A firefighter in need of help...

I'm new here so I'm very sorry if I'm reposting or if this is not in the right area, please grant me a little leeway as I am very tired.

I am a 27 Y.O. Male, 6'7" and about 245 LBS.  I'm a little husky but not by much.  I am a medic and a firefighter and work all kinds of crazy hours.

For as long as I can remember I have been so very tired.  I toss and turn while sleeping, wake up 3-4 times a night (that I can remember at least), wake up with headaches, am constantly tired, never feel rested when awake, have issues with slightly high blood pressure and cardiac arrhythmias, and when sleeping on my back I wake up with the sensation that I have not been breathing or have been holding my breath (which is why I can rarely fall asleep on my back.  But here's the kicker, I have never been told that I snore.  I have been told that I "breathe heavy” or “weird” when sleeping with someone, but not snoring.

That being said I'm not married so I really don't have anyone to keep an ear open on a regular basis for how I sleep.

I have been reading up on sleep apnea and wonder if I might be dealing with it and not know it.  The only problem is I'm not really overweight by much, and had these issues even when I was “fit” for my age and height.  Also, I don't snore...

I'm frustrated with my doctor because I have mentioned it to him twice and he shrugs it off and offers a sleeping pill prescription.  I really don't want to be on a pill, and because of my job I really can't afford to be sedated at night.  I'm thinking about looking for a new doctor, but I hate going to them in the first place (once or twice a year is more than enough for me).  Which brings me to my second problem...

I really dread the thought of a sleep study, I get worked up enough just going to the doctor let alone having to sleep with them around.  I'm not good at being a patient, I'm usually the one treating the patient.  How the heck would I ever be able to sleep all wired up and being watched?

Please help, am I making a mountain out of a molehill? Should I look for another doctor?  Could some of the symptoms above be sleep apnea?  

Thanks for your help ahead of time.

-Eric

every person has different symptoms and we all come in different sizes, shapes and physical conditions. the one common symptom that drove most of us to the doctor was being sick and tired of being sick and tired. if the primary doc is adamant about not referring you to a sleep doctor, fire him. as far as sleeping in a sleep study, nobody likes it but everybody does it, somehow. think positive.

Find a better doctor and ask for a home sleep study.

You are a big boy and you know better, go and interview the doctors you are "hiring" - because you or your insurance is paying their salaries, treat them like any employee.

Eric:
If you have insurance, the sleep study is not something to dread.
It is inconvenient, yes; but your doctor needs the data in order to prescribe new equipment for you.
If your doctor is stubborn about it--fire him! Get one who will refer you to a sleep doc.
There are ways to buy used equipment without a prescription, but if you can afford it,
nothing is as reliable as a sleep study for ruling out other health conditions you may not even be aware of.
Not every snorer has apnea--not everyone with apnea snores.
The fact that you "breathe funny" in your sleep is grounds for suspicion.
The health consequences of untreated apnea are numerous and cumulative.
Take care of yourself.

Your symptoms could be from sleep apnea. They could also be from some other health condition. You know that since you have researched things.
Not everyone who has sleep apnea will snore and lots of us out here have sleep apnea and we aren't fat, middle aged, frumpy people. Skinny kids can have it. One of our forum members has an 8 year old son with sleep apnea. Old skinny women can have it and all the possible combinations in between. Don't have to be fat or old or out of shape.

There are home sleep studies available. While maybe not as comprehensive as a formal sleep study in a sleep lab setting it would get you headed in a suitable direction. There are more sleep disorders than just sleep apnea that mess with how we feel and a sleep lab is a better place for those to be monitored.

You could get an overnight recording pulse oximeter to see if you are having oxygen level drops during the night. Those can be found for around $75. Have to make sure it records all night and not just a spot check oximeter. Only problem with those is that not everyone will have significant oxygen level drops with apnea events so the absence of any drops in oxygen doesn't necessarily guarantee that someone doesn't have sleep apnea but the presence of significant drops in oxygen levels would sure be a positive marker for sleep apnea. The least expensive one that I know of with a good history from those of us who have used one is the CMS D50 Plus. The Plus part is important..the regular CMS D50 doesn't record all night.

Ideally a sleep lab study would be the best way to go but many people go the home study route and/or even self diagnose and self treat.

