Sleep Studies: Effective Treatment For Insomnia?

Sleep studies are often carried out to diagnose insomnia, a sleep disorder that affects 10-30% of adults. Insomnia is characterised by difficulty falling asleep or staying asleep, even when one has ample time and an environment that is conducive to sleep. The diagnostic process for insomnia may consist of multiple exams and appointments. While there is no single test to diagnose insomnia, a combination of questions, exams, and sleep studies can help doctors understand a patient's sleep patterns and diagnose insomnia.

Sleep studies can be done at home or in a sleep lab

Sleep studies are a common diagnostic test that can help diagnose many conditions and sleep-related issues, including insomnia. They can be performed at home or in a sleep lab.

At-Home Sleep Studies

At-home sleep studies are a simplified version of the tests performed in sleep labs. They are often used to detect sleep apnea, a condition in which a person's breathing is interrupted during sleep. At-home sleep studies use sensors to monitor breathing patterns, oxygen levels, and the effort it takes to breathe. The sensors may include probes placed on the finger, tubes inserted into the nostrils, and sensors placed on the chest and abdomen.

The process of an at-home sleep study typically involves the following steps:

• Schedule a visit with a healthcare provider to discuss your symptoms and determine if an at-home sleep study is appropriate for you.
• Obtain the necessary equipment, which may be mailed to you or picked up at a sleep lab or clinic.
• Follow the instructions provided by your healthcare provider to set up the equipment and perform the test at home.
• Return the equipment to the specified location after the test is complete.
• Meet with your healthcare provider again to discuss the results of the study.

At-home sleep studies offer several advantages, including convenience, privacy, and lower cost compared to in-lab sleep studies. However, they may not capture all the data that an overnight sleep study in a lab can provide.

Sleep Lab Studies

Sleep lab studies, also known as polysomnography, are conducted in a controlled environment, usually resembling a comfortable hotel room. During the study, various sensors are attached to the participant's body to monitor multiple systems, including brain activity, heart rate, breathing, and more. Elastic belts may be wrapped around the chest and abdomen to measure breathing, and a clip may be placed on a finger or earlobe to monitor oxygen levels.

The process of a sleep lab study typically includes the following:

• Arrival and Setup: Participants arrive at the sleep center in the evening and are escorted to their sleeping quarters. A technician applies the necessary sensors to the participant's head and body using adhesive.
• Calibration: The technician ensures that the sensors are properly calibrated and functioning correctly. This may include asking the participant to perform simple tasks like moving their eyes or mouth.
• Sleeping: The participant is given time to relax and prepare for sleep. During the sleep period, the technician monitors the participant's sleep and may make adjustments as needed.
• Post-Sleep: In the morning, the sensors are removed, and the participant is free to leave the sleep lab.
• Results: The data collected during the study is analyzed, and the results are typically discussed with the participant's doctor within a few days.

Sleep lab studies offer a more comprehensive assessment of sleep by capturing a wider range of data. They are particularly useful for people with heart, breathing, or neuromuscular problems. However, they may be more expensive and less convenient than at-home sleep studies.

Sleep studies monitor brain activity, heart and breathing rates, and muscle movements

Sleep studies are a common diagnostic test that can help diagnose many sleep-related issues, including insomnia. They are often recommended when a patient presents symptoms of conditions that affect sleep, to determine how to treat those conditions or to evaluate the effectiveness of completed treatments.

Brain activity is monitored through electroencephalography (EEG) sensors, which use a sticky, electrically conductive gel coating to detect and record the electrical activity of the brain, known as brain waves, while the patient is asleep. Different types of brain waves occur during different stages of sleep, and this is a key way to identify sleep disorders and issues.

Heart rate is monitored through electrocardiography (EKG or ECG). A single EKG sensor is worn on the patient's chest to pick up the electrical activity of their heart. Examining heart activity allows healthcare providers to identify any issues with the patient's heart rhythm and internal electrical system.

Breathing rates are monitored through several methods. Breathing sensors detect air movement through the mouth and nose, while a respiratory inductive plethysmography (RIP) belt detects the expansion of the torso when the patient breathes. A pulse oximeter, a small adhesive sensor attached to the tip of the patient's index finger, reads their pulse and blood oxygen levels.

Finally, muscle movements are monitored through electromyography (EMG) sensors, which are attached to the skin, usually on the patient's face and leg, to track muscle movement. Unlike a standard EMG, these sensors are for monitoring only and do not activate any muscles.

