Sleep Study FAQ

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SLEEP STUDY FAQ (ANSWERED BY A REGISTERED POLYSOMNOGRAPHIC TECHNOLOGIST)

By Amanda Jones RPSGT

If you have questions about undergoing a sleep study, you’re not alone. Here are some FAQ that I get asked while working at Comprehensive Sleep Care Center as a Sleep Technologist. They may be able to help you understand the process and put you more at ease.

A sleep study, known as a polysomnogram, is an overnight test done in a sleep lab. Prior to the study, a sleep technologist will place sensors on your scalp, face, chest and legs. These sensors will record brainwave activity (to assess sleep stage), eye movements, muscle activity, heart rhythm, body movements, nasal/oral airflow, respiratory effort and oxygenation. In addition, your body position will be observed on video camera. All this information will better assist your sleep physician in determining the cause of any sleep related problems.

Sleep Study FAQ

Q: WHY DO I NEED A SLEEP STUDY?

A: Sleep studies help doctors diagnose sleep disorders such as sleep apnea, periodic limb movement disorder, narcolepsy, restless legs syndrome, insomnia, and nighttime behaviors like sleepwalking and REM sleep behavior disorder.

Q: CAN MY SPOUSE OR SIGNIFICANT OTHER STAY WITH ME ON THE NIGHT OF MY STUDY?

A: Significant others may have helpful insight during the evaluation stage, but they are not usually permitted to stay with you on the night of your study. IF there is a reason they need to stay, please discuss it with your doctor during your consult.

Q: WHAT IF I CAN’T SLEEP?

A: Don’t stress, we don’t expect you to sleep as well as you would at home, and we take that into account. Nearly everyone can fall asleep during an in-lab study. In most cases, you do not need a full 6 hours of sleep for the doctor to make a diagnosis. There are several things you can do to help you sleep the night of your study. First consider waking a little earlier than usual on the day of your study. Do not take naps during the day. Avoid the consumption of all caffeine—skipping coffee, tea, soda pop, chocolate, energy drinks, and other caffeinated products.

Q: CAN I BRING MY OWN PILLOW?

A: Of course! We want you to be as comfortable as possible so you can sleep. Our sleep labs use My Pillows on each bed (one soft and one firm).  However, most people prefer their own pillow. In fact, if you have a special blanket or throw you sleep with, bring that as well! The more comfortable you feel the better you will sleep.

Q: WHAT ABOUT ALL THE WIRES? WILL THEY STAY ON ALL NIGHT?

A: After you arrive at the sleep center a technician will apply small sensors to your head and body with adhesive. The wires connecting the sensors to a headbox are usually gathered to the side with plenty of slack so you can move around during sleep. Elastic belts will be wrapped around your chest and abdomen to measure breathing. A clip will be placed on your finger or (in some cases your earlobe) to monitor oxygen levels in your bloodstream. Most people get used to it all very quickly. Everything is attached using medical tape and/or paste. The wires are attached to stay on all night. If anything does come loose the tech will enter the room to re-attach them during the night. We attempt to do this without waking the patient if possible. The sensors are attached to your body in a manner like electrocardiogram (EKG) electrodes and are not painful. In rare instances, some people with sensitive skin develop local irritation at the electrode sites. If you have experienced skin irritation due to EKG testing in the past, or have an adhesive allergy please notify the Sleep Center and the technologist prior to the study.

 Q: CAN I SLEEP ON MY SIDE? WHAT IF I MOVE AROUND IN MY SLEEP?

A: We want you to sleep in your natural position. Many people roll over and change positions multiple times during the night. While sleep apnea is more prevalent when sleeping on your back, the Technician may ask you to try sleeping on your back for a portion of the test. This allows us to check your breathing in multiple positions. IF you’re unable to, don’t worry! It may be very difficult to sleep on your stomach so the technician may ask you to use a pillow to keep you from rolling all the way onto your stomach.

Q: DURING MY SLEEP STUDY, WHAT IF I HAVE TO USE THE RESTROOM?

A: If you need to get up during your sleep study just notify your sleep technologist (by calling out or sitting up in the bed) and let them know that you need to use the restroom. They will unhook one or two central connections, which will enable you to get up and walk to the bathroom. The headbox even has a strap you can carry over your shoulder or around your neck. (The headbox is the device that all your wires connect into)

Q: MAY I SLEEP NAKED?

A: No. As a courtesy to our sleep techs we request that you sleep in pajamas or a t-shirt and shorts.

Q: HOW LONG IS THE SLEEP STUDY? WHAT IF I WAKE UP EARLY? CAN I SLEEP IN?

A: The wake-up time is 5 am, and unfortunately, we cannot allow patients to sleep in. Insurance requires a minimum of 6 hours of recording, and as long as we have reached that, you are free to leave before 5 am (some restrictions may apply depending on if the patient took a sleeping medication). Many people ask why they must get up so early. Our Sleep Technicians need to ensure all patients are up and checked out so they can upload all the data to be read and get home so they too can get some sleep.

Q: HOW HARD IS THE PASTE TO GET OUT OF MY HAIR?

A: The paste is water soluble! You can use a hairbrush, but some paste will remain. The best thing to do is wash your hair with very warm water. We recommend using conditioner first to loosen up the paste and then washing your hair. Rubbing alcohol is also an effective, quick way to remove paste but can be rough on the scalp. Also, Micellar water can be effective and less harsh.

Q: CAN THEY TELL ME THE RESULTS OF MY SLEEP STUDY IN THE MORNING?

