Sleep Services

Diagnostic Sleep Studies (Polysomnogram – PSG)

Adult PSG – Adult polysomnography is a general monitoring of sleep. It includes monitoring of brain activity, eye movements, muscle activity, nasal airflow, respiratory effort and heart rhythm. This study is performed without the initiation of CPAP therapy during the night.

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    An in-lab sleep study (also known as an attended polysomnogram) will give with the most complete evaluation of your sleep. For your attended in lab polysomnogram you will stay overnight at the Sleep Disorders Center of Santa Maria. The sleep lab is located in the Marian Hancock Building (across the street from Marian Medical Center).At the Sleep Disorders Center of Santa Maria (SDCSM) you will be monitored by a polysomnographic technician. Your comfort and safety is very important to us and therefore one sleep technologist is responsible for no more than two patients at the Sleep Disorders Center of Santa Maria.

    An in-lab sleep polysomnogram records your brain waves, EKG (heartbeats) and breathing as you sleep. It also charts your eye movements, limb movements and oxygen levels in your blood. The data from your polysomnogram will allow the professionals at the Sleep Center to make a diagnosis and help develop a treatment plan for you.

    Your doctor may recommend an in-lab sleep study to:

    • Test for sleep-related breathing disorders including sleep apnea.
    • Evaluate behaviors during sleep due to parasomnias.
    • Diagnose periodic limb movement disorder.
    • Help with the diagnosis of REM Sleep Behavior Disorder (RBD).
    • Evaluate your sleep to obtain more information about excessive daytime sleepiness (hypersomnia).
    • Diagnose narcolepsy or other types of hypersomnia. (To diagnose narcolepsy in addition to the nighttime polysomnogram you will also have a MSLT -Multiple Sleep Latency Test).
    • Diagnose various parasomnias.
    • A titration polysomnogram may be done to titrate or calibrate the levels of continuous positive airway pressure which is necessary if you will be needing CPAP for treatment of a in patients who receive CPAP therapy for sleep related breathing disorders.
    • An in lab sleep study may also be necessary to determine why treatment for a sleep disorder is not working.

    For some patients suspected of obstructive sleep apnea, the sleep physician may recommend a home sleep test instead of an in-lab study. A home sleep test uses different equipment that you can set up yourself.

    An in-lab sleep study is the way to ensure that you have the proper diagnosis for a sleep disorder. If you think you may need a sleep study you should see one of the specialists at the Sleep Disorders Center of Santa Maria or your regular health care provider.

    In-lab sleep study – Testing Process & Results

    Testing Process

    When you are ready to go to bed, the sleep technologist will attach sensors to your body. The sensors, which are glued or taped to you, monitor your body while you sleep. These sensors are painless. Make sure to tell the technologist if you are allergic or sensitive to any adhesives. The sensors measure your:

    • Brain waves- to help determine what stage of sleep your are in.
    • Chin muscle activity
    • Eye movements (to determine when you are in rapid eye movement sleep – REM or dream sleep)
    • Heart rate
    • Nasal airflow
    • Breathing effort from your chest and abdomen
    • Oxygen levels
    • Snoring
    • Leg movements- leg muscle activity.
    • Other parameters depending upon your particular situation

    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).
    The wires are long enough to let you move around and turn over in bed. At the start of the test, you will be asked to move your eyes, clench your teeth and move your legs. This will make sure that the sensors are working and that they are calibrated properly.

    You are free to read or watch TV until it is time for you to try to go to sleep. At this time lights will go off and a low-light video camera will allow the technologist to see you from a nearby monitoring room. If a sensor comes loose the technologist will come in and re-attach the wires. When you need to go to the bathroom during the night, the technologist will have to help you with the wires.

    Many patients do not sleep as well as they would at home. This may be because of the sensors or the unfamiliar environment. This typically does not affect the results. Nearly everyone falls asleep during an in-lab study. In most cases, you do not need a full eight hours of sleep for the doctor to make a diagnosis. Occasionally, you may be prescribed medication to help you sleep during the in-lab sleep study.

    In the morning the technologist will test and then remove the sensors. You will be asked to fill out a morning questionnaire that asks about the quality of your sleep and your experience in the sleep center. The in-lab study is complete once you are awake and the sensors have been removed.

