Q & A: When Sleep Apnea Looks Like Insomnia

Keisha was wondering whether to have a sleep study.

“I asked my doctor to give me something for my insomnia,” she wrote, “but he wants me to have a sleep study first. He thinks I might have sleep apnea. I don’t think I do. I don’t snore (as far as I know). I wake up a lot at night but I’m not short of breath or gasping for air.

“Besides, how could I get any sleep at all with those wires attached to my head! You say sleep studies aren’t helpful for people with insomnia. So what’s your opinion here? Should I have a sleep study or will it just be a waste of my time?”

insomnia and daytime sleepiness may actually be sleep apneaKeisha, a 37-year-old graphic designer, wrote to Ask The Savvy Insomniac recently with a question about having a sleep study.

I asked my doctor to give me something for my insomnia, she wrote, but he wants me to have a sleep study first. He thinks I might have sleep apnea. I don’t think I do. I don’t snore (as far as I know). I wake up a lot at night but I’m not short of breath or gasping for air.

Besides, how could I get any sleep at all with those wires attached to my head! You say sleep studies aren’t helpful for people with insomnia. So what’s your opinion here? Should I have a sleep study or will it just be a waste of my time?

When Is a Sleep Study Useful?

Keisha is right: I’ve blogged about sleep studies before because I’m skeptical about their value for people with simple insomnia. As conducted and scored today, they do very little to help insomniacs other than rule sleep apnea and other sleep disorders out.

But if a doctor suspects you have sleep apnea, it’s important to verify that objectively. A sleep study is then in order, at a sleep clinic or with one of the newer devices for use at home.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a serious problem. During sleep, the tongue falls back against the throat, collapsing the upper airway. This keeps you from breathing, deprives you of oxygen, and increases your level of carbon dioxide until you wake up enough to start breathing again.

OSA compromises the sleep you get, leaving you sleepy and prone to mistakes and accidents. It also leads to serious health problems. Repeated episodes of apnea stress the heart, increasing your susceptibility to hypertension, heart attacks, and other cardiovascular diseases. It’s also associated with weight gain, type 2 diabetes, inflammation, asthma, and acid reflux.

In short, it’s nothing to fool around with.

Often Looks Like Insomnia

But here’s the problem: In most cases, people with OSA are not aware of these repeated awakenings because they occur beneath the level of consciousness. Convincing support for this assertion came in a review of medical records published in the December 2014 issue of Mayo Clinic Proceedings. Take a look at some numbers here:

  • Of 1210 insomnia patients presenting at a sleep clinic in Albuquerque, New Mexico over a period of 8 years, about three-quarters (899) were using sleep aids regularly or occasionally. The majority of these—710—were using prescription sleeping pills. The rest were using over-the-counter sleep aids.
  • None of the 899 medication users reported improved sleep. So they, as well as the others, whose sleep had failed to improve following drug-free insomnia treatments, were seeking further assistance.
  • All of the patients were verbally screened for OSA. Then 942 underwent sleep studies.
  • About 91 percent tested positive for moderate to severe OSA. Yet a screening tool used by many primary care physicians to ascertain the likelihood of sleep-disordered breathing failed to detect it in 32 percent.
  • What’s more, the patients taking prescription sleeping pills were least likely to report symptoms of apnea and the most likely to report severe insomnia and other health problems.

In other words, it’s easy to mistake OSA for insomnia, and primary care physicians may do the same. You’re then treated for insomnia when you should be treated for apnea, compromising your quality of life and increasing your vulnerability to heart and other serious health problems down the line.

The Take-Away

Occasionally I hear from people like Keisha who doubt that a sleep study could tell them anything they don’t already know. There’s a chance they could be right. On the other hand, this is one instance when what you don’t know could end up hurting you a lot. And now, with much less expensive home testing devices available, there’s less reason for concern about cost.

If your insomnia takes the form of waking up several times at night and if, after being interviewed by your doctor, he or she suspects you might have OSA, bite the bullet and have the test. Insomnia is no picnic, but untreated apnea is worse.