A: Unfortunately, no. The sleep technologist is collecting data that will be interpreted by your sleep medicine physician. You will receive your results at your follow-up visit.

Whether you were a little nervous about your upcoming sleep study, or just curious about the process, we hope this cleared up a few questions and put your mind at ease! Remember, your Comprehensive Sleep Care Center sleep technologist is not only there to gather information, but they are there to make the process as comfortable as possible! We look forward to seeing you soon!

 

Six Tips to CPAP Success

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Six Tips to CPAP Success

Trouble getting comfortable with your CPAP machine? Here are some tricks and tips to being successful with your CPAP therapy at home!

PAP therapy – such as CPAP, BiPAP, ASV, etc. – can be challenging to use at first, but with the following tricks and tips, for CPAP success you’ll have yourself saying “Hello!” to sleep again before you know it.

  • Rid yourself of preconceived notions regarding the CPAP machine!

    • Most people know a family member or friend who is using a PAP machine, and he or she might love it, or hate it. Everyone goes through a very unique experience with his or her therapy, so keep your mind as open as possible, and do not let someone else’s experience influence your own.

  • Breathe naturally

    • When you first wear a PAP machine, you may be inclined to try to regulate your breathing and put in a conscious effort at inhaling and exhaling. But don’t! This can induce panic and may make you want to take the mask and machine off. Breathe naturally, and with time, typically the positive pressure becomes more comfortable.

  • Consistency of usage is key

    • “Practice makes perfect” applies to PAP therapy! The more you use the machine, the easier it becomes. On nights when you feel like you have had enough with your machine, try your best to push through. If you do need to take a brief break and step away from the therapy for a moment, do so, but plan to put the mask and machine back on before you fall back asleep for the rest of the night.

  • The mask can make or break the treatment

    • Work closely with our DME technicians to ensure that you have the best mask style and size suited for your mode of PAP therapy, your pressure settings, your facial structure, and your preferred body positioning during sleep, among other defining elements. A mask that does not fit well makes for a poor night’s rest with the machine, as the airflow can “leak” out, causing disruptive noise and discomfort.
    • Practice “mask desensitization” if you are having a hard time keeping your mask on, all night long. This involves wearing the mask and headgear for at least 45 minutes prior to bedtime, in an effort to “normalize” the apparatus and get your brain and body acquainted with the equipment before you attempt to sleep.

  • Take advantage of comfort features on your machine

    • Don’t forget about the features below for optimal comfort, and contact our DME team if you need additional assistance or further instructions on how to utilize or adjust the following:
      1. Humidifier settings – can help with dry mouth and dry mucosa
        1. Increase the level for more moisture
          1. If your tubing is “gurgling” due to water condensing in the tubing or mask when you increase the setting, ask a DME technician about a heated tube.
        2. Decrease the level for less moisture
      2. RAMP – can help you fall asleep with PAP therapy by lowering the pressure
        1. Hitting the RAMP button will drop the pressure to a lower setting (i.e. 4 cm H2O) and allow the pressure to gradually build up to your final prescribed pressure over a period of time (i.e. 30 minutes)
  • Flex – can provide extra relief when you inhale, exhale, or both, depending on your mode of PAP therapy and machine manufacturer

  • Keep your sleep medicine team involved

    • If you are having a problem using and/or tolerating your PAP therapy, let us know so we can help!

 The more you use your machine, the more you will get used to it. Give yourself time to adjust. So, stick with it and soon enough you’ll start to realize just how much treating your sleep apnea improves your sleep and your quality of life! And you can Say Hello to Sleep Again!

INSOMNIA -Why Can’t I Sleep?

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INSOMNIA-Why can’t I sleep?

Insomnia is a problem for many during normal times, but factor in a pandemic and global unrest and it has become much more widespread. Insomnia is a sleep disorder where a person has trouble falling asleep, staying asleep and/or they wake up too early in the morning. Insomnia can drain your energy level and mood, but also negatively impact your health, work performance and quality of life. How much sleep you need varies from person to person, but most adults need seven to eight hours a night.

Insomnia is characterized based on its duration. Acute Insomnia typically lasts short-term while Chronic Insomnia can last a long time.

Acute Insomnia

Lasts from one night to a few weeks and can come and go. It often happens due to life’s circumstances (Coronosomnia) or when you can’t fall asleep the night before an exam or after receiving stressful or bad news. Many people experience short term insomnia and it tends to resolve without any major treatment.

Chronic Insomnia

Happens at least 3 nights a week for 3 months or more. It can have many causes. Changes in the environment, unhealthy sleep habits, shift work, certain medications and medical disorders can lead to a long-term pattern of sleep deprivation.