    Results

    Members of the sleep team will review and evaluate the information gathered during the sleep study. It typically will take several days to properly evaluate your sleep study and to have a complete summary report.

    In analyzing the data, a sleep technologist (Registered Polysomnographic Technologist/ RPSGT) will first score your sleep study by marking your sleep stages and identifying any events of abnormal breathing or leg movement. The board certified sleep physician will then review the results to determine what kind of sleep problem you may have. After the board certified sleep physician makes his diagnosis, you will have follow up in the office to discuss the results and you options of treatment.

Pediatric PSG – Pediatric polysomnography is a general monitoring of a child’s sleep. It includes monitoring of brain activity, eye movements, muscle activity, nasal airflow, respiratory effort and heart rhythm. This study is performed without the initiation of CPAP therapy during the night. Pediatric sleep studies in most cases also include monitoring of the carbon dioxide levels or ETCO2 monitoring.

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    An in-lab sleep study (also known as an attended polysomnogram) will give with the most complete evaluation of your sleep. For your attended in lab polysomnogram you will stay overnight at the Sleep Disorders Center of Santa Maria. The sleep lab is located in the Marian Hancock Building (across the street from Marian Medical Center).At the Sleep Disorders Center of Santa Maria (SDCSM) you will be monitored by a polysomnographic technician. Your comfort and safety is very important to us and therefore one sleep technologist is responsible for no more than two patients at the Sleep Disorders Center of Santa Maria.

    An in-lab sleep polysomnogram records your brain waves, EKG (heartbeats) and breathing as you sleep. It also charts your eye movements, limb movements and oxygen levels in your blood. The data from your polysomnogram will allow the professionals at the Sleep Center to make a diagnosis and help develop a treatment plan for you.

    Your doctor may recommend an in-lab sleep study to:

    • Test for sleep-related breathing disorders including sleep apnea.
    • Evaluate behaviors during sleep due to parasomnias.
    • Diagnose periodic limb movement disorder.
    • Help with the diagnosis of REM Sleep Behavior Disorder (RBD).
    • Evaluate your sleep to obtain more information about excessive daytime sleepiness (hypersomnia).
    • Diagnose narcolepsy or other types of hypersomnia. (To diagnose narcolepsy in addition to the nighttime polysomnogram you will also have a MSLT -Multiple Sleep Latency Test).
    • Diagnose various parasomnias.
    • A titration polysomnogram may be done to titrate or calibrate the levels of continuous positive airway pressure which is necessary if you will be needing CPAP for treatment of a in patients who receive CPAP therapy for sleep related breathing disorders.
    • An in lab sleep study may also be necessary to determine why treatment for a sleep disorder is not working.

    For some patients suspected of obstructive sleep apnea, the sleep physician may recommend a home sleep test instead of an in-lab study. A home sleep test uses different equipment that you can set up yourself.

    An in-lab sleep study is the way to ensure that you have the proper diagnosis for a sleep disorder. If you think you may need a sleep study you should see one of the specialists at the Sleep Disorders Center of Santa Maria or your regular health care provider.

    In-lab sleep study – Testing Process & Results

    Testing Process

    When you are ready to go to bed, the sleep technologist will attach sensors to your body. The sensors, which are glued or taped to you, monitor your body while you sleep. These sensors are painless. Make sure to tell the technologist if you are allergic or sensitive to any adhesives. The sensors measure your:

    • Brain waves- to help determine what stage of sleep your are in.
    • Chin muscle activity
    • Eye movements (to determine when you are in rapid eye movement sleep – REM or dream sleep)
    • Heart rate
    • Nasal airflow
    • Breathing effort from your chest and abdomen
    • Oxygen levels
    • Snoring
    • Leg movements- leg muscle activity.
    • Other parameters depending upon your particular situation

    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).

    The wires are long enough to let you move around and turn over in bed. At the start of the test, you will be asked to move your eyes, clench your teeth and move your legs. This will make sure that the sensors are working and that they are calibrated properly.

    You are free to read or watch TV until it is time for you to try to go to sleep. At this time lights will go off and a low-light video camera will allow the technologist to see you from a nearby monitoring room. If a sensor comes loose the technologist will come in and re-attach the wires. When you need to go to the bathroom during the night, the technologist will have to help you with the wires.

