Evaluation and treatment of patients with sleep disorders
Patients are encouraged to seek consultation with a sleep specialist when they first become aware that they have any symptoms suggestive of a possible sleep disorder. We obtain a complete medical history including a detailed sleep history.
Questions include:
- What time do you go to sleep and wake up?
- Do you maintain the same sleep and wake schedule on the weekends or tend to sleep longer?
- How much caffeine do you drink?
- Do you smoke?
- How much alcohol do you drink?
- Is your room dark, quiet and comfortable?
- Do you read, watch television, or engage in activities other than sleep in the bedroom?
- Do you nap during the day?
- How long does it take for you to fall asleep most nights?
- Do you have pets that sleep in the bedroom?
- Do you have young children who keep you awake at night?
- Does your bed partner snore or interfere with your sleep?
- When do you eat dinner?
- Do you exercise? What time of the day?
We always try to obtain additional information from your bed partner, as we usually have no idea what happens while we are sleeping and this information is often instrumental in helping to arrive at an accurate diagnosis and in assessing response to treatment.
We then perform a careful physical examination with particular attention to weight, neck circumference, medications or other medical conditions that may be interfering with sleep, and a detailed examination of the upper airway. Patients may be asked to complete a two-week sleep diary or may be asked to wear a small activity monitor with a light sensor on their wrist called an Actigraph for one to two weeks. Some patients are scheduled for a noninvasive overnight sleep study called a polysomnogram in one of several conveniently located sleep centers we are affiliated with.
Once we have completed our evaluation, we then work to diagnose your particular disorder and find a treatment that works for you. Proper treatment varies depending on the type of sleep disorder, but may consist of behavioral modification, weight loss, and avoidance of activities, medications or foods which may interfere with sleep. Obstructive sleep apnea is often treated with a medical device called a Continuous Positive Airway Pressure (CPAP) machine which prevents the airway from obstructing and collapsing during sleep. We monitor the compliance of our patients on CPAP and provide a CPAP support group for those requiring additional help. Surgical consultation and treatment is sometimes necessary with sleep disorders. We have access to a number of well-trained expert consultants in ENT who can assist when surgical management of snoring or obstructive sleep apnea appears indicated. We also have relationships with several excellent dentists who can assist in providing dental appliances for those with benign snoring or mild to moderate sleep apnea when indicated. Medications are often prescribed for those with anxiety or depression contributing to difficulty initiating or maintaining sleep or for those who continue to experience difficulty getting to sleep or staying asleep after appropriate sleep hygiene and behavioral modification. As part of our comprehensive commitment to sleep, we also provide an insomnia support group for those with chronic sleep difficulties.