Insomnia Symptoms may Include:

  • Difficulty falling asleep at night
  • Waking up during the night
  • Waking up too early
  • Not feeling well-rested after a night’s sleep
  • Daytime tiredness or sleepiness
  • Irritability, depression or anxiety
  • Difficulty paying attention, focusing on tasks or remembering
  • Increased errors or accidents
  • Ongoing worries about sleep

Common Causes of Insomnia Include:

  • Stress-Concerns about work, school, health, finances or family can keep your mind active at night, making it difficult to sleep. Stressful life events or trauma also may lead to insomnia.
  • Travel or work schedule-Your circadian rhythms act as an internal clock, guiding such things as your sleep-wake cycle, metabolism and body temperature. Disrupting your body’s circadian rhythms can lead to insomnia. Causes include jet lag, working a late or early shift, or frequently changing shifts.
  • Poor sleep habits-Poor sleep habits include an irregular bedtime schedule, naps, stimulating activities before bed, an uncomfortable sleep environment, and using your bed for work, eating or watching TV. Computers, TVs, video games, smartphones or other screens just before bed can interfere with your sleep cycle.
  • Eating too much late in the evening-Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable. Many people also experience heartburn which may keep you awake.
  • Mental health issues–Anxiety disorders may disrupt your sleep. Insomnia often occurs with other mental health disorders as well.
  • Medications-Many prescription drugs can interfere with sleep, such as certain antidepressants and medications for asthma or blood pressure. Many over-the-counter medications such as some allergy and cold medications, and weight-loss products can contain caffeine and other stimulants that can disrupt sleep.
  • Medical conditions- Examples of conditions linked with insomnia include chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson’s disease and Alzheimer’s disease.
  • Sleep-related disorders–Sleep apnea causes you to stop breathing periodically throughout the night, interrupting your sleep. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.
  • Caffeine, nicotine and alcohol- Coffee, tea, cola and other caffeinated drinks are stimulants. Drinking them in the late afternoon or evening can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can interfere with sleep. Alcohol may help you fall asleep, but it prevents deeper stages of sleep and often causes awakening in the middle of the night.
  • Changes in sleep patterns- With age, your internal clock often advances, so you get tired earlier in the evening and wake up earlier in the morning. But older people generally still need the same amount of sleep as younger people do.
  • Changes in health- Chronic pain from conditions such as arthritis or back problems, can interfere with sleep. Issues that increase the need to urinate during the night, such as prostate or bladder problems, can disrupt sleep. Sleep apnea and restless legs syndrome become more common with age.

 If you are experiencing insomnia symptoms you should speak to your doctor or call Comprehensive Sleep Care Center at 703-214-0318 to see one of our sleep medicine specialists. We are now offering TeleMedicine visits to new and returning patients. Comprehensive Sleep Care Center offers expert diagnosis, treatment, and care for sleep disorders with the goal of providing a better night’s sleep and a better day ahead.

CPAP and COVID-19

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10 Things You Need to Know CPAP and COVID-19

We are receiving a lot of questions about CPAP use during the COVID-19 Pandemic. Comprehensive Sleep Care Center is here to help you with this, and all your sleep care needs. That includes the use of CPAP (Continuous Positive Airway Pressure) as well as BiPAP and ASV Therapy during the COVID-19 Coronavirus Pandemic.

First and foremost, the most important thing we can tell you is DO NOT STOP USING YOUR CPAP without first speaking to your doctor! You were prescribed a CPAP for a medical reason and stopping can put your health at risk.

The information below is for educational use only. If you need specific medical advice, please call the office to speak to the physician or DME-Durable Medical Equipment representative.

Do I have a higher risk of getting coronavirus because I have sleep apnea?

  • There is no evidence linking sleep apnea with coronavirus risk.

 If I do have the coronavirus, will CPAP help me treat it?

  • Your CPAP is used to treat one thing, your obstructive sleep apnea.
  • The question becomes, if you Do Not use your CPAP, what could happen? We know that we want to stay healthy. Well good quality sleep is needed to do that. If you’re not using your CPAP, you’re going to further weaken your immune system. And if you do have coronavirus, or you’re worried about getting coronavirus or any virus, you’re going to be more susceptible if you stop using your device.

 What’s the Difference Between CPAP Machines and Ventilators?

  • CPAP machines and ventilators are both considered mechanical ventilation. They both assist with a patient’s breathing. But there is a big difference -CPAP machines deliver a steady stream of pressurized air to keep the airways open while sleeping, thus preventing the collapse of the passageway and episodes of interrupted breathing. A ventilator is necessary for more severe respiratory conditions in which a patient is unable to breath on their own. A ventilator requires a tube being medically inserted. If you’re using a CPAP machine because you’re in respiratory distress due to COVID-19 infection, you need to call talk to your primary care or go to the emergency room.

 If I have symptoms or have tested positive for Coronavirus, should I continue using my CPAP?

  • Coronavirus doesn’t change your sleep apnea diagnosis – or your need to continue using CPAP therapy. You should continue to use your CPAP machine because a full night’s sleep benefits your overall health.
  • If you have symptoms of the coronavirus, you should isolate yourself in a separate bedroom and use a separate bathroom, if available. In this “recovery room,” you can continue to use CPAP while you sleep alone.
  • In the event of COVID-19 diagnosis, it is important to continue the cleaning guidelines provided for your unit. Please refer to our web page for step-by-step instructions on cleaning your device and mask.
  • We recommend increasing the weekly cleaning to a minimum of bi-weekly during an active infection.
  • After you are free from the coronavirus, replace your CPAP filters and disposable accessories as soon as possible.

 Can my CPAP machine spread Coronavirus to my bed partner?

  • The latest information says non-invasive ventilation (delivered by a mask with air diffusers) has a low risk of aerosolization, provided that there is a good mask fit, and you follow patient isolation (recovery room) guidelines.

Will my insurance still request compliance while in the Pandemic?

  • This is a bit tricky. Insurance companies have not provided any information to indicate that there are any changes to the compliance requirements. If there are extenuating circumstances for a patient, inform your doctor immediately so they can document the information. But it will not ensure that if compliance is requested the extenuating circumstances will override the compliance requirements.

How often should I clean and disinfect my CPAP mask and hose?

