What to Know About Sleep Clinics

Expert Insights from Dr. Luis Javier Peña-Hernández, MD, FCCP, a lung health specialist at PCSI, the largest integrated pulmonary and chest specialty group in Palm Beach County.

A growing number of people are now experiencing some kind of sleep disturbance. It is estimated that 25 percent of the population has trouble sleeping at least 50 percent of the time.

The American Sleep Association tracks statistics on sleep disorders that show how severely American’s sleep suffers. Did you know…

• 37-40% of adults across all age groups sleep less than the required amount
• 30% of adults report some form of intermittent or short term insomnia, with 10% experiencing chronic insomnia
• 48% of the population regularly snores, which is not necessarily a sleep disorder, but can be indicative of more serious sleep problems like sleep apnea
• 9-21% of women and between 24-31% of men suffer from sleep apnea

These statistics are the tip of a very big iceberg of acute and chronic sleep disorders, and the numbers are continuing to rise. The current state of sleep disorders has escalated to become a public health problem. This issue is not too surprising since our modern world holds many challenges for healthy sleep including hectic work schedules, time spent traveling, lack of exercise, excessive alcohol consumption, and too much screen time.

The growing problem of sleep disorders has given rise to more and more expertise on the subject. Numerous sleep clinics now operate in most, if not all, major metropolitan areas in an attempt to mitigate the growing blight. In spite of this, the vast majority of sleep disorders are not diagnosed or treated.

What is a Sleep Clinic?

Sleep disorders can be difficult to differentiate. Why are you awake in the middle of the night? Is it because you have sleep apnea that woke you? Is it insomnia? Was it that extra glass of wine you had in the evening? Or is it something else?

Sometimes self-diagnosis can be effective, but other times you need a professional to diagnose your sleep disruptions. Your general practitioner may have suggestions, or you might need the expertise of a sleep clinic.

“Visiting a sleep clinic can be a powerful next step for people who have been experiencing sleep disruptions for some time,” says Dr. Peña-Hernández.

A sleep clinic is a specialized sleep center or department in a hospital, sometimes called a sleep lab, in which medical professionals work with hard-to-diagnose patients. While monitoring your sleep, they are set up to do a number of tests that supply data to the doctor in an effort to make a clear-cut diagnosis.  

A sleep clinic has rooms that look much like hotel rooms that are equipped with a number of monitoring devices. These devices record information as part of a sleep study. Clinics are accredited and prevalent in most cities. The sleep study is covered by insurance in many cases with a referral from your physician.  

What Can a Sleep Study Diagnose?

Sleep studies utilize monitors that can detect physiological reactions that are too subtle for us to notice.  Specifically, these devices test for changes in brain waves, breathing, heart rate, and what stage of sleep we are in and for how long.

“In many cases, you may find that you have an underlying sleep disorder,” says Dr. Peña-Hernández.

From this data your physician can get a clear picture of the root problem.

“By undergoing a sleep study, a physician can diagnose the root cause of your sleeping problems. You may receive a diagnosis for insomnia, narcolepsy, sleep apnea, or another sleep disorder,” says Dr. Peña-Hernández.

Insomnia

If you are unable to fall asleep or stay asleep in order to get the recommended 7 to 9 hours per night, you may be experiencing a case of insomnia. This is a very common sleep problem with up to one in three individuals experiencing either short-term situational insomnia or long-term chronic insomnia.

Related: How to cure insomnia without medication

Insomnia, over the course of many months, runs the risk of additional disorders like heart disease or diabetes. Insomnia can be caused by lifestyle choices or mental health conditions and can take multiple days in the sleep clinic to diagnose.

Narcolepsy  

Narcolepsy is a neurological condition hallmarked by the inability to stay awake during the day. It affects a very small portion of the population, about one in 2,000, and is challenging to manage. Symptoms include falling asleep unexpectedly, and struggling with excessive daytime drowsiness, to the degree that it compromises normal functioning.

Testing for narcolepsy is done slightly differently than with other sleep disorders. The patient is monitored both day and night to assess first if some other nighttime sleep disorder is causing the daytime drowsiness, and second to determine a pattern of daytime sleep.

Obstructive Sleep Apnea

Easily diagnosed in an overnight sleep study, the individual with obstructive sleep apnea has flaccid throat muscles that close and blocks airways. These patients frequently snore quite loudly, and periodically the blockage causes them to stop breathing and to wake. The waking is often so brief the sleeper remains unaware.

Related: Sleep apnea testing

Often the condition is not detected without medical observation. Obstructive sleep apnea happens most in overweight people and can cause excessive tiredness while awake. Treatments include mouth devices, weight loss, lowered alcohol consumption, or a certain products for sleep apnea treatment like a continuous positive airway pressure (CPAP) machine.

Rapid Eye Movement Behavior Disorder

This is a condition that happens for some individuals while in REM sleep. During these episodes, an individual’s muscles act out their dreams in a physical way. This can cause thrashing and loud vocalizations. It can result in violent movements that can injure a sleeping pattern or put the individual at risk. It is however, highly treatable.

Restless Leg Syndrome

RLS is a condition where the patient experiences strange sensations of tingling or numbness in their legs that requires movement to relieve. They can be particularly bad overnight and may make staying asleep very difficult. They can be associated with an iron deficiency and there are medications that work to relieve symptoms.

