Polysomnogram

After your initial evaluation with Dr. Perkins or another neurologist, you may require a polysomnogram or sleep study. Spending the night in our state-of-the-art sleep center might be necessary for evaluation of physical factors affecting sleep, commonly found in Restless Legs Syndrome (RLS), Periodic Limb Movement Disorder (PLMD), or Obstructive Sleep Apnea (OSA).

A polysomnogram is a non-invasive, painless procedure and can last one to several nights. Basically, you sleep at our on-site facility and your brain wave activity, eye movement, respiration, blood oxygen level, limb movement and heart rate are all monitored. The study ends around 6 AM and you are then free to shower and go home or to work. A multiple sleep latency test (MSLT), which measures how sleepy a patient is by observing how long it takes them to fall asleep, may also be prescribed. This type of study is usually performed the day after a polysomnogram and further evaluates the person’s daytime sleepiness.

Our sleep rooms are furnished with patient comfort in mind, featuring regular beds instead of hospital beds and a pleasant atmosphere that looks and feels as much like home as possible. This setting provides a more favorable environment for conducting your polysomnogram, the most common procedure for evaluating and classifying disorders.

Before Your Polysomnogram

The following recommendations are standard practice before a polysomnogram:

1. Bathe and shampoo your hair prior to coming. This will remove the oils from your skin and hair, which might otherwise interfere with the sleep study.  Except for deodorant do not add anything to your skin or hair such as makeup, moisturizers, hair spray, or hair oils as these would also interfere with the sleep study.  Additionally we recommend that you remove fingernail polish/artificial nails from 1 finger and hair extensions (if reasonable).

2. Consumption of alcohol, caffeinated beverages and non-prescription drugs should be per your usual routine unless directed otherwise by Dr. Perkins. (Caffeine may be found in coffee, tea, soft drinks and chocolates.)

3. Take your usual prescription medications, EXCEPT sleep medicines, unless otherwise instructed by your physician. Bring all your medications to the sleep study.  Do not take your sleeping medication before arriving for the sleep study.

4. You may bring over-the-counter medications such as Tylenol, Advil, Zantac, nasal decongestants, etc with you.  The Sleep Medicine Program does not have any over the counter  medications for you to take.

5. Do not nap on the day of your study (unless you have previously discussed this with Dr. Perkins).

6. Eat your evening meal before arriving at the sleep lab.

7. Smoking is not allowed:  If you feel you will be unable to complete the study without smoking then notify Dr. Perkins to see if accommodations can be made.

8. Friends and family members cannot remain in the testing area during the study. Exceptions include parents of young children or caretakers of adults with special needs. If you fall into one of these categories, please inform Dr. Perkins so arrangements can be made.

9. If you are diabetic and must eat at certain times or have special needs then please be certain to inform Dr. Perkins prior to the sleep study.

10. Contact the Sleep Medicine Program if you have severe nasal congestion or develop a bad cold.  If an illness or other problem, which may interfere with, your sleep develops prior to your study then contact the Sleep Medicine Program and your physician.

Items to bring

1. As mentioned above, please bring your prescription medications and show them to the technician.  If you use CPAP/BIPAP, bring all the equipment so we can test it.

2. Loose fitting 2-piece cotton pajamas, sweat suits, T-shirts, shorts or pants to wear to sleep.  Do notwear 1-piece gowns or silky material.  You are free to bring a robe and slippers.

3. Although we will provide pillows and linens you are welcome to bring your favorite blanket or pillow.

4. A shower is provided for your use. You must supply your own toiletries. 

5. If you typically read before going to bed then you may want to bring a book. If there are other items you need for your "pre bed" routine then please contact the sleep center to make sure that there will be no problem accommodating your requests.

After you check-in and get settled, a sleep technologist will ask you to change into your nightclothes. Small sensors or electrodes will then be attached to parts of your head and body. (A glue-like substance called collodion is usually used; however, it can be removed easily and painlessly with fingernail polish remover after the procedure.) Flexible wiring is attached to the sensors, which is then connected to a central unit. A monitoring area is located close to your room, just across the hallway. Once all of the sensors, electrodes, and belts are attached, the technician will take some initial readings while you are awake.

While You Are Sleeping

The attached sensors monitor and record various physical activities, such as heart activity and rate (EKG), eye movements (EMG), muscle activity, breathing, leg movements, and blood oxygen levels. More or fewer characteristics may be studied depending on your symptoms.