    Many patients do not sleep as well as they would at home. This may be because of the sensors or the unfamiliar environment. This typically does not affect the results. Nearly everyone falls asleep during an in-lab study. In most cases, you do not need a full eight hours of sleep for the doctor to make a diagnosis. Occasionally, you may be prescribed medication to help you sleep during the in-lab sleep study.

    In the morning the technologist will test and then remove the sensors. You will be asked to fill out a morning questionnaire that asks about the quality of your sleep and your experience in the sleep center. The in-lab study is complete once you are awake and the sensors have been removed.

    Results

    Members of the sleep team will review and evaluate the information gathered during the sleep study. It typically will take several days to properly evaluate your sleep study and to have a
    complete summary report.

    In analyzing the data, a sleep technologist (Registered Polysomnographic Technologist/ RPSGT) will first score your sleep study by marking your sleep stages and identifying any events of abnormal breathing or leg movement. The board certified sleep physician will then review the results to determine what kind of sleep problem you may have. After the board certified sleep physician makes his diagnosis, you will have follow up in the office to discuss the results and you options of treatment.

Split Night PSG – A split polysomnography is a test that is usually ordered for adults as a first-time study or if a patient has not been evaluated for several years and does not use their therapy at night. This study monitors many body functions including brain activity, eye movement, muscle activity and heart rhythm during sleep. If the patient qualifies and clearly has moderate or severe sleep apnea during the first part of the night, the patient will be placed on continuous Positive Airway Pressure (PAP) therapy in an attempt to determine the optimal pressure that will resolve the sleep related breathing disturbances.

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    A split polysomnography (SNPSG) is a test that is usually ordered for adults as a first-time study or if a patient has not been evaluated for several years and does not use their therapy at night. The SNPSG is essentially a combination of a diagnostic polysomnogram and a titration polysomnogram done all in one night. This study monitors many body functions including brain activity (EEG), eye movement (EOG), muscle activity (EMG) and heart rhythm (EKG) during sleep. If the patient qualifies and presents moderate or severe sleep apnea during the first part of the night, the patient will be placed on continuous Positive Airway Pressure (PAP) therapy in an attempt to determine the optimal pressure and appropriate CPAP mask that will eliminate sleep disturbances.

Titration PSG – A titration polysomnogram is performed to determine the necessary CPAP pressure required to alleviate apnea or other sleep disorders such as snoring. This study monitors the same body functions as the PSG while the patient is using CPAP.

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    PAP or positive airway pressure treatment is used to manage sleep-related breathing disorders including obstructive sleep apnea, central sleep apnea, complex sleep apnea and hypoventilation and hypoxemia. Once you are diagnosed with one of these disorders, you may need a CPAP titration study before you can begin treatment. A CPAP titration study is a type of in-lab sleep study used to calibrate continuous positive airway pressure (CPAP) therapy. The titration polysomnogram will also allow the sleep technician fit you for a comfortable fitting mask that will work well for your needs.Although we generally refer to all forms of positive airway pressure therapy as “CPAP” there are a number of other variations on PAP therapy which are different ways of delivering the air pressure. A PAP titration polysomnogram will allow your sleep specialists to determine which type of PAP device is best for your. Some of the types of PAP devices include: CPAP, Bilevel PAP, APAP, VPAP, VPAP-ASV, VPAP-ST, and IVAPS.

    In some cases, members of the sleep team may perform a CPAP titration study on the same night as your diagnostic in-lab sleep study. This is known as a split-night sleep study. The CPAP titration occurs in the second half of the night. This is usually only offered if the sleep apnea is moderate to severe and the diagnosis is clear early on in your diagnostic polysomnogram.
    In more mild cases of sleep apnea, the CPAP titration study may occur on a second night after the sleep specialist reviews the results of the diagnostic in lab sleep study.

    CPAP Titration Study – Preparing for your study

    Your CPAP titration study involves an overnight stay at a the sleep center. The testing environment at the Sleep Disorders Center of Santa Maria is set up so you will be comfortable during your stay.

