- Today we're gonna be talking a little bit about
sleep disorders.
My name's Zack Evans with Woods and Woods Attorneys
in Evansville, Indiana.
Why does good sleep hygiene matter?
The first is alertness and effectiveness.
Sleep hygiene has an impact on your metabolism,
your overall physical health.
It also can impact your safety in the workplace.
If you're getting poor sleep
and you're not alert while you're driving,
it can be a danger to yourself and other motorists.
If you're not alert while you're at work,
you're likely to suffer from lower effectiveness.
If you're not getting good sleep
that can impact you physiologically.
It can impact your hormone levels,
it can impact the way your body fights infection.
Sleep hygiene is something that regulates
all of the body's systems.
If you get poor sleep,
it's a lot more difficult for you to be an effective person.
It impacts everything.
Sleep is the way for your body to recharge.
Your mental health and your ability to maintain
mood stability is greatly impacted
by your sleep hygiene.
Even things like injury recoveries
which we wouldn't automatically associate
with something like sleep,
can be greatly impacted by your sleep hygiene.
What's one of the things that the doctor tells you
after you have an operation
or you're in the middle of fighting an illness?
The doctor will tell you,
get plenty of rest.
Drink a lot of water.
If you're not getting rest
you're not giving your body down time
to fight an infection or to heal from an injury
or a surgical procedure.
The first condition we're going to be discussing
related to sleep disorders today, is narcolepsy.
Narcolepsy is characterized by sudden, intense attacks
of sleep onset.
Often, these are unpredictable.
Over time, this can lead to dangerous symptoms
such as hallucinations.
This is an extreme safety issue on the job.
Think about a retired veteran
who suffers from narcolepsy,
and is an over-the-road truck driver.
This would be fatal to their CDL license.
Narcolepsy onset usually occurs between 10
and 30 years old.
Think about the significance of that.
Usually, that's the age which someone is serving
in the military,
so it's not uncommon that when we do see a narcolepsy case,
the onset occurs while they're serving
in the United States Armed Forces.
The exact cause of narcolepsy is unknown.
Research has not gotten us far enough
to tell us what the true root cause
of this condition is.
It could be multi-factorial.
What we're going to be looking for,
we're going to be hunting for problems in service.
We'll be looking through your file
and looking for service treatment records,
STRs as we call them.
When we're scanning your service treatment records,
we're going to be looking for disciplinary violations.
Were you falling asleep in the mess hall?
Were you late to reveille?
Did you fall asleep on watch?
These disciplinary records from command
can be a good signpost
that we found something related to a sleep disorder.
And if it's uncontrolled sleep onset,
and you were later diagnosed with narcolepsy
after you left service,
that's good evidence of onset.
Narcolepsy is a somewhat rare disorder,
but you are not alone.
Vets can win service connection for this
and if that happens, from my perspective,
that's the ball game on TDIU.
Because you're nearly unable to work in any capacity.
Doesn't matter whether it's a factory,
and you fall asleep on the factory production line,
which for obvious reasons is a danger,
or if you're in an office setting
and you cannot stay awake at a keyboard at a computer.
The next condition we're going to be discussing is insomnia.
This is a chronic inability to fall asleep.
This condition is a big one,
and I see this a lot in my client's cases.
Insomnia is rated under the Diagnostic Code
for Mental Health Symptoms.
It's considered a symptom
or a complication of an underlying mental health disorder.
Sometimes it can be rated as its own condition.
PTSD, depression, and anxiety
can sometimes all present with insomnia
as a component of the symptom complex.
Unfortunately, for those who are unable to maintain
healthy levels of sleep,
or stay asleep for long periods of time
so that the brain can get enough REM sleep to recharge,
you end up in a vicious cycle
of worsening of mental health symptoms.
Whenever I'm viewing service treatment records
or I'm viewing a C-file,
what I'm looking for for insomnia onset
is paths to direct service connection.
I'm looking for long shifts,
I'm looking for long watches.
I'm looking for interrupted sleep.
Were you interrupted by submarine alarms?
Were you interrupted by security alarms?
Air raid alarms on foreign operating bases.
These types of things can interrupt
your circadian rhythm,
and over a long period of time
can greatly impact your ability to return to baseline
even once you leave the military,
and attempt to return to civilian life.
Aside from direct theories of service connection,
we also look for ways to identify
potentially secondary causes of insomnia.
Good examples of this include tinnitus,
orthopedic injuries, ailments, pain,
mental health disorders, as we've discussed,
as I've discussed previously.
Think about lying awake ruminating in bed at night,
PTSD sufferers who are constantly playing over
their period of trauma
from their time in service.
And another pretty frequent cause of insomnia
is nocturia.
This could be a result of kidney issues
or certain types of cancer like prostate cancer.
Where you have to wake up in the middle of the night
to go to the bathroom.
If this happens enough,
this can really impact your sleep hygiene.
Another sleep disorder that we see commonly
in veteran's claims files, is sleep apnea.
Sleep apnea is known as the silent killer,
and I'm gonna get into why that is in just a moment.
Have you been told that you snore a lot?
That you snore loudly?
Even that you stop breathing at night.
Do you wake up sweating?
Are you out of breath?
Do you have nightmares about running?
Being chased? Being underwater?
Do you wake up with morning headaches?
These could all be signs that you suffer from sleep apnea.
Most people who suffer from sleep apnea
are not aware of it themselves.
The key to why sleep apnea is so dangerous
is blood oxygen saturation.
Blood oxygen saturation is how much oxygen
whenever you take a deep breath,
how much of that is your blood carrying.
Whenever you stop breathing during sleep,
your blood oxygen saturation drops,
and this is extremely dangerous for the body systems
including the heart and the brain.
There are two types of sleep apnea.
