Sleep Medicine Dr. Says I Don't "Look" Like I'd Have Apnea

[jaycee2]

I found a sleep medicine doctor/pulmonologist to see me last week! But he said that I don't look the type to have sleep apnea. I'm not obese and my throat was open and clear when he examined me. But he ordered a sleep study anyway based on my symptoms. However it will not be a split study because he seems certain that I don't have apnea. He wants me to take melatonin and zolpidem/Ambien for the study to make sure that I sleep. Otherwise the insomnia might interfere. He said that if need be I would return to the sleep lab for titration or do an auto-titration at home. And the sleep lab is backed up due to "summer vacations" so I won't have the study for 3-4 weeks. After that it will take 10 days for him to get the results.

Is there a "type" or look or typical sleep apnea patient? It would be wonderful if he were right, no apnea.

[DWolf]

I found a sleep medicine doctor/pulmonologist to see me last week! But he said that I don't look the type to have sleep apnea. I'm not obese and my throat was open and clear when he examined me. But he ordered a sleep study anyway based on my symptoms. However it will not be a split study because he seems certain that I don't have apnea. He wants me to take melatonin and zolpidem/Ambien for the study to make sure that I sleep. Otherwise the insomnia might interfere. He said that if need be I would return to the sleep lab for titration or do an auto-titration at home. And the sleep lab is backed up due to "summer vacations" so I won't have the study for 3-4 weeks. After that it will take 10 days for him to get the results.

Is there a "type" or look or typical sleep apnea patient? It would be wonderful if he were right, no apnea.

There is no type or look of someone that has sleep apnea. Granted extra weigh can increase the issue but I am not obese, could lose a few pounds, but otherwise a healthy weight and I suffer from sleep apnea. Terrible snoring, countless elbows to the side from my wife when I stopped breathing and to get me to roll over before using a CPAP.

As for your study type that's how mine was too. I went for a full night non titration study first and than went back for a second study when it was determined I did have sleep apnea.

I'll be honest I liked it that way, sure I had to go twice but at least there was more than just a few hours of data to pick from.

[Pugsy]

I didn't "look" like it either.
At the time of my sleep study I weighed around 110 pounds and had a skinny 12 inch circumference neck and my airway is wide open with tonsils long ago shrunk up to nothing. "Look" doesn't mean squat.

There's a misguided stereotype for OSA people...obese with thick necks and/or airways occluded by tonsils or uvula or tiny airway in general.

[zoocrewphoto]

I found a sleep medicine doctor/pulmonologist to see me last week! But he said that I don't look the type to have sleep apnea. I'm not obese and my throat was open and clear when he examined me. But he ordered a sleep study anyway based on my symptoms. However it will not be a split study because he seems certain that I don't have apnea. He wants me to take melatonin and zolpidem/Ambien for the study to make sure that I sleep. Otherwise the insomnia might interfere. He said that if need be I would return to the sleep lab for titration or do an auto-titration at home. And the sleep lab is backed up due to "summer vacations" so I won't have the study for 3-4 weeks. After that it will take 10 days for him to get the results.

Is there a "type" or look or typical sleep apnea patient? It would be wonderful if he were right, no apnea.

Many doctors run on the old assumption that most people with sleep apnea are overweight males with large necks. Unfortunately, that is completely wrong. There are plenty of ladies with sleep apnea as well as many skinny people. It has also been found that sleep apnea has a tendency to cause weight gain, so while they are often related, it is not clear which caused which in each individual case.

Many people have found that having a small mouth, small chin have been true for them regardless of their neck size and weight. Thankfully, your doctor did schedule a test, so at least he isn't letting his preconceptions from getting you tested. Some labs do a split night and some don't. Those that do, will only do si if you meet certain criteria within a certain time frame. They usually don't tell you the exact criteria, but basically, they will go ahead and start the titration if you are obviously severe with enough time left to do the titration. If you aren't severe, they will want to do the diagnosis phase to see how bad you are all night long. Many people are worse during REM sleep which is more at the end of the night. And some are worse on their back. I did a split night study, but I managed a 79 ahi in less than 2 1/2 hours with barely any back sleeping, and I never even got to deep sleep or REM sleep. An average of the whole night probably would have been higher than 79, but that really doesn't matter when the cutoff for severe is 30, and I was clearly over it.

