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Self-screening for SDB
The subject involved is a 25-year old female with a stellar academic background and has started off with a roar on her young career. She has many friends and is in a high-exposure and high personal-contact career. On the surface everything seems fine. But knowing her and her family fairly well, I see problems.
The young lady calls her mother almost daily, crying about fears and insecurities. This is a continuing pattern that started as soon as she began college.
Her mother has stated that the daughter "doesn't do well" unless she gets plenty of sleep. The daughter tries to arrange her schedule so that she has nine hours in bed per day. She tends to have dark circles under her eyes and takes care to cover them with makeup. She has a narrow jaw and needed braces as an adolescent.
I once asked if the daughter snores and the answer was, “No.” I asked her mother if the daughter had been screened for sleep apnea and the answer was, “She doesn’t have sleep apnea. She just has insecurities.” It was obvious from the tone of the answer that the mother did not want me to ever mention this again. (Rhetorical question - Why are people like this?)
I have looked at the Berlin Questionnaire and scored it for this young lady as best I can. I gave her one point each on questions six and seven and no points on the other questions. Two points total equals low risk for sleep apnea. But I fairly well convinced that she should still be screened by a sleep doctor. (Well, I think everyone should be screened every time they have a physical examination. But that is a separate subject.)
My question to the forum: Is there another tool available for self-screening which would be sensitive to SDB and particularly silent UARS?
Knowing what I went through in all those years of “undiagnosis/misdiagnosis”, it pains me to see others suffer.
The young lady calls her mother almost daily, crying about fears and insecurities. This is a continuing pattern that started as soon as she began college.
Her mother has stated that the daughter "doesn't do well" unless she gets plenty of sleep. The daughter tries to arrange her schedule so that she has nine hours in bed per day. She tends to have dark circles under her eyes and takes care to cover them with makeup. She has a narrow jaw and needed braces as an adolescent.
I once asked if the daughter snores and the answer was, “No.” I asked her mother if the daughter had been screened for sleep apnea and the answer was, “She doesn’t have sleep apnea. She just has insecurities.” It was obvious from the tone of the answer that the mother did not want me to ever mention this again. (Rhetorical question - Why are people like this?)
I have looked at the Berlin Questionnaire and scored it for this young lady as best I can. I gave her one point each on questions six and seven and no points on the other questions. Two points total equals low risk for sleep apnea. But I fairly well convinced that she should still be screened by a sleep doctor. (Well, I think everyone should be screened every time they have a physical examination. But that is a separate subject.)
My question to the forum: Is there another tool available for self-screening which would be sensitive to SDB and particularly silent UARS?
Knowing what I went through in all those years of “undiagnosis/misdiagnosis”, it pains me to see others suffer.
Views: 27
Replies to This Discussion
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Permalink Reply by susan mccord on
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Banyon--I don't have the answers to your questions but I have,in common with you, the preoccupation with symptoms I hear repeated frequently out here that, to me, scream OSA. I also wonder "What's up with people being so resistant to the thought that they may have apnea???" They really ARE!!!
My closest friend of 30+ years has lupus and Meneire's Disease, works fulltime as a gifted child teacher in elementary school. She has every single symptom I can name of OSA. I've talked with her many times about it, and her response is always "I see so many doctors now, I can't stand the thought of going to one more"--that happens to be true. She does. But I know her well and there's a denial factor that can't be ignored. She saw her PCP this week who, after hearing about her now critical level of exhaustion, (she always has some due to lupus), suggested a sleep study!!! My friend agreed, because the MD recs it, thank God.
THEN she saw her rheumatologist (lupus) later in the week---SHE told her she doesn't think she has sleep apnea, that she thinks it's her heart. Well, J.C. and all the saints, it could be both!, but how can she rule out OSA out of hand????? She's a rheumatologist and excellent at that, but to tell a highly-compromised, symptomatic patient something like that, to me, borders on malpractice. What's with these MDs that so many of them either ignore or dismiss apnea symptoms???????
I'm really torqued about this. My friend has decided now that she'll have a cardiac consult but not a sleep study. OMG, it's making me nuts!!! I've talked with her about the co-morbidity factor of HD and apnea, etc., etc.,........but now because of one stupid opinion from one specialist in another field altogether. she's not gonna follow up with a sleep study;
This woman teaches all day, goes home late afternoon, goes to bed THEN and doesn't get up till time for school the next day. She has dinner with me once a week, can't go to movies anymore 'cause she falls asleep, fights falling asleep driving, is quite overweight, snores hugely, .....on and on and on........I'm just so pissed off that this rheumatologist negated one of her longtime docs' recs when she obviously doesn't know what the hell she's talking about!!!! My friend sleeps the better part of nearly every single weekend and has gotten worse over recent months.
I don't know what to do. I'm scared to death for her.........what is it about apnea that has doctors acting stupid and people ignoring symptoms and denying any possibility that they may have a sleep problem??????????????????
Susan McCord
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Permalink Reply by Banyon on
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susan mccord said:.........what is it about apnea that has doctors acting stupid and people ignoring symptoms and denying any possibility that they may have a sleep problem??????????????????
Susan McCord
Susan, That's the best rant I've heard this week. Thanks for saying it.
But I still have my problem and want to "work" on this young lady to get to a good sleep doctor.
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Permalink Reply by Henning on
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Banyon,
The problem with UARS is that even an in-lab sleep study normally will not show if there are problems with UARS. This requires an additional PES measurement.
However, I believe that there are simple metrics for this. Take a look at this website. It is from one of our members David E. Lawler DDS.
http://www.centerforsoundsleep.com/Upper-Respiratory-Resistance-Syn...
