I Was Sleeping in the Lab Late One Night…

Sleep studies can be frustrating. The goal is to watch the full sleep cycle unfold in a laboratory environment, but you can imagine how issues arise as you try to sleep normally while covered in electrodes, surrounded by beeping machines and watched by a technician. It's undoubtedly difficult trying to relax on a cold, hard hospital mattress.

However, due to their effectiveness in identifying sleep disorders and, therefore, preventing complications further down the line, these studies are strongly emphasized by sleep specialists as a diagnostic method.

"Ninety-eight percent of all sleep disorders are caused by undiagnosed sleep apnea," said Abhinav Singh, M.D., the facility director of the Indiana Sleep Center. "And these can be consolidated into two categories: the patient who avoids seeking answers and the patient who insists on inaccurate diagnosis tools such as at-home sleep studies."

At-home sleep studies often go wrong

"When a patient performs an at-home sleep study, so many things can go wrong," Singh said. "The patient could hook up the machine improperly, loosen an electrode or [encounter] any other equipment failure that would render the test invalid."

Singh clarified that most of his patients put themselves through the hassle of an at-home sleep study because they believe it'll be more convenient, only to discover their test was inconclusive or presented inaccurate readings, which can sometimes result in misdiagnosis. This is a frustrating result, and most patients find themselves repeating the test in a sleep lab anyway.

In addition to providing reliability, the presence of trained professionals during the sleep study can also ensure any necessary adjustments to the machinery are made.

"The lab team can identify irregularities as they happen," said Raj Dedhia, M.D., otorhinolaryngology (ear, nose and throat) and sleep specialist at Penn Medicine in Philadelphia. "And because we film the patient sleeping, we can see how your physiology actually impacts your sleep."

Dedhia explained that any patient who seeks treatment at his center is referred for repeat sleep studies because he focuses on multiple diagnostic tools. First, he performs the sleep study but sometimes follows up with an endoscopy—a nonsurgical procedure used to examine a person's digestive tract—or a CT scan so he can get a full picture of how the airways and the surrounding pathways of the nose and throat function.

"Ultimately, the lab sleep study provides the most accurate and reliable picture, so we can be sure that you are properly diagnosed and treated," Singh said.

Diagnosing a sleep disorder

"Most sleep disorders can be classified into three categories," Singh continued. "You fall asleep but can't stay asleep; you can't fall asleep but then sleep well; or you fall asleep and get a poor quality of sleep."

If a sleep lab study rules out physical causes of sleep disturbances, the focus shifts to psychological and brain chemistry factors. To decide where to go next, Singh recommends his patients seek a mental health professional to explore potential psychological causes of sleep disturbances, while he continues to work on identifying the chemical causes.

"Many times, we can tell from our brain wave scans when and how the brain is disturbed in its sleep cycle," Singh clarified. "There are a number of medications that we can use to alter the sleep cycle to help patients fall asleep, stay asleep and/or get a more restful sleep."

For many patients, these sleep aids can be used temporarily to reset the body's clock, and eventually, the patient develops a healthy sleep pattern without the use of medication.

"Sleepwalking and other sleep interruptions are dangerous to yourself and your partner," Singh continued. "We need to figure out what is causing this, so we do a night and day test to see if your brain can stay awake during the day, which is typically tracked with journaling and tracking sleep patterns."

In these instances, the causes are typically psychological, such as racing thoughts that prevent sleep or something that prompts a patient to come out of restorative sleep to light sleep. Anxiety can actually wake them up. Singh said many of his patients find success by talking with a mental health professional, and he may also prescribe a temporary sleep aid while he works to address the root of their problems.

When someone feels tired during the day, they may feel prompted to nap, but daytime sleep can impact the ability to sleep at night. Singh explained that many times when patients get into a pattern of taking naps during the day, they cannot achieve restorative sleep at night. His first goal is to break this sequence of events.

"Sometimes, the patient cannot stop this pattern," Singh clarified. "When this happens, we usually discover that the patient has narcolepsy."

This diagnosis leads to a process of using sleep medications at night to help the brain achieve the restorative cycle it needs, so patients do not need to sleep during the day.

Many people with undiagnosed sleep disorders may not know the right time to seek the help of a sleep specialist, but regularly tracking wakefulness every morning is a good start. If you feel tired upon waking or during the day on a regular basis, you may want to set up a meeting with your general practitioner.