Health Services

SLEEP LAB

Home Sleep Testing
An HST (home sleep test) is an accurate, convenient, and efficient method to detect significant obstructive sleep apnea (OSA). It has been validated in clinical research studies and is approved by the American Academy of Sleep Medicine (AASM) to diagnose OSA.
It involves taking a device home with you after our technicians have hooked up the necessary sensors and returning the device in the morning after a night of sleep at home. It is the most commonly ordered test for our patients.
To help get a good night’s sleep, you will also receive a Sleep Hygiene Guide.
The following flow diagram provides an overview of the overall process:
Forms

Sleep Lab - Equipment
Sleep Lab - Insomnia Severity Index
Sleep Lab - Questionnaire for Adults


SLEEP LAB - FAQS

WHAT IS OSA?
OSA stands for obstructive sleep apnea. It is a breathing disorder that occurs during sleep caused by partial or complete blockage of the upper airway (pharynx) leading to fragmented sleep, decreased blood oxygen levels and increased stress on the heart and blood vessels.
 
If untreated, severe OSA can contribute to hypertension, diabetes, stroke and heart disease. Mild OSA can contribute to daytime sleepiness, poor concentration, and non-restorative sleep. Diagnosis requires overnight testing to monitor breathing and oxygen levels in the blood.

WHAT IS REM SLEEP?
REM stands for rapid eye movement sleep and was discovered by Kleitman and Aserinsky at the University of Chicago in 1953. It is characterized by low muscle tone, dreaming, active brain wave patterns (similar to wakefulness) and rapid eye movements. The exact role of REM sleep is unclear. People normally cycle from non-REM sleep to REM sleep every 90 minutes or so and have longer periods of REM sleep as the night goes on. Breathing problems tend to be worse during REM sleep due to decreased muscle tone.

WHAT IS INSOMNIA?
Difficulty falling asleep, staying asleep or having poor quality sleep is known as insomnia. Insomnia is a very common problem. 50% of our clinic patients have occasional insomnia. Up to 19% have chronic insomnia that persists for months to years.
The following general recommendations for good sleep hygiene come from various studies and consensus recommendations from organizations such as the National Sleep Foundation.
Behavioral techniques have been shown to be more effective than sleeping pills in treating chronic insomnia. Most commonly prescribed sleeping pills have not been approved for long-term use by the FDA.
More information about insomnia and other sleep disorders can be found at the national Sleep Foundation website:
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Sleep_apnoea?open  

WHAT IS A SLEEP STUDY?
A sleep study is frequently used to help diagnose obstructive sleep apnea (OSA). It involves using a cannula to monitor airflow through the nose and mouth, belts to monitor respiratory effort and a pulse oximeter to monitor oxygen levels in the blood. A body position sensor and a microphone are also commonly used.

The testing can be done at home or in the sleep lab. Testing in the sleep lab is monitored by a technician who is there to ensure adequate collection of data or start CPAP treatment if needed. In addition to respiratory and oxygen data, sleep lab testing involves monitoring brain electrical activity (EEG) for sleep staging and monitoring leg movements with wires. These data are useful in diagnosing other conditions such as seizure disorder and parasomnias.

Usually, home testing is adequate to diagnose OSA in patients who do not have underlying heart or lung disease.

HOW DO I GET A SLEEP STUDY ORDERED?
You may want to talk with your Primary Care Manager (PCM) if you have symptoms of OSA.

These are common signs and symptoms of obstructive sleep apnea.

• Very loud snoring
• Witnessed apneas
• Choking or gasping at night while asleep
• Waking un-refreshed
• Morning headaches

WHAT IF I’VE ALREADY HAD A SLEEP STUDY?
If you have a sleep study from an outside medical facility please obtain a report and contact your PCM for treatment options. In some cases, a repeat study may be required. A sleep clinic appointment can be requested by your PCM.

