Insomnia, Snoring, Sleep Apnea

The world and life of a sleep tech

Posts Tagged ‘sleep testing’

Should I Have a Home Sleep Study or Go to the Lab?

Posted by amykr on March 23, 2010

Technology has come a long was and studying sleep is no exception. We are now able to perform sleep studies in the home as well as the sleep lab. This is a great thing because it allows more people to be tested for sleep disorders then every before. The drawback is that there are limitations to what can be done in the home versus the lab.

In home sleep studies are generally modified unsupervised sleep studies. This means that the equipment is delivered to the patient and then they are responsible for applying it and taking it off. In some areas a technician will come out in the evening to apply the equipment and you will wear it the rest of the night, then you may have to take it off or the technician will come back in the morning and remove it. Generally these types of studies are limited in nature and only monitors certain parameters, oxygen level, heart rate, breathing, and whether you are awake or sleep and position. Because the study is limited it is designed strictly to diagnoses sleep apnea. Other conditions a person may have will not be diagnosed, such a periodic limb movement disorder and teeth grinding. This type of testing is also not good for patient with significant health issues such as congestive heart failure or COPD.

In lab testing has several differences. The first one is there is a technician there with you if any problems should arise. If one of the wires become dislodged it can be fixed right away. You do not need to have another study performed. The technician is also there to answer questions should you have any during the nights. The most important role of the technician, however, is that they can intervene if there is a significant health issue during the night. They can also do a special type of study called a split night, or combination study, which allows you to be diagnosed and treated for your sleep apnea on the same night. This way if you have severe sleep apnea you can be treated right away instead of waiting. You also are able to be evaluated for other conditions you may not know you had.

Treating sleep apnea after the home sleep study can occur in two different ways as well. You can be brought into the sleep lab for a titration study. During this test the technician finds a mask that works for you, educates you about CPAP and how it works and then finds the right pressure to eliminate most of the apneas and snoring. This test also allows the doctor to look for the other disorders such as periodic limb movements.

The other option for treatment is to have a homecare company deliver an auto-titrating CPAP. This machine is set to allow a range in pressure that adjusts as you have events during the night. The technician will fit you for a mask and then leave the machine for you to use. The drawback is that there is no one there during that first night to assist you if there is an issue. The other issue is that unless you call your doctor or the company that delivered the machine they may not be able to correct any problems that happen until they download the information in the CPAP memory.

Overall home sleep studies do have a place in the diagnosis and treatment of sleep apnea. They are very good for diagnosing the straight forward sleep apnea patient. If, however, there is any issues that need to be addressed right away or if a person needs some assistance this may not be the best choice. A full sleep study allows for the possibility for quicker treatment and intervention. There is also the ability to diagnose other conditions that might go unnoticed in the home setting. That and the personal care involved in testing help to create a successful long term care situation.

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Sleep Studies do More Then Listen to Snores

Posted by amykr on August 4, 2009

Many people go to the doctor because they have something they want fixed. They expect that a pill will do the trick. What they do not think about is what caused the problem in the first place. It is this search for the reason for problems that send many to the sleep lab for a study.
The obvious patient is the one who snores, gasps and wakes their spouse during the night. We all know or are related to this patient. Uncle Harry fall asleep in the recliner Thanksgiving afternoon, snore louder and louder, suddenly stops and then wake up snorting and gasping just to fall back to sleep again. He also has other health issues.
Then there is the overweight person. However, there weight is actually not what sends them to the sleep lab. It is other symptoms they might have that send them in to the lab. Hypersomnia, or difficulty staying awake, is usually the symptom that sends them to see how they are sleeping at night.
The people who have high blood pressure that is hard to control or unexpected can also send a person to a sleep study. If a person has sleep apnea, every time they stop breathing they put stress on their body and their heart. Eventually this stress can show up as high blood pressure, especially in the morning. Many times this type of blood pressure issue is difficult to control with medication. It is necessary to treat the cause of the issue, the apnea, in order to get the blood pressure under control.
The same problem with blood pressure can show up as uncontrolled blood sugars as well. The stress on the body caused by apnea can cause increases in blood sugars. This is especially true if a person tends to wake with higher then expected blood sugars on a regular basis. The body does not deal well with this type of repeated stress.
There are other conditions that will send a person for a sleep study. If a person has a history of moving around during their sleep especially while dreaming they may come in for a sleep study. That could be a symptom of several different conditions. The only way to diagnose what type of problem they have is through observation and testing.
People with congestive heart, head injuries and neuromuscular conditions may have sleep studies performed to assure that they are breathing well and getting enough oxygen in their sleep. This is so important to the quality of their daily life.
If your doctor orders a sleep study and you are not sure why, ask him or her. There is a good reason it is ordered. If you decide not to have the study your doctor may not be able to fully treat you. Treating a sleep disorder may help you to feel better and feel healthier over the long run.

