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Lilly2 · Nov 10, 2019, 07:09 AM

Quote:

Originally Posted by seesaw

I also naturally sleep on my side, and the at-home test, in which I was on my side, was negative, but the in center test, for which I was in an extremely uncomfortable hospital gurney, not even a bed, with a flat pillow, was forced to sleep almost with an arched back. I had a PTSD nightmare, and they claim the test was positive. After that I read into the details of how the tests are scored and read that about 50% are miscalculated... Yeah... I don't snore, and I don't have the symptoms of sleep apnea. But he's trying to attribute my symptoms to sleep apnea. Anyways, I'm waiting to change my healthcare in open enrollment now and start this process all over again.

Thank you, Seesaw!

The pulmonary docs are not therapists, even though they may have taken some psych courses back in the day, or even some CE courses today.

They still don't have sleep studies that include psychology-based psychometrics, such as PTSD-related insomnia, the interaction between PTSD and sleep apnea (if both do coexist, or if both are comorbid), a listing of when someone falls asleep in their natural habitat and when they wake up (how many times do they fall asleep and wake up throughout the night), their circadian rhythmic changes within a one-month period (which would be more accurate), better head sensors that don't affect sleep or the PTSD (such as a cap instead of all those wires), house camera for the bedroom, etc.

They should be monitoring/asking within a one-month period of time:

1. What time does the client fall asleep?
2. What thoughts preceeded bedtime?
3. What kind of dreams or nightmares have been experienced (if any) upon wake?
4. Does the client wake to use the restroom?
5. Does the client have stress incontinence or incontinence?
6. Does the client wet the bed?
7. Does the client have gastrointestinal problems (e.g., IBS, GERD, etc.)?
8. Has the client experienced past traumas? If so, what kind(s)?
9. Does the client experience any PTSD symptoms prior to bedtime?
10. Does the client experience any PTSD symptoms during wake?
11. How many times does the client fall asleep and wake up throughout the night/day?
12. Has the client ever had swing shifts, graveyard shifts, changing shifts, over 9 hours of work per day, or multiple jobs throughout his/her lifespan?
13. Does the client sleep alone or with a partner?
14. Does the client have a child or children?
15. Does the client have a pet? If so, what kind(s)?
16. Does the client have to walk the pet or tend to the pet before bedtime?
17. Does the client have to walk the pet or tend to the pet upon waking?
18. Has the client been the primary caregiver for an infant who wakes frequently in the night? (e.g., a parent who wakes every two hours on average to feed the baby, change the baby's diaper, hold the baby for comfort)
19. Does the client live in a noisy neighborhood?
20. Does the client live in a noisy apartment building or house?
21. Does the client live in a dangerous neighborhood?
22. What is the SES of the client?
23. What are the reasons why the client wakes (list each one and frequency during sleep-wake cycles throughout the night, such as three times to use the restroom, once due to a night terror, once due to a nightmare, total of five sleep-wake cycles throughout the night)?
24. Do the circadian rhythms change over a one-month period? (e.g., the client falls asleep at different intervals, ranging from normative bedtime hours to sleeping during the day and being awake all night)
25. Are there any other reasons why the client has sleep-wake problems?
26. What is the client's prescription drug routine?
27. Does the client need to watch television or listen to sounds to fall asleep?
28. Does the television or sounds remain on?
29. Does the client keep a light on during sleep?
30. If the light is kept on during sleep, how bright is it?
31. Is the client afraid of the dark?
32. How long have the symptoms of sleep-wake problems been going on?
33. Were the sleep-wake problems progressive over the lifespan, meaning that they got worse over time and/or worse when responsibilities of adulthood increased?
34. Were there times when sleep was good?
35. Under what conditions were there times when sleep was good?
36. Is the client seeing a therapist?
37. Does the client have problems sleeping after a therapy session?
38. What is the client's current occupation?
39. What was the client's previous occupations?
40. Is the client in school?
41. Is the client attending school full-time, part-time, or quarter-time?
42. Does the client have financial troubles?
43. Does the client have relationship problems?
44. Does the client have any other mental disorders besides, or apart from, PTSD?
45. Does the client have any other medical (e.g., CFS, MS, STIs, etc.) and/or dental problems (e.g., wearing braces, wearing retainers, having toothaches, having painful sores in mouth, having gingivitis, etc.)?
46. Do the symptoms of any other medical and/or dental problems affect the client's ability to fall asleep or stay asleep?
47. What other areas affect the client's ability to fall asleep and/or stay asleep that are not mentioned above? (assuming that the client doesn't sleep walk or have any other sleep-wake disorders besides insomnia)

The above questions would provide a comprehensive team-approach to care for those with insomnia or related sleep-wake disorders.

The issues for insomnia aren't always due to sleep apnea, or the issues could be a combination of factors (including or not including sleep apnea).

Taking an assessment for why CPAP machines don't help those with insomnia would be beneficial.

Having more trauma-friendly sleep aids would be helpful.

Understanding fears related to sleeping in the dark would be helpful (I'm afraid of the dark, so I have to sleep with a light on, and it has to be a minimum of 40 watts, though on some occasions, I need a full 60 to 100 watts).

Understanding all the other conditions as well as symptomatic thoughts, routines, emotions, etc., would help.

Having a treatment team to help with insomnia might work better than pulmonary specialists who hypothesize that we have "mild" sleep apnea. To me, it's not a diagnosis; it's a hypothesis, and one that is getting tested with or without our awareness.

I seek care at the VA. My civilian doctors never suggested sleep apnea or sleep studies to me. My VA doctors have. I found that odd, but it also coincides with my Medicare versus my VA Care. My VA Care covers everything, my Medicare does not. So go figure. Healthcare influences diagnoses and treatments, sometimes. Someone should be doing a study on that as well, including economists.

I think of the details and of the bigger picture when it comes to things like this.

Are patients really getting better, or are they now tasked with using additional machines - and costly ones at that (typically costing an average of $1800 per CPAP) - which adds to their bedtime routine? For some, the CPAP machine works great. I have friends who have NO mental illnesses and swear by the CPAP. Nearly ALL of my friends with mental illnesses, however, could not nor will not use the CPAP for one reason or another (including me). That should be saying something. Instead of blaming those with mental illnesses, blame the lack of alternative treatments that should be understanding of mental illnesses.

That's my long-winded reaction to all this.

(((safe hugs)))