Q. Do I have to wear pyjamas?
Q. Do I have to remove my acrylic nails?
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 need to remove my toe nail polish?
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. Is there any parking?
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 public transport?
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 wheelchair access?
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 the study covered by my health fund?
A. Yes there is a lift to the second floor.
Q. Is the study performed by the doctor?
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. How long before my doctor gets the results?
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. Do I need a referral to have a sleep study?
A. Usually within 5-10 days of test date.
Q. Can my GP refer me for a CPAP pressure determination study?
A. Yes; a written referral from a registered doctor is required for all diagnostic studies.
Obstructive Sleep Apnoea:
Q. What is Obstructive Sleep Apnea (OSA)?
A. No, prior to a CPAP pressure determination study you will need to be seen by Sleep/Respiratory Physician who will refer you for this type of study if required.
Q. What are the symptoms of 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. I snore, is this a significant problem?
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. If OSA is left untreated what could happen to my health?
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. How is OSA assessed?
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. What is the treatment for OSA?
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 a CPAP pump?
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. Can I do anything to help OSA?
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.
Restless Leg Syndrome:
Q. What is “Restless Leg Syndrome”?
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.
Q. How is RLS diagnosed?
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. What are the common treatments for RLS?
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 types of insomnia?
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.
Q. How is insomnia investigated?
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. What are the common treatments for insomnia?
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. Is there a link between sleep apnoea and heart disease?
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.
Q. Does OSA cause hypertension?
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 atrial fibrillation?
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 diabetes?
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 mood disorders or make them worse?
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).
Other Medical Diseases:
Q. Is there a link between OSA and hormonal problems?
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”.
+ Sleep Disorders and Driving
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.
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
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).