  • It’s important to clean your equipment as specified in the instructions for use that came with your equipment.  Poor or inappropriate maintenance can make your sleep therapy ineffective and damage your equipment.
  • If you’ve been sick, it’s smart to wash your mask, tubing, humidifier and filter daily until your cold, flu or virus symptoms are gone. That can help reduce the amount of time you spend feeling under the weather.
  • To be cautious in this time of COVID-19, we recommend increasing the weekly cleaning to bi-weekly cleaning.
  • Keeping it clean: CPAP hygiene
  • Replace your mask and other equipment to keep your machine clean and functioning optimally. We recommend you replace your mask/supplies every 90 days as allowed by your insurance carrier.

Distilled water is unavailable in my area. What should I use in my CPAP humidifier?

  • Optimal humidifier performance requires distilled water. That’s because most or all its minerals have been removed, preventing mineral buildup in the humidifier tub. That said, bottled (purified) water may also be used. It will not harm the device or pose a risk to patients. It will, however, require more rigorous humidifier cleaning to prevent excess mineral buildup in the tub.

 Will a CPAP cleaning machine disinfect my CPAP device and mask?

  • No, CPAP cleaning machines are not FDA-approved and especially right now, I would say, soap and water are still your best option to effectively clean your device.

 Are there any additives or chemicals that I should use to clean a CPAP machine during the coronavirus outbreak?

  • The answer is NO!
  • During a time like this, people may be tempted to try different things like bleach or other chemicals in their CPAP machine. But remember these chemicals can get in your lungs and cause damage. Please, just stick to what’s recommended. Don’t add anything else.

CPAP Cleaning Instructions

 Daily Cleaning

**Do not use moisturizing soaps, bleach, scented oils, chlorine, or alcohol-based solutions to clean your supplies. These solutions may cause irritation to your skin and lungs and may reduce the life of your products.

**If you’ve been sick, it’s smart to wash your mask, tubing, humidifier and filter daily until your cold, flu or virus symptoms are gone. That can help reduce the amount of time you spend under the weather.

  • Before using your mask -wash your face daily with soap and water to remove excess facial oils.
  • Wipe down your mask (including areas that come in contact with your skin) using a damp towel with soap and warm water. This will remove any oils, dead skin cells, and sweat on the mask that can affect the quality of the seal. Gently rinse with a clean towel and let the mask air-dry out of direct sunlight.
  • **You can also use unscented baby wipes or pre-moistened towels designed specifically for cleaning CPAP masks, which are available on-line. DO NOT USE CLOROX OR DISINFECTING WIPES.
  • If your unit has a humidifier, empty any leftover water instead of letting in sit in the unit all day. Refill the humidifier with clean, distilled water right before bedtime for optimal use

Weekly (more more frequent) Cleaning

  • Your mask and tubing need a full bath at once a week to keep it free of dust, bacteria, and germs. (During COVID-19 or any other virus we recommend more frequent cleaning)
  • Clean the CPAP tubing, nasal mask, and headgear in a bathroom sink filled with warm water and a few drops of ammonia-free, mild dish detergent. Avoid using stronger cleaning products, including dish detergents, as they may damage the mask or leave harmful residue. Swirl all parts around for about five minutes, rinse well and let air dry during the day. Hang the tubing over the shower rod, on a towel rack or in the laundry room to ensure all the water drips out.
  • The mask and headgear can be air-dried on a towel or hung on a hook or hanger.
  • You should also wipe down your CPAP machine with a damp cloth. Ensure the unit is unplugged. The towel shouldn’t be too damp or wet, as water could get into the machine.
  • Clean the filter by removing it and rinsing it in warm tap water. Run it under the water and squeeze to make sure there is no dust. Then blot down the filter with a towel.
  • Do not wash your machine’s white filter, if one is present—those are disposable and should be replaced every two weeks. If you are recovering from being sick, we recommend changing the filter sooner.
  • If your CPAP has a humidifier, that also needs to be cleaned weekly.
  • Empty any remaining water and then wash the water chamber in the sink with warm soapy water. Rinse well and drain out as much of the water as possible. Let the chamber air-dry before placing it back into the CPAP unit.
  • Every other week you should disinfect the humidifier. Do that by soaking it in a solution of one-part vinegar to five parts water for 30 minutes, thoroughly rinsing and then placing in your dishwasher’s top rack for washing. And keep it clean by using only distilled water to prevent mineral deposits that can build up and cause damage to your machine.

**The following are examples of soap that may be used: Johnson & Johnson baby soap, Ivory soap (plain).

With a little upkeep, your CPAP can continue to help you breathe better for a long time. Just a few minutes a day can help keep your CPAP running efficiently for years to come.

Stay Healthy and Stay Strong!

 

 

Coronasomnia

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It’s not Insomnia. It’s CORONASOMNIA

Yes, it is a real thing

 

Are you quarantined alone or with a houseful of kids? Are you working full-time or searching for a new job? The stresses caused by Coronavirus are real and it is causing us to lose sleep. It’s called Coronasomnia and yes, it is a real thing.

I do my best to keep a regular schedule. I try to go to bed and wake up at the same time every day like the experts recommend. But on many nights (especially if I watch the news before bed), as soon as my head hits the pillow, my mind goes into overdrive. I am wide awake wracked with anxiety about  Coronavirus. I worry about my family. Those that live far away, those that live close by, but I can’t visit. I worry about my job. I worry about my friends that own small businesses and restaurants. What is going to happen? What can I do to help? What if I get sick? When is this ever going to end?

