Sleep Center

Initial consultations can be completed by your primary physician, or your primary physician may refer you to the Sleep Center for an evaluation. Patients may also directly call the CHI St. Alexius Health's Sleep Center to make an appointment with a Sleep Center physician. Appointments can be made Monday through Friday from 8 a.m. to 4:30 p.m. Sleep studies are scheduled Sunday through Thursday nights. Please note that sleep studies MUST be ordered by a physician.

If you have any questions related to sleep, or CHI St. Alexius Health's Sleep Center, please feel free to contact the Sleep Center at 530-SLEEP (7533).

What Are Common Sleep Disorders?

Sleep Disordered Breathing (sleep apnea) - All snoring is NOT sleep apnea, but if your snoring also includes gasping for air, pauses, snorts or excessive daytime sleepiness, you may have sleep apnea. When a person has sleep apnea, he or she stops breathing multiple (about 200-300) times during the night. The length of time the person stops breathing can be up to one minute each time. Sleep apnea that goes undiagnosed or untreated causes many nights of nonrestorative sleep or restless nights. This in turn can cause increased fatigue and sleepiness, drowsy driving, as well as increased risk of heart disease and other illnesses. Treatment options include CPAP therapy, surgical interventions, oral appliances, weight loss and lifestyle changes. To find out if you have sleep apnea, see a sleep specialist at CHI St. Alexius Health's Sleep Center or talk with your physician.

Obstructive Sleep Apnea (OSA) - a group of disorders characterized by cessation of breathing during sleep, excessive daytime sleepiness and frequent nighttime awakenings. Treatment often includes the use of device to assist breathing known as Continuous Positive Airway Pressure (CPAP) as well as some types of surgery depending on the severity of the sleep apnea. Other treatments may include oral appliances and weight loss. Undiagnosed and untreated OSA can lead to increased risk of heart disease and stroke. See a sleep specialist at CHI St. Alexius Health's Sleep Center or talk with your physician.

Restless Leg Syndrome - a condition in which one experiences unpleasant sensation in the legs and feet, especially at night. Often, patients complain of crawling, tingling, aching, stabbing, heaviness, or pins and needles sensation in one or both legs and even arms, usually when lying down or sitting. People affected by RLS may have trouble falling asleep or staying asleep which can lead to chronic sleep loss. This sleep loss can in time affect one's daily life. A sleep specialist at CHI St. Alexius Health's Sleep Center can help diagnose RLS or talk with your physician.

Periodic Limb Movement Disorder - this disorder is caused by the involuntary movement of the arms and legs during sleep or while going to sleep. PLMD seems to occur equally in men and women and occurs more as we age. The person suffering from PLMD may not notice the movement, but may feel the affects the next day due to excessive daytime sleepiness. See a sleep specialist at CHI St. Alexius Health's Sleep Center or talk with your physician.

Narcolepsy - a disease characterized by excessive daytime sleepiness and irresistible sleep attacks. These episode may last from seconds to minutes and occur two to six times a day. Sometimes there are bouts of sudden sleep attacks, insomnia, dream-like hallucinations and a condition called sleep paralysis. Symptoms generally develop when the person is an adolescent or young adult and can go unrecognized as the symptoms gradually develop over time. If you think you or someone you know may be suffering from Narcolepsy, contact a sleep specialist at CHI St. Alexius Health's Sleep Center or talk with your physician.

Insomnia - the inability to sleep at a time when the person expects sleep to occur. The difficulty may be in either falling asleep or remaining asleep, or both. The disorder may be primary or secondary to some other illness, condition, or circumstance. There are significant consequences for not getting a restful night sleep which may include daytime fatigue, depression, decreased ability for decision making and other health issues. See a sleep specialist at CHI St. Alexius Health's Sleep Center or talk with your physician.

Parasomnias (sleepwalking; sleeptalking) - abnormal behavior or movement during sleep such as sleep walking, talking in one's sleep, nightmares, and bedwetting. See a sleep specialist at CHI St. Alexius Health's Sleep Center or talk with your physician.

