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What is Sleep Apnea?
Apnea, as described by The American Sleep Apnea Association literally means "without breath." There are three types of apnea: obstructive, central, and mixed; of the three, obstructive is the most common. Despite the difference in the root cause of each type, in all three, people with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer.

Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnea, as the name implies, is a combination of the two. With each apnea event, the brain briefly arouses people with sleep apnea in order for them to resume breathing, but consequently sleep is extremely fragmented and of poor quality.

Sleep apnea is very common, as common as adult diabetes, and affects more than twelve million Americans, according to the National Institutes of Health. Risk factors include being male, overweight, and over the age of forty, but sleep apnea can strike anyone at any age, even children. Yet still because of the lack of awareness by the public and healthcare professionals, the vast majority remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant consequences.

Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. Fortunately, sleep apnea can be diagnosed and treated. Several treatment options exist, and research into additional options continues.
Who Needs a Sleep Study?
You might need a Sleep Study if You:

bullet Have excessive daytime sleepiness
bullet Have spells of NO breathing during sleep (Sleep Apneas)
bullet Have seizures at night
bullet Have bizarre behavior while asleep
bullet Have excessive daytime sleepiness and
bullet Are overweight
bullet Have a neck size greater than 17 1/2" (men) or 16" (women)

Please take a moment to answer our Online Questionnaire
What Can I Expect During a Sleep Study?
Click the to expand the Sleep Study Expectations.
  • Sleep Study Agenda and Terminology
    bullet The Polysomnogram (PSG)

    A Sleep Study or Polysomnogram (PSG) is a multiple-component test, which electronically transmits and records specific physical activities while you sleep. The recordings become data, which will be "read" or analyzed by a physician to determine whether or not you have a sleep disorder.

    There are 4 types of Polysomnographic Studies.

    * Diagnostic Overnight PSG - General monitoring and evaluation.
    * Diagnostic Daytime Multiple Sleep Latency Test (MSLT) - Used to diagnose Narcolepsy and measure the degree of daytime sleepiness. To ensure accurate results, it is performed on the morning following a Diagnostic Overnight PSG.
    * Two Night PSG with CPAP Titration - General monitoring and diagnostic evaluation is conducted on the first night. If Sleep Apnea is discovered, the patient returns for a second night to determine the necessary CPAP pressure required to alleviate apnea.
    * Split Night PSG with CPAP Titration - Split Night PSG is conducted when moderate or severe Sleep Apnea has been discovered or strongly suspected during the first part of the nights study. The second half of the night is used for CPAP Titration.


    Let's Get Started

    After we receive the referral from your doctor. We will contact you to schedule the sleep study. One of our experience staff members will gladly explain to you what to expect, what to bring, how long the test will take.

    Our qualified staff have years of experience in sleep medicine and are happy to answers any questions you might have so please don’t hesitate to contact us with your questions! Our goal is to make you feel as comfortable as possible. “Modern Science with the Comforts of Home”

    Alcohol or caffeine can interfere with your sleep and should be avoided.

    Pack a small bag with your pajamas, toothbrush and any other items you will need the next morning. You are welcomed to bring your own pillow!

    Once you arrive at our Dr. Zzz’s Sleep Center, our technician will show you to your private room. Each room has a TV/DVD and a ceiling fan. We have comfortable queen size beds for your comfort. Each room is equipped also with some diagnostic equipment, a camera and an intercom system. This is how our technicians monitor your well-being. If you have any problems or questions, our technicians will be able to react very quickly if you need something, or have a question while in your room.


    The hook-up process will take place in the comfort of your private room by one of our qualified and professional technicians. Once you are hooked up and the preparation is over, you will have time to relax, watch TV or a DVD you might have brought with you.

    Setup can take 25-35 minutes or more in order to get everything connected properly. There are a large number of supplies that are used in the process. The soft belts are placed around your chest and abdomen to measure your respiratory efforts, and the band-aid like oximeter probe on your finger measures the amount of oxygen in your blood. The electrodes are temporarily "glued" to your skin and scalp. Don't worry, the glue comes off easily the next morning!

    A key part of a sleep study is understanding what is happening while you sleep. By attaching the electrodes to your body, the recorded electrical signals generated by your brain and muscle activity are sent back through the wires and recorded digitally and on continuous strips of paper. The pattern of this activity can be recognized by a sleep specialist who "reads" or interprets the study. These valuable clues reveal whether or not you have a sleep disorder, and if present, how severe it is.


    This is a close up of the gold plated surface electrodes that will be glued to the skin and scalp during the PSG. They will record the extremely low levels of electrical energy present during any muscle or brain activity.



    The EEG or electroencephalogram, is a major part of a sleep study. It measures and records four forms of brain wave activity - alpha, beta, delta and theta waves. Alpha waves are usually found during relaxed wakefulness, particularly when your eyes are closed. Theta waves are seen during the lighter sleep stages 1 and 2, while delta waves occur chiefly in deep sleep, the so-called "slow wave sleep" found in sleep stages 3 and 4.


    The EMG or electromyogram, records muscle activity such as face twitches, teeth grinding, and leg movements. It also helps in determining the presence of REM stage sleep. The amount and duration of these activities provides the doctor important information about your sleep.

    The EOG or electro-oculogram, records eye movements. These movements are important in determining the different sleep stages, particularly REM stage sleep. The electrodes are usually placed on the outer aspect of your right eyebrow and along the outer aspect below or beneath your left eye.

    EKG or electrocardiogram, records heart activities, such as rate and rhythm. Electrodes are placed on your chest.

    Chest/Abdomen Belts: Records breathing depth, apnea and hypopnea events. Soft, elastic “belts” are placed around your chest and abdomen.

