I wrote a post a few years back which I did not publish about the saga of being fitted with a CPAP machine and its implications for my working life. I recently deleted that draft, since (as I’ve mentioned several times—and will doubtless keep mentioning) I’ve decided to start my clock to retirement, which fact makes the whole issue moot.
Or so I thought. I guess I just didn’t think hard enough.
The issue a few years back was this: I’ve been overweight my whole life, hovering around the BMI figure where in my career as an airline pilot I might be evaluated for sleep apnea. The FAA looks at BMI and neck size (not sure how they know this figure) and blood pressure and determines whether further scrutiny is warranted. So my AME (Aviation Medical Examiner) for years would tell me “You’re right on the line for needing a sleep apnea evaluation, so don’t gain any more weight! Better, yet, you ought to lose 15 pounds and you won’t have to worry about it.” I never gave the issue much thought, since I know I do not have sleep apnea. I have the most challenging sleep circumstance of anyone I know, and if I were suffering from sleep issues I’d sure as hell be the one to know it (to say nothing of the guarantee that my wife, the world’s lightest sleeper, would march my ass to the doctor the morning after she heard me gasping in my sleep). I was confident that if I were evaluated for sleep apnea I’d be cleared.
But that’s not how the game works.
Well, my old AME that I had used for 15 plus years ended up dying from COVID. (That’s another post—he had fallen down some rancid Alex Jones rathole and had decided that, despite having several big risk factors and despite formal training in virology and infection, he would eschew traditional medical practices and “protect” himself with a magic key fob around his neck that emitted some kind of magic Jesus Wave that warded off the evil viral spirits. And Darwin came calling.) So I found a new AME. And that guy, unbeknownst to me, was actually a pulmonologist in real life. So if anything were to happen to me medically in my job that warranted any kind of investigation, this guy would have ho place to hide. He would not be able to say (as the last guy, a retired dermatologist, might have done) “Yeah, I looked at him but he assured me he was fine.” The FAA would call it dereliction of duty that a pulmonologist didn’t report a fat guy for a sleep apnea evaluation.
And so the certified letter from the FAA duly came, and after 28 years of flying without incident I found myself headed to a sleep clinic. This seems bad enough, though it’s a fair question to ask whether some scrutiny is not warranted and when that line might be crossed. But I wasn’t unduly worried, as I knew I had no sleep issues.
But strangely enough, nobody ever asked me about my sleep issues and habits. What I thought or wanted, and what my experiences were, was of no interest to anybody. I was given two separate evaluations and found to have no obstruction, no diminution of my blood oxygen. So, good, right? Well, only if the results of the tests actually mattered. But no, they prescribed a CPAP machine regardless, despite my vocal protests that such a therapy would be EXTREMELY intrusive in my line of work. My objections were met with stiffer and stiffer resistance, eventually bordering on abuse. I had the distinct impression that the staff were used to fielding objections and had ready responses to them. (As the controversy escalated, I contacted our pilots’ union for advice and was told “Oh yeah, if you are evaluated for sleep apnea then you’re getting a CPAP machine. The results of the test don’t matter.” It would have been nice to know this information beforehand.)
In all, I was out of work for five and a half months while this all got sorted (the diagnosis of sleep apnea caused me to lose my medical until such time as the FAA granted a “special issuance” medical with the condition listed) so I had the summer of 2023 off for literally no practical reason, though it did let me take retirement for a test-drive. (We do have loss of license insurance, so I was able to pay my bills, but the leave of absence was nonetheless a pretty substantial pay hit.)
Fast forward to today. I was able to get my special issuance medical (there are loads of CPAP machines among airline pilots) and I returned to work about 10 months ago and have been steaming along since. In the back of my mind, I’ve been looking forward to the escape valve of retirement when I can jettison the unneeded and unwanted CPAP machine—along with freedom from all the other bits of intrusive scrutiny the job entails. But I hadn’t properly considered what this might look like going forward. If I intend to do ANY flying in retirement—even recreationally, to say nothing of potential side work—then I’m going to need to qualify for a medical. And now I have a historical diagnosis of Obstructive Sleep Apnea on my record (despite my pointedly NOT having Obstructive Sleep Apnea). To procure that medical (of whatever class) I’m going to have to present documentation that I’ve been using the CPAP machine for the entire preceding year. It’s not something I can fudge; the machine itself tracks its usage and reports it via its own cellular connection to my medical facility, which then provides the documentation to the FAA. It’s VERY big brother.
I’m not a medical skeptic, though I certainly believe that big pharma needs regulating just as big business and free markets absolutely do. But this little CPAP wormhole seems like a scam, an iron-clad way for the clinic and supporting structures to get their cut of a $1000 machine and yearly visits (I am contacted every six months and solicited to take my box of insurance-approved replacement supplies—hoses and masks and filters—all at no cost to me! Thus the medical supply company pockets another $600).
I do this or I stop flying. Those are my options.
I decided that playing along was the easiest option for my last year or two, but a part of me would like to do my part in dismantling the whole rotten enterprise. Don’t get me wrong, I know sleep apnea IS a thing, and if one has it then I understand this technology can be life-changing. But the bar seems to be set very low, and the hooks are very deep. They put me in charge of a $200 million machine but I’m not allowed to assess my own sleep life.
For now I'm content to stay out of the cockpit. If I decide I'd like to fly again, I *may* be able to hold a third class medical without reference to the sleep apnea. But I wouldn't be able to be paid to fly. So maybe I can find a sleep doctor who will play ball with me and get my diagnosis expunged. Or maybe I start using the damned machine again. But I doubt it.
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