[Pad A Cheek]

Unfortunately there are people out there that don't have the physical features that some doctors look for when suggesting sleep apnea testing.

These people will slip through the cracks if the doctors do not realize that sleep apnea could be at the root of the conditions the patient is presenting with. Heart issues, hypertension, diabetes, stroke, cognitive impairment, and metabolic issues can all be caused by sleep disordered breathing issues, obstructive sleep apnea being one possibility.
As education about the condition grows, more doctors are being taught about the atypical sleep apnea patient. That is a good thing, because so many people that actually can be helped with CPAP therapy are missed by the old sleep apnea body habitus classification of middle aged, obese man that snores loudly.

As the topic of sleep apnea becomes more widely discussed, more people will question their doctors about it. That is a good thing. Sleep apnea treated by CPAP is minimally invasive and very effective when done right.

I wish you the very best in your sleep study and follow up titration. If you are diagnosed, there is a world of information on this site that will serve you well as you grow to become your best advocate for treatment.

Take care,
Karen

[OhHelpMe]

Is there a "type" or look or typical sleep apnea patient?

Yes. The person who is at low risk for sleep apnea will have 32 teeth that are straight (without needing braces) and not crowded.

Go to the mirror, count them and judge their degree of straightness and crowdedness.

Anyone who does not meet this criteria is at risk for sleep-disordered breathing.

[Guest]

All they need is two hours of diagnostics to determine if you have events enough to qualify for treatment but you do need to be asleep during those two hours. The point is the rest of the night you would be suffering with more events until they released you.

I am always suspicious when they stretch the PSG to two separate nights when that is needless. Not to mention it could be weeks again before you get a titration appt. Then another 10 days? Then it can take a month or more before you get your equipment. Meanwhile you will be advised not to drive if you fail the diagnostic portion.

I would insist on a split-nite study.

They must get more money when they do two nights.

[kteague]

Sometimes there are visible indicators, like a crowded mouth, narrow airway, large tongue, lots of loose fleshy tissue in the soft palate, etc. But they are merely indicators, not evidence. Some people with those indicators surprisingly might not test positive for sleep apnea. Then there are those like you and many others whose indicators are symptoms - nothing physically apparent. All your doctor was saying was he didn't take one look at you and think sleep apnea. Good that the doc is ordering the study anyway since we all know appearances can be deceiving.

What are your symptoms that sent you to the doctor? Have you already ruled out other possible causes besides sleep apnea?

[jaycee2]

[quote="kteague"

What are your symptoms that sent you to the doctor? Have you already ruled out other possible causes besides sleep apnea?[/quote]

My symptoms started during a time when I was taking zolpidem every night to fight insomnia. The insomnia was a well known side effect of a hormonal medication that I was taking to lower estrogen. I am a breast cancer survivor.

Symptoms: I stop breathing while asleep on my back, I choke also during this time, I awake exhausted (even more than I do with fibromyalgia). I often awake with a racing pulse. But the symptom that first sent me to the dr. was anxiety and waking up with a feeling that something was very, very, very wrong. This was before my husband noticed the lack of breathing while on my back. It doesn't happen on my side.

I often wonder if it was the lack of estrogen or the use of zolpidem that initiated this cycle. I can't take estrogen but could give up the zolpidem if that were causing apnea. I use it now 2 or 3 times per week instead of nightly.

Thoughts? Advice?

[ChicagoGranny]

Ambien (zolpidem) is not known to cause sleep apnea. But note that an obstructive apnea ends when you awaken to flex the throat muscles and open the airway. So, I suspect that Ambien can delay the time it takes to awaken from an apnea and thereby prolong the apnea. Of course the longer the apneas, the more severe the condition and the more damage it does.

Note that in females, the onset of obstructive sleep apnea quite often occurs at menopause. So you might think that anything that causes a significant lowering of estrogen could have an unwanted side effect of causing the onset of sleep apnea.

But do be aware that sleep-disordered breathing is highly prevalent in postmenopausal women with no other health problems. It's hard to avoid it. But happily there is CPAP which treats it well in many cases.

Good luck.

