The Coast Guard is seeking public comment on a proposed policy clarification regarding the specific medical documentation it will consider in determining whether a medical waiver is warranted for merchant mariners with sleep disorders (among other disorders it seeks to issue clarification for). The proposed policy clarification specifies that narcolepsy, idiopathic hypersomnia, and other hypersomnias of central origin are “medically disqualifying and generally not waiverable due to significant risk of sudden and unpredictable incapacitation of individuals who have these conditions.” The comment period ends on May 19, 2015.
The proposed rules include the following:
“NVIC 04-08, Condition # 179: Obstructive Sleep Apnea, Central Sleep Apnea, Narcolepsy, Periodic Limb Movement, Restless Leg Syndrome or other sleep disorders.
1. Submit all pertinent medical information, including sleep studies and a status report. If surgically treated, please submit a post-operative polysomnogram to document cure.
2. Narcolepsy, idiopathic hypersomnia and other hypersomnias of central origin: Due to the significant risk of sudden and unpredictable incapacitation of individuals who have these conditions, narcolepsy, idiopathic hypersomnia and other hypersomnias of central origin are considered disqualifying. Additionally, the Coast Guard does not consider the conditions of narcolepsy, idiopathic hypersomnia, or other hypersomnias of central origin, as low enough risk to warrant consideration for a medical waiver.”
“Obstructive Sleep Apnea (OSA):
A. Medical waivers for OSA require submission of an annual sleep specialist evaluation that documents treatment efficacy, the patient’s treatment compliance and an assessment for symptoms of daytime sleepiness. If treated with CPAP/BiPAP, the evaluation should include a compliance information report from the positive airway pressure device that covers the preceding 12 months. For OSA treated by other means, submit a polysomnogram demonstrating the effectiveness of the alternative therapy.
B. For purposes of receiving or maintaining a medical waiver, minimum compliance with positive airway pressure therapy is defined as:
(i) Proper use of the CPAP/BiPAP device for at least four hours per night (or per major sleep period) during all major sleep periods while acting under the authority of the mariner credential, and
(ii) Proper use of the CPAP/BiPAP device for at least four hours per night (or per major sleep period) on at least 70% of all nights (or major sleep periods).”