My Appointment:
Location
Procedure
Facilities
FAQ
Referrals:

Q. Do I need a referral to have a sleep study?

A. Yes, a written referral from a registered doctor is required. You must also meet the pre-screening requirements set out by Medicare (see details on referral or below).

Q. Can I be referred by a GP for a sleep study?

A. Yes, for diagnostic sleep studies providing you meet the pre-screening criteria as per the Medicare Schedule from 1st November 2018. See “Home” page for screening questionnaire and pdf referral.
If you do not meet the pre-screening criteria, your GP will need to refer you to a Sleep Physician to assess your suitability for a sleep study (or alternate test). You may still be suitable for a GP referral for a Sleep Clinic study in some other situations. Please contact Peninsula Sleep Clinic for assessment of suitability.
Alternatively, your GP can refer you for home oximetry.
Some specialised sleep studies can only be referred by Respiratory/Sleep Physicians.

Q. What happens if you do not meet the screening criteria for a sleep study test?

A. If you do not meet the screening criteria then your GP/Specialist can refer you for a consultation with a Sleep Physician to further assess suitability for sleep study testing. Alternatively, your GP can refer you for home oximetry, as an initial screening test.

Q. What are the screening criteria requirements for a sleep study?

A. You must meet the following criteria:
  • an OSA50 score of 5 or more; or
  • a STOP-Bang score of 4 or more; and must have
  • an Epworth Sleepiness Score of 8 or more
If you do not meet the screening criteria then your GP/Specialist can refer you for a consultation with a Sleep Physician to further assess suitability for sleep study testing. Alternatively, your GP can refer you for home oximetry, as an initial screening test.

Q. Can I be referred by a GP for CPAP, MSLT, MWT sleep studies?

A. No, you must be referred by a Sleep Physician. If you are over 18 years of ages for an MSLT or MWT you can be referred by a Neurologist.

Q. Are there age restrictions for sleep studies at Peninsula Sleep Clinic?

A. Peninsula Sleep Clinic conducts sleep studies on patients greater than or equal to 14 years of age.

Q. Who does the referral need to be made out to?

A. For a sleep study it can be made out to Peninsula Sleep Clinic. If your doctor would like you to have a consultation with one of the Sleep Physicians from Peninsula Respiratory Group, they can select the doctors name on the referral or select the box “first available” if they do not have a preference for doctor and want you to have the earliest appointment available.

Peninsula Respiratory Group is a separate business and can be contacted on 9975 4911.



My Appointment at Sleep Clinic:

Q. Do I have to wear pyjamas?

A. Yes, even if you don’t wear pyjamas at home you will need to in the Clinic. Two piece (top and bottom) cotton pyjamas with underpants underneath (essential). This preserves patient modesty (as we have male and female staff) and hygienic practices. Shiny fabrics are slippery making lead application difficult.

Q. Do I have to remove my acrylic nails?

A. No, the acrylic nails don’t have to be removed. However, if you have a dark polish or a colour that contains glitter then you will need to remove this from one finger on each hand. Alternatively you can remove the nail polish from both feet, and this sensor may be applied to your toe nail.

Q. Do I need to remove my toe nail polish?

A. No, unless you have dark or glittery polish on your finger nails. Please refer to the question above (Do I have to remove my acrylic nails?).

Q. Is there any parking?

A. Yes, during the day there is limited parking under the building and in the street. There are no problems finding parking at night.

Q. Is there any public transport?

A. Yes the 136 bus from Manly to Chatswood stops at the Parkway Hotel which is the next building along in Frenchs Forest Road.

Q. Is there wheelchair access?

A. Yes there is a lift to the second floor.

Q. Is the study covered by my health fund?

A. Usually, however this depends on how long you have been with your fund and whether you have adequate cover and an excess or co-payment. Individual 'Statement of Fees' and informed financial consent are provided to all patients prior to any study.

Q. Is the study performed by the doctor?

A. No the study is set up, monitored and analysed by a registered nurse/technician under the supervision of a Sleep Consultant. The analysed data is later reported by the supervising Sleep Consultant.

Q. How long before my doctor gets the results?

A. Usually within 5-10 days of test date.



Home Sleep Test Appointment:

Q. Why have I been referred for a Home Sleep Study rather than a Laboratory test?

A. Your doctor has recommended a Home Study for you at this time, or you may prefer to be tested at home.

Q. How do I book a home sleep study?

A. Contact reception on 9451 0522. You will need a relevant referral from your doctor. See our home page for further details on referrals.

