#and waiting on a sleep study with a multiple sleep latency test

[chaoslynx]

ughhhhh I miss writing for you all so much!!!! I'll try to get back into it soon! Sorry I can't promise anything yet

[healthcarercmservices]

Prior Authorization Services for Sleep Medicine

Sleep medicine plays a critical role in diagnosing and treating disorders like sleep apnea, insomnia, restless leg syndrome, and narcolepsy. However, navigating the complex insurance landscape often becomes a significant barrier for providers. The need for timely diagnostic studies such as polysomnography, CPAP therapy, or home sleep tests often hinges on a frustrating and time-consuming approval process. That’s where prior authorization services for sleep medicine make a real impact.

Understanding the Prior Authorization Process in Sleep Medicine

Prior authorization is a requirement by many insurance payers before approving payment for certain sleep-related tests and treatments. This process is meant to control healthcare costs but often results in care delays, administrative headaches, and poor patient experiences. Providers must submit documentation that proves medical necessity, follow up with payers, and sometimes appeal denials.

Prior Authorization Services for Sleep Medicine help bridge this gap by managing the end-to-end process—ensuring accuracy, compliance, and faster approvals.

Why Sleep Medicine Requires Specialized Prior Authorization

Sleep medicine is a niche specialty that relies heavily on diagnostic testing and long-term therapeutic equipment like CPAP machines. Unfortunately, insurance companies treat many of these services as non-urgent, requiring detailed justification for approvals.

Common procedures that often need authorization include:

Polysomnography (PSG)

Multiple Sleep Latency Test (MSLT)

CPAP titration studies

CPAP/BiPAP equipment and supplies

Home sleep apnea testing (HSAT)

Given the unique nature of sleep studies, clinical documentation must be precise. Prior Authorization Services for Sleep Medicine specialize in understanding these nuances, ensuring accurate submissions and timely follow-ups with payers.

Benefits of Outsourcing Prior Authorization for Sleep Practices

Managing authorizations in-house can be overwhelming for front desk or billing staff already juggling multiple roles. By outsourcing to experts in Prior Authorization Services for Sleep Medicine, sleep clinics can:

Reduce delays in patient care by accelerating the approval process.

Improve approval rates through accurate documentation and timely submission.

Free up staff time for patient-facing tasks and clinical work.

Stay compliant with ever-changing payer guidelines.

Enhance patient satisfaction by avoiding frustrating scheduling delays.

With professionals handling prior auths, practices can expect faster turnaround, reduced denials, and a more predictable workflow.

The Practolytics Advantage

At Practolytics, we provide specialized Prior Authorization Services for Sleep Medicine tailored to meet the unique needs of sleep specialists. Our experienced team understands the coding, documentation, and payer policies related to sleep studies and therapies.

Here’s what sets us apart:

Dedicated prior auth experts trained in sleep medicine billing and payer guidelines.

Real-time tracking and status updates for all authorizations.

Integrated advancedmd EHR and medical billing systems for seamless data exchange.

Appeal support for denied or delayed claims.

Compliance-driven workflows to ensure accuracy and prevent costly mistakes.

Our goal is to reduce your administrative burden while improving your practice’s operational efficiency.

How the Process Works

Case Intake: We collect all necessary patient and clinical data via your EHR or secure portal.

Payer Verification: Our team verifies the insurance requirements and identifies if prior authorization is needed.

Documentation Preparation: We compile clinical notes, sleep study recommendations, and previous treatments to prove medical necessity.

Submission: Authorizations are submitted through the payer's preferred method—online portal, fax, or phone.

Follow-up: We follow up rigorously until a decision is obtained, often reducing wait times significantly.

Communication: You’re updated at every step—approval, denial, or need for additional info.

Common Challenges in Sleep Medicine Authorizations

Despite advancements in digital healthcare, sleep clinics still face several hurdles when it comes to prior authorizations:

Frequent denials due to insufficient documentation.

Delays in sleep study approvals that prolong diagnosis.

Miscommunications between payers and providers.

Lack of dedicated staff to track and manage pending authorizations.

Payer-specific policies that vary widely by plan and region.

Prior Authorization Services for Sleep Medicine are specifically designed to handle these pain points efficiently.

Impact on Patient Care

Timely access to diagnostic studies and therapy is critical in sleep medicine. A delay in initiating CPAP therapy for obstructive sleep apnea can lead to worsening symptoms, reduced productivity, cardiovascular risk, and poor quality of life.

By outsourcing Prior Authorization Services for Sleep Medicine, practices can ensure that patients begin treatment sooner—leading to better outcomes, higher satisfaction, and improved compliance with follow-up care.

Final Thoughts

In today’s fast-paced and heavily regulated healthcare environment, efficient prior authorization isn’t optional—it’s essential. For sleep specialists, this process can mean the difference between early diagnosis and prolonged suffering.

Investing in professional Prior Authorization Services for Sleep Medicine empowers your practice to focus on clinical excellence while administrative experts manage the payer hurdles. At Practolytics, we’re committed to helping sleep clinics reduce delays, cut through red tape, and deliver the timely care their patients deserve.

[ellymackay]

How Machine Learning Could Transform the Way We Diagnose Narcolepsy

How Machine Learning Could Transform the Way We Diagnose Narcolepsy See more on: www.ellymackay.com

Researchers at Virtual SLEEP 2020 explained machine learning’s potential in sleep medicine.

By Lisa Spear

Even under the care of a sleep medicine clinician, narcolepsy patients may have a long wait before receiving a correct diagnosis. Researchers think that machine learning and the use of neural network analysis could speed up the diagnostic process, and pave the way for more precise care.

“Within the next few years, sleep scoring by technician will be replaced by automatic deep learning networks that will automatically annotate the sleep study and the task of the technician or doctor will only be to verify the event,” sleep scientist Emmanuel Mignot, MD, director of the Stanford Center for Narcolepsy, said during a presentation.

During Virtual SLEEP 2020, Mignot and a panel of other experts spoke about the future of artificial intelligence and machine learning in sleep medicine.

The panel discussed how these tools could potentially improve treatment for countless patients, lead to the use of phenotyping for diagnosing obstructive sleep apnea, and speed up the diagnostic process for those who experience narcolepsy with cataplexy, also known as type 1 narcolepsy.

By using statistical methods to find features unique to narcolepsy type 1, including a short REM latency period, researchers can build machine learning systems to help diagnose the disorder, Mignot explained. In the future, he said, all narcolepsy type 1 cases will be able to be detected remotely, from the patient’s home, over the course of a few days.

“We believe that this will be applied soon, where you will be able to wear a simplified device that you will wear at home for an entire weekend. Then, maybe you will have a blood test, combined with a deep learning algorithm, and that will get a beautiful diagnosis for narcolepsy.”

[RELATED: Linking Narcolepsy to the Flu? Researchers Make Progress Identifying Molecular Mimicry]

During his presentation, Mignot spoke about how he and his Stanford team have been working on creating machine learning systems to pinpoint narcolepsy type 1 cases. According to work presented during SLEEP, his team has demonstrated that using deep learning with polysomnography (PSG) could help clinicians bypass the multiple sleep latency test (MSLT), while producing an accurate diagnosis.