I thought it was just insomnia but it’s not. It’s Coronasomnia!

Clearly, I am not alone in this. Everyone I know is having sleep issues. They ask me for my advice because I work at a sleep center. I tell them it is Coronasomnia; an epidemic inside of a pandemic! Even children are starting to feel the stress and it is causing sleep issues for them. Try getting a teenager to adhere to a sleep schedule, or any schedule, when there is no school or sports.

Although the pandemic has only been around for a few months, experts are already seeing an impact. A poll released by the American Psychiatric Association (APA) found that nearly half of Americans (48%) are anxious about the possibility of getting Coronavirus (COVID-19), and nearly four in ten Americans (40%) are anxious about becoming seriously ill or dying from Coronavirus. But far more Americans (62%) are anxious about the possibility of family and loved ones getting Coronavirus.

More than one-third of Americans (36%) say Coronavirus is having a serious impact on their mental health and most (59%) feel Coronavirus is having a serious impact on their day-to-day lives.

Lack of sleep can affect your immune system

It is a never-ending cycle. Stress causes sleep deprivation and insomnia which makes you more stressed. Then the news and life’s uncertainties add to that stress. Here is an even bigger problem; lack of sleep can affect your immune system. Studies show that people who don’t get quality sleep or enough sleep are more likely to get sick after being exposed to a virus. Lack of sleep can also affect how fast you recover if you do get sick. Great double the trouble!

There are several key factors that are likely contributing to Coronasomnia sleep issues

  • Information overload from news sources and other media
  • Excessive exposure to screens; blue light from screen inhibits your body’s natural release of melatonin, which can make it harder to fall asleep
  • Loss of daytime routines and structure; less consistent bedtimes and wake times
  • Depressed mood and daytime napping can make it more difficult to fall asleep at night

I know many of us feel like there is nothing we can do but just deal with it and hope it goes away when things finally get better. The problem is that insomnia can have a significant impact on our health. So, what can we do to try and get the 7-8 hours of quality sleep we need?

Here are some tips that may help you get a better night’s sleep:

  • Stick to a sleep schedule – the same bedtime and wake up time. This helps to regulate your body’s clock and could help you fall asleep and stay asleep for the night.
  • Limit your exposure to the news especially right before bed
  • Decrease screen time before bed – blue light from screens can interfere with your circadian rhythms and decrease your melatonin levels.
  • Wind down. Your body needs time to shift into sleep mode, so spend the last hour before bed doing a calming activity such as taking a bath or reading. Try practicing a relaxing bedtime ritual.A relaxing, routine activity right before bedtime conducted away from bright lights helps separate your sleep time from activities that can cause excitement, stress or anxiety which can make it more difficult to fall asleep.
  • Avoid naps- Power napping may help you get through the day, but if you find that you can’t fall asleep at bedtime, eliminating even short catnaps may help.
  • Exercise daily- Vigorous exercise is best, but even light exercise is better than no activity.
  • Evaluate your room. Design your sleep environment to establish the conditions you need for sleep. Your bedroom should be cool – between 65 and 68 degrees. Check your room for noises or other distractions. Consider using blackout curtains, eye shades, ear plugs, “white noise” machines, humidifiers, fans and other devices.

If you’re still having trouble sleeping, don’t hesitate to speak with your doctor or to call one of my sleep medicine specialists here at Comprehensive Sleep Care Center. As much as Coronavirus related sleep issues are common and understandable, we all need to get a decent night’s sleep to stay healthy.

Written by Sharon Goldman, Marketing Manager at Comprehensive Sleep Care Center

Sleep Study FAQ

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Sleep Study FAQ (Answered by a Registered Polysomnographic Technologist)

By Amanda Jones RPSGT

If you have questions about undergoing a sleep study, you’re not alone. Here are some common questions that I get asked while working at Comprehensive Sleep Care Center as a Sleep Technologist. They may be able to help you understand the process and put you more at ease.

A sleep study, known as a polysomnogram, is an overnight test done in a sleep lab. Prior to the study, a sleep technologist will place sensors on your scalp, face, chest and legs. These sensors will record brainwave activity (to assess sleep stage), eye movements, muscle activity, heart rhythm, body movements, nasal/oral airflow, respiratory effort and oxygenation. In addition, your body position will be observed on video camera. All this information will better assist your sleep physician in determining the cause of any sleep related problems.

Q: Why do I need a sleep study?

A: Sleep studies help doctors diagnose sleep disorders such as sleep apnea, periodic limb movement disorder, narcolepsy, restless legs syndrome, insomnia, and nighttime behaviors like sleepwalking and REM sleep behavior disorder.

Q: Can my spouse or significant other stay with me on the night of my study?

A: Significant others may have helpful insight during the evaluation stage, but they are not usually permitted to stay with you on the night of your study. IF there is a reason they need to stay, please discuss it with your doctor during your consult.

Q: What if I can’t sleep?

A: Don’t stress, we don’t expect you to sleep as well as you would at home, and we take that into account. Nearly everyone can fall asleep during an in-lab study. In most cases, you do not need a full 6 hours of sleep for the doctor to make a diagnosis. There are several things you can do to help you sleep the night of your study. First consider waking a little earlier than usual on the day of your study. Do not take naps during the day. Avoid the consumption of all caffeine—skipping coffee, tea, soda pop, chocolate, energy drinks, and other caffeinated products.

Q: Can I bring my own pillow?

