Stoughton Health - Sleep Disorders Center
From the Show: Stoughton Hospital Health Talk
Summary:
Air Date: 4/13/23
Duration: 10 Minutes
Did you know that sleep studies can be performed at Stoughton Health? Join Dottie to learn who needs a sleep study and what to expect. Stoughton Health Sleep Disorders Center is accredited by the American Academy of Sleep Medicine and offers state-of-the-art services for diagnosing and treating sleep disorders for individuals two and older.
Transcription:
Deborah Howell (Host): Welcome to Stoughton Health Talk. I'm Deborah Howell, and I invite you to listen as we get introduced to the Stoughton Health Sleep Disorder Center and find out how it's helping patients find their way to a better night's sleep. Joining me is Dorothy Love, but everybody calls her Dottie. She's a registered polysomnographic technologist at Stoughton Health Sleep Disorder Center. Dottie, such a pleasure to have you on with us today.
Dorothy Love, RPSGT: Thank you for inviting me.
Host: Oh, it's our total pleasure. So, let's jump in. First of all, what are some symptoms that indicate one needs a sleep study?
Dorothy Love, RPSGT: Well, most commonly, we will see people that express some fatigue or daytime sleepiness, and it could be associated with snoring or like choking sounds. Another disorder is movement, a lot of movement at night. Some of the more uncommon ones are just people that have difficulty falling asleep or staying asleep during the night. So, there's various reasons as to why people might complain of a bad or a disruptive sleep that would bring them into the sleep lab.
Host: Okay. Now, can anyone just walk in or does a person need a referral?
Dorothy Love, RPSGT: Generally, they would go to their primary care with their initial complaints. And once they do that, they primary care physician would put out a referral request and then they would have a consult with the sleep specialist. Then, the sleep specialist is the one who actually orders the sleep study.
Host: Okay. And what age does one need to be for the study?
Dorothy Love, RPSGT: At Stoughton, we actually do pediatric and up. So, we take as young as two years and all the way up to whenever. So, my oldest patient was probably 98 that I've had in the lab.
Host: My goodness, you run the gamut. And I suppose the sleep studies are a little different based on age.
Dorothy Love, RPSGT: It is. On some people that have like very distinct possible sleep apnea symptoms. We might do a home study first. And if that is not conclusive, then they would come into the lab. With the children, we have a couple different or additional things that we monitor versus the adults.
Host: Can you give us an example of a person doing a home study?
Dorothy Love, RPSGT: They generally will present with very clear sleep apnea symptoms like snoring. The witnessed pauses or apnea in their sleep, usually by a bed partner and then, the daytime sleepiness, that's very clear cut on what they have. And then, they would be screened with a home test, which measures your respiratory breathing airflow, and then your oxygen and your heart rate, so very minimum what they're measuring. And then, it uses something, an algorithm, something similar to like one of those watches that people wear that will determine like if they're awake or asleep during it..
Host: Okay. And how are these measurements taken?
Dorothy Love, RPSGT: Well, in the home study, it's pretty simple that they have a belt across their chest that has this little device that fits onto it. They have a cannula that fits into their nose, looks like an oxygen tubing and a finger probe that measures their oxygen and their heart rate. Most people are familiar with that. It's similar to like if you go to the doctor and they want to see what your oxygen level is, and that's pretty basic for the home studies.
Host: Okay. Say I'm a patient now that has qualified for an in-lab sleep study. Take me through what I might experience as a patient.
Dorothy Love, RPSGT: So when they come in, it's a much more involved study. They will have 16 to 24 different sensors placed on them. We monitor their brain activity so that we know exactly the type of sleep, how much sleep they're getting, how much disruption in their sleep. We monitor their respiratory, not only their airflow, but their effort, their oxygen, their what is called CO2 or their exhaled gas; and their effort, how hard is it for them to get a breath in. We also monitor movement at night and eye movement, so we can determine when they go into dream sleep. They have something called REM or rapid eye movement, and then also muscle tone in their face.
