Laboratory sleep studies
The best way to diagnose or treat a sleep disorder is by spending a night in the sleep laboratory under direct observation. We utilise facilities at various private hospitals, as well as public hospitals for patients with insufficient health insurance.
A laboratory sleep study is a comprehensive recording of a number of different variables including:
- Heart rate
- Brain wave activity
- Eye movements
- Muscle tone
- Respiratory effort
- Oxygen and carbon dioxide levels
- Limb movement
- Body position
- Infrared video recording
Admission is at 7:00pm and you are usually discharged by 7:00am the following morning. On the night of your sleep study, staff will attend to you and ensure that all the relevant monitoring is performed adequately. We often start CPAP treatment or adjust CPAP treatment on these nights, as well as check body positioning or the use of oxygen. Mandibular advancement splints used for snoring or sleep apnoea are also checked in this way.
Further daytime tests may occasionally be requested. These measure the propensity for sleepiness and the ability to maintain wakefulness (MSLT and MWT) and are usually undertaken for narcolepsy.
On the night of your sleep study, bring along your favourite pillow, toiletries, your usual snacks, drinks or nightcaps, reading material, as well as all your usual medications. If you have a CPAP unit or a mandibular advancement splint, bring this along unless you’ve been told otherwise.
Home sleep testing
A home sleep test uses a small monitor (a Somté), which is worn overnight to record heart rate, brain wave activity, respiratory effort, airflow, oxygenation and sleep position. There are less leads attached to you than with the laboratory sleep study to make the process simpler and more comfortable.
If you have insufficient insurance for an in-hospital stay or a very strong preference for a home test, this can be organised through our offices.
Your GP is also able to request home sleep tests (without sending you to us for a consultation), as long as an adequate referral has been received by our office to ensure that the testing is appropriate for you. In this case, results are sent to both you and your referring doctor, and a follow-up appointment with one of our physicians can be organised if required.
We perform home sleep testing through our affiliate, National Sleep Diagnostics, present in most states and territories including regional centres.
On the day of your home sleep study, we ask that you come to our offices at approximately 4:30pm, wearing a comfortable t-shirt/singlet that you are happy to sleep in, over which the equipment is partially fitted. You then put on the remaining equipment as you prepare for sleep that night and remove the equipment in the morning before returning it to our office or the testing agent.
All of our specialists are Melbourne trained, members of the Royal Australasian College of Physicians, members of the Thoracic Society of Australia and New Zealand and certified as qualified Sleep Disorders Physicians.
A comprehensive and proper initial assessment is vitally important so that a plan of action pertinent to your needs is organised at the first visit. In general, we focus on your symptoms, background health and other contributory factors. An initial assessment, particularly when there are complex features or components, may last up to 45 minutes or more, and more simple consultations may last up to 30 minutes. Blood tests, x-rays and other investigations are usually ordered on the first visit, and many of these can be done on site.
Sleep testing is typically organised following your initial assessment, either in the sleep laboratory or sometimes as a home test, depending on circumstances. We may ask you to keep a sleep diary which we would provide, or ask you to wear an activity monitor called an Actigraph, which also measures sunlight exposure. Specialised sleep tests are occasionally requested, such as a multiple sleep latency test (MSLT) or a maintenance of wakefulness test (MWT), which measure the degree of sleepiness and the propensity towards sleepiness.
After an initial specialist assessment, we frequently ask our affiliated sleep counsellor to help in situations where broken sleep appears to be due to primary insomnia; in other words, not secondary to other situations.
Kathleen Latage, Manager of Counselling Services with the Sleep and Respiratory Group, is an experienced psychotherapist with extensive experience in the field of family therapy, psychology, psychoanalysis and social work. As a therapist, she specialises in insomnia, stress, anxiety, depression, relationship issues, drug, alcohol and gambling problems, loss and grief. She works with couples, individuals, children and families – providing both short, brief solution focused and CBT interventions, in addition to longer term work.
By working with a sleep psychologist, the factors which may impact on broken or insufficient sleep can be dissected and rearranged to be more conducive to a better night’s sleep. Strategies to change unhelpful habits would be implemented and managed over a number of sessions.
Ongoing treatment is in conjunction with, or in liaison with the responsible sleep physician. This ensures that progress is monitored and a review plan can be arranged if needed.
If there is substantial agitation, anxiety or depression, a start on basic treatments can be undertaken, but we may also recommend a review by a specialised sleep psychiatrist to help determine further treatment options.
Starting CPAP treatment can be frustrating, confronting and confusing. We have good working relationships with a number of commercial CPAP providers in the community, whom we work closely with and can recommend. We depend on these suppliers to undertake CPAP initiation and offer ongoing troubleshooting and maintenance support.
As CPAP treatment can be expensive, should you not have health insurance extras coverage, it is our role to provide you with impartial and considered advice to make CPAP comfortable and beneficial. Occasionally we loan out our own units and perform downloads over a period of 1 – 4 weeks for troubleshooting or to ensure CPAP effectiveness.
Once established on CPAP, it is fairly usual to come back through the sleep laboratory for troubleshooting or to ascertain CPAP effectiveness, including changing over masks and determining mask leakage and fitting issues. As time goes on, the need for these laboratory sleep studies becomes less and less, with long-term patients generally being seen every 1 – 3 years.
Sleep disorders do not usually occur in isolation. We are therefore reliant on colleagues and professionals to determine if other factors are at play which may be interfering with sleep. We work with knowledgeable mandibular advancement splint dentists who not only provide anti-snoring type mouthguards, but also assess jaw structure, bruxism and teeth grinding, and jaw joint issues which may impact on sleep and breathing.
We may ask a commercial CPAP provider to help you or refer you to a sleep psychologist. Occasionally we think it’s best that a sleep psychiatrist reviews your situation. There are a number of other specialists with whom we work fairly closely.
Ear nose and throat (ENT) surgeons often make assessments of the need for removal of tonsils, straightening noses or improving nasal patency through trimming of the internal structure of the nose and sinuses. We work with a number of ENT surgeons who are knowledgeable in sleep medicine.
As heart issues often create problems at night, a number of cardiologists who are knowledgeable in sleep medicine are affiliated with our clinic. Pain and discomfort is typical in fibromyalgia and chronic fatigue, and we work closely with a rheumatologist. Abnormal behaviours at night sometimes require an assessment from a neurologist. Being overweight and having diabetes is often an accompaniment of sleep apnoea, and we therefore work closely with endocrinologists, weight loss specialists and weight loss surgeons.
We will normally recommend specialists in your area and will endeavour to organise all affiliated services in conjunction with your general practitioner.