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Beyond Snoring: Unveiling the Hidden Epidemic of Sleep Apnea

How often are sleep disorders undiagnosed, under-treated, or mistreated?

Key points

  • CPAP devices are not "set it and forget it" and may need tweaks over time.
  • Obstructive sleep apnea doesn't always match the stereotype—older overweight male who snores loudly.
  • Complaints of poor sleep lasting more than three months is enough to prompt a referral to a sleep specialist.

I just don’t sleep well.

I don’t really snore. I am a light sleeper. I don’t wake up refreshed. I grind my teeth. I have acid reflux at night. My sleep is restless. I use the restroom often. These symptoms are frequently associated with sleep apnea, not insomnia. Obstructive Sleep Apnea, OSA, is characterized by the National Institute of Health as episodes of complete or partial airway collapse with an associated decrease in oxygen saturation or arousal from sleep, resulting in fragmented sleep.

I am on my soapbox about the importance of diagnosing and properly treating sleep disorders, specifically OSA, and let me explain why.

In 2008, as my 20-year marriage was ending, I began to experience panic attacks. Many of these episodes woke me at 4 AM with severe chest pain. Flash forward to 2024 and I can finally sleep through the night and wake up refreshed.

No, it wasn’t Lexapro or finding love again that cured me. It was an incredibly long journey, and I finally arrived back at restful sleep and energetic days after a visit with my fourth sleep specialist.

Serendipitously, in July 2023, Avinesh Bhar, MD, emailed to introduce his practice and cultivate referrals. I replied immediately and scheduled a telemedicine appointment for myself. He made a simple change to the setting on my sleep CPAP machine, continuous positive airway pressure, that I had been using for many years due to a diagnosis of OSA. He advised me to replace my machine with a new one as mine was 10 years old and they wear out after five years. He then shipped me another home sleep test (probably my fourth) and subsequently altered additional settings on my new machine.

While the simple CPAP device setting change improved my ‘nocturnal panic attacks’, the new CPAP machine was the last piece of the puzzle. When he replaced my mask with a different version, I had positive dreams again. How could such seemingly simple interventions by a sleep telemedicine physician with such a profound effect on my life, alluded me and my previous highly regarded providers for 16 years?

I wondered, how many patients have come to any of us and we missed the diagnosis of a sleep disorder? And how often are sleep disorders under-treated? Or mistreated with sleep aids? I asked Bhar these questions.

“Our medical training beats into us a list of symptoms associated with specific diseases within our field of specialty. Fatigue or insomnia to a sleep specialist triggers different clinical pathways compared with a psychiatrist or a general physician. Due to the siloed nature of our work, we tend to force some diagnoses based on equivocal laboratory results and or subjective patient responses such as I sleep longer with Trazadone or I feel less fatigued with my B12 shot’”

Bhar then shared his own misstep with sleep apnea. “My wife, MG, had to self-diagnose her sleep issues because her board-certified sleep physician-husband tried to man-splain her issues as depression or a caffeine crash. Fortunately, my physician-wife disregarded my attempts to get her to resume her antidepressant (from her previous postpartum) and she insisted on getting a sleep study instead. In my defense, she does not snore, or at least I never noticed it. She is slim, young, and doesn’t fit the sleep apnea profile. Yet, her sleep study revealed that she had sleep apnea. She is now well-treated with an oral appliance fitted by a sleep-certified dentist. Her fatigue and mood have improved, and she sleeps soundly through the night. I got this one completely wrong.”

It is important to note that we do not need to snore or snore loudly to have sleep apnea. Unfortunately, many healthcare providers (and even some sleep specialists) continue to revert to the sleep apnea stereotype of an older overweight male who snores loudly. This is a dangerous misconception.

According to the National Institute of Health, the US population has about 25-30 percent of men and 9-17 percent of women who meet the criteria for obstructive sleep apnea. (In the United States, it has been reported that 25-30 percent of men and 9-17 percent of women meet the criteria for obstructive sleep apnea. The prevalence can be much higher in specific populations, such as obese patients or those with cardiovascular diseases. If a patient walks in with multiple medical issues, we should pause and ask if we (providers) may be missing a sleep-related issue.

Complaints of interrupted, restless, or poor sleep lasting more than three months are enough to prompt a sleep study or a referral to a sleep specialist. Don’t try to explain it away as Bhar did with his wife, and don’t undertreat it as I experienced for well over a decade.

I hope you will consider referring your patients to a sleep specialist in your area so that we can all provide optimal care.

I strongly believe that sleep studies should be a routine part of mental health care. They sure are easier than mammograms and colonoscopies. They may save even more lives, and the impact on quality of life is enormous and almost immediate. Breathe well, sleep soundly.

“Sleep…Chief nourisher in life’s feast.”



Bhar runs the group practice Sliiip (pronounced ‘sleep’).

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