A: Of course! We want you to be as comfortable as possible so you can sleep. Our sleep labs use My Pillows on each bed (one soft and one firm).  However, most people prefer their own pillow. In fact, if you have a special blanket or throw you sleep with, bring that as well! The more comfortable you feel the better you will sleep.

Q: What about all the wires? Will they stay on all night?

A: After you arrive at the sleep center a technician will apply small sensors to your head and body with adhesive. The wires connecting the sensors to a headbox are usually gathered to the side with plenty of slack so you can move around during sleep. Elastic belts will be wrapped around your chest and abdomen to measure breathing. A clip will be placed on your finger or (in some cases your earlobe) to monitor oxygen levels in your bloodstream. Most people get used to it all very quickly. Everything is attached using medical tape and/or paste. The wires are attached to stay on all night. If anything does come loose the tech will enter the room to re-attach them during the night. We attempt to do this without waking the patient if possible. The sensors are attached to your body in a manner like electrocardiogram (EKG) electrodes and are not painful. In rare instances, some people with sensitive skin develop local irritation at the electrode sites. If you have experienced skin irritation due to EKG testing in the past, or have an adhesive allergy please notify the Sleep Center and the technologist prior to the study.

 Q: Can I sleep on my side? What if I move around in my sleep?

A: We want you to sleep in your natural position. Many people roll over and change positions multiple times during the night. While sleep apnea is more prevalent when sleeping on your back, the Technician may ask you to try sleeping on your back for a portion of the test. This allows us to check your breathing in multiple positions. IF you’re unable to, don’t worry! It may be very difficult to sleep on your stomach so the technician may ask you to use a pillow to keep you from rolling all the way onto your stomach.

Q: During my sleep study, what if I have to use the restroom?

A: If you need to get up during your sleep study just notify your sleep technologist (by calling out or sitting up in the bed) and let them know that you need to use the restroom. They will unhook one or two central connections, which will enable you to get up and walk to the bathroom. The headbox even has a strap you can carry over your shoulder or around your neck. (The headbox is the device that all your wires connect into)

Q: May I sleep naked?

A: No. As a courtesy to our sleep techs we request that you sleep in pajamas or a t-shirt and shorts.

Q: How long is the sleep study? What if I wake up early? Can I sleep in?

A: The wake-up time is 5 am, and unfortunately, we cannot allow patients to sleep in. Insurance requires a minimum of 6 hours of recording, and as long as we have reached that, you are free to leave before 5 am (some restrictions may apply depending on if the patient took a sleeping medication). Many people ask why they must get up so early. Our Sleep Technicians need to ensure all patients are up and checked out so they can upload all the data to be read and get home so they too can get some sleep.

Q: How hard is the paste to get out of my hair?

A: The paste is water soluble! You can use a hairbrush, but some paste will remain. The best thing to do is wash your hair with very warm water. We recommend using conditioner first to loosen up the paste and then washing your hair. Rubbing alcohol is also an effective, quick way to remove paste but can be rough on the scalp. Also, Micellar water can be effective and less harsh.

Q: Can they tell me the results of my sleep study in the morning?

A: Unfortunately, no. The sleep technologist is collecting data that will be interpreted by your sleep medicine physician. You will receive your results at your follow-up visit.

Whether you were a little nervous about your upcoming sleep study, or just curious about the process, we hope this cleared up a few questions and put your mind at ease! Remember, your Comprehensive Sleep Care Center sleep technologist is not only there to gather information, but they are there to make the process as comfortable as possible! We look forward to seeing you soon!

 

SLEEP, STRESS AND THE CORONAVIRUS

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SLEEP, STRESS AND THE CORONAVIRUS

In times of crisis and stress, sometimes our basic needs go out the window. Everyone is struggling with the myriad of changes in our daily lives due to COVID-19. From healthcare workers and first responders working extra-long hours. A parent at home with children, struggling to keep them busy. Or those locked down at home binge watching shows day and night. It feels like the whole world has changed in the past few weeks.

These stresses can significantly impact the quality and duration of our sleep. Lack of sleep, whether from added stress or a significant change in your daily schedule, can have a severe impact on our physical and mental health at a time when we need to be our strongest.

According to the Centers for Disease Control and Prevention (CDC), 35.2 percent of adults in the United States are getting less than 7 hours of sleep each night. Experts recommend that adults aim for 7–9 hours of sleep a night. So, what can we do to try and improve our sleep quality during these troubled times?

It can be easy to lose sight of how changes in our daily habits influence our ability to sleep well. The concept of sleep hygiene focuses on how to use your habits and routines to your advantage when it comes to sleep. It also includes optimizing your sleep environment so that you can relax and rest easy when you turn in for the night.

  1. Stick to a sleep schedule with the same bedtime and wake up time.This helps to regulate your body’s clock and could help you fall asleep and stay asleep for the night.
  2. Exercise daily– even light exercise is better than no activity at all.
  3. Evaluate your room. Design your sleep environment to establish the conditions you need for sleep. Your bedroom should be cool. Your bedroom should also be free from any noise that can disturb your sleep. Consider using blackout curtains, eye shades, ear plugs, “white noise” machines, humidifiers, fans and other devices.
  4. Wind down and place a moratorium on TV and Social Media. Your body needs time to shift into sleep mode, so spend the last hour before bed doing a calming activity such as reading. Set a moratorium on news and social media each night. The constant stress of the world will only add to your stress level and keep your mind working overtime when you should be sleeping.
  5. Get some sunshine. It may seem counterintuitive, given our recommendation about the importance of sleeping in a dark room, but a daily dose of sunshine can actually help you sleep better. Our sleep-wake cycle is closely connected to our circadian rhythms. Your brain relies on sunshine during the day to recognize it’s time to be awake and alert. The more natural light you receive, the more your body stays in tune to the regular day-night rhythms, and your brain learns to associate the darkness that comes in the evening with falling asleep.
  6. If you can’t sleep, go into another room and do something relaxing until you feel tired. It is best to take work materials, computers and televisions out of the sleeping environment. Use your bed only for sleep and intimacy to strengthen the association between bed and sleep. If you associate a particular activity or item with anxiety about sleeping, omit it from your bedtime routine