[archangle]

I suspect a good doctor can spot a lot of apneacs on sight. Various combinations of weight, age, behavior, general appearance, neck size, throat appearance, etc. It's not just prejudice, there probably is a correlation. The overweight, middle age guy with a big neck probably is a lot more likely to have apnea than the skinny 20 year old athletic guy. The trick is to not fail to recognize the symptoms of apnea in the non-obvious apnea candidates.

The real problem is the doctor who is too sure of his eyeball diagnosis, and misdiagnoses an apneac because he's got delusions of grandeur and "knows" someone doesn't have apnea when they do.

Since this one looked at your symptoms and ordered a sleep test, maybe he's OK. The fact that he ordered a sleeping pill bodes well. Far too many people have been screwed because their doctor didn't provide one and they didn't sleep, but still had to pay.

Yeah, they should probably always plan for a split night study if your apnea is obvious enough in the first x hours of sleep. Sounds like the medical mafia generating unnecessary extra tests.

[chunkyfrog]

More indications:
a "scalloped" tongue,
daytime sleepiness,
dozing off unexpectedly during the day,
waking up with a headache,
waking up breathless from strenuous nightmares,
diabetes,
heart palpitations/irregular rhythm,
falling asleep during sex (don't ask)

[archangle]

More indications:
a "scalloped" tongue,
daytime sleepiness,
dozing off unexpectedly during the day,
waking up with a headache,
waking up breathless from strenuous nightmares,
diabetes,
heart palpitations/irregular rhythm,
falling asleep during sex (don't ask)

The sad thing is that too many doctors see "not fat," "not male," or "not thick necked," mentally cross apnea off their mental checklist and ignore the other signs of apnea.

At least Jaycee2's doctor did follow the trail a little further.

Of course, Jaycee2 might not have apnea after all.

[Wulfman...]

All they need is two hours of diagnostics to determine if you have events enough to qualify for treatment but you do need to be asleep during those two hours. The point is the rest of the night you would be suffering with more events until they released you.

I am always suspicious when they stretch the PSG to two separate nights when that is needless. Not to mention it could be weeks again before you get a titration appt. Then another 10 days? Then it can take a month or more before you get your equipment. Meanwhile you will be advised not to drive if you fail the diagnostic portion.

I would insist on a split-nite study.

They must get more money when they do two nights.

+1

I'd be very suspicious of this money-grubbing idiot who thinks they can "look" at a person and diagnose whether they have sleep apnea or not.

I'm thinking you should RUN from this one and find another. I don't like what I've read so far.


Den

.

[zoocrewphoto]

All they need is two hours of diagnostics to determine if you have events enough to qualify for treatment but you do need to be asleep during those two hours. The point is the rest of the night you would be suffering with more events until they released you.

I am always suspicious when they stretch the PSG to two separate nights when that is needless. Not to mention it could be weeks again before you get a titration appt. Then another 10 days? Then it can take a month or more before you get your equipment. Meanwhile you will be advised not to drive if you fail the diagnostic portion.

I would insist on a split-nite study.

They must get more money when they do two nights.

I disagree. For somebody like me who was severe, it was obvious that I was severe within 2 hours. But what about somebody who is mild or moderate after 2 hours? They might be severe if they go all night and actually reach REM sleep or do a combo of supine and REM. Wouldn't it be useful to know that they are worse in REM sleep? That will help them get an auto machine if the tech knows to titrate for non-REM and REM.

Also, a lot of people are in denial when they get diagnosed. If they come out of the study believing they are mild or moderate, they have a higher chance of quitting because they think it isn't a big deal. Finding out that you are severe is a useful shock. I knew I had sleep apnea for over 10 hours, but I didn't think it was a big deal. When I was diagnosed, I saw data for an ahi of 79. That is more than once a minute. You bet that got my attention. I know it is likely worse, but that was severe enough to get my attention. Had it been only 10 or 20, I would be easier to let myself skip nights and not try very hard.

As to cost, my split night study was billed at over $6,000. Yes, three zeros. And they got over $4400 of that. It was not cheaper by any means. But the facility was comfortable, the tech was awesome, and my titration was spot on. Best night of sleep I had in years, and that got me off to a really good start. The tech even fitted with me with the best mask on the first try.