Sleep apnea
What the FAA's documents say about sleep apnea, in plain words, with the FAA's own words one press away.
FAA term: Obstructive Sleep Apnea (OSA)
Short version
The FAA's table sorts it into six groups.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Group 1The applicant is on a Special Issuance Authorization for OSA. | Examiner issues | AASI |
| Group 2The applicant has had a prior sleep assessment. | Examiner issues | Special Issuance |
| Group 3The applicant does not have an Authorization or has not had a previous assessment, and the examiner determines they are not currently at risk for OSA. | Examiner issues | Examiner can issue |
| Group 4The applicant does not have an Authorization or has not had a previous assessment, and is at risk for OSA, but in the examiner's opinion at low risk for OSA. | Examiner issues | Examiner can issue |
| Group 5The applicant is at high risk for OSA. | Examiner issues | Special Issuance |
| Group 6The examiner observes, or the applicant reports, symptoms severe enough to represent an immediate risk to aviation safety of the national airspace. | Defers to the FAA | FAA review |
Show the FAA's words: the FAA's table for Sleep apnea
- Group 1 · AASI
The applicant is on a Special Issuance Authorization for OSA. The protocol has the examiner follow the AASI or Special Issuance for OSA, write it in Block 60, and issue if the applicant is otherwise qualified.
If the applicant is on a Special Issuance Authorization for OSA … select Group 1 on the AME Action Tab: Follow AASI / SI for OSA … Notate in Block 60; and … Issue, if otherwise qualified
- Group 2 · Special Issuance
The applicant has had a prior sleep assessment. Where the pilot is under treatment, the protocol has the examiner give the AASI's requirements and say an Authorization of Special Issuance has to be obtained. The examiner gives Specification Sheet A, says a letter will come from the Federal Air Surgeon asking for more information and that it will give 90 days to provide it, writes it in Box 60, and issues if the applicant is otherwise qualified.
If the applicant has had a prior sleep assessment … select Group 2 on the AME Action Tab: If the airman is under treatment, provide the requirements of the AASI and advise the airman they must get the Authorization of Special Issuance; … Give the applicant Specification Sheet A ( PDF ) and advise that a letter will be sent from the Federal Air Surgeon requesting more information. The letter will state that the applicant has 90 days to provide the information to the FAA / AME ; … Notate in Box 60; … Issue, if otherwise qualified
- Group 3 · Examiner can issue
The applicant does not have an Authorization or has not had a previous assessment, and the examiner determines they are not currently at risk for OSA. The protocol has the examiner write it in Block 60 and issue if the applicant is otherwise qualified.
If the applicant does not have an AASI / SI or has not had a previous assessment, the AME must: … If the AME determines the applicant is not currently at risk for OSA … select Group 3 on the AME Action Tab: Notate in Block 60; and … Issue, if otherwise qualified
- Group 4 · Examiner can issue
The applicant does not have an Authorization or has not had a previous assessment, and is at risk for OSA, but in the examiner's opinion at low risk for OSA. The protocol has the examiner discuss the risks with the applicant, provide resource and educational information as appropriate, issue if the applicant is otherwise qualified, and write it in Block 60.
If the applicant does not have an AASI / SI or has not had a previous assessment, the AME must: … If the applicant is at risk for OSA but in the opinion of the AME the applicant is at low risk for OSA … select Group 4 on the AME Action Tab: Discuss OSA risks with applicant; … Provide resource and educational information , as appropriate; … Issue, if otherwise qualified; and … Notate in Block 60
- Group 5 · Special Issuance
The applicant is at high risk for OSA. The protocol has the examiner give Specification Sheet B, say a letter will come from the Federal Air Surgeon asking for more information and that it will give 90 days to provide it, write it in Block 60, and issue if the applicant is otherwise qualified.
If the applicant is at high risk for OSA , the AME must … select Group 5 on the AME Action Tab: Give the applicant Specification Sheet B ( PDF ) and advise that a letter will be sent from the Federal Air Surgeon requesting more information. The letter will state that the applicant has 90 days to provide the information to the FAA / AME ; … Notate in Block 60; and … Issue, if otherwise qualified
- Group 6 · FAA review
The examiner observes, or the applicant reports, symptoms severe enough to represent an immediate risk to aviation safety of the national airspace. The protocol has the examiner write it in Block 60, and says in capitals that the examiner defers.