    On the day of your in-lab sleep study, you should:

    • Try to follow your regular routine as much as possible.
    • Avoid napping
    • Eliminate use of caffeine after lunch
    • Shower or avoid using hair sprays or gels that can interfere with the monitors for your sleep recording

    If you are on a regular medication, speak with your board-certified sleep medicine physician. Your doctor may recommend for you to temporarily discontinue using the medication.
    When it is time to report for your CPAP titration study, bring any items that you need for your nightly routine. Prepare for the sleep study as if you are staying at a hotel for a night. You may want to bring:

    • Comfortable pajamas or clothes to sleep in
    • A toothbrush, toothpaste and dental floss
    • Makeup remover
    • Reading material
    • Clean clothes for the morning

    CPAP Titration Study – Testing

    The main goal of your titration polysomnogram is to find the right amount of air pressure to prevent your upper airway from becoming blocked. This eliminates breathing pauses in your sleep and should allow you to breath easily while you are sleeping. During a CPAP titration study, members of the sleep team will calibrate your CPAP and adjust your pressures. The polysomnogram technician will also fit you for a comfortable mask.

    When you show up for the study in the early evening, you will be fitted with an appropriate mask that is connected by a tube to a small electric PAP unit. The fitting process is an important first step in the CPAP titration. Be sure to tell the technologist if the mask is uncomfortable or if there are air leaks around the edges of the mask. The PAP unit has a fan that blows air through the tube, into your mask. When you wear your mask, the air will gently blow into the back of your throat acting as a pneumatic stent to keep your airway from collapsing while you are sleeping.

    You will have some time to make yourself at home. There will not be any other patients in your room. You will have a bathroom available to use, and you will have a television that you can watch for a short time before your fall asleep.

    The sleep technologist will attach sensors to your body to monitor your sleep in just the same way as in the in-lab sleep diagnostic study. These sensors measure your brain waves, heart rate, breathing, oxygen levels and leg and arm movements. The wires are long enough to let you move around and turn over in bed. You will be asked to move your eyes, clench your teeth and move your legs. This will make sure that the sensors are working and to calibrated all of the equipment.

    Using a computer in the control room, the technologist will be able to control the PAP air pressure and the way the pressure is delivered to you. At certain intervals throughout the night, the technologist will remotely change the air pressure you receive through your mask. Pressure starts at a very low level and gradually increases. If problems are detected, the technologist may come into the bedroom to adjust or replace the CPAP mask. Tell the technologist if you are experiencing any discomfort with the CPAP treatment.

    Many patients do not sleep as well as they would at home. This may be because of the sensors or the unfamiliar environment. Occasionally, you may be prescribed medication to help you sleep during the titration sleep study.

    In the morning the technologist will test and then remove the sensors. The CPAP titration study is complete once you are awake and the sensors have been removed. You are free to leave and return to your normal activities.

    CPAP Titration Study – Results

    The board certified sleep physician will review the information gathered during the CPAP titration study to determine what level of CPAP treatment will work best for you on an ongoing basis. The physician will contact you when the results are ready. At a follow up visit your results will be discussed and a CPAP will be prescribed for you. You will be given instructions on how to get a CPAP unit and mask for use in your home.

    CPAP Titration Study – Follow-up

    On rare occasions, a CPAP titration study may fail to find the right pressure to treat your sleep apnea. In these cases, you may need a variable pressure device (or one of the other types of devices described above) instead of continuous pressure. The sleep physician may recommend a second titration study.

    Follow up in the office is very important to confirm the efficacy and compliance you’re your PAP treatment. When you come in for your follow up visit at the Sleep Disorders Center of Santa Maria it is important to bring in your PAP unit with the tubing mask etc. The CPAP will be downloaded at the follow up visit and the data reviewed. You should also have a list of any problems or complaints that you have with the CPAP so that these issues can be addressed. Changes in pressure, air temperature, air humidity, mask size or type and device type may be needed during the first few months of treatment.

    Sometimes the CPAP titration study may not determine your ideal set-up. If you have problems with the masks, straps, pressure or air temperature of your machine, contact the Sleep Disorders Center of Santa Maria as soon as possible. The sleep specialist may suggest a new mask, a machine that provides a different algorithm of pressure delivery or a change in your humidifier to make your treatment more comfortable. A nasal spray in some cases may help CPAP users with nasal congestion problems. Always talk to your sleep medicine physician before making any changes to your treatment.

