Friday, May 2, 2008
Doctors to accurately diagnose sleep apnea
| Trust your doctor to diagnose your sleep apnea? Think again… I specifically wanted to address this issue as my very own doctor did not detect my classic tell tale signs of obstructive sleep apnea such as sudden weight gain, excessive tiredness with day time sleepiness, high blood pressure, rapid pulse rate and GERD. All I was given was more medication to control my high blood pressure and Mylanta for my “gastric” problems. When my blood pressure situation didn’t improve, a higher dosage of drugs was prescribed to control my high blood pressure or the medication was changed. When I had to often go to the toilet at night due to nocturia, caused by sleep apnea, I was prescribed hydro chlorothiazide to help both to control my blood pressure and help me urinate more during the day so that I will feel less of the urge to urinate in the night. While nocturia is naturally more common in elderly adults, Nocturia among younger individuals who are less likely to have other medical causes of nocturia is a strong indicator of sleep apnea according to this article. I won’t want to dwell on the medical misdiagnoses nor blame my physician because of this. What I wanted to highlight was that I was not misdiagnosed due to lack or insufficient knowledge about sleep apnea. My doctor knew about sleep apnea and has heard about it, but he strongly didn’t believe all my symptoms were a result of obstructive sleep apnea. I was even lectured for putting on weight! It was not until I convinced him to set me up with an appointment to see a sleep specialist and the results came back positive that he realized that I had this condition. It is perhaps this medical prejudice that might lead to one doctor being more open to suggestion of a potential sleep disorder compared to another, as this 2004 study published by the Singapore Medical Association done on a group of Singapore medical students suggests. This study was undertaken to assess the knowledge and attitude among medical students towards sleep medicine. It was also to examine if there was any correlation between a negative attitude and knowledge of sleep medicine. The results from this survey published from the Singapore Medical Association indicated some alarming statistics amongst 3rd, 4th and final year medical students. A complete copy of the study done by the Singapore Medical Association of the behavior and attitude of medical students and their knowledge of sleep medicine pdf copy can be downloaded here. The web version of the findings of the attitudes and behavior of Singapore medical students on sleep disorders can be view here. I have taken some of the key points from the study:
“Given the extent of sleep problems in the population, attempts must be made to incorporate sleep medicine topics as a module into psychiatry or neurology rotations. It can be further emphasized at all levels of medical education”.The point I am generally trying to bring across from what I gathered from this article is that although there is a high degree of sleep disorders in the population, sleep knowledge is generally low as observed in medical students. To make matters worse, there is also a certain degree of personal biasness where sleep disorders are concerned from some medical students and doctors. It all depends on how open a specific doctor is. The more the doctor is inclined towards the topic and seriousness of sleep related disorders, the more their personal interest in sleep disorders will be. This should NEVER be the case! It is however good that this issue has been addresses and now more emphasis is placed on sleep apnea and sleep related disorders. After reading this I find it’s better to get a second opinion or err on the safe side. We trust our lives to doctors to give us their best medical advice based on their years of experience in their specific field of expertise. There is also a conflict of interest as many individuals would be either afraid to question their doctors or the doctors in turn would act defensively when questioned or when asked by a layman who is not a trained medical professional. While I am not a doctor, it’s MY body and MY health that is at risk. I cannot risk my personal health being compromised should a doctor “thinks” that his diagnosis is final and should not be questioned. While I am not trying to say that you should NOT listen to your doctor, I am just emphasizing that when you’re in doubt, seek a second or third opinion from another doctor or seek treatment from certified sleep specialists. Its best to hear a couple of different opinions. After all, doctors are humans after all and they do make mistakes as we have seen or heard off in many instances. I usually find more resistance with more senior or older doctors as they usually feel “undermined” when questioned or when you simply ask more. I never had any issues with the younger doctors who tend to be more open with suggestions and who are more willing to listen to the concerns of their patients. After all, we’re paying for the bill and it’s our body who is being treated for a potential condition. We are all entitled to our medical rights. My doctor was a very senior physician and had not detected the classic symptoms of my obstructive sleep apnea which had been going undetected and untreated for close to 2 years. While I had obstructive sleep apnea since birth, my condition actually became more severe over a routine health check. The doctors noticed that my blood pressure was on the high side. I was quickly put on dose of propranolol and later to atenolol to help control my high blood pressure. I had to actually “convince” him to refer me to a sleep specialist. Personally I think this shouldn’t have been the case at all. Sometimes persistence pays off. In my case, hadn’t I insisted I would have been already “dead” or very sick by now judging from my severe symptoms of obstructive sleep apnea. The video above indicates potential tell tale signs of sleep apnea. It provides good information on sleep apnea diagnosis as well as treatment with the aid of a CPAP device. Labels: sleep apnea diagnosis |