If the AME observes or the applicant reports symptoms which are severe enough to represent an immediate risk to aviation safety of the national airspace … select Group 6 on the AME Action Tab. Notate in Block 60 … THE AME MUST DEFER
- A note on the table, 1
For an applicant who does not have an Authorization or has not had a previous assessment, the protocol has the examiner calculate the body mass index and consider the American Academy of Sleep Medicine's risk criteria in Tables 2 and 3.
If the applicant does not have an AASI / SI or has not had a previous assessment, the AME must: Calculate BMI ( PDF ) ; and … Consider AASM risk criteria Table 2 & 3 ( PDF )
- A note on the table, 2
The protocol says the risk criteria come from the American Academy of Sleep Medicine, and that the examiner is expected to use their clinical judgement when applying them.
The American Academy of Sleep Medicine has established the risk criteria ( PDF ) (utilizing Tables 2 and 3) for OSA . When applying Table 2 and 3, the AME is expected to employ their clinical judgment.
- A note on the table, 3
The protocol says that while it focuses on OSA, the examiner must also be mindful of other sleep-related disorders that may also interfere with restorative sleep, naming insomnia, parasomnias, sleep-related movement disorders, central sleep apnea and other hypersomnias, and circadian rhythm sleep disorders, among others. It says all sleep disorders are also potentially medically disqualifying if left untreated, and has the examiner contact the Regional Flight Surgeon or the Aerospace Medical Certification Division for guidance when one of these other disorders is first identified during the examination.
While this protocol focuses on OSA , the AME must also be mindful of other sleep-related disorders such as insomnia, parasomnias, sleep-related movement disorders (e.g. restless leg syndrome and periodic leg movement), central sleep apnea and other hypersomnias, circadian rhythm sleep disorders, etc., that may also interfere with restorative sleep. All sleep disorders are also potentially medically disqualifying if left untreated. If one of these other sleep-related disorders is initially identified during the examination, the AME must contact their RFS or AMCD for guidance.
The FAA pathways for sleep apnea
Which exam
Which specification sheet did your examiner give you?
The examiner gives Sheet A to a pilot who has had a prior sleep assessment, and Sheet B to a pilot at high risk for OSA.
Your plan
Step 1: Specification Sheet A
What Sheet A asks you to provide, and where to submit it.One question insideWhat Sheet A asks for
Within 90 days: either a completed and signed OSA Treated Status Report, or all reports and records of your OSA assessment by your primary care physician and/or a sleep specialist.
If you are being treated, also
- A signed FAA Compliance with Treatment sheet, or equivalent
- The results and interpretive report of your most recent sleep study
- A current detailed progress note from your treating physician saying OSA treatment is still effective
Where it goes
- To your AME, to upload into your FAA file with your reference number (PI, MID or APP ID)
With a dental or positional device
- Reports, once dental devices that record or monitor are available
The PAP machine's cumulative annual report
A copy of the PAP machine's cumulative annual report.
Target
- 75% or more
- 6 hours or more
Show the FAA's words: Specification Sheet A
You must provide the following information to the Aerospace Medical Certification Division (AMCD) or your Regional Flight Surgeon within 90 days:
A completed and signed OSA TREATED STATUS REPORT
OR
All reports and records regarding your assessment for OSA by your primary care physician and/or a sleep specialist.
If you are currently being treated, also include:
A signed FAA Compliance with Treatment sheet or equivalent;
The results and interpretive report of your most recent sleep study; and
A current Detailed Clinical Progress Note from your treating physician indicating that OSA treatment is still effective.
FAA source: OSA – Specification Sheet A, Information Request. FAA date 27 May 2026; checked by Crosscheck 14 October 2026.
4. Is there evidence of adequate compliance? For FAA purposes this means:
75% or more of nights used;
6-hours or more per night on average;
AHI 5 or less (treated);
For a dental device, no symptoms and daily use of device.
FAA source: OSA Treated Status Report. FAA date 27 May 2026; checked by Crosscheck 14 October 2026.
For CPAP/ BIPAP/ APAP:
A copy of the cumulative annual PAP device report.
FAA source: OSA – Specification Sheet A, Information Request. FAA date 27 May 2026; checked by Crosscheck 14 October 2026.
Target goal should show use for at least 75% of sleep periods and an average minimum of 6 hours use per sleep period.
FAA source: OSA – Specification Sheet A, Information Request. FAA date 27 May 2026; checked by Crosscheck 14 October 2026.
For Dental Devices or for Positional Devices:
Once Dental Devices with recording / monitoring capability are available, reports must be submitted.
