On-site Lab Study
1. Why do I need a sleep study?
2. What can be determined by having a sleep study?
3. What causes sleep apnea?
4. What should I bring to my sleep study?
5. Why do I need a list of medications, insurance card and an I.D.?
6. How long does a sleep study take?
7. Do you really expect me to sleep with all these wires?
8. Am I able to watch TV?
9. How is the test conducted?
10. What if I have sleep apnea?
11. Why do you need to video tape the sleep study?
12. When do I have to stay for the nap test?
13. How do I get results?
Home Sleep Study
14. Can anyone have a home study?
15. What clinically can prevent a person from being eligible for a home sleep test?
16. How do I get a home sleep study?
17. What is the difference between an at home sleep test, and a test in the sleep center?
18. If I have a sleep study at home, will I still have to come into the sleep center eventually?
19. What will a home study tell me or my physicians?
20. How will I know if the test is working once I get home?
21. How do I set up the equipment once I get home?
22. What if something goes wrong during the test? Equipment stops working, comes lose?
23. What if I return the equipment and it didn’t record? Something went wrong?
Sleep studies are commonly performed on patients with one or more of the following complaints and symptoms:
- Daytime Sleepiness
- Dosing off to sleep while driving
- Your bed partner may have noticed that you stop breathing, snore loudly, gasp or choke during sleep or you toss and turn
- Interrupted or disturbed sleep
- Frequent trips to the washroom at night
- Feeling un-refreshed upon awaking from sleep
- Waking up with a headache
- Waking up with a dry or sore throat
- High blood pressure
- Sexual dysfunction
Sleep studies are typically used to rule out or diagnose many sleep disorders including sleep apnea, narcolepsy, periodic limb movement disorder (PLMD), parasomnias, and REM behavior disorder.
There are two main types of sleep apnea: Obstructive Sleep Apnea and Central Sleep Apnea.
Obstructive sleep apnea occurs when the muscles in the back of the throat relax. These muscles normally support an open airway. When the muscles relax, the airway narrows or closes, and breathing stops or becomes very shallow for a moment. Obstructive sleep apnea is always accompanied by snoring, choking, or gasping sounds.
Central sleep apnea occurs when the brain fails to send signals to the breathing muscles. The most common cause of central sleep apnea is heart disease.
Both types of apneas commonly result in a lowering of the levels of oxygen in the blood. The brain senses this inability to breathe and causes an arousal from sleep so breathing can resume. These arousals or awakenings are usually very brief and not remembered; although they impair the ability to achieve restful phases of sleep. Apneas occur 5 - 60 times or more each hour during sleep.
- A list of all medications that the patient is currently taking
- Medications that they will need during the study, including enough supplemental oxygen to sustain them for the drive to and from the sleep center
- Comfortable nightclothes such as pajamas, robe, slippers, etc.
- Toiletry items such as toothbrush, toothpaste, etc.
- The completed Sleep Questionnaire that will be mailed to the patient upon scheduling the test
- Health Insurance Card and any physician referral forms
- State Identification Card (driver’s license, etc.)
- Favorite bedtime snack, drink, etc.
- Favorite pillow if they have a preference
- Reading materials, cell phones, iPods/iphone/itouch/laptops are permitted but their use will be limited once the “sleep time” has arrived. They can be turned on after the completion of the study in the morning.
- Reading materials, card games, puzzle books are permitted but again their use will be limited.
- Children may want to bring their favorite toy (or a few) to play with during the few minutes before the measurements begin. They might also like to bring the toy they sleep with.
- Patients that are unable to / or choose not to drive themselves to their test must arrange for their own transportation from the facility between 5:30-6:00am on the morning after the test.
5. Why do I need a list of medications, insurance card and an I.D.?
The sleep lab does not have access to your doctor’s records so a list of all your medications, insurance cards and a picture I.D. must be brought to the lab. The technician needs to know what medications you are using, as many do affect the quality of your sleep.
From start to finish, it takes roughly 10 hours. You will come into the lab around 8:30 pm and get situated into your room. You will fill out some patient history paperwork and change into what you will be comfortable sleeping in. The technician will then come in and start your hook up process which can last from 30 to 45 minutes. During this time, the technician will explain the test and answer any questions you may have. Patients that are unable to / or choose not to drive themselves to their test must arrange for their own transportation from the facility between 5:30-6:00 am on the morning after the test.
Almost everyone will ask this question during the hook up. Most people do not have a problem falling asleep with the wires. The wires are bundled together and pulled out of the way so you are free to move about in sleep. If you need to get up to use bathroom in the middle of the night, just call for the technician and they will unplug a single cable and you will then be able to freely go to the bathroom by yourself.