The team created a score for a sample of PSG recordings to reflect how close the recordings are to narcolepsy type 1 patterns. “The model generalized remarkably and had a high predictability for diagnosing narcolepsy,” said Mignot, professor of psychiatry and behavioral science at Stanford University.

Machine learning, the researchers said, can analyze large swaths of data without human bias. By applying machine learning and analyzing the data further during nocturnal PSG in narcolepsy type 1, clinicians could raise the specificity of detecting different sleep stages and transitions, Mignot said.

Another advantage is the ability of machine learning to score very brief periods of time. Instead of the 30-second epoch, which is typically scored by a human technician, machine learning can score up to a 5-second window, said Mignot, who is leading a sleep analytics project called the Stanford Technology Analytics and Genomics of Sleep (STAGES).

“Similarly, also you can compare the performance of the machine learning network to each technician. What you can show, in fact, is that the machine learning routine is closer to the consensus of all technicians than any single technician. In summary, machine learning is doing better than any single technician at recognizing all the sleep stages,” Mignot explained. “It has a superior performance.”

[RELATED: How Does Cataplexy Change Over Time?]

While it is known that narcolepsy with cataplexy is caused by a hypocretin deficiency, measuring hypocretin requires a lumbar puncture, an invasive procedure that is unpleasant for patients and not commonly used as a sleep medicine diagnostic tool.

Typically, diagnosis instead involves an overnight stay for an in-lab p PSG, followed by a daytime MSLT. The MSLT measures excessive daytime sleepiness by asking patients to nap 4 to 5 times for 20 minutes every 2 hours during the day. During these naps, sleep latency and the presence of REM sleep are observed.

Unfortunately, the MSLT can produce both false positive and false negative results, says Mignot.

“The fact that the MSLT is not a perfect test for narcolepsy, and the fact that it takes quite awhile for the MSLT, PSG to be conducted, during the night and then during the day, led us to believe that there might be a better way to analyze the data of a patient with narcolepsy and maybe diagnose narcolepsy with only one night of sleep using machine learning,” Mignot said.

Another flaw in the current diagnostic process for detecting narcolepsy type 1 is using the observation of cataplexy as diagnostic criteria.

“The problem with cataplexy is that it is subjective, so it cannot be 100% certain as a predictor,”  Mignot said.

Cataplexy is also not present in all cases of hypocretin deficiency, said Nathaniel Watson, MD, MSc, director of the Harborview Sleep Clinic and co-director of the University of Washington Medicine Sleep Center in Seattle, during the Virtual SLEEP 2020 session.

Watson explained that machine learning systems “could save time and increase the probability of diagnosing patients in sleep clinics.”

Lisa Spear is associate editor of Sleep Review.

from Sleep Review https://www.sleepreviewmag.com/sleep-disorders/hypersomnias/narcolepsy/machine-learning-diagnose-narcolepsy/

from Elly Mackay - Feed https://www.ellymackay.com/2020/09/14/how-machine-learning-could-transform-the-way-we-diagnose-narcolepsy/

[snoringhq]

Why Do Sleep Psychologists Study Snoring?

For most people, sleep is associated with mental, emotional, and physical relaxation and replenishment. During sleep, the brain and body relax to allow sleep processes to occur. Typically, this physical relaxation includes the muscles of the throat to permit the flow of air into the lungs during sleep. However, some people have a narrower passage, and this can result in snoring and labored breathing.

Snoring and other problems that interfere with sleep are of interest to Sleep Psychologists. They want to know more about these problems and how to treat them. Read on to learn more about Sleep Psychologists and how to stop snoring.

What is a Sleep Psychologist?

Sleep Psychologists are specially trained to understand sleep and treat sleep disorders. They have training in normal sleep, sleep physiology, sleep cycles, sleep regulation, sleep changes that occur with age, sleep deprivation, the effects of sleep medications on the brain, assessments of sleep, and treatments for sleep disorders.

Sleep Psychologists are trained to use many different tests to assess and diagnose problems. They also work in a variety of settings including educational, residential, and private practice, as well as medical and mental health centers.

What do Sleep Psychologists do?

Sleep Psychologists integrate psychological research and science with applied practice to understand and improve sleep. They are concerned with the behavioral, psychological, and physiological factors that lead to normal sleep and those factors that cause sleep problems. They study sleep and sleep disorders, to evaluate the problems and develop treatments.

Why is Sleep So Important?

Sleep is essential for physical and mental health. While you are sleeping, your body rests and restores. This supports physical health and brain functioning. During sleep, our brains go through stages and cycles. Each is important, and we need a certain amount of sleep regularly to maintain physical and mental functioning.

Without regular and adequate sleep, you will have a sleep deficiency. Many body systems can start to malfunction. Lack of sleep can lead to many problems, a few examples include—hormonal imbalance, elevated blood sugar levels, and impaired immune system. Over time, you may become so sleep deprived you have micro-sleeps.

A micro-sleep is when you briefly fall asleep. It can happen anytime, anywhere, even while driving. Sleep Psychologists want to prevent these sorts of problems.

Why Study Sleep Disorders?

These researchers are concerned with sleep and sleep disorders for three reasons. First, they want to know what might be happening in the human brain to cause these disorders. Second, they want to know how these conditions might affect mental functioning. Third, they want to know how to help treat these disorders.

Sleep Psychologists study disorders, including snoring, because of the negative effects they can have on people’s mental and physical health.

What Sleep Disorders do Psychologists Study?

Sleep Psychologists study many different sleep disorders including insomnia, narcolepsy, sleep cycle disorders, nightmares, sleep walking, sleep terrors, and nighttime teeth grinding.

They also study disorders that cause snoring and/or problems with breathing during sleep, such as sleep apnea. Currently, sleep apnea is one of the most active areas for sleep research. Many key agencies and funding sources work with Sleep Psychologists to study sleep apnea. Some of these disorders come in pairs, which are even worse. One example of that occurring is with insomnia.

What is Insomnia and How is it Treated?

People with insomnia have great difficulty falling asleep. Psychologists are concerned with ensuring people get adequate sleep because it is necessary for healthy functioning. Insomnia is one disorder that can negatively affect people’s quantity and quality of sleep. This is further compounded by problems with snoring or sleep apnea.

Sleep Psychologists often use Cognitive Behavioral Therapy approaches to help people with insomnia. These approaches often help people achieve long-term results as they can fall asleep more quickly and stay asleep longer.

Cognitive Behavioral Therapy helps in two ways. First, it addresses people’s false beliefs and misconceptions about sleep. These can include unrealistic expectations that might put too much pressure on you and make it harder to fall asleep. Reducing these thoughts relieves the pressure you might put on yourself to fall asleep.

Second, the behavioral components change how you interact with your bed. The idea is to maintain a regular sleep schedule (no napping). Then, only use the bed for sleep (in other words, do not eat, read, or watch television in bed). It is important to wait to go to bed until you are tired. If you are unable to fall asleep within 20 minutes, get up and leave the bed until you feel tired.

What is Sleep Apnea Disorder?