FAA source: OSA – Specification Sheet A, Information Request. FAA date 27 May 2026; checked by Crosscheck 14 October 2026.
Please submit the aforementioned information to your AME for upload into your FAA file using your reference number (PI, MID, or APP ID).
FAA source: OSA – Specification Sheet A, Information Request. FAA date 27 May 2026; checked by Crosscheck 14 October 2026.
AME Instructions.
If not currently on an authorization, the AME can issue a medical certificate (see OSA Protocol) if all items are in the “YES” column. Upload this page and the FAA may issue an authorization.
FAA source: OSA Treated Status Report. FAA date 27 May 2026; checked by Crosscheck 14 October 2026.
*If any concerns with the quality or duration of sleep, or “NO*” answers you MUST DEFER or contact AAM.
FAA source: OSA Treated Status Report. FAA date 27 May 2026; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which group of the FAA's table describes the case.
Group 1Examiner issuesAASI
The protocol has the examiner follow the AASI or Special Issuance for OSA, write it in Block 60, and issue if the applicant is otherwise qualified.
Group 2Examiner issuesSpecial Issuance
Where the pilot is under treatment, the protocol has the examiner give the AASI's requirements and say an Authorization of Special Issuance has to be obtained. The examiner gives Specification Sheet A, says a letter will come from the Federal Air Surgeon asking for more information and that it will give 90 days to provide it, writes it in Box 60, and issues if the applicant is otherwise qualified.
Group 3Examiner issuesExaminer can issue
The protocol has the examiner write it in Block 60 and issue if the applicant is otherwise qualified.
Group 4Examiner issuesExaminer can issue
The protocol has the examiner discuss the risks with the applicant, provide resource and educational information as appropriate, issue if the applicant is otherwise qualified, and write it in Block 60.
Group 5Examiner issuesSpecial Issuance
The protocol has the examiner give Specification Sheet B, say a letter will come from the Federal Air Surgeon asking for more information and that it will give 90 days to provide it, write it in Block 60, and issue if the applicant is otherwise qualified.
Group 6Defers to the FAAFAA review
The protocol has the examiner write it in Block 60, and says in capitals that the examiner defers.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Group 1 · AASI
The applicant is on a Special Issuance Authorization for OSA. The protocol has the examiner follow the AASI or Special Issuance for OSA, write it in Block 60, and issue if the applicant is otherwise qualified.
If the applicant is on a Special Issuance Authorization for OSA … select Group 1 on the AME Action Tab: Follow AASI / SI for OSA … Notate in Block 60; and … Issue, if otherwise qualified
- Group 2 · Special Issuance
The applicant has had a prior sleep assessment. Where the pilot is under treatment, the protocol has the examiner give the AASI's requirements and say an Authorization of Special Issuance has to be obtained. The examiner gives Specification Sheet A, says a letter will come from the Federal Air Surgeon asking for more information and that it will give 90 days to provide it, writes it in Box 60, and issues if the applicant is otherwise qualified.
If the applicant has had a prior sleep assessment … select Group 2 on the AME Action Tab: If the airman is under treatment, provide the requirements of the AASI and advise the airman they must get the Authorization of Special Issuance; … Give the applicant Specification Sheet A ( PDF ) and advise that a letter will be sent from the Federal Air Surgeon requesting more information. The letter will state that the applicant has 90 days to provide the information to the FAA / AME ; … Notate in Box 60; … Issue, if otherwise qualified
- Group 3 · Examiner can issue
The applicant does not have an Authorization or has not had a previous assessment, and the examiner determines they are not currently at risk for OSA. The protocol has the examiner write it in Block 60 and issue if the applicant is otherwise qualified.
If the applicant does not have an AASI / SI or has not had a previous assessment, the AME must: … If the AME determines the applicant is not currently at risk for OSA … select Group 3 on the AME Action Tab: Notate in Block 60; and … Issue, if otherwise qualified
- Group 4 · Examiner can issue
The applicant does not have an Authorization or has not had a previous assessment, and is at risk for OSA, but in the examiner's opinion at low risk for OSA. The protocol has the examiner discuss the risks with the applicant, provide resource and educational information as appropriate, issue if the applicant is otherwise qualified, and write it in Block 60.
