Q: I am 48 years old and married with three children. For the past eight years, I have only been able to sleep for about three hours each night. I've tried everything in the book but nothing works.

I've even visited a sleep clinic. The doctor did a sleep study and found that I had obstructive sleep apnoea. A successful operation was done but I still don't seem to be able to get enough sleep.

I still get only about three hours of sleep each night and I feel very tired and weak in the morning. Can anything else be done?

A: First, I will need to look at the issue of obstructive sleep apnoea. I would need to know how severe it is, as determined by the sleep test. It is also important to know what type of sleep test was done. There are different types, ranging from those of a screening nature to the more complete type of polysomnogram or apnoea graph test.

A polysomnogram or apnoea graph type study is usually more reliable.

If the obstructive sleep apnoea is mild, then it would be unlikely that this condition should be blamed for the inability to sleep more than just three hours each night.

Assuming that you had a moderate to severe type of obstructive sleep apnoea and as your symptoms of tiredness and feeling weak persist, I would investigate to what degree the obstructive sleep apnoea condition has improved with the given treatment.

You mentioned that the operation was successful. However, in this situation, I think it would be best to assess the success or otherwise of the treatment based on a repeat polysomnogram or apnoea graph test.

If a repeat test were to show that the obstructive sleep apnoea problem was still significant, a review would be necessary. A reasonable method would be to give a trial of continuous airway pressure to see if this solves the problem you have described. If it does, then you could choose to continue to use this method of treatment.

If you wish to explore alternatives, then it would be worthwhile to carefully assess what prevented the previous operation from working and to discuss what could be done surgically to correct that.

In the event that there is no significant obstructive sleep apnoea issue, you should consider the possibility of insomnia which can be temporarily helped with medication.

However, long-term treatment usually involves psychological therapy or traditional Chinese medicine.

Dr Stephen Lee

-Dr Stephen Lee is a consultant ear, nose and throat surgeon at Raffles Hospital.

This story was first published in Mind Your Body, The Straits Times, on Oct 16, 2008.

For more The Straits Times stories, click here.

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