Sleep Medicine Services

Sleep apnea is a sleep related breathing disorder, in which a person has recurrent pauses in breathing or shallow, ineffective breaths while sleeping. There are 2 kinds of sleep apnea, “obstructive sleep apnea” and “central sleep apnea”.

Obstructive sleep apnea is a very common condition in which a person has pauses in breathing while asleep due to obstruction of air flow in the back of throat, often because of large tonsils, a big tongue, a low hanging soft palate, or a thick/obese neck.

Central sleep apnea is a less common condition in which a person has pauses in breathing while asleep because the brain is not sending frequent enough signals to the muscles of breathing. Central sleep apnea may be due to narcotic pain medicines, a prior stroke, or poorly controlled congestive heart failure, among other reasons.

Symptoms and signs of obstructive sleep apnea (OSA)

Common symptoms of OSA that a person may experience include:

• daytime sleepiness or fatigue
• non-refreshing sleep
• frequent awakenings from sleep
• waking up with a sensation of choking or gasping
• need to frequently urinate at night
• morning headaches

Common signs that others may observe in a person with OSA include:

• snoring
• recurrent snorting or coughing with partial awakening from sleep
• obvious pauses in breathing while asleep
• difficult to control high blood pressure

Risk factors for OSA include:

• increasing age
• male gender. OSA is about twice as common in men as women
• obesity
• large neck (ex. collar size > 17 inches in men, or > 16 inches in women)
• large tonsils, especially in children
• small or recessed jaw

Health effects of OSA

Patients with untreated OSA may develop recurring episodes of low blood oxygen or high blood carbon dioxide while asleep. In addition blood levels of catecholamines (stress hormones) may be elevated due to the recurring apneas that occur during sleep.

Untreated OSA has been associated with an increased risk of cardiovascular problems, such as high blood pressure, heart attacks, heart rhythm problems and stroke.

Untreated OSA has been associated with an increased risk of automobile accidents, due to the effects of poor sleep quality on daytime alertness and concentration.

Treating OSA can reduce the risk of the above problems.

For information on CPAP, click these helpful Sleep Lab documents or click on the web links that offer additional information on Sleep Apnea and treatment options.

http://www.sleepapnea.org
www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea

Diagnosis of OSA

OSA can be diagnosed easily by a “sleep study”, which can be arranged by your PCP or any physician that you see. If you are scheduled for a sleep study test, please read the instructions and complete the questionnaire prior to your test appointment.

Sleep Study Test

 There are different kinds of sleep studies that can be done. In our department we offer home based testing and can also facilitate in-lab testing as needed. The 2 types of home based tests presently available are:

• Watch-PAT study – involves a take-home device used to diagnose Obstructive Sleep Apnea (OSA). Click on the link to watch the set-up for Watch-Pat study.
• NOX T3 study – involves a take-home device with respiratory belts, nasal cannula, and oximeter used to diagnose OSA and central apnea for pediatrics and adults. Click on the link to watch the set-up for NOX T3 study.

If you need an in-lab sleep study, that will be arranged locally for the vast majority of our patients.

However some patients may require additional testing and will be directed to undergo an overnight attended sleep study.

Referral Information:

Your physician can schedule you a sleep study in our department or can send a referral in which we will contact you to schedule the study at your convenience. Some of the appointments will take place as a group appointment. Please print these test instructions and your appointment questionnaire. You can complete the questionnaire and bring to your appointment.

At the appointment you will get instructions on how to use the portable sleep study device so that you can take the testing unit home and use it while you sleep through the night. The monitoring units store information on how you sleep through the night. The sleep lab will retrieve the monitoring unit the next day and download the information of your nights sleep. A pulmonologist in our sleep lab will read, review, and interpret the information.

Once your study is scheduled you will need to remember:

• Contact Member Services at 1-800-464-4000 for your Cost of Share for the appointment and sleep study if you choose or need to know.
• The information is not available at the sleep study appointment.
• Come to your scheduled appointment 15 minutes early to complete a questionnaire about your sleep patterns.
• The ring and index finger need to be free of nail polish and artificial nails.
• Be sure that you can return the equipment the next day prior to 10:00 AM. You may bring the equipment to our Emergency Department or to Suite 190 if after 8:30 AM.

Your Sleep Study Results

After your results have been reviewed by a physician, you will be contacted by the sleep clinic to discuss your physician’s recommendations. Your Primary Care Physician also has access to your sleep study results.

For information on CPAP, click these helpful Sleep Lab documents or click on the web links that offer additional information on Sleep Apnea and treatment options.

http://www.sleepapnea.org

http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea

Treatment of OSA

The most effective treatment for most cases of sleep apnea is CPAP(continuous positive airway pressure), in which a patient wears a mask that connects to a tube and a small machine while sleeping. The CPAP machine generates pressurized air that keeps the soft tissues in the back of the throat from collapsing down and causing obstruction during sleep. Different CPAP masks are available, and the most appropriate mask will vary from person to person.

