Chapter 3
What’s Up, Doc? Getting a Diagnosis
In This Chapter
Figuring out what kind of doctor to see
Investigating insurance coverage
Understanding sleep tests
People who think they may have a sleep disorder sometimes put off getting medical help because the process of diagnosis and treatment seems mysterious or frightening. Or maybe they just don’t know where to start or what kind of doctor to see.
Sometimes people don’t know that they even have a sleep disorder. Perhaps they think that feeling not quite so perky when they wake up is a normal result of aging. They don’t realize that the ultimate purpose of sleep is to restore and refresh the body and the mind.
Occasionally, potential patients may be embarrassed that they snore or worried that their doctor will think they’re hypochondriacs for complaining about sleep problems. But if you’re having trouble sleeping, don’t let any of these factors keep you from seeking the help you need to get the peaceful slumber your body requires to stay healthy.
In this chapter, we tell you what sort of doctors deal with sleep disorders and the type of help you may expect to receive. We also demystify the diagnostic process and walk you step by step through the procedures your healthcare provider may use to help determine what’s causing your sleep disturbance. We look at insurance coverage and offer tips about how to get help for a sleep disorder if you don’t have insurance.
The hardest part is taking that first step. Use the information in this chapter to gain the confidence to seek medical help. So what have you got to lose? Nothing but another night’s sleep!
Consulting a Doctor
Not so long ago, in a galaxy not so far away, doctors who specialized in treating sleep disorders were regarded as only slightly less mysterious than Houdini. No one, including their professional colleagues, was quite sure what they did, or what it was they were treating.
Back in that same galaxy, when you mentioned the term sleep disorder, people stared at you as if you were speaking in tongues.
Today, thankfully, all that has changed. Just about everyone has heard or read about insomnia (see Chapter 4) or sleep apnea (see Chapter 9). Doctors who treat patients with sleep disorders even have a recognized practice of their own — they’re known as sleep specialists.
However, a sleep specialist is usually not the first doctor you see when you’re experiencing problems with your sleep. Most insurance companies require a referral from your family doctor before you can see a sleep specialist, so the best place to start looking for help is your primary care physician (PCP). He or she can perform a basic examination and decide if your symptoms require further study by a sleep specialist.
Starting with your PCP
Your PCP is the best place to start looking for help. In fact, your PCP may be the only place your insurance company allows you to start.
After your PCP reviews your sleep diary, he or she may give you a complete physical to rule out underlying conditions that may be causing your difficulties. For example, if you have arthritis, your pain may be keeping you awake or awakening you in the middle of the night. Or perhaps an acid reflux condition (heartburn) is disrupting your slumber. For more information about pain and indigestion and how they disrupt sleep, see Chapter 5.
Be sure to let your doctor know if you’re dealing with any ongoing stressful situations or emotional problems because they may be contributing to your sleep difficulties. For example:
Your company has announced upcoming layoffs.
You’re going through a divorce.
You have a terminally ill family member.
These stressors can contribute significantly to a temporary or worsening sleep problem. Knowing about them helps your doctor pinpoint possible causes for your sleeplessness or sleepiness.
If your problem is insomnia and your doctor strongly suspects that a temporary stressful situation is causing your sleep problems, she may give you a prescription for a short-acting sedative-hypnotic medication, such as Ambien. (See Chapter 4 for more information about prescription sleep aids.) These medicines are safe and appropriate for short-term use to help you get through the rough patch without becoming too sleep-deprived. However, if your problems are more complex, or if your doctor notices symptoms related to an underlying movement or breathing disorder, she will probably refer you to a specialist for additional testing. See the “Being referred to a sleep specialist” section later in this chapter for more information about sleep specialists.
If your PCP doesn’t seem sympathetic to your concerns, he may not be well versed in identifying and treating sleep disorders. Some doctors may even dismiss your concerns. One factor contributing to this situation is that the subject of sleep disorders isn’t even included in many medical schools’ curriculums.
In addition, your doctor may be hesitant to prescribe a sleep aid such as sleeping pills because some PCPs still believe that all sleeping pills are addictive. In the past, they were! However many excellent, nonaddicting sleep medicines are now available that your PCP may not be aware of.
