Sleep disorders under-diagnosed, could pose severe health risks

Oct. 02--Tweet

Sleep disorders are among the most under-diagnosed, treatable illnesses in the United States. Studies show between 10 and 20 million Americans have sleep apnea, the second most common and most under-diagnosed sleep disorder, but around 90 percent are undiagnosed.

"Forty percent of adults report treatable sleeping problems," said Steve Doe, technical coordinator at Samaritan Medical Center's Sleep Disorders Center. "(Sleep specialists) see maybe 1 percent for treatment."

Dr. Daniel A. Barone is an assistant professor of neurology at Weill Cornell Medical College, an assistant attending neurologist, and sees patients at the College's Center for Sleep Medicine. According to Dr. Barone, while doctors have started to see and hear about sleep disorders far more, under-diagnosis is a tremendous problem, especially for sleep apnea, which afflicts about 24 percent of men and 9 percent of women.

Sleep apnea causes pauses in breathing and periods of shallow breathing during sleep. The most prevalent form, obstructive sleep apnea, is characterized by blockage of air flow. Other common sleep disorders include insomnia, restless leg syndrome, teeth grinding and narcolepsy.

DIRE CONSEQUENCES

Sleep disorders that go undiagnosed can have serious consequences, including strokes, heart attacks, high blood pressure, even death. Some symptoms, like snoring and choking, are more obvious and most people know when they struggle to fall asleep. Still, many think they are getting their recommended eight hours or, after many years, are accustomed to sleeping poorly.

Sleep apnea also stresses the heart by causing an irregular or interrupted flow of oxygen. Mr. Doe said sleep problems are strongly linked to the risk of Type 2 diabetes, even in otherwise young and healthy individuals.

Because sufferers of sleep apnea are more likely to be overweight, their symptoms can easily be misattributed or ignored entirely. Some symptoms, like fatigue, lack of focus, apathy and irritability are common to both sleep problems and depression. Antidepressants are more likely to be prescribed than a sleep test.

Recent research indicates that women are especially under-diagnosed with sleep apnea. According to the Journal of Clinical Sleep Medicine, men are around twice as likely to have sleep apnea, but 75 percent of all sleep research has been conducted strictly in male subjects.

Traditional symptoms, like heavy snoring, choking and obesity, are not always as pronounced or present in women who more often report difficulty falling or staying asleep, early morning awakenings and leg cramps. Meanwhile, common symptoms in women such as general fatigue, morning headaches and anxiety are easy to attribute to something else.

"Women have it less frequently. However, the classic thinking is that women can't have sleep apnea, this is a disease of obese men who snore heavily and have thick necks," Dr. Barone said, "I've seen thin women and people you wouldn't expect with (narrow throats.) They may snore or just wake up feeling unrefreshed. There is no harm in testing someone for a sleep disorder."

Carthage Area Hospital Sleep Center Coordinator Lisa Parlato attributes some of this discrepancy in diagnoses to the fact that before menopause, women are half as likely to have sleep apnea, but after menopause experience it in numbers equal to men. Ms. Parlato said that women may also be less open about symptoms like snoring and that doctors look for mood disorders more often in women with depression and anxiety than they do for sleep disorders.

A well-documented, if unconscious, bias that leads to certain illnesses as being wrongly perceived as "male" or "female" has also been cited for the discrepancy between genders.

Symptoms and medication tend to pile up when sleep disorders go untreated.

"(We can) get a patient who has been 100 pounds overweight for 20 years, and is on 50 kinds of medication, but their sleep has never been checked even after decades of problems," Mr. Doe said. "If we had seen them 10 years earlier, they could be on a third of the medication and have far fewer problems."

MANY CAUSES

Many sleep disorder cases are genetic or simply caused by anatomy, but external factors like weight and stress can play a large role. According to the American Academy of Physiological Medicine and Dentistry, between 2 and 4 percent of children have sleep apnea. However, it predicts a rise in the rates of pediatric obstructive sleep apnea following rising childhood obesity.

Doctors more commonly prescribe sleep aids than sleep disorder testing. According to the Centers for Disease Control and Prevention, in 2013 nearly 9 million Americans took a sleeping pill of some kind.

"Sleeping pills put you to sleep but they do nothing about the quality of sleep." Mr. Doe said.

For those with sleep disorders, if anything, sleeping pills mask the cause of symptoms such as insomnia and fatigue and do nothing for problems including high blood pressure.

Modern hurdles to quality sleep such as obesity and sleeping pills aside, overall diagnoses of sleep disorders have risen quickly in recent decades. Sleep medicine is a relatively young field, but it's gaining traction. A joint study conducted in part by the CDC found that sleep related diagnoses saw a 266 percent increase between 1999 and 2010, from 3.3 million to 12.1 million. "There is definitely more emphasis placed on finding treatments and disorders such as restless leg syndrome than 20, 30 years ago," Dr. Barone said, "Now we know it's a very real condition. As we learn more as we go along, our information is going to skyrocket."

Overnight sleep testing and sleep centers are also becoming more accessible, both as a part of existing medical providers and hospitals and as standalone services.

When sleep disorders are suspected, patients are tested overnight, either at home or in a monitored room in a lab. Home tests are cheaper, can be more comfortable and are often required, by insurers looking to cut costs, as a precursor to in-lab tests.

However, these test results are limited and can be used only to diagnose sleep apnea.

SLEEP CENTERS PLENTIFUL

Both Samaritan Medical Center in Watertown and Carthage Area Hospital operate full-service, accredited sleep centers with tests monitored by respiratory therapists. Canton-Potsdam Hospital in Potsdam and Claxton-Hepburn Medical Center in Ogdensburg offer sleep tests and services in St. Lawrence County.

"I think a lot of people are nervous about it at first, about someone watching them sleep. It's very personal," Ms. Parlato said, "Once they understand what we are doing and why, that it is painless, they are receptive."

When coming in for the comprehensive tests, patients are recommended to bring their most comfortable pajamas, their own pillows or blankets if they'd like, and everything they need for the next day.

The rooms at Samaritan Sleep Disorders Center and Carthage Area Hospital Sleep Center are set up much like hotel rooms, equipped with nice beds and TVs -- even leather recliners in some. Patients will often arrive around 8 p.m. and can go about their routine before sleep.

Patients are then set up with a veritable thicket of wires, EKG and electrode sensors.

"I always have people saying they're not going to sleep, but when they come to us they are exhausted and they almost always sleep more than they expected to," Mr. Doe said.

Technicians spend the night tracking brain waves, pulse, breathing and much more via the sensors. Rooms also each have a camera and microphone to keep an eye on movements and sleep talking, and to communicate with the patient when needed.

Most diagnoses take a single night, though some patients spend several nights.

Once diagnosed, the path to a solid eight hours becomes much clearer. Most sleep disorders are highly treatable, whether it's sleeping with a small CPAP machine for sleep apnea, medication or being educated in routine and stress management tools. As for treatment costs, Ms. Parlato said most insurance policies cover at least a percentage of treatment costs with low co-pays, and costs can be estimated before patients commit.

"We all know how we feel after one bad night of sleep," Mr. Doe said, "Now imagine that every night for a year, or a decade, or more. It's amazing how much we can change lives. I get excited and it's not even my life."

"There is still under-diagnosis and undervaluation of these conditions and how they relate to overall health," Dr. Barone said. "If you have even an inkling (of sleep problems,) get tested."

___

(c)2016 Watertown Daily Times (Watertown, N.Y.)

Visit Watertown Daily Times (Watertown, N.Y.) at www.watertowndailytimes.com

Distributed by Tribune Content Agency, LLC.