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    If you’ve been having difficulties with your sleep, your primary care provider may recommend you complete a sleep study. But what qualifies you to do a sleep study? What happens while you sleep? What is being measured? Dr. Usha Nandhini, Sleep Medicine Physician, at Palouse Sleep Medicine, a member of the Pullman Regional Hospital Clinic Network, shares what her patients should know.

    Are all sleep studies the same?

    Routine sleep studies, also known as polysomnograms, are tests used to diagnose sleep disorders. These tests are performed in a sleep lab overnight while monitors record different body functions. Pullman Regional Hospital has a team of technologists who staff the Sleep Lab, where these tests take place.

    Aside from routine polysomnograms, there are some specialized tests that your physician may order depending on your sleep issues and health.

    • Positive Airway Pressure (PAP) Titration is done after the diagnosis of Sleep Apnea. A CPAP (continuous positive airway pressure) or a BIPAP (bilevel positive airway pressure) machine is used while technologists determine the optimal pressure setting of the machine to treat sleep apnea. During the study, the air pressure delivered through the machine is gradually increased, if needed, while the patient is sleeping until the respiratory events that occur with sleep apnea are well controlled.
    • Split-night PSG: this test is conducted when severe Sleep Apnea is noted during the first part (first two hours) of the routine polysomnogram test. The second half of the night is utilized for PAP titration.
    • Multiple Sleep Latency Test (MSLT): This study consists of five 20-minute nap trials scheduled two hours apart during the day; the test measures a person's tendency to fall asleep during regular waking hours. This test is used to diagnose Narcolepsy or other types of Hypersomnia (excessive sleepiness). It is performed in the morning following a routine overnight polysomnogram sleep test. If you’re scheduled for a Multiple Sleep Latency Test, you may be required to complete a routine drug test beforehand.

    What does a sleep study measure?

    During a sleep study, measurements are being recorded including: heart rate, eye movement, limb movement, chest and abdominal movement, oxygen saturation, breathing rate and breathing pattern, brain waves, snoring and other noises you make during sleep, and other sleep-related movements.

    “Sleep studies are truly non-invasive tests- they’re painless,” reassures Dr. Nandhini.

    Why do I need a sleep study?

    Your primary care provider or specialist may recommend a sleep study if they suspect you have any of the following:

    • Sleep apnea: repeated pauses during breathing which could be associated with snoring, choking, gasping for air, and causes daytime sleepiness, irritability, difficulty concentrating, and not getting good quality sleep
    • Narcolepsy: sudden attacks of sleep, excessive daytime sleepiness, and other features such as sudden loss of muscle control in response to strong emotions such as laughter
    • REM Behavior Disorder: enacting your dreams resulting in injury to yourself or partner and causing daytime sleepiness
    • Unusual behaviors during sleep such as walking, talking, rhythmic movements, or excessive movements
    • Chronic Insomnia: difficulty falling asleep or maintaining sleep
    • Periodic Limb Movement Disorder: commonly associated with Restless Leg Syndrome, this condition manifests itself with movements throughout sleep that result in sleep disruption and daytime sleepiness.
    How can I prepare for a sleep study?

    “A sleep study is looking at the quality and length of your sleep, so anything that interferes with those aspects should be avoided prior to your study,'' cautions Dr. Nandhini. Alcohol and caffeine (including coffee, tea, soda, and chocolate) should be avoided in the afternoon before your study.

    You’ll also want to arrive ready to sleep, so it’s important not to nap in the afternoon on the day of your study so your quality and quantity of sleep is not impacted.

    What happens during a sleep study?

    Sleep studies occur overnight, so you’ll arrive in the evening and return home the next morning. You’re encouraged to bring comfortable, loose-fitting clothing, a change of clothes for the following day, and any personal toiletry items you’ll need.

    At your study, you’ll be instructed to get ready for bed (change clothing, brush teeth, etc.) then a sleep technologist will place sensors on your scalp, temples, chest, legs, and arms using a mild adhesive. Belts are placed along the chest and abdomen to monitor your breathing. A small clip will be placed on your finger or ear to monitor the oxygen level in your blood. Wires connect all of these sensors to a computer, but don’t worry- the cables are long enough to let you move around comfortably in bed.

    During the night, the sleeping area is dark and quiet. Since there is no light in the room, a low-light video camera helps the polysomnography technologists monitor what is happening in the room. An audio recorder in the room monitors snoring and other noises.

    If you need to use the restroom during the night or you’re experiencing discomfort with any of the sensors, you can let your sleep technologist know and they can assist you.

    My provider recommended a Home Sleep Apnea Test… what’s that?

    A Home Sleep Apnea Test (HSAT) is a type of sleep study that’s completed at home. This type of test uses a limited number of sensors that monitor your heart rate, airflow, breathing rate, oxygen saturation, and snoring during a night of sleep. Don’t worry- before completing a test, your provider will instruct you on how to use it. Dr. Nandhini recommends following your regular bedtime schedule when doing a Home Sleep Apnea Test to ensure accuracy.

    Home Sleep Apnea Tests are not recommended for patients with significant underlying medical conditions such as heart failure, severe lung issues, or neuromuscular diseases.

    Next Steps

    After your sleep study, a sleep specialist reviews the study results and determines if you have a sleep disorder. “Based on the results, another sleep study may be recommended to further measure and treat the issue. If another sleep study is not needed, a follow-up visit with a sleep medicine physician or your primary care provider is the next step,” says Dr. Nandhini.

    If you’re not sleeping well or have concerns about your sleeping habits, talk to your primary care provider about making a referral to Dr. Usha Nandhini with Palouse Sleep Medicine.


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