Your physician wants you to have a Sleep Study done. Their office has scheduled an appointment. What’s next? What do you do? Where do you go? Are there needles involved? What if I can’t sleep?
It can be confusing when your doctor walks back into the room and tells you he/she thinks you have Sleep Apnea.
What is that anyway?
Sleep Apnea is what they call it when you stop breathing during your sleep for 10 seconds or more. This can be mild, in which case you might not need any therapy but would be monitored and possibly take another sleep exam in one-two years. A moderate case would mean you stopped breathing quite a few times during the night and would likely need to come back for the second part of the Sleep Study. The severe cases always come in for the second test and likely have other prominent and severe health issues that will be addressed by your physician.
Why am I having this done?
That is between you and your physician. I do not know or understand why sometimes your doctor will not mention WHY you are having the test done. I do know that I have patients that have ranged in age from 3 years to 68 years old. Some of them have had other health problems such as partial hearing loss, diabetes or some sort of heart condition. Others seem perfectly healthy but are under severe stress and the sleeping medications aren’t helping. There is no way for your Technician (Sleep Tech) to know for sure why you are there. This is something you should ask your doctor.
Ok, my doctor said I have to have the study. What now?
You go about your day as you normally would. Your physician’s office will get in contact with someone who offers Sleep Studies. They give them your name, phone number, address and some medical background such as age, date of birth, weight, height and any concerning health issues. From there it is up to whoever will do the Sleep Studies to contact you. At our office we have someone who will call you and set up an appointment date that is convenient for you. Our studies are done at night, when you would usually sleep. Our office will tell you that you will receive a call from your Technician one day prior to the appointment to verify you are still able to make it and set an appointment time.
Not all offices do this. Personally, in one cities I work in I have two locations. One being within the doctor’s office which called about the need for a Sleep Study and the other for those physicians who simply do not have room in their offices. Some Sleep Labs will have one permanent location for you to go to. Likely they will go ahead and give you a set time. Be certain you ask them on the phone, even if you have to call them back.
What do I tell the Sleep Lab when they call me? What would they possibly need to know?
When the Sleep Lab calls you they will verify the information they were given to them. If there are any other contact numbers aside from the number the number where they called you, give them that information. This will help the Technician to get in touch with you later. For example should you not be home when they call you may want to give them your work or cell phone number to reach you easily. Do not give them numbers that have been disconnected. If you are that determined not to have a Sleep Study done, please, tell them you refuse this treatment and do not wish to be called again. It’s a waste of the Lab’s time as well as the Technician’s time if you are scheduled and refuse to show up.
It never hurts to ask them for your Technician’s name either. If you work 2nd or 3rd shift, give them that information when they call you. If you are a parent and it is your child having the study, please give them your name and mention that it’s a child/teen having the study. If it is a child or teen under the legal age there will need to be an adult present at the time of the study. If you need some sort of paper for your work or school you may also mention this. Ask about their facility. Do they have twin beds or full? Do they have televisions, cable or DVD players? Is there a fan or alarm clock available? Anything that you might ordinarily do at home, be sure to ask about. Do you get up to smoke? Do you need water by your bed side? Don’t be afraid to ask questions.
When does the Sleep Tech call?
Personally I call the day before I have a Study. If for some reason I am unable to call you or if I have attempted to call and not spoken with someone I will call the day of the test. Sometimes the study can be done as early as that week you saw your physician. Other times it’s weeks or months away. In larger cities there is a possible waiting list that you would be on for this test. It is possible someone will cancel and there will be an empty slot, ask them to put you on some sort of list if you want to fill in. This will likely mean having to come in at the last minute but usually you would have one full day’s notice. Don’t forget though, your Sleep Tech is awake all night long monitoring you so they must sleep during the day. Your call likely will likely be in the morning or evening hours for this reason.
What about my insurance? Do I need to bring in all that information with me?
Not likely. You will want to ask the Sleep Lab on the phone prior to going for your test to be certain. Our Lab does not require that you bring any insurance information because your doctor’s office has already sent us that information and we have verified with your insurance company that you are covered and on file.
