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Obstructive Sleep Apnoea case-based scenario
Bill knew he snored, but he was staggered to learn how often he stopped breathing during his sleep. Luckily a sleep clinic gave him a simple machine to use which soon had him sleeping soundly and flying again.
A 39 year old businessman who owns an earthmoving company supplying services and equipment to the mining industry, Bill flies great distances in the company-owned light twin, managing the needs of his clients.
Bill was a keen sportsman in his younger years and played rugby league for his local club and at representative level until his late twenties. He sustained various injuries during his sporting career and towards the end had several operations on his knees.
"I must admit, between the demands of the business and my 'dicky' knees, I haven't been exercising nearly as much as I should over recent years, so I have steadily put on weight," he says. "My wife kept telling me my snoring was getting worse the heavier I got, but to be honest, I didn't pay her much attention. I had to have a rethink when she started insisting I was choking in my sleep."
The only surgery Bill had ever had was on his knees. He was not on any tablets and had never had any allergic reaction to medicines. On the rare occasion he had seen the family doctor, the doctor had warned Bill his blood pressure was up and urged him to try to lose weight and cut back his salt and alcohol intake. There was also a family history of illness to consider: Both Bill's father and mother were on tablets for high blood pressure and his mother also has diabetes.
When Bill finally agreed to see the local doctor about his snoring and choking, the practice nurse began the appointment by taking some measurements.
"I wasn't surprised when the nurse told me my blood pressure was higher than normal and that I weighed quite a bit more than I had on my last visit," Bill says. "I was surprised, and fairly annoyed, when he told me my weight put me in the obese range."
When the doctor welcomed Bill into her room she began asking a lot of questions about his sleep and about tiredness during the day. Bill imagined she would simply give him some nasal sprays to stop the snoring. He wasn't very happy when she referred him to a specialist sleep clinic and was even less impressed when the she told him not to fly or drive heavy machinery until his sleep apnoea was sorted out.
Once she explained the health and safety risks associated with untreated sleep apnoea, Bill began to understand the significance of the symptoms he had been having and grudgingly agreed to go to the sleep clinic.
It was three weeks before Bill could get in to a sleep study at the nearest clinic. The delay caused him a great deal of stress at work, as he put off meetings with unhappy clients. He was measuring his blood pressure at home and wasn't surprised that the numbers were 'through the roof' under the stress.
When he finally got to the appointment Bill was surprised just how much equipment the sleep clinic attached to him before telling him to try to sleep. When morning finally arrived he felt as if he had hardly slept at all.
A few days later Bill went to an appointment with the sleep specialist. The specialist told Bill that the sleep study was positive for sleep apnoea.
"The specialist told me that I had stopped breathing for up to 20 seconds at a time, as many as 30 times an hour. I was absolutely amazed. He advised me to have treatment for this condition and made clear that until the condition was sorted I shouldn't fly or operate heavy machinery. He also gave me some brochures explaining sleep apnoea and its treatment."
Visit to DAME
When Bill rang his Designated Aviation Medical Examiner (DAME), the DAME told Bill not to fly until he got a clearance from CASA. The DAME asked Bill to send him a copy of the specialist's report so that he could notify CASA of the change.
The DAME explained to Bill that sleep apnoea was a significant condition in pilots due to the risks associated with daytime sleepiness but also because it increased the risk of heart problems and stroke.
The DAME reassured Bill that he had looked after many other pilots who were able to get back to flying without any troubles once the apnoea was brought under control.
The doctor at AvMed reviewed the reports from the Specialist that accompanied the notification from the DAME.
Because the report indicated that the sleep apnoea was of significant severity and because treatment had not yet begun, CASA advised Bill to remain grounded until he could provide an updated report from the specialist showing the condition was under control. Bill was still unhappy about the delays but now understood that this was an important issue, as much for his health as for his flying.
Bill returned to the sleep clinic and was fitted out with a small machine that provided a slightly increased air pressure to his nose and mouth while he was sleeping.
"At first I didn't think I would ever get use to wearing a mask over my face while I was sleeping," he says. "Much to my surprise, within a few days, I noticed I felt dramatically better in the mornings after using the machine. I had much more energy and even my libido had improved. I had to laugh though – my wife complained she was having trouble sleeping now because she was so used to my loud snoring – not that she was complaining. My blood pressure readings also began to drop back to normal."
The machine that Bill used had a download function which meant that he was able to provide a printout to his DAME and CASA. This proved that his sleep apnoea was well controlled. As soon as CASA received the printout, Bill was cleared back to flying. CASA advised Bill that he should use the machine regularly and definitely the night before flying. He was told that he would need to provide a printout to his DAME to accompany his medical certificate application.