Sleep Apnea Test

Rose here….good evening everyone. As you know from my previous article I have been talking to my sister, Apnea. Apnea was given her name because our mother, Polysomno Pickwickian (Poly for short), suffered from Obstructive Sleep Apnea especially during her pregnancy with her. Obstructive Sleep Apnea (OSA) may be a common form of sleep apnea, but the constant repetitive episodes of cessation of breath due to her large tonsils and the pressure on her lungs due to her pregnancy; she experienced excessive daytime sleepiness, morning headaches, dry mouth and heartburn. Poly, born in the 20th century, complained to her doctor, William Osler about her symptoms and Poly was the first person to be diagnosed with a sleep apnea test.

Dr. William Osler coined sleep apnea the ‘Pickwickian Syndrome’ and wrote a paper that became the well known Pickwick Papers, an accurate clinical picture of adult obstructive sleep apnea syndrome…..and everyone thought he named it after Charles Dickens.

Dr. Osler found that the cessation of breath is associated with the reduction in blood oxygen saturation when the airway becomes obstructed by excess tissue, large tonsils, large tongue and/or sometimes the jaw or nasal passages can be a factor. Other symptoms include; loud snoring, depression, insomnia, frequent nighttime urination, overweight, high blood pressure and rapid weight gain. Some symptoms are not even recognized by the patient and their bed partner/spouse is the only one aware that there is a sleep apnea problem.

Major life threatening risks are heart attacks, strokes, impotence, erratic heartbeat and heart disease if OSA is untreated. Also, you might experience drowsiness when you are awake making it dangerous to drive or operate machinery. Fortunately for my mother her symptoms dissipated after Apnea was born and her tonsils were removed.

It was many years after Dr. Osler’s Pickwick Papers that a machine was invented to monitor and diagnose sleep apnea. Since my mother was the first person diagnosed with sleep apnea the sleep apnea test was called polysomnography. There are two types of sleep apnea tests; one an overnight test that involves monitoring the brain waves, muscle tension, rapid eye movement, breathing and oxygen level in the patient’s blood, the second test is a home monitoring test where a patient takes a polysomnograph home, is instructed how to use it and returns the next morning. These are painless test and might be covered under your health insurance.

If you are like Poly some treatment involves lifestyle changes or minor surgery. Other lifestyle changes are; losing weight and/or just sleeping on your side. If these changes aren’t enforced the patient’s sleep apnea will worsen as they age.

Some patients will use an oral mouth device to help keep the airways open by bringing the jaw forward, elevating the soft palate or preventing the tongue from falling back and obstructing the airway. There are many oral mouth devices on the market today

If the patients has severe sleep apnea it is recommended that they are treated with a C-PAP or continuous positive airway pressure machine that with a nose mask keeps the airway open and unobstructed by blowing air into their nose.

Other severe sleep apnea is caused by facial deformities and can be corrected by surgery. Some of these deformities are; a small jaw causing a small opening at the back or their throat, deviated septum, large tonsils and/or adenoids. All of these can be corrected with minor surgery.

Other surgeries include:

Prior to 1980, a tracheotomy was performed where a small hole was cut into the neck and a tube with a valve was inserted to eliminate obstructions. This procedure is only performed today as a last resort to alleviate the patient from respiratory distress or other major medical complications.

Today the uvulo-palato-pharyngoplasty is preformed for those that cannot tolerate the C-PAP. The uvulo (the skin that dangles in the back of your throat) is removed along with any excess tissue. If you are considering this surgery please discuss the risks involved. Statistics show that the procedure helps 50% of those who have had it and due to scar tissue some may still need to use the C-PAP.

For those with a small jaw which causes the tongue to obstruct the airway a mandibular myotomy is preformed. This surgery involves cutting a piece of bone from the jaw to which the tongue muscles are attached. The bone is pulled outward, rotated 90 degrees and reattached thus pulling the tongue forward and eliminating the air obstruction. This surgery requires a high trained, experienced surgeon in both ENT surgery and maxillofacial surgery.

There are two other surgeries; a LAUP or laser assisted uvuloplasty (removes the uvula) and a somnoplasty aka RF or radiofrequency (shrinks the uvula) that improve airflow and eliminates snoring. Also there is a new treatment that has been approved by the FDA, in which radiofrequency reduces the tongue. This RF treatment to the tongue involves inserting a needle and heating the inner tissues to 158 to 176 degrees causing the tissue to shrink. Since this procedure is new it may not be covered by health insurance.

