Referred Condition - Sleep Apena w/ Hypersomnolence

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USN_1997

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Has anyone ever had any success getting that condition rated by DOD at a PEB? Apparently, my sleep apena is causing or contributing to hypersomnia during the day. I have 2 or more episodes of interrupted sleep at night. Been on CPAP since 2014 with not real improvement. Have had 2 MSLT’s - ins strong for narcolepsy diagnosis, the other possible narcolepsy but probably hypersomnia.

I thought I might have narcolepsy, but the doctor says the wake ups make him think otherwise...
 
My referred condition is similar, narcolepsy without cataplexy, with OSA possibly contributing to it, with an addition of migraines. The PEB recently found me "Unfit", and am currently waiting on the VA, so I might be able to answer your question in about 2 months...

What do you mean by "wake ups"?
 
AerithLives said:
My referred condition is similar, narcolepsy without cataplexy, with OSA possibly contributing to it, with an addition of migraines. The PEB recently found me "Unfit", and am currently waiting on the VA, so I might be able to answer your question in about 2 months...

What do you mean by "wake ups"?
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Where I wake up in the night. I typically pop-up randomly...
 
Ah... I don't get that often, but I have mentioned it to my sleep doctors that they do, they haven't mentioned it being an indicator of the condition not being Narcolepsy, just an indicator that my sleep patterns suck...
 
AerithLives said:
Ah... I don't get that often, but I have mentioned it to my sleep doctors that they do, they haven't mentioned it being an indicator of the condition not being Narcolepsy, just an indicator that my sleep patterns suck...
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I have a referral for another opinion, but it will not be in time for the IPEB. 09 APR is when I’ll be seen for that. If I do have narcolepsy, I’ll have to go to a FPEB to have it considered as a referred condition.
 
USN_1997 said:
Has anyone ever had any success getting that condition rated by DOD at a PEB? Apparently, my sleep apena is causing or contributing to hypersomnia during the day. I have 2 or more episodes of interrupted sleep at night. Been on CPAP since 2014 with not real improvement. Have had 2 MSLT’s - ins strong for narcolepsy diagnosis, the other possible narcolepsy but probably hypersomnia.

I thought I might have narcolepsy, but the doctor says the wake ups make him think otherwise...
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Are you being seen by a sleep specialist? Have you requested a second opinion?

Have alternates to CPAP been discussed?
 
Does the referral include a polysomnograph? Did you already have a polysomnograph?
 
Not sure - it's just a referral to a civilian sleep doctor since I am on isloated duty under Tricare Remote. He'll probably want to do his own workup...
 
I am currently going through IPEB for Narcolepsy with Cataplexy. It actually surprises me that your sleep doc said that constantly waking up at night is contrary to narcolepsy when it is one of indicators used when narrowing down to hypersomnolescence/narcolepsy. Regardless, the main thing that definitively identifies narcolepsy is the SOREM or time to onset of REM sleep during the naps. For me my average was 9 minutes to being in REM and 2.5 min average sleep latency. I also woke up 37 times during my polysomnograph.

I would honestly be surprised if at the second opinion, the new doc wanted a new study. I would expect them to just review the sleep charts from the other tests and give you their diagnosis.
 
GrilledCheezus said:
I am currently going through IPEB for Narcolepsy with Cataplexy. It actually surprises me that your sleep doc said that constantly waking up at night is contrary to narcolepsy when it is one of indicators used when narrowing down to hypersomnolescence/narcolepsy. Regardless, the main thing that definitively identifies narcolepsy is the SOREM or time to onset of REM sleep during the naps. For me my average was 9 minutes to being in REM and 2.5 min average sleep latency. I also woke up 37 times during my polysomnograph.

I would honestly be surprised if at the second opinion, the new doc wanted a new study. I would expect them to just review the sleep charts from the other tests and give you their diagnosis.
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Based on the general criteria for narcolepsy diagnosis (sleep latency of less than or equal to 8 minutes and 2 or more periods of REM occurring), you meet the criteria. Another thing to note is that sleep docs don't outright state a diagnosis of narcolepsy, they always state: strongly abnormal sleep results indicate a great possibility for narcolepsy. This is due to the ambiguity of the diagnosis criteria and how little is known of narcolepsy at this point. Another big factor is the possibility of cataplexy, which can have a major impact on diagnosis if present.
 
GrilledCheezus said:
I am currently going through IPEB for Narcolepsy with Cataplexy. It actually surprises me that your sleep doc said that constantly waking up at night is contrary to narcolepsy when it is one of indicators used when narrowing down to hypersomnolescence/narcolepsy. Regardless, the main thing that definitively identifies narcolepsy is the SOREM or time to onset of REM sleep during the naps. For me my average was 9 minutes to being in REM and 2.5 min average sleep latency. I also woke up 37 times during my polysomnograph.

I would honestly be surprised if at the second opinion, the new doc wanted a new study. I would expect them to just review the sleep charts from the other tests and give you their diagnosis.
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I don’t know what the new doc will do. I do plan to have an IMR completed and I’ll try to get narcolepsy added again. The C&P examiner was like, “Yep, you’ve got it!” He asked me # of episodes and I showed him my sleep tracker where I had 8-10 napping episodes a week...
 
GrilledCheezus said:
Based on the general criteria for narcolepsy diagnosis (sleep latency of less than or equal to 8 minutes and 2 or more periods of REM occurring), you meet the criteria. Another thing to note is that sleep docs don't outright state a diagnosis of narcolepsy, they always state: strongly abnormal sleep results indicate a great possibility for narcolepsy. This is due to the ambiguity of the diagnosis criteria and how little is known of narcolepsy at this point. Another big factor is the possibility of cataplexy, which can have a major impact on diagnosis if present.
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I don’t think I have cataplexy; I don’t pay enough attention when I’m going to sleep or waking up to notice...
 
But like I said, I had a second MSLT done 6 months later and I had ZERO naps - so they said possibly hypersomnolence...
 
Cataplexy is prevalent throughout the day and can range from full body dropouts to your face going limp after laughing. It took me a while to realize how it occurred for me (knees get real weak and face goes limp).

Normally if there is a test that indicates narcolepsy and one that doesnt they rule on the side of the one that diagnosed it due to the fact that it is impossible to force REM during the MSLT after completing the polysomnograph. The VA would definitely rate it as if it were narcolepsy based on their benefit of the doubt in the veterans favor policy.
 
Well hopefully my disability lawyer will fight and get an addendum added to the MEB to address that when the time comes...
 
Definitely fight for it regardless. An IMR, as long as the reviewing doc is competent, should get that situation sorted out.
 
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