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Sleep Disorders

Sleep apnea test question

11/16/2007

Question:

Several years ago I was building a cabin with a friend. This was very physical work. I was told that I snored like a freight train when we stayed overnight. I thought he was crazy I said I only talked in my sleep.

I also went on fishing trips to Alsaka these trips were called red eye specials. I would be so exhausted from the late night trip. That my friends would wear ear plugs because of my snoring.

So a couple of years ago I went and had a sleep study test done. I was hooked up to all the wiring and finally fell asleep around 12:00 pm. I woke up at 4:00 am to go the bathroom and could not fall back to sleep. At 6:00 am the technican came in and took off all the wiring. I asked her if my snoring annoyed her? She said I did not really snore. I later was told I did not have sleep apnea.

Recently I have gone back to my family doctor because I`ve been so tired. I had been working on a big job, the harder I worked at my construction job the more tired I was getting. He did a complete physical exam, the physical test came out normal. However 4 months later I rarely wake up feeling rested.

My wife has told me that my snoring is making it difficult for her to sleep.

Can sleep test results be different one night to another? Is there a inexpensive test that can be done at home?

Answer:

This is an interesting question and there are many items to address in your story. The main questions you have are whether or not you might have obstructive sleep apnea (OSA) and how best to diagnose or exclude this condition. I’ll discuss OSA in general and attempt to speak to the particulars of your case as we go.

OSA is a common condition, affecting roughly 5% of middle aged adults in America. Most individuals with this condition are still not diagnosed and, of those that are diagnosed, many have had it for many years prior to undergoing appropriate testing.

OSA is a condition where the airway partially or completely collapses during sleep. This results in fragmentation of sleep and, in some individuals, low oxygen level during sleep. The consequences of this condition can be serious and range from a poor quality of life (morning headaches, disabling sleepiness, poor concentration, irritability, etc) to increasing problems with blood pressure control, heart disease and strokes. Symptoms may include waking up choking or gasping at night, very loud snoring (as you describe), poor and unrefreshing sleep, morning headaches and daytime sleepiness. The risk factors for sleep apnea include obesity and craniofacial abnormalities. If you are overweight or have a crowded upper airway (such as from enlarged tonsils or a large tongue or a crooked nose) and have some of the symptoms mentioned above, it’s possible that could have OSA.

As mentioned above, most patients with OSA have had it for several years by the time they are diagnosed. The diagnosis requires some form of objective monitoring of sleep, typically done by an in-lab sleep study. Some sleep centers do offer limited channel home sleep studies, though there is controversy about whether these studies are accurate enough for routine use and not all third party payers will acknowledge or pay for these types of studies.

In your case, you may still have OSA, but it was not diagnosed on the initial study. There can be some night-to-night variability in sleep apnea and sometimes one night of sleep, especially if it was short in duration, may not be sufficient to exclude OSA. In addition, capturing only 4 hours of sleep time may not include supine and/or dream (REM) sleep, times when OSA is usually at its worse. It is also possible that you may have developed OSA over the last 4 years with aging or additional weight gain that may have affected your airway anatomy. Infrequently, a traumatic event, such as a broken nose, could be the trigger that leads to the development of OSA.

Without objective testing (a sleep study), there is no way to tell with certainty, based on historical information, if you have OSA or not. There are other possible explanations for your symptoms that need to be considered as well. Narcolepsy, inadequate sleep, a circadian rhythm disorder and periodic limb movement disorder are all sleep disorders that can be associated with some of the symptoms you report. Numerous other factors may influence the quality of your sleep and can lead to fragmented sleep with resulting excessive fatigue and sleepiness. These can range from the environment you sleep in (i.e. too warm, too loud) to other medical problems (i.e. heartburn or breathing problems) to medications you may be taking. In some cases, no clear cause for sleepiness can be found and the condition is labeled as idiopathic hypersomnia.

It would probably be a good idea to discuss your case with your primary doctor. Referral to a Sleep Specialist in your area may be useful. They can review your records as well as your history / exam and determine if additional testing is needed and if so, what method of testing would be best for you. I recommend seeing a Sleep Specialist that is board certified and working at an accredited Sleep Center.

To learn more about sleep apnea or other sleep disorders, please visit the American Academy of Sleep Medicine website. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you. Good luck and here's to good sleep!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University