Another disorder that can disrupt the quality of sleep is sleep apnea. This disorder involves impaired breathing. Two factors can disrupt normal breathing during sleep. One is when the airway is physically obstructed. Another is when an area of the brain that controls breathing does not correctly signal the muscles (called Central Sleep Apnea).

When breathing is disrupted, the brain will signal the body to automatically restart the process. Often, this can happen outside of conscious awareness. However, these stops and starts cause a physical toll. Often, people with sleep apnea will experience daytime fatigue and early morning headaches. In some cases, sleep apnea can cause high blood pressure, heart attacks, and strokes. In this way, it can lead to premature death.

Those who experience sleep apnea will typically exhibit snoring (luckily not everyone who snores has sleep apnea, but if you do snore and feel fatigued, you may want to be checked for it). The sleep apnea events are often associated with choking sensations.

Sleep apnea can have a big impact on mental functioning due to disrupted sleep patterns. Lack of quality sleep causes sleepiness, lethargy, headaches, attention problems, memory loss, poor judgment, and other personality changes, including depression and anxiety. Some individuals may also show symptoms of hyperactivity or unusual automated behaviors.

Sleep apnea can have a negative effect on work and school functioning, as well as on relationships. Spouses or significant others may be kept awake by the snoring and noises. Coworkers and friends may notice a change in the person. Sleep Psychologists want to help prevent these negative effects on mental functioning and quality of life.

How is Sleep Apnea Diagnosed?

When you exhibit sleep problems, a doctor may refer you to a specialized sleep center. You might work with neurologists, pulmonologists, and other doctors with special training to work with sleep disorders. You might be asked to do a sleep study at home, or you may be asked to sleep at a sleep center for an evaluation.

Diagnosis of sleep apnea is difficult because of the different causes. Multiple tests might be needed to clarify the problem. At a sleep center, you may be connected to testing equipment. One test for sleep apnea is polysomnography. This test can record brain waves, heart rate, breathing, and blood oxygen.

Another test is the Multiple Sleep Latency Test (MSLT), which measures how fast you fall asleep. Patients are given opportunities to fall asleep during the day and the time to sleep is measured. Most people usually take 10-20 minutes to fall asleep (because they are not very tired). People with sleep disorders usually fall asleep in less than five minutes (because they are so sleep deprived).

What are the Treatments for Sleep Apnea?

When sleep apnea is diagnosed, there are multiple treatments that may be prescribed, depending on the severity of the condition and your situation. It is not recommended to use any sleeping medication because those can reduce the body’s natural reflex of waking to restart breathing. Nose strips are also not very helpful.

The goal of treatment is to open the airway and keep it open during sleep. This will prevent sleep apnea episodes. Specific treatments are selected based on the severity of the sleep apnea and the person’s circumstances (such as medical history). For example, for individuals with nasal congestion, a decongestant might be prescribed.

Doctors may initially treat sleep apnea with prescribed behavioral changes. This might include also stopping drinking and smoking because these can contribute to airway collapse. Sometimes these behavioral changes are enough to reduce sleep apnea.

Someone with mild sleep apnea, who is overweight may be asked to lose weight. Research has shown that a 10% weight loss can reduce sleep apnea for most patients. For some people, weight loss and sleep positions are not enough to reduce sleep apnea.

Some individuals may be asked to have surgery to correct anatomical problems. Surgery options may include removal of the adenoids, tonsils, nasal polyps, or other growths that should not be in the airway. It could mean correcting other structural deformities. These surgeries are typically more helpful for young people. Some surgeries will reduce the snoring sounds, but they will not reduce the sleep apnea.

Some patients will benefit from oxygen administration. However, this does not eliminate the sleep apnea or prevent some of the other associated concerns. Some patients may not respond to this treatment well. So, the use of oxygen is debated.

Some patients may be asked to avoid sleeping on their back. You may be asked to take steps to prevent this. For example, special pillows can help.

As noted, some sleep apnea cases are caused by obstruction such as too much relaxation in the throat, tongue, uvula, and roof of the mouth. In some cases, these obstructions can be reduced with devices such as CPAP or EPAP machines.

What Pillows Help Sleep Apnea?

If you are struggling with sleep apnea and your doctor recommends that you avoid sleeping on your back, you can invest in an anti-snoring pillow to help. A good pillow will keep you off your back, support side sleep, support the position of your head for optimal air flow, and some pillows can even prevent too much relaxation in your throat muscles, which will alleviate the symptoms of sleep apnea.

One good option is the Nitetronic goodnite™ Anti-Snoring Pillow. This pillow does more than just help with your body position. It also monitors breathing sounds. The pillow can detect any snoring and will inflate/deflate to gently move your head. This will stimulate the throat muscles and reduce snoring. It also communicates with apps through Bluetooth to provide data on your sleep and help reduce your snoring.

Another good option is the Smart Nora Pillow. Some people may enjoy this option because you can use it with your own pillow. It also communicates with the Pebble device to detect snoring sounds. The Smart Nora Pillow then inflates and deflates throughout the night to change your head position and reduce snoring. One drawback is this pillow requires more equipment to manage when compared to the Nitetronic.

Another good option are u-shaped pillows. These pillows are great for people who do not usually sleep on your side. The design helps to keep you in a side sleeping position. The u-shape will support your head and neck while you sleep on your side. The curved part of the pillow helps to reduce weight off your shoulders and neck.

Contour pillows are also a good option for people with sleep apnea. These pillows have a wave design that supports the back of your neck while holding your head in place. This prevents the head from tilting forward and keeps the airway free from obstruction. In general, they support good body posture.

How are CPAP and EPAP Used for Sleep Apnea?

Some serious cases of sleep apnea require treatment with continuous positive airway pressure (CPAP). A Nasal CPAP is one such device. It uses a mask and pump that work together to keep the airway open. If you use a CPAP machine, CPAP pillows will also be helpful. These help with posture and are designed for use with the CPAP Machines.

EPAP or Expiratory Positive Airway Pressure is a newer method to reduce snoring and sleep apnea. With this device, pressure is created while exhaling. This pressure then stabilizes the upper airway and snoring is reduced with your own breathing. Currently, the only FDA-approved EPAP device is Theravent.

Sleep Apnea Prognosis

The prognosis for sleep apnea varies. For some people, eliminating the obstruction reverses the problem and any associated side effects (such as high blood pressure). Some people need ongoing treatment with special devices. If you fall into this group, you will need to incorporate these into your lifestyle and sleep routine.

Conclusion

If you experience a sleep problem, such as snoring and/or sleep apnea, it can be more than an inconvenience. It can have a negative effect on your functioning, disrupting your mental and physical health. It can even be dangerous. Sleep Psychologists study sleep problems, including sleep apnea and snoring. They research ways to diagnose and treat sleep problems, to improve your quality of sleep and quality of life.

Do not let your sleep problems, such as snoring or sleep apnea, go untreated. If you have one or more of these conditions, visit a Sleep Psychologist and see what they recommend. If they recommend snoring aids or other snoring solutions as part of your treatment, you can easily purchase those items and build your treatment regimen.

The post Why Do Sleep Psychologists Study Snoring? appeared first on Snoring HQ.

