Sleep apnea

[tonker]

Hello all

I went to my doctor to try and address my snoring during sleep, which occasionally wakes me up. My epworth score was 6, and I don't have sleepiness during the day or drop off in flight.

But I want it adressed as the better the sleep, the better my levels of energy, more fitness etc. IE I want to be fitter

He has phoned me as he is worried that it makes me unfit on a class 1. This in turn has me very worried, and wishing I hadn't gone to see him in the first place.

Any advice appreciated

[PPRuNe Dispatcher]

If you suspect you do have sleep apnoea then get yourself properly tested. That may mean a night in a sleep clinic, or it may mean a night at home being wired up to a set of kit that monitors your pulse, O2, respiration, etc.

The results will let the medics know if you actually have sleep apnoea.

Sleep apnoea can be fatal; recent studies show that someone with untreated sleep apnoea has less than a 75% chance of living to 60 if they are 50. The usual cause of death is either a stroke or heart attack, as during apnoea your pulse can reach 200 or more as your CO2 levels increase. Sleep aponea treatment is simple; it's using a CPAP machine every night. If you don't have sleep aponea and are otherwise healthy, you have over a 95% chance of making it to 60 if you are 50.

I don't know if having treated sleep aponea means a class 1 medical cannot be issued, but certainly in the maritime profession, treated sleep apnoea is no reason not to have a medical certificate issued.

A friend of mine (a senior cruise ship officer) died in May 2015 of a heart attack, probably due to untreated sleep aponea - he was in his early 50s and very fit for his age. The medics (ER/Intensive care specialists) were with him within two minutes of his heart attack but they couldn't save him.

[tonker]

Thanks very much, very focusing. This is why I went in the first place.

I've spoken to our company medic who's happy about licences etc, but I'll peruse it further.

Regards

[paully]

Tonker

I`m in the same position as you, although not with the same considerations re employment thankfully. As was explained to me, there are 2 types of Apnoea. One as you describe, like me, which does not allow the heart to rest at night as it should and can lead to fatal consequences. The other type is much more serious and is one that authorities are very nervous about and that is where you suddenly drop off to sleep without warning. Frightening..

In the general NHS type treatment it sadly has a low priority these days and is generally nurse led, so hard to find specialist doctors, who know what they are talking about, to speak to in some areas. Some sort of weight loss (I wish) also helps, so they tell me. Important thing is to try to find a specialist in this field and talk to them.

By the way you do get used to the mask and the C=pap machine, but getting the damn thing through security sometimes makes you wonder why you bother!!..Best wishes and feel free to PM if I can be of any further assistance

[tonker]

Thanks I will. Buying a cpap machine privately

[gingernut]

I'm a little confused.

Isn't an Epworth Score of 6 completely normal ?

[paully]

Tonker

Good idea re the private route..All the benefits and none of the drawbacks. With a bit more experience that is what I would have done..

[gingernut]

Hmmm......you have to ask yourself this question.

Will going private solve the problem, or medicalise me further ?

[Alsacienne]

Tonka I have sent you a PM with what I hope will be useful information.

[Radgirl]

Hi Gingernut

The Epworth score is a screening tool for daytime sleepiness. This may be caused by obstructive sleep apnoea (OSA) but may be due to other causes.

The screening tool for OSA is the STOPBANG score.

Paully there is only one OSA which is where you stop breathing in your sleep. Some but not all sufferers are tired in the morning and nod off in the day. It can cause many problems and as you say carries a risk, but if treated these risks fall away.

The best way to get help is a referral to a sleep clinic (only a sleep study can give a definitive diagnosis) or failing that an ENT surgeon. Self prescribing CPAP may not be the best idea. It is also a significant risk in relation to a general anaesthetic so many anaesthetic preassessment clinics also have an interest in the condition.

[tonker]

Thanks everyone. Looking forward to sorting this out.

[gingernut]

cheers Radgirl......it's what happens if you retire.

[Loose rivets]

New findings on the way the brain clears waste from cells/neurons finds that the process relies on sleep. I'm assuming they'll be taking an even closer look at the statistics relating to Alzheimers and sleep.

More than just a career involved when sleep is poor. (this is fairly basic, the new findings are about the brain's methods of cleaning where there is no lymphatic system.)


In one study, researchers at the Johns Hopkins Bloomberg School of Public Health in Baltimore found that getting less sleep or sleeping poorly was tied to an increase in brain levels of beta-amyloid, a toxic protein that builds up and forms plaques in the brains of those with Alzheimer’s.


https://www.alzinfo.org/articles/poor-sleep-may-be-linked-to-alzheimers-disease/



Our country was run by a woman taking four hours sleep a night.

[LTCTerry]

Sleep apnea is covered by a special issuance medical in the US. Once the FAA has approved it the first time, the medical can be reissued yearly by the doc. This is an AASI or AME Assisted Special Issuance, Aviation Medical Examiner Assisted Special Issuance. Why put an abbreviation within an abbreviation?

I would caution against self treating by buying a CPAP. The machines are programmed to operate within limits that come from a professional evaluation of the sleep study.

If obstructive sleep apnea is a grounding medical condition where you are, then you should not fly until it's resolved. I realize this is a huge issue for a professional pilot who requires a valid medical to earn his/her living.

For Private privileges in the US, the new Pilots' Bill of Rights provides for flying w/o a traditional medical within some very broad limits (6,000 pounds, day, night, VFR, IFR, single, multi). This follows on the heals of a great safety record of more than 60 years of glider flying and almost 15 years of Light Sport flying with no medical.

I once asked a physician friend of my dad if it made sense to have GP and flight surgeon in one person. His response (he was a grounded pilot) was, "Hell no, you might have to lie!" I don't advocate lying; fly healthy.

[lurkio]

Tonker. Class 1 with obstructive sleep apnoea is OK if it has been treated and is under control. Unfortunately you will be classed as temporarily unfit until the treatment has started and is seen as working. I seem to recall that when treatment with a CPAP machine has commenced the CAA want to see something like 1 months successful usage of the machine before they will class you as fit again.
The best thing is find a sleep clinic local to you, the NHS have a few and your GP should be able to point you in the right direction. Get yourself referred by your GP and then pester the living daylights out of them to get an early appointment and explain you need the medical clearance to work. It is usually one night in the unit fully wired up to a computer (try sleeping with that lot attached) and they record the parameters. If confirmed and severe enough, the level of severity decides if it needs treating but as you will have a suspended medical I would say any diagnosis will require treatment. They will need to give you a recording CPAP to take home for a week and the download from this trial will decide if it is right for you, ie the machine, mask and settings. If it is then they should supply one for you (last I heard they were about £800 a time. The CAA like to see records every 3 months initially then, as time goes on, the reporting period is extended.

As Paully says weight loss does help and they do go on about the further complications of apnoea, stress on heart, diabetes etc etc. and yes, you do get used to the mask very quickly.

Take a look at the CAA aeromed section and in the downloads there is some documentation about apnoea and the reports they want etc. Also, if it is diagnosed you are obliged to tell the DVLA and your motor insurance company. Not normally a problem if it has been diagnosed and is treated and under control.

As long as the CPAP machine is mains powered and does not have Li-ion batteries then airport security are usually OK, just treat it like a laptop and take it out of your bag at search time, they are fragile and should be in hand luggage. Some airlines allow the bag it comes in as a second piece of hand luggage if you have a letter saying you need it and it cannot go in the hold.

It is not the end of the world if diagnosed just a nuisance for a couple of months. Hope this helps.