Sleep Laboratory Services

It is estimated that more than 40 million Americans suffer from a chronic sleep disorder. If you think you might be one of these people, the Sleep Laboratory at St. Joseph’s Hospital Health Center can help. The Sleep Lab focuses on diagnosing and treating Obstructive Sleep Apnea and sleep-related breathing disorders, and has the largest number of sleep-credentialed physicians and registered sleep technologists of any sleep lab in the area. To find out how we can help you improve your health and live your best life, continue reading or call us at the numbers listed below.

Accreditation
The Sleep Laboratory at St. Joseph's is fully accredited by the American Academy of Sleep Medicine (AASM), the national accrediting body for sleep disorders centers and laboratories for sleep-related breathing disorders. This accreditation is the standard the public can use to evaluate sleep medicine services. Our accreditation ensures that we display and maintain proficiency in areas such as testing procedures and policies, patient safety and follow-up, and physician and staff training. In some cases, insurance carriers are more likely to reimburse you for treatment from an AASM-accredited sleep center.

Sleep-Related Breathing Disorders
Obstructive Sleep Apnea is the most common and most severe form of Sleep Apnea. The disorder causes your body to stop breathing during sleep. Tissues in the back of the throat collapse and block the airway, stopping air from getting into the lungs. Blockage of the airway can happen a few times a night or several hundred times a night. Nearly 90 percent of people with sleep apnea remain undiagnosed.

Complications of Sleep-Related Breathing Disorders

• Excessive daytime sleepiness
• Morning headaches
• Cardiovascular complications

Left untreated, Sleep Apnea can greatly interfere with your professional and social life. Injuries at work, poor work performance, intellectual dysfunction, and automobile accidents can result from Sleep Apnea. Recent studies have found that the risk of premature death is three times higher in people with undiagnosed Sleep Apnea. The good news is that the Sleep Laboratory at St. Joseph's is here to help.

AWAKE--The CNY Sleep Disorders Support Group
St. Joseph's offers the area's only support group for people with sleep disorders. AWAKE--also known as Alert, Well, and Keeping Energetic--holds quarterly meetings for recent patients and provides people a support network as they continue on their way to optimal health. Patients who participate in support groups experience higher success in managing their disorders long term.

How Do I Get Diagnosed and Treated?
Talk to your physician about Sleep Apnea and other sleep disorders, or contact the Sleep Laboratory at St. Joseph’s Hospital Health Center for information. You will be asked to complete a questionnaire so it can be reviewed by the Sleep Lab medical director. If the questionnaire suggests a sleep disorder, you will be scheduled for a sleep evaluation.

Patients requiring overnight studies visit the Sleep Laboratory on an outpatient basis. Some patients may require more than one night of testing and perhaps some daytime testing. Most patients are able to continue with their normal routines the next morning.

How Is My Sleep Monitored?
You will be scheduled to report to one of our three Sleep Laboratories. Once you are ready for bed, a technologist will apply sensors, electrodes, and other monitoring devices. This painless procedure takes 30 to 45 minutes to complete. The monitoring devices are connected to a computer that records various aspects of your sleep, including: brain activity, eye movements, muscle activity in chin and legs, heart activity, breathing effort, and oxygen saturation. A camera records your sleep throughout the night.  At all times, you are able to speak with a technologist in an adjacent room by intercom.

What Are the Rooms Like?
The rooms are designed to make you feel as comfortable as possible by representing a home-like environment. They are carpeted and include large beds, televisions, and air conditioning.

What do I Need to Take with Me?
It is important that you take comfortable night clothes you are used to wearing. Two-piece pajamas, required for women, make it easier for the technologist to apply electrodes while respecting your privacy. You may decide to take your own pillow if it will help you sleep more comfortably. Also take any medications or equipment you may need. You should be finished with your test and on your way in the morning, unless you are required to have daytime testing.

Daytime Testing
You may be required to have a series of daytime tests consisting of several napping periods at two-hour intervals. These usually start at 8 a.m. and continue until 2 p.m. or 4 p.m. Daytime testing is also available for people who work night shifts and sleep during the day.

What do I Need to Take for Daytime Testing?
Daytime testing, as well as overnight testing, is considered an outpatient procedure. You will need clothing for the next day, food or money to buy food, personal toiletries, something to work on or read, any medications or equipment you may need, and a complete sleep diary.

Will  My Medical Insurance Cover Charges?
Most insurance carriers cover some or all of the costs involving sleep studies. Because insurance policies vary, it is your responsibility to verify insurance coverage prior to your study.

If You Miss an Appointment
Because the Sleep Laboratory has a limited number of beds and study rooms, you missing an appointment causes a longer wait time for other patients. We encourage you to keep appointments. If you do need to cancel, we ask that you do so more than 24 hours in advance, so someone else can be offered your appointment time. If a patient continues to miss appointments, we will discontinue service to that patient.

