By TODD HUVARD.
It is a sticky web indeed when the unsuspecting airman flies too near to the spidery reach of the FAA’s Aeromedical Certification Division. Once caught in the trap, a slow and anguishing process begins that has only a bureaucrat’s timeline to meet.
This story began as a joust with high blood pressure. For several years my BP readings were edging toward the Twilight Zone as my weight inched upward and outward. Finally, I submitted to the white-coats’ wishes and began taking medication. When it was time to renew my Class II medical, my trusted aeromedical examiner of the past 20-odd summers gave me a list of items I would have to submit with my application.
This time, I would have to provide a fresh EKG, fresh blood work, blood pressure readings and a narrative from my primary care doctor about my general health and family history. Well, I figured, fair enough. All the tests were normal and at my exam the AME issued me a fresh Class II. He then sent the details to the MedFeds in Oklahoma City.
This is when the plot, or at least the web, thickened.
My primary doctor had included a few pages of his office notes with the general narrative. These showed the last several blood pressure readings since I had begun taking the BP medication. As it turned out, there was more in the notes than necessary. Earlier in the spring, at a routine office visit, I had an innocuous conversation with him about my occasional loud snoring. At the time I had hit an apex in my personal weight and I figured if I lost some heft I would lose some volume. Not for nothing did my quack go to med school. He jotted down the fateful comment: “possible sleep apnea, refer for sleep evaluation.” Naturally, this scrawl was embedded in the notes sent to the FAA.
Some weeks after receiving my medical certificate, an ominous letter from the FAA Aerospace Medical Certification Division arrived at the house. “Based upon our review of the information submitted, we are unable to establish your eligibility to hold an airman medical certificate at this time.”
It was a 95° July day and this one line sent an ice-cold chill coursing down my spine.
An overly astute clerk had combed though the doctor’s office notes and stumbled upon sleep apnea remark. The faceless, featureless, emotionless, unassailable, omnipotent FAA now demanded to know more about my sleep apnea and to see the results of a sleep evaluation. And they wanted the answer in 30 days — or else.
Of course, I had never been diagnosed with sleep apnea nor had I undergone a sleep test. It was just a simple, casual conversation with my doctor. Not anymore. The letter from the FAA lit off a series of events that would leave me sucking air from a machine — and more.
My immediate reaction to the letter was doom-and-gloom. And anger that some bureaucrat in Oklahoma could so easily pencil whip me out of the air. A total disruption to my life was about to ensue, and I was pissed off that the person causing the disturbance was just “doing a job.” Yeah, right. Doing a job on me.
My first call was to my AME. He was sorry to have missed the notes in the reports, but told me that the FAA would not be likely to let go of my leg over sleep apnea. He told me to go get a sleep test – very casually, of course. No big deal. Yeah, right. No big deal for him.
Then I went to my quack, who would not retreat on ordering the tests. I had no say in this unless I just did not want to fly anymore. Pure CYA. I was really irritated, but succumbed to the inevitable. I scheduled the test.
Allow me to describe a sleep evaluation: Show up at a hospital room, allow a way-too-happy technician to apply enough wiring to your face, skull, chest and legs to power a small city. A strange techno-reggae transformation occurs. And here’s some advice: Avoid mirrors.
The process takes about 30 minutes, during which time various straps, sensors and clamps are placed on your chest, belly and hands. Naturally, there is no way anyone can sleep under these conditions. Strange bed. Hooked up like a Rube Goldberg contraption. Under video surveillance.
Apparently, the term sleep evaluation is a misnomer. In fact, no one really cares if you get any rest at all. But if you do manage to fall asleep for any period of time, they can snatch the data they need from the barrage of sensors. Eye twitches, leg twitches, flip-flopping. Whatever.
Of course, you can’t possibly sleep — and a diagnosis of sleep apnea is almost always made. With something like an estimated 18 million Americans suffering from the condition, it dawns on one that the whole reason the sleep disorder center exists is to drive revenue to the for-profit hospital’s bottom line. I slept a total of 4.4 hours out of nine hours in bed. I received a bill for $3,065 for the one-evening study.
A huge bill and bad news: I have mild to moderate sleep apnea. And while I do not suffer from daytime hypersomnolence — sleepiness — I wondered out loud to myself why there are snooze rooms at every airport for pilots to catch catnaps. For years, I trained myself to be able to steal bits of sleep here and there between flights.
Now I had to go back to the sleep center and undergo a CPAP trial. CPAP stands for Constant Positive Airway Pressure, and the machine blows a constant stream of air through the nasal passage to keep the airway open.
To get a feel for what this is like, take two two-liter plastic Coke bottles, cut them in half and jam them up your nostrils. Then take a Hoover, plug the hose into the reverse hole, turn the dial to jet stream or speed of sound, and let that hurricane into your skull while you try to sleep. That, my friend, makes for a miserable friggin’ evening. The hose, hooked to the whirring dervish, prevents you from rolling over to get comfortable. But at just $1,495 plus tax, what do you expect?
So I gathered all of the incriminating evidence from the study. Three reports by people I have never met, whose qualifications I will never know, and whose opinions I don’t give a damn about. I stuffed all of that and a meek salutation in an overnight envelope and posted it to the FAA in OK City. I would have to wait and see if they’d continue to place hoops between me and my medical.
Meanwhile, I was prescribed a CPAP machine and found a chop-licking medical hardware dealer from which to order it.
About six weeks after the first spirit-dampening missive from the FAA, I filed with the Aeromedical Certification Division a battery of reports, test results, testimonials, and a page of personal whimpering. Several weeks passed and another letter arrived. This was a thick packet of documents that began by informing me that I was ineligible to hold a medical certificate, but that the Division, in its wisdom and its knack for divining the true condition of applicants 900 miles away, had granted me a six-year Authorization for Special Issuance of Medical Certification. This glorious letter, so long as I subscribe to an annual review of my sleep apnea and hypertension, provided me with my a 2nd Class medical certificate and gave me my wings back.
And to think, it only cost about $8,000 to be restored to my original configuration as a rated pilot. Excuse me, but I need a nap. This BS just wears me out!
This all happened a few years ago. The story is about the real fears we face when confronted with the possibility of losing our medical certificates and the reaction to the system that would deny you the privilege of flying.
As it turns out, I have grown to love my CPAP machine. Now I plug into that thing every night and conk out, seldom waking and getting great sleep. I would never have thought it possible to adapt to it, but if you flop around at night or your wife complains about your snoring, do yourself a favor and learn more about sleep apnea, the risks of doing nothing, and the benefits of CPAP.
And those quacks at Oklahoma City? Turns out they do know what they hell they’re talking about.
Todd Huvard, president of AircraftMerchants, a North Carolina-based aircraft brokerage, is a commercial pilot with multi-engine, instrument and seaplane ratings and is typed in Cessna 500 and Falcon 20 jets. He founding editor and publisher of The Southern Aviator.