So what DO I need to bring?
Bring any medications that you ordinarily take at night. Other medications you have taken or are taking will likely be addressed in a survey so remember the names or bring a list. Your Technician will likely tell you to get a bath or shower prior to the appointment. Use only shampoo, no conditioner and no lotions. This is because we use a completely non-invasive method for the test. We use lots of cream and tape to keep the electrodes on and conditioner as well as lotions contain oils that keep things from staying in place all night. You would then see your Technician every 30 minutes or so during the night while they re-apply the electrodes to ensure you have an accurate test. Bring or wear comfortable, appropriate clothing to sleep in. We prefer pajamas (shorts or pants) over nightgowns, as it is easier when applying some equipment. No, you can’t sleep naked. Sorry, it’s just for one night.
If you know we do not have tv or a fan, ask if you can bring your own. You might me able to bring a laptop or portable DVD player. You may also bring books, cards or magazines to read. Ask questions.
Get to it already! What happens during the sleep test?
Forms
You may arrive on time or a few minutes early to fill out forms and sign paperwork. Yes, there is almost always something to sign.
*Packets may vary but in our packet we have our Work Order Sheet, this is what we have to have you initial and sign verifying we have your permission to administer the test.
*Next we have a paper telling you a little about our company, how many days it will take to get your results back and a phone number to reach us. With our company it takes 10-12 days to get the results. Our Sleep Specialist has tests come in from 50+ technicians, most are mailed in, so it takes a bit of time to get caught up and to get the information. Once they get it, they process it and alert your doctor of the results. Should your doctor call you for a re-test or for the second test (CPAP or Titration), ASK THEM WHY. I can’t stress that enough. You have a right to know any information about you. Ask for it.
*We have a form for you to sign that we send to your insurance so that they will pay for your test
*You will receive a copy of your Privacy Policy which states how important you personal and medical information is and any HIPPA information you may need. There is also a special email address and phone number if you have questions.
*A paper stating that you received and understood your Privacy Policy will need signing also.
*Finally is your survey. This will ask you any questions about how you sleep, any medications you are taking and a few other general things like your name, your date of birth, what doctor sent you to us, etc
Once you have completed the forms it’s test time. The setup takes roughly 45 minutes to an hour. Some technicians are faster at it but I’ve seen none that set up in under thirty minutes. Each test facility will differ. I can only tell you what we have and how I do the tests. You can ask each Technician how they do the test or just play the wait and see game.
Generally I have a cart with equipment on it. This varies by location. In smaller offices I set up a clean environment and put everything there. I begin at the lowest point and work my way up. First is our Leg Sensors. These look like mini paddles with wires that come from the top. One is labeled with an L the other R for left and right. These go on a specific muscle on your leg to monitor any leg movements during the night. Next come the belts; Abdominal, which goes around your waist usually around the belly button area and are secured with velcro straps and Thoracic, which goes under your arms around your upper chest, also secured with velcro straps. These monitor activity of your lungs and the wall of your chest. I place a Positioner on the Thoracic belt, this shows what side you are sleeping on at any given moment. ECG pads are placed on your chest. One above your heart and another on the right side of the chest. These will monitor your heart rhythm. Next is the Mic, which does what you think it does, it monitors any snoring that may be present. This is placed at the base of the neck around your esophagus. No it doesn’t record words, only lines.
Now for the fun part, your head and face. I call this the fun part sarcastically because this is where I draw the most complaints. Each wire is color coded so that we know exactly which each one is and where it goes. Order doesn’t matter but I’ll start from the base of the face and move upward. Two wires will be placed on your chin (EMG wires), spaced an inch or more apart depending on chin size and if you have a beard. On children it might even be on the sides of the jawline as these do come off very easily. EMG=Electromyography We use this to monitor mouth and jaw activity. Some sleep problems stem from gritting your teeth in your sleep or TMJ (Temporomandibular joint syndrome) which can be fixed with dental appliances or surgery. Two electrodes will be placed on either side of your head. Two on each side. One behind each ear and one on your scalp on either side. These are EEG and EEG (Sec) (electroencephalogram) and these monitor brain waves as you sleep. Lastly there are two that are placed around the eyes. One on either side and one on the forehead. These are the EOG(L) and EOG(R) leads or electro-oculography, and these will monitor any eye movement or brow movement. This will show us, along with brain waves, when you are in a deep REM sleep.
