SAFE WINGS

Flight Safety Magazine of Air India, Air India Express and Alliance Air Issue 31, DECEMBER 2014

This issue…
 JUST A NIGHTMARE

 OBSTRUCTIVE SLEEP
APNOEA OR OSA

* For Internal Circulation Only

SAFE WINGS December Edition 31

1|Page Flight Safety Magazine of Air India, Air India Express and
Alliance Air
 December Edition 31 SAFE WINGS

I
t was around the end
of October and south-
west monsoons were
just on the wane. We
were on our way back
from Sharjah and now
preparing for the descent
into Calicut. The forecast
was for 2000m in haze
with some probability of
rain and showers, which
was a standard tailpiece
for every forecast during
this period; the weather of course would actually be clear – at least that
was what I thought. The satellite picture on departure showed some
clouding but come on, once the IMD says the monsoons are over they are -
aren’t they!

Around 200 miles from Calicut, when the ATIS said 2000m in moderate
rain with tailwinds of 10 to 12 knots for runway 28 and the first officer
reminded me that the glide slope for runway 10 was also unserviceable, a
mild furrow came across my forehead. I mean, who wants this situation
at 3 in the morning after an eight hours flight. But no worries, between
the two of us we had over 3000 hours on the machine and knew Calicut
like the back of our hands. Since the zero fuel weight was high we barely
hand ten minutes of holding fuel. Cochin was reporting similar weather
and Chennai was also in the grip of the receding North- Easterly
monsoon. Trivandrum was marginally better with 4000m in drizzle but
the standard probability was there too.

So, mentally both of us prepared ourselves for a landing into Calicut for
runway 28 and readied the aircraft as we would normally do. Flap 30,
autobrake 3, ILS set and we were on our way down the descent path.
Through the descent the ATC reminded us twice about the tail winds but
we thought it was better to land with the ILS than attempt a non-
precision approach for runway 10. As we turned finals, the aircraft began
to dance around a bit and the FMC indicated 35 knots of tail winds at
2000 feet. Still no worries, after all the surface winds were in the region
of 10 knots only – ‘things will settle down’ I said. The first officer kind of
agreed but the earlier confidence in his voice wasn’t there anymore. I
refused to pay attention to these nuances.

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SAFE WINGS December Edition 31

1000 feet – speeds were varying from plus 15 to minus five of V app,
forward visibility was dropping and the rain was now beating hard on the
front windshield. We could barely see the approach lights. Winds were
now steady 12 tail – ‘they will die down to ten’ I croaked through my dry
mouth. I disconnected the autopilot but kept the auto-throttle on.
Approaching the threshold, I could barely see the PAPI and the runway
edge lights were a blur. As the radio callouts jumped rapidly I
inadvertently eased back on the control column and started flying parallel
to the ground at 30 feet. The first officer called out – ‘Captain PAPI all
white’. I disconnected the auto throttle and powered back to idle. After
what seemed like two lifetimes, the aircraft skipped once before settling
down on the runway. By this time I had eaten up a lot of the strip and
the thought of going around briefly crossed my mind. But the Mangalore
accident flashed in front of my eyes and I went for the reversers. The
first officer now yelled – ‘we have crossed Alpha’ and I then slammed on
the brakes. The aircraft did not seem to slow down at all and at some 60
knots left the end of the runway and crashed into the wall!

3|Page Flight Safety Magazine of Air India, Air India Express and
Alliance Air
 December Edition 31 SAFE WINGS
I heard the screams of the passengers and woke up with a jolt and to my
huge relief found myself in pool of sweat but safely in my bed in my
room.

What a nightmare!

But this is almost exactly what had happened to American Airlines

B 737 800 NG whilst landing into Kingston Jamaica on 22nd December
20091. After leaving the runway at the opposite end the aircraft crashed
through the fence, broke into three pieces and was destroyed.
Fortunately there were no fatalities.

The details of the report are available on the link given as a footnote but
I thought it would be interesting to draw some parallels from the
accident.

So what were the mistakes made by me and my first officer?

Firstly, despite the forecast we were mentally not prepared to expect

such weather at this time of the year. It was as if after competing with a
tough monsoon we thought that the match was won and now we were in
the rest period. Even after hearing the ATIS we thought it was okay –
denial?

Secondly, we did not consider an approach for runway 10 which would

have been a into-wind runway because of our level of comfort with ILS
Zulu RW 28. Also, it would have been a non-precision approach. But
what is the big deal -we were trained to carry out non-precision
approaches. Then why did we not deliberate on this point in the course
of our descent and approach preparation? Why did the first officer not
question my decision – fixation? lack of CRM?

