The question this week comes from a young man who’s experienced years of insomnia, both intermittent and continuous. He cites various reasons from pre-test anxiety in school to temperature variations to being a light sleeper. He would like to pursue a career as a pilot or air traffic controller and is worried he won't be able to make the grade without relying on sleeping aids. He has trouble both falling asleep and staying asleep and he's taken various products to help sleep, including over-the-counter products and prescriptions like Rozerem. His question is, what can he do to help himself sleep better without violating FAA regulations for sleep medications?
Karlene, as you know, sleep is one of the most challenging daily routines pilots deal with. The FAA also recognizes sleep quality and quantity as major aviation issues and a frequent cause of pilot error. For this reason, sleep apnea, or breath holding while asleep, has become an area of focus for the FAA as well.
Copious amounts of literature have been written regarding sleep making it almost impossible to provide a brief answer to this young man's question. It's a multifaceted problem and it’s not unusual to spend an hour discussing just one patient's sleep issues. A fifteen minute appointment might work if we jump right to prescribing medication along with referencing some behavioral changes.
What then are the options for pilots? Basically, there are two: medications (including all OTC products) and behavioral modifications. The latter is more challenging, tougher to undertake and longer to see success, and can present cost related issues. The former (medication) is typically easier, gets quicker results and can be relatively cheap. However, medications have limitations for flying and can become ineffective. Either path can be successful according to numerous studies.
A few prescription sleeping pills are compatible with flying. Newer products like Ambien, Sonata and Lunesta “may be” ok if not used more than once or twice a week and not within 12 hours of flying. Older meds such as trazadone, doxepin or amitriptyline are disqualifying in and of themselves so they are not ok under any circumstances. Rozerem, a newer insomnia agent, works on melatonin receptors in a different way than OTC melatonin. Typically, melatonin works best for sleep shift disorders and I haven’t been impressed with its efficacy in helping people stay asleep.
OTC products are not regulated by the FAA. Pilots however, have a responsibility to avoid something which causes drowsiness prior to flying. Tylenol PM or any of the “PM” medications usually contain diphenhydramine, or Benadryl, and as a sedating anti-histamine, its ability to make people drowsy and cause cognitive dysfunction is well established.
A medication free option to consider is Cognitive Behavioral Therapy, or CBT. It’s a form of talk therapy equally effective to medications for chronic insomnia. CBTforinsomnia.com was created to provide this intervention at a very reasonable cost ($35). It takes work which fits the old adage: the hardest work often produces the best results.
These thoughts are the tip of the iceberg. The best individual success will come from working with a provider specializing in sleep disorders and the FAA will not look negatively on this type of work. They welcome pilots who are trying to better themselves.
Once last comment. Some people believe if an AME states a medication is ok, then the FAA will back it up. This is absolutely false! An AME cannot override the FAA. We are designated by the FAA and they have final say over everything we do while acting on their behalf.
To your good health,
Thank you for the great information.
For those of you who know me, you know that I'm adamantly against sleep aids. With that said, do I use them? Absolutely...on the rare occasion. It beats the alternative. However, I've got some great "how to" sleep tips without drugs. If you're interested please read a previous post by clicking: DRUNK WITH FATIGUE.
Do any of you have how to sleep tips? We would love to hear them!
Enjoy the Journey!
Dr. Larry Greenblatt
"Concierge healthcare that's all about you! "
Care Medical Associates, PLLC
1407 116th Ave. NE, Suite 102
Bellevue, WA 98004