A visit to the sleep specialist is a new experience for most of our patients. Its purpose is to diagnose your sleep disorders and improve your sleep patterns.
If you are having trouble sleeping, you will first come to one of our sleep centers for a consultation. We will take your sleep history, which is significantly different from the medical history that you commonly provide your primary care physician.
Your sleep history involves detailed information about your sleep habits, circadian rhythms, environmental factors that include information about your bedroom and bed partners, and your food and beverage intake. In addition, a diagnosis will include information about your emotional background, and intrusive thought processes that occur during the night. Your diagnostician will take into consideration daytime performance issues you may experience like hypersomnolence, fatigue, tiredness, poor concentration, and decreased memory capacity, as markers of poor sleep efficacy.
Your sleep consultation starts with your filling out a sleep questionnaire followed by your doctor interviewing you. It may be a good idea to bring your bed partner to provide observations and to participate in the interview. Your doctor then conducts a physical exam. You will go on a tour of the area where sleep studies take place.
Polysomnography, or a sleep study, is a complex evaluation that includes collection of data during your sleep. The study can be diagnostic or therapeutic.
This evaluation includes measurement of the following and more:
- EEG (electroencephalography) of brainwaves
- EMG (electromyography) of muscle tone
- Eye movement measurement
- Breathing measurement that includes measurement of:
- Nasal breathing
- Oral breathing
- Effort of breathing
- Continuous electrocardiogram
- Movement sensors and recording
- Continuous oximetry
- Continuous positive airway pressure (CPAP) titration
Nocturnal and daytime sleep evaluations are performed with state-of-the-art equipment. The study is supervised and attended by a sleep technologist, and your physician interprets the evaluation immediately after the study is conducted.
If you are a subject for MSLT (multiple sleep latency test) or MWT (maintenance of wakefulness test), in between naps you will remain in an area known as the dayroom. The dayroom is a very comfortable area with chairs, table, desk, refrigerator, microwave, and a computer with internet access where you can relax.
You may read the following document to help you prepare for your sleep study.
Your evaluation will include the review of daily activities and sleep habits.
We will take your detailed medical and social history. We allow ample time to explore aspects of your daily experience that impact your sleep, such as mood, lighting, activity, meals, and medications.
Managing insomnia always considers multiple factors, and your doctor will develop a plan that will help you improve your ability to sleep. It may involve behavioral changes as well as medication. Ongoing follow up may occur in person, by telephone, or via email.
Often group sessions help you make changes to improve your sleep habits. These instructional sessions support your understanding and ability to make changes. Small groups of people gather weekly for four weeks to learn about sleep and practice habit changes in structured sessions. Individuals share their successful techniques and failures. These groups are led by Dr. Joyce Walsleben.
Sleep hygiene is a term used to describe the many behavioral techniques that reinforce good sleep. It includes maintaining systematic sleep times, decreasing foods and drinks that interfere with sleep, ensuring that there is darkness for sleep and light for waking, and quiet at night and activity during day.
Behavior modification is simply the change in your habits that will improve your sleep. We can suggest behavioral modification techniques that you can use such as relaxation therapy and visualization.
Circadian Rhythm Disturbances
Circadian rhythm refers to activity within the 24-hour day. Sleep and wake is but one set of activities. Most of our bodily functions are modulated by changes across 24 hours. One example of a circadian disturbance is jet lag. Shift workers experience these symptoms weekly as they shift from night work to day time socializing The symptoms of circadian rhythm disturbance can be very disruptive to sleep and wake time performance and safety. Treatments exist to improve these symptoms. The treatments may include medication or behavioral changes.
Snoring, Apnea & Obesity
Often, improving sleep patterns involves addressing the following conditions:
- 10 to 30 percent of adults have primary snoring.
- About five percent of the adult population suffers from obstructive sleep apnea.
- The most common symptoms of sleep apnea are loud snoring, excessive daytime somnolence, nocturnal choking or gasping, poor concentration and memory impairment.
- Due to the hypersomnolence, car accidents are very common in patients with sleep apnea.