Pediatric Sleep Disorders - Children have different sleep patterns and also have different sleep needs. It is important to observe if a child is having problems breathing during sleep or if the breathing is noisy, if a child snores and if the snoring is loud, unusual nighttime awakenings, of if a child has difficulty falling asleep or difficulty maintaining sleep. Any of these problems along with daytime behavioral problems may also indicate a sleep disorder. See a sleep specialist at CHI St. Alexius Health's Sleep Center or talk with your physician.

What to expect when you visit

When you come to our sleep center for your test, you will be shown to one of our 6 private suites. You will have a full size bed, private bathroom and shower. The tech will be in an adjoining room during your test with the specialized sleep equipment monitoring your sleep.

Before you are hooked up with devices, you will be asked to complete a bedtime questionnaire which will include questions regarding the types of medication you may have taken on the day of your study as well as how you feel the day of your study.

You will be asked to put on your bedtime clothing and prepare for "hookup". This means the technicians will fasten all of the recording equipment to you. There will be recording electrodes on long wires adhered to your head, legs, chin and next to your eyes with a special glue or paste. They are used to measure brain activity as well as muscle movement during the test. These wires are connected to a special box next to the bed but you will still be able to move around as needed and get up to the bathroom if you need to.

The next device they will add will be a small tape-like device to the area just above your lip and below your nose to measure airflow out of your mouth and nose. This will be followed by 2 stretchy belts, one on your chest and one on your abdomen. These belts measure the movement of your chest and abdomen as you breathe throughout the test. The last thing is a small clip with an infrared light on your finger used to measure the oxygen in your blood while you sleep.

Once you are all set up, the technicians will need to perform a few calibration tests to assure everything is working correctly. Now it is time to wish you "Sweet Dreams" and the lights are turned out. The technicians are available if you should need anything during the night.

When morning arrives you will be awakened between 6:00 am and 7:00 am and all of the recording devices will be removed. There will be one more questionnaire for you to complete so that you can let us know how your night was and if it was different than what you normally experience. You are welcome to shower after the electrodes are removed.

We will always ask that you make an appointment with the physician who ordered the sleep study in order for you to get your results.

CHI St. Alexius Health's Sleep Center prides itself on being a comfortable place to visit and we will do whatever it takes to make sure your stay with us is a good one.

Most insurance companies do cover sleep studies. Although some insurance providers may require prior-approval before the study can be performed. To receive prior approval, the completed sleep questionnaire, as well as documented medical necessity (chart notes, letter of necessity from ordering physician) must be submitted.

Please contact the Sleep Center, or your insurance provider if you have any questions.

What Happens During A Sleep Study?

Standard protocol at the sleep center for diagnosing sleep-related disorders includes a pre-assessment of the patient. There is a history and physical exam (H&P), as well as a questionnaire. The patient is questioned regarding sleep patterns and difficulties. Following the evaluation, a diagnostic sleep study may be scheduled. The study is performed and scored by a registered respiratory therapist or registered polysomnographer. It is then interpreted by sleep center physicians to determine if treatment is necessary, and if so, what treatment should be prescribed. If desired, the ordering physician may also refer the patient to the sleep center for evaluation and treatment after the sleep study.

Things to remember the day of your study. General instructions for the day:

• Shower and shampoo the day of your study. Do not use hair products such as hair oils, sprays or hair gels.
• Do not take a nap the day of your sleep study.
• Continue taking prescribed medication unless otherwise advised by your physician.
• Avoid alcohol the day of your sleep study. Avoid caffeinated beverages 4-6 hours prior to your sleep study. This includes coffee, tea, chocolate, cocoa and colas. Decaffeinated beverages are highly recommended.
• Eat a good dinner before you come to the sleep center for your appointment.

If for some reason you cannot make your scheduled appointment, please call us before 3 p.m. the afternoon of your appointment to reschedule.

Tests Performed in our Sleep Center

Polysomnography or Overnight Sleep Study
This test is an overnight test used to help diagnose and evaluate sleep disorders. A PSG generally includes monitoring of the patient's airflow through the nose and mouth, respiratory effort, electrocardiogram (EKG), blood oxygen level, electroencephalogram (EEG), electro-oculogram (EOG), snoring, body position, and chin electromyogram (EMG).

Multiple Sleep Latency Test -MSLT
This is a series of naps given the day following a PSG which does not show evidence of sleep disorder. This test is used to determine the level of sleepiness or inability to stay awake.

