Singapore Sleep Apnea Site: May 2008

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:

Sleep medicine knowledge is generally low in medical students.
Higher scores in basic sleep knowledge agreed with the statement that “sleep disorders should be included in medical school curriculum” and secondly, they disagreed that “most behavior changes to improve sleep quality are common sense and not a good use of time to learn”. Thus, a better “attitude” indicates a better learner and better knowledge scores
As expected, medical students with higher scores in basic sleep knowledge felt it was an important inclusion in their curriculum and of use to them. It is likely that these medical students had acquired this knowledge through their own reading and study, and had realized the usefulness of this knowledge.
In most countries, to date, medical school curricula do not include courses on sleep medicine and sleep- associated disorders.
In the United States, the average time spent on sleep medicine during medical school education is 1.6 hours, and pediatricians are reported to receive a mean of 4.8 hours of instruction on sleep medicine and sleep disorders.
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.

It further goes on to state:

“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