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The problem for millions of Americans is that they don’t sleep well or in many cases are not aware they are not sleeping well. This leads to numerous health related problems which reach far beyond just feeling tired the next day.
Although there are over 80 known sleep disorders, the most common by far, is Sleep Disordered Breathing syndrome or sleep apnea as it is commonly called. Others you may have heard of are:
- Insomnia
- Narcolepsy
- Restless leg syndrome
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Sleep disorders can occur at any age, including during a persons young adult life, while others may begin after menopause. Although some disorders like sleep apnea occur more prevalently in males than females, gender is typically not a determining factor. Physical symptoms include:
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- Snoring and gasping for breath
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- Excessive daytime sleepiness
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- Leg jerking while sleeping
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- Irritability and/or behavioral changes
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- Difficulty falling asleep or staying awake
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- Teeth grinding while sleeping
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There is now overwhelming evidence suggesting a strong link between sleep apnea and cardiovascular disease. In some cases, it is unclear what initiates the cause, but the resulting consequences are related to:
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Stages of Sleep
Usually sleepers pass through five stages: 1, 2, 3, 4 and REM (rapid eye movement) sleep. These stages progress cyclically from 1 through REM then begin again with stage 1. A complete sleep cycle takes an average of 90 to 110 minutes. The first sleep cycles each night have relatively short REM sleeps and long periods of deep sleep but later in the night, REM periods lengthen and deep sleep time decreases.
Stage 1 is light sleep where you drift in and out of sleep and can be awakened easily. In this stage, the eyes move slowly and muscle activity slows. During this stage, many people experience sudden muscle contractions preceded by a sensation of falling. You may not appear to be sleeping to someone observing you during this period.
In stage 2, eye movement stops and brain waves become slower with only an occasional burst of rapid brain waves.
When a person enters stage 3, extremely slow brain waves called delta waves are interspersed with smaller, faster waves.
In stage 4, the brain produces delta waves almost exclusively. Stages 3 and 4 are referred to as deep sleep, and it is very difficult to wake someone from them. In deep sleep, there is no eye movement or muscle activity. This is when some children experience bedwetting, sleepwalking or night terrors.
In the REM period, breathing becomes more rapid, irregular and shallow, eyes jerk rapidly and limb muscles are temporarily paralyzed. Brain waves during this stage increase to levels experienced when a person is awake. Also, heart rate increases, blood pressure rises, males develop erections and the body loses some of the ability to regulate its temperature. This is the time when most dreams occur, and, if awoken during REM sleep, a person can remember the dreams. Most people experience three to five intervals of REM sleep each night.
Infants spend almost 50% of their time in REM sleep. Adults spend nearly half of sleep time in stage 2, about 20% in REM and the other 30% is divided between the other three stages. Older adults spend progressively less time in REM sleep.
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DO YOU NEED A SLEEP STUDY?
There are a number of factors that will determine if you need a sleep study. These include physical symptoms, daytime sleepiness, cardiovascular condition, sleeping habits or problems, body mass index, family history and an overall feeling of wellness. Your physician can evaluate your need for a sleep study during a history and physical or regular office visit, usually using a standardized questionnaire called the Epworth Scale.
WHY DO I NEED A REFERRAL?
Your physician can refer you directly for testing, or you may call to schedule an appointment with one of our Board Certified Sleep Medicine physicians. In either case, a physician’s order is required for testing.
Along with your physician’s order, we will ask your referring physician to send us a copy of your history and physical including information about your primary complaint or sleep problem (i.e., reason for the study). If you elect to see one of our physicians, you will be scheduled for a consultation where they will perform a history and physical, and schedule you for any testing or evaluations necessary. Not all sleep disorders require a sleep study for their evaluation and/or treatment.
WHAT IS A SLEEP STUDY?
A sleep study, or polysomnogram (PSG) as it is medically defined, is a diagnostic test that is performed as you sleep during the night. The procedure itself involves applying electrodes and sensors to specific areas of the body utilizing standard methodology. You will be connected to our computer controlled recording device, and your sleep study will begin as close to your normal bed time as possible. Certain physiological activities including brainwaves, muscle activity, eye movements, heart rate, breathing patterns and oxygen levels in the blood are monitored by the technologist from a separate room. This test is completely safe and totally noninvasive (no needles).
WHAT HAPPENS NEXT?
In the morning you will be detached from the sensors and, if you wish, take a shower in a private bathroom and enjoy a light continental breakfast before leaving. Upon discharge you will receive the appropriate paperwork and a few additional questionnaires on how you slept and quality of the facility and staff. During the next 2 – 3 days, your recording will be analyzed by a Registered Polysomnographic Technologist and the results interpreted by a Board Certified Sleep Specialist. A report which includes recommendations for treatment, if required, will be sent to your referring physician. You will then be instructed to schedule an appointment with your referring physician to go over the results and treatment recommendations.
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