Some family practitioners may also overlook sleep apnea and fail to refer patients who truly need treatment because they don’t recognize the symptoms the patients describe as life-threatening. An article published in Medical Clinics of North America in 1999 reported that between 90 and 95 percent of all sleep apnea goes undiagnosed; many of these cases slip right through the nets of family practitioners, unnoticed. Very recent studies, published in leading medical journals this past year, indicate that sleep-disordered breathing has much wider spread and more serious consequences than previously realized. This sort of late-breaking medical news was obviously not available years ago when your doctor was in medical school, even if sleep medicine had been taught.
Sleep specialists and PCPs aren’t the only doctors who work with sleep disorder patients. After your doctor completes your initial exam, if he believes you need additional diagnostic procedures or more specialized care, he may refer you to a specialist. After you see your PCP, you may also see a
Neurologist
Psychologist or psychiatrist
Pulmonologist or internal medicine specialist
Pediatrician (if the patient is a child)
Otolaryngologist or ear, nose, and throat specialist (ENT)
Dentist who specializes in dental sleep medicine
Being referred to a sleep specialist
Your PCP will refer you to a sleep specialist if he determines that you need further evaluation. As we mention earlier in this chapter, many different kinds of doctors can see sleep disorder patients. Sleep medicine is an emerging specialty, and more and more doctors are choosing to focus their studies in this area. But sleep medicine is still a subspecialty, and doctors must complete their medical training and primary specialty training before they study sleep medicine. For example, a doctor can be a neurologist, or a neurologist and a sleep specialist, but not just a sleep specialist.
Sleep specialists are trained to recognize the symptoms of all known sleep disorders, including sleep apnea, parasomnias, narcolepsy, various primary and secondary insomnias, restless legs syndrome, and periodic limb movement disorders. In addition, they also
Conduct sleep tests including overnight polysomnography (PSG) and multiple sleep latency tests (MSLTs) and interpret the results
Formulate treatment plans for patients who need continuing specialized care
Identify the different stages of sleep, including sleep arousals, abnormal breathing patterns, nocturnal movements, snoring, and epileptiform brain wave patterns (brain waves associated with epilepsy)
If you live in a rural area, you may not be able to find a sleep specialist nearby because sleep medicine is a relatively new specialty that just now is beginning to catch on outside of large urban and teaching hospital settings.
Neurologists
If you have a sleep disorder like narcolepsy (falling asleep suddenly and sometimes without warning throughout the day), idiopathic hypersomnia (sleeping too much), restless legs syndrome (involuntary movement of the limbs), or a sleep problem associated with Parkinson’s disease or multiple sclerosis, your PCP may refer you to a neurologist experienced in diagnosing and treating sleep disorders. These disorders originate with some sort of abnormality within the brain or nervous system. Many of the early pioneers in sleep medicine were neurologists who were interested in how the reorganization of the nervous system during sleep made it vulnerable to dysfunction. Because neurologists specialize in treating brain and nervous system disorders, they’re uniquely qualified to treat sleep disorders like narcolepsy.
Becoming a sleep specialist
Sleep specialists are MDs, DOs, and PhDs who, after completing their basic training, complete either a sleep studies fellowship of at least one year (although some programs run two or three years) or an elective year of sleep disorders study within their own specialty program. Some fellowship training programs are accredited by the American Academy of Sleep Medicine. The American Board of Sleep Medicine (ABSM) offers a two-part exam to clinicians completing sleep fellowships and clinicians in sleep dis-orders who have been practicing before such fellowships existed. Individuals who pass the ABSM examination may refer to themselves as Diplomates of the American Board of Sleep Medicine. However, some doctors call themselves sleep specialists even though they haven’t become a Diplomates of ABSM.
A neurologist experienced in the diagnosis and treatment of sleep disorders is a relatively rare bird. A little more than 900 of the slightly more than 12,000 neurologists in practice in the United States are listed with the American Academy of Sleep Medicine as sleep specialists.
