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Direct Sleep Testing
Direct testing performed in the sleep center refers to sleep studies ordered by a non-Sleep Medicine Associates physician, or practitioner, and take place without a Sleep Medicine consultation being performed prior to the study. Patients sent for these studies will typically have a specific question regarding their sleep that is to be answered, i.e. does this patient have obstructive sleep apnea? If your doctor has ordered a direct sleep center study for you, it is important that you understand the reasons to have a study, and be familiar with simple steps that you need to follow to ensure that the highest quality study is obtained to best answer the question that has been raised regarding your sleep.
Dr. Cocanower, and the staff of Sleep Medicine Associates, P.C. are committed to providing the highest level of sleep medicine services in a cost-effective and patient friendly environment. The goal of the practice is to improve the sleep of patients with sleep-related problems, and as a result to promote better health and quality of life in the patient. Though the practice has in place processes to achieve this goal, the patient plays an important role as well by adherence to recommendations made to treat the sleep problems, and by providing feedback if problems are not resolved completely. The role that a patient plays in achieving improved sleep is greater when a direct sleep study is performed, because consultation with the sleep physician is initially bypassed. The information that follows is provided to “fill in” informational gaps that can occur when patients are not seen first in the practice before a study is performed.
Why have a sleep study?
A sleep study is performed to evaluate a person’s sleep. This test provides important information about sleep stages, including which stages are present, and the amount of sleep in each stage, interruptions in sleep, and what may be causing them, how one breathes during sleep, whether snoring is present, or whether apneas (stop-breathing events) are occurring and how frequently, whether leg movements are present and how frequently, and to identify abnormal behavior during sleep. A sleep study performed in a sleep center is considered the “gold standard” for evaluating sleep, and diagnosing problems that occur during sleep. Though the observations of those sleeping with a person suspected of having a sleep disorder are important, a test is usually needed to adequately diagnose many of the disorders that occur during sleep.
A home sleep study, or portable test is used to diagnose obstructive sleep apnea, and utilizes fewer channels of information gathering sensors. Portable, or home sleep testing requires proper patient selection to avoid pitfalls in test interpretation. Because the information gathered from a portable study is less than an in-lab study, and because sensors may come off during the study that may not be corrected during the test at home, non-diagnostic results are more common, requiring repeat testing, typically in the laboratory.
What will a sleep study show?
Information provided by a having sleep study includes how long it takes to fall asleep, how much sleep, and the stages of sleep that occurred, and whether abnormalities of sleep are present. Sensors used during a sleep study include those to assess brain waves (EEG-electroencephalogram), eye movements (EOG-electrooculogram), muscle activity (EMG-electromyogram), airflow at the nose and mouth, snoring, chest and abdominal wall movements, oximetry (measures the blood oxygen saturation), limb movements (arm and leg), and body position. This information is recorded using specialized equipment, and is stored for processing, review, and then, interpretation.
The information gathered includes whether snoring and apneas are present, in what stage of sleep they are occurring, whether position affects the apnea frequency, and also whether abnormal movement of the arms and legs is occurring, and whether acting out of dreams is present. With additional brain wave monitoring, studies can also help determine whether seizures explain abnormal activity during sleep. Portable, or home sleep tests typically utilize fewer channels of information gathering sensors than testing in the lab, and usually provide information regarding airflow at the nose and mouth, snoring, chest/abdominal wall movements with respiration, and oxygen saturation. Depending on the portable system used, additional channels including position, and leg movements can be utilized.
Where will I have the study?
Sleep Medicine Associates, P.C. uses a cutting edge, state of the art sleep facility to provide expert patient-focused sleep services. The Center is fully accredited at the highest level by the American Academy of Sleep Medicine. Located on the second level of the practice’s main office building, this 8-bed facility uses the latest in computerized sleep monitoring equipment for comprehensive sleep evaluations (currently only 4 beds are used regularly). Sleep studies are performed most nights of the week (includes weekends). Patients stay in their own rooms, that are equipped with the sleep monitoring equipment, and high-tech surveillance systems, that allow a sleep technician who is present for the study, to monitor the study from an adjacent control room. This technician, trained to perform these studies, hooks up the patient to the sleep diagnostic equipment, and is available to the patient during the night if needed. The technician also makes adjustments in the equipment and sensors to ensure that adequate information is obtained during the study.
The study rooms are typical of a hotel’s standard room in regards to furnishings, and amenities, though with some minor modification to facilitate the study, and include their own bathroom with shower. Patients are given instructions prior to their study night that outline what to bring, and what to expect on that night. Individuals generally go to sleep at their usual times, and are awakened the following morning at the conclusion of the study. A breakfast snack is available for patients in the morning.
Preparing for the study
It is important that routines and behaviors of sleep be maintained as much as possible for the night of study in the sleep center. While it is obvious that many aspects of sleep on that night will be different (not at home, sleep partner not present, wearing sensors), those aspects of routine that can be maintained (time to bed, reading or watching TV before bed, medications) should be kept. It is best to avoid sleep during the day of the night study, and though consuming some alcohol on the night of study is permitted (if that is a usual routine), an individual should never consume alcohol prior to coming to the lab if they will be driving.
Medications typically used to help one fall asleep (either used chronically, or when sleeping away from home), are permitted, and should be brought to the lab, and their use documented on the questionnaires you will be given to complete in the laboratory. If you have concerns regarding your ability to sleep in the laboratory, this should be discussed with the physician ordering your study prior to your test, so that consideration can be given to the use of a sleep aide on that night. Though it is more ideal to avoid taking a sleeping medication on the night of study if this is not your routine, having medication available may relieve anxiety regarding the testing experience. A checklist of important instructions regarding a study is provided below, and can also be printed for reference.
Patient instructions regarding sleep studies
Laboratory sleep studies
All laboratory based sleep studies will be conducted at the Sleep Medicine Associates sleep facility located on the second level of the practice’s main office building, 7307 Columbia Street on Evansville’s east side. Typically, you will be asked to arrive at the sleep center at 7:30 pm, unless other arrangements have been made in advance.
Home sleep studies
A portable sleep study may be scheduled by your physician, provided your history and physical exam features are consistent with findings that predict an appropriate patient for home sleep testing.
Maintenance of Wakefulness Test
The Maintenance of Wakefulness Test (MWT) does not need to be done in conjunction with an overnight sleep study. You will be given a time to arrive at the sleep center, typically 7:30 am.
What about sleep studies in children?
Sleep disorders occur in children of all ages as well as in adults. A recent poll by the National Sleep Foundation found that sleep disorders in children often go undiagnosed. Pediatric patients older than eight years of age may be seen in the practice on a case by case basis, with the sleep physician reviewing each request to determine appropriateness. The majority of children evaluated in the practice will have symptoms suggesting obstructive sleep apnea. Sleep studies performed on children and adults are very similar. When studying a child under the age of 18, a parent must be present with the child during the entire testing period. Parents of minor children are expected to stay in the room with the child, however they will not sleep in the bed with the child, as this can adversely affect the study results.
In order to make the child undergoing a sleep study as comfortable as possible, it is often helpful to bring child’s favorite toy, book, or blanket along. Every effort will be made to follow the child’s normal bedtime routine and bedtime. Parents will be asked to not watch television, read, or talk on the telephone once the child’s sleep study begins, as these activities may disrupt the child’s ability to sleep and interfere with testing results.
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