Personally I think that dentists are far more advanced in terms of UARS than sleep physicians.
Henning
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Permalink Reply by Jerri Lynn on
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Banyon, perhaps your friends doctor is one of those that "brushes off apnea" and instead attributed the daughters symptoms to "insecurities" as the mother stated to you.
MANY people......TOO MANY people look at apnea and/or think of apnea as some kind of horrible, embarrassing, disfiguring, disgusting, anti-social disease or psychological disorder......almost as if it were some nasty communicable disease caught through drug abuse, sexual improprieties, hygiene, unsanitary living/life styles, WHATEVER!
The response of the young woman's mother, to your suggestion of SDB suggests she too, misunderstands this medical condition.
Hopefully the young women will seek medical attention herself.
I'm an intelligent individual and have no idea why I was so personally adverse to accepting the diagnosis. I was, and am still stressed as to how CPAP will affect my social and intimate life.
I had to hit the bottom of the pit before I would listen to my doctors. It wasn't until EVERY aspect of my life was adversely affected that I was willing to listen. It was suggested to me 15 years ago that I had apnea. It wasn't until this year that I agreed to a sleep study. It then took me another 3 months to agree to CPAP and an additional two months to actually get CPAP.
When I say bottom of the pits......I mean bottom of the pits!........
Due to lack of understanding and other variable reasons unknown, there's definitely a degree of stigma associated with apnea. Thereby, it's difficult for people to admit, acknowledge and accept this life threatening disorder.
Perhaps you should suggest and provide the young woman and her mother with some reading material. After that, suggest she visit SG.
It was actually the members of this site that made me realize I should accept my doctors diagnosis and give CPAP a shot.
I still don't like my diagnosis or CPAP, as I know it's going to be life changing for me......both positive and negative changes. I'm trying to focus on just the positive changes for now......as in my health. I handle the social changes as I'm forced too.
I finally admitted this morning to one of my daughters (an RT) that I had OSA and was on CPAP. Until this morning, only my doctors and the members of SG were aware of my OSA......
I'm making baby steps!
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Permalink Reply by RockRpsgt on
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I am currently in Chicago on my pda so I do not have access to my files. When I get home I will see what I can dig up for you. In the mean time what can you tell us about her medical background? Anxiety , depression, even being a klutz can be tied to bad sleep. The shortest distance between two points is always a straight line, but sometimes the loop is the only option.
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Permalink Reply by 99 on
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in situations like this it is much better to talk about yourself your symtoms your problems your frights your misery
to deflect the conversation from herself
let her come to that conclusion herself
oh and by the way you have the EPWORTH SCALE to help in diagnosis
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That information on the Watch=PAT200 is impressive (http://www.centerforsoundsleep.com/Upper-Respiratory-Resistance-Syn...). If I had one of those, I would be harassing a dozen people to wear it overnight.
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Banyon, knowing this family as you do, do you have any sense that the mom may be getting some kind of personal affirmation/payoff from having her daughter so dependent on her? She seems pretty vested in staying in the "mommy" role with her daughter as opposed to helping her learn to make independent decisions and think for herself.
When you take a look at the girl's accomplishments to date, it's clear that she's highly competent in many ways.
The fact that the clinginess began when she left for college makes me wonder just whose dependence it really is. SEPARATION ANXIETY? If so, whose anxiety is it, really?...............this girl has a good education, a fine, people-oriented career, and tons of friends. Sounds like a recipe for success to me!!!!! What's standing in her way??.........food for thought.........
Most healthy parents, even though they struggle with their kids leaving home (I sure did!), make an effort to cut them loose to live their lives the best they can. This girl has tremendous potential from what you report. It wouldn't surprise me at all to learn that Mom is over-dependent on daughter, not the other way around. Guilt is a powerful manipulation, especially with kind, compliant, compassionate kids.
Mom MAY be subtly (or not so subtly) encouraging her to stay dependent on her to meet her own needs, or fear of "empty-nest" syndrome. The fact that she flat out denies her daughter has apnea and makes her own "diagnosis", which by the way is quite demeaning to a daughter who is so clearly bright, intelligent, social, and making her way out in the world in significant ways, is somewhat revealing in and of itself.
What's her vested interest in encouraging her grown, successful, people-oriented daughter ro remain so emotionally dependent on HER???
Does Mom work? Does SHE have friends? Does she have other children and, if so, what kind of relationship does she have with them? Is Mom in a relationship herself?
This is just another perspective on what sounds like a complex mother/daughter relationship. Where's the father in this situation?
I sure have asked a boatload of questions here, but my gut sense is that the lack of willingness to seek diagnosis/treatment COULD lie in an interdependent relationship that's not serving either of them well.
This girl may very well be suffering from sleep apnea. She ALSO may be suffering from feeling caught between her life as a child in her mother's eyes, and her very powerful opportunity to be independent and successful. That's a huge burden for ANY young person 'cause often they're then confused about where their loyalty lies.
Just another perspective for you to consider as you go about the business of trying to help this family.....you might want to give some thought to befriending the young woman and beginning to affirm to HER that she's an adult and capable of making decisions about her life and her health separate from her mom.....it can be a VERY difficult concept in some families. If I'm anywhere even close to the reality of this situation, she's in for a real struggle to separate, as is normal for someone her age.
Good luck! Keep us posted.......
Susan McCord
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susan mccord said:Banyon, knowing this family as you do, do you have any sense that the mom may be getting some kind of personal affirmation/payoff from having her daughter so dependent on her?..........
As charity work, I just try to get 'em to go for a consultation with a sleep doc. If we get into psychotherapy, my rates are $225/hour for males and $375/hour for females. :)
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