If the applicant does not have an AASI / SI or has not had a previous assessment, the AME must: … If the applicant is at risk for OSA but in the opinion of the AME the applicant is at low risk for OSA … select Group 4 on the AME Action Tab: Discuss OSA risks with applicant; … Provide resource and educational information , as appropriate; … Issue, if otherwise qualified; and … Notate in Block 60
- Group 5 · Special Issuance
The applicant is at high risk for OSA. The protocol has the examiner give Specification Sheet B, say a letter will come from the Federal Air Surgeon asking for more information and that it will give 90 days to provide it, write it in Block 60, and issue if the applicant is otherwise qualified.
If the applicant is at high risk for OSA , the AME must … select Group 5 on the AME Action Tab: Give the applicant Specification Sheet B ( PDF ) and advise that a letter will be sent from the Federal Air Surgeon requesting more information. The letter will state that the applicant has 90 days to provide the information to the FAA / AME ; … Notate in Block 60; and … Issue, if otherwise qualified
- Group 6 · FAA review
The examiner observes, or the applicant reports, symptoms severe enough to represent an immediate risk to aviation safety of the national airspace. The protocol has the examiner write it in Block 60, and says in capitals that the examiner defers.
If the AME observes or the applicant reports symptoms which are severe enough to represent an immediate risk to aviation safety of the national airspace … select Group 6 on the AME Action Tab. Notate in Block 60 … THE AME MUST DEFER
If the examiner defersFAA review
The protocol's sixth group is the one it says the examiner defers, for symptoms severe enough to represent an immediate risk to aviation safety of the national airspace.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The protocol's sixth group is the one it says the examiner defers, for symptoms severe enough to represent an immediate risk to aviation safety of the national airspace.
If the AME observes or the applicant reports symptoms which are severe enough to represent an immediate risk to aviation safety of the national airspace … select Group 6 on the AME Action Tab. Notate in Block 60 … THE AME MUST DEFER
At later examsAASI
The protocol's instruction is that on every exam the examiner must triage the applicant into one of six groups.
Show the FAA's words: how often the FAA asks again
AME Actions – On every exam, the Examiner must triage the applicant into one of 6 groups:
For a pilot currently on an AASI for OSA, examiners may reissue when the pilot provides what the sheet lists, beginning with the Authorization the FAA granted, and either a completed and signed OSA Treated Status Report or a current detailed clinical progress note from the treating physician indicating that OSA treatment is still effective. The sheet ends that progress-note line with AND, then goes on under three headings, for CPAP, BIPAP or APAP, for dental and/or positional devices, and for surgery.
Show the FAA's words: at later exams
AMEs may re-issue an airman medical certificate to airmen currently on an AASI for OSA if the individual provides the following: An Authorization granted by the FAA; AND … A completed and signed OSA TREATED STATUS REPORT … OR … A current Detailed Clinical Progress Note from your treating physician indicating that OSA treatment is still effective AND … For CPAP/ BIPAP/ APAP: … For Dental Devices and/or for Positional Devices: … For Surgery:
What AASI is
AASI stands for AME Assisted Special Issuance. The Guide describes it as a process that lets the examiner reissue a certificate under the provisions of an Authorization for Special Issuance, to an applicant who has a medical condition that is disqualifying under 14 CFR part 67.
How the FAA pathways workThe Authorization granted by the FAA
The AASI sheet's first item for a reissue is the Authorization the FAA granted.
Show the FAA's words: The Authorization granted by the FAA
An Authorization granted by the FAA; AND
The status report, or a progress note saying OSA treatment is still effective
The AASI sheet asks for a completed and signed OSA Treated Status Report, or a current detailed clinical progress note from the treating physician indicating that OSA treatment is still effective.
Show the FAA's words: The status report, or a progress note saying OSA treatment is still effective
A completed and signed OSA TREATED STATUS REPORT … OR … A current Detailed Clinical Progress Note from your treating physician indicating that OSA treatment is still effective AND
The cumulative annual report from the PAP machine
For a pilot on CPAP, BIPAP or APAP, the AASI sheet asks for a copy of the cumulative annual report from the machine showing the actual time used, and distinguishes it in its own words from the report typically generated for insurance providers.
Show the FAA's words: The cumulative annual report from the PAP machine
A copy of the cumulative annual PAP device report which shows actual time used (rather than a report typically generated for insurance providers which only shows if use is greater or less than 4 hours).
How much the machine is used
FAA target: the AASI sheet says the target goal should show use for at least 75% of sleep periods and an average minimum of 6 hours use per sleep period.
Show the FAA's words: How much the machine is used
Target goal should show use for at least 75% of sleep periods and an average minimum of 6 hours use per sleep period.
