600vw]

PacerPilot: I feel your pain. I did the same but broke my neck from, well they never did know from what. Then I crushed vertebrae more then 5 times. Bulging disc's are part of it as are hair line fractures.
They found I have Osteoporosis and have it bad. My T scores are those of a 100 yr old woman some lower then that. Two years ago I had only one good bone inmy body and it was my left forearm or whatever they call that bone. All others where almost off the charts, one hip is gone 1/4 left. I am running on borrowed time but what do you do.
Get a Bone density check ASAP, and don't let them do just the wrest or angle do a complete body scan, takes about 5 mins. I was 42 when this hit me or took my life from me. I have learned to deal with it. Our Lord has been good to me, do not feel sorry for me and I do not feel sorry for myself. I am a lucky man.

Just call me...Osteo-Man...LOL


Tony

[Floatsflyer]

CPAP machines are not the only solution for snoring and OSA. Oral Appliance Therapy is an alternative and a very effective treatment for those with mild to moderate OSA. There are 2 types: Tongue Retaining Device and Mandibular Advancing Device. They are far less invasive, less expensive and much more tolerable to wear than CPAP. TALK TO YOUR DENTIST.

[WLIU]

"If one is healthy, I don't see anything to worry about."

I think that this statement illustrates a lot of how we allow regulations to make it harder and harder to fly and do many of the other things that we value.

First they make individuals who have a BMI of 40 and make them do $2000 testing. Then they lower the threshold to 35. Then 30. Then 25. In their eyes you are not healthy anymore. But having let this go on, not supporting the early "victims" of this bad policy, when they get to you, you won't get any support when you are standing there crying "but I'm healthy!".

I didn't get it when I was much younger, but now I get what Ben Franklin meant when he famously stated "We must, indeed, all hang together or, most assuredly, we shall all hang separately.".

We all need to support pushing back on this proposal hard.

Best of luck,

Wes
N78PS

[Bob Dingley]

If this issue ever comes up for comments, here is an example of a "plus sized" pilot James B. McGovern who functioned well under stress despite his alleged obesety. Nick-named Earthquake McGoon because of his six foot, 260 lb frame. "Earthquake" was an Air America pilot supporting the defense of Dien Bien Phu when he was hit hard. Despite his large waistline and a tendancy to snore, he got his crippled bird 75 miles to Laos where he crashed and was killed. He had no CPAP on board.


I remember his character appearing in either Terry and the Pirates or Steve Canyon, Sunday comics of the era.


http://en.wikipedia.org/wiki/James_B._McGovern,_Jr.


Bob

[WeaverJ3Cub]

Totally agree Wes. Well said. We need to remember Nartin Niemöllers quote.


First they came for the communists,
and I didn't speak out because I wasn't a communist.

Then they came for the socialists,
and I didn't speak out because I wasn't a socialist.

Then they came for the trade unionists,
and I didn't speak out because I wasn't a trade unionist.

Then they came for me,
and there was no one left to speak for me.

[WeaverJ3Cub]

And they plan to lower it to a BMI of 20?!?!?

I'm 23 and a regular runner of half marathons and 5k races and at 6' 1" my BMI is 23.1. There is no way I'm overweight by anyone's standard.

And it really rankles with me how they didn't issue a NPRM or anything....just popped it out on everyone. Are they trying to see if we're awake? I guess they found out. :)

[FloridaJohn]

If this issue ever comes up for comments, here is an example of a "plus sized" pilot James B. McGovern who functioned well under stress despite his alleged obesety. Nick-named Earthquake McGoon because of his six foot, 260 lb frame. "Earthquake" was an Air America pilot supporting the defense of Dien Bien Phu when he was hit hard. Despite his large waistline and a tendancy to snore, he got his crippled bird 75 miles to Laos where he crashed and was killed. He had no CPAP on board.
Six foot tall and 260 lbs gives him a BMI of 35.3, so even he would be safe from this new initiative. He would have to weigh over 295 pounds to get a BMI over 40.

[martymayes]

And it really rankles with me how they didn't issue a NPRM or anything....just popped it out on everyone.

