Waking Up to the Problem of OSA: Improved Recognition

Doctors, get your asses educated now!

"Obstructive sleep apnea (OSA) is a sleep-related breathing disorder (SRBD) characterized by partial/complete airway obstruction resulting in suspended breathing. Classic symptoms during sleep include loud snoring, gasping/choking, and severely fragmented sleep, whereas waking symptoms include excessive sleepiness, cognitive difficulties, and mood swings. Associated risk factors include being male, older age, high BMI, hypertension, family history, and having a large neck circumference and/or a narrowed airway. Untreated OSA is associated with serious societal and personal consequences. The cardinal symptom of OSA is excessive sleepiness, which can interfere with daily activities and heighten the risk of motor vehicle crashes.(1) OSA is associated with numerous medical comorbidities, with the most compelling data exhibiting a link between OSA and hypertension.(2) Prompt recognition and management of OSA is crucial to mitigating the consequences - however, less than 20% of OSA cases are currently diagnosed and treated. New data indicate that women and older people may not present with classic findings; for example, women are less likely to report witnessed apneas, and older people are less likely to be obese. In this live, evidence-based, neuroscienceCME VOICE activity, the experts will explore the risks associated with untreated OSA and present strategies for improving recognition of this SRBD."

Source: http://www.neurosciencecme.com/cmea.asp?ID=258

Doctors, get your asses educated now!

I second that. The only reason I got diagnosed is because I was snoring so loud I could wake the dead. Poor hubby started sleeping on the couch and pushed me to go to doc. I had high blood pressure at a young age and the doctor just prescribed blood pressure medicine instead of finding the root cause. It isn't normal for a person in their 20's to have hbp. Years went by and one symptom after another that was just masked by medicine or dismissed and a lot of it has improved since treatment.

I have been complaining of extreme fatigue, depression, cognitive difficulties, etc. for years. For the past nine years I have seen at least 5 different internists and a psychiatrist. I have also been telling the doctors that I had a brother who died at age 53 from a heart attack, who'd been in heart failure for 5 years at the time he died and had sleep apnea. NOT ONE OF THEM SUGGESTED THAT I MIGHT HAVE SLEEP APNEA. I was treated for depression.

I decided to change psychiatrists because the medication was doing nothing for my depression. The psych I had kept adding medications. It was a blessing that I dumped him. The new psychiatrist (also a board certified internist) asked a whole bunch of questions at my first visit and immediately sent me to a pulmonologist to schedule a sleep study. Of course, I have severe sleep apnea.

I do not snore. Physically, I do fit the profile for apnea. I am obese, have a short, fat neck, a small lower jaw, a large tongue, and a narrow trachea. I think that an MD should have picked up on my sleep apnea long ago.

I do think that sleep apnea is becoming more widely publicized. I was reading a Womans Day magazine at my therapist's office today and it had an article on sleep apnea.

Anne

AnneO wrote:I have been complaining of extreme fatigue, depression, cognitive difficulties, etc. for years. For the past nine years I have seen at least 5 different internists and a psychiatrist. I have also been telling the doctors that I had a brother who died at age 53 from a heart attack, who'd been in heart failure for 5 years at the time he died and had sleep apnea. NOT ONE OF THEM SUGGESTED THAT I MIGHT HAVE SLEEP APNEA. I was treated for depression.

I decided to change psychiatrists because the medication was doing nothing for my depression. The psych I had kept adding medications. ........

Anne

Myself and many others on this board have similar stories. What a shame that the medical profession has missed this elephant in the room. I noted the statistic that 80% of apnea sufferers still haven't been diagnosed.

I assume that 80% also includes patients who have symptoms but don't go to see their doctor??

Maybe it's because of what we've been thru (or it takes one to know one), but it seems fellow OSAers have little trouble recognizing an untreated sufferer.

Just today I had an appointment and the petite and (relatively) young woman across the desk from me was discussing her upcoming sleep study. She spoke of her doctor's awareness that sleep disorders are responsible for more problems than commonly thought. I commended her doctor - they're a keeper.

But while in the waiting area there was a young woman who reminded me of myself a couple years ago. She dozed intermittently while waiting, looked miserably fatigued, appeared to be on steroids, and even while dozing was bouncing her legs incessantly. Being the shy woman that I am, it took me all of five minutes to initiate a conversation with her. Sure enough, she had been advised to get a sleep study, but was too overwhelmed by all her health issues to make that happen. So, even with a history of a heart attack she had untreated OSA, and based on her bouncing legs, RLS and maybe PLMD were on her diagnosis list.

Since I was already in her business, I asked her, and she described how tormenting her nights were between the waking up struggling to breathe and the legs. She expressed such utter despondency over her deteriorating health. In that moment I knew I was to use my burden of OSA, RLS & PLMD to encourage her that there was hope for her to feel better, and to encourage her that it should start with treating her OSA.