[ellymackay]

What Measures Are Sleep Lab Implementing Before Reopening?

What Measures Are Sleep Lab Implementing Before Reopening? was initially published on Elly Mackay's Blog

A sleep lab manager shares how his center is navigating the difficulties of testing and treating patients for sleep disorders during a pandemic.

By Henry L. Johns, RPSGT, CRT, CPFT

We have all been faced with a challenge we never thought we would see. After an almost three-month shutdown, how do we safely reopen our sleep labs in the middle of a pandemic? No matter if you have a hospital-based or freestanding sleep lab, the challenge is the same: What do we need to consider for reopening, and most importantly, to maintain the trust of our patients and communities?

SARS CoV-2 is a highly contagious disease that primarily causes respiratory distress. It is easily spread by airborne droplets from a cough or forced exhalation. Since the use of CPAP could possibly produce a steady stream of exhaled particles, we must take precautions for the safety of patients and staff.

Here is what I tried to consider when the time came to reopen our lab.

Updating the Bedrooms

Best practice is to use negative airflow rooms, also called isolation rooms. But most sleep labs do not have this capability or even an HVAC (heating, ventilation, and air conditioning) system robust enough to exchange air as often as recommended. According to the Environmental Protection Agency, evidence is growing that this virus can remain airborne for longer times than previously speculated and travel distances of more than 6 feet.1 A study published by the Centers of Disease Control and Prevention (CDC) in July 2020 reports that numerous cases of COVID-19 occurred in Guangzhou, China, in February 2020 due to droplet transmission through the building’s air conditioning system.2 This is also suspected in the Diamond Princess cruise ship cases.3

We considered converting some, or all, of our bedrooms to negative airflow; however, we quickly discovered it would be cost-prohibitive. What’s more, the negative flow units we researched were extremely noisy—and would not lend themselves to letting patients sleep. Our building’s HVAC system does not allow for any additional air exchange with the outside or additional filtration behind the hospital-grade filters that were already in place. Since our lab has 4 bedrooms and would be using no more than 2 per night, we have opted to rotate rooms to allow for the time needed by the HVAC system to exchange the air in the room several times.

Recommendations for room air exchange to help reduce transmission of the virus include:

increase ventilation with outdoor air and increase air filtration measures (this is sometimes difficult in commercial buildings);

use portable air cleaners with high efficiency particular air (HEPA) filters to supplement increased HVAC system ventilation and filtration;

direct airflow so it does not blow directly from one person to another (many sleep labs use fans for patient comfort and should review their use and location of them); and

rotate room use to allow at least 24 hours of down time between uses.

Protecting Staff & Patients

Another important consideration to reopening is the anxiety of patients and staff about COVID-19 transmission. We have all been under a lot of stress over the past few months. It is especially important to try to reduce any fears people have when they come into the lab. A high percentage of our patients (and in some cases, staff) are in high-risk categories due to age or comorbidities. Careful screening is an important factor, along with access to COVID-19 testing.

[RELATED: What’s Next for Sleep Disorders Centers?]

Since PAP will most likely be used during the night, it is helpful to have patients self -quarantine before their scheduled sleep studies, and I would strongly urge you to consider COVID-19 testing for patients (no more than 72 hours prior to the sleep study). Patients who test positive for the virus should have their sleep studies postponed.

Staff should use standard personal protective equipment (PPE), including masks and face shields, during sleep study equipment hook up. If the patient has not had a COVID-19 test or there is a chance of exposure, the staff should use full PPE, which means an N-95 mask, face shield, gown, and gloves. Donning and doffing PPE should take place outside of the patient room.

Our staff members use N-95 masks three nights in a row (unless soiled), covering the N-95 with a surgical mask (which is discarded after each shift) to help protect it. Each week, the N-95s are sent for reprocessing and returned to the lab. So far, it has not been necessary to use the reprocessed masks. Face shields are always worn when working directly with the patient. Gowns are only used if there is a COVID-19 presumptive positive due to symptoms or for staff comfort.

We use a supply system that requires staff members to log in for access. It allows for more accurate tracking of PPE usage. With PPE in short supply in many areas, strict monitoring may be necessary to conserve your supply.

Additionally, because of the possibility of inadvertent spread of virus, sleep testing should be limited to one-on-one care. This is not the most cost-effective practice for a lab, but it may be the safest option during the pandemic. As part of our reopening plan, our lab is functioning at 50% capacity until December. Hospital-based labs and labs with an associated durable medical equipment arm may find this easier financially than an independent lab that depends on a higher review stream. In many cases, Centers for Medicare & Medicaid Services (CMS) reimbursement covers sleep lab space, equipment, supplies, and staff, but leaves little or no margin.

Our lab is fortunate to have a top-notch environmental care (housekeeping) crew. The bedrooms are cleaned thoroughly each day and allowed to remain dormant for a night before the next use. We have shifted all daytime testing and multiple sleep latency testing (MSLTs) to days without nighttime use since we are not currently sleep testing 7 nights/week.

To summarize, precautions to protect patients and staff include:

telling patients to self-quarantine and requiring a negative COVID-19 test result within 72 hours of a sleep study;

screening patients and staff upon arrival each day, using a no-touch thermometer to check temperatures and asking if they are experiencing common symptoms such as cough, shortness of breath, flu-like symptoms, loss of taste or smell, body aches, nausea, fatigue, or headache;

using disposable PSG sensors, belts, and electrodes (almost 90% of our lab’s are disposable);.

terminally cleaning bedrooms each day (your housekeeping staff are important team members);

and extending wait times between room uses to allow ventilation.

What About CPAP?

The risk of a PAP generator blowing a continuous stream of virus-laden particles into the air is frightening. Although there are no COVID-19-specific cleaning recommendations for PAP devices for, the best we can and should continue to do is to follow the manufacturers’ recommendations for cleaning.

In our lab, we wondered about the air intake on the device and the possibility of the blower becoming contaminated, as well as possibly entraining virus and sending it straight into the patient.

[RELATED: How Is the Coronavirus Impacting Sleep Medicine Professionals?]

To help reduce risk, workable measures include:

replacing intake filters with HEPA filters (we cut material from an N-95 mask to fit the intake opening, which is changed between patients; although not perfect, it is better than no inlet filer at all);

discontinue the use of humidifiers (this was done because of the use of bacteria/viral filters);

using bacteria/viral filters on the circuit;

using disposable tubing and interfaces.

Increased Role of Home Sleep Testing

Home sleep tests (HST) have taken on a more important role since in-lab testing has been reduced due to the pandemic. In our lab, about a third of patients qualify for HST each week. We use standard inclusion criteria, with some additional exclusion criteria tailored to our patient population.

We handle instruction in person, although many labs have existing mail-out programs that allow for remote instruction and contact-free device delivery. The biggest challenge for HST is how to handle and clean the equipment. Again, we use disposables as much as possible. The unit is then cleaned using a viricidal wipe and allowed to remain idle for 24 hours. [Editor’s Note: The American Academy of Sleep Medicine recommends at least 72 hours of idle time between uses.4]

Practices to lower risks of virus spread via home sleep testing include:

using disposable belts and sensors;

disinfecting per manufacturers’ recommendations;

ensuring at least 24 hours of idle time after disinfection before the next use;

use of autoPAP where applicable for HST patients with obstructive sleep apnea (our lab brings in severe OSA cases for a full titration).