Q. What signals are monitored during a home sleep study?

A. The signals monitored are: EEG, EOG, submental EMG, thermocouple, nasal flow, ECG, thoracic and abdominal RIP effort, leg movements, oxygen saturation, inbuilt position. There is no video monitoring or diaphragmatic EMG measured.

Q. Is the study performed by the doctor?

A. No the study is set up at Peninsula Sleep Clinic and analysed by a registered nurse/technician under the supervision of a Sleep Consultant when the equipment is returned to the Clinic. The analysed data is later reported by the supervising Sleep Consultant.

Q. Do I need to apply the equipment myself?

A. No the study is set up at Peninsula Sleep Clinic and analysed by a registered nurse/technician and you are sent home with most of it in place. There are three leads you need to apply yourself (thermocouple, nasal cannulae and oxygen saturation probe) as these will inhibit your driving. You will be educated in their application and sent home with written instructions.

Q. Do I need to start the recording?

A. No, the study is set up to starts recording automatically so you do not have to do anything.

Q. What happens in the morning?

A. You do not need to turn off the equipment. However, you will need to remove the leads carefully and place them in a bag to return to the Clinic first thing. The equipment needs to be returned promptly so it can be downloaded and information analysed. The equipment is booked by other patients and if you do not return it in time you will incur additional costs.

Q. Do I have to wear pyjamas?

A. Yes, it is ideal if you can wear pyjamas or comfortable clothes you can drive and also sleep in. Two piece (top and bottom) cotton pyjamas with underpants underneath (essential). This preserves patient modesty (as we have male and female staff) and hygienic practices. Shiny fabrics are slippery making lead application difficult.

Q. Do I have to remove my acrylic nails?

A. No, the acrylic nails don’t have to be removed. However, if you have a dark polish or a colour that contains glitter then you will need to remove this from one finger on each hand. Alternatively you can remove the nail polish from both feet, and this sensor may be applied to your toe nail.

Q. Do I need to remove my toe nail polish?

A. No, unless you have dark or glittery polish on your finger nails. Please refer to the question above (Do I have to remove my acrylic nails?).

Q. Is there any parking?

A. Yes, during the day there is limited parking under the building and in the street. There are no problems finding parking at night.

Q. Is there any public transport?

A. Yes the 136 bus from Manly to Chatswood stops at the Parkway Hotel which is the next building along in Frenchs Forest Road.

Q. Is there wheelchair access?

A. Yes there is a lift to the second floor.

Q. Is the study covered by my health fund or Medicare?

A. Your Health Fund does not cover the cost of a home sleep study. Medicare will partially cover the cost and there are some “out of pocket” expenses associated with the test. Individual 'Statement of Fees' and informed financial consent are provided to all patients prior to any study. Please contact reception on 9451 0522 to discuss.

Q. How long before my doctor gets the results?

A. Usually within 5-10 days of test date.



Home Oximetry:

Q. Why have I been referred for a Home Oximetry?

A. You may not meet the screening criteria determined by Medicare for a sleep study test. Or, you or your doctor may have a preference for a simple screening test at home.

Q. What is home oximetry?

A. It is a sensor worn on your finger and wrist that measures your oxygen saturation. The test is for overnight home oximetry, so you wear the sensor at night.

Q. What signals are monitored during a home oximetry?

A. Oxygen saturation.

Q. How do I book home oximetry?

A. Contact reception on 9451 0522. You will need a relevant referral from your doctor. See our home page for further details on referrals.

Q. Is the study performed by the doctor?

A. No the study is set up at Peninsula Sleep Clinic and analysed by a registered nurse/technician under the supervision of a Sleep Consultant when the equipment is returned to the Clinic. The analysed data is later reported by the supervising Sleep Consultant.

Q. Do I need to apply the equipment myself?

A. Yes, however you will be shown by a qualified staff member how to apply the sensor and sent home with written instructions.

Q. Do I need to start the recording?

A. Yes, recording starts when you connect the cable to the wrist piece.

Q. What happens in the morning?

A. You need to disconnect the cable from the wrist piece and the recording will stop. Then you will need to remove the sensor carefully and return to the Clinic first thing. The equipment needs to be returned promptly so it can be downloaded and information analysed. The equipment is booked by other patients and if you do not return it in time you will incur additional costs.

Q. Do I have to remove my acrylic nails?

A. No, the acrylic nails don’t have to be removed. However, if you have a dark polish or a colour that contains glitter then you will need to remove this from one finger on each hand.

