My wife seems to think I have sleep apnea. My general practitioner thinks I do not. He says I have none of the "outward signs"-stating that I'm not fatigued, my blood pressure, heart rate, etc. are all text book, and I'm not depressed or anything like that. However, my wife says I sleep incredibly loudly, and that sometimes I choke in my sleep and typically hit her/scratch her in my sleep-and I don't remember any of it come morning. I have no family history of sleep apnea or any sleep problems whatsoever. I am about 20 pounds overweight. Should I try to lose weight before going to a pulmonary specialist? Do I listen to the doctor or my wife?
Doctors Answers (5)
First, I would recommend that you see a neurologist rather than a pulmonologist. You have symptoms which could be more than just sleep apnea. A bed partner is the best source of information. Half of our patients with sleep apnea don't fit the "typical" pattern of what we used to think all apnea patients should exhibit. I would not wait to lose weight before being tested in a sleep lab. There are more issues than sleep apnea which must be addressed. Listen to your wife.
You sleep with your wife, not your doctor. For her peace of mind, I would suggest a sleep-center study that would diagnose or rule-out on apnea problem. Losing weight is always a good idea ifor health reasons if you are truly overweight. Speak with your doctor again with your and your wife's concerns and about a sleep-study referral.
The symptoms which your wife has described such as loud snoring, witnessed choking episodes, and thrashing during sleep accompanied with being overweight would warrant an evaluation with a sleep specialist. I would suggest you schedule a consultation to discuss your symptoms in greater detail.
You may have episodes of apnea but need a certain amount to be clinically diagnosed with the condition. Not all patients have high blood pressure, depression, or the same collection of symptoms. Not having a family history may simply mean no one was diagnosed with the condition. Approximately 50% of people who snore have diagnosable sleep apnea. If you snore heavily and your wife has witnessed episodes of choking in your sleep and you are overweight, I would consult a sleep specialist or seek a second opinion. You could try to lose weight first and have your wife see if your episodes at night diminish before seeking another opinion because it is quite possible that you may get a reduction of those nightly events.
The direct observations by your wife are far more concrete evidence that some form of sleep disordered breathing may be taking place. Yes, in many instances of Sleep Apnea, patients do have high blood pressure, fatigue, and even depression, however if these symptoms are present, it is more likely that you have had untreated Sleep Apnea for quite some time. It is possible that you may simply be a loud snorer without any quitting breathing or clinical Obstructive Sleep Apnea, however the most prudent option would be to seek consultation with a sleep specialist (especially if your primary provider is not going to consider more work up or assessment). This would allow for a thorough evaluation of your current sleep practices and possibly an overnight sleep study to determine the presence or absence of definite Obstructive Sleep Apnea.