Guest Blog: How Did My Doctor Miss My Sleep Apnea for So Long?
If you are like most people with a sleep disorder, you will see doctors for several years and run up thousands of dollars in medical bills before realizing you have a sleep problem. When you discover the truth---when you go online and read about your diagnosis, and all the pieces fit together like a jigsaw puzzle---you will probably feel frustrated and angry. You will probably ask (out loud) “Why didn’t that ____ I was seeing tell me I had a sleep disorder?”
Don’t blame your doctor. He or she may not know how to diagnose sleep disorders. If you find out that you have obstructive sleep apnea (OSA), you are one of the 20% who has this disorder. Despite the growing number of sleep labs and the growing body of knowledge about sleep disorders, primary care doctors are no better at picking up sleep apnea now than they were twenty years ago.
Part of this has to do with the nature of sleep apnea. If you have a changing mole---i.e. skin cancer---you can see the changing mole. You can point it out to the doctor. You can say “This needs to be checked out". However, if you snore and stop breathing at night, you do not know it---the apnea happens when you are unconscious. You are aware of your tiredness, your headache, and your high blood pressure. Also, you may have muscle spasms, erectile dysfunction or morning angina. You go to your doctor and tell her about these symptoms. You do not talk about your sleep. And, since she does not know how to diagnose sleep disorders, she does not ask about your sleep. Maybe she will say...
“How do you sleep, Mr. Jones?”
“Ok, I guess.”
“That’s good. Now, tell me about this chest pain that wakes you up at night.”
Now, if you step back and think about physiology—how the body works--- people should not have angina when they are asleep. They have it when they are running or climbing stairs. The doctor should be wondering what is going on at 3 am in the morning that is making Mr. Jones’ heart do extra work. However, doctors are like everyone else. They look for recognizable patterns---patterns that they learn during their medical training or during their years of practice. If they have seen the pattern of a patient with three am angina who is discovered to have OSA, gets the OSA treated and averts a heart attack, they will see the next patient with this pattern. If they have not seen the pattern before, there is a very strong chance that they will not assemble the puzzle pieces correctly. The patient will get a cardiac catheterization---a procedure in which dye goes into the coronary arteries looking for blockage----and the cathe will be normal. He will be sent home after being reassured that everything in his heart is fine, he was just being anxious---and, despite his healthy coronary arteries, he will be back in the emergency room with a heart attack a month later, because of his unsuspected, untreated OSA.
Moral---your primary care doctor may know less about sleep apnea than you do. The good news---you can help educate your primary care physician. Let them know how you are improving with your OSA treatment. They will be much quicker to pick up the diagnosis next time.
The author, McCamy Taylor, is a family physician. Despite her medical training, she was not aware of her own sleep apnea. So, she retired from medical practice at the age of 40, convinced that she was burned out. After several years of treatment for various complications of her unsuspected sleep disorder, she found out by accident what was really wrong with her. It took a few more years for her to find a combination of treatments that controlled her type of OSA. Now she is back at work as a family physician. And, to her surprise, she has discovered that the medical community is still blind when it comes to sleep disorders. She would like to help fix that. McCAmy has a Masters in Public Health and did her thesis on the topic of sleep apnea and family practice. She is also a writer, and one of her books is “Life After CPAP,” available at Amazon Kindle.