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Is The Epworth Sleepiness Scale A Reliable Indicator of Sleep Apnea. For Everyone?
The Epworth Sleepiness Scale is used as a quantifying the level of daytime sleepiness in specific situations. I would like to ask the sleep professionals on Sleep Guide how they rate this scale. I ask because my answers to the scale delayed my diagnosis of sleep apnea.
My internist was a good diagnostician; he apparently suspected I had sleep apnea because at each visit he presented me with the Epworth Sleepiness Scale, asking me to complete it. My answers, all in the negative - I never had the slightest risk of falling asleep, at any place in the daytime. I didn't do much better at night either. Eventually he firmly suggested a sleep study. I didn't comply right away, but completed the Polysomnography in 2000.
The doctor was right when he thought I might have sleep apnea. I was diagnosed with severe Obstructive Sleep Apnea Syndrome with almost 100 apneas and hypopenas per hour of sleep accompanied by moderate to severe oxygen desaturations. A titration study was ordered. In the Study Summary, the comment was included "Nevertheless, she has a low Epworth scale score, of 1 out of a possible 24, indicating a low degree of daytime somnolence"
Some of my earliest childhood memories including laying awake for a long time at night. By teen age and adulthood I experienced chronic insonmia - perhaps partly because I was a curious and didn't want to miss having a part in anything interesting.
Cpap mask had not reached their current technicological level, and I could not get a mask that didn't blow directly into my eyes. I eventually had UPPP surgery. I have had subsequent sleep studies indicating moderate sleep apnea. I bepan CPAP therapy in January 2009..
I had experienced insonmia, or an unwillingness to go to sleep till starting CPAP, My Epworth Sleepiness Scale also changed after starting CPAP. I fell asleep in plays, at church, in a doctor's office; almost anyplace I sat down. I was sleep deprived at that time, and attributed my daytime sleepiness to lack of sleep. I am not sleep deprived now, but I have frequently have to fight falling asleep in the daytime. I estimate my currnent Epworth Sleepiness Scale would be around 14.
Can a sleep technician tell if a person's body chemistry changes during CPAP - or what could have created such a drastic change? Have others had a change in their daytime sleepiness. I am puzzled, and would like to understand the intricities of sleep, and why they can change later in life.
person and didn't want to miss being a part of anything interesting.
My internist was a good diagnostician; he apparently suspected I had sleep apnea because at each visit he presented me with the Epworth Sleepiness Scale, asking me to complete it. My answers, all in the negative - I never had the slightest risk of falling asleep, at any place in the daytime. I didn't do much better at night either. Eventually he firmly suggested a sleep study. I didn't comply right away, but completed the Polysomnography in 2000.
The doctor was right when he thought I might have sleep apnea. I was diagnosed with severe Obstructive Sleep Apnea Syndrome with almost 100 apneas and hypopenas per hour of sleep accompanied by moderate to severe oxygen desaturations. A titration study was ordered. In the Study Summary, the comment was included "Nevertheless, she has a low Epworth scale score, of 1 out of a possible 24, indicating a low degree of daytime somnolence"
Some of my earliest childhood memories including laying awake for a long time at night. By teen age and adulthood I experienced chronic insonmia - perhaps partly because I was a curious and didn't want to miss having a part in anything interesting.
Cpap mask had not reached their current technicological level, and I could not get a mask that didn't blow directly into my eyes. I eventually had UPPP surgery. I have had subsequent sleep studies indicating moderate sleep apnea. I bepan CPAP therapy in January 2009..
I had experienced insonmia, or an unwillingness to go to sleep till starting CPAP, My Epworth Sleepiness Scale also changed after starting CPAP. I fell asleep in plays, at church, in a doctor's office; almost anyplace I sat down. I was sleep deprived at that time, and attributed my daytime sleepiness to lack of sleep. I am not sleep deprived now, but I have frequently have to fight falling asleep in the daytime. I estimate my currnent Epworth Sleepiness Scale would be around 14.
Can a sleep technician tell if a person's body chemistry changes during CPAP - or what could have created such a drastic change? Have others had a change in their daytime sleepiness. I am puzzled, and would like to understand the intricities of sleep, and why they can change later in life.
person and didn't want to miss being a part of anything interesting.
Views: 399
Replies to This Discussion
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Permalink Reply by Mike on
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I've never personally related to the Epworth Sleepiness scale myself, and think it's kind of a broken metric in my case.
