Obstructive Sleep Apnea and Your Medical Certification

Seventeen years ago, a Go! Airlines aircraft flying from Honolulu to Hilo, Hawaii, overshot its destination by nearly 30 miles before the flight crew recognized its error and safely returned to the planned arrival airport. A subsequent NTSB investigation revealed that the captain and first officer had fallen asleep.

The captain’s undiagnosed obstructive sleep apnea (OSA) and the flight crews’ recent work schedules, which included three consecutive days starting at 5:40 a.m., were identified as contributing factors. An FAA pamphlet addressing this insidious health condition noted, “Up to that time, OSA was relatively unknown outside the medical community.”

OSA occurs during sleep when the airflow through one’s upper airway becomes blocked by soft tissues from the mouth, tongue, neck, or pharynx. A document on sleep apnea from the medical library of the Aviation Medicine Advisory Service (ALPA’s Aeromedical Office) reports, “After a period of apnea (not breathing) or struggling to breathe, the individual arouses slightly, increases the tone of the muscles, unblocks the airway, and then moves air through the mouth and nose into the lungs. This process is repeated dozens to hundreds of times during the night.”

It’s estimated that 7 percent of the adult population has sleep apnea (including central sleep apnea). Risk factors include obesity, age, genetics, heart or kidney failure, regular alcohol consumption, and smoking. Snoring is a common byproduct, although not everyone who snores has OSA, and symptoms include fatigue, excessive daytime sleepiness, irritability, and difficulty concentrating. In addition, OSA is more common among males than females. It’s the primary reason for most cases of sleep-disordered breathing and can contribute significantly to many chronic health problems.

Individuals with mild-to-moderate OSA can experience cognitive impairment equivalent to .06 to .08 percent blood alcohol levels, which is considered legally intoxicated in many locations. Not surprisingly, untreated OSA is a disqualifying condition for pilots in both the United States and Canada. The good news is that it’s also highly treatable.

Pilots who can manage their condition in accordance with aviation regulatory guidelines can receive medical certification. In the U.S., this involves the special-issuance provisions outlined in 14 CFR 67.401.

OSA is diagnosed with polysomnography testing, which measures the apnea-hypopnea index (AHI). This procedure measures brain activity, the severity of abnormal breathing, and other physiological factors. In addition, the Maintenance of Wakefulness test (MWT) and Multiple Sleep Latency test are used to measure daytime alertness, although the FAA no longer accepts MWT results for special-issuance consideration.

Managing your OSA often involves lifestyle modifications, which can include changing your sleeping position from your back to your side or stomach. Sometimes your sleep environment can be a factor. Consider the quality and firmness of your mattress, the amount of light in the room, and the temperature. In addition, if you’re overweight, a 10 percent weight loss can decrease your AHI by as much as 25 percent.

The FAA accepts three types of treatment for OSA: continuous positive airway pressure (CPAP) and its variants, dental repositioning devices with compliance monitors, and some types of oral surgery if OSA is documented as unresolved. Annual compliance reports and physician statements are required to maintain the special issuance. Routine checkups are recommended along with adherence to any other related regulatory guidance.

To meet airline pilot medical certification protocols in Canada, pilots diagnosed with OSA will need to demonstrate that they’re being treated and that the treatment is effective. Transport Canada typically requires the submission of a 30-day CPAP compliance report and an updated sleep medicine consultation. Pilots are also reminded to review Canadian Aviation Regulation Section 404.06, which advises “to not exercise their privileges if they have an illness, injury, or disability; are taking medications or drugs; or are undergoing medical treatment that could impair their ability to function safely.”

If you’re concerned that problems sleeping may be due to OSA, an over-the-counter home sleep test can be a helpful first step. However, it’s by no means conclusive. An International Federation of Airline Pilots’ Associations’ human performance briefing leaflet recommends, “Pilots who suspect they might be suffering from sleep apnea should consult their doctor for diagnosis and treatment.”

This article was originally published in the June 2025 issue of Air Line Pilot.