Part 2 - Sleeping and transportation - mandatory rules/testing? Pilots talk

Sarah posed a few great questions to sleep leaders on my last blog post Sleeping and transportation - mandatory rules/testing? Sleep activi..., and once I began replying to her, I realized the topic deserved a post of its own.

Part 1

She writes:

"I wonder if there could ever be a restriction against OSA for pilots - without proof they were "cured" or treated well enough to fly, they wouldn't be able to get their license. I think it might be a good idea however involved it might be."

Getting and maintaining a pilot's license of any kind is extremely complicated, and it's an ongoing process that never truly ends. From a health standpoint, I'll try to describe as accurately as I can from a non-pilot's perspective, how it works...

If you have a pilot's license, you must have a special full medical examination by a doctor that is specially trained in giving the examination. Creatively called a 'Medical' it is basically an extremely in-depth physical exam and questionnaire.

**If you are a private pilot, the exams must be done at least every 3 years until you reach the age of 40 yrs. After that the exam must be passed every other year.

**If you have a commercial pilot's license, the exam is done yearly.

**If you are a commercial pilot who flies airliners, the exam must be passed twice yearly.

Additionally, before a pilot solos for the first time, he must pass a medical. This means a 100% perfect grade on every point and question, without any question on the doctor's part at all. The physician has 100% of the control and there are no second chances. Their job is to find a reason, any reason to keep you on the ground. If the pilot does not receive a perfect 100% grade during any part of the medical, they will lose their pilot's license. They cannot get it back.

In Part 1, I talk about waivers, but these are very rare.

There is another license in which a pilot does not need to pass a medical exam. This license restricts the pilot to very small/light sport aircraft. So long as the Sport Pilot has never been denied a medical certification at any time, and can pass all the other requirements, a medical is not necessary for this type of license. Private and commercial pilots who have carried licenses to fly in the past, and may not be able to pass a full medical anymore, will often downgrade their licenses to fly only sport/light aircraft so they can continue to stay in the air for their own pleasure. This switch has to occur before a failed medical however, because once you fail, that's it. You're done flying - period.

Re: Obstructive sleep apnea:

Fatigue in the cockpit has been a topic of a good deal of conversation among pilots lately. Apparently, just a few months ago apnea became an area of concern for the FAA, and new guidelines are in the works. When my source passed his last medical in June, apnea was not included in the questionnaire. Now it is. Currently the FAA considers this a disqualifying condition, however it may be possible for a pilot to regain his license after treatment, although I'm told this is a very difficult and complicated procedure. See this link for more information FAA Apnea disqualification:

Here's the interesting part worth mentioning - pilots are on the honor system to answer the medical questionnaire correctly. So long as they don't have a positive test for apnea or any other health disorder listed, they can honestly answer "no" when asked, "Do you have now, or have you ever had sleep apnea?" As a result, many pilots choose instead to go untested, and therefore untreated so they can keep their licenses.

I find apnea an interesting thing to consider when talking about FAA regulations. For example - we know that fatigue is the reason that apnea is an area of concern for pilots. An absence of apnea means the fatigue it causes won't play into the pilot's overall fatigue/health picture. Apnea is treatable. Some with OSA may find that weight loss and lifestyle changes are all that is necessary to achieve normal sleep patterns and an absence of fatigue. Some may require surgery, or a CPAP to have them sleeping properly again, but once they're sleeping and the apnea is gone, so is the associated fatigue. This brings up the question, how to handle the situation of screening for apnea in pilots, and what to do if it's found.

Apnea is one of those secret disorders - you probably don't even know it when you've got it, so asking the question without testing may not be the most complete way to screen pilots or anyone else. Asking about snoring (a part of apnea which you may be more aware of) seems excessive.

Because you are sleeping, you may not notice that you snore. If you snore occasionally, how do you answer the question that asks IF you snore? If the answer is yes (tell me one person that hasn't snored before for some reason), then should we test for apnea? If it is found, what then would be the appropriate response by the FAA? Should these pilots have their licenses permanently revoked? Should they be allowed to fix the problem, go thru additional testing and be allowed to have their pilot's license restored? Is apnea the problem or the fatigue that it causes, and should there be a test to determine fatigue level instead of blindly disqualifying pilots on the assumption it will affect them in the cockpit? Should the qualifications for all types of licenses be the same, and why/why not?

What then about other health problems the FAA currently considers unacceptable, yet are quite treatable, even curable? Do we need then to test every pilot for every disallowed disorder in the FAA rulebook, and how frequently should that be done?

This brings up the final point:

What are pilots saying about the missed landing in Minneapolis? My sources tell me that there seem to be two camps. Either you believe the pilots were sleeping in the cockpit, or you believe they were on their laptops. Of those I know, I'm told the largest camp sides with sleeping at the yoke. The smaller of the two is the laptop excuse. You might change your own mind when you learn that the consequences for sleeping in the cockpit are much lighter than the potential consequences for playing on the computer. By telling us they were on their computers (a conscious choice), the pilots set themselves up to be hurt far more than if they admitted to falling asleep, which was inadvertent.

By playing on the computer and missing 88 minutes of radio contact because of distraction, the pilots could lose their licenses for dangerous flying, because playing on the computer is no accident. (Think of careless and imprudent driving) This means if they ever want to fly again, they must start over from the beginning - a feat that takes years. By admitting to falling asleep (an accident), they may have broken the rule of the airline for which they would be punished, but they don't risk "dangerous flying" and the loss of their pilot's licenses and some really hefty fines.

What is your opinion on sleeping in the cockpit? What are your communities saying?

For more information, see the FAA website Medical Certifications page

Free trial versions of fatigue scheduling software may be found on this aviation site including one developed by the Air Force