Sooo, between the endless accounts of docs who miss their patient's diagnosis and the patients who are just too depleted to even follow thru on medical advice, there's a whole lot of unnecessary suffering going on. I spoke directly with three people during this appointment. Two of them have sleep issues; neither had a missed diagnosis. Seems we're everywhere. And not all docs are off base. Good to know that.

Kathy

split_city wrote:I assume that 80% also includes patients who have symptoms but don't go to see their doctor??

So many of us were misdiagnosed for so long. I even suggested a test to my doctor 4 years ago and he totally pooh-poohed it. Because I like and trust this doctor, and didn't know much about OSA, I believed him. This is the doctor who couldn't wait to get me on statin drugs.

The members of my family are currently being tested. TWo of them have had multiple strokes. One has every symptom of sleep apnea you can imagine. Others have other symptoms that no doctor should have missed. Because of multiple health problems these are folks that have multiple doctors and doctors visits.

So, why is it that it falls to me to convince these family members to get sleep tests (which some of their doctors have rather reluctantly agreed to). So far both the ones tested have it. I have no doubt the others do, too. The man I date also has classic symptoms and sees at least 5 specialists including cardiac and diabetes specialists. Not one of them, NOT EVER, suggested a sleep test. I twisted his arm to see a sleep doctor, before I was diagnosed. He has severe osa.

None of these people have ever even been screened for it. These are people who participate in health care systems that are consistently rated at the very top of list. Three of them have seen doctors from the Cleveland Clinic. My health care system is one of the top rated in the U.S. as well.

None of my friends at work has ever been screened by their doctors for a sleep disorder. They are in the same top rated health care system as I am. I'd know, since we share other personal health care information. I'm sure that they don't have it, but they have been screened for cholesterol (which takes more effort than a Berlin Questionnaire), high blood pressure, and and host other potential problems.

These systems are broken, badly broken when it comes to sleep disorders. Split_City, you don't live in the U.S. perhaps it's better in Australia, but that 80% statistic strikes me as meaningful. I don't know the source of the statistic, but I'd bet that of the people who see doctors and who have glaring signs of sleep apnea, more than 80% are missed by the doctors. It's only when the spouse complains of a snoring problem that the light bulb goes on in the doctor's head.

I like and respect my doctors (or I wouldn't go to them). But they sure are missing the boat on sleep disorders. And that's a HUGE error given the risk factors.

I do agree there are some who are on the ball. The one who sent me for a sleep study has it together on this one. But so far, he's the only one I've seen who has it together. Perhaps that number will grow, but so far I don't see a lot of evidence.

I'm a breast cancer survivor. The chemo causes chemically induced menopause, for me this happened at age 40. All those years without estrogen causes other physical problems. Doctors are very quick to check for osteoporosis, but seem to ignore OSA. This is another related problem. If you have a thyroid problem they tend to focus on that for feeling tired. Women need to be checked for OSA after menopause.

allergyridden wrote:I'm a breast cancer survivor.

Congratulations! Really, sincerely happy for you!

Anonymous wrote:even while dozing was bouncing her legs incessantly.

Maybe she was on one of the more stimulating SSRIs? I couldn't keep my legs still when I was put on Prozac. Never had the problem since.

allergyridden wrote:I'm a breast cancer survivor. .

congratulations! ...so glad you made it through

What bothers me about untreated cases of OSA is that they still pay less for life insurance. When I apply for life insurance and I tell them that I have OSA that's being treated with CPAP they up the rate. That is such a load of BS because some joker who doesn't know he has OSA is more of a risk but he's paying less than I am. If anything I should get a DISCOUNT for being properly diagnosed and getting treated with CPAP. That's my two cents, as Kent Brockman would say.

[quote="WindFlyer"]What bothers me about untreated cases of OSA is that they still pay less for life insurance. When I apply for life insurance and I tell them that I have OSA that's being treated with CPAP they up the rate. That is such a load of BS because some joker who doesn't know he has OSA is more of a risk but he's paying less than I am. If anything I should get a DISCOUNT for being properly diagnosed and getting treated with CPAP. That's my two cents, as Kent Brockman would say.

[quote="rooster"][quote="WindFlyer"]What bothers me about untreated cases of OSA is that they still pay less for life insurance. When I apply for life insurance and I tell them that I have OSA that's being treated with CPAP they up the rate. That is such a load of BS because some joker who doesn't know he has OSA is more of a risk but he's paying less than I am. If anything I should get a DISCOUNT for being properly diagnosed and getting treated with CPAP. That's my two cents, as Kent Brockman would say.

Well technically, she is just writing a check out of my earnings. She hasn't worked in 22 years and did not bring a big dowry into the marriage. It is amazing that "I earn it, she spends it" has worked so well for 31 years. .

On the other hand, I have a friend whose wife made a millionaire out of him. ............he was a billionaire when they wed.