Tuesday, April 8, 2008
Sleep Apnea Diagnosis
I was diagnosed with Obstructive Sleep Apnea (OSA) since early 2002 and have been long suffering from sleep apnea for years. It went undetected because no one knew about it as there was lack of understanding about sleep apnea here in Singapore. Nobody knew much about sleep apnea in Singapore and its potential underlying dangers that it can cause to an individual both physically and mentality. Sleep apnea has the potential to cause harm not only to yourself but others from driving accidents. Not forgetting to mention that it will have disastrous effects on your career by always looking tired and inattentive to your colleagues and bosses (late night of partying huh?) Try studying for that major exam tomorrow if you had not slept a wink for days? Eventually, if left untreated, sleep apnea will not only destroy your career but your health as well. You also become a bane to your family members or your partner due to excessive snoring. You might think that you are the only one who suffers from the lack of sleep. That’s where you’re wrong! Your partner would also be deprived from the lack of rest due to your excessive snoring that will keep them awake throughout the night! So do yourself a favor by getting treated for sleep apnea and snoring as soon as possible. To date, not many individuals realizes the full gravity and extent of sleep apnea and how it can seriously damage one’s life. I hope the information provided here will persuade and convince yourself, or someone you know, to get treated for this sleep disorder today.It was not until I’ve learnt about sleep apnea that it peaked my interest to start writing about my personal experiences, as well as wanting to have a sleep apnea resource site with the sole aim of provide information about sleep apnea and its related sleep disorders. Writing from a personal experience is also much easier, as you know what sleep apnea is all about and how to deal with this condition. I hope to give sufferers of sleep apnea like myself, encouragement and information on how to deal with this problem. I have learnt to live with this condition, and have gotten back to a normal life except for being totally reliant now on a CPAP machine. I also no longer drive in fear of falling asleep at the wheel! Due to the severity of my sleep apnea, I have since stopped driving totally as the risks involved are great. Individuals with sleep apnea double the risk of traffic accidents. Sleep apnea induced driving death statistics found here. You can also get more information about sleep apnea and driving here.  According to my parents, I have been snoring since I was 4 or 5 years old. My guess was that I had sleep apnea as a kid, but they didn't noticed it or realized the severity of the issue until 20 years later. Studies have shown that there have been large number of cases of child obstructive sleep apnea or OSA in very young children and infants. I remember that when I was around that age, I was constantly having problems breathing when trying to sleep, so my dad asked me to try to sleep breathing through my mouth. It helped somewhat, but this also attributed me to start snoring even louder due to an open mouth. Its only when I was later diagnosed that my ENT (Ear Nose & Throat Specialist) who is an expert in sleep apnea found out that I had a very narrow throat that had culminated with my obstructive sleep apnea (OSA). That would have accounted for that fact why I was always tired and falling asleep while trying to study and could not concentrate well enough during my younger days. It was only until much later on after I was diagnosed as having sleep apnea that I realized why I was often tired while doing my revision and homework. At school, I'd always have difficulty concentrating and grasping new ideas. It was however not until much later on that the full effects for obstructive sleep apnea (OS) started haunting me resulting in many problems. My condition was left untreated for close to around 20 years until my life started spiraling out of control.As a child while growing up, I think generally much of the lack of true sleep was compensated by a the raw bundle of energy attributed from youth. But as I've noticed when you start growing older, your lifestyle starts changing and so does your body mechanism and metabolism. When I was around 18 to 22 years of age I still could manage to cope with sleep apnea being undetected and untreated. I was however feeling the strain and constantly struggling when I was in the army trying not to fall asleep. I was still very fit and active then. My sleep apnea condition was more evident and pronounced after I started with a job. Working longer hours, I had less time for exercise. Sitting all day behind a desk didn't really help. I began to put on some weight. As you gain weight, being able to exercise starts becoming more difficult due to laziness and having to work extra hard to shed those additional pounds. The extra weight also made you tire easily and you tend to want to rest more, but due to sleep apnea, you can’t get proper rest. As a result of that, you tend to want to rest more than try to exercise. My condition started deteriorating. Soon, the only thing that I was constantly preoccupied with was sleep. My whole day soon started revolving around sleep. Time at the office dragged as you constantly had to force yourself to stay awake. Minutes felt like days to me and I was constantly falling asleep at my desk. I was hardly able to concentrate and no matter how much sleep I tried to get at home and over the weekends it was never enough. My weekends were just spent sleeping and resting. But it was never enough, my body was constantly deprived