Sleep Disorders have a major impact on our physical and mental health. At the Neurology and Sleep Clinic, we believe that Sleep Medicine is a multidimensional clinical art and that every patient is unique and needs to be comprehensively evaluated to determine the best approach for a diagnostic and therapeutic plan.
The first step of a sleep evaluation is the clinical assessment whereby the health care providers at the Sleep Clinic obtain a clinical history of the sleep complaint. This is coupled and correlated with a comprehensive assessment of the patient's sleep, work, and social schedule as well as history of any other medical conditions that may impact the diagnosis and treatment of the disorder. This is followed by a clinically focused examination.
The above information is combined to formulate an individually structured diagnostic and treatment plan, which is thoroughly discussed and explained during the initial clinical visit. This evaluation is an excellent opportunity for us to discuss any questions or concerns our patients may have.
Simultaneously when scheduling any diagnostic testing, a follow up visit is scheduled to discuss the results. The findings will be discussed in detail, as will recommendations for any further diagnostic or treatment procedures. This approach ensures that our patients are fully informed about their sleep disorder and provides for a better outcome.
The clinical team at The Sleep Clinic is committed to providing our patients with superior care for their sleep disorders. We are committed to continue working with our patients until we achieve a successful outcome ensuring better sleep for a better day.
A sleep study or polysomnogram (PSG) is a procedure that records and charts numerous physiological functions during sleep. This includes the measurement of brain waves or EEG by using electrodes placed on the scalp. ECG and heart rate are measured using chest electrodes. Breathing parameters measured include chest and abdominal effort, airflow, and blood oxygen saturation. Eye movements and muscle activity help determine the physiological stage of sleep. Measurement of limb movement also helps identify disorders such as Periodic Limb movements of Sleep (PLMS).
The recording of the PSG during the night is called nocturnal PSG. Daytime recordings for shift workers may be arranged as well. The PSG is most informative when it is performed during the individual's normal sleep time.
Although the PSG requires patients to have multiple recording devices and wires, they are free to move around in bed, and the recording equipment may be disconnected at a junction box as needed to allow the patient to get up and use the rest room. If leads do happen to come off, our technologists will go in to replace them, ensuring the accuracy of the study.
We do understand that many of our patients may not regularly sleep on their backs; however, it is necessary to document the sleep disorder in all positions and we do ask our patients do so as much as possible.
Nasal Positive Pressure (NPAP) Titration
Individuals diagnosed with Sleep Disordered Breathing may need to undergo NPAP titration. This is a specialized sleep study during which nasal positive pressure treatment is applied and the optimal pressure necessary to relieve the breathing difficulty is determined. The treatment level is adjusted by monitoring the breathing while the pressure on the PAP device is gradually increased. Once control is achieved, the patient is maintained on that pressure, but adequate sleep time at a specific treatment level is necessary to ensure optimal response. This whole process is remotely performed by the technologists without disrupting the patient's sleep.
There are numerous PAP devices including: Continuous Positive Airway Pressure (CPAP), Bilevel PAP, and the newest treatment option, Adaptive Servo Ventilation, for patients with cardiac disease and central apneas. Deciding which device to use depends on the clinical picture and how the patient responds during the titration.
Multiple Sleep Latency Test (MSLT)
MSLT is a standardized test to rule out Narcolepsy and/or Hypersomnolence. Both are disorders associated with excessive sleepiness during wake hours.
This study consists of a series of four or five nap studies performed during the day following a night study (NPSG). It is preferable in specific instances to allow the individual to wake up spontaneously, but in general the first nap usually begins approximately 1.5 to 2 hours after waking. Naps are scheduled at two-hour intervals, and the time it takes to fall asleep is recorded. In between naps, the patient must remain awake and out of bed.
People who have narcolepsy tend to fall asleep at unusual times during the day. The MSLT will measure how fast sleep occurs during the day. It will also show what kind of sleep you have when you take a nap.
A drug screen may be required at the time of the MSLT. There are a number of drugs that can affect the results of the sleep study. The drug screen will help validate the results and ensure the accuracy of the diagnosis.
Maintenance of Wakefulness Test (MWT)
MWT is a standardized test performed to measure an individual’s ability to stay awake and alert. It can provide information useful in measuring the success of treatment. MWT may also be used as an adjunct to determine whether the individual's sleep disorder impairs his or her ability to drive, operate heavy equipment, or work in hazardous environments.
This is a daytime sleep study conducted to desensitize patients to PAP therapy. Patients may develop anxiety about using PAP. The procedure involves the patient coming to the Sleep Clinic during the day. While monitoring the patient’s respiration, oxygen, and ECG, the patient is allowed to lie in bed and receives instructions on properly fitting the PAP interface or mask. Individual PAP coaching to overcome claustrophobia and anxiety issues is performed. The patient is allowed to sleep as the pressure is gradually increased to familiarize the patient with the equipment and pressure sensations in a controlled setting.
The entire procedure is attended by a sleep technologist and ranges from 3 to 5 hours in length, including patient check-in, instruction, approximately 1 to 3 hours of sleep time, and discharge.
Sleep Apnea Screening Tests
Sleep Apnea Screening Test, sometimes referred to as Home Sleep Test (HST) or Out of Center Sleep Testing (OCST) is primarily indicated for patients with a high probability of having Obstructive Sleep Apnea. The test usually records a limited number of respiratory parameters such as airflow, oxygen and breathing effort, but it does not record actual sleep parameters. Therefore, it is not helpful in diagnosing patients with mild or moderate Sleep Disordered Breathing or any other sleep disorder. This type of testing is also not appropriate for patients with other coexisting medical conditions. Finally, these tests are less accurate and may need to be done on multiple repetitive nights as they have a high failure rate. On occasion they may need to be done in house to ensure reliability and accuracy.
Sleep actigraphs are generally watch-shaped devices worn on the wrist. They are useful for determining sleep patterns and circadian rhythms. Normally the Actigraph is worn for 10-14 days and is correlated with a sleep diary that the patient keeps. The patient is able to move around and function normally while wearing the device. Actigraphic recordings have been found to correlate well with recorded sleep and are useful in patients with insomnia, sleep wake cycle disorders, shift work sleep disorder and in preparation for MSLT's.
Diagnostic Study Results
Simultaneously when scheduling any diagnostic testing, a follow up visit is scheduled to discuss the results. The findings will be discussed in detail along with recommendations for any further diagnostic or treatment procedures. This approach ensures that the patient is fully informed about his or her sleep disorder and provides for a better outcome.