HOW OFTEN MAY I GET A SLEEP STUDY?
In most cases, a normal sleep study excludes significant OSA and another study within 1-2 years is not indicated. You may contact your PCM for a referral to the sleep clinic to discuss special circumstances.

WHAT IF I MISS MY SLEEP STUDY APPOINTMENT?
Preparation is essential when booking your appointment and cancellations must be made within 48 hours in advance due to limited appointment slots. We are currently running 15 studies a night, seven nights per week which is our maximum capacity with current resources. Despite this, there is an equally high demand for sleep testing services.

Failure to keep your appointment will automatically cancel your sleep study referral. You must contact your PCM for a new referral if you wish to be evaluated again.

WHAT IF I DON’T GET DIAGNOSED WITH SLEEP APNEA?
If you have completed your sleep study, a report will be generated and entered in the electronic medical record within a week. We do not normally call patients with normal sleep studies. Please contact your PCM for results and possible further evaluation if you have not heard from the sleep lab after 1-2 weeks.

Other treatment for snoring:

• Nasal topical steroids
• Positional therapy: using pillows or cushions to maintain side sleeping position
• Oral appliance: retainer-like device to keep the lower jaw pulled forward during sleep
• Weight loss
• Avoidance of alcohol and sedatives
• Surgery

WHY CAN’T I STAY OVERNIGHT IN THE SLEEP LAB VERSUS USING THE “TAKE HOME” UNIT?
We are limited to four beds for attended in-lab sleep testing. In-lab testing is generally reserved for the following cases:

• Patients with congestive heart failure at risk of developing central sleep apnea
• Patients with severe lung disease who may require supplemental oxygen
• Patients undergoing evaluation for suspected parasomnias
• Patients undergoing testing for possible narcolepsy
We do accommodate some patients who have to drive over 100 miles to allow in-lab testing using portable monitors.

WHAT CRITERIA DEFER A PATIENT OUTSIDE OF THE PULMONARY/SLEEP LAB?
The following types of patients will be deferred for evaluation outside of NMCSD Sleep Center:

• Non-TRICARE Prime
• Patients who are Medicare or Prime Plus
• Patients under age 18
• Patients with insomnia who do not have symptoms of OSA. Sleep studies are not recommended for routine evaluation of insomnia according to AASM guidelines

WHAT DO I BRING FOR MY FOLLOW UP APPOINTMENTS?
All that is required from follow up appointments is a valid Government Issue ID or Military ID Card and any other medical records if seen by a different medical facility. Writing utensils are recommended.

Please bring your CPAP device with the power cord for all follow-up appointments in the Sleep Clinic. Remember to empty and dry the water reservoir to avoid damage.

WHAT SHOULD I BRING?
• Appropriate bedclothes (preferably two-piece pajamas). Nightgowns and one-piece pajamas sets are not acceptable attire, and nudity is not permitted.
• If you use a CPAP/Bilevel machine bring your current mask. If you do not know your current pressure or have been instructed by your sleep physician, bring your CPAP/Bilevel.
• Any medications you may need during the night of the study in the original medication container. Prescription and non-prescription medications are not dispensed at the Sleep lab.
• Personal toiletries (toothpaste, toothbrush, comb, brush, shampoo, etc.), and a change of clothes for the next day. The lab provides towels and bedding (but no toiletries).
• Please feel free to bring a special pillow, stuffed animal, or white noise device if desired. Children should bring favorite blankets, books, or toys.
• No animals unless medically authorized.

SHOULD I HAVE DINNER?
You can have dinner before or after (you should never interrupt your routines except what is specified in the attachment i.e. Gym, Swim, Shower, or anything that will require you to remove or will result in the removal of the sleep study machine).

CAN I HAVE A NAP?
NO, this will ensure you fall asleep

CAN I HAVE CAFFEINE?
NO coffee or caffeinated drinks, this will ensure you fall asleep

CAN I SMOKE?
No. Smoking is strictly prohibited.

