Sleep Consultation and follow-up
Every person enrolled in Optimal Sleep Health will be offered a sleep consultation. This interview and focused examination differs from other physician evaluations because the content of the meeting includes discussion about sleep habits, sleep environmental factors, night time food, and functional daytime alertness issues. In select cases, a true sleep log that records the sleep habits over one or two weeks will be needed for analysis.
Optimal Sleep Health provides ongoing counsel for those in our system. An initial physician visit establishes the individual in our system.
Subsequently, we constantly monitor the status of our patients and offer advice and counsel regarding options for treatment and then monitor the response to treatment. This ongoing outcome monitor is important and makes it clear our focus is on results.
In-lab Polysomnography (formal sleep analysis)
Traditionally, sleep analysis has been performed in a hospital or special sleep center. The study can identify many types of sleep problems, and is often used to establish a starting point of treatment after the clinical assessment has suggested a sleep disorder. Optimal Sleep Health has formal relationships with five sleep centers along the Florida west coast, from Bradenton to Port Charlotte. Each of these centers has been evaluated by our staff and meets out high standards for quality of services.
The formal in-lab sleep study measures the following:
EEG (electroencephalography—brain wave analysis)
ECG (electrocardiography—heart rhythm measurement)
EOG (electro-oculography—eye movement measurement)
EMG (electromyography—muscle tone, leg moving assessment)
Pulse oximetry (continuous oxygen measurement)
Thoracic/abdominal expansion (breathing effort measurement)
Airflow/nasal pressure monitoring
Microphone (snoring/sleep talking analysis)
Study subjects arrive between 8 PM and 9 PM and are taken to their bedrooms. Often there are snacks and a television available for relaxation prior to sleep time. The hook-up is not painful. Electrodes measuring the various bodily functions are attached to allow for freedom of movement in bed. If the subject needs to urinate one or more times in the night, it is easily arranged without the electrodes having to be removed. Subjects usually arise around 6 or 6:30 AM to depart. Analysis takes a few days. On occasion, a sleep aid may be needed for patients who are anxious about sleeping away from home. Dr. Scheer will always meet with the patient shortly after the analysis is performed to go over results and discuss treatment options.
Home Sleep Testing
The second format for testing sleep is done in the home. It involves fewer electrodes and focuses on sleep breathing to diagnose sleep apnea. The advantages of home sleep testing include the opportunity to maintain a normal sleeping environment without unusual disruptions of a test setting. All insurers are now paying for home sleep analysis. It is less expensive and can be an option for those with high deductibles or no insurance.
The home sleep study measures the following:
Pulse oximetry (continuous arterial oxygen measurement and heart rate)
Thoracic/abdominal expansion (breathing effort measurement)
Nasal pressure monitoring (airflow through nose and pressure in throat)
Microphone (snoring analysis)
At the consultation, Dr. Scheer will determine if home sleep testing is appropriate. At a scheduled office visit, the patient receives an explanation and specific instructions for how to use the home study equipment, and schedules a date and time 2-4 days later to return the equipment to the office. After Dr. Scheer performs the analysis, the patient is presented with the results and treatment options are discussed.
For patients who live far away or cannot arrive at the office, the equipment can be mailed to them.
When continuous positive airway pressure (CPAP) therapy is needed for persons demonstrating apnea or snoring, the patient will require a measurement to define how much CPAP pressure is needed. As in formal lab-based testing, Optimal Sleep Health has professional relationships with five regional sleep labs that provide CPAP measurement under our guidance.
While these measurements can theoretically be done at home without monitoring, it is much preferred for the usual case to have a sleep technician assist in the measuring. In this way, subtle problems not always detected by the patient can be addressed immediately during the titration. For example, a mask change during the proceedings may totally improve the initial adjustment to CPAP therapy. Also, a switch to bilevel PAP, an alternative breathing machine requiring a different prescription, can be decided during the initial measurement visit.
Monitoring during CPAP titrations is still needed just as in the formal polysomnography described above, including EEG, ECG, EOG, EMG, etc.
Multiple Sleep Latency Test (MSLT) & Maintenance of Wakefulness Test
Some conditions causing severe daytime sleepiness must be characterized by testing in the sleep lab. The MSLT is a repeated nap test performed during the day utilizing national standards established by the American Academy of Sleep Medicine. The format includes a series of 4 or 5 naps offered to the patient, and the time until sleep onset is measured with each nap attempt. The average score is meaningful in quantifying the degree of sleepiness.
The Maintenance of Wakefulness Test (MWT) is similar but the subject needs to show the ability to stay awake even in a boring and unstimulating room for 40 minutes in each offered period. The goal of the study is to identify if there is any sleepiness at all.
CPAP Management Program
While several options to treat sleep apnea may be discussed, continuous positive airway pressure (CPAP) therapy is the most common treatment chosen. The coming together of throat structures during sleep causes snoring and apnea. CPAP involves application of air into the nose (and sometimes mouth) under pressure to push open these throat tissues blocking the way. Because it must be worn outside the nose and mouth, it is important that the mask or cannula that delivers the air is fitting properly and comfortably— not too loosely or too tight. Shortly after prescribing the treatment, Dr. Scheer and his respiratory therapist will check to see that the treatment is working correctly to eliminate the apnea and improve the sleep quality, daytime function and alertness. We provide timely follow up for our patients on CPAP therapy to ensure optimal sleep health and treatment effectiveness.
Many persons on sleeping pills ultimately decide they would like to not be dependent on medications for sleep. If they have become habituated to hypnotic sleep aids, they may nevertheless be able to come off the medication(s) by utilizing cognitive and behavioral strategies. Dr. Scheer has established good success in helping these individuals. This exercise may take from 2 to 6 office visits.
Most patients are physician or psychologist referred. Most primary care physicians and specialists are aware of the importance of quality sleep and readily recognize the need for sleep medicine specialists to assist their patients. If your provider(s) is not familiar with us, we can make our referral process known to them.
We will also receive patients who are self-referred, and be happy to forward information about your results locally or to out-of-town physicians on request.