I still haven't informed the DVLA yet, still no car! But I had received a copy of a letter sent to my GP after I asked him if he heard from the sleep clinic regarding my check up...
Anyway here goes:
"Dear DR N,
Tiredtracey- D.O.B: sometime in the 1970s
Lives in Basildon, Essex
Thank you for your letter date 1st August regarding Tiredtracey.
She was referred to us with a history of tiredness and snoring. She had an Epworth score of 16/24 in my clinic and 18/24 in our sleep laboratory, suggesting she was significantly sleepy. (YES, dear doc, I'm shattered!!) Indeed, her EMBLETTA test was in the normal range (Didn't feel normal, going home on the bus with that gear on!!!); however, in patients who are significantly hypersomnolent there are two options open to us:
(1) Place them on a trial of CPAP therapy, to see if their symptoms improve: you may be aware that there is a condition called upper airway resistance syndrome where the actual apnoeas and hypopnoea and desaturations may not be at significant levels; however even mild obstruction can cause a poor sleep and consequent hypersomnolent.
(2) To repeat the sleep test: (Not the EMBLETTA palaver -AGAIN!
) In view of the upper airway resistance syndrome, which can only be diagnosed by oesophageal manometry, (EH?
) we provisionally provide a trial of treatment which is occured in Tiredtracey's case. It is our experience that a number of these patients do benefit from CPAP therapy, with significant improvement in symptoms (funnily enough, I do notice the difference when I forget to wear to the face hugger!). In fact, we are in the process of writing a paper on this. (I knew it! I am a snoring guinea pig!!!!
Coming back to your query; you are absolutely right there is no objective evidence of objective (think he meant "obstructive") sleep apnoea on the single test ( I had two tests! The oximeter wrist watch thingy and Embletta get up! Best of three tests anyone???); perhaps a repeat test or a more extensive polysomnogram may reveal more insight. In any case; as she is sleepy, I have opted to call her condition 'upper airway resistance syndrome' (Hmmm, sounds like it could be a "pre- condition" to OSA. Wonder if the DVLA know about it???) and place her no (must mean "on") a CPAP; however, if CPAP does not benefit her, the plan of action would be to investigate further with a full polysomnogram if required. (Does this mean I could sleep and snore as much as I like in the name of medical science!!!!)
As far as driving in concerned; the DVLA regulations state that hypersomnolence, of any cause should be follwed by cessation of driving (I haven't driven since passing my test in November 2011!!!) until treatment has been started that particular condition.
Iwould suggest that Tiredtracey does not drive until she feels better. ( I do feel better, even more so if I had a flaming car!)
We also inform our patients that is their obligation to inform the DVLA of their condition (right, I will do now, since a name has been given to it!!) and we strongly advise that they do so. after treatmenty has been started and found to be effective; in Tiredtracey's case this would be if CPAP is beneficial for her ( you don't speak to your sleep team??), then there should be no implications to driving; however whilst the intial trial has been carried out we advise all of our patients not to drive, as per DVLA regulations.
I hope this clarifies your questions. I have copied this letter to Tiredtracey for her information. (Thank you very much, dear Sir!
She is due to be seen again in our Pulmonary Physiology and Sleep Laboratory in July 2013 but she is aware that she can contact them if she has any problems with her equipment. (I hope he means CPAP.....
If you (or Tiredtracey) have any further questions then please do not hesitate to contact me again.
So, that clears it up then!