Yes, you will be able to watch television before lights out. Lights out is at 11:00 pm. This is to ensure that you get as much time to sleep as possible and that we get as much information as possible. The TV causes disruptions in sleep, affecting your sleep stages and quality of sleep.
Before the start of the sleep study, a sleep technologist will place sensors on the back of your head, face, chest and legs. These sensors will record the different brainwaves that determine stages of sleep, eye movements, muscle activity, heart rhythm, body movements, nasal/oral airflow, respiratory effort and oxygenation.
The sensors are attached to your body by a conductive paste and paper tape. Many of the sensors are similar to electrocardiogram (EKG) electrodes and are not painful. In rare instances, some people with sensitive skin develop minor skin irritation at the electrode sites. If you have experienced skin irritation in the past, please notify the Sleep Center before your scheduled study and notify the technologist before the study begins
The sleep technician will then monitor you from a separate room all night. They will be monitoring your breathing, brainwaves, heart and any movements while you sleep. If you need to get up and use the bathroom there is a speaker to call for the technician.
There are several types of treatment for sleep apnea, including but not limited to the following:
Positive Airway Pressure Devices
Positive airway pressure machines, used with a variety of breathing masks, are the most widely used treatment for moderate and severe sleep apnea. The mask, worn snugly over the nose, or sometimes nose and mouth, during sleep, supplies pressurized air that flows continuously or intermittently into the sleeper’s throat. The increased air pressure prevents the sleeper’s airway from collapsing.
The pressurized air is supplied through a flexible tube from one of several types of machines: CPAP (continuous positive airway pressure), BiPAP (bilevel positive airway pressure), VPAP (variable positive airway pressure), and so on. Studies of the effect of PAP therapy show that people with sleep apnea who consistently use their machines feel better and, as a result of the reduction of apnea and hypopnea episodes during sleep, encounter fewer complications of the disease.
Although PAP devices are not used to treat snoring alone, they do eliminate snoring in addition to treating obstructive sleep apnea.
Oral appliances for the treatment of sleep apnea continue to increase in popularity as awareness grows amongst the public that oral appliances are an effective first line treatment for many sleep apnea sufferers. Over 100 different oral appliances are FDA approved for the treatment of snoring and obstructive sleep apnea. These appliances are worn in the mouth, just like a sports mouth guard or an orthodontic appliance, while you sleep. Oral appliances hold the lower jaw forward just enough to keep the airway open and prevent the tongue and muscles in the upper airway from collapsing and blocking the airway.
The American Academy of Sleep Medicine (AASM) has approved oral appliance therapy (OAT) as a first line treatment for patients diagnosed with mild to moderate OSA. The AASM also recommends oral appliances for patients with severe OSA, who are unable to tolerate or cannot wear CPAP devices. Another option for people with severe OSA is combination therapy (wearing CPAP and an oral appliance together) to help reduce the pressure on a CPAP machine, making it more comfortable to use.
Upper Airway Stimulation (UAS) Therapy
Some people with obstructive sleep apnea, or OSA, are unable to use continuous positive airway pressure (CPAP) therapy, the most commonly prescribed OSA treatment, despite best efforts. Now there’s a new, clinically proven therapy for some people with moderate to severe OSA who are unable to use CPAP.
The system consists of three components: a small generator, a breathing sensor lead, and a stimulation lead—all controlled by the small handheld Inspire sleep remote. Simply turn the therapy on at night before bed, and off in the morning when you wake up. When activated, Inspire therapy continuously monitors your breathing patterns during sleep and delivers mild stimulation to key airway muscles, which keeps the airway open. Your UAS therapy doctor will also evaluate your airway anatomy and overall health status to determine if Inspire therapy is right for you.
To find a doctor in your area, please visit https://www.inspiresleep.com/get-started/
About 70 percent of people with obstructive sleep apnea are overweight or obese. Their health care professionals usually encourage them to lose weight.
Surprisingly, there have been few formal studies of how effectively weight loss leads to lesser, lighter snoring and diminished incidents of apnea and hypopnea during sleep. Despite this, anecdotally practitioners report striking improvements in both OSA and snoring among patients who lose weight.
In some situations a physician may wish to prescribe weight loss medications to an overweight or obese patient with OSA.
Surgery is often effective in treating snoring. It is less effective in treating obstructive sleep apnea.
The challenge that confronts the surgeon is determining what part of the upper airway is causing the obstruction to airflow. There are many possible sites, and conventional sleep testing does not identify the area the surgeon should modify. If the surgeon does not treat that site in the airway, or if there are multiple sites of obstruction, it is unlikely that the sleep apnea will diminish to a degree that eliminates the need for other treatment.