Two things will go under your nose. The Thermistor will go under your nose first. This monitors the temperature of your breathing. It is almost “T” shaped. On top of that is what is called a Nasal Cannula but is more recognizable as the tube that goes under your nose if you are on oxygen at the hospital. This will monitor your breaths per minute but will at no point be hooked to oxygen unless your doctor specifically asked for it.
The very last thing I put on is the Pulsox or Pulse Oximeter. This gives us your pulse and blood oxygen level for the night.
Once we’ve finished this you are in the home stretch. Every electrode has a wire. This drives everyone nuts. I often get the question “How can anyone sleep with all of this stuff on them?” or “Can I roll over with all of this on?”. You can roll from side to side as you usually do but should one come off we have to come in and put it back on. I wouldn’t say that it’s easy to sleep with the wires on you, but for one night it’s something that must be done to record everything and test you for sleep apnea and obstructive sleep apnea. Each wire goes to a box called a Patient Interface Box or PIB. This is connected with a thick cord to the recorder that will save all of your information. A card holds this information. Many recorders are different but ours holds a card not much larger than that of a card you would put in your camera. Each recorder also has a battery that last well over 8 hours. If you go outside or to the rest room you will take all of this with you. We can help you or give you something to help hold the cords closer while you walk.
Once you are ready for sleep we hook you up to one final cord. This is the only one that goes to the wall. Should you need to get up, you simply unplug this. This is a modem cord that connects your recorder to the company laptop. The Sleep Tech monitors this the entire time you are sleeping and keeps track of your stats every 15 minutes. We are also remotely monitored by another of our Labs. They can login to our computers and see our screens. If one of the cords becomes loose the lines that we see will go from steady to thick black lines, alerting us to the need for repair. Our Sleep Monitor alerts us if we didn’t see it because we were in a patient room or for whatever reason. They also call us or we call them with any questions or technical difficulty.
Everything we watch are a series of lines. For example, those police and hospital dramas on television show lines that spike up and down just before the patient “flatlines” or the line becomes one single unmoving line. That is what we basically watch. A series of lines.
Questions I hear:
What time can I get up?
This depends entirely on your Technician. Let’s say you are having the study done at your doctor’s office. They may open the next morning at 8am, so your technician would likely wake you around 4:30 or 5am. This is to ensure they are able to get everything off of you (usually only 15 minutes), send you home, pull off the dirty sheets and put on fresh ones, pack up the electrodes (some wash them on site others take them home to wash or sanitize), pack up their vehicle with equipment used and re-set the room to the way it was prior to the test. This could take an hour or more and employees to the office could arrive as early as 6am. Tell your Tech if you need to get up at a certain time.
What is this gunk in my hair?
That is EC2 cream. When we put the electrodes on we use creams and tape. If you are allergic to any tapes, we need to know this. Your doctor doesn’t give us a list of allergies. This cream dries and hardens a bit overnight. Not only does it keep everything in place for an accurate test but it leaves a mess in your hair the next morning. Not to worry, it washes out with warm water and soap. Your Technician can give you a wash cloth and direct you to the restroom before you leave.
Can I bring my dog? I can’t sleep without him/her.
Honestly folks. This is a medical environment. You have no idea how many times I’ve been asked this. No. I’m sorry. Fido will have to stay home alone for the night.
What if I can’t sleep?
