Problems and Pitfalls of definition of sleep apnea
* If you have a sleep problem, go to an accredited sleep disorders center.
* Sleep apnea cannot be diagnosed by just talking with a doctor.
* You need an overnight sleep study to answer:
* Do I have sleep apnea?
* How severe is it?
* How should it be treated?
Seeking the Correct Diagnosis
The first step in treating any medical problem is, of course, the correct diagnosis. To diagnose sleep apnea correctly, two important questions need to be answered:
1. Is this condition actually sleep apnea, or is it some other disorder?
2. Is sleep apnea the only disorder present, or are other conditions present that will complicate both the sleep apnea and the treatment?
The correct diagnosis of sleep apnea can be difficult for several reasons. Sleep apnea often is confused with a number of other sleep disorders, such as narcolepsy, insomnia, restless leg syndrome, or periodic limb movement in sleep. Or the opposite can occur: other disorders (heart conditions, breathing problems, seizure disorders) can be misdiagnosed as sleep apnea. Finally, sleep apnea can be hidden or aggravated by other factors, such as certain medications (sedatives, hypnotics, and beta blockers), alcohol, depression, heart disease, and obesity. For these reasons, it is important for someone with suspected sleep apnea to be thoroughly tested by a sleep specialist. Incorrect or mistaken treatment can be harmful.
Difficulties in definition of sleep apnea
The diagnosis of sleep disorders is a challenge. Unlike with most other diseases, a person may be completely unaware that he has a sleep disorder. Therefore, he may not be able to describe the most obvious symptoms because he is asleep when they occur. In some rare instances, a person will report a feeling that the throat is closing off during sleep, a feeling of choking on the tongue, or a feeling of gasping for breath during the night. Usually, however, people are completely unaware of any problem with breathing. Reports of breathing difficulties may come from a bed partner, roommate, or family member, but these descriptions can also underestimate the severity of the breathing problem.
Sleep specialists use a technology called polysomnography to confirm the diagnosis of sleep apnea and other sleep disorders. Other methods of diagnosing sleep disorders, such as questionnaires, have been tried in the past, but are not accurate enough to recognize particular sleep disorders or estimate severity.
Polysomnography is the electronic measurement of sleep. It consists of using electronic monitors to record the patient’s physiological signals during a full night’s sleep, and then analyzing the recording of the electronic signals. Until these tools became available, sleep apnea went unrecognized.
Appropriately used, polysomnographic testing can distinguish between sleep disorders and other conditions and can measure their severity.
Even with these modern tools, however, sleep apnea can be misdiagnosed. Inappropriate sleep testing can lead to incorrect diagnosis and treatment. Tests must be done according to established standards; otherwise, the test results may be faulty. For example, testing for sleep apnea by means of daytime naps or a partial night’s sleep may give a false picture. Daytime sleep is qualitatively different from nighttime sleep. Because sleep apnea often is worse during the second half of the night, when most REM sleep occurs, a partial night sleep test may underestimate the severity of sleep apnea. Also, if the person sleeps poorly during a test, he may appear to have little or no apnea. Definition of sleep apnea may actually improve with disturbed sleep and appear less severe because the person is in a lighter stage of sleep, so that the healthy, “awake” breathing center is more active than it is during a usual night’s sleep.
Another reason sleep apnea has been difficult to diagnose is that most medical people are not very familiar with the condition. Only in the 1980s did doctors begin to recognize and define sleep apnea as a specific sleep/breathing disorder with characteristic causes and symptoms. It is still best understood by sleep specialists. Even today, the average medical student receives only about 24 minutes of instruction on sleep disorders during his or her entire medical education.
Unless your doctor is a recent graduate of one of the few medical schools that teach about sleep disorders, his or her only contact with the field may be the medical literature, which contains an occasional article about sleep disorders. Reading about sleep apnea is not the same as recognizing the symptoms in a patient. The diagnostic routines that most doctors learn in medical school never prompt them to look for the symptoms definition of sleep apnea.
A typical sequence of treatment begins when a physician fails to definee the sleep apnea and attempts to treat the symptoms. Complaints of snoring, excessive daytime sleepiness (EDS), fatigue syndrome, and/or “insomnia” should be clear signals of possible sleep apnea. Instead these symptoms often are treated with drugs, such as stimulants or sleeping medications, and the underlying sleep apnea is missed or even aggravated, sometimes for many years.
Another common sequence of treatment begins when a patient first talks with a surgeon to try to solve his snoring problem. The surgeon fails to refer the patient for proper sleep testing and does a little snoring surgery on a hunch that “you don’t have sleep apnea”. The snoring may improve for a while, but if the person has underlying sleep apnea, it remains undetected and untreated. The American Academy of Otolaryngology (ear, nose, and throat surgeons) has published guidelines that require patients with snoring to be properly tested before they have snoring surgery. Yet, some surgeons still believe they can tell if someone has significant apnea by simply talking to the person!
If sleep apnea is not diagnosed or treated properly, it may become severe enough that heart and lung complications appear, as in the case of Reverend. A Even then, many physicians will continue to treat the symptoms without suspecting that a sleep/breathing disorder may be the cause.
The difficulties in diagnosing sleep apnea have led to an enormous amount of frustration. Sick people go from doctor to doctor, for years, continuing to suffer from the symptoms of sleep apnea, desperately seeking an answer. People have died, and many more have reached the brink of death, before a chance encounter (a spouse, a friend, a news article, a change of physicians) finally has brought them to a sleep center for proper testing and a clear diagnosis of sleep apnea.
Definition of sleep apnea is number one among the hundred-plus sleep disorders recognized today. Why?
1. Sleep apnea is common: it affects one in ten middle-aged men. It is slightly less common in women.
2. Sleep apnea, untreated, can be deadly.
3. Sleep apnea patients are poorly diagnosed and treated because of the lack of trained sleep experts.
Sleep apnea robs people of vitality, health, and sometimes life itself. Loss of vitality will be familiar to many readers of this book. People suffering from sleep apnea fall asleep anywhere and everywhere, even while driving. Their heavy snoring disrupts their own sleep and often that of their family. They drag themselves to work despite exhaustion, doze at their desks, stumble home completely drained, and fall asleep on the sofa. They lack the energy to enjoy family life or the company of friends.
The health consequences definition of sleep apnea are even more grave. Untreated sleep apnea puts people at high risk for driving accidents, high blood pressure, stroke, irregular heart rhythms, and other life-threatening complications.
Treatment is available and dramatically effective. Formerly sick, sleepy people quickly regain their vigor, resume their cherished activities, and thrive. Life is restored.
Definition of sleep apnea must be with accurate diagnosis, because is the major problem. Eighty to ninety percent of sleep apnea victims are undiagnosed. The National Commission on Sleep Disorders Research has heard countless testimonies of patients suffering for 10 years or more before sleep apnea was correctly diagnosed and treated.
My primary mission in life today is to lift the shroud of darkness surrounding sleep disorders, and with it years of prolonged and needless suffering. Education is the key — public education, patient education, and medical education.
Snoring and Seep Apnea answers all three of those educational needs. It educates the sleep apnea sufferer and the public alike. Further, this site is an authoritative survey of sleep apnea diagnosis and treatment for the primary care physician.
Definition of sleep apnea is as a common and major medical disorder that can significantly impact cardiovascular and mental health, driving safety, and day-to-day functions at home and work. There are over 4,000 sleep centers across the United States and sleep medicine has been recently recognized by organized medicine as a real sub-specialty. Yet millions of individuals continue to suffer without care for their sleep disorder or receive sub-standard treatment and feel dejected that their condition has not improved.