OCST – Out of Center Sleep Testing

The only use of a Home Sleep Study is for diagnosing obstructive sleep apnea (OSA). The Out of Center Sleep Test (OCST) is often required as the initial screening tool by certain insurance companies today. Although home sleep testing works fairly well for the diagnosis of moderate to severe obstructive sleep apnea, the OCST has a high false negative rate. Cases of mild obstructive sleep apnea are often missed with this method of testing and an in lab polysomnogram will be necessary is there is significant suspicion of sleep apnea. For the home sleep test you will be given a device to take home and monitor your sleep. One of the staff will instruct you in proper use of the device in our office before you take it home. You will sleep with the device for one or two nights and you will return the monitor the next day for our review and analysis. In home sleep testing, your breathing and nasal airflow is monitored as well as your heart rate and oxygen levels.

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    OCST – OUT OF CENTER SLEEP TESTING OR LCT (LIMITED CHANNEL TEST/HOME SLEEP STUDY)

    Overview of Limited Channel Test / Home Sleep Study

    The only use of a Home Sleep Study is for diagnosing obstructive sleep apnea (OSA). The OCST is often required as the initial screening tool by certain insurance companies today. Although home sleep testing works fairly well for the diagnosis of moderate to severe obstructive sleep apnea, the OCST has a high false negative rate. Cases of mild obstructive sleep apnea are often missed with this method of testing and a in lab polysomnogram will be necessary is there is significant suspicion of sleep apnea. For the home sleep test you will be given a device to take home and monitor your sleep. One of the staff will instruct you in proper use of the device in our office before you take it home. You will sleep with the device for one or two nights and you will return the monitor the next day for our review and analysis. In home sleep testing, your breathing and nasal airflow is monitored as well as your heart rate and oxygen levels.

    Preparation for Limited Channel Test / Home Sleep Study

    A home sleep study is designed only for screening for obstructive sleep apnea (OSA) only as the sensitivity of a home sleep study is far less than that of the in laboratory sleep study (PSG). An initial meeting with a sleep specialist to determine who is eligible is required. Once a patient has met the requirements, they are given a device to take home and use during sleep to monitor breathing. As breathing is the only area being monitored, less sensors are required, hence the convenience to a home study.

    Limited Channel / Home Sleep Study Testing

    A sleep specialist instructs patients on how to use the devices and return the next day for results. All the patient must to do is set up the devices properly, sleep as usual and return the next day with the equipment for review.

    Home Sleep Study Follow Up

    A sleep professional will review and analyze the breathing patterns and problems of the patient and follow up will be done to determine a treatment plan.

PAPNAP:

A PAPNAP is a daytime study which is done to desensitize and acclimate you to CPAP therapy. This allows you to try several styles and sizes of masks and to find the best fit and size. At the Sleep Disorders Center of Santa Maria we will spend time with you at an office visit during the day to get you comfortable with CPAP, fit you with a comfortable mask, adjust the pressure and the ways with pressure is delivered, and adjust the temperature and humidity. After these important parameters have been adjusted you will be allowed to lay down with the comfortable mask on and perhaps take a nap. During your PAPNAP your will be educated about PAP treatment and your questions will be answered. You will be allowed to lay down with the CPAP on and different pressure settings will be applied to establish what pressure settings will work best for you. If necessary we will provide coaching to help you overcome anxiety, claustrophobia, stress, frustration, discomfort and insomnia which may be associated with use of your CPAP.

MASK FITTING:

To sleep well with CPAP, your mask must fit very comfortably on your face. There are hundreds of variations of CPAP masks in styles and sizes. There are masks which just cover the nostrils, just the nose, nose and mouth, entire face and masks that fit in the mouth. There are small masks sized to fit infants and toddlers as well as sizes for people who weigh 600 pounds or more. Nasal masks may be for a very wide or narrow nose. With a CPAP mask, just like with a shoe, it must fit perfectly. The first step in successful use of CPAP is getting you a comfortable, well-fitting mask. CPAP mask fitting can be done during a brief visit (usually less than 30 minutes) where we will optimize the mask interface. This is important to maximize you comfort and to avoid excessive air leak around your CPAP mask. This is also an important visit if you are having difficulty tolerating your mask at home before you repeat an overnight titration study.

