It is estimated that more than 50 million adults in the United States experience some kind of sleep disturbance. Until recently, little was known about the mysteries of sleep and sleep disorders. Few diagnostic tests and effective treatments were available. Consequently, many people suffered for years without proper evaluation and care.

But now, thanks to advancements in medical research and technology, there are facilities equipped to uncover the sleep disorders that disturb you at night. The Sleep Center for University Community Health is such a place, and is the first Sleep Center in the Tampa Bay area accredited by the American Academy of Sleep Medicine.

Many factors can affect how we sleep. Some of the most common factors include:

• Medications
• Illness
• Normal aging and life-style changes
• Poor bedtime or sleep habits
• Depression or anxiety

Disorders of Excessive Sleepiness that may be caused by:
• Sleep Apnea
• Narcolepsy
• Myoclonus/Restless Legs Syndrome/Periodic Limb Movement Disorder
• Medication-associated Sleepiness
• Neurological and other medical conditions that cause sleepiness

Parasomnias (undesirable activities during sleep) include:
• Sleepwalking
• REM Sleep Behavior Disorder
• Night Terrors
• Confusional Arousals

Breathing Abnormalities During Sleep
• Sleep Apnea
• Cheyne Stokes Respiration
• Nocturnal Asthma
• Central Sleep Apnea

Insomnia (disorders of initiating or maintaining sleep)
• Neurologic and other medical disorders that can disturb sleep continuity
• Medications that can disturb sleep continuity
• Maladaptive behaviors in response to altered sleep

Circadian Sleep Disorders
• Shift work
• Advanced Phase or Delayed Phase Sleep Disorders

Lack of oxygen to the heart may cause chest pain, heart attacks or heart failure. Lack of oxygen to the brain may cause headaches, confusion, personality changes and lowered I.Q.

Obstructive Sleep Apnea:
The more common type of apnea is upper airway Obstructive Sleep Apnea (OSA). An abnormal loss of tone in the muscles of the tongue, throat and larynx during sleep may cause partial or complete blockage of air. During the obstructive period, the diaphragm (the muscle separating the chest and abdominal cavity that helps move air in and out of the lungs) continues to contract with a progressively greater effort against the closed airway, until a partial or complete awakening occurs and normal breathing resumes.

Patients with Obstructive Sleep Apnea suffer from daytime drowsiness and fatigue. The degree of incapacity may range from drastic impairment of daytime activities because of irresistible urges to sleep, to only moderate daytime sleepiness resulting in drowsiness or falling asleep during quiet situations.

Patients with Obstructive Sleep Apnea often snore loudly. Their loud snoring is associated with snorting and is interrupted by periodic silence (apneic episodes), then breathing is resumed with a gasping or choking sound. Not all patients with OSA snore. Some may simply have increased resistance to airflow, but enough to disturb the quality of sleep.

Central Sleep Apnea
Another form of sleep apnea is Central Sleep Apnea. In Central Sleep Apnea, the diaphragm stops moving because the brain fails to send impulses through the nerves that control the diaphragm's movement. This is usually benign, without adverse effect on the individual, though some patients with Central Sleep Apnea may note periods of insomnia or difficulty maintaining sleep, or may report frequent awakenings throughout the night.

• Excessive Daytime Sleepiness
  
• Cataplexy (muscle weakness triggered by laughing or other emotional changes)
  
• Sleep Paralysis (an inability to move as sleep is beginning or ending and episodes may last a few moments to minutes)
  
• Hypnagogic Hallucinations (hallucinations which occur just before falling asleep)

Periodic Limb Movement Disorder (PLMD) occurs during sound sleep. It is a twitching movement which may disturb sleep. In the worst cases, the twitches occur every 30 or 40 seconds. The person sleeping may not awaken during this time, but the brain is aroused from a deep sleep into a lighter sleep, causing daytime fatigue or drowsiness. Patients with PLMD may or may not have RLS.

Sleepwalking, or Somnambulism, is walking during sleep. It is a series of complicated actions that begin during deep sleep, typically within the first few hours after falling asleep. Sleepwalking is more common in children than in adults, and boys are more likely to sleepwalk than girls. The condition will often resolve spontaneously, though efforts may be needed to prevent sleepwalkers from inadvertently harming themselves.

Insomnia may be caused by other medical conditions (arthritis, fibromyalgia, congestive heart failure, asthma, gastroesophageal reflux disease, etc.), by a variety of neurologic disorders (Parkinsons, Alzheimers, etc.), or by problems associated with depression, anxiety or other mood disorders.

A variety of drugs can affect sleep, including medications used for lung and heart conditions, neurologic disorders, and others. Also, the effects of caffeine, alcohol and similar substances are frequently underestimated.

Often efforts, initially attempted as adaptation to help transient sleepiness, evolve into behaviors that are self-perpetuating and difficult to correct.

