Sleep Medicine

Polysomnography

Polysomnography is a test of sleep cycles and stages. It measures and records physiologic patterns of sleep, including brain waves, eye movement, breathing rates, electrical activity of muscles, blood oxygen levels, and heart rhythm. This test is performed to evaluate sleep disorders such as insomnia, obstructive sleep apnea, breathing difficulties, behavior disturbances during sleep (sleep walking, night terrors), or other sleep disorders.

Polysomnograms are usually carried out during the night so that your normal sleep patterns can be replicated. In preparation for the test, the sleep technician will place electrodes on your chin, scalp, and the outer edge of your eyelids. In addition, monitors recording heart rate and breathing rate will be attached to your chest. Other diagnostic tests may also be performed.

Virtually every detail of your night’s sleep will be recorded, including how long it takes you to fall asleep, how often your eyes open, how long it takes you to enter each phase of sleep, and how long you remain in each phase. Sometimes your physical movements will be recorded by video camera. To prepare for this test, follow your physician’s guidance on which of your medications to take or avoid, and do not drink alcohol or caffeinated beverages before the test.

PAP (Positive Airway Pressure) titration is a test that is performed once obstructive sleep apnea has been diagnosed. You will be monitored in the same way as mentioned in the previous section, yet during this test you will be fitted with a mask that is attached to a breathing machine. You will breathe as normally as possible, while varying levels of airflow pressure are applied to determine the level at which your airway remains open and apnea is eliminated. If indicated, you will be fitted for the complete system, consisting of a programmable pressure generator, tubing, and mask.

A Multiple Sleep Latency Test (MSLT) is an accurate way to measure daytime sleepiness and is a valuable tool in the diagnosis of other sleep related disorders. The test consists of five seperate sleep opportunities spaced two hours apart. A MSLT is usually preceded by a polysomnograph. The test takes up to 8 hours to complete.

To perform this test, the sleep technologist will apply electrodes to your scalp, around your eyes, under your chin, and on your chest. You will then be asked to lie down on a bed in a private room. The technologist may ask you to follow a few simple commands (look to the left and right, swallow), and then the lights will go down and you will be allowed to fall asleep.

For the first 20 minutes of every 2-hour period, you will be monitored for the time it takes you to fall asleep. After these brief sleep periods you will be awakened and asked to stay awake until the next sleep time. Between sleep times, you are free to watch television, have a visitor, or read.

Breakfast and lunch will be provided.

The following restrictions apply during this test:

• NO caffiene. This includes all caffeinated drinks and chocolate and some over-the-counter medications.
• NO Smoking. Pinehurst Medical Clinic maintains a smoke-free campus for the health of our patients and employees.
• NO Sleeping between recording sessions.
• NO Alcoholic beverages the night before or the day of the test.

A maintenance of wakefulness test measures your ability to stay awake during a designated period of time. This test is similar to the multiple sleep latency test in that electrodes will be attached and you will be monitored at 2-hour intervals throughout the day. However, this test is designed to measure your ability to stay awake, whereas a multiple sleep latency test analyzes how long it takes you to fall asleep when you are allowed to sleep.

For the MWT you will be placed in a semi-reclined position in a comfortable, darkened room, and asked to stay awake and avoid napping. The sleep technologist will record your brain wave activity and determine if you fall asleep, and if so, how quickly and for how long. You will also be asked to report whether or not you believe you fell asleep, and if so whether or not you dreamed. This test takes up to 8 hours to complete.

The same conditions and restrictions apply as in the MSLT (see last paragraph under MSLT above) .

Nocturnal oximetry is the measurement of blood oxygen levels during sleep. In some cases, this procedure may be done at home using a small, portable oximeter equipped with a memory module that can record a full night of oxygen and pulse rate data. Your physician may use this information to help diagnose pulmonary problems, sleep apnea, and other sleep-related disturbances. Depending on the findings, you may be referred to a sleep disorders specialist.

Pinehurst Medical Clinic's (PMC) insomnia specialists are committed to ensuring their patients are rested by getting the best night of sleep possible.

PMC's insomnia specialists have the ability to evaluate the underlying cause of their patient's insomnia and develop a plan of treatment using Cognitive Behavioral Therapy for Insomnia (CBT-I). CBT-I is a structured program that helps you identify and replace thoughts and behaviors that can cause or worsen sleep problems with habits that promote sound sleep. Studies dating back over 30 years have shown CBT-I to be as effective, if not more than prescription sleeping pills.

Patients presenting with insomnia may not need to participate in a sleep study unless there are signs and symptoms of other sleep disorders. We may perform at-home monitoring with special portable devices that help to further assess and define sleep issues.

Initial appointments with a PMC sleep specialist typically last 30-60 minutes to gather information about any sleep problems the patient may be experiencing. Subsequent visits are designed to assess treatment progress, provide feedback and further improve sleep until treatment goals are met.

PMC sleep specialists are conveniently located in Cumberland, Lee and Moore counties and offer a wide range of diagnostic and treatment options to the communities they serve.

If you would like to further research sleep disorders, the following are helpful resources:

• American Academy of Sleep Medicine
• National Sleep Foundation
• Better Sleep Council
• CPAP for Seniors
• American Sleep Apnea Association