Sleep Lab Procedures:

1. You will be "hooked up" by the technician and allowed to read until the sleep study is ready to begin.  A television is accessible in our waiting area.
2. The study usually ends around 5-6 a.m., at which time you may shower and leave unless you are scheduled for an MSLT.
3. You will sleep on an extra-long twin or queen mattress in an air-conditioned room that is designed to feel as much like a bedroom as possible.
4. Although we record many physiologic parameters and can tell when you are dreaming, we cannot monitor the content of your dreams.
5. A technician will be listening to you on a microphone at all times and can “unhook” you for bathroom breaks.
6. You will not be medicated in order to aid your falling asleep; however, if your doctor has you taking sleep medication, then bring it with you. You may or may not be allowed to take your sleeping medication, depending upon the test parameters. 

So, what are all the sensors for and what are they recording? Depending on the symptoms you have described to the sleep specialist, some or all of the following will be monitored:

• Brain activity - Multiple sensors attached to your head record your brain waves. This reading shows the technologist which sleep stage you have reached.
• Airflow - A sensor placed on your upper lip monitors the airflow and temperature from your nose and mouth. For patients that suffer from apnea, these sensors show a flat reading when there is no airflow. The temperature can determine when you inhale or exhale (inhaled air is cooler than exhaled).
• Neutral area - A sensor clipped to your ear is used as a neutral reading; the ear is a part of the body that does not move much during sleep.
• Rapid eye movements - One or two sensors placed near the eyes record rapid eye movements (REM), which are associated with dreaming and deep sleep.
• Breathing - Elastic belts around your chest and stomach will measure your respiratory effort.
• Muscle tone - Muscle tone and relaxation are measured with one or more electrodes attached to your chin. It is important that this reading is low during REM sleep, the period when your muscles should be paralyzed. This reading also helps technicians determine which stage of sleep you are in.
• Heart rate - Your heart rate and activity are monitored with multiple sensors attached to your chest or back.
• Oxygen level - An oximeter (or oxymeter), a device that measures oxygen levels, is clipped or taped to either your finger or earlobe. In patients with sleep apnea, this measurement can determine how serious the apnea episodes are.
• Leg movements - If RLS or PLMD is suspected, sensors will be placed on your legs, usually near the knee.
• Body position and movement - The last area observed is your body position and any other activities.

You will be videotaped while you sleep. One or more technologists will observe you the entire night while you sleep. The sleep technologists will note if you snore and how loudly, if you kick violently, or if you have periodic movements. They will also chart your sleep stages and other measurements.

The next step is for you to get comfortable and go to sleep!

Frequently Asked Sleep Study Questions

Can I get shocked from the wires and sensors?

No. It is impossible because the electrodes and sensors detect the electrical and physical signals that you produce. There is no electricity being sent through the wires to the sensors on your body.

Is this procedure covered by my insurance?

Most insurance companies, including MEDICARE, cover sleep studies.  Insurance companies have learned that if they get their patients sleeping well, other health problems are minimized. 

What if I need to go to the bathroom during my sleep study?

Don't worry - disconnecting the wires to the nearby unit is a fairly quick process and a technologist is always awake and available to help you. However, it is a good idea to avoid drinking any fluids after 6 PM.

Will I be able to sleep easily during my polysomnogram?

This is a very common question. Most people doubt their ability to sleep in our sleep center, especially if they are unable sleep at home. However, polysomnographic technologists often claim that most patients sleep better in our sleep center than they do at home. Some individuals are simply relieved that someone is taking an interest in their problem, it will soon be diagnosed, and he or she is on the road to better sleep. Even if you do not sleep well at our center, polysomnographic testing will still be able to determine a great deal of information.

In the Morning

After you wake up in the morning, the technologist will help you remove the monitoring equipment between 5 and 6 AM. You may be asked to complete another questionnaire about your night's sleep, with questions such as how many hours you felt you slept, whether you slept well, or how long you think it took you to fall asleep. Some patients need to spend more than one night in the sleep center. If that is the case, you will leave the center, perform your regular activities, and return later that night (8 or 9 PM) to repeat the process. After your polysomnogram, you are able to resume your normal activities as soon as possible.

The technologist and Dr. Perkins will review how long you spent in each stage of sleep, when and how long you dreamed, the amount and level of snoring, body movements, and a host of other activities. Because of the enormous amount of data collected from your sleep study, you will be asked to make a future appointment with Dr. Perkins or another neurologist to discuss your results and treatment options.