With many of the mentoring sessions I run, I suspect there’s often a misperception that the learning is one way. Part of what thrills me about being a mentor is all the learning opportunities I am personally presented with.
Recently, I had an exceptional example. You see, I am privileged to have a colleague, Sonya Cacciotti, in one of my groups. She has worked for over a decade in tandem with an extraordinary doctor up here in Ballina, and they have had a particular long-standing interest in sleep quality, assessment and management. Consequently, her knowledge in this area is exceptional, particularly with regard to not just obstructive sleep apnoea (OSA) but the much more and often missed, upper airways resistance syndrome, that is especially common in women. She’s been in my ear on numerous occasions and during group sessions saying, ‘Watch out for this Rachel, it’s more common than we all realise and could be behind many people’s problems‘.
As luck would have it, I have seen a series of cases now within quick succession that all look suspiciously like undiagnosed apnoea or airways resistance. I was listening all along but now Sonya’s wise words and these conditions have my full attention.
So here is some information that will a) likely totally change your work-up of female clients with sleep or energy issues and b) blow your mind by shining the light on just how this insidious and common disordered breathing pattern actually presents. Well, it did both for me.
- Do you ask questions about snoring, snort arousal response, waking with a dry mouth etc as your screen for apnoea?
- Are you most likely to predominantly ask these questions of men, especially those who are overweight or obese, or have a large neck circumference?
- Do you perhaps even use the validated OSA screening tool called Stop-Bang?
Well I was too until I knew better! Thanks especially to Sonya and a great Medscape article that popped into my inbox a few months ago. Here’s the lowdown:
- The STOP-BANG is possibly not as sensitive nor specific for detecting OSA in women – as their apnoea and sleep disordered breathing (SDB) is less often linked to the high BMI
- Rather than snoring and snort arousals etc. women with SDB tend to present with very different stories – things like: insmonia, headache, night sweats, nocturia, fatigue, depression and anxiety….OH MY…what have we been missing??!!
- Sounds like peri-menopausal vasomotor sx? You’d be correct! In fact rates of OSA jump with menopause due to sex hormone changes that make our respiratory centre less sensitive and responsive..OH MY OH MY…so in fact the two things are often clinically underdistinguishable and in fact in many instances the onset of SDB may be mis-diagnosed and dismissed as menopause. This study by Gao et al (2018) found that women with ‘severe vasomotor symptoms’ had a 1.87 X higher risk of intermediate to severe OSA…OH MY OH MY OH MY
Cue one of my favourite quotes: “I did then what I knew how to do. Now that I know better, I do better.” Maya Angelou.
And another wonderful reminder that learning doesn’t happen in a ‘top down’ direction, it can happen from any direction and the best learning & mentoring is reciprocal 🙂
Interested in teaching Rachel something…and learning a little from her to boot?! Rachel’s group mentoring applications for 2019 open in October but you can send us an email now to go on the ‘first alert’ list if you’re keen. In the interim, she offers one on one sessions that can help you get up to speed with pathology reading, naturopathic diagnosis etc in order the hit the ground running with your new group in 2019.