SLEEP TESTING ("POLYSOMNOGRAPHY")

Polysomnography is the term used to describe the process of formal sleep testing. For many sleep disorders this procedure is essential to establishing the kind of accurate diagnosis needed for selection of the treatment most likely to be successful. In the disorder sleep apnea syndrome it is often also used to begin treatment or make certain a therapy has been effective.

Polysomnography is conducted in our specially designed sleep testing and treatment facility. The test consists of the continuous monitoring of a wide range of physiologic features throughout a person's usual sleep period. Things measured include sleep itself, breathing, heart rate and rhythm, oxygen levels, and movement patterns. All this information is collected from sensors, which are applied to the skin at various locations. Minimal, if any, discomfort is experienced. The sensors are connected in such a manner as to easily allow movement.

Goal

The sleep testing process is often a central part of your visit to the PSP. Our goal is to make your stay in the laboratory as pleasant and medically successful as possible. PSP staff will make every reasonable accommodation and effort to accomplish this. We view the evaluation and treatment process as a co-operative effort that involves us all, patients and professionals alike. Below you will find information which we feel is important to reaching the goals of a clear understanding of the sleep disorder problem and finding a solution to it. If you have any questions or concerns about the policies and procedures or have any special needs, please advise our staff directly.

Laboratory Staff

All testing in the laboratory is conducted by PSP certified sleep technologists. They work in the specially designed control room, where all the recording instruments are located. They remain with you throughout the entire testing process.

Timing of Testing

Recording sleep that is as close to what is experienced at home is obviously important. Most people have a characteristic time for sleep. The PSP is organized so that we are generally able to conduct testing at any time during the 24-hour light-dark cycle. For rotating shift workers the time for testing is determined during the sleep disorders consultation.

How Many Nights?

In the past it was standard practice to obtain two consecutive nights of testing. Though following such a course may be more precise, 95% of the time in our laboratory the same diagnostic conclusions and treatment decisions are made at the end of the first night as would be at the end of a second one. Consequently, we never schedule more than one night for diagnostic purposes. At times a second night is needed to begin certain kinds of treatment or to objectively evaluate the results of therapy. In cases of sleep apnea of especially severe intensity, we also may try to combine a portion of the night dedicated to diagnostic monitoring together with a therapeutic segment involving treatment initiation using nasal continuous positive airway pressure.

What to Bring

You should bring certain items with you to your sleep test. Generally, a robe, slippers, and pajamas along with personal toiletry items are most appropriate. Nightgowns may be worn though are less convenient than pajamas from the standpoint of sensor application and movement. Shampoo is provided though you may wish to bring your own. Bringing your own pillow can be especially helpful, as this is often a very individual item. Snacks are appropriate at times as well but this should be discussed with Program staff member scheduling your testing.

Other Preparations

• Obtaining clear signals from the sensors is important. Avoid oily skin moisturizers or hair preparations. Men should shave prior to arrival. It is not necessary to remove beards or mustaches. Nails with heavy artificial coloring can make it hard to record oxygen levels, so it may need to be removed from one finger.
  
  Bedrooms
• Each person has his or her own private bedroom. The beds are comfortable, extra long queen style. Firmness of the mattress is adjustable. Every effort is made to maintain a temperature conducive to sleep. Each room is quiet, sound-attenuated.
  
  Bathroom
• The bathroom is just a few steps away from your bedroom. Disconnection from the recording equipment is quite easy. It is not necessary to remove and then re-apply the sensors in order to do so. A shower with towels, etc., is available for use after your test, if you wish to do so before your departure.
  
  Assistance
• If you require any special assistance during your test, please feel free to make your needs known to the technologist. Although serious problems with the testing process are unusual, it is important to try and solve whatever problem you might have in order to optimize the accuracy of the results.
  
  Caffeine
• Caffeine being the stimulant that it is may sometimes interfere with the sleep testing process. Each person's situation is different, however, so you should inquire about this if there is any doubt. Generally, caffeine in any of its various forms should be discontinued before testing if you are undergoing evaluation for narcolepsy, insomnia, if you are a light sleeper, or if you tend to sleep poorly the first night away from home when you travel. Those individuals having testing for sleep apnea usually don't need to make changes. Remember to taper off your caffeine in order to avoid a withdrawal headache or daytime sleepiness - don't stop abruptly!
  
  Alcohol
• Though alcohol has a reputation for helping sleep, in fact it usually has a negative effect. Its continued consumption may have an impact on sleep testing results. For most evaluations it will not be necessary for you to change your patterns if you have a steady one. Abstain the day of testing if your consumption is just occasional, however. Intoxication is not appropriate for any testing session and is important to avoid during the week before testing in any event. As always, remember not to drive to the laboratory the night of testing unless you can do so completely safely. Should alcohol discontinuation be deemed necessary, a gradual tapering off is important in order to avoid unpleasant - or even dangerous - withdrawal reactions for persons with daily consumption. Every individual undergoing narcolepsy assessments must be free of alcohol before testing.
  
  Tobacco Products
• Like other health care facilities, the PSP is completely smoke-free. The chemicals in smoking and other tobacco products may adversely affect your sleep and the testing process. If you must continue smoking just prior to or during the sleep testing, you may do so just outside the laboratory. We recognize how difficult this may be and will make every effort to accommodate your particular situation.
  
  Medications
• Medication being taken may affect the testing process and polysomnography results. It is important that you NOT discontinue any prescription medications before testing, without carefully discussing this with the prescribing clinician or doctor. It is relatively unusual that you will actually need to stop something. It is particularly crucial not to stop medicine being given for diabetes, heart problems, high blood pressure, asthma, blood thinners or anticoagulants, or seizures. The disorder where this issue is most apt to come up is in the assessment of the daytime sleepiness disorder narcolepsy. It is important to be aware that many so-called over-the-counter, non-prescription drugs or herbal preparations may influence sleep. The decongestants are a particular concern as they are often stimulating. Many antihistamines, on the other hand, are often sedating; they may or may not be a concern depending upon the circumstances. At times these agents may even be helpful obtaining a valuable recording. Please review these issues with our clinic staff. Remember to bring any medications, either prescription or over-the-counter, that you routinely take, or may need to take, with you to the laboratory.
  
  Food
• Meals are not provided in the PSP though beverages are available. Bringing snacks or foods which meet your particular needs is encouraged. A refrigerator and microwave oven are available right in the laboratory and may be accessed conveniently at any time during your testing.
  
  Sleep Attire
• Pajamas are recommended. Men may wear shorts if they prefer. For women, nightgowns may be worn though are less convenient than pajamas from the standpoint of sensor application and movement. Remember that you should bring your own sleep attire; this helps to ensure a more representative test.