Where the machine does not record
The sheet allows a one-year exception for a pilot with an established diagnosis of OSA who does not have a recording CPAP, in which they provide a personal statement that they regularly use CPAP and use it before each shift when performing flight or safety duties.
Show the FAA's words: Where the machine does not record
For persons with an established diagnosis of OSA who do not have a recording CPAP, a one-year exception will be allowed to provide a personal statement that they regularly use CPAP and use it before each shift when performing flight or safety duties.
Treatment by a dental or positional device
For a dental or positional device, the AASI sheet asks that there are no conditions known to be co-morbid with OSA (e.g., diabetes mellitus, hypertension treated with more than two medications, atrial fibrillation, etc), and says that once dental devices with recording / monitoring capability are available, reports must be submitted.
Show the FAA's words: Treatment by a dental or positional device
For Dental Devices and/or for Positional Devices: No conditions known to be co-morbid with OSA (e.g., diabetes mellitus, hypertension treated with more than two medications, atrial fibrillation, etc). Once Dental Devices with recording / monitoring capability are available, reports must be submitted.
Treatment by surgery
For a pilot treated successfully by surgery, the sheet says a statement attesting to the continued absence of OSA symptoms is required.
Show the FAA's words: Treatment by surgery
For successfully treated surgical patients, a statement attesting to the continued absence of OSA symptoms is required.
The status report's instruction to the examiner: on an authorization
The status report's instructions to the examiner say that if the applicant is on an authorization, all items are in the YES column and the examiner has no concerns, the examiner issues a medical certificate (if otherwise qualified) with a time limitation of one year, following the authorization letter instructions.
Show the FAA's words: The status report's instruction to the examiner: on an authorization
AME Instructions. … If on an authorization, all items are in the “YES” column, and you have no concerns, issue a medical certificate (if otherwise qualified) with a time limitation of one year. (follow the authorization letter instructions)
The target goals on the sheet for two or more machines
The FAA's sheet on OSA treated with PAP and two machines (or more) says successful continuation of the Special Issuance will rely on combined usage time and the percentage of time used, and gives its target goals: a minimum of 75% of days with device usage, an average usage of 6 hours on the days used, and a residual Apnea-Hypopnea Index (AHI) of 5 or less.
Show the FAA's words: The target goals on the sheet for two or more machines
Successful continuation of Special Issuance will rely on combined usage time and the percentage of time used. Target goals: … Minimum percent days with device usage 75% … Average usage (days used) 6 hours … Residual Apnea-Hypopnea Index (AHI) 5 or less
With two or more PAP machines
The sheet on two or more machines says an airman may use one machine at home and a separate, portable machine while traveling, and that continuation of the Special Issuance is based on the cumulative time used. Where all machines are used during a normal month (a continuous 30-day period), it says to use the same one-year date range for each machine (if possible), submit device downloads from all machines used, and clearly annotate the number of machines used on the 8500-8, in a letter from the pilot, or on the treating physician's status report. Where a single machine is used for more than a month and then additional machines are used, it says to verify the compliance reports identify the date range used, submit all device downloads for the past year, and clearly annotate the number of machines used the same way.
Show the FAA's words: With two or more PAP machines
may use one machine at home and a separate, portable machine while traveling. Continuation of the Special Issuance is based on the CUMULATIVE time used. … A. If all machines are used during a normal month (a continuous 30-day period): … 1. Use the same one-year date range for each machine (if possible). … 2. Submit device downloads from all machines used. … 3. Clearly annotate on your 8500-8, a letter from you or on the status report from your treating physician, the number of machines used. … B. If a single machine is used for more than a month (a continuous 30-day period) and then additional machines are used: … 1. Verify the compliance reports identify the date range used. … 2. Submit all device downloads for the past year. … 3. Clearly annotate on your 8500-8, a letter from you or on the status report from your treating physician, the number of machines used.
When the examiner defers a reissue
The AASI sheet has the examiner defer to the AMCD or the Region for further review where there are concerns about the adequacy of therapy or non-compliance, or significant weight gain or the development of conditions known to be co-morbid with OSA (e.g., diabetes mellitus, hypertension treated with more than two medications, atrial fibrillation, etc). The OSA Treated Status Report says that if there are any concerns with the quality or duration of sleep, or NO answers, the examiner must defer or contact AAM.
Show the FAA's words: When the examiner defers a reissue
Defer to the AMCD or the Region for further review if: Concerns about adequacy of therapy or non-compliance; … Significant weight gain or development of conditions known to be co-morbid with OSA (e.g., diabetes mellitus, hypertension treated with more than two medications, atrial fibrillation, etc).