Host: That's fascinating. I hadn't heard about the muscle tone in the face. And then, how long is that person in the lab?
Dorothy Love, RPSGT: The studies have to run for six hours. So generally, they come in about an hour and a half before they go to bed. So, they come in say about 8:30. We usually have them in bed by 10:00 and then, the studies have to run for six hours. We usually wait and wake people up. You know, if they go to bed at 10:00, we'll wake them up between 5:30 and 6:00, so they get a full night's sleep. But we have to have a minimum of six hours.
Host: So, I understand that you can't reach a REM state, this is what we learned in school anyway, until you're four hours deep into sleep. Is that still the rule?
Dorothy Love, RPSGT: So, REM sleep cycles go in about a 90-minute to 120-minute period. And so, you generally go into deep sleep first, so you'll kind of trans into a deep sleep. Now, this is on a normal person without any type of disorder. They would go into a deeper sleep. After a little while of that, close to 90 minutes or so, they'll have a very brief REM period. Again, this is on someone that's not on any medications or have a disorder. Then, they would come out of that REM period and again, process into some deep sleep. And then, in about another 90 to 120 minutes have another REM period. Or, after that, each period gets longer and longer. So by the end of the night or that four hours or two or an hour before you wake up, those REM periods are longer. So, people don't think they're dreaming early on, but because they're more aware of it later.
Host: I see. So for me, I have to take a little sleep aid every night and it still takes me well over an hour to get to sleep. The people who come to you as patients, they're not allowed to take anything at all before sleeping. Is that correct?
Dorothy Love, RPSGT: We prefer them not to take a sleep aid, just because we want it more natural. But if a person like yourself that normally takes a sleep aid, then the doctor would say that it would be okay for them to do that. So as long it's been ordered by the physician and it's a normal routine, that's fine. We also have sometimes people that come in with a little anxiety or first night effect where they are saying, "There's no way I'm going to fall asleep in a strange place." And then, the physician can also order them something to bring with them.
Host: And the medication does not really have any major effect on the outcome of the study.
Dorothy Love, RPSGT: It's not going to give them a sleep disorder. It may make them sleep through some of the sleep disruption that we would see, but it doesn't make it go away and it doesn't make it worse.
Host: How does one prepare to have a sleep study?
Dorothy Love, RPSGT: Well, generally, the information that we give them is to not to drink a lot of water in the afternoon. We don't want them getting up to go to the bathroom a lot. So, we try to limit your fluid intake for the day of the study; to avoid caffeine, again, we don't want anything after noon generally. We want normal levels of activity, not excessive or extreme exercise in the later part of the afternoon or evening. So, just try to keep a normal even keel that day of the study. They can take a shower and be relaxed when they get here, because, you know, we want them to be hooked up and ready to get into bed without a lot of fuss before that.
Host: Sure. Especially the kids, and I'm sure you let them bring a stuff to animal or whatever their normal routine is. Correct?
Dorothy Love, RPSGT: Yes, we do. And we with the littler ones especially, we have the mom maybe bring a book to read. We want them to not encourage and not to bring electronics to use, and that's for adults as well. We want them avoided electronics two hours prior to going to sleep. So, we do limit that. But, you know, having a book will let the parent be with the child and read them a book and kind of get them relaxed and stuff after they're hooked up to kind of calm them down a little bit. And even adults sometimes, they need to read to relax a little prior to going to sleep as well.
Host: Absolutely. Now, you spoke a little bit about this earlier, but I'm going ask again in case you want to add anything to it. What is the technologist actually recording and analyzing in the study?
Dorothy Love, RPSGT: We look at the brain activity to look for any type of disruption, that is our primary focus initially. So, we see if there's disruption going on, if there is a disruption to the sleep, then we try to identify the cause. So through those sensors, we are looking to see if they're having any snore arousal, any breathing events, decreased breathing that results in a fragmentation of their sleep or drop in their oxygen. We look for any leg movements or body movements that could be causing disruption in the sleep, anything that we can identify. When we're looking at their brain activity, we're saying, "How long is it taking them to go to sleep? Are they maintaining sleep or is it being fragmented again and, you know, a lot of disruption?" So, that's kind of what we go by first, is we look at that brain activity to look at the sleep and then try to find a reason if there's a problem with it.