Psychologists and psychiatrists
Understanding the relationship between sleep and dreaming was within the psychiatric-psychological domain long before the field of sleep medicine was born. Experimental psychologists and psychiatrists, now considered giants of the field of sleep medicine, paved the way for later clinical applications with early sleep research they conducted in the 1950s, ’60s, and ’70s.
Today you still find some sleep medicine specialists who initially trained as psychologists and psychiatrists and who have a background in behavioral medicine. This training helps them develop behavioral therapies to encourage their patients to comply with treatment plans. In addition to being fully qualified to interpret sleep study results, psychiatrists and psychologists can also treat coexisting emotional problems like stress, anxiety, or mood instability that may be contributing to sleep disturbances. Additionally, such clinicians are especially well suited to treat various forms of insomnia.
Psychologists and psychiatrists who specialize in treating sleep disturbances often use cognitive behavior therapy (CBT), stimulus control therapy, relaxation training, or universal sleep hygiene therapy to help their patients develop better sleep habits and attain a better quality of sleep. (See Chapter 4 for more on CBT and stimulus control, and Chapter 6 for information about relaxation techniques and sleep hygiene.)
Because they’re not medical doctors, psychologists can’t prescribe medications to help you sleep. However, most psychologists maintain working relationships with psychiatrists or other physicians they know and trust, who can evaluate your case and write the necessary prescriptions.
In addition, sometimes when you visit a mental health specialist, you get more than you bargained for, and find yourself being questioned about all sorts of other mental “disorders” that you think have little or nothing to do with your sleep problem. If you feel like your psychologist or psychiatrist is getting off track, remind him gently that you really want to deal with your sleep problem now, and will consider discussing other issues after your sleep problems have been addressed. But don’t forget that many mental problems, such as stress and anxiety, are tied directly to sleep disturbances. So don’t be too quick to take offense. It is important to know what sort of marriage you have or if you hate your boss.
Pulmonologists and internists
Your PCP may refer you to a pulmonologist or an internist if he suspects that you have a breathing disorder such as sleep apnea that requires more advanced management.
Pulmonologists are doctors who specialize in the diagnosis and treatment of lung disease. You may wonder why in the heck a person who treats lungs would be interested in sleep disorders. Well, sleep apnea involves a cessa-tion of breathing, and that interests pulmonologists very much.
Internal medicine specialists, often called internists (not to be confused with interns, who are doctors in training) are concerned with diseases of the internal organs in adults. Internists don’t perform surgery, but they manage patients’ conditions through a combination of medications and dietary and lifestyle modifications.
Pulmonologists and internists are particularly concerned with sleep apnea and the damaging effects it may have on the heart and lungs. In addition, internists may see patients whose sleep disturbances are caused by an underlying condition including acid reflux disease, gallbladder disease, or any condition that may cause pain and discomfort significant enough to disturb sleep. Pulmonologists likely see asthma patients whose breathing problems interfere with sleep much more than most people realize.
Most pulmonologists are primarily concerned with breathing disorders that affect sleep, such as obstructive sleep apnea (OSA), central sleep apnea (CSA), and nocturnal asthma. Your PCP will refer you to a pulmonologist or internist if he or she suspects a serious, life-threatening condition like OSA. Unless that pulmonologist or internist is a certified sleep specialist, he may not be as well versed in other types of sleep disorders that often coexist with your apnea.
Otolaryngologists
Otolaryngologists are doctors who specialize in the diagnosis and treatment of disorders of the ears, nose, and throat (that’s why they’re often referred to as ENTs). Your PCP may refer you to an ENT if you have some sort of abnormality in the architecture of your nose, mouth, or throat that may be contributing to snoring or sleep apnea. ENTs can perform surgery intended to reduce snoring.
Very few ENTs are well versed in sleep disorders, so the likelihood of finding an ENT who specializes in the treatment of sleep disorders, particularly in a rural area, can be quite small.
Pediatricians
If your child is experiencing a sleep disruption, don’t go see your PCP. Instead, first go see a pediatrician. A pediatrician can give your child a complete physical to rule out any underlying causes, and then refer you to an appropriate specialist for further testing and treatment.