WHAT HAPPENS WHEN I ARRIVE AT THE CENTER?
All testing is performed in the Sleep/EEG Lab which is located in building 3, 2nd floor. For clinic visits, please report to the Sleep Clinic which is located in building 3, 3rd floor.

WILL I HAVE A PRIVATE ROOM?
All overnight PSG testing is performed in private rooms.

WHAT IF I NEED TO GO TO THE BATHROOM DURING THE STUDY?
Rest room facilities are located in close proximity to your private rooms. Keep In mind once a Sleep Study has begun there are restrictions on the removal of clothing items from the waist up.

WHAT HAPPENS WHILE I AM ASLEEP?
Once you have fallen asleep you will be continuously monitored by video camera and sensor probes to keep track of your oxygen levels, nasal airflow, breathing effort, snoring, and limb movements.

WILL I BE TREATED FOR MY SLEEP DISORDER WHILE I’M THERE?
If we observe moderate or severe obstructive sleep apnea during overnight testing, the technician may start CPAP treatment during the study. We may observe you on CPAP for the remainder of the night to ensure effective therapy.

WHAT TIME WILL I BE AWAKENED?
All home testing equipment must be returned to the Sleep Lab by 8 a.m. the next day unless special arrangements have been made. If your habitual wake up time is later, you will need to make arrangements with the technician for a later drop-off time. If you fail to return the equipment by the appropriate time, your Chain of Command will be notified. The technician will instruct you on how to disconnect the unit, place in a plastic bag provided and have the unit returned by 8 a.m.

WHAT HAPPENS IF I AM SCHEDULED FOR A NAP TEST (MSLT OR MWT)?
If you are scheduled for and MSLT, you will remain after your sleep study to undergo 4-5 nap tests every two hours. All testing is complete by approximately 5:30 p.m. the next day. The technicians will go over the entire procedure and will conduct your study throughout the day.

WHAT HAPPENS AFTER MY SLEEP STUDY?
If your sleep study is abnormal, you will be notified by our staff to schedule a group clinic visit to review obstructive sleep apnea (OSA) and CPAP treatment. Risks, benefits, and alternatives of treatment will be discussed during a 35 minute presentation. Sleep test results will be reviewed individually and CPAP treatment will be offered.

If your study is normal, we recommend contacting the ordering provider to discuss the results and investigate other possible causes of your symptoms.

WHEN WILL MY DOCTOR RECEIVE RESULTS?
All home sleep tests are reviewed by a technician and then by a sleep physician. A report will be entered in the AHLTA electronic medical record in approximately 5 days after testing. In-house polysomnograms and MSLT/MWT are also reviewed by a technician and a sleep physician. Results are available in approximately 5 days.

HOW DO I GET MY RESULTS AND HOW LONG WILL IT TAKE?
Once a sleep study is completed, a report will be entered in the AHLTA electronic medical in approximately 5 days. The referring physician, PCM, or Outpatient Records may print the report for you. You will also receive a copy of your sleep study report during your group clinic visit.

WHAT IS A CPAP UNIT?
A continuous positive airway pressure (CPAP) is a machine used to create an “air splint” to keep your airway open during sleep.

WHERE DO I GET THE CPAP UNIT FROM?
If your sleeps study reveals that you have obstructive sleep apnea, you will be given an appointment in a group OSA/CPAP session. If you decide to proceed with CPAP treatment, we will initiate a referral through TRICARE and United Health for approval authorization for CPAP therapy. The CPAP machine will be issued by a civilian DME company that has been approved by TRICARE.

WHAT IS DME?
DME provider is a company that provides medical equipment as well as training and supplies for equipment such as CPAP. They are reimbursed by TRICARE for services but are not part of the military treatment facility. They are distinct from the actual manufacturer of CPAP devices in a similar way that mobile phone service providers (i.e. Verizon) are different from the manufacturer of the mobile phone (i.e. Apple)

HOW LONG DOES IT TAKE TO GET A CPAP UNIT?
The approval process can take up to 3 weeks after the referral is placed. The DME company will then issue the CPAP machine and supplies within a few days.