The Federal Air Surgeon is within his bounds by issuing a medical standard. And they didn't just "pop it out" on everyone, this has been in discussion for several yrs, the impetus for action was in 2008 when both pilots on a Go! Airlines flight from Honolulu to Hilo, Hawaii fell asleep and overflew their destination. I don't necessarily agree with the methodology and they are only targeting the highest risk group for now. Just like HBP, or diabetes, if someone has OSA, they need to get treated for long term health reasons, whether or not they can fly airplanes should be a concern that is distant second.

Progressive lowering of the BMI standard will probably self destruct like the National Health Care website. CAMI just can't handle that kind of traffic.

Oh, and it should be clear(er) now why the class 3 medical exemption has hit a brick wall at the Federal Air Surgeons door.

[WeaverJ3Cub]

Progressive lowering of the BMI standard will probably self destruct like the National Health Care website.

I have to respectfully disagree. Once a government rule/law/bill is passed or implemented the chances of it getting pulled back are nearly nil. To use your example, the PTB will just ratchet down further and say that this proves that we need a single-payer system.

If it does self-destruct, it's a question of how much it takes out when it blows up. Sometimes the effect is the same as the originally feared consequences.

[jjhoneck]

I have to respectfully disagree. Once a government rule/law/bill is passed or implemented the chances of it getting pulled back are nearly nil.

Truer words have never been spoken. Just look at EPA.

They had largely accomplished their original mission by the mid 1980s. Instead of disbanding, or at least downsizing, they have continued to tighten air and water quality standards, justifying their continual expansion.

This principle applies to every government agency. There is simply no way that a large, powerful bureaucracy is ever going to voluntarily shrink, or even remain static.

[Bob Dingley]

Six foot tall and 260 lbs gives him a BMI of 35.3, so even he would be safe from this new initiative. He would have to weigh over 295 pounds to get a BMI over 40.

Good catch John.


Pictures of the era (Life Magazine) showed him < 300. I'm guessing that an Air America physical of the mid 50's conducted who-knows-where would let you weigh what ever you want. Didn't prevent him from flying an amazing number of C-119 hours daily.


Lets keep our eye on the ball. Fatigue is the major reason for sleepy pilots. There is a reason why FBOs have a dark room full of Lazy-Boys. It aint for the folks flying flying their personal planes. You may hear corporate/Commercial pilots use the term "safety nap."




Bob

[martymayes]

"If one is healthy, I don't see anything to worry about."

I think that this statement illustrates a lot of how we allow regulations to make it harder and harder to fly and do many of the other things that we value.

The Federal Air Surgeon is simply telling folks if they want to get a medical and fly they need to shape up - step away from the donut box in the pilot's lounge, put some of the beer back in the fridge and put down the cigs. Very early on in this game I realized that holding on to a medical is directly related to lifestyle choices. Have to be smart with your health and not leave it to chance. If one is healthy, they have nothing to worry about.


First they make individuals who have a BMI of 40 and make them do $2000 testing.

Doesn't have to cost $2k but at any rate, YES! it's a reasonable test for OSA because the relation to obesity. If there is a 95% chance someone has OSA based on the numbers, they should be tested. (I've had expensive medical testing done when the probability of disease was much, much lower).


Then they lower the threshold to 35. Then 30. Then 25. In their eyes you are not healthy anymore. But having let this go on, not supporting the early "victims" of this bad policy, when they get to you, you won't get any support when you are standing there crying "but I'm healthy!".
Let's see where the BMI goes before making predictions. I don't see it going lower than mid '30's.


We all need to support pushing back on this proposal hard.

There's nine other disqualifying medical conditions. If one has a disqualifying medical condition and goes for a SI, they will probably have to submit ot a battery of tests costing thousands of dollars. OSA is just another disqualifying condition. I guess denial only goes so far and that's the reason some folks are getting wrapped around the axle.

[martymayes]

Lets keep our eye on the ball. Fatigue is the major reason for sleepy pilots. There is a reason why FBOs have a dark room full of Lazy-Boys. It aint for the folks flying flying their personal planes. You may hear corporate/Commercial pilots use the term "safety nap."

Bob, one of my good friends at work thought he was fatigued from the flying/work schedule. Then he was diagnosed with OSA. He got treatment and now feels 1000x better and is back at work flying the same schedule as before. Maybe it wasn't the schedule after all......That's what we need to find out.

BTW, he said after a week of deep restorative sleep, he said it felt like he was 25 yrs old again. Boundless energy, improved vitals, etc.