You may be thinking, what are they talking about? Children don’t have sleep disorders! Oh yes, they do. Any of these sound familiar? Bedwetting, nightmares, sleepwalking, sleep-related teeth-grinding, talking during sleep, waking up in a state of terror, problems falling asleep? If you’re a parent of a small child, some of them probably do. Furthermore, many children snore loudly, suffer from nocturnal cough, or both. And all these conditions are either sleep disorders or contribute to poor-quality sleep in children.
Some pediatricians may dismiss your concerns and tell you that your child will outgrow whatever is causing the problem. But if nighttime sleep interruptions cause daytime sleepiness, crankiness, and poor school performance, you really do need to get to the bottom of the problem. Don’t be deterred from getting your child the help he or she needs to get back on a more normal sleep schedule. If your pediatrician won’t take your concerns seriously, then schedule an appointment with one of the other specialists we discuss in this section. Also refer to Chapter 14 for more on pediatric sleep disorders.
Dentists
Dentists who specialize in treating patients who snore or have sleep apnea practice a subspecialty called dental sleep medicine. Although they don’t diagnose such patients, they do create custom-made and fitted oral appliances that can help reduce snoring and keep air passages open for sleep apnea patients. The Academy of Dental Sleep Medicine promotes research on the use of oral appliances and oral surgery to treat sleep-disordered breathing. Many dental sleep medicine specialists are affiliated with sleep clinics.
Because dental sleep medicine is a relatively new subspecialty, specialists who practice this form of dentistry may be difficult to locate. Oral appliances are expensive, and some patients find that they’re so uncomfortable they can’t wear them for the entire night. Convincing your health insurance company to cover the cost of an oral appliance is sometimes difficult.
Getting Current on Your Insurance Coverage
Most companies that provide medical insurance have finally arrived in the 21st century, covering the cost of most sleep tests. These insurance companies now know that treating a patient with sleep problems early in the game can save them from forking over a bunch of money to satisfy claims for heart disease caused by sleep apnea or a fatal automobile accident caused by sleepiness. That said, don’t take anything for granted. Investigate your insurance coverage before you undergo any tests so you know whether the procedures are partially or completely covered.
Give the agent the list of tests your doctor ordered, and ask her if your policy covers each test. Finally, ask your agent to fax a copy of the approval for the tests directly to the doctor’s office. This simple step can save you tons of time and trouble later on when someone at the insurance company may “forget” that the company has already approved payment for the tests.
The total bill for your sleep test can vary depending upon the number of tests your doctor has ordered, your geographic location (test prices vary from city to city), and whether your insurance covers sleep studies. Most insurance companies pay between 70 to 90 percent of your total bill, depending on your coverage and deductible. The total diagnostic cost for an initial sleep lab work-up runs between $2,000 to $4,000 dollars, so your share of the bill could range from a low of about $200 to a high of $1,200. Your doctor can tell you what the costs will be for your particular case, and your insurance company can tell you what your share of those costs will be.
In some cases, insurance policies don’t cover the cost of sleep testing. In addition, more than 40 million adult Americans don’t have any health insurance at all. What should you do if you fall into one of these categories?
If you’re a private pay patient with no health insurance, some hospitals and clinics can arrange a payment plan that requires a down payment prior to the test with monthly payments thereafter until the bill is paid in full.
If you’re a veteran, many Veterans Affairs Medical Centers have excellent sleep labs and testing facilities available. Fees are generally based on a sliding scale according to your income or are charged according to what percent of service connected coverage you have been awarded. Check your phone book or call a government information hotline to get information about local services.
The availability of sleep testing in community and charitable hospitals is less consistent, but sometimes such hospitals have a working partnership with a nearby for-profit hospital that does the necessary testing. These partnerships make sleep study services available to some patients who may not otherwise have access to them. Local social service agencies can advise you about the availability of such services in your community and help determine if you’re eligible for this type of assistance.
