Why does the sleep study evaluation process take so long?

February 7, 2017 by Sound Sleep Health

You wouldn’t visit a foot doctor (podiatrist) to treat suspected diabetes, would you? Or a reproductive health specialist if you think you’ve gotten a sprained ankle? All levity aside, you would, of course, visit the appropriate medical specialist for the appropriate medical condition.

The same goes for any person who suspects they may suffer from a sleep disorder. But because you are asleep when your symptoms express themselves, how can you possibly diagnose or even be made aware that you are snoring, may have restless leg syndrome, or could be suffering from obstructive sleep apnea?

Realizing You May Have a Sleep Disorder

Because of the nature of sleep disorders, it may take years for you to become aware that you have a problem. Even if you live with family members or have a regular bed partner who constantly complain about your thunderously loud snoring, it may be difficult to accept the reality of a sleep disorder.

The first major step in self-assessment of a possible sleep disorder is objectively evaluating how you feel in the mornings.

• Do you have trouble staying awake during regular daytime hours?

• Do you suffer from a sore throat when you first wake up?

• Are you having difficulty concentrating on everyday tasks, including reading, working, and even driving?

• Do you wake up feeling unrefreshed, unrested, unsatisfied with your nights sleep, even if you have slept eight hours or more

If any or all of these are true, they may indicate that you are suffering from a sleep disorder, quite possibly from obstructive sleep apnea : a condition in which your breathing passages are partially or completely blocked while you sleep. The basic cause is the relaxation of neck and throat muscles during sleep, which may cause the airways to collapse (much like a straw can be pinched shut by even a small weight on top of it).

This condition may occur in anyone, regardless of weight, height, gender, neck size, nose size, anything. A person who suffers from obstructive sleep apnea literally stops breathing for at least ten seconds at a time, up to 30 (or more) times per hour.

As a result, the body’s autonomic nervous system panics and literally jolts you awake, long enough for your neck muscles to unpinch your airway and for you to take a deep, often gasping breath. This unfortunately also prevents you from ever experiencing deep sleep and REM sleep resulting in all the symptoms described above and more.

Seeing a Sleep Medicine Doctor

So now that you understand that you may be suffering from a sleep disorder, you are ready to see an
experienced professional to diagnose and treat it. (No, not a podiatrist or fertility doc!)

In the case of sleep disorders, such as obstructive sleep apnea (OSA), there is no substitute for visiting a board-certified sleep medicine doctor in an accredited sleep center.

Unlike treating a sprained ankle, though, a proper diagnosis of a sleep disorder requires more than just a quick office visit.

At your first visit with a sleep medicine doctor, all of your signs and symptoms will be taken down and discussed. Based on this, your doctor can determine whether a home sleep apnea test will be sufficient or if a full in-lab sleep study will be required.

The Sleep Study Procedure

An overnight sleep study is called a polysomnogram . This exam studies your external sleep habits, such as what position in which you normally sleep, whether you are a mouth or nose or combination breather, and any movements of your eyes and legs.

A polysomnogram also measures your internal activity. This includes your brain activity (EEG or electroencephalogram), heartbeat (pulse/heart rate) and your breathing (respiration).

A proper sleep study will take place at an accredited sleep center or lab. There, a board-certified sleep medicine physician will have the equipment and environment all set up for a complete evaluation of your sleep. Their team of experienced technicians will ensure your polysomnogram is complete and accurate.

Here is what to expect from a sleep study:

1. Arrival . You will arrive at the sleep center, generally in the early to middle evening hours. You will take care of any required paperwork, and be shown the equipment that will be used during the polysomnogram. This is the best time to ask any questions you may have, as well as to mention any recent changes in your sleep patterns or potential issues with the study (such as colds or allergies).
2. Get Ready to Sleep. The sleep technologist will escort you to your sleep study bedroom. The room will be very much like a nice hotel room, with excellent soundproofing. Here, you will take as much time as you need to prepare for bed, just as you would do at home. You may change into your accustomed nightclothes, and wind down per usual.
3. Get Hooked Up. To collect all the necessary data for your sleep study, the tech will need to attach several small sensors to your head and body. Each sensor has a long wire long enough to allow you normal, easy movement to the sleep center computer.
   1. These little metal discs are exactly the same as those used in typical EEG and EKG machines. They will be attached to your forehead, scalp, and legs.
   2. Soft, flexible elastic belts will loop around your chest and abdomen to measure your breathing effort.
   3. A nasal cannula, that measures airflow in and out from your nose and mouth.
   4. A standard pulse ox clip on your fingertip or earlobe will monitor your pulse/heart rate, and blood oxygen level.
   5. CPAP Mask. Depending on the type of study, you might be fitted with a CPAP mask. Likely the basic model that covers your nose (nasal mask), but depending on your sleep habits, you may instead be asked to wear one that covers both your nose and mouth (full face mask), or a slim mask that fits into your nostrils (nasal pillows) much like an oxygen feed tube.

In addition to these sensors, the study bedroom is equipped with a night vision camera, microphone, and speaker, through which you and the technician will communicate. All of this information is recorded for your polysomnogram.

4. Sleep and Study . The technician, who will be in another room, will monitor your sleep the whole night, waking you occasionally with instructions for the study. You may be asked to sleep on your back or side. You may also be instructed to place the CPAP mask on your face.

Once sufficient data has been collected by your sleep technician, you will be left in peace to sleep for the rest of the night.

Interpreting the Results of your Sleep Study

During your time in the sleep study room, the tech will immediately be able to count how many instances of apneas occur. They will also have tested for other sleep breathing disorders, calibrated (or titrated) for your best CPAP pressure levels, options for masks, and which sleep positions come most naturally for you.

After you complete the test, the technician will collate all your sleep study information and submit it to your sleep doctor. It may take up to two full weeks for proper evaluation of your study: the results will require analysis by a board-certified sleep physician, who will check for all possibilities including:

• parasomnias (abnormal movements, behaviors, etc.)
• hypersomnia (excessive sleepiness such as narcolepsy)
• circadian rhythm disorders (inability to follow normal sleep times)

Follow-up Meeting

Once the results are in, it is time to discuss treatment options with your sleep doctor. If you are diagnosed with obstructive sleep apnea, for example, you will then begin the process of using a CPAP, or Continuous Positive Airway Pressure machine.

A CPAP is essentially an air compressor that blows a column of pressurized air into your nose and/or mouth while you sleep. This air effectively prevents apneas (blocked breathing) by using air pressure to hold your airway open.

Depending on your individual needs, you may need to experiment with different types and models of CPAP machines, tubing, face masks, etc. In addition, the process of acclimatizing to using the CPAP can take days, weeks, or even months, depending on how you respond to the machine both consciously and unconsciously.

Your sleep doctor may recommend other options, ranging from medication to surgery.

Conclusion

While the benefits of a good nights sleep are indisputable, sleep remains a complex, incompletely understood process. Not only do multiple parts of the brain control different phases of sleep, from Non-REM sleep to REM sleep, but science genuinely does not fully understand why humans and other creatures sleep at all.

A sleep study in a qualified sleep center is the most complete method of analyzing your sleep. The massive amount of biological and behavioral data gathered requires careful review in order to recommend the best course of treatment for your sleep disorder.