Sleep studies can help diagnose sleep apnea, narcolepsy, or restless legs syndrome

Sleep studies are an effective way to help diagnose sleep disorders such as sleep apnea, narcolepsy, and restless legs syndrome. These studies are usually performed in a sleep laboratory, requiring an overnight stay followed by a series of daytime naps. They provide valuable insights into an individual's sleep patterns and can help identify any underlying conditions causing sleep disturbances.

In the case of narcolepsy, sleep studies play a crucial role in diagnosis. They typically consist of two parts: an overnight polysomnogram and the Multiple Sleep Latency Test (MSLT) the next day. The polysomnogram involves recording brain waves, eye movements, muscle tone, and breathing during sleep. This test helps evaluate the quality of nighttime sleep and identify any additional sleep disorders, such as sleep apnea or periodic limb movements.

The MSLT, on the other hand, is a series of five scheduled naps spread across the day, with the patient given the opportunity to sleep for 20 minutes or more every two hours. This test is crucial for diagnosing narcolepsy, as it reveals how quickly a person falls asleep and whether they enter REM sleep rapidly. People with narcolepsy tend to fall asleep faster and experience REM sleep during their daytime naps, indicating impaired regulation of REM sleep.

Additionally, sleep studies can also help diagnose sleep apnea and restless legs syndrome, also known as periodic limb movement disorder. By monitoring breathing and leg movements during sleep, sleep studies can identify disruptions caused by these conditions. Sleep apnea is characterised by pauses in breathing during sleep, while restless legs syndrome involves involuntary leg movements that can disturb sleep.

Overall, sleep studies are a comprehensive tool for understanding sleep patterns and diagnosing various sleep disorders. They provide valuable data that helps doctors develop effective treatment plans for their patients, improving their sleep quality and overall health.

Actigraphy tests can be done at home and involve wearing a sensor on the wrist or ankle

Actigraphy tests are a type of sleep study that can be done at home. They involve wearing a sensor on the wrist or ankle, which records your movements to determine when you are asleep and when you are awake. The data collection process usually takes place over several days or weeks, during which you can go about your normal routine.

Actigraphy can be used to establish total sleep time and identify how long it takes a person to fall asleep on average over a period of several weeks. It can also be used to identify sleep patterns over multiple days and nights, which can help doctors create an appropriate treatment plan.

The process is simple and requires little to no preparation. The actigraphy device is usually worn on the non-dominant wrist and should not be covered with clothing. Your doctor will instruct you on how to use it, how long to wear it, and how to troubleshoot any problems. Once you have finished collecting the data, you return the device to your doctor, who uploads the data into a computer for interpretation.

Actigraphy is generally considered more accurate than a sleep log and less accurate than polysomnography. It is quite accurate at identifying how long healthy people sleep but less accurate when evaluating fragmented sleep, reduced sleep time overall, long periods of trying to fall asleep, or restless sleep.

Blood tests can rule out thyroid problems or other conditions that affect sleep

Blood tests are often used to rule out underlying medical conditions that may be causing insomnia. A host of medical conditions can cause or exacerbate insomnia, and blood tests can help doctors identify these. Doctors may recommend blood tests to check for thyroid issues, low iron levels, or other conditions that can cause sleep problems.

Thyroid function can be assessed by checking the levels of thyroid hormones in the blood. These hormones help regulate the body's metabolic processes. A thyroid function test may indicate an underactive thyroid gland (hypothyroidism), which can cause fatigue and lethargy, or an overactive thyroid (hyperthyroidism), which can cause insomnia or fatigue. Either of these conditions can play a role in sleep problems.

Blood tests can also be used to check for low iron levels, which can cause restless leg syndrome, a condition that can disrupt sleep. Additionally, abnormal levels of hemoglobin may indicate an iron deficiency, chronic illness, or lung disease, all of which can contribute to sleep problems.

Another blood test that may be performed is the arterial blood gases test, which measures the levels of gases, including oxygen and carbon dioxide, in the blood. This test can help diagnose or rule out breathing problems, such as sleep apnea, which can affect sleep.

Drug and alcohol toxicology screening is another type of blood test that may be used to diagnose insomnia. This test can determine if drugs or alcohol are contributing to sleep disorders. While a glass of wine before bed might initially help with drowsiness, alcohol can cause middle-of-the-night wakefulness, resulting in insufficient sleep.

Frequently asked questions