of sleep and exercise. My weight started increasing, I hardly could enjoy a movie or the news on tv without falling asleep. A trip on the bus or in the taxi would find me dozing off and snoring away to the amusement of the taxi drivers and commuters. To this day, I still see sleep apnea suffers in the buses or trains having this problem and I also see people looking and laughing at them. I don’t laugh at these people, but shake my head and sympathize with them. Shuddering at the thought that I used to be one of these people that had been mocked and laughed at before I was treated for obstructive sleep apnea. Check out public service announcement from the American Sleep Apnea Association below. The question that often comes to mind is that Why they don't get help? Why don’t their friends and family members help them? Together with awareness, this problem can be cured and you can live close to a normal existence with a few minor inconveniences. With proper treatment you will get the quality of life back. Victims are generally men who are more obese in nature. But it has been proven that sleep apnea does NOT only afflict obese individuals, a study has shown that it doesn’t matter if you’re obese or thin, obstructive sleep apnea (OSA) will still affect both individuals if conditions are right. My blood pressure started increasing but my doctor then did not suspect it was sleep apnea and continue prescribing me medications for hypertension. My blood pressure was getting worst and I was always waking up with cold sweats every night and constantly going to the bathroom with the urge to urinate. The doc gave me some medication to make me urinate more in the morning so that I didn’t have this urge to go in the right, but this did not help, as I kept on having to visit the toilet averaging between 3 to 4 times a night. My life slowly began to fade away with this nightly routine. Going to work every day was absolutely a dread, keeping awake was an absolute torture. I was falling asleep during meetings and on my desk at 9am in the morning! The situation had gotten so bad that my boss had asked me if I was keeping late nights or if I had any problems at home causing me this day time sleepiness. Home and the bed was the only heavenly solace I had, well at least that was what I presumed. Can you imagine life as a walking living zombie? Worst, I started getting nightmares about choking and having not enough air to breath, my wife and family members were saying that I was talking to myself in my sleep while snoring away. Then began the reflux attacks. I initially thought it was heart burn or gastic. While I was sleeping all of a sudden I could feel like I was vomiting out the contents from my stomach which incidentally smelt like puke. It got regurgitated on the my pillow. Again my doctor prescribe Mylanta to ease my “gastric problems” These attacks happened a couple of times. Only much later until after I was diagnosed with sleep apnea did I learnt that this was a case of acid reflux or gastroesophageal reflux disease (GERD) which is often commonly associated with sleep apnea. Naturally, I had no energy to exercise and my weight was steadily increasing and so did all the complications that came with it. It was slowly turning into a was a vicious cycle with my health spiraling out of control. The last straw came when on a holiday with my parents almost by accident (as I don’t stay with them now) noticed me snoring loudly and stopped breathing for close to 15 to 20 seconds and thought I had died or past out. My dad shook me awake and when I suddenly woke up, he told me that whatever I was having, it was serious! They watched me grow up snoring but never experience me stop breathing so this was severe. He had read an article about this medical condition called "sleep apnea" and suspects that I might have this condition. I went back to my regularly doctor and told him about this, he initially dismissed this. It was only after I insisted that he referred me to see my current ENT specialist Dr John Abisheganaden a senior consultant at the Tan Tock Seng Hospital -Department of Respiratory Medicine here in Singapore. Dr John Abisheganaden examined me initially and said that he suspected I had Obstructive Sleep Apnea (OSA) from the symptoms described. He however could not tell me how severe my condition was until I did a sleep study or sleep test to determine the severity of my sleep apnea. He offered me two suggestions, to do the sleep test at the hospital or at home. The home option would be a much cheaper and a more convenient solution, as I wouldn’t need to stay at the hospital for a night incurring additional costs, as well as being in more comfortable environment to fall asleep compared to an unfamiliar surroundings such as a hospital. The home option was also not performed by the hospital, but from a qualified technician from one of the major manufacturers of CPAP device RESMED dealing with the sleep equipments or CPAP machines. The sleep test itself consists of a probe to your nose to measure your breathing, some straps to your chest as well as a blood pressure monitor that was attached to one of my fingers. All the data was recorded in small box like device the size of a compact disc player. It was relatively light and did not hinder any of your movements. In short, it was a relatively painless exercise done at the convenience of your own home. The technician from Resmed came sometime in the evening around 10pm set up the sleep test device. Setting up took around 5 minutes, he gave me some instructions on how to disable and dismantle the device should I need to go to the toilet in night. He left for the night and returned the following morning to collect the device which contained all the vital data collected. It will determine how severe my sleep apnea condition was. My initial response to the data collecting device? I was worried that I could not fall asleep, but