Unclear diagnosis of morning headache, ET fullness etc.

[JacGallo]

Hi Dr.

2 or 3 days per week, I awake with a dull pressure-headache in my forehead, fullness in left eustachian tube, slight nasal congestion, malaise, very dry mouth, and scratchy throat..  The symptoms usually reduce a by the afternoon. I have noticed that this usually happens even after full night's sleep.  In fact,  if I sleep only 5 hours at night, then I don't get these symptoms. However, if I sleep a full 7-8 hours, I get the symptoms.  I find this strange! I do feel a little day-time drowziness and fatigue, but I''ve felt this way for as long as I can remember, even before my current symptoms started.

I've this problem for many months now after a bout of Otitis Media in Oct 2008.  In October I was told that I had an underlying sinus infection and was put on Flonase for 6 wks. This did not help. I was then sent for Sinus CT scan that showed all sinuses clear, except a mild mucosal thickening in maxillary. I was then put of 3 rounds of antibiotics by my ENT, first Cefuroxime, and then 2 rounds of Azythromycin (6-Pak). Didn't.  The ENT also did endoscopy of sinuses and this was normal.

In early Jan 2009, I went to an Oto-neurologist, who sent me for Brain MRI, which showed no problems in brain or mastoids. It did show mild mucosal thickening of Ethmoid and Maxillary Sinus, which the was dismissed as insignificant and unlikely to cause my symptoms.  This doctor says I had some ET dysfunction left-over from the Otitis Media, and that my headaches are either tension headaches or I have SLEEP APNEA. I have since been put on Astelin nasal spray and told to just 'wait out' the headaches. If the headaches don't clear in 2 weeks, he wants to send me for a sleep study and put me on Effexor anti-depressant. First, I would rather not take Effexor, because I'm not depressed. Second, I'm not convinced that I have sleep apnea, because I don't snore (although, i sleep alone, so can't be sure)

Do my symptoms indicate sleep apnea? Is sleep study worth it?

thanks,

Akshay

[Steven Y Park, MD]

Your history could be consistent with obstructive sleep apnea, and here's why:

The longer your sleep, the more likely you'll be in REM sleep, when your muscles relax the most and more likely to obstruct and stop breathing. This can suction up your stomach contents into your throat, ears and sinuses, causing swelling and inflammation. Inflammation of the sinuses can partially block your sinuses, giving you sinus pressure and discomfort.

Poor sleep can also cause a neurologic inflammatory response in your sinuses and ears due to a relative imbalance of your involuntary nervous system. This makes your nose extra sensitive, runny or stuffy.

You don't have to snore at all to have sleep apnea. Even young, thin women who don't snore can have significant sleep apnea.

Please keep me up to date with the results of your sleep study.

[JacGallo]

Hi Dr. Park,

Thanks for your response. I'm scheduling my sleep study for next week. By the way, I just visited your website, which is awesome!  I watched the video of you going through your own sleep study and it's very good. But, didn't you find it hard sleeping with all those wires attached to you?  Also, in my case, I usually need to read, watch tv, or surf the web on my laptop for a while before I actually fall asleep.. I guess it's part of my sleep 'routine'.  Are you allowed to do any of these things at the sleep lab to help you fall asleep? Are you allowed to bring your cell phone to talk to your wife or friends? This is also sometimes part of my sleep 'routine.

I guess I'm just nervous that the expectation to sleep properly will weigh on my mind while at the sleep lab, and this may skew the test result. So I'm hoping I can simulate my 'normal' sleep routines as closely as possible to help me forget I'm in a sleep lab.

I'm very interested to know in what your think about this.

rgds,

Akshay