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Tests and Treatments : Investigating Sleep Problems

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You may have picked up this content because you have problems with sleep; maybe your partner, friend, colleague, child, or a relative has sleep problems. Do you really have a sleep problem? How do you get a sleep problem investigated? What kinds of tests are done to diagnose sleep disorders? What are the treatments? This section gives you a brief outline of answers to questions like these.

Investigating Sleep Problems

Q: How do I discuss a sleep problem with my doctor?
A: Doctors nowadays are much more aware of sleep problems and realize how important sleep is to health and normal functioning. Discussing a sleep problem with your doctor should be as natural as discussing a cough. If the problem is simple, then, often, your doctor will be able to guide you in examining your lifestyle and issues concerning sleep. If the problem is more complicated, you may be referred to a specialist in sleep medicine.
Q: How are sleep problems investigated?
A: There are many ways to investigate sleep problems. People with insomnia are best served by first addressing sleep hygiene issues, or, if there is significant mood disturbance, to a psychiatrist or counselor, who can help uncover the reasons for the sleep disorder. People with chronic pain may benefit from referral to a specialized pain clinic that uses a multidisciplinary approach. Children with sleep disturbance should be referred to a pediatrician or a sleep specialist with experience in pediatrics.
Q: Where are sleep disorders investigated?
A: This depends on the type of sleep disorder you might have. If sleep apnea is suspected, you might be referred for an overnight study at a sleep center (sleep lab) or even be sent home with recording equipment that you return to the sleep center the next day. If narcolepsy is suspected, you should be investigated in a sleep center where they can also conduct tests of daytime sleepiness.
Q: What kinds of sleep investigations are there?
A: Sleep investigations take many forms and are adapted to the wide variety of disorders that are diagnosed by sleep specialists and respiratory specialists. Some investigations must be done in a sleep center; others can be done in the comfort of your own home. The main sleep-related investigations that are performed in a sleep center include polysomnography; multiple sleep latency testing and maintenance of wakefulness tests; and tests of vigilance. Monitoring of sleep using portable systems, actigraphy, keeping a sleep diary, and filling out questionnaires about your sleeping habits can all be done at home.
Q: What is polysomnography?
A: The most common investigation in a sleep laboratory is polysomnography (PSG) ?. PSG allows the sleep specialist to assess how much you have slept and what the quality of your sleep was. At the same time, information is obtained on your breathing patterns during sleep and on any abnormal movements during sleep such as periodic limb movements.
Q: What does polysomnography involve?
A: Polysomnography involves an overnight stay in a sleep center. This investigation is not as daunting as it sounds. The laboratory is usually set up to look like a bedroom. Each person sleeps in his or her individual bedroom, which is also sound-proofed. Nurses or technicians are present all night and keep a close eye on participants so that problems, if any, can be dealt with immediately. In the morning, you can leave the lab and get on with your day normally, just as if you had spent a night sleeping in your own home.
Q: Are there investigations that can be done without going into a sleep center?
A: Although most sleep specialists do not recommend home studies, some centers lend portable recording devices for overnight use. The patient puts the device on at home and return it the next day. The overnight information stored on a computer chip in the device is downloaded and interpreted by a sleep technologist or sleep physician. The devices range from sophisticated machines to simple oximeters that are minimally obtrusive. Some centers use minimally invasive devices with video recording during the night to diagnose certain sleep disorders.
Q: What is a multiple sleep latency test (MSLT)?
A: This is a daytime test of sleepiness and should ideally follow an overnight PSG in the sleep center. The patient is asked to have naps on 4–5 separate occasions several hours apart to assess whether there is excessive sleepiness during the day. This test is most commonly used to diagnose narcolepsy. The test is conducted in the sleep center and involves PSG. The data is recorded and assessed by the sleep technician and sleep specialist, who look for excessive sleepiness and note the time it takes the patient to fall asleep for each nap.
Q: What is the maintenance of wakefulness test?
A: This tests assesses a person’s ability to stay awake during the day. It comprises 3–4 periods evenly spaced across the day when the patient is asked to stay awake while inactive for a specified period of time. This test should ideally be preceded by an overnight PSG in the sleep center. The maintenance of wakefulness test is often used to assess the effectiveness of treatment for excessive daytime sleepiness, whatever the cause (obstructive sleep apnea, for example).
Q: What is a test of daytime vigilance?
A: These are daytime tests that check one’s ability to perform boring tasks that require significant concentration. They mimic, for instance, the level of attention required to monitor ships on a radar screen or to watch the road on a long drive. Examples include the Oxford sleep resistance (OSLER) and maintenance of wakefulness tests. These are performed in a sleep center; the results show whether significant sleepiness is present and affecting vigilance.
Q: What is actigraphy?
A: Actigraphy is activity monitoring using a instrument which can detect motion. It helps differentiate periods of rest or sleep from periods of activity while awake. Actigraphy is commonly used to assess circadian rhythm disorders. Modern actigraphs are generally shaped like a wristwatch and worn on the ankle or wrist. The time you spend being inactive and active over 24 hours is downloaded from the actigraph and used to plot sleep and wake times in a more objective manner, as compared to a sleep diary.
Q: What is a sleep diary?
A: A sleep diary is a simple tool for tracking sleep patterns and habits, and to document changes that occur with treatment. Sleep diaries are especially useful in treating of circadian rhythm disorders, insomnia, narcolepsy, and where lifestyle issues are of concern.
Q: Why are questionnaires used in the assessment of sleep problems?
A: Questionnaires such as those included in this content help you think about your sleep problem in a structured way. They also help researchers derive normal data for the general population against which an individual response can be assessed. They thus become important tools for a sleep professional to assess your problems and to monitor progress.

Assessing your own sleep

You are best placed to know what your sleep is like. To examine the patterns and quality of your sleep, you can ask yourself the following questions. These questions are modeled on the Pittsburgh Sleep Quality Index, which is designed to assess sleep in adults.

These questions are designed to make you think about your sleep patterns and overall sleep. If you are concerned about any of your responses, you should seek medical advice.

  1. When do you usually go to bed?

  2. How long do you usually take to fall asleep?

  3. When do you usually get out of bed in the morning?

  4. How many hours of actual sleep do you get on an average night (this does not refer to the actual number of hours you spend in bed)?

  5. How often do you have trouble sleeping because of:

    • Being unable to get to sleep within 30 minutes of getting into bed?

    • Waking up in the middle of the night or early morning?

    • Getting up to go to the toilet during the night?

    • Inability to breathe comfortably?

    • Coughing or snoring loudly?

    • Feeling too cold?

    • Feeling too hot?

    • Experiencing bad dreams?

    • Being in pain?

    • Other reasons?

  6. Do you often take medicine to help you get to sleep?

  7. How often do you have trouble staying awake while driving, taking part in social activities, or during meals?

  8. How difficult is it for you to keep up your enthusiasm to get things done?

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