In essence, there is a wide variety of causes for the symptoms of insomnia. The treatment, which may include medication, behavior modification, biofeedback, relaxation techniques, sleep hygiene education, etc., will be tailored to the diagnosis of the underlying cause.

Polysomnography
If your physician determines that a formal analysis of your sleep is required, you may be scheduled for a polysomnography test (PSG). This is a test performed to evaluate the cause of excessive sleepiness or other medical problems potentially causing a disturbance of sleep. These include:
obstructive apnea, other sleep-related breathing disorders, nocturnal myoclonus and other medical problems which can produce fragmented or non-restorative (ineffective) sleep.

The procedure involves applying electrodes (wires which monitor activity) on the skin with adherents. No needles, nothing that punctures or injures the skin are used, though the large number of monitoring wires may be annoying. The application process may take one to two hours, after which the patient is asked to sleep in a large, private room which can be darkened to his/her level of comfort.

If obstructive apnea is noted and at the request of the patient's physician, a nasal CPAP device may be tried.

A nasal CPAP is a small mask that rests over the patient's nose, held in place with straps around the back of the head. It fits somewhat snugly over the patient's nose and may initially feel a little uncomfortable. Most patients adapt to this device over a short period of time. The purpose of this device is to apply air pressure through the nose to the back of the throat, acting as a splint which keeps the airway from closing. By measuring the success of the device, and the amount of pressure required to overcome the airway closure, the physician can advise the patient about a variety of treatment options.

Though initially uncomfortable, most patients find CPAP to be of substantial benefit and actually sleep better once the airway closure is corrected.

Polysomnography is usually a monitored, overnight test that will end by 5:30 or 6 a.m. The patient's physician should be able to review the results with him/her within one to two weeks.

Multiple Sleep Latency Test
A Multiple Sleep Latency Test (MSLT) is performed to determine the tendency for pathologic hypersomnolence (excessive sleepiness) in cases not otherwise explained by PSG testing. This test is frequently used to assist with the diagnosis of patients with narcolepsy.

This procedure is similar to a PSG where multiple wires are placed on the patient with an adherent. The patient is then asked to sleep on command and remain awake between naps. Naps are scheduled every two hours through the day (usually, five naps over ten hours from 8 a.m. until 4 p.m.).

Very commonly, a daytime MSLT is scheduled to immediately follow an overnight PSG. Thus, the patient will come to the hospital at 6:30 p.m. on one day, have an overnight PSG that night, and stay the entire next day until 4:30 or 5 p.m. to complete the MSLT. The results of the MSLT are generally available within one week for the patient and physician to review together.

Maintenance of Wakefulness Test
The Maintenance of Wakefulness Test (MWT) is similar to, but the obverse of the MSLT. It measures an individual's ability to stay awake. The same monitors and wires are used for this test, as with an MSLT. Every two hours, the patient is challenged to stay awake for 30 minutes in a darkened, quiet room. The ability to stay awake is determined and can be used as a measurement of the patient's ability to maintain viligence on the job, or assess the success of therapy for hypersomnolent disorders (excessive sleepiness). The results are usually available within one week for the patient to discuss with his/her physician.

What about meals?
PSG Test: Have dinner before you come to the lab for the PSG. If you usually snack, bring something with you. Meals are not provided between 7 p.m. and 7 a.m.
MSLT/MWT Test: Breakfast and lunch are provided.

What about taking my medications?
Discuss this with your physician or the Sleep Medicine Consultant, but under most circumstances, it is best to continue your usual medications. Any medication you would usually take in the evening should be brought with you (likewise for any medication you would usually take in the morning, if you will not be going home after the test).

For certain tests (MSLT/MWT), it may be necessary to withhold specific medications for two weeks before the test. Discuss this with your Sleep Medical Consultant.

What clothing should I wear and can I shower?
Something comfortable is best, however, clothing should allow the technician access to placement of the electrodes. A two-piece pajama set or the equivalent works very well. A shower is usually available in each room.

What time will I be finished?

Overnight PSG Test: Finished by 6 a.m.
MSLT/MWT Test: Finished by 5 p.m.

When will I be informed of the results of my test?
Each test generates as much as 1,000 pages of computer data which must be analyzed and reviewed by the interpreting physician. A completed report is usually available within 7 to 14 days after the test is completed.

Where is the UCH Sleep Center located?
At University Community Hospital's Medical Arts Center, located at 13601 Bruce B. Downs Blvd., Tampa, Florida. The Sleep Center is located in Suite 151 on the 1st Floor.

How do I contact the UCH Sleep Center?
Our telephone number is (813) 615-7410 or you can call toll-free at 1-866-84-SLEEP. If we are not immediately available to answer your call, please leave a message, and someone from The Sleep Center will return your call.