This is understandable. You are in a strange place with a strange person and strange wires all over you. We understand this. No, we can’t give you anything to go to sleep. We also do not recommend taking any cough medicine that will make you sleepy. This should be as close to a home environment as possible. If you don’t do that every night, don’t do it at the Lab. Most Sleep Specialist will tell you they need at LEAST 4 hours of sleep time to analyze. It doesn’t have to be consecutive but there is no exceptions. If there isn’t enough time to evaluate on the card you will have to return for a retest. Some things that help are not drinking coffee or tea before coming in. Don’t drink lots of caffeinated drinks, eat sugary foods or go outside to smoke. The caffeine, sugar and nicotine are stimulants and are likely helping keep you awake.
What if I’m still not sleeping?
I tell this to all my patients, “I lock the doors to keep people out, not keep them in. If for any reason you feel uncomfortable or don’t feel you can sleep the full 4 hours; even if you wake in the night and “know” you won’t go back to sleep, I will not force you to stay there. I do let you know that you could possibly have to return for a retest. Some choose not to come back at all. That’s up to you. We call you for a reschedule later in the week. You can tell them whatever you like. If you decide to retest, set the date. If you decide you can’t do it again, refuse treatment. Your name will be sent back to the doctor and the reason for cancellation. The rest is between you and your physician.
If my child comes in, can my husband and I stay?
That all depends. One parent must stay with the child. The location used will likely have a full sized bed and this shouldn’t be a problem. You should be sure to ask when you call. If there is only a twin, ask that they have another bed sent over. If there is a two bed facility (separate rooms of course) ask if you will be the only patients there. Sometimes they’ll let your spouse use the extra bed.
What if my child doesn’t want to go?
It’s up to you. Doctors have recently been refusing to remove the child’s tonsils and adenoids until a sleep test if performed. I have parents that come in because their child snores, are obese and/or has breathing problems. Adults too of course. Adults can choose not to come, children are under parental direction. If you think they will have trouble during set up, often we can wait until they are asleep. You must still bring them in at the scheduled time so that they can meet the Tech and get use to the environment. This really helps them. Again, we can’t force anyone to stay. We do have a paper to sign called the Against Medical Advice (AMA) sheet. This is mostly in case someone is on sleep medication and wants to drive home before the test is up. This is not advisable but we can’t keep you for that reason, so you may need to sign an AMA.
LAST ONE
What if I have to come in for the second test? What is it and how will I know?
10-15 days from the time you had your test done your doctor will receive your results. If he feels it is necessary for a second test he’ll call the Sleep Lab and you will be scheduled for the second test. Usually the reason for this test is because you have stopped breathing a great number of times per minute and you are being tested to take home a CPAP machine. This is a box that administered forced air. It’s not oxygen per se. You don’t walk around with a tank and you don’t need it to maintain your daily life. You will receive a hose and mask that will be placed on you for testing. These usually go home with you also. The test itself is the same. The only things that differ are 1)The Mic is not used, you won’t be snoring with the mask on. It’s purpose is to stop the snoring by keeping the air passages open. 2)Thermistor and 3)Nasal Cannula are not used. You will have the mask on.
The CPAP machine will have a card in it to record what level number you need for your personal machine. When you test the machine will determine what level is best for you and this is what you will use on your machine. Test results are the same, 10-15 days and then you will receive your CPAP machine. The length of time you are on the machine is mostly up to you. Many things can get you back in for a retest and possibly so that you can get rid of the CPAP. Loss of weight (dramatic) or surgical procedure to correct the problem are just a couple of ways. Remember if this is what you need to help you breathe during sleep … embrace it!
If you have any medical problems such as a condition that causes you to have seizures or if you are diabetic, etc. please alert your Technician. They are not able to get your personal medical history but it’s good to know what to watch for should someone start convulsing out of the blue. We are not a daycare. Do not bring your child in and leave for any reason without your child. Please eat dinner before you come to the test. You may bring a snack or water. You can also ask the Tech if there is a water fountain or dispenser on premises.
Most importantly :
ASK QUESTIONS! It’s your body. Don’t be afraid to ask about your diagnosis.
You might have to take the test, but don’t be down about it. This is something that can change your life for the better! If you are getting oxygen to your heart and brain the way it needs to be, you will feel better and live healthier. This is good for you! So smile and be thankful you have a physician that cares enough to have you tested.
