View Full Version : Sleep Apnea vs. Inattentive


Isaiah
01-03-07, 01:07 AM
I have seen a psychiatrist and we are working towards a diagnosis. He seens very capable, open minded and he comes highly recommended.

After my first visit a couple of weeks ago he told me that he does think there is something impairing my cognitive functioning and that I am not working optimally. Uh, yeah, I agree. He thinks sleep apnea is the most likely explanation at this point. I got some blood work done that I am waiting to hear back on so we can rule out thyroid. Apparently, the appearance of my uvula and the back of my mouth mark me as a snorer. I have been told this in the past but rarely and when I have been told I was snoring it was faint. I do have sleep issues, in that I feel tired fairly often in the afternoons when I am on a 'normal' schedule. The sleep disorder that clearly fits is delayed sleep phase syndrome. My preference is bed time around 5 am with regular trips around the clock going to bed at 2-3 hours later each night. But if I have to settle for one bed time 5 am seems like the best choice. I also like to nap. Compared to most people I'm pretty low energy. Even during periods where I'm getting regular exercise I don't get a boost in energy. I'm a male, mid 30s, about 25 pounds overweight, all of that in the last year and a half.

So I've done some audio taping of myself sleeping at the psychiatrist's suggestion. I've done it a few times but not every night like I should have because I'm not that on the ball with regular activities and I'm something of a procrastinator to boot. Maybe you can relate. Some nights there is nothing on the tape, like I can't hear anything at all. One night though about two hours in I did tape myself snoring, not particularly loud or every time but for about an hour or so it was semi-regular. There were no pauses in the snores where I was holding my breath.

One concern is that I don't have medical insurance. I can pay whatever it takes to get this sorted out but cost is a factor. Sleep apnea is clearly a serious condition and I want to address it if necessary. Sleep studies are expensive (approx. $2000-2500) and I would rather not unless I have to. In my reading I've come across a number of people where their use of CPAP machines did not result in any improvement to their energy level or their concentration. These are two of my biggest issues. Quite a few CPAP users also discontinue use within a year.

He offered to write me a prescription for Wellbutrin which I turned down since we are still collecting data. I feel kind of weird taking something long term that will affect my mood. I have used drugs recreationally for about 15 years but have also been clean for the last two, I mentioned this on the initial visit. I don't know if this means he is disinclined to prescribe stimulants (amphetamines were never a focus of mine as a user). Stimulant medication is of interest to me because I want more energy and focus. Assuming thyroid is not an issue I may try the Wellbutrin but I am not particularly enthusiastic about it.

While I am keeping an open mind about what the diagnosis will be I tend to think that sleep apnea is less likely because there are no breaks in the snoring and I don't seem to snore all that much, also I have some relatives on my mother's side, including my mother that seem to have some ADD symptoms. It also feels like I have had these symtoms all my life but unfortunately it is 'feels'; my memory, especially of childhood, is not that strong. I do remember some specific instances but not that many. On the other hand my father did snore quite a bit with some apneas. There was also a period where I would get quite drowsy while driving almost falling asleep, hasn't been that way for about 10 years though. Frankly I also wonder if my interest in stimulant medication, which I was quite opposed to when I first thought I might have ADD, is also coloring my outlook. Even now that I've seen a psychiatrist, told him my story and he agress that a closer look is warranted, I wonder if I'm not fooling myself and looking for an easy answer. I wish there was more to the diagnostic process than telling my story, some objective measure would be comforting. Depression is also a possibility. I am somewhat half hearted in going through this because I fear a lot of money will be spent without resolution, and yet the list of symtoms resonates very strongly with me. Despite my psychiatrist's capabilities I am also somewhat scared I'm going to get sucked into a mindset where I and others will start defining me with these vaguely defined fuzzy labels that overlap yet have different treatments. It just seems like there is huge potential for error.

If you have read this too long post, my thanks. I know that some people with ADD also have sleeping disorders. If you have experience with this I would love to hear from you. My main interest is in distinguishing between the two. It doesn't seem very easy and I haven't found much on the internet. But anything else you can share about the diagnostic process for either of these conditions like the costs and time involved also how stimulant medication interacts with sleep disorders would also be of interest. General comments on the whole situation are also welcome.

Thanks again.

P.S. Here's a bit of humor. Before even considering that I might have ADD I got interested in neurofeedback. Spent a couple of months reading all about it, the various brands, protocols, etc. I took a good look at the DIY EEG (OpenEEG) and started that project. Yeah, I didn't finish. It stayed on my mind and I kept looking at various models. It seems like the only thing I hyperfocus on is consumer choices. Eventually I bought a high quality model. As most of you know a number of people have had good results with ADD patients using neurofeedback devices. Apparently some people with sleep disorders have been helped as well. I've had my device for a few months now. How many times have I used it? Once. WTF?!

Tomorrow. I start with it tomorrow.

FrazzleDazzle
01-03-07, 01:30 PM
I would encourage you to find a way, if you can, to properly diagnose sleep apnea, or other sleep issues, and how severe you may have it. Only a sleep study can tell you. Observations from others isn't enough. Sleep disturbances such as apnea have been documented by the best medical institutions as "causes" of ADHD, so it could be life-changing to diagnose it and to treat it. Sleep disturbances can also affect your entire well-being. Not getting the proper amount of the sleep phases and/or constantly coming in and out of them (yes, up to 100 times per hour) can take it's toll on all body systems and be very detrimental to your long-term health. A sleep study can be as simple as wearing a meter on your finger at night in your own home during sleep, to coming into a sleep clinic where they do more intensive monitioring sleep levels/phases/oxygen, etc.

