Common sleep questions
I have an adolescent who cannot fall asleep before 2:00 am and is missing school frequently due to inability to wake up in the morning? Does he/she need a sleep study?
If the patient is otherwise healthy and does not exhibit risk factors for obstructive sleep apnea (snoring, pauses in breathing while asleep, obesity, and large tonsils), periodic limb movements/restless legs syndrome (frequent kicking while asleep, complaints of leg pain in the evening) or anxiety/depression, then a sleep study will not provide useful information. In these cases we would recommend a full evaluation in the Sleep Medicine Clinic. The most common diagnosis for this type of complaint is delayed sleep phase syndrome also known as a circadian rhythm disorder. This is usually treated with light box therapy to "shift the internal clock" to a more appropriate sleep cycle. It is very helpful to have the adolescent bring a completed two week sleep log with them to the clinic visit.
I see several different types of sleep study choices available on your order form. Which one should I order?
A full polysomnogram always provides the most useful information for a complete diagnostic study. A polysomnogram with EEG is used when seizure activity is suspected as a possible cause for frequent night time awakenings or daytime fatigue. Limited polysomnograms will not give you sleep staging but may be appropriate for infants who are being studied to determine whether or not oxygen is necessary or if you are concerned that they may not be at the appropriate liter flow. A polysomnogram with CPAP titration should be ordered if the child has already had a polysomnogram demonstrating obstructive sleep apnea and surgical options are not appropriate. These patients should always be seen in our CPAP clinic for evaluation, mask fitting and acclimation prior to the study to decrease their anxiety level and improve the chances of a successful titration.
What is the appropriate treatment plan for a snoring toddler?
Snoring is always abnormal in children. If the child has large tonsils (3-4+ in size) and exhibits behavioral problems such as daytime sleepiness or hyperactivity, loud snoring on a nightly basis and disrupted sleep, you should consider direct referral to an ENT. If the parents show reluctance to consider surgical options or daytime symptoms are less clear cut, a sleep study (polysomnogram) would be indicated to determine the degree of obstruction, oxygen saturations and CO2 analysis along with sleep staging.
The pulmonary/sleep clinic is always happy to evaluate children with sleep disorders that you find difficult to manage. Behavioral sleep disorders (bedtime refusal, etc.) can be seen in Dr. Barton Schmitt's clinic.
