Julie Power -Jun 10, 2016
Sleep technologist Ciara Holland prepares Kathrin Bain for her overnight sleep study. Photo: Wolter Peeters
Along with about a third of the population, sleep problems left tax law lecturer Kathrin Bain tired all day, desperately looking forward to that moment when she could go to bed.
"I'd be crushing up No Doz and putting it in my coffee every morning. And I don't even like coffee," said the 33-year-old Ms Bain, of Tempe.
For 10 years, she suffered from excessive sleepiness that left no time or energy for social life. GPs dismissed her suggestion that it could be sleep apnea, because she wasn't overweight, and tested her for viruses including Ross River and glandular fever.
Finally, she saw a qualified sleep specialist who suggested a supervised and overnight sleep study similar to the one she did on Wednesday night at St Luke's Hospital. It involved 18 leads, a video camera and a microphone monitoring everything from heart rate to her REM sleep and even whether she ground her teeth or thrashed about wildly.
Her sleep study was just one of around 800,000 that have been conducted on adults since they were first covered by Medicare in 2009-2010.
Anxiety about the quality and quantity of sleep – about one in five Australians get fewer than six hours – has become the new zeitgeist, says Sydney University's Professor of Sleep Medicine, Ron Grunstein from the
Woolcock Institute of Medical Research.
Around 33 per cent of Australians have a problem with sleep, including 10 per cent who have obstructive sleep apnea. Others don't get enough, have trouble going to sleep or staying asleep. Some, like Ms Bain, have conditions where they need more sleep than others.
Sleep specialists can't keep up with demand from people with serious sleep problems that cause depression, contribute to other health problems and undermine productivity.
Lack of sleep also makes us grumpy, more emotional, and more likely to take unnecessary risks, including in a casino or on the roads. Testing has shown that driving without having slept for 17 hours is equivalent to driving with a blood alcohol reading of 0.05. A few more hours awake and it is like driving way over the limit.
"Every day a patient will turn up with an app," said Dr Anup Desai, a sleep specialist at Sydney Sleep Centre and Prince of Wales Hospital who is Ms Bain's doctor. "Whether it is good or not is another issue."
Sleep issues were common, but not well diagnosed because most doctors received little or no training at sleep, he said.
As a result, 90 per cent of patients who complain to their doctors of insomnia receive a prescription for a sedative although cognitive behavioural therapy had been shown to highly effective, said the Australasian Sleep Association's president Maree Barnes.
The market has been swamped by commercial operators whose business is sleep, says Professor Grunstein.
Chemists and commercial operators of sleep centres now offer inexpensive sleep studies, mostly leading to the sale of expensive CPAP machines (continuous pressure airwave pumps) that usually retail for between $1000 and $3000. Even hairdressing supply shops are getting in on the action, selling a range of therapeutic devices.
"There is quite a bit of bad medicine that is going on in the sleep area that we are increasingly seeing," he told Fairfax. Many of his patients were seeking second opinions after being sold the wrong – and often expensive – solution elsewhere.
Demand for sleep studies has risen so sharply that it has been given priority in the current review of Medicare.
The area of greatest concern to sleep experts are unsupervised sleep studies which have risen by 142 per cent since 2009. This area has grown at about three times the rate of other Medicare items.
"The area is being hijacked by corporate or non-medical processes and proper careful medical assessment is being lost," said Dr Desai, who said a commercial operator wouldn't have been able to diagnose cases like Ms Bain's.
In many commercial sleep centres, the test results were reviewed by a doctor, who usually didn't see the patient, and the results were discussed with a sales rep who usually suggested an expensive solution such as CPAP machine.
Many had not seen a doctor at all. Nearly 70 per cent of those people who had an unsupervised sleep study, had not met with a Medicare-billed physician in the 12 months before or after the test, said Dr Barnes.
And 28 per cent of those having a lab test, supervised by a sleep physician, did not see a doctor in the same time.
"While some patients may have seen a doctor in a public hospital clinic, which is not Medicare billed, it is fairly certain that not enough people are having adequate clinical review after their sleep study, to discuss what was found in the sleep study and how best to proceed from there," she said.
It took five sleep tests to identify and refine Ms Bain's treatment. She was diagnosed initially with mild sleep apnea, and was fitted with a mouth splint. After that failed to fix the problem – prompting the huge doses of coffee – she was diagnosed by Dr Desai as suffering from idiopathic hypersomnia (the need to sleep too much) which she now treats by taking Dexamphetamine.
It made her heart beat a bit faster than normal, but allowed her to have a normal day. "I am not sleeping 12 hours now," she said, adding that she could work, travel and socialise like anyone else.
Experts are hoping that the review of sleep studies in Medicare will recommend more detailed items, the need for tests to be reviewed by the patient's doctor or sleep specialist in person, and will also see doctors and pharmacist trained to provide expert advice on sleep problems.