Q. Is there any parking?

A. Yes, during the day there is limited parking under the building and in the street.

Q. Is there any public transport?

A. Yes the 136 bus from Manly to Chatswood stops at the Parkway Hotel which is the next building along in Frenchs Forest Road.

Q. Is there wheelchair access?

A. Yes there is a lift to the second floor.

Q. Is the study covered by my health fund or Medicare?

A. No, your Health Fund/Medicare do not cover the cost and there are “out of pocket” expenses associated with the test. Individual 'Statement of Fees' and informed financial consent are provided to all patients prior to any study. Please contact reception on 9451 0522 to discuss.

Q. How long before my doctor gets the results?

A. Usually within 5-10 days of test date.



Obstructive Sleep Apnoea:

Q. What is Obstructive Sleep Apnea (OSA)?

A. It is where breathing slows or stops for short periods during sleep. This can occur many times during the night. During deep sleep most muscles relax including the tongue and the muscles in the back of the throat, this can cause a blockage of the airways. Such episodes are called apneas.

Q. What are the symptoms of OSA?

A. The most common symptoms are:
  • Snoring is very common in the community (60% of men over the age of sixty snore regularly). Snoring is usually a social nuisance, but is often also a marker of a more serious problem called Obstructive Sleep Apnoea (OSA).
  • Obstructive Sleep Apnoea (OSA) is the most common sleep disorder in the community after insomnia. An apnoea is the cessation of breathing for ten seconds or more in an adult. The common predisposing conditions are obesity, aging, maleness, and facial shape, but it can also occur in children and women. If untreated, OSA can cause hypertension and makes several other conditions worse including: diabetes, heart failure, abnormal heart rhythms. If severe enough it can cause premature death usually from stroke or heart attack.
  • Choking / gagging / gasping in sleep these are symptoms of OSA typically in mild-moderate disease, which paradoxically disappear as the disease gets worse.
  • Gastro-oesophageal reflux is commonly a marker of OSA.
  • Sleepiness / tiredness are perceived by men and women differently. Women often describe this as a ‘lack of energy’ or ‘poor motivation’ but men describe it as ‘sleepiness’ or ‘tiredness’. It is usually due to inadequate refreshing sleep; either too little sleep time, or poor quality sleep (as is the case in OSA). It reduces performance in most areas of daily life and often is associated with irritability or ‘grumpiness’. It also predisposes people to traffic and industrial accidents.

Q. I snore, is this a significant problem?

A. Snoring is very common in the community (60% of men over the age of sixty snore regularly). Snoring is usually a social nuisance BUT is often a marker of OSA.

Q. If OSA is left untreated what could happen to my health?

A. If OSA is left untreated it can cause high blood pressure (hypertension) heart attack and stroke. It can also make other conditions worse, such as diabetes, heart failure and abnormal heart rhythm. If severe it can cause premature death.

Q. How is OSA assessed?

A. Firstly you will need to be assessed by your doctor. Once it is determined you have a sleep problem your doctor may refer you to a sleep laboratory for full assessment by an overnight sleep study. At the laboratory you will be fitted in a very systematic way with sensors and leads. The leads are connected into a computerized system and your sleep will be monitored overnight. The data collected is analyzed then reported by a doctor, this report is then forwarded to your referring doctor. Trained staff are in attendance for the entire procedure. The study does not include a consultation with a doctor.

Q. What is the treatment for OSA?

A. Treatment depends on the severity of the OSA. Less severe OSA can be treated by individually designed dental devices and nasal surgery to improve the airflow flow. A CPAP pump is the most common treatment for moderate to severe OSA.

Q. What is a CPAP pump?

A. A CPAP pump is a machine that delivers airflow at a specific pressure (which has been determined by another sleep study wearing the equipment) via a tube attached to a close fitting mask. The equipment is worn during sleep and air is delivered at a positive pressure which keeps the airways open.

Q. Can I do anything to help OSA?

A. If overweight try and lose weight, avoid alcohol, sleeping tablets and tranquillisers, improve nasal congestion and avoid sleeping on back may be helpful in some circumstances.



Restless Leg Syndrome:

Q. What is “Restless Leg Syndrome”?

A. The “Restless Leg Syndrome” (RLS) is a clinical entity characterised by the need to move the legs prior to bed or sleep onset in response to an unpleasant sensation in the legs. Movement relieves the sensation. Once asleep patients with RLS often have uncontrolled “Periodic Limb Movements” (PLMs) which are a different disorder and can be detected in a sleep study.

