New home sleep testing available at Sierra Nevada Memorial Hospital
July 31, 2014
Now you can take a sleep test in the privacy and comfort of your own home to help doctors diagnose sleep apnea or related disorders.
Home sleep testing (HST) is available through the Cardiopulmonary Department at Dignity Health Sierra Nevada Memorial Hospital (SNMH), according to Suzanne Belew, RRT, NPS, clinical specialist in respiratory therapy.
It's a test that could save your life, Belew said. Obstructive Sleep Apnea (OSA) may contribute to stroke, diabetes, hypertension, heart failure, obesity, and depression. She said about 43 million Americans suffer from sleep problems, and 80 percent of them are undiagnosed.
Testing for apnea has been done in overnight sleep labs for years, and required patients to try to sleep in a web of wires while a technician in another room observed and took readings from all those attachments.
The home device is simpler and easier, and should encourage many more patients to take the test, Belew said. It is covered by most health insurance plans.
"Unlike an overnight sleep lab, the HST does not measure and record brain waves, eye and facial movement, or record heart rhythms, so there are fewer wires," she explained. "The HST receiving device is small and includes two belts that go around the upper chest and abdomen, nasal tubing, and a pulse oximeter that attaches to a finger. The unit measures airflow and snoring, chest excursion (movement), patient position, pulse rate and oxygen levels."
Apnea is a Greek word that means "without breath," Belew said. Sleep apnea is an involuntary cessation of breathing that happens while one sleeps. There are three types — obstructive (OSA), central and mixed. OSA is the most common, she said, and it happens when the airway becomes blocked as muscles in the back of the throat relax and impede airflow into the lungs. The diminished flow of air reduces oxygen in the blood and that is what can lead to serious health issues, she explained.
The home test is not advised for people with central sleep apnea, where the brain doesn't send proper signals to muscles that control breathing, causing breathing to start and stop during sleep, Belew said. Nor should it be used in mixed apnea, which involves both obstructive and central versions.
Some health conditions, including moderate to severe pulmonary disease, neuromuscular diseases (like Parkinson's, stroke, or epilepsy), narcolepsy or periodic limb movements during sleep, would require the traditional sleep lab environment, she noted. The hospital refers patients to Sierra Sleep Diagnostics in Nevada City for overnight sleep lab testing.
Belew said people should contact their physician to discuss testing if they have these symptoms: snoring, waking up with a very sore or dry throat, waking with a choking or gasping sensation, restless sleep and sleepiness/lack of energy during the day, sleepiness while driving, morning headaches, and forgetfulness or mood changes.
She said that an order from a physician, nurse practitioner, or physician assistant is required for the testing. When the Cardiopulmonary Department receives that referral, the department will contact a patient for a half-hour appointment to pick up the testing unit and be instructed in how to use it. The device is returned the next day, and sent to board certified sleep physician John Lace, who will interpret the collected data.
Several treatment options are available for patients diagnosed with sleep problems, Belew said. Traditionally, a CPAP facial mask is prescribed. The CPAP, which stands for continuous positive airway pressure, provides pressured airflow to keep the back of the airway open and unobstructed during sleep.
The latest version is known as an auto-titrating device, which adjusts pressure throughout the night to reflect the patient's changing needs. Mild to moderate sleep apnea may be treated with an oral appliance that enlarges and stabilizes the upper airway. Some problems may be treated with surgery — tonsillectomy, adenoidectomy, or maxillofacial surgery.
Jamie Kearns, a cardiopulmonary rehab services assistant at the hospital, took the home test and wound up having minor surgery to take care of her problem.
"I have always snored, though I prefer to call it purring," she said. "But I also found out I was waking up in the middle of the night gasping for air. I was waking up feeling tired, even after eight hours of sleep."
She said the testing device is easy to use.
"For me, a lab is not an option," Kearns declared. "I'm a mother of three and it would be very difficult to find a way to schedule a test in a lab setting, not to mention how difficult I know it would be to sleep in an unfamiliar setting."
Kearns had a turbinate reduction — a cleansing of nasal obstruction that allows normal air passage.
"I can breathe so much easier now," she said. "My children have even commented that they barely ever hear me 'purring' these days. I'm very happy with the outcome."
All physicians providing care for patients at SNMH are members of the medical staff and are independent practitioners, not employees of the hospital.
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