Sleep Center

The Sleep Disorders Center of Santa Maria is a complete sleep center with full accreditation by the American Academy of Sleep Medicine (AASM), for the diagnosis and treatment of all adult and pediatric sleep disorders. Diagnosis and treatment are offered in a comfortable and relaxed environment with special attention to patient questions and concerns. Our 4 beautifully appointed sleep rooms are designed with special accommodations for children and families. All rooms have queen size beds, high definition TV’s and easily accessible restrooms.

How to choose a sleep lab

There are many places to have “sleep testing”, however few are fully accredited sleep centers. American Academy of Sleep Medicine (AASM) accreditation is the gold standard by which the medical community and the public evaluate sleep medicine services. Their rigorous standards for accreditation ensure that sleep medicine providers display and maintain proficiency in areas such as testing procedures and policies, patient safety and follow-up, and physician and staff training. For more information go to http://www.aasmnet.org

Home sleep testing/out of center sleep testing (HST/OCST) is available for patients with special needs, and others at a reduced cost compared to in lab studies. The Sleep Disorders Center of Santa Maria has additional and specific AASM accreditation for HST/OCST. Special attention is focused on continuing sleep education for patients and families treated for sleep disorders to ensure patient comfort and compliance with the variety of treatment offered.

We also have the only pediatric accredited sleep center on the central coast of California having patients referred from Santa Barbara to northern San Luis Obispo county. This is important since children have significant differences from adults in the way they sleep which affects how testing is interpreted.

Unlike many sleep labs who only do sleep testing, select medication prescribing and positive airway pressure (CPAP/BiPAP), we offer a full spectrum of treatment options including surgery. This allows us to customize treatment based on you symptoms and anatomy. We also offer diagnostic and treatment options for insomnia, narcolepsy, periodic limb movement disorder, REM behavior disorder, and other parasomnias.

Sleep testing

What to expect during your sleep study?

Attention to your comfort and safety while in our sleep center is very important to us, as such, and upon the recommendation of the AASM, one sleep technologist is responsible for no more than two patients.

Our technologist will introduce and orient you to the sleep lab. You will be ushered into your private sleep room where you may then change into appropriate sleep wear.

20-30 minutes will be needed to gently apply sensors to your scalp, face, chest, hands, and legs that will record brain waves, eye movement, air flow from nose and mouth, breathing effort, oxygen levels, heart rate, muscle activity, and limb movement. All sensors are applied with mild adhesives, and are gently removed the following morning with light oil.

After sensor application your technologist will run a sensor check referred to as “bio-calibration”. Following that, for our adult patients, a gentle sleep aid may be offered to encourage sleep. You are then encouraged to lie down and sleep.

Monitoring is done from a tech room. For your safety and convenience, technologists will be at hand to assist you through the night. All techs are thoroughly trained in basic life support (CPR).

Sleep Apnea

What is Obstructive Sleep Apnea?

Apnea literally means “cessation of breath”. Obstructive sleep apnea (OSA), also called obstructive sleep apnea syndrome, occurs when there are repeated episodes of complete or partial blockage of the upper airway during sleep. When the soft tissues of the upper airway collapse during inspiration the diaphragm and chest muscles work harder to pull air into the lungs. Because there is not enough airflow to the lungs, the entire body including the heart and brain do not receive the oxygen that they need. The brain performs many restorative functions at night while progressing through different and important stages of sleep. When the oxygen levels drop due to obstruction, the brain must “wake up” partially adjust the body in a way to restore oxygen flow to the lungs. This not only is disruptive normal sleep but has numerous bad effects on the body.

Who Gets Obstructive Sleep Apnea?

According to the National Heart, Lung, and Blood Institute, more than 12 million people in the U.S. have sleep apnea. Of the total, more than half are overweight. Those figures also estimate that one in 25 middle-aged men and one in 50 middle-aged women have sleep apnea. However these numbers continue to increase. If you are related to someone with sleep apnea, you are more likely to develop sleep apnea yourself.