Other treatments that can help reduce the severity of OSA include weight loss, positional sleep strategies, such as avoiding sleeping on one’s back, and avoiding alcohol and other sedatives. These measures may not be adequate alone in many patients, and so appropriate follow up in the sleep department may be needed to determine the efficacy of these measures.

Oral appliances that are worn at night to help pull the jaw forward can be used in some people with OSA. Because oral appliances are less effective that CPAP at normalizing the sleep disordered breathing in most patients with OSA, careful patient selection with the help of a sleep specialist is important to identify appropriate candidates for these devices.

Various surgeries are available to treat OSA, but are generally reserved for patients who can not tolerate CPAP or other non-surgical measures. The most common sleep apnea surgery involves removing excess tissue in the back of throat including the uvula and tonsils (if present). Because the success rate of this surgery in curing OSA is poor (less than 50%), careful patient selection is important before it is recommended. Other surgeries available to treat OSA include jaw reconstruction surgery and tracheostomy.

The best treatment option for OSA will vary from person to person, though CPAP remains the most common and appropriate option for most patients. In our Pulmonary/Sleep Medicine Department, we are dedicated to finding the best treatment for each of our patients diagnosed with OSA.

CPAP Treatment

If the physician recommends CPAP, you will be invited to an individual or group appointment to learn more about Sleep Apnea and CPAP treatment. You will be offered a CPAP unit and fit for a mask. This will enable you to use a Kaiser owned unit to help you sleep for a specific amount of time, usually 1 week. We also call this a CPAP trial. You will return the unit and the information of your CPAP titration trial. It is very important to try to use the unit each night. It can feel awkward at first, try to stay with it as you are helping your body get a good night’s sleep. You will return the unit for data download and to see how well the unit is working for you. A prescription will be completed by a physician for a unit if it was helpful and treatment was achieved.

Need Your Results?

The information collected during your sleep study or the information gathered while using a CPAP unit are looked at by a Pulmonologist and the results are sent to your physicians. If you would like a copy of your test results, you can contact Medical Secretaries at 209-824-6302, or visit the Manteca Medical Secretaries to file a request.

Oral Appliance Information

For information on Oral Appliances, including coverage, please use our information page:

• Oral Appliance Information
• National Center on Sleep Disorder Research

Things to Remember While Trying CPAP

• Begin the first night wearing the unit. You may take it off, but try to wear it longer each night.
• Titration Instructions
• Care and Cleaning Instructions
• Using Oxygen with your Machine
• Nasal Wash Instructions

Frequently Used Information for CPAP Treatment Users

You can reorder CPAP Supplies through:

Kaiser Durable Medical Equipment
Phone: 1-800-732-3408

Apria
Modesto 209-548-4409
Stockton 209-475-6860

• CVA CPAP Reordering Schedule

For information on CPAP, click these helpful Sleep Lab documents or click on the web links that offer additional information on Sleep Apnea and treatment options.

• http://www.sleepapnea.org
• www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea

Healthy Habits for Sleep Time

Here are some ways to promote a restful night sleep:

• Keep active during the day
• Watch caffeine intake, and avoid consuming caffeine late in the day or at night
• Keep regular hours of sleep, including weekends
• Do not take naps
• Avoid strenuous exercise for 2-3 hours before bedtime
• Skip bedtime snacks
• Try to go to bed at the same time each night
• Minimize light and noise at bedtime
• Do something relaxing before bed such as reading, lounging, or taking a bath
• Stop worrying! Try writing worries down to clear your mind before going to bed
• Don’t use bed for studying or watching TV. The bed should be for sleep and sex only
• Don’t stay in bed if not sleepy

Healthy Habits for Sleep Time

Here are some ways to promote a restful night sleep:

• Keep active during the day
• Watch caffeine intake, and avoid consuming caffeine late in the day or at night
• Keep regular hours of sleep, including weekends
• Do not take naps
• Avoid strenuous exercise for 2-3 hours before bedtime
• Skip bedtime snacks
• Try to go to bed at the same time each night
• Minimize light and noise at bedtime
• Do something relaxing before bed such as reading, lounging, or taking a bath
• Stop worrying! Try writing worries down to clear your mind before going to bed
• Don’t use bed for studying or watching TV. The bed should be for sleep and sex only
• Don’t stay in bed if not sleepy

For information on sleep, click these helpful web links that offer additional information on Sleep:

Total Health Assessment (Complete to access Insomnia Course)

Overcoming Insomnia