My son's father's side has likely undiagnosed sleep apnea, AND ADHD on their side. I did have my 14-year-old son checked out for it, and although he doesn't have the symptoms yet, the hereditary shape of his palate and such will predispose him to it later in life. He was offered a sleep study, but, same as you, we cannot afford it just yet. It reads as if you are already under excellent care!

speedo
01-03-07, 05:54 PM
Even if you actually have sleep apnea, the cpap machines will only help in about 50% of the cases. I have sleep apnea and the cpap machine has definitely helped my attention issues a little. I'd really recommend a sleep study if you can afford it.

Me :D

Desert Dweller
01-03-07, 06:54 PM
In the past year my business partner was showing signs of ADHD and seemed to be getting worse. Jumping from one thing to another not remembering what he needed to do. Changing subjects in the middle of my sentences and he was oblivious to it. I would swear he was a perfect fit for an ADHD diagnosis.

He did the sleep study after his wife made him and [turns out he has sleep apena. He did not want to use the cpap machine so he chose a surgery (can't remember the name) that embeds little strips of something in the pallet. That over time builds up tissue and makes the pallet more firm.

I have noticed a big change in how he functions everyday. He said he feels more rested now also.

sloppitty-sue
01-03-07, 10:26 PM
HOLY CR#9!!! Geesh! I'm a single mother! How would someone like ME know if I need to look into finding out if I have a sleep disorder!! I can't tell you how many times I have complained to every doctor and therapist I have how tired and sleepy I am every, dam DAY!!! They always say the same things: exercise, go to bed earlier, stop sugar, take a vacation. I also always get the blood work - which always is pretty o.k. Oh! And I'm always assumed to be depressed too! (Well - feeling crappy every day can make a person a little CRANKY!?)

I'll bet I have some kinda sleep issue that is causes this early onset dementia and chronic daily sleepiness!!

UGH!!!

Isaiah
01-03-07, 11:43 PM
First off, thank you to everyone who waded through my post. I'm confident that I am working with a good doctor and that honest and open exploration of symptoms is the path that has the highest chance of resulting in a good outcome. I guess I just have some fears and insecurities about the possibilities of a misdiagnosis when the boundaries of these conditions seem so ill defined and overlapping. Not to mention that all the reports of people not being helped by the treatments, medications, machines and surgeries sometimes give me a feeling of futility, particularly when I consider the $ involved. Then there's the whole tension between relief at a diagnosis that offers an explanation and the upset that comes with considering that there's something not right with my brain that will require some permanent compensation. Anyway, you're familiar with all that and I'm thankful for your listening and all your responses.

1kid2dogs: Thanks for pointing out that there are other tests available. I had just assumed that the overnight sleep study was the next step. I will look into these and speak to my doctor about them.

slopitty-sue: Since my first meeting with the psychiatrist I've done a bit of reading on sleep disorders. They seem to be largely under diagnosed and not given sufficient attention by the medical establishment. I'm a bit surprised though that no one has even mentioned the possibility to you if you have brought it up consistently. One of the things that my psychiatrist pointed out is that while there are several mental conditions that can share symptoms with ADD like depression or anxiety and there are also a couple of physical conditions that can cause the symptoms we associate with ADD. Thyroid seems to be the most well known and apparently sleep apnea could also be responsible for a fair number of cases as well. There is no book on sleep disorders that strikes me as a 'must-read' but flipping through _The Promise of Sleep_ at the bookstore might be worth your while. It talks in detail about how sleep disorders deserve a lot more attention from doctors than they have received and how serious a health issue it is for those suffering from it. If you are going to investigate this sleepnet.com seems like an OK starting point. As 1kid2dogs mentioned a sleep study doesn't have to be an overnight affair at a sleep clinic. There are some other tests and now that I've had them pointed out to me I'm going to look into getting some of these cheaper alternatives done before signing up for an expensive study.

Best wishes.

wallywest
01-04-07, 11:52 PM
Sorry for the personal question, you certainly don't have to post a response.

But are you overweight? I am, a little bit. Not too bad but this holiday season has been bad for me. Gained about 10 pounds. I have sleep apnea and it definitely gets worse the heavier I get. For the most part right around the point where I go from "plump" to "where's my feet?" my snoring gets much worse and the basic symptoms of being tired all the time gets a lot worse too.

It's amazing what dropping even ten pounds will do. I need to lose about 40 pounds or so to be in good shape.

Isaiah
01-05-07, 05:57 AM
wallywest,

I'm not sure if you're asking me as I did post that I am, about 25 lbs, all of it gained in the last year and a half during a family crisis. I don't think I mentioned that to my doctor but I will. My ADD symptoms go way back before this but so do some sleep issues. Not the snoring, I wasn't told that I snored untill 10 years ago and it definitely seems to have increased lately. The delayed sleep phase syndrome though has been there at least since late high school if not earlier. I would also frequently nap in class despite getting a full night of sleep at home.

wallywest
01-05-07, 11:37 AM
I'm not sure if you're asking me as I did post that I am, about 25 lbs
Doh, sorry, must have missed that somehow.

I would also frequently nap in class despite getting a full night of sleep at home.
Oh yeah, I did that a lot in my college days. Not on purpose but sometimes it was just impossible to stay awake.