Take time to investigate local medical schools. Many times the hospitals and clinics affiliated with medical schools have excellent sleep programs with services offered for reduced fees, or, if you take part in a study or clinical trial, you can sometimes get services for a limited time for free.
If your child is having sleep problems and you’re eligible for Medicaid or a state-sponsored child health insurance program, you probably can access services through that program. Because individual states administer Medicaid, guidelines regarding eligibility and available services vary. For an overview of the requirements for your state, visit http://cms.hhs.gov/medicaid/ and select your state in the pull-down menu.
If you’re age 65 or disabled, you may be able to get services under the auspices of Medicare. For more information on Medicare coverage, visit www.medicare.gov/Coverage/Home.asp.
Testing, Testing — One, Two, Zzzzz: Undergoing Evaluation at a Sleep Lab
Okay, you’ve been to the doctor, and he’s concerned about your sleep problems. He tells you he wants to schedule a sleep study in a sleep lab to help determine if you have a sleep disorder and what type of sleep disorder you may have. You may wonder, what is a sleep lab? How does a doctor test the quality of sleep? Lucky for you we answer these questions and take you on a tour of a sleep lab in the following sections so you know what to expect during your visit. Read on!
Locating an accredited sleep lab
The American Academy of Sleep Medicine distinguishes sleep labs that primarily study breathing problems that interfere with sleep (like sleep apnea) from sleep centers that routinely evaluate the full spectrum of sleep disorders. For the sake of expediency, we use the term sleep lab globally in this book to refer to any testing facilities that diagnose sleep disorders of any sort. You don’t need to worry about the difference; when your doctor refers you for testing, he selects a facility he trusts that offers the kind of tests you need.
As the practice of sleep medicine continues to expand, sleep labs are opening in more and more cities across the country as well as in Canada, Germany, Italy, France, and recently, Great Britain. Some are located in hospitals and some are free-standing. The advantage of a sleep lab is that the staff usually includes a cross section of different specialists. In fact, it may include most, if not all the doctors listed earlier in this chapter. All the equipment necessary to run the various tests used to diagnose sleep disorders is available in one central location, so you don’t have to go to multiple locations to complete the diagnostic process. No matter what’s disrupting your sleep, you can find someone knowledgeable and experienced to diagnose and treat you if you visit a full-service sleep disorders lab.
In locations where an accredited sleep lab isn’t available, ask your doctor to refer you to a reputable certified sleep specialist working in an unaccredited lab. (Wyoming is the only state that doesn’t have an accredited sleep lab.) You can still get high-quality care from a certified sleep specialist even in an unaccredited lab.
Touring a sleep lab
You may think that a sleep lab is some futuristic place where mysterious things happen, but these testing facilities aren’t something from the Star Trek galaxy; in truth, they look more like a comfortable motel bedroom. A second room is called the recording control room. It houses computers and testing equipment like a polysomnograph and sensors to measure various body functions such as breathing, heartbeat, and brain waves, a video camera to record you as you sleep, and speakers so that technicians may listen to any noises you make during the observation period. A trained technologist attends the machinery, adjusting recordings and re-hooking sensors if they fall off. He also monitors your condition on closed-circuit TV.
Other than a mobile cart that contains the various leads or transducers the technician attaches to your body, you really don’t see any equipment unless you specifically ask to see the recording control room.
Are you wondering what those nifty gadgets and gizmos are used for? The following section explains.
Being tested
Unlike some medical tests that may cause discomfort or even pain, sleep tests are non-invasive and painless. You simply go to the lab where a sleep technician hooks you up to a number of monitoring devices, get into a comfortable bed, and fall asleep. That’s it. (You can even bring your own pillows and favorite teddy bear if you want!) While you’re sleeping, technicians are busy monitoring a number of your bodily functions and recording your every move to determine if you have a sleep disorder.
Preparing for testing
Plan to spend the entire night in the sleep lab. (Normal arrival time is about 8 to 9 p.m. for most sleep labs.) Pack a small overnight bag, just as if you were visiting an out-of-town friend. Include any personal items you need such as a toothbrush or deodorant and any items that make you feel more comfortable such as a favorite pillow or blanket, plus a change of clothes for the next morning.