Also, some vendors are now offering totally or mostly disposable HST equipment now.

Take Home Messages

Henry L. Johns, RPSGT, CRT, CPFT

There is no perfect way to navigate the times we are in, but we can make things as safe as possible by instituting a few measures. Check in with your staff often to find out what works and what does not. Keep up with the latest from the CDC and state health agencies. Air exchange and filters in rooms, screening for symptoms, and COVID-19 testing are all part of a wider strategy that includes social distancing, masks, handwashing, and surface disinfection. We all hope that within the next 12 months an effective vaccine will be developed. The combined strategy of in-lab PSG and HST may help many labs survive. As we learn more, we are better able to respond to our new normal.

Henry L. Johns, RPSGT, CRT, CPFT, is a supervisory program specialist at the US Department of Veterans Affairs’ Eastern Kansas Health System.

References

hUnited States Environmental Protection Agency. Indoor Air and Coronavirus (COVID-19). 16 July 2020. Available at www.epa.gov/coronavirus/indoor-air-and-coronavirus-covid-19

Moses FW, Gonzalez-Rothi R, Schmidt G. COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerging Infectious Diseases. 2020;26(9):2298.

Correia G, Rodrigues L, Gameiro da Silva M, Gonçalves T. Airborne route and bad use of ventilation systems as non-negligible factors in SARS-CoV-2 transmission. Med Hypotheses. 2020 Aug;141:109781. Epub 2020 Apr 25.

American Academy of Sleep Medicine. Considerations for the practice of sleep medicine during COVID-19. 27 Aug 2020. Available at aasm.org/covid-19-resources/considerations-practice-sleep-medicine

Photo 178948729 © Frank Armstrong – Dreamstime.com

from Sleep Review https://www.sleepreviewmag.com/sleep-diagnostics/in-lab-tests/measures-sleep-lab-reopening/

from Elly Mackay - Feed https://www.ellymackay.com/2020/09/01/what-measures-are-sleep-lab-implementing-before-reopening/

[ellymackay]

What’s Next for Sleep Disorders Centers?

The post What’s Next for Sleep Disorders Centers? was originally published to https://www.ellymackay.com

Even as the United States reopens, it’s not just exposure to COVID-19 that sleep professionals need to worry about. With sharp increases in unemployment and many facilities seeing drops in revenue, the road ahead for sleep labs is likely to look different than what has been traveled before.

By Yoona Ha

To learn about how the landscape of sleep medicine might change, Sleep Review interviewed a dozen business owners and clinicians on what the new normal in sleep will feel like. What trends are here to stay? How will infection control practices grow and develop? Who’s left out of treatment? Which innovations will stick around post-pandemic?

Sure, the pandemic may be unprecedented, but there are patterns in how the sleep industry is responding that gives us hints to what to look out for when the virus subsides.

A Future of Digitally-Enabled Care

Even long-time advocates of telemedicine didn’t foresee that the explosion of sleep medicine practice over the Internet would happen so suddenly.

“Part of me feels like people have been almost forced into adapting telemedicine before they were ready, but then the other part of me feels like people were extremely ready for this change,” says Seema Khosla, MD, FCCP, FAASM, medical director of the North Dakota Center for Sleep, who has offered virtual visits for more than a decade.

A COVID-19 impact study conducted by artificial intelligence-powered diagnostics company EnsoData found that 64% of sleep center interviewees are using telehealth platforms during the pandemic. Uses include video and phone appointments, diagnostic evaluations, treatment discussions, and CPAP education. “Forward-thinking sleep centers may focus on sustainable changes to the gross proportions of at-home versus in-clinic care in a post-COVID-19 world,” the study notes, which may signal a new era for digitally-enabled care.1

Khosla, for one, talked about her mother, a primary care physician who had never imagined video chatting being a replacement for in-person visits.

“It’s not uncommon for providers needing to acclimate to tech-enabled solutions, but what’s interesting is that I’ve seen people like my mother start from a place of having trouble with telemedicine platforms getting better at it,” Khosla says. She has even seen her mother’s personal calls improve. “I used to stare at her ceiling a lot during video calls, but now her experience with telemedicine has translated into better Facetime sessions,” she says.

Long-term, Khosla anticipates providers will continue to leverage telehealth while also addressing gray areas. For example, they may direct patients on how to aim a phone camera to show the back of the throat.

Kholsa recommends setting up multiple telemedicine platforms in case technical glitches emerge on one. “Technology is supposed to improve our healthcare experience and sometimes we tend to get ahead of ourselves and forget that it’s the human behind these platforms that can be transformative for the patient,” she says.

Video visits have also proved to be transformative for some clinicians, particularly those who are caregivers for young children or older relatives.

Of course, in-person alternatives depend on clinical discretion. “Initiating therapy based on clinical judgment requires excellent follow-up to ascertain the effectiveness of therapy; this is possible using telemedicine, but triage is needed to ensure that patients are seen in a timely manner,” says Shannon Sullivan, MD, vice chair of the American Academy of Sleep Medicine (AASM) Public Safety Committee and medical director of the EVAL Research Institute in Palo Alto, Calif. “In addition, in many cases when labs are reopened, it will be important for clinicians to consider completing missing elements of the workup. A silver lining in all of this is that sleep physicians may, in some cases, welcome the opportunity to do what they do best—practicing sleep medicine based on their expertise and experience rather than checking the boxes of payer requirements, which may at times be overwrought.”

But still, given that insurance coverage for ongoing care in a post-pandemic world is not yet defined, it’s hard to predict how coverage for telemedicine will continue to evolve.

Is the Surge in Home Sleep Testing Here to Stay?

[RELATED: “Unprecedented Demand”: Sleep Medicine Scales Its Remote Offerings]

Pre-COVID volumes were 70% in-lab and 30% home sleep testing (HST), according to EnsoData’s survey, which found this in-lab to home testing ratio flipped during the pandemic.1

“It’s a big question—whether we’ll see the reversal of the prevalence of HSTs versus in-lab sleep studies continue after the pandemic,” says Chris Fernandez, EnsoData co-founder and CEO. “But I do think that the trends we see in sleep medicine—increases in HSTs and the accelerations we’ve seen in telemedicine—won’t go away post-COVID. We believe that sleep providers with a bias towards action and a care delivery model that enables them to shift gears when they need it will be the most resilient during and after a pandemic because this won’t be the last outbreak we’ll ever see.”

Indira Gurubhagavatula, MD, MPH, chair of the AASM Public Safety Committee and associate professor in the Perelman School of Medicine at the University of Pennsylvania, says sleep medicine has long been poised to adapt to telemedicine approaches. “Our primary diagnostic and therapeutic data, which comes from sleep studies and positive airway pressure devices, can be accessed electronically by leveraging remote, cloud-based networks without relying on smart cards and face-to-face appointments to retrieve data,” Gurubhagavatula says.

