50 to 70 million Americans are affected by chronic sleep disorders and intermittent sleep problems that can significantly diminish health, alertness and safety. Untreated sleep disorders have been linked to hypertension, heart disease, stroke, depression, diabetes and other chronic diseases. Sleep problems can take many forms and can involve too little sleep, too much sleep or inadequate quality of sleep.
The Institute of Medicine recently estimated in its report, Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem, that “hundreds of billions of dollars a year are spent on direct medical costs related to sleep disorders such as doctor visits, hospital services, prescriptions, and over-the-counter medications.” Sleep problems and lack of sleep can affect everything from personal and work productivity to behavioral and relationship problems. Sleep problems can have serious consequences. According to the National Highway Traffic Safety Administration, drowsy driving claims more than 1,500 lives and causes at least 100,000 motor vehicle crashes each year.
Compounding the problem is the fact that most people know when to seek medical help for physical discomfort such as fever or pain—but sleep problems are often overlooked or ignored. In fact, the overwhelming majority of people with sleep disorders are undiagnosed and untreated.
Should Your Sleep Be Evaluated?
To determine whether you might benefit from a sleep evaluation, ask yourself the following questions:
- Do you regularly have difficulty getting to sleep or staying asleep?
- Do you have a problem with snoring? Has anyone ever told you that you have pauses in breathing or that you gasp for breath when you sleep?
- Are your legs “active” at night? Do you experience tingling, creeping, itching, pulling, aching or other strange feelings in your legs while sitting or lying down that cause a strong urge to move, walk or kick your legs for relief?
- Are you so tired when you wake up in the morning that you cannot function normally during the day?
- Does sleepiness and fatigue persist for more than two to three weeks?
If you answered yes to any of these questions, then a complete sleep evaluation should be considered and discussed with your physician. Before your visit, it may be helpful to track your sleep patterns and medications.
Primary Care Physicians and Sleep Specialists
Depending on your insurance plan and other factors, your primary care physician may start your evaluation by running tests for specific medical disorders that are known to affect sleep. Your physician might even be able to diagnose a sleep problem based solely on your symptoms and recommend initial treatments. At some point, you may be referred to a sleep specialist for a more extensive assessment of your sleep complaints and for more specific treatments.
If this occurs, be sure to ask your physician to refer you to a certified sleep physician. Certification requires that a physician undergo formal training and pass an examination in sleep disorders to demonstrate a higher level of expertise. To check if your sleep physician is certified, or to find a sleep professional, go to either www.absm.org to check ‘verification of diplomates,’ or to the ‘who is certified’ section of www.abim.org.
Sleep Studies (Polysomnograms)
After an initial consultation with your physician or a sleep specialist, you may be referred for a sleep study. The medical term for this study is “polysomnogram,” which is a noninvasive, pain-free procedure that usually requires spending a night or two in a sleep facility. During a polysomnogram, a sleep technologist records multiple biological functions during sleep, such as brain wave activity, eye movement, muscle tone, heart rhythm and breathing via electrodes and monitors placed on the head, chest and legs.
After a full night’s sleep is recorded, the data will be tabulated by a technologist and presented to a physician for interpretation. Depending on the physician’s orders, patients may be given therapy during the course of the study, which may include medication, oxygen or a device called continuous positive airway pressure therapy, or CPAP.
Preparing for Your Sleep Study
A list of specific instructions is typically provided to patients before their arrival at the testing facility, but you may want to consider asking additional questions before your test, such as:
- Does it matter if I take a nap the day before or the day of the study?
- Should I refrain from drinking coffee, tea or other caffeinated products or energy drinks? If so, for how many hours before my test?
- What can I eat before the study? In addition to caffeinated products, are there any other foods/beverages that I should avoid?
- Should I avoid stimulants, alcohol or sedatives? What about other prescription and non-prescription medications, dietary or herbal supplements? How long before the sleep study should these be discontinued?
- What should I bring to wear?
- May a family member or attendant stay with the patient during the study?
- On the day of the procedure, should I change my cosmetic, skin or hair care routine?
- Are personal comfort items, such as snacks, a pillow, slippers or robe, allowed?
- What time will I be able to leave?