[WLIU]

There is a big difference between a chronic condition that deserves a trip to the right physician, and a regulatory requirement that takes away someone's livelihood or even ability to fly recreationally.

Regulations have to serve a purpose and make sense, not just be the latest good idea. In the case of the existing list of disqualifying conditions, each can be clearly explained to have the potential to be suddenly incapacitating, immediately affecting the safety of a flight. The condition that the Aeromedical branch is saying that they are concerned about does not meet that test.

Getting treatment for Sleep Apnea is likely a good idea, but many good ideas make very bad law.

Historically, the making of rules for the sake of making rules just leads to a larger and large population of folks ignoring the rules and doing whatever they want. Aviation is not immune from this part of human nature. We need the rules to make sense. This proposal runs counter to that.

I see that there are rumblings of a political solution. The trucking industry has some muscle in Congress and aviation might benefit from the general push back across all of the industries affected.

I will suggest that beyond the current dustup, all aeromedical changes should go through the formal rule-making process. Every system needs checks and balances and requiring formal notice and comment would be a valuable check on the aeromedical side of the FAA. After all, good ideas should make it through the formal comment process just fine right?

Best of luck,

Wes
N78PS

[pacerpilot]

PacerPilot: I feel your pain. I did the same but broke my neck from, well they never did know from what. Then I crushed vertebrae more then 5 times. Bulging disc's are part of it as are hair line fractures.
They found I have Osteoporosis and have it bad. My T scores are those of a 100 yr old woman some lower then that. Two years ago I had only one good bone inmy body and it was my left forearm or whatever they call that bone. All others where almost off the charts, one hip is gone 1/4 left. I am running on borrowed time but what do you do.
Get a Bone density check ASAP, and don't let them do just the wrest or angle do a complete body scan, takes about 5 mins. I was 42 when this hit me or took my life from me. I have learned to deal with it. Our Lord has been good to me, do not feel sorry for me and I do not feel sorry for myself. I am a lucky man.

Just call me...Osteo-Man...LOL


Tony

YIKES 1600VW!!! You're a good example of why I don't complain about my little issues. I hope you're keeping everything in check. As for your osteoporosis remember, "milk does a body good!". My doc makes me drink a quart a day at least and exercise (that'll take care of that low "T" too). What really bothers me is the FAA aero-med branch doesn't care. Most pilots I know are in reasonably good shape. Better than most non-pilots for sure because we're conscious of the requirements of flight. It has become apparent to me the FAA is only interested in not assuming any liability and reducing the number of pilots.

[1600vw]

PacerPilot: I love milk and drink it by the 1/2 gallons. As for exercise a few years leading to this I would cut and split 10 cords of fire wood a year by hand. I loved doing this, kept me in shape. Then one day everything changed. The doctors told me, you have to exercise. I then told them of my fire wood cutting, and that was only one thing I did. I was a very active person before this hit me. Today not so much.

I try and do what I can, then I have those whom throw it in my face. How can someone whom claims to be on disability do what you do. I hear it all the time. I tell them if you only knew what I use to do before I became ill you would see, really I do nothing compared to what I did do.

Woman are good at saying this to me. I have Osteoporosis and I do not walk with a chain nor am I disabled.

I had a friend tell me he walked into a hobby store here in town, we only have one, and a group of people where standing around talking about me and how I claim to be disabled but I can fly an airplane. They said he don't look ill to us. Lets just say my friend was not happy he knows my condition and what I go through. To look at me you can not see anything is wrong with me, but walk in my shoes for a mile then get back with me.

I was out one evening singing at a Karaoke bar when everyone in the bar turned on me. I thought I was going to get beat, they told me it was people like me that is causing our country to be in the shape it is. The owner had to walk me to my car to keep me from being attached by a mob of people. They would have killed me that night or I thought so as did the owner of the bar. All because I do not look ill and I walk with a cain. I could tell you more stories like this. People judge you by how you look, I look fine or healthy.

The doctors have given up trying to find why I have this and we have given up trying to fight it, they tell me my body is eating its self from the inside and nothing they can do about it.