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Why is He Here?

Posted by amykr on May 6, 2009

I love my patients, but I have to admit there are some patients that make this job more challenging. They are not the patients with severe apnea or the patients who do not believe they have apnea; They are the patients who do not have anything.

You know the ones I am referring to: you put them to bed, you read their questionnaire, and you expect to see an AHI of at least 15 events per hour. Then it is 1 a.m. and you hear nothing. Not a snore, not a gasp, nothing. You look at the study and they have had plenty of stage 3 and REM already. You look to see if maybe they had not done any sleeping on their back. Nope, they have been asleep on their back the whole time.

When you talk to them the next morning you get one of two responses. My favorite is “This is the best night sleep I have had in years.” The other type of patient is convinced he did not sleep.

We had the former patient in our lab last week. He teaches college. He scores papers on his laptop in his bed until 1 in the morning, most nights. His wife complains that he snores but he says she snores as well. The best part was when I handed him the sleep hygiene tips sheet. He said I left one item off the sheet. He informed me that he slept with his two children in bed with him. Now I was standing there trying to figure out how he did not tell his doc this before the doc sent him to the sleep lab.

I do not know about you, but if I stayed up until 1 a.m. every morning, had two squirming children in bed with me every night, and taught college all day, I would be exhausted.

So what do we learn from this patient? That every once in a while it is nice to have an easy patient.

Oh yeah, and if he even remotely looks young enough to have kids, ask if they have their own room.
Reprinted for http://www.advanceforsleep.com

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You expect me to sleep with all that!

Posted by amykr on January 9, 2009

People who come to the sleep lab always seem to expect the worst. It does not help that their friends have told them all sorts of horror stories and that the internet is full of misinformation. So when most people come in they are usually either totally clueless as to what will happen or they are terrified that we are going to tie them to the bed and attach all sorts of things to them. Really a sleep study is not bad at all.

The first thing you should know is that at my sleep lab we our rooms look like your bedroom or a hotel room. There is a queen size bed and a flat screen tv in each room. People do not need to share rooms. However you also can not share your room with your spouse. I know you wives out there are excited to have a snore free night to yourselves.

The next thing you should know is that we do attach some wires to you with tape and paste. These wires are so we can monitor the electrical activity in your brain and in certain muscles. The wires are very thing with a cup or a snap at the end. They are tied together in a bundle so that you will not get tangled in them. I have never ever lost a patient do to self hanging during a sleep study. I also use sticky pads like when you have an EKG done.

The third thing you should know is that the tests are recorded for sound and video. This is so the physician can see and hear anything unusual. There are people who act out their dreams and who sleep walk that we need to have on video. This way the doctor can see what was going on and will be able to get the proper diagnosis.

The fourth thing you should know is what we are looking at while we, the technician and the physician, are sitting at the computer. We have 6 channels that look at brainwaves from different portions of your brains. We monitor your eye movements so we can tell when you are dreaming (do not worry we never see what you are dreaming.) We have three wires on your chin to monitor for teeth grinding. We monitor your heart and your oxygen levels. We monitor your leg movements to see if you have leg movement or leg cramps during the early part of the night. We monitor your snoring to see how loud it is. And finally we monitor your breathing with two belts, one around your chest and one around your belly. We also put on a thermister and pressure transducer to monitor your breathing in and out of your nose and mouth.

Finally you should know about the CPAP but I will leave that to another blog entry because there is so much to talk about just with that. I will also talk about what conditions we are testing for. I think people should know we are not just looking for sleep apnea.

I hope this makes you feel a little more comfortable about what will happen when you arrive at our lab. You are always welcome to visit any time you are in Apopka.

One of the rooms at Emery Sleep Solutions

One of the rooms at Emery Sleep Solutions

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