- May I take a shower and dress for work the morning after the study?
- Will I be able to discuss the results of the study with my doctor before leaving the facility?
- Will my primary care physician or the sleep specialist take the lead in providing continuing care after the study?
Once at the sleep facility, you may notice that the testing bedrooms are designed to resemble a typical bedroom, with décor and televisions to help make you feel as relaxed as possible.
Patients Should Ask…
The National Sleep Foundation’s web site, www.sleepfoundation.org, offers sleep information on a wide range of topics, ‘ask the expert’ opportunities, online community forums, sleep blogs and more.
Important Questions to Ask Before Your Sleep Study
A sleep study can be conducted in either a hospital or in an independent facility. Ask if the sleep lab or sleep center to which you have been referred is accredited by the American Academy of Sleep Medicine (AASM). This recognition denotes that the facility adheres to the highest standards of care for sleep disorder patients. A list of accredited sleep facilities is available at www.aasmnet.org.
A related issue to address is whether your insurance carrier requires testing in accredited facilities in order to cover the cost of the procedure; in many states, medical insurance will not reimburse the cost of sleep studies unless they are conducted at an AASMaccredited facility.
If you are referred for a sleep study or a polysomnogram, be sure to request that the technologist conducting your study is a Registered Polysomnographic Technologist (RPSGT). An RPSGT is a fully trained sleep technologist who has met the rigorous requirements to become credentialed by the Board of Registered Polysomnographic Technologists.
Treating Sleep Problems
After the sleep study has been conducted and reviewed, several conditions may be diagnosed, and various specific treatments may be recommended. There is a wide range of methods for treating sleep problems. Medications may be prescribed by your physician. Sometimes a sleep psychologist is called upon to recommend non-drug approaches that may include addressing patients’ pessimism about their sleep surroundings, correcting misconceptions about sleep, controlling stimulating factors that hinder sleep and identifying positive behaviors that aid sleep. Improving your diet, your sleep environment and your bedtime rituals, including the timing of physical exercise, alcohol intake, and other factors may all contribute to a better night’s sleep.
Some patients may be candidates for night-time oral or dental applicances to reduce snoring and apnea. The American Academy of Dental Sleep Medicine at www.aadsm.org lists dental sleep medicine specialists by state.
Sleep Problems and the Importance of After Care
Patients will often need continuing support in terms of evaluating and managing their response to various medications, treatment methods or recommended behavioral measures. Sometimes, a primary physician will prescribe the initial treatments and continue seeing the patient for followup treatments; whereas in other settings, after care occurs in dedicated sleep clinics.
Ideally, the sleep specialist who performed the initial evaluation and reviewed the sleep study with the sleep technologist will direct the patient’s after care, including follow up in his or her clinic and with other allied health professionals involved with treatment.
In addition to medications and behavioral measures, some sleep disorders, such as sleep apnea (in which breathing is briefly and repeatedly interrupted during sleep), may include the use of medical equipment during sleep, such as CPAP therapy.
CPAP is an air pressure system that helps hold the air passages in the nose and throat open during sleep and eliminates snoring and pauses in breathing. Proper fitting and instruction for use of CPAP equipment – whether simple nosepieces or more elaborate masks – is critical to ensure your comfort and willingness to continue with treatment. There may be a period when different equipment is used and several adjustments are made. It is important that you share your questions and concerns with the sleep specialists who are working with you for the best possible outcome.
In truth, some treatment methods may be challenging to follow, and having continuing care available from a certified sleep specialist to oversee a patient’s progress is crucial. Ask your primary care physician or sleep doctor if continuing after care will be offered at the referred sleep clinic. At the very least, most patients schedule annual visits at their sleep clinic to learn about the latest advances in the treatment of sleep problems and sleep disorders.
You Are Not Alone
Nearly 7 out of 10 Americans say they experience frequent sleep problems. However, when proper diagnosis and treatment of sleep disorders occurs, the feeling of sleepiness declines, memory improves and safety risks decrease dramatically. In fact, sleep disorder specialists help an estimated 85 to 90% of their patients get better sleep. With the wealth of treatment options now available, a good night’s sleep is within reach.