As for sleep and aging, I know that it becomes more difficult to get deeper levels of sleep as we grow older, and that our sleep becomes more fragmented. we experience the deepest and "best" sleep in our early youth, around 10 years old. It's downhill from there on in, from what I've read.
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Permalink Reply by Ruth Rayceen on
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Thanks Mike - You are the voice of sanity in a crazy world, and you encourage me-as you do everyone here. In fact, I see little bits of Mike everywhere. jRR
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Permalink Reply by RockRpsgt on
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I believe those scales to be a measure of fatigue or a persons abiltity to fall asleep in certain situations. I would not say that it is good for measuring apnea, but by seeing how tired you are in certain situations a dr might be able a predetermine a need for a study. The test are biased based on a persons honesty.
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i n k
- I n the first paragraph you describe the Epworth as a tool - I agree. In the second , you propose a concept I would have rejected a few months ago. But as I re-read it, it is almost like you had a glimpse into my subsconscious mind. From teen-age though adulthood, I was a high-energy person. An amazing capacity for work during the day - and play at night.I didn't know how to admit I was tired--tired enough that I developed a series of diseases - High Blood Pressure, Diabetes and Fibromyalgia by fatiguing my body, but I kept on going.
Foward to January of 2009, after beginning Cpap therapy, it didn't take me long to realize I couldn't be up frequently at night - trying to resolve the early issues of therapy, mask problems, alarms sounding - and keep going at the same level.I had to change, or the sleep deprivation felt like it was going to break me.. So I slowed down, worked to find a satisfactory mask.. It certainly wasn't a high charged existence.
We went to see the play "Lion King. It was something I wanted to see - I did something, I have never done before - I slept through most of it. The friends we went with were amused and said that was a first for me. I fell asleep in a lecture. My head kept dropping at the most inopportune times. I felt baffled, but there is a good possibility you have solved the puzzle for me. I also agree with your thought to maintain a even sleep schedule.
I don't consider it an oversimplified theory. It may not be precisely correct - but it is reasonable. You may have the same quality as my previous doctor - an excellent diagnostician. Thanks for a most interesting proposal. Ruth
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I so understand that "didn't want to miss being a part of anything interesting"!!!! I've been a "night person" so long as I can remember. It seemed like after the "after dinner lull" things started to pick up and all kinds of doings were going on I didn't want to miss out on.
I found live chat on the net to be ADDICTING! Heaven forbid I should go to bed if there one person left in the chat room to chat with!!! Even when I had to be up at 5:30 AM.
I managed to break most of my bad habits, but I still find it difficult to go to bed before midnight. On those nights when I am so tired I DO crash early I wake up in the middle of the night - wide awake - and there is NO GOING BACK TO SLEEP for 2-4 hours.
One thing I have found thru the years. My best hours of sleep are from 6 AM to 8:30 AM. Even if those are the only hours of sleep I get I will feel MORE RESTED than if I slept 8 hours but had to be up BEFORE I got those two precious 6 AM to 8:30 AM hours of sleep.
I've tried all the sleep hygiene suggestions at one time or another. One thing that does NOT work for me is to just lay there in bed when the ole mind is a whirring and not wanting to shut down and go to sleep. All that gets me is a bunch of physical aches and pains, especially the lower back, or maybe the hips. But when still working, getting up if I hadn't fallen asleep w/in 30 minutes wasn't really any too practical either.
There was the suggestion to gradually change your circadian rhythm - gradually is the key - that "might" be of help to you IF you are not working outside your home. If I were you I would look into that as it sounds like that might work for you.
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Here is a good explanation of circadian rhythm and circadian rhythm disorders. I'm looking now for the routine for bringing your circadian rhythem back into line w/your needs.
http://emedicine.medscape.com/article/1188944-overview
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Here is a recommended course of treatment for circadian sleep disorder. Its somewhat different than I remember reading about in that I was thinking it was in 1 hour increments rather than 2-3 and over a longer period of time, I was thinking like maybe an hour a week. But I would assume this recommendation is more up to date. Maybe.
http://www.emedicinehealth.com/sleeplessness_and_circadian_rhythm_d...
Food for thought for you anyway. Good luck!!!
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Judy - I could have written your post. Why go to bed when there is something - anything else to do. You could be my twin. We could have been a dangerous duo together. I have never gotten into on-line chatting. Please tell me about it. I went to bed last night - slept for an hour, was restless and got up and and e-mail back and forth with some night-owl friends. ounds like we both have some friends to play with at night. And like you, I went to bed somewhere between six and seven, and got up at nine
I have been reading your posts and noticed you had been doing extensive research - that is another of my fav things..