Maintenance of Wakefulness Test-MWT
This is used to assess the severity of sleepiness in patients complaining of excessive daytime sleepiness. This test is performed during the day, and the patient is asked to stay in a darkened room and asked to relax and try to stay awake and avoid napping.

Actigraphy
This is the use of instruments sensitive to movement, typically worn on the wrist, to record activity over time. Activity levels correlate with sleep/wake patterns, pain level, mood, energy expenditure, fatigue/alertness and other quantifiable parameters.

CPAP/BiPAP
CPAP is short for Continuous Positive Airway Pressure. A CPAP machine is used to treat Obstructive Sleep Apnea (OSA). The CPAP machine blows a prescribed pressure in your upper airway to decrease the obstruction that causes the snoring, gasping and apnea. The optimal pressure should be determined during a sleep study and prescribed by your physician. A mask that covers just your nose OR your nose and mouth is used with the CPAP.

BiPAP or Bilevel is like a CPAP but uses two different pressures to keep the airway open. These 2 levels of pressure are used to eliminate or alleviate airway obstructions and snoring.

Nutritional Consultation
Weight loss can be a treatment for OSA. A visit with a dietitian can help manage caloric intake as well as helping you make better food choices. Losing just 10% of your body weight can reduce sleep apnea and help you get a great night's sleep.

Biofeedback
This tool can be used to train a person to use signals from the body to improve health. In the case of insomnia for example, one would learn techniques that would help one relax, decrease stress and help a person fall asleep. Biofeedback cannot cure a disease or disorder, but it can help one cope with and treat the problem.

Position Retention Therapy
This is just a fancy way of saying "Stay off your back". This can be accomplished by sleeping on one side or the other, by using a body pillow or by simply sewing a pocket in the back of a t-shirt and placing a tennis ball in the back. This will surely keep one off of one's back.

Pharmaceutical Interventions
Sometimes medication may be the only way to treat a sleep disorder. Restless Leg Syndrome (RLS) is a good example in which medication can be used to control the jerking of the legs and control for the sufferer to move his or her legs constantly. Medication may also be used to treat Insomnia and Narcolepsy. Your physician will know which medication is right for your problem.

Surgical Options
Surgery is an option for snoring and mild sleep apnea. Some procedures that can be performed to alleviate or decrease symptoms are:

• Nasal/turbinate surgery
• Tonsillectomy and Adenoidectomy
• Uvulopalatopharyngoplasty (UPPP)
• Laser Assisted Uvulopalatopharyngoplasty(LAUP)
• Tongue Surgery
• Genial advancement and hyoid suspension
• MaxilloMandibular Advancement
• Tracheostomy

Of course, discussion about any surgical procedure should be discussed with your physician.

Behavioral Modification
This means current behavior must be changed. Changing sleep habits to be more conducive to sleep may be all that is needed.

Some examples are:

• Setting a fixed bedtime and awakening time
• Avoiding alcohol, caffeine and nicotine 4-6 hours before bed
• Avoid napping during the day
• Exercise regularly, avoiding strenuous exercise 2-6 hours before bedtime
• Keep the sleep environment comfortable, cool, dark and quiet

Cognitive Behavioral Therapy for Insomnia (CBT-I)

CBT-I is a short-term psychotherapy or “talk therapy” for insomnia based on scientific knowledge about sleep. This non-medication treatment for insomnia is highly recommended as the first-line treatment of insomnia. Research has shown it to be as effective as sleeping aides in the short-term treatment of insomnia and usually more effective than sleeping aides in the long-term treatment of insomnia. The goals of CBT-I are to help you fall asleep, stay asleep, and improve your quality of life and daytime function as a result of better sleep at night.

CBT-I usually requires only six sessions to be effective. Some cases, may require extra sessions but your insomnia may also get better in fewer than six sessions. Each session lasts about 45–60 minutes.

For more information, talk with your CHI St. Alexius Health provider or contact CHI St. Alexius Sleep Center at 701.530.7533.

Other Sleep Study Resources

• American Sleep Apnea Association
• Restless Legs Syndrome Foundation
• American Academy of Sleep Medicine
• Download Sleep Center Brochure