Stress and sleep are closely linked. We hope that these trying times soon will pass. But if your sleep issues continue, it is important to see a sleep medicine professional to get a thorough evaluation to help identify the possible cause. Stay safe out there.

Coronavirus -How A Good Night’s Sleep Can Help You Fight Back

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Coronavirus -How A Good Night’s Sleep Can Help You Fight Back

Sleep is a natural immune booster. While lack of sleep or sleep deprivation, can adversely affect your immune system. Studies show that people who don’t get enough sleep are more likely to get sick after being exposed to a virus, such as a common cold, or the Coronavirus. Quality sleep can also affect how fast you recover if you do get sick.

A healthy immune system can fight off many infections. A sleep-deprived immune system doesn’t work as well. In one study, researchers found 164 men and women willing to be exposed to the cold virus. Not everyone became sick. But those who regularly slept less than six hours a night were 4.2 times more likely to catch the cold compared with those who got more than seven hours of sleep. Risk was even higher when a person slept less than five hours a night. Long-term lack of sleep also increases your risk of obesity, diabetes, and heart and cardiovascular disease.

So how much sleep do you need to bolster your immune system?

The optimal amount of sleep for most adults is seven to eight hours of quality sleep each night. Teenagers need nine to 10 hours of sleep. School-aged children may need 10 or more hours of sleep.

The coronavirus outbreak that has everyone searching for answers. Making sure we consistently get a good night’s sleep is one of the best ways we can improve our immunity and defend against viruses and disease.

If you are not getting quality sleep, or if you suspect you may have a sleep disorder, contact the team at Comprehensive Sleep Care Center at 703-729-3420 or visit our website www.comprehensivesleepcare.com. We have nine convenient locations located in the DMV.

 

 

 

Pediatric Sleep Disorders

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PEDIATRIC SLEEP DISORDERS

Up to 30% of children today have some type of sleep disorder. Pediatric sleep disorders can lead to tired and cranky children, but also to a number of behavioral problems at home, in school, and in their social lives as well.

SYMPTOMS

Signs and symptoms of sleep disorders in children might include:

  • Impulsiveness
  • Irritability
  • Difficulty focusing/concentrating
  • Hyperactivity
  • Snoring /gasping, pauses in breathing
  • Restless sleep
  • Nightmares / night terrors
  • Sleepwalking
  • Snorting, coughing or choking
  • Mouth breathing
  • Bed wetting (over the age of 5)
  • Unexplained decrease in daytime performance
  • Obesity
  • Grinding teeth during sleep
  • Trouble falling asleep due to leg discomfort

Infants and young children with obstructive sleep apnea don’t always snore. They might just have disturbed sleep.

Children who have sleep disorders may often exhibit symptoms (inattentiveness, over-activity, restlessness) similar to ADHD. Studies have suggested that as many as 25 percent of children diagnosed with attention-deficit hyperactivity disorder (ADHD) may actually have symptoms of obstructive sleep apnea and that much of their learning difficulty and behavior problems can be the consequence of chronic fragmented sleep. Bed-wetting, sleep-walking, retarded growth, other hormonal and metabolic problems, even failure to thrive can be related to a sleep disorder. Several recent studies show a strong association between pediatric sleep disorders and childhood obesity. Children exhibiting these symptoms or other behavioral problems should be carefully assessed by a pediatric sleep medicine specialist to assess their sleep problems.

American Acedemy of Pediatrics Guidelines

The American Academy of Pediatrics (AAP) guideline recommends that children who frequently snore should be tested for obstructive sleep apnea.  The clinical practice guideline “Diagnosis and Management of Childhood Obstructive Sleep Apnea” was published in the September 2012 issue of Pediatrics. The guideline recommends in-lab polysomnography for children with daytime learning problems, labored breathing during sleep and disturbed sleep with frequent gasps, snorts or pauses. The guidelines also call for children and adolescents to be screened for snoring as part of routine physician visits. The AAP recommends adenotonsillectomy as the first-line treatment for children with sleep apnea. Pediatricians may also recommend weight loss in obese patients or CPAP if surgery is ineffective or not conducted. 

Causes 

There are differences between pediatric obstructive sleep apnea and adult sleep apnea. While adults usually have daytime sleepiness, children are more likely to have behavioral problems. The underlying cause in adults is often obesity, while in children the most common underlying condition is enlargement of the adenoids and tonsils. However, obesity also plays a role in children. Other underlying factors can be craniofacial anomalies and neuromuscular disorders. Early diagnosis and treatment are important to prevent complications that can affect children’s growth, cognitive development and behavior.

