Sleep Disorder Evalutation

History — Evaluation always begins with obtaining a detailed history of any sleep related issues as described by the patient, in addition to their general health. A sleep questionnaire and Epworth Scale are completed by the patient. An Epworth Scale is a brief, one page questionnaire in which the patient rates their propensity for falling asleep during certain everyday activities, such as reading, or watching the TV. After treatment the patient will usually be asked to repeat the Epworth Scale questionnaire to subjectively monitor for improvement.

Physical Exam — A physical exam is performed not only to assess general health, but especially to ascertain whether any structural abnormalities exist in the nose, face, jaw, throat, or neck. Certain anatomical variations may be associated with obstructive apnea.

Polysomnogram — A polysomnogram, more commonly known as a sleep study will be ordered if any possibility of sleep apnea exists. This may be accomplished by sleeping overnight at a testing laboratory, or at home using a simple device loaned to you by our staff who will also instruct you on its use. If you have a preexisting heart or lung condition a sleepover at the testing lab is usually necessary. Other reasons requiring the same include obtaining videos to aid us in diagnosing REM behavior disorder, or recordings aiding us in diagnosing movement disorders. Both studies involve sleeping while attached to sensors which monitor parameters such as snoring and breathing. A laboratory study is usually considered to be more accurate and measures more parameters, such as brain wave patterns.

Multiple Sleep Latency Testing (MSLT) — This test is only done in the lab and always follows a polysomnogram done the previous night in the same lab. An MSLT is necessary to aid in the diagnosis of narcolepsy, as well as hypersomnias. It involves a series of morning naps and measures your propensity for falling asleep while sensors are attached to monitor brain wave patterns (EEG).

Multiple Wakefulness Testing (MWT) — This is also only performed in the lab. It is less commonly ordered and measures your propensity to stay awake. This is sometimes required of commercial truck drivers who are being treated for apnea.

Sleep Diary — Most patients are given a Sleep Diary to complete on a daily basis for at least two weeks in order to assess sleep and wake patterns, as well as any activities or behaviors which might affect sleep.

Actigraphy Study — An actigraphy study may also be ordered. This involves wearing a small monitor, usually on the wrist, continuously for at least two weeks. It gives us information about sleep and wake patterns.

Lab Specimens — Occasionally, laboratory specimens will be ordered. Serum ferritin is usually ordered when a diagnosis of restless legs or periodic limb movements is noted. Thyroid and female hormone levels are also sometimes useful. Ascertaining when melatonin levels peak in a 24 hour cycle may be helpful in diagnosing and treating circadian rhythm disorders. Certain genetic markers have been linked to some sleep disorders, however, they are generally not useful in clinical practice and not routinely ordered.