Obstructive Sleep Apnea
Obstructive sleep apnea is a phenomenon resulting from relaxation of the muscles, and laxity of the tissues, that keep the airway open during sleep. Once the individual reaches a certain depth of sleep, the airway collapses and the sufferer is unable to breathe. The body then reflexively arouses from sleep as a survival mechanism. People who suffer from this disease may unknowingly experience this many times per hour while attempting to sleep. Subsequently, an adequate depth of sleep needed for rest is never achieved and chronic fatigue and sleepiness, lack of ability to concentrate, and irritability are the most common obvious symptoms.
New Guidelines from the FAA
The Federal Aviation Administration has recently issued new guidelines regarding the screening and management of pilots potentially suffering with a disease entity known as obstructive sleep apnea.
The FAA has been aware of the obvious risks associated with obstructive sleep apnea for people functioning in critical jobs, such as piloting aircraft, for many years. Aviation medical examiners are cautioned to be on the lookout for this problem as well as other sleep related disorders that can prevent adequate restorative sleep. Such diseases untreated are regarded as sufficient to disqualify pilots from flight privilege until adequately managed.
Prior to the recent change, the most current guidelines dated from November of 2013. At that time, the FAA issued the previous guideline that was based exclusively on screening the body mass index (BMI) of the pilot being evaluated. BMI is essentially just a ratio between height and weight. Since obesity is known to correlate closely with a higher risk for obstructive sleep apnea, individuals with a high BMI were not allowed to fly until properly evaluated and if necessary, successfully treated for obstructive sleep apnea.
The new guidelines, taking effect as of March 2, 2015, will follow more closely the recommendations of the American Academy of Sleep Medicine. Now the medical examiner will be asked to integrate information from the pilot’s history, symptoms and physical examination to determine with greater sensitivity whether or not the individual is at risk for obstructive sleep apnea. The pilot will no longer be immediately grounded, but will have 90 days or longer to seek a full evaluation, and get adequately treated for the disease if necessary.
Although it may seem the new guidelines are more lenient, and may allow pilots with untreated obstructive sleep apnea to continue flying for a limited period of time, the reality is that the previous guideline incentivized pilots to conceal possible symptoms of disease for fear of losing the ability to work. Under the new guidelines, pilots with concerns about symptoms can be more confident about being open about a problem and working to find a solution.
Sleep Apnea in the Cockpit
On February 13, 2008, Mesa Airlines Flight 1002 flew twenty-six miles past their island destination toward the open ocean. For more than eighteen minutes, the crew was unresponsive to air traffic control. It was ultimately determined that the pilot and co-pilot had both fallen asleep in the cockpit. The flight ultimately turned around once the crew awakened and landed safely at the destination. Subsequent evaluation concluded the pilot suffered from severe undiagnosed obstructive sleep apnea.
According to the British Airline Pilots Association, 56% of pilots report having fallen asleep in the cockpit. The NTSB has identified 34 incidents, 32 of which were fatal, in which obstructive sleep apnea was listed in the pilot’s history. Although the sleep disorder was not identified in these incidents as the cause of the events, the NTSB clearly recognizes the increased risk created when the crew directing the craft is potentially impaired in this way.
Options for Treatment of Obstructive Sleep Apnea
The primary means of treating obstructive sleep apnea is the use of a device known as a CPAP. This is a machine that assists a sleeping individual to breath by applying positive air pressure through the nose and mouth via a mask worn on the face. Many patients tolerate this device very well and find the symptoms of sleep apnea to be completely relieved by its use. Patients with less severe sleep apnea may also benefit by wearing a device fitted to the teeth, which is designed to open the airway.
Many patients find for various reasons they are unable to tolerate either of the medical devices described above. These individuals are candidates for surgery to correct the deficiency in the size of the airway. Historically, many of the surgical interventions utilized for the management of obstructive sleep apnea have been of limited benefit, or complicated by very difficult and long recovery periods.
The doctors of the Surgical Arts Centre in Missoula, Montana offer an outpatient procedure that has been demonstrated to completely eliminate the need for CPAP for more than 95% of patients. Most patients who undergo this procedure are back to most normal activities in 7-10 days.
For More Information
Patients travel from all over the world to seek the care of the surgeons at the Surgical Arts Centre in Missoula, MT. If you have additional questions about alternatives to CPAP and the surgical treatment of obstructive sleep apnea, contact the doctors at the Surgical Arts Centre to schedule a consultation today by calling 406-549-6600.