DURING THE DAY, CHILDREN WITH SLEEP DISORDERS MIGHT:

  • Perform poorly in school
  • Have difficulty paying attention
  • Have learning problems
  • Have behavioral problems
  • Have poor weight gain
  • Be hyperactive

 MAKING A DIAGNOSIS

As in adults, a polysomnography (sleep study) is the only tool for a definitive diagnosis and assessment of the severity of pediatric obstructive sleep apnea. It needs to be conducted during an overnight stay in a sleep lab, with the test conducted by technologists experienced in working with children and the data interpreted by a sleep medicine physician with pediatric experience. In addition, since children’s sleep apnea is frequently most pronounced during REM sleep late in the sleep cycle, home sleep studies and daytime nap studies are not useful and can be misleading.

FINDING A SPECIALIST

Comprehensive Sleep Care Center offers expert diagnosis, treatment, and care for pediatric sleep disorders for children from the age of 2 months and up with the goal of providing a better night’s sleep and a better day ahead for the entire family.

If you suspect your child might have a sleep disorder, contact our physicians at Comprehensive Sleep Care Center. We have a team of pediatric sleep medicine specialists on staff and ready to help.

 

CPAP vs APAP

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CPAP vs APAP

WHAT IS THE DIFFERENCE?

CPAP = CONTINUOUS POSITIVE AIRWAY PRESSURE

AUTOPAP, AUTOCPAP, OR APAP = AUTOMATIC POSITIVE AIRWAY PRESSURE

CPAPA vs APAP? We get a lot of questions on this and there is a lot of confusing information out there. When patients are diagnosed with Obstructive Sleep Apnea (OSA), the long-standing gold standard of treatment is Continuous Positive Airway Pressure (CPAP).  For patients who cannot tolerate CPAP, the sleep medicine physician may try an Automatic Positive Airway Pressure or APAP.

The main difference between CPAP and APAP is how the air pressure is administered.

CPAP machines are set at a fixed pressure that is determined through an in-lab titration sleep study. The goal of an in-lab CPAP titration is to achieve a pressure setting where the patient demonstrates high-quality sleep, reduction in respiratory events by keeping the airway “propped” open while sleeping, and a consequent improvement in their circulating oxygen. An APAP, on the other hand, is given a range of pressures, rather than a single fixed pressure, and therefore has the ability to auto-adjust to the patient’s breathing. This option can be used when a patient’s recommended in-lab titration study is denied by the insurance carrier. Specifically, some CPAP machines available today include a new technology that allows the machine to change to a 30-day APAP mode. Once the 30 days are completed, the machine automatically selects a fixed pressure that is based upon the 90th percentile pressure administered to the patient through the machine during its APAP trial period. A dedicated APAP machine, however, may be more appropriate than a fixed CPAP for certain patients.

There is a lot of misleading information on the internet about CPAP vs APAP treatment.

It is important to note that much of the information is coming from the manufacturers of APAP machines and it may not be based on scientific research. Here at Comprehensive Sleep Care Center, we follow the guidelines of the American Academy of Sleep Medicine (AASM), not equipment manufacturers and distributors.

The below practice parameters are the most recent updates from the AASM regarding the use of auto-titrating positive airway pressure (APAP) devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome.

Continuous positive airway pressure (CPAP) at an effective setting verified by attended polysomnography {in-lab sleep study} is a standard treatment for obstructive sleep apnea (OSA). APAP devices change the treatment pressure based on feedback from various patient measures such as airflow, pressure fluctuations, or measures of airway resistance. These devices may aid in the pressure titration process, address possible changes in pressure requirements throughout a given night and from night to night, aid in treatment of OSA when attended CPAP titration {in-lab sleep study} has not or cannot be accomplished {insurance denial}, or to help improve patient comfort.

A task force of the Standards of Practice Committee of the American Academy of Sleep Medicine has reviewed the literature published since the 2002 practice parameter on the use of APAP.

CURRENT PAP RECOMMENDATIONS FOLLOW:

(1) APAP devices are not recommended to diagnose OSA

(2) patients with congestive heart failure, patients with significant lung disease such as chronic obstructive pulmonary disease; patients expected to have nocturnal arterial oxyhemoglobin desaturation due to conditions other than OSA (e.g., obesity hypoventilation syndrome); patients who do not snore (either naturally or as a result of palate surgery); and patients who have central sleep apnea syndromes are not currently candidates for APAP titration {sleep study}or treatment.

(3) APAP devices are not currently recommended for split-night titration {in-lab sleep study for OSA and if present the addition of PAP device to find appropriate settings}.

(4) certain APAP devices may be used during attended titration with polysomnography {in-lab sleep study} to identify a single pressure for use with standard CPAP for treatment of moderate to severe OSA.

(5) certain APAP devices may be initiated and used in the self-adjusting mode for unattended treatment of patients {at home use} with moderate to severe OSA without significant comorbidities {the simultaneous presence of two chronic diseases or conditions in a patient} (Congestive heart failure, COPD, central sleep apnea syndromes, or hypoventilation syndromes).

(6) certain APAP devices may be used in an unattended way to determine a fixed CPAP treatment pressure for patients with moderate to severe OSA without significant comorbidities (Congestive heart failure, COPD, central sleep apnea syndromes, or hypoventilation syndromes).

(7) patients being treated with fixed CPAP {set pressure} on the basis of APAP titration or being treated with APAP must have close clinical follow-up {follow up with sleep medicine office}to determine treatment effectiveness and safety.

(8) a re-evaluation and, if necessary, a standard attended CPAP titration study {in-lab sleep study} should be performed if symptoms do not resolve or the APAP treatment otherwise appears to lack efficacy.

https://aasm.org/resources/practiceparameters/pp_autotitrating.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225554/