Eric, your symptoms seem pretty telltale to me -- if not sleep apnea, then some 'flavor' of sleep problem that needs attention. The sleep study could save your career, your health, and ultimately your life. Let us know if you need some tips on managing "white coat" anxiety. I just scheduled an overnight study and got a few tips on how to maximize the chances of sleeping decently while in the lab all wired up. If you do end up scheduling a sleep study you might be able to go there before the day/night of your study, see what the place looks like, ask questions about what to expect, etc. That can help reduce anxiety quite a bit. Let us know what happens. You're young, it's a bummer that you have to deal with these issues already, but on the other hand because you are young, you can take steps now that could make a world of difference to your quality of life.

Keep us posted!

Also get a Rx for some type of sleeping pill for the night of the sleep study, wished I done that on my first ... Second time around it was out cold!

Your symptoms sound like sleep apnea to me. I started having symptoms when I was 15 and only weighed 140! I am now 25 over 200 lbs and my symptoms just got worse as I got older. My symptoms were constant fatigue, headaches, frequent nighttime urination, sleep paralysis and extreme nightmares. My family has a history of sleep apnea as well. As for snoring, I don't always snore. There is a long list of symptoms for sleep apnea some of which overlap with other illnesses.

So, I would say to get a new doctor who's going to listen to you. It really isn't as bad as you think! They simply hook you to wires and you sleep. It is a little wierd but look up what could happen if sleep apnea is left untreated! My dad had OSA for over 30 yrs without even knowing it. His blood pressure was so high the doctor said he would die in a matter of years if it wasn't treated! Thankfully the dr suggested a sleep study! Hence I had one as well! It's ok to be scared but it's not ok to let that fear possibly be what kills you.

OldBearIan wrote:I'm frustrated with my doctor because I have mentioned it to him twice and he shrugs it off and offers a sleeping pill prescription.

Eric -- I don't know where you are located, or if you have health insurance, etc., but in my area, (Twin Cities, MN) many sleep centers have their own sleep doctors on staff. They don't require a referral from a primary care physician, as they will want to do a personal interview with you anyway, to determine whether or not to send you for a sleep study. In my (albeit small) experience, those doctors are -very well trained- in all matters of sleep related maladies, not just sleep apnea. If you have health insurance, you'll want to check with them to see what sleep centers or sleep doctors they cover. If not, start calling sleep centers directly, and let them know you will be paying yourself, and they should work with you to set a fair price for a consultation and a sleep study.

Based on what you've written, I would think there would be value in a sleep study. Many centers are working on ways to make you feel more comfortable, whether via home-based study, or studies conducted in "regular" hotel rooms.

Personally, I'd be very wary of a doctor who wanted to start with prescribing a pill when a non-invasive sleep study would provide excellent data in just one day.

The sleep study isn't all that bad! I was very apprehensive about it. The reality was that the environment was pretty nice, the sleep technician was sympathetic, and the bed comfortable. After I was "wired up", I got to watch TV until I felt ready to go to sleep. I got an Ambien which helped too. The value of getting the measurements and information about what was going on while I was asleep was incredible, and in retrospect I'm SO HAPPY I did the sleep test. This is a life threatening condition and easily controlled if you know you have it. It's completely worth it to find out.

Talk to your doctor or find a new one who takes your symptoms seriously. And get a sleep test! The advice to get an oxygen saturation monitor is also sound, if you want to see if something is going wrong when you are asleep. If that is abnormal, you know you need to take the next step.

I believe someone already mentioned a recording pulse oximeter, which is a good idea.

If you have a Android phone, there are apps that are supposed to be able to gauge how much you snore etc. I believe there are apps for the Iphone as well. I searched the Google Market for Sleep Apnea, and found at least one. If you use the app, and the pulse oximeter you may be able to correlate episodes of breathing disturbances. Make sure the times on both devices are synced, so any graph is also synced.

Neither of the above suggestions beats a sleep study, but it can be a more information for your doctor to consider.

As far as sleep studies, I never had a sleep study in a clinical setting. My HMO (Kaiser Permanente) sent me home with a recording device, so I slept in my own bed, at my own time, and as comfortable as I could be. There was a band around my chest and cannulas in my nostrils to measure stuff, but it still was easier for me. That and the fact that I work shift work, made it a lot easier.

-Bill

As a medic, what advice would you give a patient with low oxygen saturation, headaches, etc. who didn't want to go to the doctor because they got all worked up at the thought of it?

The sleep study isn't too bad. I've had two of them. For the first one, I was really concerned about all the wires and what if I pulled one off, etc? For the second one (about 1 month later) I just decided that I didn't care about the wires. I didn't care if I pulled on off because I realized that if I did, the techs would know and they would take care of it. I also had an Ambien for my 2nd study. I was just sleeping. They even did need to wake me to make a couple of adjustments. I didn't care- I just went back to sleep when they were finished. There is nobody in the room for 95% + of the time.