Ingvar Hjalmarsson, chief product officer of sleep diagnostics company Nox Medical, says Nox has helped patients on lengthy waiting lists gain access to OSA treatment through a “rental relief” program, which provides sleep centers short-term device rentals until they are able to reduce waits to manageable levels.

“We believe that our innovations are a great fit for the opportunities that the post-COVID-world introduces,” Hjalmarsson says, adding that its new dual PSG-HST device provides sleep professionals with more flexibility on study location.

“The trends we see in sleep medicine—increases in HSTs and the accelerations we’ve seen in telemedicine—won’t go away post-COVID”

Chris Fernandez, EnsoData

Businesses that offer HST logistics have been popular.

“Our focus is on figuring out what sleep centers need, and we’ve identified pain points in the logistics: mailing, keeping track of monitors and supplies, scheduling studies, just to name a few,” says Hani Kayyali, CEO of CleveMed, which offers a mail-order service. “What health systems are finding out are the financial benefits of streamlining HST offerings. Some of the health systems we work with have doubled or tripled their volume of patients with existing staff, and that’s probably one area that’s become more obvious since the pandemic.”

Some HST providers who relied on in-person patient training or a classroom model could not continue to provide services during the pandemic, says sleep physician Dominic A. Munafo, MD, FABSM, chief medical officer of BetterNight, which offers sleep telehealth screenings, in-home testing, and remote initiation of PAP and insomnia therapies. “The ability to provide diagnostic and therapy services safely was the primary concern,” Munafo says. “Our existing protocols for sanitizing diagnostic recorders and offering ‘no-touch’ PAP setups were quite reassuring to new clients. Also, the use of disposable sleep recorders [Itamar WatchPAT ONE] was a vital tool to reassure both patients and doctors.”

Southern Sleep Society manager Marietta Bibbs, BA, RPSGT, CCSH, FAAST, says it makes sense for providers to shop around for better deals and partner with companies that provide leasing or renting options. “With the focus on infection prevention, the only place to really manage budgets is to manage staff like decreasing overtime, shorter work shifts, and making sure that night technologists score their sleep studies so that day staff can concentrate on patient follow-up and other accreditation requirements,” Bibbs says.

Advice for Resuming Operations

Managers also have to navigate how to protect staff and patients from potential exposure to coronavirus.

“Increasing telehealth availability, and all the coordination, staff training, hardware and software adaptations, and patient education this entails, is one arena,” says Sullivan, clinical associate professor of psychiatry and behavioral sciences at Stanford University. “In a field reliant on lab testing for complex respiratory disorders, hypersomnias, and some types of parasomnias, figuring out how to safely reopen has become essential.”

Since home sleep studies are only indicated for patients with a high pretest probability of sleep apnea, people who have symptoms of other sleep disorders have in many cases been waiting extra months for their diagnosis.

“Polysomnography and/or MSLT [multiple sleep latency test] are indicated in the work-up of non-respiratory sleep disorders as well, so I think there are burgeoning, unmet needs among all sorts of patients right now,” Sullivan says.

Challenges for sleep practices, according to Sullivan, include staff retention, procurement of personal protective equipment (PPE), cleaning services, altered staff-to-patient-ratios, and altered reimbursement profiles. Sleep labs may also face productivity reductions from keeping equipment out of service, reducing patient flow to minimize contact, deploying triage strategies, and addressing cancellations.

“There isn’t a one-size-fits-all approach to tackling this long list of concerns, but instead providers should continue to remain agile and creative in addressing these challenges for the foreseeable future,” Sullivan says.

Even before the pandemic, insomnia resources were inadequate to meet patient needs, says BetterNight’s Munafo. “With the advent of COVID, there has undoubtedly been an uptick in insomnia complaints,” Munafo says, adding that BetterNight’ makes a cognitive behavioral therapy for insomnia (CBT-I) app that can eliminate the need for in-person CBT-I.

Heightened Infection Control

[RELATED: Will the Pandemic Be a Tipping Point for Disposables in Sleep Medicine?]

Heightened scrutiny over anything that comes into contact with patients is likely to remain a priority for the foreseeable future. Managers will likely have to spend more money on PPE, hand sanitizer, thermometers, disinfection, on screening patients and staff for COVID-19 symptoms, and potentially on new equipment or supplies that may reduce transmission risk.

“Moving forward there will continue to be a need for in-person studies,” says John Blackburn, marketing operations manager for Sizewise. The mattress company makes a medical-grade wipe-down top that doesn’t degrade with the use of harsh cleaning chemicals, which Blackburn characterizes as “an important preventative piece for every facility’s infection control protocols.”

Even before the pandemic, Todd Eiken, RPSGT, FAAST, vice president of product development at Dymedix Diagnostics, saw increases in sales for disposable sensors. He described the boost during COVID-19 as the tipping point. “What we’re asking providers to consider is the costs: compare the costs of cleaning and disinfecting reusables along with the time costs of providers in charge of disinfection with the cost of using disposable sensors,” he says.

Eiken says the looming risk of liability combined with lingering concerns regarding sensors that sit under a person’s nose convince many to switch patient-adhered sensors to those that are discarded after single-use.

Managers may also need to reeducate team members on best practices, for example, halting the practice of using a reusable electrode to scoop skin prep gel out of the jar. New practices may also need to be deployed, such as doing electrode and sensor hookups from the back of the patient, instead of the front. For procedures that can potentially aerosolize viruses, such as CPAP titrations, some sleep labs are opting to add bacterial/viral filters or blocking ventilation ports, though it’s best to check with your device manufacturer before making changes.

Some clinicians are also switching to disposable home sleep test devices, though AASM guidance states that as long as devices are disinfected properly and the time between patients is sufficient, switching to a disposable device like Itamar Medical’s WatchPAT ONE is not essential. “The WatchPAT ONE uses Bluetooth and so eliminates the need to return shipment, cleaning and preparation, which significantly reduces patient and staff exposure to infection,” says Amit Shafrif, vice president and general manager – cardiology at Itamar Medical.

Economic Losses Will Linger

Bibbs, who is also manager of sleep and neurodiagnostics at Morton Plant Mease Healthcare, says the closure of sleep clinics has placed some sleep techs in a position of concern about future employment opportunities. “Those employed in freestanding facilities that are without pay are concerned that these facilities will not reopen again, and this has indeed been the case for some facilities,” she says. “I think that hospitals will reassess many of their outpatient services related to profitability due to the substantial losses resulting from the pandemic, and sleep services may be included in that model.”

On the other hand, hospital-owned sleep centers were better able to deal with the closure, according to Bibbs, with some sleep techs attending to other areas of care, including temperature screening and respiratory equipment.

Health Disparities Brought Forward

Bibbs says the pandemic’s disproportionate effect on Black patients has further highlighted the necessity of sleep clinicians to address the health disparities that medically underserved populations face.2

Reduced capacity and closed sleep clinics translate into reduced access to care; for some, the pandemic’s effect has proved fatal, according to Bibbs. She cited an example of a family member who passed away in their sleep after dealing with multiple comorbidities and sleep apnea.

