Many of these cases may be due to sleep-disordered breathing, which is massively under-diagnosed because of a little known controversy within the sleep medicine

Many of these cases may be due to sleep-disordered breathing, which is massively under-diagnosed because of a little known controversy within the sleep medicine field involving the scoring of sleep polysomnographies. The American Academy of Sleep Medicine (AASM) admitted to a horrible mistake in their original scoring guidelines [1], but sleep physicians and labs are still way behind on catching up to this. The usual scoring methodology will only detect people with traditional obstructive sleep apnea, because it looks exclusively for long pauses in breathing and significant drops in oxygen saturation. By contrast, there are many people experiencing heavily fragmented sleep because of micro-arousals that will not meet those criteria. Here are some quotes from the AASM on this: > Respiratory events associated with arousals, even without oxygen desaturation, cause significant, and potentially dangerous, sleep apnea symptoms. During PSG, arousal-based respiratory scoring should be performed in the clinical evaluation of patients with suspected OSA, especially in those patients with symptoms of excessive daytime sleepiness, fatigue, insomnia, or other neurocognitive symptoms. > Studies have shown that not utilizing arousal-based scoring may lead to a missed diagnosis in up to 30% to 40% of patients with OSA, especially in patients who are younger and non-obese. > Not including arousal-based respiratory events of any form when scoring a PSG may lead to either lack of proper diagnosis of OSA, misclassification of OSA severity, or misidentification of another sleep disorder or medical disorder (eg, idiopathic hypersomnia, chronic fatigue syndrome). These patients may remain improperly treated, leading to persistent sleep symptoms, worsened work performance, decreased neurocognitive function, and poor clinical outcomes. This is a massive, stupefying failure in medical ethics that has persisted for unclear reasons (though likely having to do with insurance). Undiagnosed sleep-disordered breathing is probably at fault for a substantial share of seemingly treatment-resistent mood disorders. Here's a quite informative talk that goes into some of the relevant details: https://www.youtube.com/watch?v=tV4NBugGSnQ https://www.youtube.com/watch?v=tV4NBugGSnQ. If you think you may have a sleep disorder, the best thing you can do is get a proper sleep study that uses arousal-based scoring. If you can't find a physician or a sleep lab that does this, then the WatchPAT is a cutting edge and affordable OTC option that will also work well: https://www.amazon.com/Home-Sleep-Study-Apnea-Test/dp/B07XKWC1TL https://www.amazon.com/Home-Sleep-Study-Apnea-Test/dp/B07XKW.... [1] https://jcsm.aasm.org/doi/10.5664/jcsm.7234 https://jcsm.aasm.org/doi/10.5664/jcsm.7234