[pacerpilot]

PacerPilot: I love milk and drink it by the 1/2 gallons. As for exercise a few years leading to this I would cut and split 10 cords of fire wood a year by hand. I loved doing this, kept me in shape. Then one day everything changed. The doctors told me, you have to exercise. I then told them of my fire wood cutting, and that was only one thing I did. I was a very active person before this hit me. Today not so much.

I try and do what I can, then I have those whom throw it in my face. How can someone whom claims to be on disability do what you do. I hear it all the time. I tell them if you only knew what I use to do before I became ill you would see, really I do nothing compared to what I did do.

Woman are good at saying this to me. I have Osteoporosis and I do not walk with a chain nor am I disabled.

I had a friend tell me he walked into a hobby store here in town, we only have one, and a group of people where standing around talking about me and how I claim to be disabled but I can fly an airplane. They said he don't look ill to us. Lets just say my friend was not happy he knows my condition and what I go through. To look at me you can not see anything is wrong with me, but walk in my shoes for a mile then get back with me.

I was out one evening singing at a Karaoke bar when everyone in the bar turned on me. I thought I was going to get beat, they told me it was people like me that is causing our country to be in the shape it is. The owner had to walk me to my car to keep me from being attached by a mob of people. They would have killed me that night or I thought so as did the owner of the bar. All because I do not look ill and I walk with a cain. I could tell you more stories like this. People judge you by how you look, I look fine or healthy.

The doctors have given up trying to find why I have this and we have given up trying to fight it, they tell me my body is eating its self from the inside and nothing they can do about it.

Wow, that's rough man. I think I'd stay out of bars, drink at home and, only sing in the shower!

[martymayes]

I will suggest that beyond the current dustup, all aeromedical changes should go through the formal rule-making process.
Careful what you wish for. The rules can be much, much worse.

[WLIU]

I am very careful what I wish for these days. In this case, the federal formal rule making process requires publishing a proposal in the Federal Register, a comment period where all stakeholders (like us) submit their views, the department that proposed the rule must respond to all inputs, and only then can a final rule be published. This process, which applies to other federal rule making, provides a valuable check and balance and prevents surprises like the one that we have just experienced. Time to apply this standard federal process to the aeromedical branch. I will note that the FDA, that regulates all stuff medical outside aviation, must use this process. And of course the rest of the FAA must follow this process. It is supposed to be hard to create new rules. This allows the really good ideas to move forward and the not so good ideas to die.

Best of luck,

Wes
N78PS

[martymayes]

OSA in airmen will be addressed. The proposed response is manageable. The alternative is unknown. Good luck.

http://www.faa.gov/pilots/safety/pilotsafetybrochures/media/Sleep_Apnea.pdf

[WLIU]

I will suggest that the alternative is very well known. OSA did not start occurring yesterday. It has likely been present in the airman population since shortly after Wilbur and Orville. If it was an issue that was obviously causing accidents the NTSB would have been all over it a long time ago.

So the alternative is what we do today. Pilots that have health issues seek treatment and go fly.

If the aeromedical branch had solid data that there was a safety issue that needed to be solved right now we would not be having this debate.

Best of luck,

Wes
N78PS

[martymayes]

I think the data indicates most OSA is undiagnosed. So pilots are NOT seeking treatment - they don't even know they are affected. The FAS has identified a safety issue (no need for fatalities) and solved it by adjusting the medical standards It will be in effect in < 2 yrs despite rumblings from alphabet groups.

[dewi8095]

I am very careful what I wish for these days. In this case, the federal formal rule making process requires publishing a proposal in the Federal Register, a comment period where all stakeholders (like us) submit their views, the department that proposed the rule must respond to all inputs, and only then can a final rule be published. This process, which applies to other federal rule making, provides a valuable check and balance and prevents surprises like the one that we have just experienced. Time to apply this standard federal process to the aeromedical branch. I will note that the FDA, that regulates all stuff medical outside aviation, must use this process. And of course the rest of the FAA must follow this process. It is supposed to be hard to create new rules. This allows the really good ideas to move forward and the not so good ideas to die.

Best of luck,

Wes
N78PS

The rule making procedure is the only check I know of that those outside government have on federal agencies. The FAA and other agencies are staffed by non-elected people who do not, and do not have to respond to the criticisms of those they supposedly serve. Congress still has some oversight of agencies because of its budgetary and appointive powers, but that leverage is cumbersome and slow. Federal agencies are beyond the reach of concerned citizens and don't need to respond to them. We, as pilots, need the help of the alphabet groups whenever issues like this arise.