Providers need to stay vigilant about providing equitable care to patients in all communities, Bibbs says. Before COVID-19, community health facilities that connect patients with devices and care would help uninsured patients, and in light of recent concerns about how CPAP could spread COVID-19, many facilities now also sanitize donated CPAP machines. She also sees telemedicine playing a role to reduce those gaps in access during and after the pandemic. “Sleep providers concerned in closing the gap in disparities can volunteer their time at these community medicine clinics and become visible members in their communities to earn the trust of those medically underserved patients,” Bibbs says.

“Sleep providers concerned in closing the gap in disparities can volunteer their time at these community medicine clinics and become visible members in their communities to earn the trust of those medically underserved patients”

Marietta Bibbs

Accreditation Surveys Go Virtual

Throughout his many years with the Accreditation Commission for Healthcare (ACHC), program director Tim Safley’s focus has remained on the patient. During the pandemic, the accreditor started conducting its surveys virtually (in conjunction with limited on-site reviews in areas with less than 500 reported cases of COVID-19).

“From our standpoint, we know that in-person site visits will never go away, site verification is incredibly important so to ensure that we’re meeting safety protocols we are conducting virtual visits with the expectation that we can validate that they’re meeting our standards at any time without notice,” Safley says.

The experience of these virtual site surveys has been facilitated by secure, encrypted video platforms. “It’s no different from an on-site survey in terms of the thoroughness and what we’re looking for and the good news is that we have seen no pushback from providers,” he says.

Dottie Covey, RPSGT, an ACHC surveyor advocated for sleep clinics to look at their existing vendor relationships to identify opportunities for cost savings during a webinar on infection control in sleep labs that was attended by more than 400 people. “You need to be thinking differently about your current processes and what else you could be doing to improve,” she said in the webinar. “We should and always continue to operate as if the next patient that comes in could be a contagion; it’s not just during a pandemic that we need to heighten infection control practices.”3

Moving Forward

This moment will serve as a unique time in history for incoming trainees in sleep medicine, which was heavily impacted by COVID-19, says Gurubhagavatula.

“With the move to telemedicine approaches, educators and learners have had to adapt quickly to achieve required metrics and competencies,” says Gurubhagavatula, director of the Sleep Disorders Clinic at the Crescenz VA Medical Center in Philadelphia. “Some challenges, as well as opportunities, exist in this new environment. Moving forward will require dynamic, innovative, and collaborative learning models.”

Yoona Ha is a freelance writer and healthcare public relations professional.

References

COVID-19 sleep center impact study. EnsoData. 2020. Available at https://www.ensodata.com/landing-pages/covid-19-sleep-center-impact-study.

COVID-19 in racial and ethnic minority groups. CDC. 4 June 2020. Available at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html.

Infection control in the sleep lab. ACHC-U. 21 May 2020. Available at https://register.gotowebinar.com/register/7672731193098899211.

Image: © Mast3r | Dreamstime.com

from Sleep Review https://www.sleepreviewmag.com/sleep-diagnostics/in-lab-tests/sleep-disorders-centers-pandemic/

from Elly Mackay - Feed https://www.ellymackay.com/2020/07/17/whats-next-for-sleep-disorders-centers/

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What to Expect at a Sleep Center

Sleep Disorders

There are over 100 different types of sleep disorders including those that cause difficulty sleeping at night and those that produce excessive daytime sleepiness. Here is a list and a brief explanation of some of the more common disorders:

Sleep-related Breathing Disorders (Sleep Apnea)

Sleep apnea is a common disorder in which one or more pauses in breathing or shallow breaths occur during sleep. Breathing pauses can last from a few seconds to minutes and may happen 30 or more times an hour. Sleep apnea usually is a chronic condition that causes the sufferer to move out of deep sleep and into a light sleep. The quality of sleep is poor, creating a tired feeling during the day. Sleep apnea is a leading cause of excessive daytime sleepiness. Obstructive Sleep Apnea (OSA) occurs when the throat muscles intermittently relax and block the airway. Central sleep apnea (CSA) happens because the brain sends improper signals to the muscles that control breathing.

Snoring

Snoring is the breathing sound produced when obstructed air movement causes a vibration of the respiratory structures while sleeping. In most cases, the sound can be loud and unpleasant. Snoring during sleep may be an indication of obstructive sleep apnea (OSA).

Upper Airway Resistance Syndrome (UARS)

Upper airway resistance syndrome is a sleep disorder characterized by airway resistance to breathing. During sleep, the muscles of the airway become relaxed which reduces the diameter of the airway. Typically, the airway of a person with UARS is already reduced in size, and this natural relaxation reduces the airway even further. Symptoms include daytime sleepiness and excessive fatigue.

Insomnia

Insomnia is a disorder causing difficulty falling asleep or staying asleep. People with insomnia usually experience one or more of the following symptoms: low energy, fatigue, mood shifts, difficulty concentrating, and decreased performance in work or at school.

Shift Work & Circadian Rhythm Disorders

Shift work sleep disorder (SWSD) is a daily rhythm sleep disorder characterized by insomnia and excessive sleepiness affecting people whose work hours overlap and interfere with the typical sleep period.

Restless Legs Syndrome

Restless legs syndrome (RLS) occurs during sleep and is a neurological disorder characterized by unpleasant sensations in the legs and an uncontrollable, urge to move them. Moving the legs relieves the discomfort.

Pediatric Disorders

Pediatric Sleep Disorders are disturbances often due to temporary or chronic medical problems and are observed in as many as 25 to 30 percent of children. The disorders may range from insufficient sleep, bedwetting problems and sleepwalking to sleep apnea and narcolepsy.

Narcolepsy, Kleine-Levine Syndrome & Other Hypersomnias

Narcolepsy is a neurological disorder that causes excessive daytime sleepiness and intermittent, uncontrollable sleep episodes during the daytime.

Kleine–Levin syndrome (KLS), also known as Sleeping Beauty syndrome, is a rare sleep disorder characterized by persistent episodic hypersomnia and cognitive or temperament changes. Many patients also experience an abnormally increased appetite for food, hypersexuality and other symptoms.

Nighttime Sleep Behaviors

Sleepwalking is much more common in children than adults and is more likely to occur if a person is deprived of sleep.

In a person with REM sleep behavior disorder (RBD), the paralysis that normally occurs during REM sleep is incomplete or absent. RBD is characterized by the acting out of dreams that are vivid, intense, and violent.

Sleep paralysis is a phenomenon in which an individual, during the transitional state between wakefulness and sleep, briefly experiences an inability to move, speak, or react.

Confusional arousal or sleep drunkenness is considered a parasomnia. This category of sleep disorder involves abnormal movements, behaviors, emotions, perceptions, and dreams that occur during all stages of sleep.

A nightmare is a dream occurring during rapid eye movement (REM) sleep that involves strong feelings of terror, distress or extreme anxiety.

The Sleep Center Experience

A sleep study in a sleep center accredited by the American Academy of Sleep Medicine is the best way to identify a sleep disorder. Whether your symptoms include chronic snoring, pauses during sleep, excessive daytime sleepiness, difficulty falling asleep at all, or one of several other sleep-related disorders, a sleep study can help you get to the bottom of your ailment.

