Insomnia – A Qualitative and Quantitative Analysis

Insomnia – A Qualitative and Quantitative Analysis

by | General, Healthcare, Insomnia, Letters to Winston, Professional, Sleep Blog, Sleep Disorders, Sleep Evaluations, Sleep Symptoms

Winston

Yes, that is what I said;  “A problem with insomnia needs to be analyzed qualitatively.”

During my college years, I majored in the study of chemistry. The study requirements included courses in qualitative and quantitative analysis.  Essentially, the study of what a substance is made of and how much of each component part is included.  My comment on analyzing insomnia qualitatively means that a physician should know the components of the complaint. 

The term, insomnia, has a multitude of meanings in common use as well as in medicine.  The physician needs to know what the person using the term is experiencing.  In essence, what are the specific issues involved?  It is only with this type of clarity that the patient’s situation can be assessed.  The analysis includes the effects on daytime activities and is designed for nocturnal sleepers.  Those whose primary sleeping time is during the day, for example shift workers, require a different approach.  

Difficulty falling asleep or initiating sleep is the most recognized problem described by the term.  Defining the time required for sleep onset is the first step in assessing insomnia.  A problem with sleep initiation may be someone’s sole issue or it may be just one part of the patient’s problem.

Another difficulty often described as insomnia is waking frequently during the sleep period.  It is common and considered normal to wake once or twice a night.  Waking more often disrupts sleep and is frequently an issue for the patient.   Those with this complaint may or may not have a third type of problem, returning to sleep.

Returning to sleep after waking during your night of sleep, can be a singular issue or can be associated with other insomnia issues.  Some will wake frequently while others will wake only once or twice.  A problem returning to sleep can occur in either situation.

Waking earlier than desired is another issue commonly reported as insomnia.  All of these complaints may occur independently or in combination with one or more of the others.   

Knowledge of the effects of the sleep problem on daytime wakefulness and napping is helpful diagnostically.  Is the person sleepy during the day?  Do they nap?  Do they nod off?

To analyze complaints of insomnia, a physician needs to understand:

  • Are there problems with sleep initiation?
  • Are there problems with sleep maintenance? 
  • Are there problems with returning to sleep after awaking?
  • Are there problems with waking too early for the day?
  • Are there problems with daytime sleepiness?

A patient’s historical ‘insomnia qualitative profile’ information is required for accurate assessment.  Unfortunately, getting the information can be difficult, time consuming and even impossible. When obtainable, it will help with establishing a diagnosis, but a pattern of difficulty does not indicate a specific reason or cause for the issues.  In fact, many or most individuals will have more than one potential causative or aggravating issue.  

The frequency the symptoms occur and their intensity are important in narrowing the potential reasons or contributing factors to the sleeplessness problem.  How significant is each of the symptoms reported?  This step is the quantitative analysis of each of these factors 

Diagnostic considerations of insomnia require knowledge of the specific complaints (the qualitative analysis) and the degree to which they are present (the quantitative analysis) for assessing factors that are known to produce insomnia.  

So Winston, I have returned to my youth of qualitative and quantitative analysis.  A famous troubadour once penned a song; “All my life’s a circle, sunrise to sunset.”  So it appears to be.  I suspect this is more than you probably wanted to know.  Maybe I should prepare a short primer for you on the roles of the qualitative and quantitative assessments in identifying the factors, conditions and behaviors known to produce and aggravate insomnia.  

A Bear in the Bedroom

A Bear in the Bedroom

by | General, Sleep Apnea, Sleep Evaluations, Sleep Symptoms

Many, if not most people, come to doctors, sleep doctors or clinics because of symptoms or at the request of a family member.   Symptoms can be almost any issue with sleep and its quality, but nonrestorative sleep with daytime tiredness is the most common. More on that at another time. Family members often become concerned because of a person’s snoring or the interrupted breathing of a family member – a Bear in the Bedroom.

A bear you might not want in your bedroom

Snoring is extremely common with estimates running greater than 50% of some populations reviewed. Snoring is common in Obstructive Sleep Apnea and snoring is a sign of possible apnea.  But, not all those individuals with Obstructive Sleep Apnea snore and not all snorers have the condition. 

Well, what about a bear in the room?  To be honest, I don’t even know if bears snore.  The phrase, ‘snores like a bear,’ is frequently used to describe loud snorers. Loud is hard to define.  One person’s loud is another person’s soft. However, if we define loud as being able to hear someone outside of their sleeping room and down the hall or up or down stairs, those folks almost always have apnea and it is usually significant apnea.

Hear Someone Snoring From Outside Their Room? They All Most Always Have Apnea!

Do you hear you mother, father, sister, brother, friend, roommate, spouse or significant other snoring from the other side of the house?  They should be considered to have Obstructive Sleep Apnea until testing proves that is not the case.  Loud snoring is almost always Obstructive Sleep Apnea.  We’ll talk more about snoring in a future issue.

The Intermittent Bear in the Bedroom

You can hear the person sleeping.  They are snoring, first softly and then more loudly.  The snores develop a rhythmic pattern.  They start to come and go.   The pattern of noise gets your attention and keeps you from sleeping.

There is a loud, gasping, rough sounding snore or several in a row.  Following these grating, rattling noises, a slow, steady, almost melodious series of snores rhythmically lull you back toward your own sleep.  The snores fade and stop.  You listen and hear nothing. Then, after this quiet period, the grating, gasping suddenly returns and jars you awake. 

Does the above experience sound familiar?  They are the sounds of obstructive apnea.  The quiet period is the apnea.  The person is breathing and the diaphragms are working to move air into the lungs, but the airway is closed and no air is moving. The person takes a forceful breath and the airway opens with a loud gasp.

If you have been observed to have these events, you are extremely likely to have obstructive apnea. If you have seen these events in others, they are also likely to have apnea.

Hear Someone Having Breathing Problems While Asleep? They Almost Always Have Apnea!

If you sleep in a room or home with a bear, you are sleeping with someone who probably has significant Obstructive Sleep Apnea.

What Have We Reviewed

Loud snoring is almost always a sign of Obstructive Sleep Apnea.

Not everyone with Obstructive Sleep Apnea snores.

Hearing and Observing someone with breathing problems while he is asleep is almost always a sign that he has Obstructive Sleep Apnea.

Mr. Oso. The only type of bear you want in your bedroom. (Best Friend of SPH).

Previously

Obstructive Apnea is a very common problem for humans.

Symptoms and signs are often non-specific

 When sleep symptoms are present, Obstructive Apnea is often the cause.

What to Expect in Future Installments

What is Obstructive Apnea?

Why are individuals with Obstructive Apnea tired and sleepy?

Do you know what your apnea number was when you were diagnosed?

What are the goals of Apnea Therapy?

What is your apnea number now?