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When Should I Visit A Sleep Specialist?

It’s time to see a doctor specially trained in sleep disorders when you have had trouble sleeping for more than a month or if you are tired during the day for unknown reasons. If you have trouble falling asleep or staying asleep, it is important to have the cause evaluated in a sleep lab. You and your primary care physician should not assume that you have “insomnia”.

Recent studies show that a high percentage (30-50%) of people diagnosed with insomnia actually have another sleep disorder such as obstructive sleep apnea. Also, it is very important to have your nocturnal breathing pattern evaluated before starting sleeping agents, because they may depress your respiratory drive.

What Are Some Of The Consequences Of Sleep Disorders If Left Untreated?

Some of the risks include:

  • Risk of developing high blood pressure, heart disease, diabetes and stroke
  • Daytime sleepiness and fatigue
  • Cognitive impairment and poor job performance
  • Anxiety, depression, memory loss and dementia, hypertension, cardiac disease, stroke, and traffic accidents.

What Does A Sleep Study Entail?

A sleep study is a non-invasive, painless evaluation of your sleep. Electrodes attach with paste and they monitor your brain waves, rapid eye movements, breathing patterns, respiratory efforts, oxygen levels, snoring, muscle tone and leg movements, electrocardiogram and heart rate. You are able to move from side to side.

What If I Can’t Fall Asleep?

There’s no way I can fall asleep with all that stuff on me!” The good news is that almost everyone does, it just may take you a little longer than normal. If this is a concern, please voice this to our physician during your appointment.

How Long Do I Have To Be At The Sleep Lab?

Patients are requested to arrive between 7:30 and 8:15 pm and generally will be able to leave between 6:00 am and 8:00 am unless of course you are an early riser. Patients are usually with us about 9 hours. We aim to get at least 7 hours of sleep study time.

What Should I Bring?

Pack as if you were going to a hotel. We do have showers in the bathrooms and will provide towels.  Please do bring your toiletries if you will need them.

What If A Spouse Or Caregiver Wants To Accompany An Adult Patient?

If a patient needs 24-hour care, we ask that the caregiver stay with the patient in our rooms in a cot that we will provide. If a spouse wishes to accompany the patient so as not to stay home alone, arrangements can be made.

Are Sleep Studies Covered By Insurance?

Yes. Medicare and most private health insurance companies cover office visits, sleep studies and CPAP services. We accept most major insurance plans except for Health Net.

Do You Need A Referral?

If you have Medicare or a PPO: No. HMO’s usually require one. Generally you can call your doctor and ask him/her to fax us a referral. We would be happy to assist you by faxing our referral form to your doctor.

Do I Have To Have An Office Visit Before My Sleep Study?

Usually that is the best way. Dr. Patel will perform an extensive review of your medical history with a special focus on sleep and he will perform a physical exam aimed at uncovering common causes of sleep disruption. He will evaluate you for one of the more than 80 sleep disorders that are currently known.

Some sleep disorders may be treated without requiring a sleep study, while others require a sleep study to determine which disorder you may have and its severity. This visit not only insures that we are providing you with the best possible service, but it is also preferred by the sleep center to meet the high standards of accreditation by the American Academy of Sleep Medicine.

A physician may refer a patient directly for a sleep study if it is for suspected Obstructive Sleep Apnea and the patient is in very good health.

What If I Have To Go To The Bathroom?

No problem. The electrodes are collected together to a central attachment that easily detaches to free you to get up and out of bed. Bathroom and shower facilities are available for all patients.

Can I Watch TV?

Yes. Each room has Direct TV. There is also wireless internet if you wish to bring your laptop. You are free to use any of these electronic media as you try to acclimate yourself to this new environment. Of course, we ask that you choose a relaxing activity.

Does The Insomnia And Sleep Institute Of Arizona Accept Pediatric Patients?

Yes, ages 2 and older. A sleep consultation is required prior to a sleep study unless it is a simple case of ruling out Obstructive Sleep Apnea. A parent or guardian must accompany the child and remain for the entirety of the study. We have rooms specially fitted with recliners so that the caregiver can sleep with the child. See use The Institute New Patient Packet for the pediatric sleep medicine patient registration form.

Diagnose Your Health (6)

Overnight Polysomnography (Psg)

Overview Of Overnight Polysomnography

The most common test in diagnosing obstructive sleep apnea (OSA) is Polysomnography (PSG). Using electrodes, PSG monitors brain function, eye movement, muscle activity, heart rhythm, respiratory airflow and other body functions involved in sleep patterns. Usually one night of sleep is adequate to receive sufficient information for a diagnosis.