Don’t eat or drink anything containing caffeine, and don’t drink alcoholic beverages on the day of the test. Don’t take a nap; it will make falling asleep more difficult. And don’t do anything out of the ordinary as far as your diet or exercise regimen. If you take regular medications, ask your doctor if you should take them before the test. Your doctor will give you any more specific instructions he wants you to follow.
Getting wired to the polysomnograph
When you arrive, a technician shows you to a comfortably furnished bedroom loaded with unobtrusive scientific equipment. After you get dressed in your pajamas, gown, or any comfortable loose nightclothes, technicians attach sensors or transducers to your head, near your eyes, nose, and mouth, and on your chin, chest, and legs. A technician applies a special gel to your skin before attaching each sensor; this decreases electrical resistance and improves the signal quality. Note: The jelly can be cold! Sometimes the technician places a gauze patch with electrode cement over the electrode or tapes the sensor using special hospital-grade tape. The technician attaches another sensor, called a pulse oximeter, to one of your fingers or your earlobe. This sensor doesn’t require the use of gel.
What you’re being attached to is a polysomnograph machine, which records sleep patterns and bodily responses during sleep. The detail it provides can give your doctor a wealth of information about exactly what’s going on in your brain and body while you’re sleeping. The polysomnograph records the information, and a computer converts the information into graphical charts and summary statistics your doctor can interpret. The polysomnograph records
Airflow from the mouth and nose
Blood-oxygen levels
Brain waves (electroencephlaogram or EEG)
Eye movements (electroocuolgram or EOG)
Heartbeat (electrocardiogram or EKG)
Muscle activity and movements (electromyography or EMG)
Rib cage and abdominal movements
Each sensor measures something different. Table 3-1 explains the location of each sensor and what it measures.
| Location of Sensor | What It Measures | |
|---|---|---|
| Head | Brain waves | |
| Face near eyes | Eye movements | |
| Near mouth and nose | Air flow | |
| Earlobe or fingertip | Oxygen saturation | |
| Chin | Muscle tension | |
| Chest | Heartbeat | |
| Chest and abdomen | Breathing movements | |
| Legs | Leg movements |
Your doctor can look at a readout of your polysomnograph and tell
When you went to sleep
When you entered rapid eye movement sleep (see Chapter 1)
When you awakened and for how long
When and if you stopped breathing (sleep apnea)
How long it took for you to begin breathing again
Your doctor can also detect sleep-related movement disorders, abnormal heart rhythms and brain waves, and the level of oxygen saturation in your blood while you’re sleeping. All this information together gives your doctor an excellent idea of what is causing your sleep disturbances.
After you’re wired, the technician turns on a video camera (to record you as you sleep) and speakers (so that he can hear any sounds you may make). The technician also turns on all the sensors to start sending data back to a central computer where it will be recorded to produce a graphical record of your night’s sleep.
You may think you can’t possibly get to sleep with all the wiring, but that rarely happens. Surprisingly, even though they’re away from their familiar bedtime environment and wired up like a TV studio on election night, most patients fall asleep. That’s when the real sleep study begins.
If you snore very loudly, you may have obstructive sleep apnea or OSA. During OSA episodes, a sleeper stops breathing for 10 seconds or more, because the soft tissue in his mouth and throat collapses, blocking the flow of air. If you demonstrate signs of OSA during the sleep test, a technician may wake you up to fit a mask over your face to deliver positive airway pressure (PAP). PAP is one of the primary treatments for OSA; using the mask during the test tells technicians if it will benefit you or not and, more importantly, how much pressure you need to keep your airway open.
Taking a multiple sleep latency test
A multiple sleep latency test (MSLT) is a series of recordings that together provide a complete picture of your sleepiness pattern. Your doctor uses a polysomnograph to perform a MSLT, and he uses the test to measure how long it takes you to fall asleep at different times during the day.
