Sleep Medicine

Insomnia is a common sleep disorder that makes it hard to fall asleep or stay asleep through the night. Our brains control when we wake up and when we sleep. Insomnia can happen when the brain is too alert or doesn’t have enough sleep drive. It can also be caused by medical or mental health conditions, including:

• Arthritis
• Asthma
• Certain medications
• Chronic pain
• Depression
• Reflux
• Sinus allergies

Narcolepsy is a lifelong sleep disorder that causes sudden, extreme tiredness, which may even make you fall asleep instantly. There are two types of narcolepsy:

1. Type 1: You feel very sleepy during the day and may experience sudden loss of muscle tone triggered by strong emotions.
2. Type 2: You experience excessive sleepiness but don’t have sudden muscle tone loss. Taking a nap can leave you feeling refreshed.

This disorder is rare in children, but about 2,000 people have narcolepsy and may not know it. Symptoms of narcolepsy include:

• Excessive daytime sleepiness
• Hallucinations
• Memory problems
• Sleep paralysis
• Sudden loss of muscle tone

Parasomnias are sleep disorders that involve unwanted experiences before, during, or after sleep. These may include abnormal movements, perceptions or dreams. You might not remember these experiences in the morning. There are different types of parasomnia, including:

• Bedwetting
• Frequent nightmares
• REM sleep behavior disorder
• Sleep hallucinations
• Sleep talking
• Sleep terrors
• Sleepwalking

Restless leg syndrome (RLS) is a neurological sleep disorder that causes an irresistible urge to move your legs. Like other sleep disorders, RLS can affect other areas of your life. It can make falling asleep difficult, as it’s hard to get comfortable. RLS may happen during the day, but symptoms often get worse at night. Common symptoms include:

• Burning or itching inside your legs
• Irritability
• Less than 5 hours of sleep per night
• Trouble sitting for long periods
• Urge to move your legs

Sleep apnea is a common sleep disorder that causes breathing to slow down or stop for a few seconds or minutes during sleep. "Apnea" means a pause in breathing for any reason. At night, your brain and nervous system control your breathing. Different types of sleep apnea can either block or interrupt your breathing, and they often share the same symptoms.

The most common signs of sleep apnea, include:

• Choking or gasping during sleep
• Feeling tired even after a full night's sleep
• Loud snoring
• Waking up with a dry or sore mouth

Types of sleep apnea, include:

• Central sleep apnea: This happens when the brain doesn't send the right signals to the muscles that control breathing, causing breathing to stop. After a short pause, the body starts breathing again on its own. Unlike obstructive sleep apnea, central sleep apnea may not wake you up, so you might not even realize you have it.
• Obstructive sleep apnea (OSA): The most common type of sleep apnea. It happens when the muscles in your throat relax during sleep, blocking your airway. About 18 million Americans—1 in 15 adults—have OSA. This often occurs when the tongue falls back in the throat, stopping oxygen from reaching the blood. When this happens—sometimes hundreds of times a night—the brain signals the body to wake up and take a breath.
• Mixed sleep apnea: When you have both central and obstructive sleep apnea at the same time. If you think you may have sleep apnea, your doctor may recommend an overnight sleep study to check for mixed sleep apnea.

For patients with severe sleep apnea, maxillofacial surgery may be necessary. This procedure involves repositioning the jaw to open up the airway and improve breathing during sleep. By moving the jaw forward, the airway is expanded, reducing or eliminating obstructions that may cause breathing interruptions. Maxillofacial surgery is typically considered when other treatments, such as CPAP, have not provided sufficient relief.

For individuals who snore or have mild sleep apnea, palatal surgery may be an effective solution. During this procedure, small rods are implanted in the soft palate to help prevent airway collapse while sleeping. This can improve airflow and reduce or eliminate snoring, making it easier to breathe through the night. Palate surgery is often recommended when other non-surgical treatments have not been successful in managing symptoms.