Host: And what happens after the test? How long does it take to get the result?
Dorothy Love, RPSGT: It varies a little bit from physician to physician. Generally, the process can take up to four to six weeks to get all of the results and the recommendations. You know, we make sure that the patients do understand that it's not going to happen overnight. But it depends on which provider is actually reading the study.
Host: Okay. And I want to be clear about this, if a person comes in and they have their sleep study and they do one night and they don't do well, they just don't sleep at all, do you ever repeat?
Dorothy Love, RPSGT: So if we have someone that you know, they are unable to get to sleep or we don't get enough information, during the recording, we will have them come back. Sometimes we have to do two night studies, one is a diagnostic that tells us what the problem is, and then the second one is a treatment so we can implement the treatment that the doctor orders.
Host: I've just learned so much and you've been so clear and concise about explaining everything. Is there anything else you'd like to add to our conversation?
Dorothy Love, RPSGT: I've been doing this for 27 years. It's something that I've always found very interesting and the stories that people share with us, you know, it just makes us feel like a part of their life and their process. And so, it's always been very rewarding and I like to make them feel that they're at home when they're here, that they have someone that cares about what's going on and trying to help them find solutions.
Host: Oh, that's so nice. Dottie Love. Such a wonderful, wonderful time to have you on our podcast today. And, you know, sleep is just so important. If you can help somebody sleep better, you're giving them the gift of life, really.
Dorothy Love, RPSGT: Absolutely. Absolutely. It makes a huge difference.
Host: Thank you so much for joining us today.
Dorothy Love, RPSGT: Thank you again for having me.
Host: And for more information, you can head on over to our website at stoughtonhealth.com. And that concludes this episode of Stoughton Health Talk. Please remember to subscribe, rate, and review this podcast and all the other Stoughton Hospital podcasts. I'm Deborah Howell. Have yourself a terrific day and sleep well.
Deborah Howell (Host): Welcome to Stoughton Health Talk. I'm Deborah Howell, and I invite you to listen as we get introduced to the Stoughton Health Sleep Disorder Center and find out how it's helping patients find their way to a better night's sleep. Joining me is Dorothy Love, but everybody calls her Dottie. She's a registered polysomnographic technologist at Stoughton Health Sleep Disorder Center. Dottie, such a pleasure to have you on with us today.
Dorothy Love, RPSGT: Thank you for inviting me.
Host: Oh, it's our total pleasure. So, let's jump in. First of all, what are some symptoms that indicate one needs a sleep study?
Dorothy Love, RPSGT: Well, most commonly, we will see people that express some fatigue or daytime sleepiness, and it could be associated with snoring or like choking sounds. Another disorder is movement, a lot of movement at night. Some of the more uncommon ones are just people that have difficulty falling asleep or staying asleep during the night. So, there's various reasons as to why people might complain of a bad or a disruptive sleep that would bring them into the sleep lab.
Host: Okay. Now, can anyone just walk in or does a person need a referral?
Dorothy Love, RPSGT: Generally, they would go to their primary care with their initial complaints. And once they do that, they primary care physician would put out a referral request and then they would have a consult with the sleep specialist. Then, the sleep specialist is the one who actually orders the sleep study.
Host: Okay. And what age does one need to be for the study?
Dorothy Love, RPSGT: At Stoughton, we actually do pediatric and up. So, we take as young as two years and all the way up to whenever. So, my oldest patient was probably 98 that I've had in the lab.
Host: My goodness, you run the gamut. And I suppose the sleep studies are a little different based on age.
