These are patients who often present with a chief complaint of insomnia.Įrinn E. Getting rid of their sleep apnea often helps PTSD symptoms. For example, patients with post-traumatic stress disorder who have sleep apnea have a much worse time with PTSD than patients who do not. We know that the presence of apnea can mean underlying psychiatric disturbances. Karl Doghramji, MD: It’s very important to keep a high index of suspicion for sleep apnea in the context of insomnia, especially in psychiatric disease. But in the patient who comes in and doesn’t have any real other risk factors or issues, we’re going to be steering away from it. When we see other signs that there might be something else going on, then we can move down that pathway. Of course, in the context of this discussion, it’s important to note that that insomnia alone is not an indication for polysomnography. But those might be the type of individuals for whom you’d end up identifying sleep-disordered breathing, in which you thought you were dealing with a primary insomnia problem. They have some fatigue and sleep disturbance, so it can be difficult at times. What I’m getting at is this upper-airway resistance syndrome, which might be a female who’s younger and thinner, and nobody is telling them they’re snoring. They’re not an older, obese male who’s snoring and sleepy. Nathaniel Fletcher Watson, MD: It may be that these patients don’t check all the boxes. I’ve found that there tends to be a fairly high prevalence, at least in the patients that I’ve seen with refractory insomnia that have some degree of sleep disorder breathing present that no one has thought to look for because this person is complaining, “I can’t get to sleep” or “I can’t stay asleep.” No one is thinking that to go hunting for sleep-disordered breathing or sleep apnea. Vikas Jain, MD, FAASM, FAAFP, CCSH, CPE:I would say it’s a lot more likely than 1 would think. Thorpy, MD:How also would you pick up sleep apnea in a patient who may have insomnia? Are there any particular patients where that’s more likely to occur? Thus, it can be helpful sometimes when you’ve tried several interventions and you say, “What else could there be?” That can be helpful to elicit if there’s an underlying cause for it. There was a study several years ago in Mayo Clinic proceedings that showed a high prevalence of sleep disorder breathing in many patients who’ve gone for a long period of time with chronic insomnia. I also like to consider doing sleep testing, more in patients who’ve had a long-standing history of insomnia that hasn’t seemed to respond to traditional interventions with our pharmacological interventions. ![]() I might consider looking for sleep-related breathing disorders. I’m a restless sleeper.” That might make me think more about periodic limb movement disease and if they’re a snorer in addition to these awakenings. When I’m getting history, 1 is trying to get some sense of, are they having a lot of sleep disruption? Are they complaining of a lot of awakenings that seem to be occurring during the night? Could they be complaining of excessive limb movements? Or “I kick around a lot. Vikas Jain, MD, FAASM, FAAFP, CCSH, CPE:I look at a few things. ![]() Vikas, when might you consider getting a sleep study on a patient who has insomnia? But there are times we need to consider doing sleep studies. Thorpy, MD:We all agree that history is the most important part of assisting a patient with insomnia.
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