An implantable device called Upper Airway Stimulation (UAS) is FDA-approved and used to treat moderate to severe obstructive sleep apnea. The device works by stimulating the muscles in your airway to keep them open during sleep, eliminating the need for a mask or CPAP machine.

The UAS device is implanted under the skin, typically in the chest area, with a small wire connected to the nerve that controls the airway muscles. A small, external remote is used to control the device, allowing the person to adjust settings as needed.

UAS may be an ideal solution for individuals who:

• Are at least 22 years old
• Have moderate to severe obstructive sleep apnea
• Are concerned about the lack of oxygen and sleep deprivation caused by OSA
• Are not significantly overweight
• Have not responded well to CPAP therapy
• Feel excessively tired and struggling with daily activities

This implantable, mask-free treatment option can improve sleep quality and overall health, offering a more comfortable and effective solution for managing sleep apnea.

Before your sleep study, we take several important steps to make sure everything goes smoothly and that we gather the most accurate information to help with your diagnosis.

Before your sleep study:

1. Your order is received from your referring physician, reviewed, and notes are obtained
2. Your sleep study is scheduled
3. The insurance approval process begins

Day of your sleep study: When you arrive at the sleep center, a technician will guide you to your room. While the technician prepares the equipment, you can change into your sleepwear and relax. You can use our Wi-Fi or watch TV during this time, and there may also be some paperwork to fill out.

The technician will show you the equipment, explain the sleep study in detail, and answer any questions. The equipment includes:

• Two dozen sensors are applied to your skin with conductive paste and adhesive
• Elastic belts around your chest and abdomen
• A probe placed on your finger

What do the sensors do? These sensors monitor brain waves, muscle and eye movements, and snoring. The elastic belts measure your breathing efforts, and the finger probe monitors oxygen levels and heart rate. The equipment is designed to be comfortable and usually doesn’t interfere with sleep. Though your sleep at the center may differ from home, it generally won’t affect the study’s accuracy.

During the night: Lights out is at 11 p.m. You’ll be able to change positions easily. The technician (in a separate room) will be available if your sensors need adjusting or if you need to use the bathroom. Most people get up at least once during the night. You’ll be awakened at 6:30 a.m.

After the sleep study: A sleep technologist will process the data and work with a sleep medicine physician to interpret it. The technologist reviews the study twice for accuracy, and it may take up to 3 weeks for interpretation.

• If you had a diagnostic sleep study, your physician will send you a letter with the results, including whether you tested “positive” or “negative” for sleep apnea. Your physician will discuss the results at your next appointment.
• If you had a sleep study with a CPAP machine (also called titration sleep study), your physician will send a prescription for a CPAP machine to a durable medical equipment company. They will contact you to set up your machine, and we’ll schedule a follow-up appointment.
   

Here’s how to get ready for your sleep study so you feel comfortable and get the best results.

Before coming to the sleep center:

• Wash and dry your hair
• Pack an overnight bag, like you would if staying at a hotel
• Notify the center if you're on oxygen at home
• Bring your CPAP mask and headgear if you use a CPAP machine at home (no need to bring the machine)

For your sleep study:

• Do not use hair spray, oils, or gels – your hair should be clean and dry
• Continue your regular prescriptions, but let our team know what they are so we can check if any medication affects your sleep
• Bring your medications with you
• Wear loose-fitting sleepwear
• You can bring comfort items like blankets or pillows, but it’s not required
• Bring snacks since food is not provided

Yes, in some cases, you can do a sleep study at home. Home sleep testing uses a small device to monitor your breathing, oxygen levels and heart rate while you sleep in your own bed. Before your test, you'll receive instructions on how to set up the machine and properly place the sensors. We will show you how everything works so you can feel confident using the equipment. Your doctor will let you know if this option is right for you.

If you think you have a sleep disorder, start by talking to your primary care doctor. They can help determine if you need to see a sleep specialist.