Luckily for my mother the only thing she had to have done was have her tonsils removed, but in the 20th century it was still considered a major surgery. If it wasn’t for Dr. Osler she would have never been diagnosed with sleep apnea with a sleep apnea test. Today the polysomnography is used to diagnose, or rule out, many types of sleep disorders including narcolepsy, restless legs syndrome, REM behavior disorder, parasomnias, and of course sleep apnea.
Good Day,
Rose Sheepskill

Sleep Study

Hello, Tonight I want to talk about sleep study or a polysomnography sleep study (PSG). To get a PSG you must be tested at a sleep study clinic. Sleep study clinics have a polysomnogram that records data while you sleep by attaching electronic transmitters to your face and scalp. The recordings or sleep study scoring will determine if you have a sleep disorder.

There are four types of sleep disorder study:

1. Diagnostic Overnight PSG; Study of sleep by brain wave, eye movement and number of arousals, etc. to determine the amount of non-REM and REM sleep. This sleeping study also monitors body functions including breathing patterns, oxygen levels, heart rhythms and leg/arm movements.

2. Diagnostic Daytime Multiple Sleep Latency Test (MSLT) This sleep research study diagnoses narcolepsy and measures restlessness, sleepiness during the hours you are awake. This study of sleep is usually done after a PSG test and will conclude if you fall asleep easily during the day and monitors how often you enter REM sleep.

3. Two-night Evaluation PSG and CPAP Titration; a sleep apnea study CPAP or Continuous Positive Airway Pressure involves using a specially designed nasal mask that evaluates the delivery of air into the airways. The first night is general monitoring to determine if you have obstructive sleep apnea (OSA). The OSA sleep study will show if you stop breathing during your sleep. The second night is required to see if CPAP pressure will alleviate apnea.

4. Split-night PSG with CPAP Titration; Instead of two consecutive nights this test splits one night in half. If you have been diagnosed with sleep apnea with the first half of the study then the second have they will use the mask to determine the CPAP pressure required to lessen your sleep apnea.

When you arrive at the sleep center you will be assigned a private room that may appear to look like a bedroom. It will have a nice bed, coffin or a coffin couch. (which I prefer) This room is a central monitoring area where technicians will record and analyzes you while you sleep. There you will be hooked up to the monitor. Electrodes will be attached to your face and scalp so that your electrical signals will be sent to the measuring equipment. An Oximeter will be put on your finger to calculate the oxygen level in your blood and a strap will be placed around your chest to measure your breathing. All the machines and wirers may look intimidating and uncomfortable, but most patients fall asleep without any problems.

There are other tests and scoring sleeping studies such as:

• EEG (electroencephalogram) to measure and record brain wave activity.
• EMG (electromyogram) to record muscle activity such as face twitches, teeth grinding, and leg movements. It also helps in determining the presence of REM stage sleep.
• EOG (electro-oculogram) to record eye movements. These movements are important in determining the different sleep stages, particularly REM stage sleep.
• EKG (electrocardiogram) to record heart rate and rhythm.
• Nasal Airflow Sensor to record airflow.
• Snore Microphone to record snoring activity.

Other sleep studies are the MSLT test or multiple sleep latency test which evaluates how long it takes you to fall asleep and the MWT test or multiple wake test that measures whether you can stay awake during your normal waking hours.

Sometimes you may have shift work sleep disorder and your internal clock or circadian rhythm is causing you to become restless during the day. A home sleep study test called Actigraphy, a device that looks like a watch, will assess your movement during night and day. It will help your doctor to determine what times during the day you are active and what times you are sleeping. Aren’t most of us sleeping during the day?

Before you have a sleep study test your doctor may ask you to keep a sleep diary for 1 or 2 weeks. Try to adhere to your normal routine for a more accurate record. 2 or 3 days before the test do not take any naps, stop taking any drugs such as sleeping aides, don’t drink or eat anything with caffeine.

On the day of the test take a shower but do not put anything is your hair like hair spray or hair gel. Some of the test equipment will be attached to your face and fingers so no makeup, fingernail polish or fake nails. Pack a small sleepover bag; bring a book, pjs, dirt or your favorite pillow if you like.

All pertinent forms should be completed prior to the sleep study test day. Make sure you complete and answer all answers honestly this will help your doctor to diagnosis your sleep disorder accurately. And above all else ask questions and discuss concerns with your doctor.