Thirdly, why did we not consider a flap 40 landing when we knew we

were going to be landing in tailwind? Why was the auto brake selection
kept at 3 and not at MAX? Why did we calculate landing distance based
on wet runway and not on based on contaminated runway which would
be the actual case when landing in heavy rain - inadequate knowledge
of SOP? lack of situational awareness?

http://www.skybrary.aero/index.php/B738,_Kingston_Jamaica,_2009_%28RE_HF%29?utm_source=SKYbr
ary&utm_campaign=df779b122e-
300_Jamaica_RE_13_10_2014&utm_medium=email&utm_term=0_e405169b04-df779b122e-276506465

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SAFE WINGS December Edition 31

Fourthly, why was the approach continued below 1000 feet when the
approach lights and runway lights were not clearly visible? Why did the
first officer not ask me to go around - overconfidence on my part?
lack of CRM? under confidence on the part of the first officer?

Fifthly, why did I not (as per company and Boeing procedures) disconnect
the auto throttle when I disconnected the auto pilot? Was it a private
practice that I followed on my own simply because I thought it was right
- routine violation of SOP on my part?

Finally, after touching down so deep – which could have been a

consequence of strong tailwinds, delayed thrust reduction, black hole
effect due to typical geographical factors, inadequate depth perception
due to wet windshield/rapid wiper movement etc, why did I not execute a
go around/rejected landing - loss of face? fear of consequences?

After going through the report on the American Airlines accident, one
would notice that majority of the recommendations made are already in
place in our company. Nevertheless it is important that we continually
remind ourselves of the vulnerabilities that we face in our profession and
remain as well prepared as possible to contend with them. Such reviews
in my opinion are meant to serve as pit stops where we recharge our
minds to re-enter the high speed circuit with greater confidence.

The above by no means is an exhaustive analysis of the report and I

would encourage the reader to go through the detailed accident report to
understand the other aspects of the accident that have not been covered
here.
Capt Pradeep Deshpande served in the Indian Air Force as a
fighter pilot for 22 years, flying various MiG variants
namely 21, 23 and 29. Whilst in the Air Force he also served
as an Instructor for 16 years with instructional tenures at
Air Force Academy, Hyderabad and Flying Instruc-
tors'School,Tambaram Chennai, and was an Air Force Examiner
in the Aircrew Examining Board for two years. After joining
Air India he has flown the A 310 for over 2500 hours and is
presently flying the B737 on deputation with AI Express.

5|Page Flight Safety Magazine of Air India, Air India Express and
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 December Edition 31 SAFE WINGS
Obstructive Sleep Apnoea or OSA
Asleep at the controls

A few years back you may have heard about a commercial aircraft with two pilots
which flew past its destination airport after both the captain and first officer fell asleep.
The pilot awoke and turned back to the destination airport, where all deplaned safely -
but behind schedule. The Inquiry concluded that contributing factors to the incident
were the captain's undiagnosed Obstructive Sleep Apnoea (OSA) and the flight crew's
recent work schedules, which included several days of early-morning start times.
Earlier, OSA was relatively unknown outside the medical community. Today, OSA is
recognised as a major contributor to many possible health-related ailments and is of
concern for everyone not only pilots.

The pathophysiology of OSA

Apnoea is a medical term that means “being without respiration." Apnoea = absence of
breathing, hypopnoea = reduced rate of breathing. Obstructive sleep Apnoea is
characterised as a repetitive upper airway obstruction during sleep, as a result of
narrowing of the respiratory passages. The ensuing sleep fragmentation causes
daytime sleepiness, especially in monotonous situations, resulting in a three- fold
increased risk of road accidents.

Most people with this disorder are

overweight and have higher deposits of
adipose (fatty) tissue in their respiratory
passages, and the size of their soft
palates and tongues are larger than
average. Being Male doubles the risk.
Alcohol and Sedatives increase the
likelihood of snoring and apnoea by
further relaxing the muscles of the
throat. These conditions decrease the
size of the upper airway and decrease
airway muscle tone, especially when
sleeping in the supine (back down and
horizontal) position. Gravity can pull tissue down and over the airway, further
decreasing its size, impeding air flow to the lungs during inhalation. The major impact
of OSA, Snoring, can result when the airway becomes partially obstructed. With
further tissue obstruction of the airway, there may be complete occlusion. Around 40%
of middle aged men and 20% of middle aged women snore. Whether the obstruction is
partial (hypopnea) or total (Apnoea), the subject struggles to breathe and is aroused
from sleep. Often, these sleep interruptions are unrecognised, even if they occur

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SAFE WINGS December Edition 31

hundreds of times a night. The real danger is that the OSA sufferers may not realise
the condition and are only aware that they typically awaken feeling sleepy and tired.
Losing sleep is more than a simple inconvenience. Good, sound sleep is essential for
good health and clear mental and emotional functioning. Additionally, OSA is
associated with a reduction in blood oxygen levels feeding the brain, which, of course,
is a major health concern. These awakenings are so brief that the person has no
recollection of them. After a series of loud deep breaths, that may awake their bed
partner, the person rapidly returns to sleep, snores and becomes breathless once
more. This cycle of breathlessness and awakening may repeat itself many hundreds of
times per night and results in severe sleep fragmentation which in turn causes
variations in blood pressure, which may, at a future date lead to sustained
hypertension(high blood pressure) , heart related problems and stroke( paralytic attack
due to reduced blood supply to the brain).