MSLT – Multiple Sleep Latency Testing (MSLT) is a daytime nap study that tests for narcolepsy or other forms of hypersomnia. This study is performed in conjunction with a POLYSOMNOGRAM the night before. This test is to assess how quickly a person is able to fall asleep during the day after a typical night of sleep.

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    Excessive daytime sleepiness occurs when you are sleepy when you should be awake and alert. The board certified sleep specialist at the Sleep Disorders Center of Santa Maria will recommend an MSLT if he or she suspects you have excessive daytime sleepiness related to narcolepsy or another type of hypersomnia. Narcolepsy is a sleep disorder which occurs in about one in 2000 people.The multiple sleep latency test (MSLT) is the primary test done to make the diagnosis of narcolepsy. The MSLT tests for excessive daytime sleepiness by measuring how quickly you fall asleep in a quiet environment during the day. The MSLT is the standard test used to diagnose narcolepsy idiopathic hypersomnia.

    The MSLT is a full-day test that consists of four or five scheduled naps separated by two-hour breaks. During each nap trial, you will lie quietly in bed and try to go to sleep. Once the lights go off, the test will measure how long it takes for you to fall asleep. You will be awakened after sleeping 15 minutes. If you do not fall asleep within 20 minutes, the nap trial will end.

    Each nap will be taken in a dark and quiet sleep environment that is intended for your comfort and to isolate any external factors that may affect your ability to fall asleep. A series of sensors will measure whether you are asleep. The sensors also determine your sleep stage.

    Multiple Sleep Latency Test (MSLT) – Preparing for the MSLT

    A variety of factors can affect the results of your MSLT. These include:

    • Anxiety
    • Tension
    • Depression
    • Age
    • Caffeine
    • Drugs and medications
    • Amount of sleep prior to the study

    Because these factors may affect the results of your test, we recommend the following before your MSLT:

    1. Keep a sleep diary for two weeks. This will allow the doctor to see your sleep-wake patterns. This may help the physician identify other factors that may be causing daytime sleepiness. It will also help to ensure that you are allowing an adequate amount of time for sleep. (you can download a sleep diary form or you will be given this by the staff at the Sleep Disorders Center of Santa Maria).
    2. You will need to discuss the use of stimulants including caffeine with your sleep physician prior to your MSLT as these substances can alter the results of your MSLT. If you are on any medications, your sleep physician will help you to determine when you can use your medications before the MSLT.
    3. The night before your MSLT you will have an overnight sleep study. For the MSLT to be accurate, you will need to sleep at least six hours during the overnight sleep study. An overnight sleep study is also necessary to determine if another sleep disorder such as obstructive sleep apnea is causing your excessive daytime sleepiness.
    4. In rare cases, you may be required to take a drug test the morning of the MSLT. The drug test is to ensure that the MSLT will be accurate. There are a number of drugs that can affect the results of the sleep study. The results of the drug test will be kept private between you and the physician.

    MSLT Testing Process

    The MSLT will last for the entire day. Over the course of the day, you will take four or five scheduled naps. Each of these nap trials is separated by a two-hour break.
    You will take your first scheduled nap about two hours after you wake up from the overnight sleep study. About an hour before your first nap trial, you will eat a light breakfast.
    A sleep technologist will gently place sensors on your head, face and chin. These sensors are connected to a computer. Each sensor is long enough so you can move around and turn over in bed. The sensors show when you are asleep and awake. The sensors also transmit data used to determine when you are in REM sleep. Once you are connected, the sleep technologist will test the sensors by asking you to move your eyes, clench your teeth and turn your head. A low-light video camera will allow observation of your MSLT from a nearby room.

    The nap trial begins when the lights are turned off. You will lie quietly in bed and try to go to sleep. The MSLT will measure how long it takes you to fall asleep. It will also measure how long it takes for you to reach REM sleep (dream sleep).

    The technologist will awaken you after you have slept for 15 minutes. If you are unable to fall asleep, the nap trial will end after 20 minutes. At this time you will have an approximately two-hour break until your next nap opportunity. You will need to stay awake during this however other than not sleeping you are free to keep busy in whichever way you choose.

    This process will repeat four more times. After your second (noon) trial, you will have a light lunch. After your final nap trial, you will test the sensors again and they will be removed.