• If you think you have insomnia, talk to your doctor. If sleep problems affect your daily life, addressing them may improve your overall well-being. Your doctor may suggest keeping a sleep log, answering a questionnaire or doing a sleep study to better understand your sleep patterns.
• If you think you have a parasomnia, talk to your doctor. Conditions like sleepwalking, night terrors, or acting out dreams can disrupt your sleep and daily life. Your doctor may ask about your sleep habits, have you keep a sleep log, or refer you to a sleep specialist. Sometimes, a sleep study is recommended to see what happens while you sleep.
• If you think you have restless leg syndrome, talk to your doctor. If symptoms are interfering with your life, they can help you find ways to manage them.
• If you think you have sleep apnea, talk to your doctor. If you or your partner notice symptoms, bring them up during your visit. Sleep apnea can affect your quality of life in the short and long term. Your doctor may recommend a sleep study to monitor your sleep patterns and confirm a diagnosis.

As you go into deep sleep, your jaw and tongue muscles relax. But if your throat isn’t wide enough, those muscles block your breathing airway and limit oxygen intake, which wakes you up.
 

It is more common than you think. If 18 million Americans are affected by sleep apnea, maybe there’s a reason everyone is so tired all the time. Among US adults between the ages of 30 and 70, 26 percent are estimated to have obstructive sleep apnea, and 75 percent of cases go undiagnosed. And the numbers are rising due to increasing obesity rates. 
 

The CPAP machine is the most common and effective treatment for sleep apnea. It uses a steady stream of air through a mask to keep your airway open while you sleep. This prevents interruptions in your breathing, improving sleep quality and overall health.

CPAP is ideal for moderate to severe sleep apnea. It includes a small pump, tube and mask, which may cover your nose, mouth or both. If you have mild sleep apnea, a dental device may also be an option, which helps keep your airway open by repositioning your jaw.

Benefits of CPAP include:

• Better sleep and more energy
• Lower risk of health issues like heart disease
• Reduced snoring

While adjusting to CPAP can take time, it’s a highly effective way to improve your sleep and health. We will help you find the right mask and settings for your needs.

Sleep apnea is typically diagnosed through a sleep study, either in a sleep lab or at home. The study monitors your breathing, heart rate and other vital signs while you sleep.

Treatment options for sleep apnea vary based on the severity and type of apnea. Common treatments include CPAP machines, dental devices and lifestyle changes such as weight loss or positional therapy. In some cases, surgery may be recommended to help open the airway.

For those who cannot tolerate CPAP, Upper Airway Stimulation (UAS) may be an option. UAS is an implantable device that helps keep the airway open by stimulating the muscles that control breathing. It works with your natural breathing pattern and is an alternative for people with moderate to severe obstructive sleep apnea who have not had success with other treatments.

Yes. There are two types:

• Type 1: During the day you feel excessive sleepiness and may have sudden muscle tone loss triggered by a strong emotion.
• Type 2: Experience excessive sleepiness but do not experience loss of muscle tone. Taking a nap will leave you feeling refreshed.
   

Improving sleep can involve setting a regular sleep schedule, reducing caffeine intake, creating a comfortable sleep environment and managing stress. For more serious issues, treatment options like therapy or medications may be recommended.

A sleep study is a test that monitors your body while you sleep to help diagnose sleep disorders like sleep apnea, insomnia, restless leg syndrome and parasomnias.

During a sleep study, small sensors are placed on your skin to track brain activity, breathing, heart rate, oxygen levels and movement. This can be done in a sleep center or, in some cases, at home. The results help doctors understand your sleep patterns and recommend the right treatment.

Yes, sleep studies are typically covered by most insurance plans, especially if they are medically necessary. However, coverage can vary depending on the insurance provider and the type of sleep study (in-lab or home sleep apnea test). It's important to check with your insurance company to confirm coverage details and any out-of-pocket costs, such as deductibles or co-pays.

Before scheduling your sleep study, it's a good idea to:

• Verify with your doctor or sleep specialist if the study is covered under your plan.
• Contact your insurance provider to ask about coverage, pre-authorization requirements, and any costs you may need to pay.

Some insurance plans may require a referral or documentation from your primary care physician before approving the study.