A potential problem in flight?

The implications for pilots and crew-
members are significant. It has been
suggested that people with mild-to-
moderate OSA can show performance
degradation equivalent to 0.06 to 0.08%
blood alcohol levels. Most pilots will not fly
intoxicated, but OSA sleep deprivation may
be causing the equivalent effects! Further
exacerbating the problem are time zone
changes and post-flight alcohol
consumption, which can inhibit wakefulness.
Normally, when you stop breathing while
asleep, the brain automatically sends a
wake-up call after about 10 seconds, and you wake up, gasping for air. Multiple time
zone changes and alcohol consumption both inhibit arousal mechanisms and may
result in oxygen deprivation of 30 seconds or longer before you heed the wake-up call.
When you add up the oxygen starvation resulting from many occurrences per night,
along with the subsequent arousals, the effect is significant fatigue.

Recognising OSA..

Typically, a person suffering from OSA is not aware of the condition. The only way it
can be detected is through a sleep study. A complaint of loud and excessive
snoring may be an important clue, since that is characteristically the first sign of
OSA.

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 December Edition 31 SAFE WINGS
EXCESSIVE DAYTIME SLEEPINESS is the principle complaint of these patients and
SNORING is virtually universal. The patient feels that he or she has been asleep all
night but awakens un-refreshed. Bed partners report loud snoring in all body positions

and will often have noticed multiple breathing pauses (apnoeas).

Epworth Sleepiness Scale :

How likely are you to doze off or fall asleep in situations described below? Use the
following scale to choose the most appropriate number for each situation and add up
the score :-

Score

0 = would never doze

1 = slight chance of dozing

2 = moderate chance of dozing

3 = high chance of dozing.

Situations

a. Sitting and reading

b. Watching TV

c. Sitting inactive in a public place ( in a theatre or a meeting)

d. As a passenger in a car for an hour without a break

e. Lying down to rest in the afternoon when circumstances permit

f. Sitting and talking to someone

g. Sitting quietly after a meal without alcohol

h. In a car, while stopped for a few minutes in the traffic.

Normal subjects score an average of 6

Persons with severe Obstructive Sleep Apnoea score an average of 16

SO WHAT SHOULD ONE DO ? First try one of the following:-

• Change sleeping position (sleep on your side ).

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SAFE WINGS December Edition 31

• Change sleeping environment (mattress, light level, temperature, etc.).

• Lower body fat (10% weight loss will decrease the OSA index by 25%).

• Dental appliances that thrust the lower jaw forward or otherwise open the airway
are an excellent treatment for mild-to-moderate OSA and are about 75%
effective.

Surgical methods are not advisable as there is no evidence that they are
successful.

NON-SURGICAL METHODS:-

Continuous positive airway

pressure ---(CPAP) Machine is
Probably the best, non-surgical
treatment for any level of OSA.

It Uses air pressure to hold the

tissues open during sleep.

It Decreases sleepiness, as
measured by surveys and
objective tests.

CPAP, Continuous Positive

Airway Pressure, is a treatment
that uses mild air pressure to
keep your airways open. CPAP
typically is used for people who
have sleep breathing problems,
such as sleep Apnoea. CPAP
is considered the gold standard
for OSA treatment. CPAP is comprised of a mask that delivers air to the nose or mouth
during sleep. It is highly effective for most people.

A CPAP machine has three main parts:

 A CPAP mask that fits over your nose or your nose and mouth. Straps keep the
mask in place while you sleep.

 A tube that connects the mask to the machine's motor.

 A motor that blows air into the tube.

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 December Edition 31 SAFE WINGS

OR THE BEST OPTION

CPAP MACHINE

A good CPAP machine should cost between Rs 40000 to 70000 depending on the
make and country of manufacture, and is available in India. Users (and their partners)
are extremely satisfied with the results.

The Bottom Line

If you experience one or more symptoms of obstructive sleep Apnoea, it is

recommended that you consult a physician, since OSA treatment scores a very high
success rate. However, flying with untreated OSA constitutes an unnecessary risk and
can become a safety-of-flight issue. It's up to you! So...sleep on it!

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PROMISING A SAFER SKY, AIR INDIA, AIR INDIA EXPRESS & ALLIANCE AIR

Editorial: -Bhavish B S, Indu P G

Designed by Bhavish BS