Dorothy Love, RPSGT: It is. On some people that have like very distinct possible sleep apnea symptoms. We might do a home study first. And if that is not conclusive, then they would come into the lab. With the children, we have a couple different or additional things that we monitor versus the adults.
Host: Can you give us an example of a person doing a home study?
Dorothy Love, RPSGT: They generally will present with very clear sleep apnea symptoms like snoring. The witnessed pauses or apnea in their sleep, usually by a bed partner and then, the daytime sleepiness, that's very clear cut on what they have. And then, they would be screened with a home test, which measures your respiratory breathing airflow, and then your oxygen and your heart rate, so very minimum what they're measuring. And then, it uses something, an algorithm, something similar to like one of those watches that people wear that will determine like if they're awake or asleep during it..
Host: Okay. And how are these measurements taken?
Dorothy Love, RPSGT: Well, in the home study, it's pretty simple that they have a belt across their chest that has this little device that fits onto it. They have a cannula that fits into their nose, looks like an oxygen tubing and a finger probe that measures their oxygen and their heart rate. Most people are familiar with that. It's similar to like if you go to the doctor and they want to see what your oxygen level is, and that's pretty basic for the home studies.
Host: Okay. Say I'm a patient now that has qualified for an in-lab sleep study. Take me through what I might experience as a patient.
Dorothy Love, RPSGT: So when they come in, it's a much more involved study. They will have 16 to 24 different sensors placed on them. We monitor their brain activity so that we know exactly the type of sleep, how much sleep they're getting, how much disruption in their sleep. We monitor their respiratory, not only their airflow, but their effort, their oxygen, their what is called CO2 or their exhaled gas; and their effort, how hard is it for them to get a breath in. We also monitor movement at night and eye movement, so we can determine when they go into dream sleep. They have something called REM or rapid eye movement, and then also muscle tone in their face.
Host: That's fascinating. I hadn't heard about the muscle tone in the face. And then, how long is that person in the lab?
Dorothy Love, RPSGT: The studies have to run for six hours. So generally, they come in about an hour and a half before they go to bed. So, they come in say about 8:30. We usually have them in bed by 10:00 and then, the studies have to run for six hours. We usually wait and wake people up. You know, if they go to bed at 10:00, we'll wake them up between 5:30 and 6:00, so they get a full night's sleep. But we have to have a minimum of six hours.
Host: So, I understand that you can't reach a REM state, this is what we learned in school anyway, until you're four hours deep into sleep. Is that still the rule?
Dorothy Love, RPSGT: So, REM sleep cycles go in about a 90-minute to 120-minute period. And so, you generally go into deep sleep first, so you'll kind of trans into a deep sleep. Now, this is on a normal person without any type of disorder. They would go into a deeper sleep. After a little while of that, close to 90 minutes or so, they'll have a very brief REM period. Again, this is on someone that's not on any medications or have a disorder. Then, they would come out of that REM period and again, process into some deep sleep. And then, in about another 90 to 120 minutes have another REM period. Or, after that, each period gets longer and longer. So by the end of the night or that four hours or two or an hour before you wake up, those REM periods are longer. So, people don't think they're dreaming early on, but because they're more aware of it later.
Host: I see. So for me, I have to take a little sleep aid every night and it still takes me well over an hour to get to sleep. The people who come to you as patients, they're not allowed to take anything at all before sleeping. Is that correct?
Dorothy Love, RPSGT: We prefer them not to take a sleep aid, just because we want it more natural. But if a person like yourself that normally takes a sleep aid, then the doctor would say that it would be okay for them to do that. So as long it's been ordered by the physician and it's a normal routine, that's fine. We also have sometimes people that come in with a little anxiety or first night effect where they are saying, "There's no way I'm going to fall asleep in a strange place." And then, the physician can also order them something to bring with them.
Host: And the medication does not really have any major effect on the outcome of the study.
Dorothy Love, RPSGT: It's not going to give them a sleep disorder. It may make them sleep through some of the sleep disruption that we would see, but it doesn't make it go away and it doesn't make it worse.