- Primary snoring, increased upper airway resistance, and obstructive sleep apnea are linked closely to obesity.
- Dietary advice and weight loss plays a significant role in the treatment of these disorders.
- You have several options for treating snoring and sleep apnea including
- CPAP (continuous positive airway pressure) therapy
- Upper airway evaluation
- Possible procedures by ENT (ear nose and throat) specialists
- Dental appliances
- Exercise programs
Home Sleep Studies
For some, a sleep study can be done at home rather than in a sleep study facility. This may be more convenient and comfortable and can result in accurate diagnosis of some sleep disorders such as apnea.
Once a home sleep test is ordered, we provide you with the necessary measurement device kit and 30 minutes of instruction on the correct application and best practices on the use of the devices. We also give you an instructional manual as well as an online support video.
For support or emergencies related to one of our home studies, please call:
Daytime Support: 212-481-1818
Night Support: 917-484-1026
Oral Appliance Therapy
Oral appliances are devices that prevent the narrowing or collapse of your airway. They help keep the airway open by repositioning the jaw forward or by maintaining the tongue in a forward position while you sleep. The oral or dental appliance is used to treat snoring and obstructive apnea. It can also be used to treat upper airway resistance syndrome.
Types of Oral Appliances
The sleep center does not make dental devices. Once you have a dental evaluation, your dentist will produce and manage it. The sleep center can test the efficacy of the appliance when the dentist considers that evaluation timing appropriate.
Your doctor will prescribe the most appropriate option for you.
The tongue retainer has a suction property that brings the tongue upfront, creating more space in the back of the throat.
Mandibular Repositioning Devices
The mandibular repositioning device brings the jaw forward. It helps maintain the tongue and the muscle tone of the airway with a more favorable position. This combined effect prevents the narrowing of the upper airway.
Standards for Dental Device Use
Your doctor may suggest using a dental device if you have primary snoring or mild obstructive sleep apnea, (OSA) you do not respond to or you are not a candidate for treatment with behavioral measures such as weight loss or sleep-position change.
We suggest using an oral appliance if you have mild to severe OSA, and if you:
- Had an initial trial of nasal CPAP
- Are intolerant of or refuse treatment with nasal CPAP
- Refuse treatment, or are not a candidate for tonsillectomy and adenoidectomy, cranofacial operations, or tracheostomy
Evaluation of Hypoxemic and Hypercapnic Respiratory Failure
Treatment for sleep disorders is essential to protect you from respiratory failure due to the following conditions:
Cardiovascular disease is a leading cause of morbidity and mortality. Congestive heart failure (CHF) is the leading cause of hospitalization in people over 65.
Central sleep apnea is commonly present in patients with CHF. Many patients can have both obstructive and central sleep apnea.
Continuous Positive Airway Pressure (CPAP) is the treatment of choice for obstructive apnea. Patients with central apnea may need variable positive airway pressure with adaptive servo-ventilation. The treatment of obstructive and central apnea improves outcomes and quality of life.
Patients with morbid obesity have a higher risk of developing hypoventilation. They can have very low levels of oxygen and elevated CO2. A sleep evaluation will define the existence of this disorder and provide adequate non-invasive ventilation with bilevel positive airway pressure support.
Chronic Lung Disease
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in the general population. COPD is characterized by chronic airway obstruction, inflammation and enlargement of air spaces. Patients with COPD have abnormalities in gas exchange: oxygenation and elimination of carbon dioxide. Many patients with advanced COPD commonly have worsening of the gas exchange during sleep and require treatment.
A sleep evaluation includes a consultation and a nocturnal polysomnogram to evaluate the need for positive airway pressure or oxygen supplementation during sleep. Treatment improves oxygenation, perfusion-ventilation relationship and hemodynamics (how your blood flows).
There are several ways your doctor evaluates your condition during sleep:
- Pulmonary function test (PFT)
- CO2 response: measures the amount of carbon dioxide in your body
- Ventilation study: measures how well air moves through your body
- P100: measures airway pressure