Sleep studies are usually done at a sleep clinic and your results should be available within 1-2 weeks. Depending on the diagnosis your results may be sent to your family physician, a neuorologist or a doctor that specializes in sleep disorders. I don’t know about you, but all this boring sleep study talk is making me tired.

Good Evening,
Rose Sheepskill

Sleep Study

Hello, Tonight I want to talk about sleep study or a polysomnography sleep study (PSG). To get a PSG you must be tested at a sleep study clinic. Sleep study clinics have a polysomnogram that records data while you sleep by attaching electronic transmitters to your face and scalp. The recordings or sleep study scoring will determine if you have a sleep disorder.

There are four types of sleep disorder study:

1. Diagnostic Overnight PSG; Study of sleep by brain wave, eye movement and number of arousals, etc. to determine the amount of non-REM and REM sleep. This sleeping study also monitors body functions including breathing patterns, oxygen levels, heart rhythms and leg/arm movements.

2. Diagnostic Daytime Multiple Sleep Latency Test (MSLT) This sleep research study diagnoses narcolepsy and measures restlessness, sleepiness during the hours you are awake. This study of sleep is usually done after a PSG test and will conclude if you fall asleep easily during the day and monitors how often you enter REM sleep.

3. Two-night Evaluation PSG and CPAP Titration; a sleep apnea study CPAP or Continuous Positive Airway Pressure involves using a specially designed nasal mask that evaluates the delivery of air into the airways. The first night is general monitoring to determine if you have obstructive sleep apnea (OSA). The OSA sleep study will show if you stop breathing during your sleep. The second night is required to see if CPAP pressure will alleviate apnea.

4. Split-night PSG with CPAP Titration; Instead of two consecutive nights this test splits one night in half. If you have been diagnosed with sleep apnea with the first half of the study then the second have they will use the mask to determine the CPAP pressure required to lessen your sleep apnea.

When you arrive at the sleep center you will be assigned a private room that may appear to look like a bedroom. It will have a nice bed, coffin or a coffin couch. (which I prefer) This room is a central monitoring area where technicians will record and analyzes you while you sleep. There you will be hooked up to the monitor. Electrodes will be attached to your face and scalp so that your electrical signals will be sent to the measuring equipment. An Oximeter will be put on your finger to calculate the oxygen level in your blood and a strap will be placed around your chest to measure your breathing. All the machines and wirers may look intimidating and uncomfortable, but most patients fall asleep without any problems.

There are other tests and scoring sleeping studies such as:

• EEG (electroencephalogram) to measure and record brain wave activity.
• EMG (electromyogram) to record muscle activity such as face twitches, teeth grinding, and leg movements. It also helps in determining the presence of REM stage sleep.
• EOG (electro-oculogram) to record eye movements. These movements are important in determining the different sleep stages, particularly REM stage sleep.
• EKG (electrocardiogram) to record heart rate and rhythm.
• Nasal Airflow Sensor to record airflow.
• Snore Microphone to record snoring activity.

Other sleep studies are the MSLT test or multiple sleep latency test which evaluates how long it takes you to fall asleep and the MWT test or multiple wake test that measures whether you can stay awake during your normal waking hours.

Sometimes you may have shift work sleep disorder and your internal clock or circadian rhythm is causing you to become restless during the day. A home sleep study test called Actigraphy, a device that looks like a watch, will assess your movement during night and day. It will help your doctor to determine what times during the day you are active and what times you are sleeping. Aren’t most of us sleeping during the day?

Before you have a sleep study test your doctor may ask you to keep a sleep diary for 1 or 2 weeks. Try to adhere to your normal routine for a more accurate record. 2 or 3 days before the test do not take any naps, stop taking any drugs such as sleeping aides, don’t drink or eat anything with caffeine.

On the day of the test take a shower but do not put anything is your hair like hair spray or hair gel. Some of the test equipment will be attached to your face and fingers so no makeup, fingernail polish or fake nails. Pack a small sleepover bag; bring a book, pjs, dirt or your favorite pillow if you like.

All pertinent forms should be completed prior to the sleep study test day. Make sure you complete and answer all answers honestly this will help your doctor to diagnosis your sleep disorder accurately. And above all else ask questions and discuss concerns with your doctor.

Sleep studies are usually done at a sleep clinic and your results should be available within 1-2 weeks. Depending on the diagnosis your results may be sent to your family physician, a neuorologist or a doctor that specializes in sleep disorders. I don’t know about you, but all this boring sleep study talk is making me tired.

Good Evening,
Rose Sheepskill