What Happens if I'm Diagnosed?
Patients who are diagnosed with Obstructive Sleep Apnea will likely be treated with Continuous Positive Airway Pressure (CPAP) or BiLevel Positive Airway Pressure (BiPAP). These therapies relieve the airway obstruction that occurs while you sleep. Most patients experience the following reactions to treatment:

• Increased energy level and attentiveness during the day
• Fewer morning headaches
• Reduced irritability
• Improved memory
• Increased ability to exercise
• Increased effectiveness at home or at work
• Improved overall quality of life

What is the connection between nasal obstruction and obstructive sleep apnea (OSA)?
Think about how the air gets into the lungs with each breath. The air goes through a continuous pipe from the nose down to its destination - the lungs.  There are several segments to this air pipe, starting with the nasal valve (entry point of the nasal passage), the nasal passage, the soft palate, and back of the tongue before it enters the lower airway. Normally, the nasal valve area accounts for more than 50% of upper airway resistance.

In people with obstructive nasal airway, the effect of obstruction is amplified beyond their problematic nasal airway. Obviously, these people experience trouble moving air at their nasal valve regions. Beyond that, the increasing effort to breathe through the narrow nasal valve results in increased negative pressure further downstream at the soft palate and back of the tongue, resulting in collapse of these structures. This is where the snoring happens as well.

To overcome this challenge, these people will start breathing through their mouths during sleep. So how much difficult is it to breathe through mouth? During sleep, it is about 250% more difficult (higher resistance) to breathe through mouth than through the nose, and further compromising the quality of sleep.

What is the data behind nasal surgery and obstructive sleep apnea (OSA)?
Within the published studies on nasal surgery and OSA, there are some controversy as to what extent the nasal surgeries improve OSA directly. Nasal surgery to correct the structural nasal airway problem has been shown to help OSA patients who could not previously tolerate the continuous positive airway pressure device. Many patients who rely on nasal medications (such as nasal steroid, antihistamine, or other “allergy medicines”) may need less or no further medications after the surgery compared to before the surgery.

Some studies, however, have shown that the nasal surgeries do not always result in improvement of the sleep study score.  This is counter-intuitive and controversial because, it seems that if one’s obstructive nasal airway is improved, then one’s OSA score should improve also. While this is an active area of future research, growing consensus is that inadequate nasal surgery played a part in some of the old studies that fail to show significant improvement in OSA score following nasal surgery.

Recent studies in which specific anatomic problems were identified and repaired through modern functional septorhinoplasty techniques, patients experienced improvement both in qualitative measures as well as in quantitative sleep study scores. These are patients whom nasal airway was the primary cause of OSA.

What are the surgical options for nasal obstruction in patients with obstructive sleep apnea (OSA)?
Traditional basic nasal airway procedures consisted of septoplasty and turbinate reduction. In fact, correction of deviated nasal septum - also called septoplasty - continues to be the most common surgery performed by the otolaryngologists for structural nasal airway obstruction. Overall success rate, or the satisfactory outcome reported by patients with nasal airway obstruction after the surgery may ranges from 65-80% among the published studies.

More recently, the modern functional rhinoplasty and the concept of repairing the nasal valve became the main focus in nasal airway surgery. In selected patients, functional rhinoplasty procedure has shown to actually improve or even cure OSA.

Why do the traditional basic nasal procedures like septoplasty/turbinate reduction fail to help in some patients?  Would these patients benefit from functional rhinoplasty?

In 51% of the patients who require revision surgery for nasal obstruction, the nasal valve area was the persistent problem. Below are the specific nasal structures that the traditional septoplasty technique most often fails.

Persistent obstruction of internal nasal valve:

Dorsal cartilaginous septum - 65-92%

Dorsal bony septum (perpendicular plate of ethmoid) - 79%

Narrowed middle vault - 40%

Persistent obstruction of external nasal valve:

Caudal septum - 72%

Domal cartilage deformity - 38%

Why are these problematic nasal structures often missed by the traditional nasal surgery (septoplasty) performed by the general otolaryngologists?
Foremost, the techniques employed by the general otolaryngologists in which the septoplasty is almost exclusively performed through incisions inside the nose (Killian or transfixion incisions). This greatly limits the visibility of the missed nasal valve structures described above. This also makes correction or manipulation of these structures technically challenging. Secondly, these structures described above are parts of the critical supporting mechanisms of the nose. Due to the concern related to destabilizing the nose, these structures are traditionally not disturbed when traditional technique is employed.

Facial plastic surgeons with otolaryngology background approach the nose from a different perspective (with the lessons learned through the cosmetic rhinoplasty surgeons and their patients of the previous generation).

Functional septorhinoplasty may be performed either through intranasal incisions only (Endonasal approach), or through a small incision below the nose (Open approach), depending on which structures need to be corrected. This allows access and ability to correct the entire nasal structure that is causing the obstructive problem, and at the same time, re-establishing and restoring the support mechanism of the nose.