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Patient's Guide to Sleep Evaluations
Sleep Problems – an Overview
According to the National Institutes of Health,
50 to 70 million Americans are affected by chronic sleep disorders and
intermittent sleep problems that can significantly diminish health,
alertness and safety. Untreated sleep disorders have been linked to
hypertension, heart disease, stroke, depression, diabetes and other
chronic diseases. Sleep problems can take many forms and can involve too
little sleep, too much sleep or inadequate quality of sleep.
The Institute of Medicine recently estimated
in its report, Sleep Disorders and Sleep Deprivation: An Unmet Public
Health Problem, that “hundreds of billions of dollars a year are spent
on direct medical costs related to sleep disorders such as doctor
visits, hospital services, prescriptions, and over-the-counter
medications.” Sleep problems and lack of sleep can affect everything
from personal and work productivity to behavioral and relationship
problems. Sleep problems can have serious consequences. According to the
National Highway Traffic Safety Administration, drowsy driving claims
more than 1,500 lives and causes at least 100,000 motor vehicle crashes
Compounding the problem is the fact that
most people know when to seek medical help for physical discomfort such
as fever or pain—but sleep problems are often overlooked or ignored. In
fact, the overwhelming majority of people with sleep disorders are
undiagnosed and untreated.
Should Your Sleep Be
To determine whether you might benefit from a
sleep evaluation, ask yourself the following questions:
- Do you regularly have difficulty getting
to sleep or staying asleep?
- Do people tell you that you snore? Has
anyone ever told you that you have pauses in breathing or that you gasp
for breath when you sleep?
- Are your legs “active” at night? Do you
experience tingling, creeping, itching, pulling, aching or other strange
feelings in your legs while sitting or lying down that cause a strong
urge to move, walk or kick your legs for relief?
- Are you so tired when you wake up in the
morning that you cannot function normally during the day?
- Does sleepiness and fatigue persist for
more than two to three weeks?
If you answered
yes to any of these questions, then a complete sleep evaluation should
be considered and discussed with your physician. Before your visit, it
may be helpful to track your sleep patterns and medications. You can
download a sleep diary by typing those words into the search box at www.sleepfoundation.org.
Physicians and Sleep Specialists
Depending on your insurance plan and other
factors, your primary care physician may start your evaluation by
running tests for specific medical disorders that are known to affect
sleep. Your physician might even be able to diagnose a sleep problem
based solely on your symptoms and recommend initial treatments. At some
point, you may be referred to a sleep specialist for a more extensive
assessment of your sleep complaints and for more specific treatments.
If this occurs, ask for a referral to a
certified sleep physician. Certification requires that a physician
undergo formal training and pass an exam in sleep disorders to
demonstrate a higher level of expertise. Check both these sources as
your physician may be listed as certified on one, but not the other:
At www.absm.org (the American Board of
Sleep Medicine), check under 'verification of diplomates." Also, call
1-800-ASK-ABMS (the American Board of Medical Specialties).
Preparing for Your
A list of specific instructions is typically
provided to patients before their arrival at the testing facility, but
you may want to consider asking additional questions before your test,
- Does it matter if I take a nap the day
before or the day of the study?
- Should I refrain from drinking coffee,
tea or other caffeinated products or energy drinks? If so, for how many
hours before my test?
- What can I eat before the study? In
addition to caffeinated products, are there any other foods/beverages
that I should avoid?
- Should I avoid stimulants, alcohol or
sedatives? What about other prescription and non-prescription
medications, dietary or herbal supplements? How long before the sleep
study should these be discontinued?
- What should I bring to wear?
- May a family member or attendant stay
with the patient during the study?
- On the day of the procedure, should I
change my cosmetic, skin or hair care routine?
- Are personal comfort items, such as
snacks, a pillow, slippers or robe, allowed?
- What time will I be able to leave?
- May I take a shower and dress for work
the morning after the study?
- Will I be able to discuss the results of
the study with my doctor before leaving the facility?
- Will my primary care physician or the
sleep specialist take the lead in providing continuing care after the
Once at the sleep facility, you may notice
that the testing bedrooms are designed to resemble a typical bedroom,
with décor and televisions to help make you feel as relaxed as possible.
After an initial consultation with your
physician or a sleep specialist, you may be referred for a sleep study.
The medical term for this study is “polysomnogram,” which is a
non-invasive, pain-free procedure that usually requires spending a night
or two in a sleep facility. During a polysomnogram, a sleep
technologist records multiple biological functions during sleep, such as
brain wave activity, eye movement, muscle tone, heart rhythm and
breathing via electrodes and monitors placed on the head, chest and
legs. After a full night’s sleep is recorded, the data will be tabulated
by a technologist and presented to a physician for interpretation.