    MSLT Results

    It will take about two weeks to get the results of your MSLT. During this time, the results will be reviewed by a registered polysomnographic technologist and by a board certified sleep physician.
    Review of the data will determine exactly how long it took you to fall asleep during each nap study. The sleep technologist will also look at your sleep stages and determine whether or not you entered REM sleep. In patients with narcolepsy there will often two or more REM periods during the MSLT. People with idiopathic hypersomnia fall asleep easily and quickly during the MSLT however they generally do not reach REM sleep during the nap trial.

    The sleep technologist and the board-certified sleep medicine physician with than review and discuss the results. The doctor will use this information to make his or her diagnosis.
    On your follow up visit after the MSLT the sleep doctor will discuss your results, your diagnosis and your will be given options and recommendation for a treatment plan. If your primary care physician or another doctor ordered the MSLT, the board certified sleep medicine physician will send them the results.

MWT – The maintenance of wakefulness test is used to measure how alert a person is during the day. The patient sits in an isolated room without noise, bright light or any activity. The patient is to try and remain awake for a period of 20 minutes with two hour intervals. This test is commonly ordered for public transportation and safety professions to ensure the person is able to remain alert while performing their jobs.

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    The maintenance of wakefulness test (MWT) is intended to challenge patients to attempt to stay awake during periodic trials during the day. The MWT is used particularly for people in occupations where the ability to stay awake is a safety concern. The MWT is also used to determine if treatment for a sleep disorder such as obstructive sleep apnea or narcolepsy has been successful in resolving the excessive daytime sleepiness.Increasingly, a number of occupations are requiring MWTs for workers whose jobs require long periods of low-activity where safety is a concern. These types of occupations include: truck drivers, taxi drivers, pilots, and more. Many employers who are aware of an employee’s sleep disorders may want to verify that their employees are maintaining compliance with their therapy by ordering a MWT to make sure they are awake and alert during normal working hours.

    MWT procedure

    A maintenance of wakefulness test is administered over the course of a day at a the Sleep Disorders Center of Santa Maria. The purpose of the MWT is to measure how alert you are during the day and if you are to stay awake for a period of time in a quiet, relaxing, stimulation free environment.

    During the test, patients are given 4-5 trials of 40 minutes of relaxing in a quiet, dimly lit bedroom during which time you will be asked to sit still while looking forward, and not do anything stimulating that could intentionally keep you awake. You are not allowed to talk aloud, sing, read, or pinch yourself.

    The rooms are meant to isolates external factors such as noise, temperature, light, and activity. Basically anything that can keep a person awake through some sort of stimulation or discomfort is removed.

    Patients are connected to a variety of leads that monitor brain activity with 4 EEG (electroencephalography) leads, eye movements, chin movements.

    The first trial begins about 2 hours after your normal wake-up time.

    Each trial is spaced about 2 hours apart, during which time you can watch TV, read a book, have a meal, or move freely about the sleep center. You are not allowed to go outside as daylight is a factor that needs to be eliminated during a test.

    Results of the MWT

    Patients that are not experiencing excessive daytime sleepiness (EDT) should not have any trouble staying awake during each 40 minute trial. The trials end either after 40 minutes have passed and patients have remained awake the entire time, or when you fall asleep. If patients fall asleep at any time in the 40 minute trial, the trial is ended early.
    After the 4 or five trials a sleep technologist will look over the results and review the results with a board certified sleep specialist. Results of the test will help determine your level of sleepiness during the day.

    If the MWT does show you that you are unable to be vigilant and stay awake at the appropriate times during the test a medication to help with your alertness may be necessary.
    If you are still experiencing excessive daytime sleepiness after you have been prescribed therapy for your sleep disorder, you may want to discuss your symptoms with your primary care physician or contact the Sleep Disorders Center of Santa Maria to see if a maintenance of wakefulness test is appropriate for you.

    If you work in the transportation industry and your employer wants to verify you are capable of remaining awake and alert during the day, you may need to have a MWT performed. There are serious risks to drowsy driving, and making sure you are capable of maintaining wakefulness is key to not only your own safety, but the safety of others as well.

CPAP EQUIPMENT FITTING, ORDERING AND TROUBLESHOOTING.