Don

[annken100]

I think the data indicates most OSA is undiagnosed. So pilots are NOT seeking treatment - they don't even know they are affected. The FAS has identified a safety issue (no need for fatalities) and solved it by adjusting the medical standards It will be in effect in < 2 yrs despite rumblings from alphabet groups.
Marty, where is the evidence that undiagnosed sleep apnea is actually a safety issue? What data correlates undiagnosed sleep apnea with airplanes falling out of the sky and unleashing the apocalypse on unsuspecting people on the ground? Why should anyone have to go through the process to prove they don't have sleep apnea, or anything for that matter, if they are not experiencing any symptoms? Why couldn't the AME's just screen for sleep apnea during a medical and then take appropriate action if necessary? This is too dangerous a precedent to simply roll over and accept it. Every pilot, air controller, and aviation group should rumble loudly about this. This may not affect you now, or even when those with BMI's of 30 or more are "dealt with", but eventually it will catch up to you in some way and it'll be too late to do anything about it. Think about it, is it too far fetched that eventually medicals will be denied because you don't exercise enough or at all? Exercise can lower risk factors like high blood pressure, high blood sugar and high cholesterol, which in turn reduces the risk of heart disease and diabetes. It is well known that people don't exercise enough, should we then assume those who don't exercise actually have high blood pressure, high blood sugar and high cholesterol? Should we then make it mandatory to test for all those things even if symptoms are not present? Will it be ok if the FAA mandates a gym membership and an exercise log to qualify for a medical? How ridiculous is that? The sleep apnea issue is just as ludicrous. -Ken

[WeaverJ3Cub]

The rule making procedure is the only check I know of that those outside government have on federal agencies. The FAA and other agencies are staffed by non-elected people who do not, and do not have to respond to the criticisms of those they supposedly serve.

Cue the music people...truer words were never spoken. This is why agencies and bureaucracies are so bad and I'd rather be ruled by an elected body like Congress, no matter how dysfunctional.

[davidwillems]

I would assume it is not too much to ask for the FAA/NTSB to perform the following 3 actions in relation to this 'Sleep APNEA' scare. #1 is to determine the average body weight or even the BMI of all of the pilots who crash. #2 is to determine same numbers but for all pilots. #3 is rather obviously to compare the two findings. Perhaps the findings would be charted over time, etc. To get to the point, if you try to size someone up (not just flying related) as to whether they are a risk taker when you first meet them nearly the first thing you do is see if they are fat. If they are fat then they probably are not a risk taker. Why 'can' the safe pilots?

[Mayhemxpc]

I would note that the change requiring the (EAA and others) to pay for the cost of tower and approach operations was NOT subject to the rule making procedure. So apparently, there are exceptions for other than emergency rules.

[WLIU]

We should not confuse operations with rules. Charging for a service is operations not a rule. I believe that FAA has operating precedent for charging for staff for non-aviation events that have aviation support activities. I believe that EAA has historically been the beneficiary of some folks in the FAA believing that supporting Airventure and Sun-N-Fun helped fulfill the "promote aviation" part of the FAA charter. FAA HQ has fewer and fewer staff that hold real aviation credentials like pilots certificates. The wind direction is changing and not in a good way.

Best of luck,

Wes
N78PS

[martymayes]

Marty, where is the evidence that undiagnosed sleep apnea is actually a safety issue?

Google JAMA + OSA. Awareness has been ramped up with motor carriers because of the number of crashes where drivers are falling asleep. There is no evidence only if one is living under a very large rock.

The good news about OSA is it's not a permanently disqualifying condition for airmen because I work with other airline pilots that have OSA and they hold a first class medical.

What will eventually happen with the rulemaking process is the medical standard for OSA will be applied to EVERYONE, not just those with a 90% chance of having it. It will be a routine part of getting a medical certificate, just like they test EVERYONE for color blindness, sugar and protein in urine, blood pressure (no assumptions required), etc. And I'll give you one guess who will pay for it - ain't obamacare.

[1600vw]

Maybe they should do this for those operating trains....

