How do I know if I have a sleep disorder?
There are over 80 different sleep disorders recognized by the International Classification of Sleep Disorders (ICSD, 2005). Although the number of sleep disorders is many, they all tend to share varying degrees of up to three very recognizable symptoms: 1) excessive daytime sleepiness, 2) Insomnia with difficulty initiating or maintaining sleep or non-refreshing sleep, and 3) unwanted behaviors that may occur during sleep (parasomnias).
Excessive daytime sleepiness is the most common reason why patients come to seek help from a sleep medicine specialist. Excessive sleepiness is generally most noticeable when a sleepy individual sits still or becomes inactive such as reading or watching TV. Excessive sleepiness can become particularly dangerous when driving a motor vehicle, placing the individual and other drivers at risk from a motor vehicle accident from falling asleep at the wheel. A well-rested individual should be able to sit through these and other boring situations without nodding off. If you nod off when inactive, it is a strong indication that you may have a pathological sleepiness.
The most common cause of excessive sleepiness in the United States is simply not getting enough sleep at night. We tend to be sleep deprived as a nation, staying up late with various activities and getting up early the next morning for work or school. Since patients with excessive sleepiness often compensate by keeping themselves very active, some patients may not recognize or appreciate the degree or severity of their own sleepiness, particularly if it is long-standing or life-long. Finally, some patients may confuse their sleepiness with “low energy” or “fatigue”. However, patients with fatigue secondary to medical conditions other than a sleep disorder tend not to nod off when inactive. For example, patients with congestive heart failure may have prominent fatigue and low energy, but they will generally only nod off when inactive if they also have a sleep disorder. The presence of excessive sleepiness that persists in spite of allowing oneself adequate sleep at night is a strong indicator of an underlying sleep disorder.
Difficulty initiating or maintaining sleep, or non-refreshing sleep, are symptoms commonly associated with insomnia (see insomnia). Although there are several specific disorders of insomnia, insomnia can be a symptom of many other sleep disorders such as obstructive sleep apnea (see obstructive breathing in sleep), restless legs syndrome or other medical conditions such as depression or anxiety. It is helpful to regard insomnia as a symptom like a “fever”. Just as many things may cause a fever, many disorders may cause insomnia. To the extent possible, we try to identify and treat all of the underlying causes of a patient’s insomnia. If you have difficulty initiating or maintaining sleep, or non-refreshing sleep, you may have a sleep disorder and should consider an evaluation from a sleep medicine specialist.
Parasomnias are unwanted or undesirable behaviors or experiences that occur during sleep, such as sleep walking, sleep terrors, nightmares, sleep eating behavior, or enuresis (bedwetting). Some parasomnias occur more specifically during deep slow wave sleep such as sleep terrors, and, therefore, are most common during the first half of the night. Other parasomnias may present during rapid eye movement (REM) sleep, also known as dream sleep. Since REM sleep is most prominent in the early morning, REM sleep parasomnias such as nightmares or REM sleep behavior disorder are more likely to manifest during the second half of the night. Parasomnias are generally easily treatable once the underlying diagnosis has been established.
Do all snorers have sleep apnea?
The presence of snoring is a strong indication of increased resistance through the upper airway during sleep and definitely raises the suspicion that a disorder such as obstructive sleep apnea may be present. However, some patients may have obstructive sleep apnea even in the absence of snoring. Such patients may have “heavy breathing” or, in some cases, make very little noise at all. Patients who have extensive soft palatal tissue, such as a long soft palate or uvula, tend to be loud snorers. However, others who have a small or micrognathic mandible in the presence of a normal soft palate can have a severe obstructive sleep apnea even though they do not snore.
Can I have more than one sleep problem?
It is actually common to have more than one sleep disorder. For example, approximately 25% of the general population over the age of 65 has some form of obstructive breathing during sleep. The prevalence of restless legs syndrome in patients over the age of 65 is also approximately 25%. As a result, it is common for patients, just by chance, to have both obstructive sleep apnea and restless legs syndrome. We have also found that patients with narcolepsy are more likely to have or develop obstructive sleep apnea, particularly as narcoleptic patients age. Unless all sleep disorders are diagnosed and treated in any given patient, symptoms such as excessive daytime sleepiness will not adequately improve or resolve. At the Ohio Sleep Medicine Institute we take a comprehensive approach to identify and treat all sleep disorders to achieve the greatest success in patient satisfaction and outcome.
Should I get a second opinion?
If you have been seen by another sleep medicine physician or clinic yet still feel that your symptoms are not adequately improved, we would recommend that you seek a second opinion from the Ohio Sleep Medicine Institute. The quality of sleep laboratories is highly variable (see Quality), much more so than other medical specialties. Some sleep labs only treat obstructive sleep apnea and do not take a comprehensive approach in treating or managing all sleep problems. Many sleep labs are focused on seeing a high volume of patients and the patient may not even see the sleep medicine physician during an office visit. We commonly see patients who have not been satisfied with their care at other facilities. At the Ohio Sleep Medicine Institute our sleep medicine physicians see every patient during each consultation visit and specifically tailor your treatment plan to address your unique needs. If you are not satisfied with your care, we recommend that you seek a second opinion at the Ohio Sleep Medicine Institute.
Will my insurance cover a sleep evaluation?
Almost all health insurance plans cover sleep medicine evaluations from the initial consultation visit, to the overnight sleep study (polysomnogram), and most treatment options. At the Ohio Sleep Medicine Institute, we are in network with all major insurance carriers with the exception of Medicaid. However, in case we are not in network with your health insurance carrier, we recommend that you contact our office for more information. We do the precertification and predetermination of insurance for all patients. Our Institute is independent of any hospital affiliation, providing a big cost savings in patient care.
What is a CPAP?CPAP is a acronym for Continuous Positive Airway Pressure. It is the standard of care for the treatment of Obstructive Sleep Apnea (OSA). A CPAP involves the use of an adjustable blower unit connected to a small mask usually covering the nose. A nasal CPAP acts as a “pneumatic splint” by increasing pressure in the oropharyngeal airway, allowing air to flow in and out easily, thereby reducing the work of breathing. Consequently, microarousals due to apneic events are eliminated, sleep is less disrupted and patients feel more refreshed and energetic. Patients typically adapt very quickly to CPAP, and most patients report sleeping better and feeling better the next morning after using the device. Some patients may undergo an adjustment period lasting a few days to a few weeks, depending on how potential side effects are managed.
How important is a sleep evaluation?
A sleep evaluation is much more than simply an overnight "sleep study". Before an overnight study is even considered, the most important part of the evaluation is getting a good "sleep history" which involves the physician asking the patient many questions to fully understand the scope of the patient’s problems. Once this history is obtained during the initial consultation visit, the physician may or may not require an overnight sleep study or polysomnogram (see "what is a polysomnogram") to obtain additional information. At the Ohio Sleep Medicine Institute, we take a comprehensive approach in patient care and, in case an overnight study is needed, the physician will review all of the results directly with you when making diagnostic or management decisions.