Thanks for the links to Circadian rhythms - I will check them out.
My friends and I are politican junkies - We watch the two largely political TV Stations - then do our e-mail rants back and forth. If you and I are alike - I bet you are married to a Lark - Mine likes to get up at the crack of dawn and be the first one on the Golf Course. Many times, I am going to bed as he is getting up.
I have only been on cpap since late in January - I'm still trying to work it out - How long have you had apnea.
Thank you for your post - it was as much fun as talking to and old friend. Ruth.
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Ahhh, another sinner! Actually, I have reformed - to some degree. I "try" to keep a midnight bedtime. You know, sorta like Cinderella.
talkaboutsleep and apneasupport both have live chats - at scheduled times, which is a PITA 'cause I've also always fought the clock all my life. The first thing I did on retiring was toss my watch in the drawer and haven't looked at it since. The onl clock I ever look at is my 'puter clock! (Or the clock in my car when I"m rushing to an appointment I almost forgot about since I'm not one to spend much time looking at a calendar either since retirement). Ha! If I ever had to speak to a shrink and he asked me what day of the week it was .... I'd probably be in a world of hurt!!! I do keep track of who's President tho!! Which "might" save me from his clutches. Maybe.
cpaptalk.com has a live chat, open at any time, not always someone there to chat with but the forum is busy enough that sooner or later someone sees your name listed for the chat room and jumps in to jaw w/you. Like I said, chat is addicting so I try not to go into them very often. USUALLY the cpaptalk chat room has emptied out by midnight tho. There are a couple of RTs who sometimes jump in and chat w/us which is nice.
Yeah, hubby is an early bird, rise and shine, type of guy, bless his heart. I don't mind staying up in the dark but I HATE waking up in the dark!!! What'd I miss? *wicked grin*
I started CPAP in Oct 2006. Actually, I had my first PSG and titration about 1996-1998, but Wright & Filippis was the local DME I received my equipment from and they were about as much help as a sore a$$ and when I went in about 2 1/2 months after starting CPAP to ask for a "better" mask 'cause I had a raw sore on the bridge of my nose and they told me my insurance wouldn't pay for another mask .... I handed them their equipment and told them what they could do w/it not very diplomatically or quietly I'm ashamed to say. Their desk dragon was just such a ...... she torqued my jaws and I lost it.
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Jeff, there is a lot of sense to this hypothesis. I imagine it's also backed up by peer-reviewed scientific research, but i'm too lazy at the moment to go and dig it up to prove the point. the body is very wise, and your explanation falls squarely into what the wisdom of our bodies would have us do.
j n k said:What I'm about to say falls squarely in the realm of personal theory, not accepted medical science, I believe--but I'll throw it out there anyway.
First of all, any survey like the Epworth is a tool and a tool only. It is subjective. It's main purpose is to prove there is something to treat, since most people will have some AHI problems, and you can't treat them all just for fun. You treat the people who are having some problems. (so far I don't think I've strayed too far from science, but here I go . . .)
When the brain knows that every time it allows sleep it gets indications that you are being strangled to death (sorry for the drama), it naturally is going to develop an aversion to allowing that to happen. The brain does what it can to keep you awake, because it knows breathing is important, and it doesn't want you to die. (sorry, again) Once you get treatment that allows you to sleep and breathe effectively at night, the brain picks up on that and stops trying to keep you awake all the time. The floodgates open up as your body starts trying to get all the sleep and REM and deep sleep it can. The brain gets excited that suddenly it seems safe to let you sleep. That causes things to be pretty unbalanced for a while. The trick is to be very strict with your sleep hygeine at that point to train yourself to get 8 or 9 hours, because your brain is like a baby learning to walk and needs that training. Once you train yourself to sleep in your bed, at night, for 8 hours, your life will begin to get divided back up into sleep time and awake time with both phases fully what they should be, if there aren't other health issues getting in the way. That's my overly simplified theory, anyway.
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Judy,
I guessed what you were like from your first reply - I wasn't wrong, your last reply sparkles with personality. It was so much fun to read - Asa I have a bit of time, I'm going through some of the discussions and pick-out some of your responses - If I am right about them, I think I'll find they are: (I read several before you responded to this) well thought out, reasoned, intelligent, and compassionate and have an original point of view. Till we cross paths next, I would like you to be my friend. Ruth
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