Depending on the physician’s orders, patients may be given therapy
during the course of the study, which may include medication, oxygen or a
device called continuous positive airway pressure therapy,
- Is my sleep physician certified? Check
both www.absm.org and 1-800-ASK-ABMS
(separate organizations with similar acronyms). Your doctor may be
listed on just one,
- Is my sleep facility accredited? Check www.aasmnet.org
- Is my sleep technologist registered?
The National Sleep Foundation’s web site,
www.sleepfoundation.org, offers sleep information on a wide range of
topics, ‘ask the expert’ opportunities, online community forums, sleep
blogs and more.
Important Questions to
Ask Before Your Sleep Study
A sleep study can be conducted in either a
hospital or in an independent facility. Ask if the sleep lab or sleep
center to which you have been referred is accredited by the American
Academy of Sleep Medicine (AASM). This recognition denotes that the
facility adheres to the highest standards of care for sleep disorder
patients. A list of accredited sleep facilities is available at
www.aasmnet.org. A related issue to address is whether your insurance
carrier requires testing in accredited facilities in order to cover the
cost of the procedure; in many states, medical insurance will not
reimburse the cost of sleep studies unless they are conducted at an
If you are referred for a sleep study or a
polysomnogram, be sure to request that the technologist conducting your
study is a Registered Polysomnographic Technologist (RPSGT). An RPSGT
is a fully trained sleep technologist who has met the rigorous
requirements to become credentialed by the Board of Registered
Treating Sleep Problems
After the sleep study has been conducted and
reviewed, several conditions may be diagnosed, and various specific
treatments may be recommended. There is a wide range of methods for
treating sleep problems. Medications may be prescribed by your
physician. Sometimes a sleep psychologist is called upon to recommend
non-drug approaches that may include addressing patients’ pessimism
about their sleep surroundings, correcting misconceptions about sleep,
controlling stimulating factors that hinder sleep and identifying
positive behaviors that aid sleep. Improving your diet, your sleep
environment and your bedtime rituals, including the timing of physical
exercise, alcohol intake, and other factors may all contribute to a
better night’s sleep.
Some patients may be candidates for
night-time oral or dental applicances to reduce snoring and apnea. The
American Academy of Dental Sleep Medicine at www.aadsm.org lists dental sleep
medicine specialists by state.
Sleep Problems and the
Importance of After Care
Patients will often need continuing support in
terms of evaluating and managing their response to various medications,
treatment methods or recommended behavioral measures. Sometimes, a
primary physician will prescribe the initial treatments and continue
seeing the patient for follow-up treatments; whereas in other settings,
after care occurs in dedicated sleep clinics. Ideally, the sleep
specialist who performed the initial evaluation and reviewed the sleep
study with the sleep technologist will direct the patient’s after care,
including follow up in his or her clinic and with other allied health
professionals involved with treatment.
In addition to medications and behavioral
measures, some sleep disorders, such as sleep apnea (in which breathing
is briefly and repeatedly interrupted during sleep), may include the use
of medical equipment during sleep, such as CPAP therapy. CPAP is an air
pressure system that helps hold the air passages in the nose and throat
open during sleep and eliminates snoring and pauses in breathing.
Proper fitting and instruction for use of CPAP equipment – whether
simple nosepieces or more elaborate masks – is critical to ensure your
comfort and willingness to continue with treatment. There may be a
period when different equipment is used and several adjustments are
made. It is important that you share your questions and concerns with
the sleep specialists who are working with you for the best possible
outcome. In truth, some treatment methods may be challenging to follow,
and having continuing care available from a certified sleep specialist
to oversee a patient’s progress is crucial. Ask your primary care
physician or sleep doctor if continuing after care will be offered at
the referred sleep clinic. At the very least, most patients schedule
annual visits at their sleep clinic to learn
about the latest advances in the treatment of
sleep problems and sleep disorders.
You Are Not Alone
According to recent polls conducted by the
National Sleep Foundation, nearly 7 out of 10 Americans say they
experience frequent sleep problems. However, when proper diagnosis and
treatment of sleep disorders occurs, the feeling of sleepiness declines,
memory improves and safety risks decrease dramatically. In fact, sleep
disorder specialists help an estimated 85 to 90% of their patients get
better sleep. With the wealth of treatment options now available, a good
night’s sleep is within reach.
The Board of Registered Polysomnographic
Technologists is the independent, non-profit certification
board that administers the examination required to become a Registered
Polysomnographic Technologist (RPSGT), respected worldwide as the
leading credential for polysomnographic technologists.
BRPT is moving. New mailing address,
effective July 1, 2008:
Board of Registered Polysomnographic
8400 Westpark Drive, Second Floor
McLean, VA 22102
The National Sleep Foundation
an independent, non-profit organization
dedicated to improving public health and safety by achieving
understanding of sleep and sleep disorders, and by supporting
sleep-related education, research and advocacy.
National Sleep Foundation
Photos: Jupiter Images
1522 K Street, NW, Suite 500
Washington, DC 20005