“In complex cases, long-term treatment may be required to resolve your sleep problems,” says Dr. Peña-Hernández.

How Does a Sleep Study Work?

A sleep study is an overnight test conducted at a sleep clinic or in a sleep lab. You can check-in during evening hours, sleep there, and leave in time for work in the morning.

An initial sleep study is generally one night, overnight. To treat for some specific sleep disorders, a longer 24-hour study may be required to test daytime sleep patterns as well.

Related: Sleep report test discussions

Once you are checked in, you will be hooked up to a number of monitors that will measure brain waves, oxygen levels, breathing, heart rate, and more. These measurement tests are non-invasive, not painful, and only minimally inconvenient. Some people even sleep better in the sleep study room because it is dark and relatively sensory free.

In any case, even if you don’t sleep well during the study, enough information can be gathered to help formulate a diagnosis and treatment plan. The primary diagnostic measurement tests include the following. 

Polysomnogram (PSG)

This is the main overnight test to assess all essential functions like blood pressure, heart rate, brain waves, breathing, oxygen levels in the blood, eye movements, and body movements. Sensors are places on your head, face, and chin, and the data from the polysomnogram will indicate the need for further testing or allow for a diagnosis.

Multiple Sleep Latency Test (MSLT)

MSLT is an additional daytime test that is used when looking at narcolepsy as a possible diagnosis or to test the possible efficacy of sleep apnea treatments. The MSLT is considered a “nap” study. This test measures brain activity and eye movements in order to access daytime sleepiness levels and quality of sleep. It looks at how tired the patient is and how quickly they enter the various stages of sleep.

Maintenance of Wakefulness Test (MWT)

The MWT is another test that can measure the effectiveness of sleep apnea treatments. This test assesses daytime wakefulness and how well the patient is able to stay awake for a defined period of time. It is used as an evaluation for jobs that require prolonged awake periods such as night security guards or over-the-road truck drives.

CPAP Titration

This is a regulatory test to determine the appropriate level of air pressure for the CPAP machine. This machine delivers forced air into the patient to keep airways open while sleeping. The test is performed during a second overnight stay at a sleep clinic, when the diagnosis of sleep apnea has been confirmed.

The CPAP machine is the current recommended treatment for obstructive sleep apnea but requires a balance of enough pressure to keep airways open, but not so much that it keeps the patient awake. This test determines the perfect setting.

What to Expect When You Undergo a Sleep Study

Most patients find a sleep study far less intimidating than it might sound. In essence, it is a prolonged doctor’s visit with testing. And, once you are hooked up to the monitors, you get to sleep through the tests.

Start preparing with the following steps:

• Choose a sleep clinic – This may happen automatically if your doctor refers you to a specific sleep clinic. If you are shopping for a clinic, consider the logistics of where it is located, especially if you plan to work the next day. Read reviews about the clinic online, and make sure it is an accredited clinic with the American Academy of Sleep Medicine.
• Determine cost and payment – Many sleep studies are covered by insurance, however you need to check that the clinic you have chosen is in network for your insurance and if you need a referral from a primary care physician. Make sure that the referral is done before the testing. You can private pay for a sleep study which runs around $1,000-$1,500 or more, depending on the need for multiple days.
• Keep a sleep diary – Your doctor may or may not ask you to keep a record of your sleep for several weeks prior to the test. You might record anecdotally things like time to bed and time awake, how many times up during the night, and for how long, and any comments from a partner like excessive snoring.

What to Expect the Night/Day of the Sleep Study

1. Arrive at the clinic – Pack an overnight bag with your tooth brush, sleepwear, and anything else you might need for an overnight stay. Arrive at the clinic at the designated time in the evening.
2. Get hooked up – Once you are comfortable, the sleep technician will begin attaching the electrodes to your head, face, and chin to monitor brain waves, eye movement, and teeth grinding. Similar monitors will be placed on your legs to measure activity. Straps will be put around your middle to measure breathing and a nasal air flow sensor placed beneath your nose. None of these monitors are painful in any way and are in fact designed to be comfortable and not to interfere with sleep.
3. Go to sleep – You will then be instructed to go to sleep. A technician will monitor you and be there in the event you need to get up and use the restroom, have questions, or experience anxiety. They will record any snoring and monitor the equipment overnight. In the morning, they will wake you at an assigned time if you haven’t woken naturally by that point. You can then plan to hear back from the doctor after test results have been complied, usually a week or more.
4. Follow-up – Once the results are in you will have a meeting with the doctor. This meeting will let you know if you need further testing, like a daytime sleep study, if you have been given a certain diagnosis, and what possible treatments are recommended. If you are diagnosed with sleep apnea, and a CPAP machine is indicated, you will need a CPAP Titration test to determine pressure.

Final Thoughts on Sleep Clinics

Good quality sleep is imperative for proper health. In an effort to properly diagnose possible sleep disorders, doctors refer to sleep clinics which conduct overnight sleep studies to gather data. These studies are non-invasive, simple, monitoring tests that give needed information. The data gathered allows for specific diagnoses and accurate formulation of a treatment plan.