Preparation For Overnight Polysomnography

An initial meeting with a sleep professional to determine the main areas of concern and past medical history is important. If a seizure disorder is suspected, more electrodes will be added in specific areas to also detect seizure activity. Other unique medical histories are determined so each PSG can be most effective to each individual patient. Because the test is overnight in a lab, patient’s generally come in early evening and are introduced to the process and prepared with EEG, EOG, EMG, EKG and respiratory and heart monitors.

Overnight Polysomnography Testing

During overnight PSG testing, the patient is wired with a minimum of 12 channels with 22 wires that are attached to a single system for recording, displaying and saving the results. After the patient is set up and falls asleep, a sleep technician observes through a video monitor.

Overnight Polysomnography Testing Follow Up

The electrodes and monitors gather data that is analyzed by a scorer. The reviews are studied in 30 second epochs, or ‘wavelengths’ of data produced by the EEG electrodes. The areas studied include sleep latency, efficiency, stages, breathing regularities, arousals of brain activity, heart rhythm, leg movement, body position and oxygen levels. The sleep professional reviewing these results looks for abnormalities and oddities that may be causing sleep problems. A treatment plan will be created based on PSG results to increase patient sleep health.

Cpap Titration

Overview Of CPAP Titration

CPAP titration is a method of study used to record and analyze continuous positive airway pressure. This study is recommended when a patient suffers from sleep breathing disorders such as obstructive sleep apnea (OSA), hypoventilation and hypoxemia. A pressurized mask is placed over the nose, mouth or both and regulated throughout the night to increase airflow. A sleep technician monitors the patient as they sleep overnight in a lab.

Preparation For CPAP Titration

The CPAP titration is an in-lab, overnight study. The patient comes in early evening and is set up and introduced before the sleep study begins. Prior to coming into the lab, a patient should follow their normal routine throughout the day, not consume caffeine after lunch time and not nap.

CPAP Titration Testing

CPAP titration is similar to PSG testing in the way it is executed. The patient is fitted with a mask and other sensors to monitor body functions. A sleep technician monitors the patient and brain, heart, respiratory and motor activity is recorded for later analysis.

CPAP Titration Follow Up

A sleep physician will review the results of the CPAP titration study and move forward with a treatment as necessary. Often the patient will be instructed to use a home CPAP mask for nightly home use.

MSLT (Multiple Sleep Latency Test)

Overview Of Multiple Sleep Latency Testing

The Multiple Sleep Latency Test (MSLT) is a method of sleep study that identifies the causes of excessive sleepiness. Polysomnography (PSG) testing is required the night prior to the MSLT. Following the PSG, the patient is asked to take several periodic naps throughout the day. The patient is monitored with sensors to record body function patterns and activity.

Preparation For Multiple Sleep Latency Testing

A PSG must precede a MSLT for accurate results. The following day, the patient will be monitored and instructed regarding naps throughout the day.

Multiple Sleep Latency Testing

A Multiple Sleep Latency Test is very similar to PSG in the way it is carried out and studying. Some differences may occur regarding electrode amount and location. MSLT focuses more on short patterns and ability to come in and out of sleep rather than a full night, continuous study.

Multiple Sleep Latency Testing Follow Up

All the results recorded from the electrodes and measuring devices will be scored and analyzed by a professional sleep technician. The results will be reviewed and an individual diagnosis and treatment plan will be developed and discussed.

Preparation For Maintenance Of Wakefulness Testing

Like Multiple Sleep Latency Test (MSLT), Polysomnography (PSG) is typically required the night before an MWT. This ensures more accurate results. In this case, testing would begin the night before with a monitored, continuous sleep followed by shorter, periodic naps.

Maintenance Of Wakefulness Testing

Following the PSG, the patient is set up with monitoring devices and asked to try and sleep four separate times, about two hours apart.

Maintenance Of Wakefulness Testing Follow Up

All the information recorded regarding body function of the brain, eyes, heart, muscles, etc. is reviewed and analyzed by a sleep specialist.

Lct (Limited Channel Test/Home Sleep Study)

Overview Of Limited Channel Test / Home Sleep Study

The only use of a Home Sleep Study is for diagnosing obstructive sleep apnea (OSA) but carries a high false negative rate and often is required as the initial screening tool by certain insurance companies today. A patient is given a device to take home and monitor their sleep, which they return the next day for review and analysis. Breathing and airflow is monitored through heart rate and oxygen levels throughout the night.

Preparation For Limited Channel Test / Home Sleep Study

A home sleep study is designed only for screening for obstructive sleep apnea (OSA) only as the sensitivity of a home sleep study is far less than that of the in laboratory sleep study (PSG). An initial meeting with a sleep specialist to determine who is eligible is required. Once a patient has met the requirements, they are given a device to take home and use during sleep to monitor breathing. As breathing is the only area being monitored, less sensors are required, hence the convenience to a home study.

Limited Channel / Home Sleep Study Testing

A sleep specialist instructs patients on how to use the devices and return the next day for results. All the patient must to do is set up the devices properly, sleep as usual and return the next day with the equipment for review.

