Questions and Answers

Q: Do you know what the apnea-hypopnea index number needs to be before Medicare /Medicaid will consider it treatable?

A: I don’t know what number triggers insurance coverage. However, it depends on a number of things: who you see, your age, your symptoms, and additional problems you might have that could be exacerbated by the apnea. Young people who have a low index, 5-15, may not get treated, but as you get older, especially if you have low oxygenation, chances for treatment increase. Someone in the audience has that information for Medicare/Medicaid and it is 5 wake-ups per hour.

Q: Can you catch up on sleep on weekends?

A: It is better than not catching up but it is best to have a consistent schedule and that will make Monday mornings easier if you have to get up for work. It is best to have as little sleep debt as possible. If you let your sleep debt go for too long, it is possible you won’t be able to pay it off and it will cause physiological changes that may be difficult to reverse.

Q: How do you approach daytime hypersomnia?

A: It would be important to find out the cause of the daytime hypersomnia and rule out disorders like narcolepsy. Anyone who is really conking out during the day and sleeping at night needs a full sleep screening. It is also important that people do not assume that ongoing daytime sleepiness and conking out in a sitting position is typically part of CFS or FM. These could be signs of a separate sleep disorder or other medical problem.

Q: Why did you not mention use of medications for sleep problems?

A: I am not an MD and I don’t give out prescriptions. I think there are more hype and advertisements for sleeping medicines than is necessarily good for us. The data on the number of Americans who are self-medicating themselves to sleep and then again to stay wake and alert is alarming versus sleeping in a normal way. In CFS, if we can begin to unravel an indication of what is going wrong, we may be able to come up with a medication that enhances sleep, perhaps by increasing spindles in stage 2 sleep. It would need to be tested and proven. There are many risky, undesirable side effects of sleep medications such that they can induce a hypnotic like state of memory-loss during which a person can do activities such as eating, driving or walking around and not remember it. Individuals who cut their sleep short but use sleep medication, there is the potential that when they arise to go to work, they are not fully alert, but they are getting in their car and driving. Many of these medications are not benign, especially if you already have medical problems. The decision to use them should be made in a careful consultation with your doctor or even better, with a medical sleep specialist.

Q: Do most insurance plans allow for sleep studies?

A: This situation is evolving right now and some people think perhaps not in the best direction. In recent years, when there is reasonable justification for it based on symptoms and history, there has been support for in-lab testing. Testing would include a full polysomnogram and results would be read to look carefully at your sleep architecture and oxygenation during the night. These tests are very expensive and insurance companies have begun backing away from them and are asking people to do home studies. The home study equipment technology is advancing. One argument for home studies is if you’re testing someone in their own bed you’re testing the way they really sleep with whatever external interruptions: i.e. light, pets, sleep partner. If a home study is difficult to read or suggests more serious problems, you can ask your doctor to advocate for you to get a sleep study done in the lab.

Q: What would you recommend for someone who is wide-awake at 3 am?

A: A newspaper route. There is a belief in the U.S. that people are supposed to sleep uninterrupted for 8 hours. But in a natural setting, indigenous people have had what was known as a first sleep and a second sleep. They would wake up and share dreams, pour over their meaning, and then go back to sleep. So, if you wake up at 3 in the morning, it doesn’t mean something is wrong with you. The real question is if you wake up and haven’t had sufficient sleep, what kind of things can you do to put yourself back to sleep? There are calming methods such as breathing exercises, soothing music, etc. If you keep a sleep diary, it may help you see a pattern or figure out what works or doesn’t work to help you fall asleep. Dr. Solet’s concluding remarks, “I encourage you to be scientists.”