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Sleep Disorder Diagnosis, Testing and Treatment

Sleep is something that is taken for granted -- relaxation at the end of the day, any time to recharge our batteries. But for many, a good night's sleep is hard to find. It wasn't long ago that people thought the worst that could come of poor sleep was baggy eyes and daytime yawns. We now know that sleep is vital to our physical and mental well-being. That's why the area of sleep medicine is growing so rapidly. In spite of this, less than 20% of all people with sleep apnea or similar sleep problems are actually diagnosed. Undiagnosed sleep apnea contributes to risk factors for heart attack, stroke, heart disease, hypertension, dementia and many other disorders. Frequent interruptions of sleep on a regular basis are very hard on the body.

What is sleep apnea? 

Although there are many types of sleep disorders, the one we hear most about the sleep apnea. Sleep apnea is a condition in which one stops breathing or is not breathing enough while asleep. This can cause repeated arousals from sleep and over-activation of the nervous system. The person suffering from sleep apnea does not necessarily wake up when this happens. The actual stopping of breathing or not breathing enough may or may not be evident to the person or persons when it happens, although snoring typically accompanies obstructive sleep apnea.

Who gets sleep apnea? 

The National Heart, Lung and Blood Institute estimates that more than 18 million Americans have sleep apnea. Men are more susceptible than women, though for postmenopausal women, that gap closes up. Furthermore, sleep apnea in women can begin after menopause when complaints of fatigue are easily chalked up to the "change of life". For all people, obesity, even moderate, is also a predisposing factor, as is a family history of sleep apnea.

“Good sleep can promote more effective school and work performance and improve quality of life and personal interactions.”

 Sleep studies in consultation with a sleep disorders physician can diagnose problems. Many people complaining of lack of sleep or daytime drowsiness eventually seek advice from their family physician, who in turn may order a sleep study and a consult with a physician specializing in sleep problems. During a sleep study, patients spend an evening in a hotel room like setting while a technologist monitors their sleep electronically on site. Then a physician specializing in sleep medicine analyzes the study to determine if sleep apnea, or some other sleep disturbance, is affecting the patient's quality of sleep. Some people may be familiar with home oxygen monitors, unfortunately these can miss even severe cases of sleep apnea. There is no substitute for a real PSG, or polysomnogram (sleep study) performed by an on-site sleep technologist.

Other sleep problems

There are other conditions beside sleep apnea that can be diagnosed by a sleep study and/or consult with a sleep medicine specialist. Two of these are Periodic Limb Movements in Sleep (PLMS) and Restless Legs Syndrome (RLS).

Treatment for sleep apnea

In some cases, surgery is suggested to treat a specific physical obstruction in the throat area but for many patients a CPAP (continuous positive airway pressure) device is recommended as a first line treatment. CPAP machines deliver a steady flow of pressurized air through a full mask, nasal tube or nasal pillows that are connected to a small compressor. There are also new machines that deliver variable pressures, which work more in sync with patients' natural breathing cycles. The modern devices are quiet and portable, with less bulky face gear and softer straps which exert less pressure. Many people have visions of some Darth Vader mask and are afraid to even try (or retry) a CPAP machine, but it is important to understand that these new machines have come a long way and the diversity (over 100 types of masks are available) means more and more people can find a comfortable means of receiving the benefits but CPAP machine, including those who have tried unsuccessfully in the past. There are many different emerging treatments for sleep apnea.

Importance of good diagnosis and treatment

Good sleep can promote more effective school and work performance and improve quality of life and personal interactions. It can lift our mood, boost our concentration, reduce daytime sleepiness and fatigue and even help improve medical conditions such as diabetes, congestive heart failure, headache and other muscle aches and heart rhythm problems. In some cases, it may reduce the quantity or even need for medications to treat these problems. It may also reduce the risk for serious health problems such as stroke and heart/vascular disorders. Sleep apnea can even be one cause of erectile dysfunction and treating the underlying sleep problem can in some cases help erectile dysfunction. Not surprisingly, one of the best parts of treating sleep disorders is seeing the amazing difference that good, quality sleep can make in the lives of patients and those around them. Many people cannot believe how great they feel in as little as one or two nights using a CPAP device. In some cases, people report they haven't slept so well in over 30 years. The results can be truly remarkable!

Common Sleep Study Procedure Types

Diagnostic Polysomnogram (PSG): 

The PSG is the most common sleep study. The PSG monitors and records; EEG (brain waves that show what stage of sleep), EKG (heart/cardiac monitor), EMG (muscle activity including leg movements), airflow from the nose and mouth, breathing effort, body position, eye movements, chin muscle tension and oxygen levels during sleep. This study is used to determine if you have Obstructive Sleep Apnea (OSA) and/or other sleep disorders like RLS/PLMS (kicking at night), parasomnias (sleepwalking or RBD acting out of dreams), and other (more rare) sleep disorders.

Polysomnogram w/PAP Titration: 

The CPAP (or BiPAP or ASV) titration study is the second study for those patients with OSA.  It’s mostly the same as a diagnostic PSG but adding a CPAP mask and machine that provides gentle positive air pressure. The air pressure is gradually raised (titrated) until OSA and usually snoring is eliminated.