*If any concerns with the quality or duration of sleep, or “NO*” answers you MUST DEFER or contact AAM.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
The PAP report must show actual use
The AASI sheet asks for the cumulative annual PAP device report showing actual time used, not the report typically generated for insurance providers, which only shows if use is greater or less than 4 hours.
Show the FAA's words: good to know, 2
A copy of the cumulative annual PAP device report which shows actual time used (rather than a report typically generated for insurance providers which only shows if use is greater or less than 4 hours).
Being issued is not the end of it
In the protocol's fifth group the certificate is issued if otherwise qualified, with Specification Sheet B. Sheet B says that if a sleep study is positive for a sleep-related disorder, the pilot may not exercise that certificate's privileges until they provide what it lists.
Show the FAA's words: good to know, 3
If the applicant is at high risk for OSA , the AME must … select Group 5 on the AME Action Tab: Give the applicant Specification Sheet B ( PDF ) and advise that a letter will be sent from the Federal Air Surgeon requesting more information. The letter will state that the applicant has 90 days to provide the information to the FAA / AME ; … Notate in Block 60; and … Issue, if otherwise qualified
If your sleep study is positive for a sleep-related disorder, you may not exercise the privileges of your medical certificate until you provide:
OSA risk despite a normal BMI
The protocol says physical findings such as a retrograde mandible or large tongue or tonsils put a person at risk of OSA requiring treatment despite a normal or low BMI. Over 90% with a BMI of 40 or greater have OSA requiring treatment, and up to 30% with OSA have a BMI under 30.
Show the FAA's words: good to know, 4
Persons with physical findings such as a retrograde mandible, large tongue or tonsils, neuromuscular disorders, or connective tissue anomalies are at risk of OSA requiring treatment despite a normal or low BMI . … Over 90% of individuals with a BMI of 40 or greater have OSA requiring treatment. Up to 30% of individuals with OSA have a BMI less than 30.
Asking to remove the AASI
The AASI sheet says the examiner may request AMCD review to discontinue it if there are indications the pilot no longer has OSA -- for example, significant weight loss and a negative study, or surgery followed by 3 years of symptom abatement with no significant weight gain or co-morbid conditions. In most cases a follow-up sleep study will be required.
Show the FAA's words: good to know, 5
Note: The AME may request AMCD review to discontinue the AASI if there are indications that the airman no longer has OSA (e.g., significant weight loss and a negative study or surgical intervention followed by 3 years of symptom abatement and absence of significant weight gain or co-morbid conditions). In most cases, a follow-up sleep study will be required to remove the AASI.
Diphenhydramine as a sleep aid
The OSA Treated Status Report says diphenhydramine (Benadryl) is not encouraged as a sleep aid, and that a pilot using it should not fly or perform safety related duties for a minimum of 60 hours after last use.
Show the FAA's words: good to know, 6
Diphenhydramine (Benadryl) is not encouraged as a sleep aid. If using, do not fly or perform Safety Related Duties for minimum of 60 hours after last use.
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- AASI for Sleep Apnea / Obstructive Sleep Apnea (OSA)Open to print: AASI for Sleep Apnea / Obstructive Sleep Apnea (OSA), a PDF at the FAA, in a new tab
The sheet the examiner follows to reissue under an FAA Authorization.
AASI
- Open to print: OSA – Specification Sheet B, Assessment Request, a PDF at the FAA, in a new tab
- Guide for Aviation Medical Examiners – Obstructive Sleep Apnea (OSA)Open to print: Guide for Aviation Medical Examiners – Obstructive Sleep Apnea (OSA), a page at the FAA, in a new tab
Examiner can issue, Special Issuance
- Open at the FAA: OSA – Specification Sheet A, Information Request, a PDF at the FAA, in a new tab
- Open at the FAA: OSA Treated Status Report, a PDF at the FAA, in a new tab
- Open at the FAA: Obstructive Sleep Apnea flow chart, a PDF at the FAA, in a new tab
- Open at the FAA: AASM risk criteria, Tables 2 and 3, a PDF at the FAA, in a new tab
- Open at the FAA: BMI chart and formula table, a PDF at the FAA, in a new tab
- Open at the FAA: OSA Treated with PAP and Use of Two Machines, a PDF at the FAA, in a new tab
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
Related conditions
Each has its own page, with what the FAA's documents say about it.
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.