Yes, I know that this is a very broad generalization. And yes, there may be one or two people out there who are unable to work and who have repeatedly been denied the Social Security Disability Claim who do not have an underlying sleep disorder...but in three years of family medical practice in a public clinic for the uninsured and underemployed, I have not seen those people yet. What I have seen instead is an epidemic of undiagnosed, untreated sleep apnea.
Here is my "typical" disability denied patient. He/she worked all her life and then got laid off in middle age---when sleep apnea tends to strike. Maybe the layoff was attributed to the recession. Maybe her job was canceled and a new job was created for which she did not qualify--i.e. she was "fired" but they did not want to call it that. Maybe she was out of work one day too many for one of the diseases that an untreated sleep disorder causes---like chronic pain, depression, stroke, car wreck. Maybe she was late getting in to work one too many days, because she gets no sleep at night and wakes up dead tired each morning. Maybe she made a terrible mistake on the job due to her inability to concentrate and remember. Maybe her disposition got bad because she has not slept in years and a customer complained.
Too bad her doctor did not diagnosis her sleep disorder while she was still working and had insurance. She could have gotten treatment which would have returned her to her old productive self. While she was waiting for treatment to kick in, she could have told her employer "I have sleep apnea which means I have a temporary disability" and the employer would have been obligated to make allowances--allowances that he did not have to make for her being tardy/crabby/forgetful.
Sadly, obstructive sleep apnea (OSA) remains the most commonly missed common diagnosis in this country, with a whopping 10% (or more) of people over 40 suffering from it and an even more alarming 80% of that 10% having never been diagnosed no matter how many times they have seen doctors for their myriad of OSA related problems. That means 8% (at least) of working Americans---and driving Americans--over 40 are running around chronically sleep deprived.
As described above, people with untreated osa do poorly in their jobs and they get fired. Or, they realize they have to quit because they are a danger to the public. They have many, many, many health issues---chronic pain, depression, accidents, elevated blood pressure, ED, strokes, heart failure, heart attack, hard to control diabetes, poor memory, poor concentration---which they can not afford to get treated since they no longer have insurance or a job.
People with OSA know that something is wrong with them. They typically see a lot of doctors and get treated for everything under the sun except their sleep disorder in the years before their OSA is diagnosed. If they are unlucky enough to lose their job during this process, they will try to get health care. Seeking a small monthly S.S. check and Medicare coverage, they fill out their disability form and list 1) back pain 2) high blood pressure 3) depression. And then, they are despondent when Social Security turns them down on the grounds "You can read and write and use your dominant hand. Get a clerical job."
Except, they can't work a clerical job. They fall asleep in front of the computer. They make mistakes. Their spouses nag--"Why aren't you the man/woman I married?" They sense that something is wrong so they go online and read about Chronic Fatigue Syndrome and other (untreatable) diseases. Do they have early dementia? That one's untreatable, too.
The OSA sufferer appeals his disability denial. He gets a lawyer. But if his family doctor was not able to diagnose his sleep disorder, his disability attorney is not likely to catch it either. Doctors are so bad at diagnosing all but the most obvious and worst cases of OSA, that your only chance of getting an accurate diagnosis is to 1) walk into the doctor's office, say "My spouse says I snore and stop breathing at night and I looked it up and I think I have sleep apnea and so does my brother/father/son" or 2) see one of the relatively few primary care doctors who has experience diagnosing and treating sleep apnea and who will not just take your word for it when you say "But doc, I don't snore." How do you know you don't snore? Have you asked your family? If I have a high suspicion of a sleep disorder, I have the patient go home and ask. Very often the patient is surprised at what they learn.
When do I suspect OSA? There are a lot of ways in which it presents. Here is one that is very common in my underemployed, uninsured patient population. When a patient who has not been involved in a catastrophic wreck and who does not have a devastating autoimmune disease like lupus has been turned down by SS for their complaint of chronic pain, I automatically do an OSA screen. And, in my experience treating middle aged, unemployed or underemployed people without health insurance, 95% of them have an undiagnosed sleep disorder. Remember, sleep deprivation increases you pain and inflammation, it decreases the effectiveness of pain meds and it increases the appetite for high calorie low nutrition foods causing weight gain---so, yes, your back really does hurt. But surgery is not going to fix that hurt. Getting a good night's sleep for a few weeks will fix that hurt. But you won't get sleep without a sleep study and OSA treatment and you won't get that without insurance.
This is a really sad Catch-22 type situation that is costing this nation dearly since it takes highly skilled and experienced workers out of the work pool and throws them into early retirement. If anyone in the government really wants to cut Medicare expenses, maybe they should create a quality measure for sleep disorders. Right now, doctors who treat Medicare patients have to document that they are screening for breast cancer, smoking, depression, diabetes and high blood pressure control. Maybe the government should toss in sleep disorders screening too. It wouldn't cost that much. OSA can usually be diagnosed based on clinical exam alone. The oximetry and sleep study are just to confirm the diagnosis, judge the severity and determine what treatments are indicated.
Maybe disability attorneys should buy their own overnight pulse oximetry machines and hire someone to reads the results. I have seen a number of patients who were repeatedly disability denied succeed in their disability claim when they could show the judge that they stop breathing 50 times an hour. One successful appeal would more than pay for the machine.
Maybe a sleep history should become an integral part of the medical history, along with "cardiac" and "respiratory." Doctors would find that many of their "difficult" patients---i.e. the ones who fail to get better---have a treatable disease. Maybe specialty boards like the Family Medicine Board should start requiring that residents in training do a sleep medicine rotation.
Maybe the auto insurance industry should conduct a public health campaign to alert drivers to the danger of having 8% of over-40 drivers driving like they are drunk--which is what untreated OSA patients do. It would cut accidents and insurance claims.
Even those who do not have a sleep disorder need to be aware of OSA. Remember, the untreated OSA from which 8% of your neighbors over 40 (make that 16% of your neighbors if you live in an African-American or Asian-American community) suffer, is costing you tax money and making your roads unsafe. And there is a 1 in 10 chance that you will be among the unlucky ones once you reach middle age.