What is a sleep study, how does it work, and how do you prepare for it?

Types of In-lab Sleep Studies

There are several different types of sleep studies offered at sleep clinics.

Polysomnogram (PSG): An overnight sleep study that records brain activity, breathing patterns, eye movements, heart rate, blood pressure, blood oxygen levels, muscle activity, and more. The results are used to help diagnose some of the following:

Obstructive and central sleep apnea (OSA).

Seizure disorders.

Periodic limb movement disorder (PLMD).

Sleep-related disorders caused by excessive daytime sleepiness (EDS).

Multiple Sleep Latency Test (MSLT): The standard measurement used to diagnose narcolepsy and excessive sleepiness that is not caused by sleep apnea or another sleep disorder. MSLT testing generally follows a Polysomnogram and consists of a series of daytime naps that measures how long it takes the patient to fall asleep.

Maintenance of Wakefulness Test (MWT): A daytime sleep study that measures the degree of alertness during the day and the patient’s ability to stay awake. It is usually performed after a PSG and can help determine if your sleepiness is a safety concern. Results of an MWT are often used in the transportation industry to evaluate the ability to drive or fly safely.

CPAP Titration: A test used to determine optimal positive airway pressure (PAP) settings. Proper PAP settings can eliminate most or all apnea events. A CPAP machine blows air through a tube, into a mask worn by the patient, and eventually into the back of the throat. The air pressure coming in through the mask is changed to find the optimal PAP settings. With the proper air flow, the patient should no longer experience periods of wakefulness throughout the night.

Bi-level or BiPAP Titration: For patients previously diagnosed with obstructive sleep apnea, but have not found an optimal continuous positive airway pressure (CPAP), a BiPAP should be considered. The bi-level PAP may be more effective for some patients because it has two pressure settings: the prescribed high pressure for inhalation (IPAP), and a lower pressure for exhalation (EPAP).

How to Prepare for a Sleep Study

Sleep is not a simple process. Many parts of the brain control sleep in various stages. These stages of sleep include drowsiness, light sleep, deep sleep, and dream sleep. An overnight sleep study is the best way to analyze sleep and it will show in very precise details exactly what happens while the patient is sleeping. The test results will identify the cause of the sleep problem and allow a sleep specialist to determine which treatment is best.

Avoid caffeinated drinks or alcohol in the afternoon or evening before an overnight sleep study. Try not to take any naps on your test day. Before going to the sleep center, wash your hair with shampoo only. Do not apply any hair sprays, oils or gels. If used, they could interfere with the sensors during the study.

Bring comfortable pajamas and a change of clothes for the morning to the Sleep Center. Include the same items you would take for a stay at a hotel. It is essential to inform your sleep specialist of any medications that you are taking, including both prescription and non-prescription drugs. Certain medications can affect your sleep and the results of the study.

Make sure you have already had dinner and are ready for bed. If you have special needs or concerns, advise the sleep center staff ahead of time.

Most sleep clinics want you to go about your usual nightly routine. If you over-prepare or deviate from your normal routine, the results may not be as accurate.

What Happens During an Overnight Sleep Study?

While there may be some variation in procedures at different sleep centers, the following description represents a typical process.

What Will Happen When I Arrive at The Sleep Center?

When you arrive for your sleep study, usually between 5:30 pm and 9:30 pm, you will be met by a registered polysomnographic technologist (RPSGT) who will be administering your sleep study. The RPSGT will review your paperwork, have you fill out any necessary forms, and discuss what the sleep study will entail. In your bedroom, a technologist will show you the sleep study equipment. Be sure to inform him or her of any recent changes in your sleep or any specific problems that you did not already discuss with your doctor.

Prepare for bed in the same manner you do at home. There may be a waiting period when you can read, watch TV, or just relax. When the technologist returns, he or she will apply wires with small cup electrodes to your scalp to measure brain activity. This measurement indicates if you are sleeping, and what stage of sleep you are in. The wires are long enough to let you move around and turn over in bed.

Wire electrodes will also be taped to your face near the eyes and chin to show muscle activity and observe possible nocturnal teeth grinding as well as other sleep disorders These also measure eye movements, which indicate sleep stages. Other test equipment connections may include:

2 flexible elastic belts around your chest and stomach to measure breathing effort.

A nasal cannula and small heat monitor to measure all breathing activity.

A wire electrode on each leg to measure body movement/muscle activity.

A clip on your finger monitors your heart rate and the oxygen in your blood.

2-3 lead EKG monitors to show heart rate and rhythm.

A small microphone applied to your throat to detect snoring.

The sensors should be comfortable and not be an obstacle to falling asleep. Once you have been hooked up to the various machines, the RSPGT will begin monitoring the data from another room. They will run a series of tests to calibrate the equipment. When the calibrations are finalized you are free to read or watch TV until your normal bedtime.

Will I be able to sleep in a strange environment with all the monitoring equipment?

Many people expect the sleeping quarters at a sleep center to be cold, harshly lit and filled with computers and beeping machines. However, most sleep centers make you feel relaxed and comfortable with nicely decorated rooms. Most patients fall asleep quickly.

What Happens During the Sleep Study?

The technologist stays awake all night in a nearby room with the computers and equipment to monitor your sleep. The sensor wires are gathered together in a manner that gives you the freedom to roll over and change sleeping positions. At some point during the night, the technologist may ask you to sleep on your back to provide better data on your breathing patterns. A video camera may also record your sleep, allowing your doctor to see any unusual movements or behavior.

If the measurements taken while you are asleep indicate obstructive sleep apnea, the technologist may awaken you and fit you with a mask for a positive airway pressure (PAP) test. It will either cover your nose or both your nose and mouth. Another mask version has soft silicone tubes called nasal pillows that fit directly in your nostrils. The mask produces a steady stream of air that gently blows into the back of your throat. While there are three kinds of PAP, Continuous positive airway pressure (CPAP), Automatic positive airway pressure (APAP), and Bilevel positive airway pressure (BiPAP), the most common is CPAP. The technician will find the right level of air pressure to help you breathe and sleep normally.

What Happens During a Nap Study?

A Multiple Sleep Latency Test (MSLT) may be required the day after your sleep study, to confirm a narcolepsy or hypersomnia condition. The trial begins between 1.5 and 3 hours after you wake up from the overnight sleep study. It consists of four or five nap opportunities with breaks lasting for two hours in between each nap. Your sleep patterns are monitored with most of the same recording equipment used the night before.

Results Analysis

A typical sleep study produces about 1,000 pages of data, including measured brain waves, eye movements, and breathing patterns. The data analysis is a complex and time-consuming process requiring hours of work from a trained professional. A sleep technologist processes this data, then forwards the result to a doctor for further evaluation. At an accredited sleep center, the doctor must be a board-certified sleep specialist. Because of the detail and amount of time involved, it usually takes about two weeks for you to get the results.

Summary

A sleep study is a reliable, scientific, and painless way to discover why you are not sleeping well. It gives you valuable insight into the process of how you sleep and can provide you with answers. With the results, a sleep specialist can develop a plan of treatment to help you finally get the kind of sleep you want and need.

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