Sleep apnea is more common in men than in women. It is also more likely to develop in African-Americans, Hispanics, and Pacific Islanders than in Caucasians. The likelihood of developing the condition increases with age. For women, the condition is more likely after menopause.

Sleep apnea is more common among people with thick or large necks. The condition is also more common among people who have smaller airways in their noses, throats, or mouths. The small airway could be related to the actual size and shape of the airway, or to obstructions or other medical conditions that are causing obstructions.

Babies and small children may have sleep apnea that is caused by enlarged tonsils and/or adenoids. Adults may or may not also have enlarged tonsils causing obstruction. More commonly, their obstruction is caused by too much tissue in the back of the throat or poor muscle tone during sleep which normally keeps the tongue and other parts of the throat stiff when awake. For some people problems breathing through their nose can worsen or occasionally cause sleep apnea.

What are the signs/symptoms of obstructive sleep apnea syndrome?

Obstructive sleep apnea syndrome affects 1 in 5 adults. Less so in children, yet the incidence of obstructive sleep apnea syndrome in children is remarkably high.

Symptoms may include some or all of the following:

  • Excessive daytime sleepiness.
  • Daytime fatigue.
  • High blood pressure (hypertension).
  • Unintentional weight gain.
  • Snoring.
  • Witnessed pauses in breathing during sleep.
  • Waking gasping for air, or observed struggling to breathe during sleep.
  • Frequent awakening.
  • Frequent urination at night (nocturia).
  • Insomnia.
  • Disorder of initiating and maintaining sleep.
  • Morning headache.
  • Excessive movement during sleep.
  • Grinding teeth during sleep (bruxism).
  • Memory loss.
  • Mood swings or irritability.
  • Depression/anxiety.
  • Impotence, erectile dysfunction.

Untreated, obstructive sleep apnea syndrome may result in:

  • Untreated, obstructive sleep apnea syndrome may result in:
  • Heart disease.
  • Stroke.
  • Motor vehicle accident from drowsiness or inattentiveness.
  • Work related injury from drowsiness or inattentiveness.
  • Heart attack and/or sudden death during sleep.

What is central sleep apnea syndrome?

Central sleep apnea syndrome has prolonged periods of sleep without breathing, but unlike obstructive sleep apnea the body is not attempting to breath. This is related to inappropriate communication between the brain and the rest of the body, which normally maintains a regular breathing pattern. This can occur for a variety of reasons but including, heart disease and other circulatory disorders, chronic obstructive pulmonary disease, stroke, serious head injury and/or opiate pain management. Though far less common then obstructive sleep apnea syndrome, central sleep apnea syndrome has a relatively high incidence in persons with these latter conditions.

Symptoms of central sleep apnea are often similar to obstructive sleep apnea and can result in significant drops in blood oxygen levels, sleep disruption, daytime fatigue, and poor daytime function. Typical CPAP treatment will routinely make these events worse.

What is Complex Sleep Apnea Syndrome?

Complex sleep apnea syndrome has elements of both central and obstructive sleep disordered breathing. Treatment for true central sleep apnea syndrome / complex sleep apnea syndrome differs from obstructive sleep apnea syndrome, so careful diagnosis is especially important.

Sleep Apnea Treatment

Although not treating mild sleep apnea may be an option depending on your symptoms, treatment for moderate or severe sleep apnea has been shown to have significant improvement in quality of life and even increases your life expectancy. There are several options for treatment including positive airway pressure (CPAP), surgery and mandibular advancement devices. Your doctor will discuss which treatment(s) are best for you based on your anatomy, lifestyle and preferences.

What is CPAP?

Continuous positive airway pressure (CPAP) or nasal continuous positive airway pressure (NCPAP) is the gold standard treatment for obstructive sleep apnea syndrome.

Gentle air pressure, supplied by a small and quiet flow generator, is applied to the airway using a light weight nasal mask or interface that rests over the nose, to stabilize the upper airway restoring unobstructed air flow. Interfaces that cover nose and mouth are also available if mouth breathing is problematic.

