Not available in The Disability Handbook.

Not available in The Disability Handbook.

The information on treatment outcomes is limited and based on self-reported measures of functioning and quality of life using quality of life indexes. Surveys designed for sleep disorders evaluate sleep, sleep disruption, the disorders of EDS, sleep apnea, restless leg syndrome, or narcolepsy. They are based on evaluation of symptoms, daily activities, social functioning, emotions, and/or overall life satisfaction. The domains measured may include vigilance, activity, general productivity, social functioning, and intimacy/sexual relationships.

Most of the information is limited to disorders of excessive daytime sleepiness, especially sleep apnea. There is poor correlation between the disease severity for sleep apnea, and treatment outcomes as measured by physical parameters normally evaluated by polysomnography. Other factors important to daily functioning and quality of life that correlate with effective treatment have not yet been adequately measured. Research is proposed to more accurately describe the 'disease burden' of sleep apnea.

All surveys show sleep disorders lead to poor health among affected individuals as compared to the general population, especially in areas of energy, vitality, physical role limitation, social roles, and emotions. Affected individuals may go for years or decades without discovery and treatment of their sleep disorder and only seek treatment for other related health problems. At the same time, the direct effects of their sleep disorder, such as symptoms of EDS, take a toll on social relationships and on daily functioning.

Scenario 1

John is in his 20's and lives by himself. He is severely depressed after loss of a job last year because of poor work performance, a consequence of his unrecognized sleepiness and cognitive impairment from an undiagnosed sleep disorder. He seeks out counseling for what appears to be strictly depression and other problems with his mood. He is given medication for his depression, but nothing seems to work. He still has problems with lack of energy and lack of motivation. He still has sleep problems; and he is moody, grumpy, and dislikes his life. He has applied for disability benefits because he does not know how he could ever go back to work since he feels so lousy. In addition, to make matters worse, he still cannot lose those extra 40 pounds, no matter how hard he works out at the gym and tries not to eat any sweets. His heart, lungs, and blood pressure seem fine. Is it chronic depression, or is there an underlying sleep disorder, sleep apnea? How would you evaluate this individual who wants to apply for vocational rehabilitation services?

Scenario 2

Sarah who is in her first year at college has symptoms of EDS, which she ignores despite always falling asleep in class. Her grades have deteriorated and she has decided to take time off from school. She is not working because she feels so tired. Treatment for her excessive sleepiness will not happen until after manifestation of cataplexy (attacks of muscle weakness where you can fall down). This will compel her to seek further medical evaluation for a diagnosis of narcolepsy. She has applied for disability benefits, but does not think she will qualify for them. In the meantime, she was advised to seek out services for vocational rehabilitation. Would she qualify for services? How would her narcolepsy influence her Individualized Plan for Employment (IPE)?

Scenario 3

Doris is a 52-year-old female who has high blood pressure. She has always had a weight problem. Five years ago, she was diagnosed with type 2 diabetes. Her blood sugar has not been well controlled in the last year. Both she and her physician are concerned since medication changes and diet have not worked to reduce her blood sugar levels; and now she finds out that her eyesight may be deteriorating. Her physician has asked her if she snores or notices an unusual amount of tiredness during the day. She said yes. Doris was given a referral to a sleep specialist for an overnight polysomnography, which revealed a moderately severe case of sleep apnea unrecognized until now. Doris will be started on CPAP therapy, which should help control her blood sugar and have a beneficial effect on her eyesight. However, Doris has been fired from her job. She has come to you for help with re-employment knowing that she has considerable health problems. Would she qualify for services? What would you address in her IPE?

Syndrome of Excessive Daytime Sleepiness (EDS)

• Confusion, mental fog, mentally slow

• Problems with vigilance, attention span, focusing

• 'Automatic behavior' and don't remember

• Extreme exhaustion, fatigue, tiredness, lack of energy, low motivation

• Can't get going in the morning, late to work or school, late to appointments

• Inefficiency and mistakes

• Worsening job performance, worsening grades at school

• Personality changes with irritability and depression, anxiety

• Recreation and social activities avoided (because of fatigue?)

Other Serious Cognitive Problems

• Impaired executive function: planning and insight, decision-making/risk-taking

• Memory problems, forgetfulness, memory loss

Other Sleep Problems

• Uncontrollable urges to sleep

• Failure to initiate or stay asleep and early awakening

• Vivid dreams when falling asleep or waking up

• Inability to talk or move for brief periods when falling asleep or awakening

• Physically acting out dreams when asleep

• Sleep-walking, talking in your sleep, bed-wetting

• Awakened by uncomfortable sensations/pain in legs/arms at night or at rest, relieved by movement

Other Physical Signs & Symptoms

• Snoring

• Gasping for air or not breathing, witnessed by others

• Being overweight and obese

• Having a thick neck

• Leg edema

• Having to urinate during the night

• Sudden loss of muscle control

• Early morning headache

Associated Health Conditions

• High blood pressure

• Coronary artery disease, heart attack, stroke, irregular heart beat

• Psychiatric problems

• Impotence (men and women)

• Type 2 diabetes

• Heartburn from reflux disease

Daily Functioning

• Unable to perform daily activities

• Difficulty keeping a job

• Problems with social life and family

• Low self-esteem