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"We are the protagonists of our stories called life, and there is no limit to how high we can fly."

PHD. MBA. MHS. Type rated on A350, A330, B777, B747-400, B747-200, B757, B767, B737, B727. International Airline Pilot / Author / Speaker. Dedicated to giving the gift of wings to anyone following their dreams. Supporting Aviation Safety through training, writing, and inspiration. Fighting for Aviation Safety and Airline Employee Advocacy. Safety Culture and SMS change agent.

Wednesday, January 25, 2012

Flying With Crap

"Off the Record Q & A with a Local A.M.E."

DR. Larry

I have Obstructive Sleep Apnea and I use a CPAP machine nightly. What’s the risk if I don’t take my CPAP machine with me when I go out on trips?

Volumes of literature now exist regarding Obstructive Sleep Apnea (OSA) and its associated risks with heart and stroke disease, mental confusion, chronic pain and fatigue. Reducing those risks for pilots and the general population by using Continuous Positive Airway Pressure (CPAP) is also well documented. For people who feel a dramatic benefit, the desire to use their CPAP machine on a nightly basis is welcomed and reinforced. Nonetheless, traveling with a CPAP machine, as small as they are, can be an obstacle to traveling light, and going through security screening makes it one more thing to carry.

With 7% or more of the population having some degree of OSA, the FAA recognizes this as a serious problem. Combined with irregular hours, long duty days and time zone changes, the effects of nocturnal hypoxia become magnified.

The question is best answered from a study undertaken a year ago by Malcolm Kohler, M.D. and reported in the American Journal of Respiratory Critical Care Medicine, August 11, 2011. They studied 40 patients who effectively used CPAP for over 12 months. When the study began, half of the 40 continued their CPAP as prescribed while the other half used sub-therapeutic CPAP levels. The following factors were evaluated before and after the trial: Epworth Sleepiness Scale tests, blood pressure, heart rate, vascular function and blood lipids.

After only two weeks, the results showed statistically significant differences in hypoxic events, a rise in morning blood pressure, heart rate, and daytime sleepiness. It was not associated with psychomotor changes or cholesterol levels.

Dr. Kohler concluded that withdrawal of CPAP was associated with a return of OSA by the first night.

We know risk is relative. Someone placed on CPAP for problems such as chronic fatigue, mental confusion or daytime sleepiness is unlikely to have severe recurrent symptoms overnight. However, if one has significant underlying cardiovascular disease, a night or two of stressful sleeping because of hypoxia may be enough to push one's body over the edge.

FAA's guidelines mandate a minimum six hours per night and 75% to 85% nightly usage. Thus, some leeway exists for not having perfect compliance. Perhaps this makes the idea of CPAP more palatable because even though the benefits of CPAP are great, some effort is involved to be compliant. Any level of sleepiness while flying is not ideal so minimizing the chance of drowsiness makes 100% compliance the best option.

To your good health and energetic days,

Dr. Larry

Dr. Larry Greenblatt

Heart Attack, Stroke and Diabetes Prevention

Sports medicine and Family Practice

"Concierge healthcare that's all about you! "
Care Medical Associates, PLLC
1407 116th Ave. NE, Suite 102
Bellevue, WA 98004


  1. Dr. Larry seems like a balanced (and sane!!) individual. I love his candid comments about the FAA and pilot behavior/thoughts in last week's post. If I still had my medical I would go to him!!

  2. wow, another tough and important topic. This has to be a biggie for pilots, given how constantly changing time zones and work hours must wreak havoc on sleep for many. I've heard the cpap machines are now much smaller than they used to be. Maybe someone will make them even better someday soon--like earbuds, only for breathing instead of hearing.

  3. nice blog..
    thanks for explain the feature of a CPAP machine....I likes it
    devilbiss cpap


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