    Oximeter: Records blood oxygen saturation. A band-aid like clip is placed on a finger.

    Video: Records body positioning and movements.


    Sleeping is a complex activity that must occur for a successful polysomnographic study. During sleep, our brain and body cycle between NREM and REM sleep approximately every 90 minutes.

    During these transitions, major changes occur in our EEG, EOG, EMG, heart rate and respiration that are necessary for healthy sleep. If abnormal changes are observed during a particular sleep stage, then we are able to define this problem as it occurs during the night.

    Some sleep disorders are generally worse in a particular sleep stage, such as sleep apnea during REM sleep and PLMD in NREM sleep. Your PSG technician and sleep specialist are well aware of these facts and want you to get as good a night's sleep as possible in order to make your test experience as fruitful as possible.


    Here you can see EMG electrodes on the chin, jaw, cheeks, and lower leg. EEG electrodes on the scalp and forehead, EOG electrodes are placed above the eyebrow.


    Elastic belts are placed around the chest and abdomen to record breathing rate and effort from the diaphragm, as well as apnea and hypopnea events.


    The hookup is complete! The electrodes and all other components are in place. The data they collect and record is what makes a polysomnographic study. Once the sleep specialist reads the "book" of data, they will know if you have a sleep problem or a sleep disorder. Following a diagnosis, the sleep specialist will work with you and your doctor to plan appropriate treatment.


    Although being hooked up may look uncomfortable and sleeping through the night seems impossible, most patients fall asleep with little difficulty.

    A CPAP Titration is required if sleep apnea is diagnosed or strongly suspected. Typically, this is a full night of study performed during a second night, but is sometimes performed during the last few hours of a split-night study.

    CPAP (Continuous Positive Airway Pressure) therapy is the first line of treatment for sleep apnea. The CPAP device delivers pressurized air through tubing to a nasal mask or nasal pillows, which are fitted around the head. The pressurized air acts as an airway splint. It gently opens the patient's throat and breathing passages, allowing them to breathe normally while asleep, but only through their nose!




    To properly treat sleep apnea, the correct CPAP air pressure setting must be determined by titration. Titration is done for each patient - there is no "one size fits all" solution.

    During a titration study, the patient will sleep all wired up, just like a normal sleep study, but they will also wear a nasal mask, which is connected to a CPAP machine. Since the pressurized air can be irritating to a nose that hasn't been used much at night, many sleep labs also connect the CPAP device to a heated humidifier during the titration procedure. This adds moisture to the air after it leaves the CPAP and before it enters the patient's nose, easing the drying effect of the pressurized air.


    To ensure effectiveness and optimal comfort, the nasal mask is properly fitted prior to application. This patient drifted right to sleep!

    During the titration study, the technician will set the air pressure on the CPAP at a certain level and then watch the resulting measurements. If that pressure does not reduce the number of apnea and hypopnea events, or eliminate the snoring, the technician will adjust the air pressure and continue observation. This process continues throughout the night until the optimum pressure is reached.

    A Multiple Sleep Latency Test or MSLT, is designed to measure the degree of sleep tendency or sleepiness in a given patient. This test is conducted during the day following a routine PSG and features a series of up to 5 naps, each lasting usually less than 30 minutes that are timed to start every two hours during the day. For example, 10 am, 12(noon), 2 pm, 4 pm and 6 pm represent a possible nap schedule.

    It is important prior to having an MSLT study that a 1-2 week sleep diary be completed and your doctor is aware of any medications (OTC or otherwise) that you are taking, since many medications can effect the results of this test.

    The purpose of the MSLT is two fold: first, to average the number of minutes that it takes to fall asleep (sleep onset latency) during all the naps and second, to record if REM stage sleep occurs during any of these scheduled napping periods.

    The testing procedure includes essentially the same PSG leads as for a diagnostic overnight study. During the periods between naps, the patient must stay awake and not fall asleep.

    This test is particularly useful in helping people with Narcolepsy adjust their medication, diagnose Narcolepsy, objectively quantify the degree of sleepiness in a particular patient, such as an OSA (obstructive sleep apnea) patient who is still sleepy despite CPAP treatment and in diagnosing Idiopathic Hypersomnolence.

    We hope this article has helped to better prepare you for your sleep study.
"My husbands snores, could this be harmful?"
Snoring is both common and overlooked! We always make fun of the snorer, but millions of unsuspecting snorers could be in a dangerous and potentially life-threatening situation. Loud snoring is a symptom of sleep apnea. Sleep apnea literally means to stop breathing while asleep. Sleep apnea episodes average in length of about 10-15 seconds, this means you stop breathing for 10 to 15 seconds numerous times each hour depending on your severity. If untreated a person is at higher risk for high blood pressure, heart attacks and strokes! In any given night the number of “apneic events” may be as high as 40 to 50 per hour; these breathing pauses are almost always accompanied by snoring between apnea episodes. Sleep apnea occurs in all age groups and in both sexes. It has been estimated that over 20 million Americans have sleep apnea.
Who needs a Study…more people than you think!!!
People with sleep disorders may suffer from fatigue, irritability, depression, reduced concentration and memory, and loss of productivity.  60% of obese persons may suffer from sleep apnea.  40% of all diabetics may have sleep apnea, and sleep study therapy will decrease insulin resistance and sleep disordered breathing.  As many as 90% of persons with Hypertension suffer from sleep apnea.  High blood pressure persons, over 60% may have sleep apnea.  Even 40% of persons diagnosed with depression have sleep apnea.  Others persons who may need a sleep study, stroke victims, cardiovascular patients, alcohol users, smokers, insomniacs, asthmatics, and persons who suffer from severe anxiety (many psychiatrists misdiagnose stress vs. apnea).

 
 
   

 

  
 

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