MSLT is usually administered the morning after a formal overnight sleep study, although your doctor may choose to administer the test separately. Your doctor orders the test to evaluate excessive daytime sleepiness (EDS), to assess the presence of narcolepsy, or to distinguish true sleepiness from physical fatigue. Therefore, a MSLT is usually conducted during the day. Your doctor may use a MSLT to evaluate obstructive sleep apnea syndrome, insomnia, circadian rhythm sleep disorders, and other causes of excessive sleepiness, and to measure the effectiveness of prescribed treatments. A MSLT requires eight to ten hours to complete.
A technician places sensors on your face and head to record eye movement, muscle tone, and brain waves. You lie down in bed, with the lights off, and a technician tells you to not resist falling asleep. During a clinical MSLT, if you fall asleep, the technician allows you to sleep for 15 minutes while making recordings before awakening you. If you don’t fall asleep, the technician terminates the test session after 20 minutes. Even if you can’t fall asleep, your doctor can still gather useful information from the study.
The technician asks you to wait for approximately two hours (bring a book or a crossword puzzle!) before another test is performed. A total of four or five 20-to-35-minute test cycles are recorded over an eight-hour period.
Looking at home sleep studies
Recently, a number of companies have received FDA approval to market sleep test devices intended for use by consumers in their homes, with the idea that using such devices can save consumers money. But unlike a complete sleep study, which looks at all the possible indications that a person may have a sleep disorder, such devices usually measure only one to five parameters such as respiration, snoring, oxygen saturation, and heartbeat.
The best use for such devices is to screen people who may need more complete sleep studies. In that case, you can add the cost of the device to the cost of whatever sleep study your doctor orders. The least expensive at $100, the SleepStrip’s manufacturers even advertise it as a screening device and nothing more.
One of the most expensive, the BedBugg System, costs about half what a lab-based sleep study costs and detects the presence of sleep apnea, but not other sleep disorders. Your doctor orders the device, it’s shipped to your home, you hook yourself up to the three monitors (chest, breath, and fingertip), and then go to sleep. The next morning, you ship the device back to the manufacturer who produces a read-out to send to your doctor. The manufacturers claim that compared to polysomnography, which is the gold standard, the BedBugg has about a 96 percent accuracy rating. The BedBugg isn’t yet widely available.
Another recently approved device is called the Watch Pat 100, a finger sensor used to screen for obstructive sleep apnea (OSA). The Watch PAT 100 measures peripheral arterial tone (PAT). The idea is that PAT reflects what’s going on with your autonomic nervous system. Certain readings are suggestive of OSA.
If these devices catch on and doctors approve their use, it may be that eventually they will help lower costs for patients. However, currently they don’t constitute the diagnostic standard of practice. They’re shortcuts and recommended mainly
If sleep lab services aren’t available in your locality
To diagnose very severe cases of sleep apnea in places that have long waiting times before a study can be conducted
For follow-up to see if the treatments are working
Realize also that if your test is negative for sleep apnea, you’ll need a sleep lab study to find out why you have daytime sleepiness or insomnia. If your test is positive for sleep apnea, you’ll need a sleep lab study to adjust positive airway pressure.
Even if the home test is positive for sleep apnea, you may have other sleep disorders that contribute to your daytime sleepiness or insomnia. Nonetheless, if you’re interested in portable recordings, ask your doctor about the availability and advisability of using such a device.
Receiving the results
Your doctor usually receives your sleep study results in a week or two. When the results are in, you’ll meet your doctor for a follow-up meeting, and he will prescribe your treatment at that time based upon your test results. In some cases, he may order additional tests like a urine drug screen, blood chemistry, thyroid function, or MRI to clarify a diagnosis.
The treatment may include medications, the use of devices like oral appliances or a breathing mask that provides a positive flow of air throughout the night, nutritional and lifestyle changes, suggestions for better sleep hygiene, or perhaps even surgery. Your doctor will discuss a variety of treatment options with you, and you may try out several until you find something that works well for you. For example, perhaps one breathing mask isn’t comfortable and makes falling asleep difficult, while another is so comfortable you don’t even know you’re wearing it.
For information on treating specific sleep disorders, look up the disorder that interests you in the table of contents. Treatment options for that disorder are provided in that chapter.