Find a doctor who will listen to you. Push for the sleep study. If it comes back clean, that is a big worry crossed-off your list. If it reveals a problem, you can treat it and begin to recover.

Tony

I just want to start by saying thanks for everyone's time and suggestions, it really helps.  Also, I'm sorry if I offended anyone by saying that I'm not overweight by much, I did not mean to imply that everyone with apnea is overweight, I only mentioned it because it seemed to be a big reason my doctor brushed me off.  Well, that and the no snoring thing.  And I really don't mean to get on here and bad mouth my doctor, it's just that I don't really see him much more than once every couple of years so when I go to him I really mean business.  I think he just has no idea how hard it is for me to go to him at all.  On the same note, does anyone know of a great doctor in the Port Huron / Utica area of Michigan?

I do have insurance (HAP Alliance) but I believe that I have a huge deductible.  I will call them today and see if they would ever cover a sleep study or CPAP machine if prescribed.  This may all be a moot point because if my insurance won't help I won't be able to pay for it myself.  They don't pay us Medics much up here...

The pulse oximeter is a great idea, I think the cheapest one I could find with a 24hr recording feature was like $90, but maybe it's worth it.  I am afraid of going through all this and finding out I just wasted everyone's time at the sleep center.  I definitely don't want sleep apnea, but I know how frustrating it must be to have someone waste your time at a place like that.  Also, I really can't afford to be wrong on this one.

I was determined to sleep on my back last night in preparation of a possible sleep study (as that seems to be the worst position for me waking up gasping) and I want to get used to it.  After about 45 minutes of trying to fall asleep, I did. I don't know for how long, but it felt like mere seconds, I woke up making a strange sound in my throat (almost like a seal bark, haha) and again had the sensation that I had been holding my breath.  It severely unnerved me and I had the worst time getting back to sleep, I tried for another hour before conceding and flipping to my side.  I slept for about 3-4 hours and woke up feeling tired and weak with severe disorientation (very normal for me) and a mild headache that went away within 30 minutes.  Sigh...

I have an iPhone so I'll check and see if there are any apps that record my sleeping.  Thanks for that suggestion, I never thought of it.

The thing is I really don't have any other medical problems at all other than what was mentioned.  I'm healthy and happy, but I'm just so exhausted all the time, I'm done feeling this way, and it's starting to affect my job performance.  That is simply unacceptable considering the profession I have.  I need to be able to think clearly and quickly or it could have grave consequences, I don't take that lightly.  

And Tony, you're totally right, if I were my patient I would be all over telling myself to get this checked out, but I make a crappy patient, and usually put the needs of others before my own (hence putting this off for so long) and I'm not good at telling off a doctor when it's about me, but you better believe that if it were about a patient I’d be up in his face about it, haha.  Also, this is a bit out of my scope of knowledge as they don't get into all this in medic, so I feel under qualified when speaking with a doctor about this.  The caliber of doctors in my area are not especially award winning, but I'm not against a drive for good care.

Regardless, I am too young (at least I think I am) to be this tired all the time...

If you were shorter, your weight would be a prime indicator of sleep apnea. The thing is since your so tall you should be heavier than average but how does that effect your non-muscular system? Stuff like the tissue blow the chin. Since we don't have that info, we can't say.

Your 27 now. Do you think your more fit now than when you were 25 or not? If the answer is no, where are you putting on the non-fit weight? Some people put it on the waist and some put it on where it causes problems.

I think you need a sleep study. There are short term solutions such as sewing a tennis ball on the back of a t-shirt to sleep in. If you can find a loaner recording cpap machine and mask, people here can tell you how to set it and and tell you about the data but that only works for common stuff. If you have a rare problem, a full sleep study is the only way to find that out and its the highest recommended course of action.

OldBearIan wrote:I have an iPhone so I'll check and see if there are any apps that record my sleeping.

Smart Alarm Clock is one iPhone App that I have used to record my snoring. It is also a "smart" alarm clock that uses a combination of your movement plus the time you set to try to wake you up within an adjustable time window (say, 20 minutes). The idea is that it can tell when you are in a lighter stage of sleep, and start the alarm music at that time so you will be less groggy when you wake up. It seems to help, but you can turn off the alarm feature if you don't want it.

It is currently 99 cents.

http://mobile.viaden.com/iphone-sleep-tracker.html