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Patients who come to the center frequently
have daytime symptoms such as sleepiness or fatigue, which
often reflects a problem with sleep during the night.
This can take the form
of an adequate amount of time in bed but loss of sleep time,
as seen in sleep
apnea (loud snoring, followed by cessation of breathing
multiple times throughout the night.) or by narcolepsy
(falling asleep briefly many times during the day, sometimes
accompanied by cataplexy which is sudden loss of muscle strength
brought on by a strong emotional stimulus such as anger, laughter,
or fear.)
Another sleep disorder
that directly affects nighttime sleep is periodic
limb movements of sleep or PLMS (repeated jerking of the
limbs, usually the legs during sleep) or Restless
Leg Syndrome (RLS). Others have problems falling asleep,
staying asleep, or both. This comprises the large category
of insomnia.
Other problems evaluated
at the Center include sleep
walking, grinding of teeth (Bruxism), night
terrors, agitation and/or confusional states during sleep
(REM
behavior disorder) and problems associated with changing
shift
work or difficulties adjusting to a "normal"
day/night schedule (Chronobiologic Disorders).
The evaluation consists of two parts. The first is a thorough
history and physical examination that is done by your primary
care physician or by the Medical Director of The Houston Sleep
Center, Dr. Todd J. Swick. At the time of the initial evaluation
you will be asked to fill out questionnaires to get detailed
information on your health, sleep habits, sleep environment
and any current medications you are taking including prescription
and over the counter or health food supplements. In some cases
you will see videotape that explains and demonstrates the
nighttime recording procedures should your condition require
it. Not all sleep disorders need an overnight recording, your
physician will explain the whys and why nots on an individual
basis. If you have a bed partner who has observed you during
sleep, he or she is welcomed and encouraged to accompany you
to this daytime appointment.
The second part of the
evaluation involves observing and monitoring your nighttime
sleep (Polysomnography) for one and occasionally two nights.
(It is not necessary that they need to be consecutive nights).
During this monitoring session we will be recording brain
waves, eye movements, air movement through the nose and mouth,
muscle activity of your legs and sometimes your arms, breathing
effort as measured by abdominal and rib cage muscle activity
or movement, electrocardiogram, and pulse oximetery (measuring
the amount of oxygen carried by the blood). All measurements
are done with surface electrodes; there are no needles or
skin punctures required. You will be sleeping in a comfortable
room and in spite of the fact that you will be in darkness
we will be recording your images on a digital recorder that
makes it look as if you were sleeping in bright daylight.
Depending on your sleep
problem, you may also be scheduled for a series of nap tests
(Multiple Sleep Latency Test) on the day following a night
study. For your nighttime evaluation, you will be asked to
report to the Center two to three hours before your regular
bedtime. During this time, the recording devices will be attached.
Small sensors and or electrodes will be attached to record
the above-mentioned functions. In some cases you will be fitted
with a special mask called a CPAP mask that allows us to treat
sleep apnea. During part or all of the sleep study a CPAP
mask might be placed over your nose and you will feel a positive
pressure in the back of your throat that keeps the airway
open during your sleep thus relieving the obstruction.
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