Limited Channel Test / Home Sleep Study Follow Up

A sleep professional will review and analyze the breathing patterns and problems of the patient and determine a treatment plan.

Advanced Brain Monitoring Sleep Profiler

Sleep Profiler™ EEG Sleep Monitor Is A New Tool Employed By The Insomnia And Sleep Institute Of Arizona In Allowing For Performing In-Home EEG Over Several Nights To Allow For Sleep Staging And Architecture To Better Allow For Evaluation Of Sleep Patterns While The Patients Sleep At Home. This Tool Allows The Physician To Be Able To Analyze One's Sleep Patterns Using EEG Monitoring To Better Assess Patients Presenting With Complaints Of Insomnia. It Providers A More Object Measure Of A Person's True Sleep At Home Rather Than The Use Of Traditional Sleep Tracking Tools Currently Available On The Market.

Insurance Plans (6)

Aetna (HMO, PPO / Medicare HMO)
  • Cofinity

  • Open Access 

  • Premier Care Network 

  • Aexcel/Aexel Plus 

  • Aetna HealthFund Plans 

  • Aetna Whole Health – Arizona Care Network (ACN) 

  • Aetna Whole Health – Arizona Care Network (ACN) HMO/HNO 

  • Aetna Savings Plus – Arizona Care Network (ACN) 

  • Aetna Medicare – PPO/HMO

  • APIPA/Personal Care Plus/Community Plan

  • UHC Dual Complete (HMO SNP) 

  • UHC Developmentally Disabled 

  • AHCCCS Medicaid 

  • Care 1st/Once Care 

  • Evercare Choice / Premier / Select 

  • HealthNet 

  • Maricopa Health Plan / Maricopa Care Advantage 

  • Kidscare

Health Net
  • Medicare HMO

  • PPO Standard 

  • Standard HMO 

  • Arizona Community Care HMO 

  • Medicaid AHCCCS

  • HealthSmart (ACCEL, Auto, HPO, PPO, Workers Comp)

  • IHP (Auto, PPO, Workers Comp) 

  • Prime Health (Auto, IME, PPO, Workers Comp) 

  • Provider Select 

  • Stratose (Auto, Medicaid/AHCCCS, Medicare, Primary Plan PPO, Supplemental, TriCare) 

  • Three Rivers Provider Network (PPO) 

  • USA Managed Care Organization (Auto medical, PPO, Workers Comp)

Banner Health Plan
  • Employee Plans Choice / Select

  • Blue Medicare Advantage w/ alpha prefix XBU

Arizona Foundation for Medical Care
  • Arizona Medical Network (AMN) 

  • American Choice Provider Network (ACPN-PPO) 

  • Beech Street (AP Plan, Auto, PPO, Workers Comp) 

  • CorVel (Auto, PPO, Workers Comp) 

  • Fortified (Auto, PPO, Workers Comp) 

  • Galaxy Health Network (PPO, Workers Comp) 

Insurance Plans 2 (7)

Blue Cross Blue Shield (including Alliance and Select networks)
  • Blue Medicare Advantage w/ alpha prefix XBU

  • Cigna Open Access Plus, OA Plus, ChoiceFund OA Plus, ChoiceFund OA Plus with Carelink

  • Cigna PPO, Choice Fund PPO 

  • Network, HMO, POS 

  • Cigna HealthSpring Medicare Advantage

  • Coventry / First Health

  • Humana / Humana Choice Care 

  • Integrated Health Plan 

  • Multiplan / PHCS 

Phoenix Children’s Care Network (PCCN)
  • Intel Connected Care (Arizona Care Network ACN)

Health Choice (effective date 7/1/2016)
  • Health Choice Value

  • Health Choice Essential

Phoenix Choice
  • Phoenix Choice HMO Abrazo & Phoenix Children’s Hospital (Network is ABZ+PCH)

  • Phoenix Choice HMO (Network is PHX)

United Healthcare
  • Choice / Choice Plus (HMO/PPO/POS)

  • Choice / Plus with Harvard Pilgrim

  • Compass (HMO/Plus)

  • All Savers (PPO – exchange plans)

  • Core (Essential/HMO/Core Essential HMO)

  • Charter

  • Navigate (HMO/Navigate Balanced/Plus)

  • Options (PPO/PPO with Harvard Pilgrim)

  • Passport Connect Choice / Choice Plus, Options PPO

  • Select (HMO/Plus/Plus HMO)

  • Medica Choice w/ UHC Choice Plus

  • AARP Medicare Complete HMO (Phoenix Direct & Lifeprint Optum)

University of Arizona Health Plans
  • University Family Care, University Care Advantage, University Health Care Group, University Healthcare Exchange, Kids Care