How much pressure is needed?
Well…atmospheric pressure at sea level is 1034 cmH2O. A sneeze generates 90+ centimeters of water pressure (cmH2O) in the chest and lungs. Maximum pressure from a CPAP flow generator is 20 cmH2O. Most patients use half of that. So…not much.

What about the mask?
The right type of mask/interface is determined during careful fitting with CPAP use. Finding the right interface is the most important part of the process, like finding the right shoes. Poor fitting, uncomfortable, or unattractive shoes generally mean that the shoes stay in the closet or are returned unused. The same goes for the CPAP mask/interface. A large part of our job is to make you comfortable with your prescribed treatment, so proper mask/interface fitting is vital. There are numerous manufactures of positive pressure mask/interfaces, and numerous styles and sizes within each. Our ability to work with you and fit you properly and comfortably is what separates us from many sleep labs. We will find what suits you best.

Masks specially designed for children are available as well.

The same goes for flow generators, those devices that provide CPAP. Additionally, these generally run on house current and, as they travel well, are usually capable of running on European current. So…your life style is a will be considered.

Am I a good candidate for sleep surgery?
Not everyone is a good candidate for sleep surgery. In general people who have success with sleep surgery have large tonsils, smaller tongues, are not significantly overweight and have less severe obstructive sleep apnea. Over the years sleep surgeons have learned that there is no one-size-fits-all surgery to cure sleep apnea. However for select patients sleep surgery may be a very good option. Your doctor will discuss these options based on your individual anatomy.

Nasal Surgery for Sleep Apnea
Some patients with significant trouble breathing through their nose and less severe forms of obstructive sleep apnea may be good candidates for nasal surgery. This can frequently be evaluated in the office for correctable areas. For people with significant nasal obstruction and less severe sleep apnea, correction may improve or occasionally cure symptoms. Nasal surgery also helps people who need to use CPAP and are having problems with higher pressures.

Pediatric Sleep Disorders

Do children get obstructive sleep apnea?

Obstructive sleep apnea syndrome in children is characterized by recurrent events of partial or complete upper airway obstruction during sleep, resulting in disruption of normal gas exchange (intermittently low oxygen and high carbon dioxide) and sleep fragmentation. The clinical spectrum of obstructive sleep-disordered breathing (SDB) includes obstructive sleep apnea syndrome (OSAS), upper airway resistance syndrome (UARS) and primary or habitual snoring at the low end of this spectrum. In other words, primary snoring, which is defined as the presence of habitual snoring in the absence of apneas, gas exchange abnormalities and/or disruption of sleep, is very frequent in children, and represents a relatively more benign, albeit non-innocuous manifestation of increased upper airway resistance during sleep.

SDB occurs in children of all ages, from neonates to adolescents. Snoring, the hallmark indicator of increased upper airway resistance during sleep, is a frequent symptom during childhood, being reported in up to 27% of children affected occasionally, and 7–12% reporting habitual snoring, that is, loud snoring recognized by parents three times or more per week. The prevalence of OSAS is estimated at 2–3%.

Symptoms of OSAS in children are often subtle and therefore not always immediately recognized by the parents. The usual nighttime symptoms and signs of OSAS in children include: snoring, noisy breathing, snorting episodes, paradoxical chest and abdominal motion, retractions, witnessed apnea, labored breathing, cyanosis, sweating, recurring nightmares, excessive movement during sleep, and restless sleep.

Children with severe nasal obstruction may open their mouths and hyperextend their necks to breathe, minimizing snoring noises.

Daytime symptoms can include mouth breathing, difficulty in waking up, moodiness, morning headaches, nasal obstruction, daytime sleepiness, hyperactivity, poor scholastic performance, and cognitive problems. More severe cases of OSAS may be associated with pulmonary hypertension and cor pulmonale (right side heart failure), systemic hypertension, failure to thrive and developmental delay.

Other sleep disorders

Other sleep disorders (Parasomnias):

  • Narcolepsy
  • Insomnia.
  • Periodic limb movement disorder.
  • REM behavior disorder.
  • Circadian rhythm disorders.
  • Sleep phase disorders.
  • Night terrors.
  • Somniloquy (sleep talking)
  • Somnambulation (sleep walking)