Obstructive Sleep Apnea (OSA) is one of the more common disabilities claimed by veterans, but also one of the most often denied. The reason it is so often denied is the lack of the VA in linking OSA to a service-connected condition. However, the VA and medical science have numerous studies that link OSA to several conditions that are frequently service-connected such as cardiovascular conditions, mental health conditions, diabetes, asthma, Alzheimer’s disorder, and ocular conditions.
Obstructive sleep apnea is a condition where the muscles in a person’s throat relax and block the airway, causing snoring. The snoring is the person’s body causing a reflex to start breathing again after the airway has been blocked. While the airway is blocked, the amount of oxygen going to the brain and red blood cells is decreased. When the body reflexes to start breathing, it also comes out of REM sleep, causing a deficit during the night of healthy, restorative sleep patterns. This lack of restorative sleep can also result in excessive daytime sleepiness leading to potential accidents and severe safety issues. The lack of oxygen can lead to increased headaches, difficulty concentrating or focusing, high blood pressure, decrease libido, and increases in symptoms of other health conditions. There are several common contributing factors that the VA usually assumes OSA is due to and will immediately use as the contributory cause: obesity, smoking; family history or other genetic issues such as a narrow airway; or chronic sinus or nasal congestion.
But, these conditions can only exacerbate OSA, they do not always cause OSA and to get an accurate rating, a pulmonologist needs to find the most likely etiology or cause of the sleep apnea. Remember, not everyone who is overweight smokes, or has asthma also has sleep apnea. Therefore it cannot be considered the only cause, and if another etiology is found, and found to be more likely the cause, the veteran may be able to get a disability rating for the condition.
Potential Issues Related to Obstructive Sleep Apnea
Obstructive sleep apnea is important to identify, treat, and get service-connected due to the higher risk those with OSA have for such conditions as cardiovascular issues such as hypertension, vascular disease including stroke, congestive heart failure, and arrhythmias, and increased risk of decreased executive function putting people at risk for increased auto accidents, occupational accidents, and decreased quality of life. Decreased executive functions can lead to loss of memory, decreased focus and concentration, increased irritability and stress, and a lower tolerance for things that would usually not bother you such as noise, activity, etc.
Orthopedic conditions are often an overlooked cause of sleep apnea. Studies by the American Academy of Sleep Medicine have shown that upwards of 77% of those with a spinal cord injury had sleep-disordered breathing that included obstructive and central sleep apnea (a neurological condition) events. Another study from 2017 published by the Turkish Thoracic Journal identified that people with fibromyalgia, a pain syndrome, had a 50% higher rate of OSA; fibromyalgia is presumptive for many of those veterans who served in the Gulf War era. Because OSA reduces the REM and Stage 3 sleep patterns, those with disorders such as fibromyalgia, chronic pain, chronic headaches, or chronic fatigue are unable to provide their bodies with the recovery process needed to battle the pain, leading to more chronic conditions. And more chronic conditions, or increased pain, stress, and disability from existing chronic conditions, leads to increased pain, sending us on a vicious circle that without treatment will continue to exacerbate each condition.
Treatment for Sleep Apnea
Sleep positions are often something doctors will tell us to change when sleep apnea is diagnosed, however, this does not always solve the problem, and changing your sleep position is often very difficult after many years of sleeping in the same position. This is especially true when someone is experiencing pain or spinal issues and sleeping is already uncomfortable or painful.
Increases in cervical conditions that cause positional changes or inflammation to the muscles have also been found to be a link to increased OSA risk. As the muscles in the neck become inflamed due to tension or spasms, they can reduce the passage of the airway for breathing. Combined with laying supine and other factors, this can lead to apneas and hypopneas and the potential for poor sleep quality and OSA.
CPAP or BiPAP therapy is often recommended as a way to treat sleep apnea and help stop the cycle of exacerbation. It can then start to decrease pain, lower blood pressure, help people get their diabetes under control, and generally just feel better and have a better quality of life. A minimum rating for the prescription of a CPAP or BiPAP for service-connected OSA is 50% and can be direct or secondary to another service-connected condition. If you snore, have daytime sleepiness, or feel that you are just not getting a good nights sleep, ask your doctor for a referral for a sleep study. Some can even be done in the privacy of your own home. If you are diagnosed with OSA, make sure you get a claim filed if you suspect it is secondary to a service-connected condition or that it is related to your military service.