Q. How is RLS diagnosed?

A. The diagnosis is made by a doctor and not based on any particular test results but the patient’s description of their symptoms.

Q. What are the common treatments for RLS?

A. The syndrome may be associated with or caused by metabolic conditions such as liver or kidney disease, or anaemia. Commonly used antidepressant medications also cause PLMs but not necessarily RLS. So, identifying and treating any underlying cause is the first line of treatment. If none are found then non pharmacological treatment can be tried such as using a bed cradle to take any pressure off the legs in bed or soaking the legs in cold water before bed. Some medications have been shown to work, but they usually have some side effects.



Insomnia:

Q. What are the common types of insomnia?

A. There are two major types of insomnia; Sleep onset insomnia (SOI) and sleep maintenance insomnia (SMI). In the first (SOI) people struggle to get to sleep. This is usually “psycho-physiological” in origin, although sometimes can be due to pain or other organic causes. The second (SMI) is usually due to a combination of some organic cause that wakes the patient (e.g. sleep apnoea, or arthritic pain), followed by psychological factors that prevent a quick return to sleep.

Q. How is insomnia investigated?

A. The first and most important investigation is a medical or psychological consultation to determine the type of insomnia and factors that are important in its initiation and perpetuation. Sleep studies are often used when SMI is suspected, although recent research suggests that all patients with insomnia should have a sleep study.

Q. What are the common treatments for insomnia?

A. SOI is usually treated by “cognitive behaviour therapy” (CBT). An intervention usually carried out by a specially trained psychologist. SMI is treated by a combination of treatments designed to prevent or ameliorate the initial waking from sleep; e.g. treatment of sleep apnoea or pain, together with CBT to aid the return to sleep.



Cardiovascular Disorders:

Q. Is there a link between sleep apnoea and heart disease?

A. Yes there are links: Sleep Apnoea (or most commonly Obstructive Sleep Apnoea (OSA)) is an accepted cause of vascular disease and stroke.

Q. Does OSA cause hypertension?

A. OSA is an accepted cause of hypertension. Interestingly once the hypertension has been present for a long time, treatment of the OSA does not seem to reduce the blood pressure (BP). In one English study only those patients who were sleepy as well as hypertensive had a reduction in BP with treatment (CPAP).

Q. Does OSA cause atrial fibrillation?

A. OSA has been associated with difficult to control atrial fibrillation (AF). Whether is actually causes AF in the first place is unknown.

Q. Does OSA cause diabetes?

A. The relationship between OSA and diabetes has been investigated in many studies in an attempt to answer that question. So far the evidence is somewhat contradictory, but on balance we believe that it probably contributes to glucose intolerance (which is a stepping stone to diabetes).



Mood Disorders:

Q. Does OSA cause mood disorders or make them worse?

A. Sleep disruption from any cause can alter daytime mood in otherwise normal people. In one trial of antidepressant medication sleep was improved by adding a sleeping tablet to the medication in half the subjects. Those with the extra sleeping tablet recovered from their depression faster than those without. By analogy then one might expect that the sleep disruption due to OSA would make depression worse. Many of the symptoms of OSA are similar to those of depression (e.g. “tiredness”, lack of motivation, poor memory, irritability) and many mood disorders impair sleep quality. Treating severe OSA with effective CPAP therapy has cured many patients with “depression”.



Other Medical Diseases:

Q. Is there a link between OSA and hormonal problems?

A. OSA is more common and probably made worse by certain hormonal abnormalities: reduced function of the Thyroid gland has been shown to make OSA worse. Conversely an overactive pituitary gland (causing acromegaly) has been associated with a high prevalence of OSA and central sleep apnoea (CSA). Menopause seems to increase the incidence of OSA in older women, yet replacement hormonal therapy has not been shown to prevent the development of OSA.



+ Sleep Disorders and Driving

Studies have shown that sleepiness is a major contributing factor in many road accidents and people with sleep apnoea have an increased risk of motor vehicle accidents.

Driver fatigue is one of the three biggest killers on NSW roads. If you are aware you are sleepy when driving it is your responsibility to discuss this with your GP and arrange further investigations and treatment.

Please refer to the AustRoads Assessing Fitness to Drive guidelines for personal responsibilities in relation to driving. The Roads and Maritime Services Website contains some useful information about driving with a medical condition (e.g. sleep disorder).

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