For less than half the patients with obstructive sleep apnea, adapting to use of CPAP therapy is easy and they need very little assistance. For most people becoming comfortable with the use of CPAP takes some work and assistance. At the Sleep Disorders Center of Santa Maria we will do everything possible to make the CPAP comfortable for you. As we like to say “We won’t rest well until you do”.

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    For less than half the patients with obstructive sleep apnea, adapting to use of CPAP therapy is easy and they need very little assistance. For most people becoming comfortable with the use of CPAP takes some work and assistance.At the Sleep Disorders Center of Santa Maria we will do everything possible to make the CPAP comfortable for you. As we like to say “We won’t rest well until you do”.

    Some of the problems that people have with CPAP include:

    1. Uncomfortable mask fit.
    2. Cough related to the use of the CPAP.
    3. Dry mouth.
    4. Marks on the face.
    5. Claustrophobia with the mask.
    6. Facial skin irritation.
    7. Sore on the bridge of the nose or other area.
    8. Persistent snoring on CPAP.
    9. CPAP noise.
    10. Air blowing on the bedpartner from the CPAP.
    11. Pressure to high
    12. Pressure to low.
    13. Need for another mode of pressure delivery

    Our experienced Respiratory Therapists provide exceptional patient education. PAP equipment, During you follow up office visit with a sleep specialist you can also have a licensed Respiratory Therapist can help you resolved any of the issues listed above as well as many other CPAP problems. We can also give a detailed review on how to use and maintain your PAP machine and supplies. If you have any questions regarding your equipment or supplies contact the Sleep Disorders Center of Santa Maria. Our registered sleep technicians are ready to assist you with you CPAP.

    Refitting with different types of CPAP Masks

    The CPAP mask may cover just your nose, your nose and mouth or fit in your nostrils or even in your mouth. No matter what type of mask you use, it is important that it fits well and is comfortable. The mask must make a seal in order to keep your airway open through the night. A good mask seal will prevent air leaks and maintain the right level of air pressure. If you are having any problems with mask fit call use for help at the Sleep Disorders Center of Santa Maria. We will sleep better when we know that you are sleeping better.

    Pressure Settings and pressure delivery adjustments:

    The amount of air pressure needed for CPAP to treat sleep apnea depends on the person. Your sleep physician may recommend a CPAP titration study to calibrate your CPAP. Most CPAP units also come with a timed pressure “ramp” setting. This starts the airflow at a very low level, so you can fall asleep comfortably. The setting then slowly raises the pressure while you sleep until it reaches the right level to treat your sleep apnea.

    For various reasons some people do not do well with the constant pressure of standard CPAP. In these cases, you may need a variable pressure device instead of continuous pressure.
    Although we generally refer to all forms of positive airway pressure therapy as “CPAP” there are a number of other variations on PAP therapy which are different ways of delivering the air pressure. Other commonly used devices include APAP (automatically-adjusting positive airway pressure) devices which automatically raise or lower the air pressure as needed during the night. BiPAP (bilevel positive airway pressure) devices have two alternating levels of pressure. When you inhale the pressure increases, and when you exhale the pressure decreases. If you have difficulty with CPAP or APAP, the physician may recommend BiPAP. They may also prescribe BiPAP if you have sleep apnea along with another breathing disorder, such as COPD.

    The sleep team at the Sleep Disorders Center of Santa Maria will determine which type of PAP device is best for your particular needs. Some of the types of PAP devices include: Bilevel PAP, APAP, VPAP, VPAP-ASV, VPAP-ST, and IVAPS.

    Follow up in the office is very important to confirm the efficacy and compliance when you are on PAP treatment. When you come in for your follow up visit at the Sleep Disorders Center of Santa Maria it is important to bring in your PAP unit with the tubing mask etc. The CPAP will be downloaded at the follow up visit and the data reviewed. You should also have a list of any problems or complaints that you have with the CPAP so that these issues can be addressed. Changes in pressure, air temperature, air humidity, mask size or type and device type may be needed during the first few months of treatment.

Follow-up Consultation – Patients may follow up in our office after their sleep study is performed. Our staff may then make appropriate treatment recommendations and order any therapy, if needed. For most insurance plans, you do not need a primary care referral be seen for consultation and evaluation at the Sleep Disorders Center of Santa Maria. If you need an appointment for a sleep study or a consultation, please call us at 805-347-9132.