Doc, I can’t sleep!

March 2015
By E. Dwight Osteen II, BS, RPSGT, Technical Director, Sleep Labs, Apollo Hospital Systems and Dr. Elizabeth Coon-Nguyen, MD., ABMS Sleep Physician

We hear it so often- a patient presents with their list of problems, and a common one is that they cannot sleep. Patient experiences can be variedsome complain of difficulty falling asleep, others have difficulty staying asleep, however it is widely acknowledged in the medical field that a good night’s sleep is imperative for optimum function of the human body. In order to establish the patient’s issue, physicians often ask general questions to screen for an obvious case of sleep apnea, and then simply write the prescription for a sedative hypnotic.

However the question must be asked- will sedatives actually correct the sleeping problem, or will it simply treat a symptom of a greater problem? Will the patient continue to take sedative hypnotics for long periods of time, despite the fact that they are usually prescribed for only short term use? If so, what other issues could the patient encounter that may worsen their condition? Recent advances in technology can now enable medical professionals to accurately diagnose specific sleep issues and subsequently treat the underlying cause. Physicians are increasingly referring patients to dedicated sleep labs, in order to treat the underlying cause of sleep issues, and to therefore generally improve the health of their patient base.

New Technologies

Insomnia testing is a new form of in-home testing available in dedicated sleep labs. Using this technology, practitioners are able to collect sleep pattern data of the patient, and can use this information to differentiate between several different sleep related conditions.

The first and most obvious is true insomnia. Sleep latency data will help the practitioner determine the presence of true insomnia. In cases of true insomnia, a long term sleep aid may be used to treat the patient. In addition, there is also the the option of treating the patient with cognitive behavioral therapy, which has been shown to improve sleep latency in insomnia patients with similar efficacy rates to that of sedative hypnotics, and with significantly fewer side effects.

Another sleep disorder is referred to as sleep state misperception. Patients with sleep state misperception are simply not aware of sleeping, and do not feel refreshed upon waking. These patients will report being awake all night, but when challenged will be unable to recall specifics from in-room stimuli, such as a television show. With the use of insomnia testing equipment, a normal sleep latency can be demonstrated as well as sleep-wake patterns, and then the patient can be treated appropriately.

Additionally, other equipment can be used to screen for Sleep Apnea. The use of pulse oximetry can suggest the presence of an underlying sleep related breathing disorder. It is not uncommon for patients suffering from sleep apnea to complain of insomnia symptoms rather than the classic hypersomnia. Patients are more likely to undergo additional testing and treatment of sleep apnea after having data presented to them from insomnia testing.

Most physicians will be familiar with the use of in-lab sleep testing, which can test for a large array of sleep disorders and is considered the gold standard in sleep testing. However, patients that have previously undergone a sleep test may have done so with staff that are not specifically trained to undertake sleep studies, or with inferior equipment that falls below the current industry standard.

The go-to mask for years at many labs has been the full face mask, however it is widely acknowledged by sleep study professionals to have several design flaws, leading it to be inferior in performance to a nasal masks. A reputable sleep lab should strive to use nasal masks wherever possible, as this will result in a higher rate of patient satisfaction. For example, patients who have previously been unable to undertake sleep therapy due to the uncomfortably high pressure experienced with a full face mask, can tolerate therapy as the pressure experienced with a nasal mask is significantly reduced.

Education Matters

In addition to utilizing the latest technology and ensuring the use of nasal masks, a comprehensive patient education system is required. It is important that any patient undergoing a sleep study should understand the process and their subsequent diagnosis in detail, as they will be typically more compliant on therapy as a result. It is also important that the patient feels supported, so any questions they have can be answered by a clinical sleep educator at a level they can understand. The end result is usually a happier, healthier patient who sleeps soundly for a full night’s sleep. Improved sleep patterns can also allow physicians to treat long-term sleep apnea through weight loss where possible.

Next Steps

If you have patients that would benefit from insomnia testing, feel free to contact the Apollo Hospital Sleep Lab directly at 281- 651-5691. We will be glad to provide you with order forms, and any other information you may require.

About the authors:

E. Dwight Osteen II, BS, RPSGT is the Technical Director for the Sleep Labs in the Apollo Hospital System. He has been in the field of sleep medicine since 2003, is a clinical sleep educator and has been a guest speaker at multiple conferences regarding sleep medicine related topics. He has treated patients as young as 3 months and as old as 97 years old for a wide range of sleep disorders.

Dr. Elizabeth Coon- Nguyen, MD is an ABMS Sleep Physician that practices in Kingwood, The Woodlands, and Montgomery, TX. Dr. Coon-Nguyen is board certified in Family Medicine and practices from her office in Kingwood, TX.