the technician assured me that they only needed to capture a couple of minutes worth of data to get an indication of how bad my obstructive sleep apnea was. Incidentally, this would be the same process done at the hospital only by the hospital attendants. Not being to sleep for somebody suffering from sleep apnea was an obvious understatement. Very soon, I was asleep and snoring away providing vital data to the sleep test survey and all the valuable information was recorded into the sleep test device. Resmed sent the results of the test to Dr John and during my next visit he explained the findings to me. The initial prognoses was not good. He told me my OSA was severe and that I was fortunate to have seen him soon to have been diagnosed. I do not have a the actual results off hand, but I did remembered asking him how severe on a scale of one to ten and he said nine! He said the blood oxygen level in my body was very low due to the apneas. I had stopped breathing many times during the course of the night due to the my airway collapsing before I gasped for air when I sleep. He also explained to my family members which I was always cranky and moody as technically, I have not slept restfully, all this while which explains the constant tiredness and mood swings. He told me that I have two options to consider, either surgery which goes not guarantee 100% results or try using a device called a CPAP machine. His recommendation was to try the Continuous Positive Airway Pressure machine or CPAP machine for short and see how I take to it and to this day I have been on a CPAP machine ever since which has been my savior and lifesaver. Since ResMed were the ones who did the Sleep Study for me, I went to them to get my CPAP machine. At that time, they had a rental policy to try the machines out before actually purchasing them. From what I understand, some people have problems adjusting to the machines so it wouldn’t be practical to buy the machines off hand and dumping about two thousand dollars on a machine that you cannot take to or use in the future. So I guess this rental trial program made more sense and was more practical. For me, I took to the CPAP machine rather easily. To this day, I can’t understand why some people are still having issues getting use to it. I guess maybe it’s just plain stubbornness or not having an open mind. Remember, this is a small price you have to pay to improve the quality of your life and its worth every penny and sacrifice for the results it will give you. I'd have to admit for someone new to the CPAP machine, it takes awhile adjusting to it, but you’ll need to come with an open mind to accept it. I had friends and relatives having been diagnosed with sleep apnea, but simply were just too stubborn to try to get accustomed to it. They gave up eventually and their sleep apnea has been left untreated. Personally for me I adjusted well without any issues and have been on it ever since. On the first night with the cpap machine, I naturally had trouble adjusting to it, but I fell asleep after some time. It took me maybe a week or so to get adjusted to the new machine which was a Resmed AutoSet Sprit. For the first time, I noticed that I didn’t wake up to have to go relieve myself until the next morning compared to an average 3 to 4 times every night. I also realized that I was becoming less tired and feeling that I had more energy as I was finally getting some real sleep! I have been deprived from real sleep for nearly 20 odd years, so it was nice to finally experience what a real restful night's sleep felt like! I only noticed another major thing that I hadn’t realized in the past. The office started getting very noisy. I attributed it to the fact that I was always in a dazed and confused sleepy state that I hadn’t really been paying much attention on what’s going on in the office and what’s happening in the background. All of a sudden, being finally rested, I realized that the office was indeed a lively place instead of a dull and quite place that I have always seen it to be. I also found out that I had much more time do so many more things that I had always wanted to do over the weekend. In the past I had been living to sleep. All my spare time or any available time I had was consumed by sleep. Now I didn’t need to sleep that much any longer as I was finally getting some real sleep. I found that I had much more time to start doing many things like going for a movie, getting more exercise doing shopping with my wife without falling asleep! Clearly, the standard of living has gotten better. I was more attentive and more productive at work and could think clearly without thoughts of home and going to bed. The vicious downward spiral has shifted upwards. All thanks to the the CPAP machine. With more energy now, I started being more active and participating in sports and exercises, I began to lose weight and slowly my health started improving. Being diagnosed and treated for sleep apnea with the CPAP machine has clearly reversed my fortunes. I am now living for the sake of living and my quality of life has been greatly enhanced. I could never have imagined what life would have been without having being diagnosed and treated for sleep apnea. Or consider life without the assistance of the CPAP machine. I shudder to think what would have happened if i did not get diagnosed or treated for sleep apnea. I would have been most likely either very dead or very sick by now. Definitely out of a job or maybe would have been prison for running over a person while falling asleep at the wheel. I am indebted for being diagnosed and freed by the CPAP machine. With my new found energy I started the sleep apnea site to convince everybody who has the means to be treated to get themselves well again. Why compromise on the quality of life and let you sleep apnea take over your life? Labels: cpap, gerd, osa, resmed, sleep apnea diagnosis, sleep apnea treatment |