Central and Obstructive.
Central sleep apnea is related to
something that occurs in the brain
where your brain essentially forgets to
or does not tell your body to take a breath.
And we see these commonly in TBI patients.
Think about veterans who have been exposed
to IED blasts in combat zones.
You also see it in stroke and tumor patients,
and we see stroke veterans
who commonly suffer that cardiovascular ailment
as a result of complications of diabetes and hypertension
flowing from their Agent Orange exposure in Vietnam.
Tumor patients additionally,
if you have a, if you suffer from a brain tumor,
think about a Vietnam veteran
also exposed to Agent Orange
that develops a glioblastoma.
These are the types of things that can lead
to a central sleep apnea.
They're somewhat rare, but they do occur
and vets are service-connected for them.
Obstructive sleep apnea
is the other type of sleep apnea
and it is by far the most common that we see
in veteran's C-files.
Obstructive sleep apnea is caused
whenever you suffer an airway collapse.
Usually this happens when you're lying on your back in bed.
The muscles in your throat
around your airway will relax
and allow the airway to close.
If it's closed for a long enough period of time
and you're not able
to take a breath through this obstruction
your body will be flooded with stress hormones
to wake you from your REM level sleep
just enough to gasp for that breath of air.
This is why spouses report to us commonly
that their partner has stopped breathing
in the middle of the night,
so there might be a lot of loud snoring
and all of a sudden it goes silent,
and then they wake and they gasp for air.
That's your brain flooding your body with stress hormones
to wake you, to exhaust that oxygen debt.
So this gets back to the blood oxygen saturation
that we were talking about earlier.
And the only way for your brain to wake you up
and rouse you from that state of relaxation,
to clear that obstruction
is to flood you with stress hormones.
If your spouse is telling you
that you stop breathing
or that you snore very loudly during your sleep,
you really need to get a diagnosis.
You need to get a sleep study.
When you get a sleep study
it's not as scary as it sounds.
You're basically, you go to a facility,
a clinic, some of them can even be performed
in the comfort of your own home.
They might set up a camera
and put some diodes on you,
might clip your little finger with a monitor
and what they're doing is they're measuring
your blood oxygen saturation.
They're measuring your breathing,
they're measuring your heart rate.
They're trying to figure out what's happening to you
during sleep.
Because there's certain hallmarks
of brain activity and pulse rates
and blood oxygen saturation
that occur with sleep apnea patients.
The next thing you need to do
is make a meds list.
And don't leave anything out.
There are a lot of medications out there on the market
that can either cause or significantly worsen
sleep apnea.
Good examples of these are mental health medications
that have a sedative effect,
and especially opioid medications that are used for pain,
for orthopedic injuries.
Think about the number of veterans out there
that have knee problems, knee replacements,
hip problems, back problems,
and they have to take some type of opioid medication
to get through the day,
and to get their day-to-day tasks done.
This medication has an effect on the brain
that suppresses that stress response.
So it's more and more difficult
for your brain to wake the body up
to retire that oxygen debt.
The reason this is dangerous
it goes back to blood oxygen saturation.
Your body has to dip to a lower and lower level
of blood oxygen saturation
in order for your brain to wake you up.
So it takes more and more cortisol,
it takes more and more of those stress hormones.
So the negative impact of sleep apnea
is much greater if you're on some of these medications.
So make a list
and make sure that you report that to your doctor
and when you call us,
make sure you tell us about all of these medications
so that we have a full picture
of what could be causing your sleep apnea
or making it worse.
From a ratings perspective,
the reason that sleep apnea is so important
for veteran claimants, when it comes to disability payments,
disability claims, is the amount
that a sleep apnea rating is worth.
The two most common ratings for sleep apnea
are 30% and 50%.
A 30% will be awarded for something called
persistent daytime hypersomnolence.
That's a fancy way of saying, I'm tired all the time.
If you wake up and you're feeling unrefreshed.
Let's say you have those headaches in the morning.
Let's say for whatever reason,
you just feel like you're a step or two slower consistently.
Then you may qualify for a 30% rating.
A good way of finding this out
is self, is doing a self-test.
Something called the Epworth Sleep Scale.
It's a simple battery of questions
that asks you if you're sitting reading,
sitting in a car,
having a conversation with someone,
how likely are you to nod off.
And it's on a scale of not likely to extremely likely
or very likely.
And then you'll get a score at the end of that,
and that tells you how tired you are
throughout the day.
So that's the type of battery of questions
that you can assess your level of fatigue
throughout the day.
And it is something that we use
to help our clients assess
Do you need to go get a sleep study?
Do you need to talk to a doctor about this?
Potentially what is this condition worth to you?
The second rating level that we see very often
is the 50% rating.
And the 50% rating is associated with a diagnosis
of sleep apnea.
Again, you have to have the sleep study.
And a prescription of a CPAP,
that's a Continuous Positive Airway Pressure Device.
What that is, is a mask
or sometimes a canula just on the nose,
and there's a gentle puff of air
that's constantly pushed into your body,
and it holds your airway open
so that you never experience that oxygen debt
while you sleep.
And the effect of that is that you are not being roused
from sleep by your brain.
You're not being interrupted.
Your REM sleep stays consistent
and your sleep hygiene is maintained.
The problem with CPAP usage
is that some veterans find it extremely difficult to use.
Especially veterans that have
comorbid mental health disorders.
It can easily lead to feelings of panic
or claustrophobia,
and sometimes it's just uncomfortable to wear
and can make the situation worse in other ways.
It can impact your sleep hygiene
in ways that weren't necessarily anticipated
whenever it was first prescribed to you.
So if you suffer from a sleep condition,
give us a call or go online.
My name is Zack Evans at Woods and Woods.
I'd love to help you out.
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