Not surprisingly, one of the most common symptoms of obstructive sleep apnea is tiredness. Unfortunately, even for individuals who have shared their symptoms with their healthcare provider, participated in a sleep study and (if diagnosed with sleep apnea) begun treatment, they may still struggle with extreme fatigue which negatively affects their quality of life.

We spoke with Dr. Atul Malhotra, a board-certified pulmonologist, intensivist and research chief of Pulmonary, Critical Care and Sleep Medicine at UC San Diego, about addressing lingering symptoms of obstructive sleep apnea. He shared the general steps he follows with his patients, but each patient is different and you should talk with your healthcare provider about any symptoms you are experiencing and discuss potential next steps.

Standard Sleep Apnea Treatment

Obstructive sleep apnea is incredibly common, with millions of Americans left undiagnosed and untreated. When sleep is interrupted, individuals tend to wake up feeling "irritable, forgetful and less able to concentrate." If left untreated, sleep apnea also puts you at greater risk for developing high blood pressure, stroke, congestive heart failure and other medical concerns. That is why it is so important for you to contact your health care provider if you or a loved one suspects you may have sleep apnea.

When someone is diagnosed with obstructive sleep apnea, the standard of care is to prescribe continuous positive airway pressure (CPAP). This machine gently blows air into your airway, keeping the airway open while you sleep and should be used every night for the best treatment. Not everyone can tolerate CPAP, so it’s important to work with your healthcare provider to try different mask options as one may work better than others to help you get your best sleep.

Lingering Symptoms

One of the most common questions Dr. Malhotra hears from his patients is, “How do I know if the CPAP is working?” He suggests a few different ways to approach this. The first is to consider how the patient is feeling and if their bed partner is noticing less snoring, gasping or sleep disruptions. More objective measures include reviewing the CPAP download data that monitors hours of use and residual sleep apnea. “The most important thing, in my opinion,” Dr. Malhotra continues, “is to look at what was driving the patient to come seek treatment in the first place and to determine if that chief complaint is resolved.”

In many instances, individuals seek help because they are feeling tired, but they may not always use the language that best describes their symptoms. “Fatigue is a lack of energy, while sleepiness is an inability to stay awake.” Dr. Malhotra explains, “The problem is patients don’t read medical textbooks and tend to use the words interchangeably.” When discussing sleep concerns with his patients, Dr. Malhotra tends to follow up words that patients use with, “What do you mean by that?” This allows him to prod deeper into the lingering symptoms patients may still be experiencing and discuss possible options.

Excessive Daytime Sleepiness

A common lingering symptom of individuals appropriately treated for sleep apnea is excessive daytime sleepiness. It can be best described as feeling excessively drowsy or falling asleep when you shouldn’t. Consider scenarios such as sitting on a deck chair watching kids in a pool, participating in a work meeting or driving a car and you can quickly see how detrimental this condition can be.

Most people who experience this level of tiredness have become good at masking their sleepiness around others. When asked to describe excessive daytime sleepiness, many patients use words such as feeling tired, experiencing brain fog, feeling exhausted or feeling that they never get enough sleep. As a result, they may need to take frequent naps and have decreased energy levels that lead to participating in fewer physical activities. While excessive daytime sleepiness is common for people with sleep apnea, it isn’t always considered in conversations with healthcare providers.

The Bottom Line

It can be hard to gauge how often to speak with your healthcare provider about sleep. If you are newly diagnosed and treated, your healthcare provider will want to see you again within three months, earlier if you are struggling. Moving forward, you should be sure to discuss your sleep apnea, including any lingering symptoms, at least once a year with your healthcare provider.

Developed by the American Lung Association through generous support from Jazz Pharmaceuticals, Inc.

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