Sleep Centers, Sleep Labs

What Are Sleep Labs?

Sleep medicine in the United States had its roots with Dr. Dement at Stanford, in California during the mid- to late-1970’s. Sleep labs are specialized facilities that perform tests to determine if you have a sleep disorder and to recommend the most appropriate methods of treatment. The number of sleep labs or centers has grown steadily since the mid-1990s, and today there are an estimated 3,000 to 3,500 of them operating in the United States. Nearly 1,400 of these are accredited.

Sleep labs that have demonstrated compliance with standards in areas such as testing procedures, patient safety, and physician and staff training may be awarded accreditation by the American Academy of Sleep Medicine or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Sleep labs or centers do not have to be accredited. However, insurance companies are increasingly requiring them to be accredited for coverage to apply. Knowing that a lab is accredited should assure consumers that they'll receive quality care by professionals who have passed strict standards. it means they are following "evidence-based medicine."

In the United States, there are 2-bed, 4-bed, 6-bed, and 8-bed sleep labs and up. Most 2-bed sleep labs run at 60-75% occupancy (4-5 nights per week). Sleep labs with a large number of beds are usually located in dense population areas and employ physicians that have been educated on the signs and symptoms of sleep disorders.

Physician education has been crucial in the past since most physicians received no sleep disorder training in medical school, during their residency, or during fellowship training. This is basically a new field of medicine. Consequently, it has only been during the past several years that medical schools, residencies and fellowships have begun to include sleep disorder education and training.

What To Expect At The Lab

At the sleep lab, you'll be fitted with various sensors, then attempt to go to sleep as you would on any other night. The sensors then transmit information such as oxygen levels and air movement to recording equipment. The whole process usually takes 7 to 12 hours.

Polysomnograms are performed at special sleep laboratories with academic or hospital affiliation, or in independently located and operated facilities. Sleep labs are often set up to resemble a bedroom, in order to help participants feel at ease. A sleep technician hooks patients up to the monitoring and recording devices, and then monitors the patient throughout the study. If a problem is noted, a second sleep study will be schedule to determine the best method of delivery.

If the sleep technician confirms that you have sleep apnea in the early part of the night you may have what is called a ‘split-night study' (half diagnosis, half titration). After about 4 hours of observing how you sleep, the technician will wake you up to initiate CPAP (continuous positive airway pressure). While on CPAP, the technician will continue to monitor you and measure the effectiveness of this treatment. This process can be done over two full nights in some cases.

"Sleep Technicians” are the people who work at the sleep lab and conduct the sleep study. Their job is to attach the monitoring equipment to your body and then observe the recordings on a computer through the night. They are also there to ensure your safety during your stay and to answer any questions you might have about the procedure.

After your night in the sleep lab, a qualified sleep specialist will analyze your sleep study. This involves isolating any irregularities in your sleep patterns or your breathing. Often they will be trying to determine if you stopped breathing while you were sleeping and if you did they will count how many times this occurred. If you had a split night study, they will compare your diagnostic portion to the treatment portion to determine how effective the CPAP was for you. A summary report will be prepared outlining these things and this will determine the severity of your condition.

Your sleep specialist will then contact you to outline their findings and discuss with you how you felt about the CPAP and what the most suitable treatment options for you.

The wait time for results may vary from a few hours to several weeks. Procedures will also vary by facility. In some cases, you may meet with a sleep physician from the sleep lab to discuss results. in other cases, results may be forwarded to the prescribing physician. They may also be handled jointly between the two.

Kinds of Tests Performed

Polysomnogram (PSG)

A polysomnogram, or PSG, is an overnight test that measures your sleep patterns. The technologist is specially trained to operate the sleep diagnostic equipment and remains all night in an adjacent control room. An intercom system is installed in each sleep room so you and the technologist may communicate.

Split Night Study

Like the polysomnogram (PSG), sensors that measure brainwaves, eye movements, muscle tone, breathing patterns and blood oxygen levels are applied to your skin using paste and tape. Once you are asleep in your private room, the technologist carefully monitors the sleep diagnostic equipment for any sign of disrupted breathing during sleep. If interruptions in your breathing (known as sleep apnea) are seen, the technologist will apply CPAP during the second half of the test. (CPAP stands for Continuous Positive Airway Pressure) and is the most effective and widely used method of treating sleep apnea. The CPAP device does not breathe for you. You can breathe at a normal rate.

MSLT (Multiple Sleep Latency Test)

People may also experience excessive daytime sleepiness or fall asleep at inappropriate times. If you suffer from these symptoms your physician may send you to the sleep disorders center for the MSLT. The MSLT, or Multiple Sleep Latency Test, consists of five scheduled “nap” recordings during which you will be allowed to sleep for a brief period. The MSLT is conducted on the day following an overnight polysomnogram (PSG). During the PSG, sensors are applied to your skin with paste and tape to measure brain waves, eye movements, muscle tone, breathing patterns, and blood oxygen levels. During the naps, the technologist will monitor your sleep/wake patterns. Generally, the last nap is completed before 7:00 PM.

CPAP Titration Study

When you've had a previous polysomnogram and have been diagnosed with Sleep Apnea (OSA), your physician may have you return to the sleep center for a sleep study with CPAP. Sleep apnea is a sleep disorder characterized by interruptions in breathing. The CPAP does not breathe for you. At the start of a CPAP study, sensors will once again be applied to your skin and the technologist will monitor your brainwaves, eye movements, muscle tone, breathing patterns, and blood oxygen levels using special diagnostic sleep equipment. Before you fall asleep the technologist will fit you with the CPAP device.

Insurance Coverage

Insurance plans typically do cover polysomnograms. However, most insurance companies have some qualifications to meet, as far as conditions that are covered. These include sleep-breathing problems such as obstructive sleep apnea, movement disorders such as periodic limb movement, and seizure disorders. Problems such as insomnia typically are NOT covered.

How To Find A Sleep Lab In Your Area

The largest “chain” or organization of sleep labs in the U.S. is SleepMed, a private company (170 sleep labs), followed by Avastra (33 labs). Other large sleep companies include Sleep Services of America, Sleep Works, and Pacific Sleep, Total Sleep.

Websites with sleep lab finder tools:

One can find a directory of accredited sleep labs at the website of the American Academy of Sleep Medicine: www.aasmnet.org. This is not a complete list of all sleep labs.

Other sleep websites:

www.sleepnet.com

www.sleepfoundation.org (The National Sleep Foundation)

Source: SleepWeb (Marketdata Enterprises, Inc.) research

*page last updated 04/28/2008

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