[Tom Charpentier]

All,

A bill that would stay this measure and make it first subject to rulemaking (which among other things would allow for public comment and a formal cost-benefit analysis) has just cleared committee. As you may have seen, we worked hard to get this bill introduced within days of the policy announcement. Please ask your representative to co-sponsor the bill, either by phone, email, or using our "Rally Congress" form (http://govt.eaa.org/12706/support-hr-3578/). The bill is H.R. 3578, and it has already gotten bipartisan support. A similar bill concerning the trucking industry passed unanimously in October.

The simple fact is that this is not good aeromedical policy, and we have a panel of senior AMEs who work with us who have told us the same thing. Thanks for your help!

Best,

Tom

[Infidel]

I didn't catch it if this has already been mentioned. I know quite a few people, family member included, that went for the sleep study and every single one of them was prescribed the CPAP machine. In other words; I've never heard of one incident where the patient was fine and didn't need the machine after succumbing to the sleep study.

Think about it. We live in a society now where every single thing has a medical label/name and prescription.

[Jeff Boatright]

...Maybe it wasn't the schedule after all......That's what we need to find out...

So shouldn't we "find out" BEFORE regulations are etched in stone? Shouldn't there be at least a modicum of testing and data collection prior to putting regulations into effect that affect EVERY pilot out there? I don't see how regulating first and then do the research second makes any sense.

[Jim Heffelfinger]

Just announced:
http://www.aopa.org/News-and-Video/All-News/2013/December/12/faa-will-move-forward-with-sleep-apnea-policy.aspx?WT.mc_sect=adv&WT.mc_id=131213epilot

[Jim Heffelfinger]

I am in renewal for my merchant marine officers credential. This happens every 5 years. Since my last renewal the process has been centralized and the oversight of medical issues has come under far more scrutiny. In the past my apnea was noted by the physician and noted as under control with a CPAP machine - done. Now a full report is needed, with compliance reports and sleep study physician report. It has added a considerable amount of time to the process - delaying by months the issuance of credential - I hope it is reissued.

Could this be a general increase in oversight of the "alertness" needed for operators? And we are just Guinea pigs
in the research?

[Jim Heffelfinger]

BMI calculator: http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html

I have a BMI of 25.8 and just fall in as "overweight". I am 5 10 180 and 62 years old. Based on this calculator most of America will fall in the overweight category.

Where do you fall in?

[tspear]

BMI calculator: http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html

I have a BMI of 25.8 and just fall in as "overweight". I am 5 10 180 and 62 years old. Based on this calculator most of America will fall in the overweight category.

Where do you fall in?

fat :P

Tim

[Jim Heffelfinger]

Well, a BMI of 40 is a 6 foot person over 300 pounds. I suggest that beyond sleep apnia there are likely to be other medical issues far more meaningful to the aviator's health.

[s10sakota]

Awesome. I'm 6'1" at 195 pounds. I'm also a body builder. According to this stupid chart I'm overweight. Hmmm....sure.

[Mike Switzer]

Awesome. I'm 6'1" at 195 pounds. I'm also a body builder. According to this stupid chart I'm overweight. Hmmm....sure.

Yea. When I was in college I was 6'2" & 270 & Squatting 640 when my left knee went out. I have been called "Fat" ever since, even though I played baseball for a long time after that & I am only 220 now.

[crusty old aviator]

Flying Tiger Air Freight had a pilot who got so fat, he had to carry a seat belt extender in his flight bag and couldn't pull the wheel back far enough to flare the aircraft while landing and keep his feet on the pedals. I can understand why the FAA is concerned about the US obesity epidemic getting into the cockpits of the airlines and adversely affecting the safety of airline passengers, but their approach is a bit flawed. As for GA and experimental pilots, I think the diminutive sizes of most of our cockpits dictate our BMI's pretty well without any FAA involvement.

[2ndsegment]

When I showed up for "Top Gun" in late 1969 at Miramar NAS. I needed to, the next day be in Pennysylvania and get in a centrifuge and then get a Dilbert Dunker done to establish I was "ejectible" just to fly in the back of a TA-4 "adversary", though on Monday (it was a Friday at the time.) the criteria might be for an F-4 "Phantom." At the time Harry Gann, the Douglas photographer caught rides, or so I thought, regularly. I currently am trying to get to a BMI of 25 just to be "normal."