Given the several sites where airway obstruction may exist, there are several types of operations currently used to treat sleep apnea. The most common is uvulopalatopharyngoplasty, or UPPP. The success rate of this operation is about 50 percent. Some surgeons have achieved very high success rates using multiple, staged operations. Nonetheless, most authorities recommend routine re-assessment for sleep apnea after surgery.
Most children with snoring or sleep apnea have enlarged tonsils, or adenoids, or both. In 75 percent of those cases, surgical removal of these tissues cures sleep breathing problems. The American Academy of Pediatrics has endorsed removal of the tonsils and adenoids as the initial treatment of choice for sleep breathing problems in children.
We need to video record sleep studies to make sure we get the best sleep recording possible, and accurately diagnose sleep disorders. It helps the technician capture any parasomnias like night terrors, movements seen in sleep, and many other sleep related disorders. The technologist and interpreting sleep specialist are the only personnel permitted to view these recordings.
Sleep Physicians will order a nap test, or MSLT (Multiple Sleep Latency Test) when they suspect a patient has narcolepsy, a disorder that causes periods of extreme daytime sleepiness. Narcolepsy also may cause muscle weakness.
The results of your sleep study will be sent to your ordering physician or sleep specialist. Your physician will discuss the results of the overnight sleep study with you and answer any questions you may have during your follow up appointment with your physician. You should always ask them for a copy of your results to keep for your personal records.
Home Sleep Testing (HST)
Yes and No. Any physician requesting a home study should first be seen by a Board Certified Sleep Specialist. Not all patients will qualify for home sleep testing based on clinical findings. For example patients with Heart Disease will not qualify clinically for a home sleep test.
We follow the suggested guidelines published by the American Academy of Sleep Medicine for the use of home sleep testing. People with the following health concerns are, by necessity, excluded from participating in an HST:
- Chronic Obstructive Pulmonary Disease (COPD)
- Congestive Heart Failure (CHF) or other significant cardiac disease
- Neuromuscular or neurodegenerative diseases
All patients requesting a home sleep study, will first be seen by a Board Certified Sleep Specialist.
You can also make an appointment with any of our sleep physicians affiliated with our locations doing home sleep testing. Simply call 888-753-5661.
Physicians wishing to order a home sleep test for their patients may do so here.
A home sleep test only diagnosis Obstructive Sleep Apnea whereas an in lab test can test for Obstructive or Central Sleep Apnea, Restless Leg Syndrome, Periodic Limb Movements, Sleep Disordered Breathing, etc., At home sleep tests monitor 8 channels, where as tests in the lab monitor 16. With a home sleep study we are monitoring Heart Rate, Blood Oxygen level, snoring, body position, body movement, breathing airflow, and effort. With an in lab test, we are monitoring all of those things as well as additional important information like EKG, limb movements and sleep time. There are pros and cons to each test for each individual patient. We suggest it is up to a Sleep Specialist to determine which test is best for you as each monitor different things, test for different disorders and can have different outcomes.
Typically, yes. We believe that doing this portion of the testing in a monitored, controlled environment will give the patient a better opportunity to get the treatment they need. In the lab we are able to monitor the mask and machine for any leaks, we are able to determine at the lowest possible pressure what will treat the patient’s Sleep Apnea effectively, and for the cases that need more than just CPAP, we have Bi Level therapies as well as Auto SV therapies to meet those needs. For the instances where a patient is unable to come into the lab, or their insurance company will not cover such testing our Board Certified Sleep Specialists will order the patient an Auto CPAP device. Over a small course of time, the Sleep Specialist will work with the patient on getting acclimated to the machine, as well as monitor their usage of the equipment to assure they are being treated properly. Typically, this will be done with the patient sleeping at home with the Auto device, as well as the home sleep study equipment they did with their first test. You can see an example of this here.
Home Studies are only used to diagnosis Obstructive Sleep Apnea. A Home sleep study will not monitor EKG, or give us sleep time.
As indicated on the directions you will hold down the start button to begin until the download bar fills completely. The device will then show a time display and then the light goes out as to not disturb you while you are sleeping.
When you appointment is scheduled to pick up your home study equipment you will meet with a Registered Technologist, who can hook you up and you can wear the equipment home that evening, or they will instruct you on how to hook up the equipment once you get home. We also provide a detailed list of instructions for each patient, you can preview them here.
We have 24/7 technical support to answer any of your questions. Call toll free 888-753-3777
Unfortunately, home sleep studies do have a high failure rate, and the studies sometimes have to be redone. We will not know if your test was successful until after one of our scoring technicians has an opportunity to download your study and review it. Typically, this is done the day you drop it off. If a re-test is needed, or the results were not accurate, that will all be discussed with you with your follow up appointment with the Board Certified Sleep Specialist.