IS THERE A WARRANTY FOR THE CPAP UNIT?
Patients will be issued brand new CPAP machine and come with manufacture warranties. Problems and concern contact the medical equipment provider (DME) for device problems, replacement masks, and filters. We recommend keeping all paper work and pamphlets on your machine. If the issue cannot be resolved contact United Healthcare/TRICARE at 1-877-988-9378 for assistance.

The Sleep Lab is not authorized to attempt repairs on CPAP devices. We recommend against repairing CPAP devices on your own.

WHERE AND HOW CAN I GET REPLACEMENT PARTS FOR THE CPAP UNIT?
Contact the DME provider directly for assistance. The DME Company is different than the manufacturer of the CPAP device. The Sleep Lab will not be able to fix our trouble shoot your machine.

If the issue cannot be resolved contact United Healthcare/TRICARE at 1-877-988-9378 for assistance.

I HAVE JUST TRANSFERRED FROM ANOTHER COMMAND AND MY UNIT IS NOT WORKING, HOW MAY I GET MY CPAP UNIT CHECKED AND/OR REPLACED?
Contact the DME provider directly for assistance. The DME Company is different than the manufacturer of the CPAP device. The Sleep Lab will not be able to fix our trouble shoot your machine.

If the issue cannot be resolved contact United Healthcare/TRICARE at 1-877-988-9378 for assistance.

I HAVE JUST TRANSFERRED FROM ANOTHER COMMAND AND MY CPAP MASK HAD BEEN RUINED DURING THE TRIP, HOW MAY I GET THIS REPLACED?
Contact the DME provider directly for assistance. The DME Company is different than the manufacturer of the CPAP device. The Sleep Lab will not be able to fix our trouble shoot your machine.

If the issue cannot be resolved contact United Healthcare/TRICARE at 1-877-988-9378 for assistance.

WILL MY CPAP UNIT WORK WHILE I’M OUT AT SEA ON A SHIP?
Yes, CPAP machines are equipped with a transformer and can handle 110-240 volts similar to laptop computers. On ships and submarines, they may require an extension cord to your berthing space. They may also require straps or cords to secure them during sudden maneuvers. All CPAP machines should be inspected by your shipboard designated safety representative.

I AM GETTING DEPLOYED. WHAT PREPARATIONS SHOULD I DO BEFOREHAND? HOW WOULD I GET ANY REPLACEMENT PARTS IF NEEDED?
Patients with mild obstructive sleep apnea do not require a waiver for CENTCOM deployments. Moderate or severe sleep apnea requires a waiver with objective demonstration of adequate CPAP use. These guidelines are subject to change; please contact the deployment screener for the latest information.

You may be eligible to obtain batteries for CPAP use during deployment to an austere location. You may also be eligible for a deployment pack with additional supplies including extra masks, headgear, and tubing depending on the location.

Most supplies can be shipped to APO/FPO addresses.

I KEEP TAKING MY CPAP MASK OFF AT NIGHT WITHOUT MEANING TO. IS THERE ANYTHING I CAN DO?
Wearing a CPAP mask at night during sleep is not natural and may take some effort initially to get used to wearing it. Some people require a few weeks of use before they become acclimated. It may also be helpful to wear just the mask disconnected from the CPAP unit while awake to improve tolerability. This is known as mask desensitization.

I KEEP FALLING ASLEEP WATCHING TV AND FORGET TO PUT MY CPAP MASK ON AT NIGHT.
It may be helpful to put the mask on prior to watching television. You can push the ramp button on the CPAP device to provide very low pressure for 20, 30, or 40 minutes similar to a “snooze” button. The CPAP machine will automatically provide therapeutic pressure after the timer stops if you fall asleep inadvertently.


 

Contact Us

Phone

(619) 532-5990
FAX
(619) 532-7625

Hours

Mon - Fri: 7:30 AM - 4:00 PM
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