Seeking Further Evaluation for Neurological Symptoms and Sleep Issues

How to seek further medical consultation?

Hello, doctor.
I'm sorry to bother you again.
After my examination, I was diagnosed with mild sleep apnea (partly central).
I have started using a ventilator, but I only feel a reduction in dizziness in the mornings upon waking.
About half an hour after getting up, I start to feel fatigued again, and at work, I experience dizziness and difficulty concentrating, among other issues.
The symptoms are very similar to the fatigue and dizziness I experience during an allergic rhinitis attack, but I rarely have sneezing or a runny nose; however, I do have nasal congestion, which alternates between sides at night (nasal sprays and oral antihistamines have been ineffective).
A previous doctor mentioned that my symptoms are more severe than what the sleep study indicated and suggested there might be other underlying causes (I do not have insomnia).
Should I consult a neurologist to check for possible neurological disorders? Before discovering my sleep issues, I had seen a neurologist, and my EEG was normal, with only signs of excessive daytime sleepiness.
Aside from dizziness (difficulty thinking), inability to concentrate, poor memory, and easy fatigue, I do not have any other significant symptoms.
Can I request the hospital to arrange for an MRI or CT scan of the brain under health insurance? Also, is the EEG during the sleep study similar to the one conducted while awake, and can it reveal any abnormalities in the brain? Thank you.

SA, 40~49 year old female. Ask Date: 2015/03/19

Dr. Gao Chunde reply Neurology

Since half of the cases are central in nature, and the use of a ventilator only improves some symptoms, it may be time to consider a consultation with a neurologist.
As for the examinations, we should not pre-determine what tests to conduct; rather, we should respect the professional judgment of the attending physician at that time.
Additionally, some issues may not be organic (structural) problems, such as those related to stress, emotions, or lifestyle factors.
Appropriate tests should be conducted to confirm these issues, so it is advisable to arrange for a specialist consultation first.

Reply Date: 2015/03/19

More Info

Hello! Thank you for reaching out with your concerns regarding your neurological symptoms and sleep issues. It sounds like you are experiencing a complex interplay of symptoms that warrant further evaluation. Given your history of mild central sleep apnea and ongoing symptoms such as fatigue, dizziness, and difficulty concentrating, it is indeed prudent to consider a comprehensive neurological evaluation.

Understanding Your Symptoms
Your symptoms of fatigue and dizziness, particularly after waking and throughout the day, can be attributed to several factors. Sleep apnea can lead to fragmented sleep, which significantly affects daytime alertness and cognitive function. Even with the use of a CPAP (Continuous Positive Airway Pressure) machine, some individuals may still experience residual symptoms if their sleep quality is not fully restored.
Additionally, the nasal congestion you describe, which is not accompanied by typical allergy symptoms like sneezing or a runny nose, could suggest other underlying issues such as chronic sinusitis or even a non-allergic rhinitis. This can also contribute to your feelings of fatigue and cognitive difficulties, as poor airflow can affect sleep quality and overall well-being.

Next Steps for Evaluation
1. Neurological Consultation: Given your symptoms and previous evaluations, it would be wise to consult a neurologist. They can assess whether there are any neurological conditions contributing to your symptoms. A thorough neurological examination can help rule out conditions such as multiple sclerosis, migraines, or other central nervous system disorders.

2. Imaging Studies: You mentioned the possibility of requesting an MRI or CT scan. In many healthcare systems, a neurologist can order these imaging studies if they deem them necessary based on your symptoms and clinical evaluation. These scans can help identify structural abnormalities in the brain that may be contributing to your symptoms.

3. Sleep Study Follow-Up: Since you have already undergone a sleep study, it may be beneficial to discuss the results with a sleep specialist. They can provide insights into whether your sleep apnea is adequately managed and if there are any other sleep disorders present, such as restless legs syndrome or periodic limb movement disorder, which can also disrupt sleep quality.

4. Cognitive Assessment: If cognitive difficulties persist, a neuropsychological evaluation may be warranted. This can help assess memory, attention, and other cognitive functions to determine if there are any deficits that need to be addressed.

Sleep Study and Brain Wave Analysis
Regarding your question about the sleep study and brain wave analysis, the electroencephalogram (EEG) performed during a sleep study is indeed different from a standard EEG done while awake. The sleep study EEG focuses on brain activity during different sleep stages, which can reveal abnormalities that may not be present when the patient is awake. However, it may not provide a comprehensive view of all potential neurological issues. Thus, if there are concerns about brain function, a separate EEG while awake may be recommended.

Conclusion
In summary, your symptoms are multifaceted and could be influenced by both sleep-related issues and potential neurological conditions. It is advisable to pursue a thorough evaluation with a neurologist, who can guide you on the appropriate tests and treatments. Additionally, maintaining open communication with your sleep specialist about your ongoing symptoms will be crucial in managing your overall health.
Please take care, and I hope you find the answers and relief you seek soon!

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