Host: How does one prepare to have a sleep study?
Dorothy Love, RPSGT: Well, generally, the information that we give them is to not to drink a lot of water in the afternoon. We don't want them getting up to go to the bathroom a lot. So, we try to limit your fluid intake for the day of the study; to avoid caffeine, again, we don't want anything after noon generally. We want normal levels of activity, not excessive or extreme exercise in the later part of the afternoon or evening. So, just try to keep a normal even keel that day of the study. They can take a shower and be relaxed when they get here, because, you know, we want them to be hooked up and ready to get into bed without a lot of fuss before that.
Host: Sure. Especially the kids, and I'm sure you let them bring a stuff to animal or whatever their normal routine is. Correct?
Dorothy Love, RPSGT: Yes, we do. And we with the littler ones especially, we have the mom maybe bring a book to read. We want them to not encourage and not to bring electronics to use, and that's for adults as well. We want them avoided electronics two hours prior to going to sleep. So, we do limit that. But, you know, having a book will let the parent be with the child and read them a book and kind of get them relaxed and stuff after they're hooked up to kind of calm them down a little bit. And even adults sometimes, they need to read to relax a little prior to going to sleep as well.
Host: Absolutely. Now, you spoke a little bit about this earlier, but I'm going ask again in case you want to add anything to it. What is the technologist actually recording and analyzing in the study?
Dorothy Love, RPSGT: We look at the brain activity to look for any type of disruption, that is our primary focus initially. So, we see if there's disruption going on, if there is a disruption to the sleep, then we try to identify the cause. So through those sensors, we are looking to see if they're having any snore arousal, any breathing events, decreased breathing that results in a fragmentation of their sleep or drop in their oxygen. We look for any leg movements or body movements that could be causing disruption in the sleep, anything that we can identify. When we're looking at their brain activity, we're saying, "How long is it taking them to go to sleep? Are they maintaining sleep or is it being fragmented again and, you know, a lot of disruption?" So, that's kind of what we go by first, is we look at that brain activity to look at the sleep and then try to find a reason if there's a problem with it.
Host: And what happens after the test? How long does it take to get the result?
Dorothy Love, RPSGT: It varies a little bit from physician to physician. Generally, the process can take up to four to six weeks to get all of the results and the recommendations. You know, we make sure that the patients do understand that it's not going to happen overnight. But it depends on which provider is actually reading the study.
Host: Okay. And I want to be clear about this, if a person comes in and they have their sleep study and they do one night and they don't do well, they just don't sleep at all, do you ever repeat?
Dorothy Love, RPSGT: So if we have someone that you know, they are unable to get to sleep or we don't get enough information, during the recording, we will have them come back. Sometimes we have to do two night studies, one is a diagnostic that tells us what the problem is, and then the second one is a treatment so we can implement the treatment that the doctor orders.
Host: I've just learned so much and you've been so clear and concise about explaining everything. Is there anything else you'd like to add to our conversation?
Dorothy Love, RPSGT: I've been doing this for 27 years. It's something that I've always found very interesting and the stories that people share with us, you know, it just makes us feel like a part of their life and their process. And so, it's always been very rewarding and I like to make them feel that they're at home when they're here, that they have someone that cares about what's going on and trying to help them find solutions.
Host: Oh, that's so nice. Dottie Love. Such a wonderful, wonderful time to have you on our podcast today. And, you know, sleep is just so important. If you can help somebody sleep better, you're giving them the gift of life, really.
Dorothy Love, RPSGT: Absolutely. Absolutely. It makes a huge difference.
Host: Thank you so much for joining us today.
Dorothy Love, RPSGT: Thank you again for having me.
Host: And for more information, you can head on over to our website at stoughtonhealth.com. And that concludes this episode of Stoughton Health Talk. Please remember to subscribe, rate, and review this podcast and all the other Stoughton Hospital podcasts. I'm Deborah Howell. Have yourself a terrific day and sleep well.
