Which patients should I refer for sleep testing?

Up to one in six adults suffers from some kind of sleep problem. Patients whose symptoms include loud snoring, excessive daytime drowsiness, memory problems or mild cognitive impairment, depression, headaches, diabetes and high blood pressure may be appropriate candidates for a sleep evaluation.

Research has shown that patients who have the most common sleep disorder, sleep apnea, have at least a four times higher risk of heart attack and stroke than their well-rested counterparts. For this reason, a sleep study can be the first step in your patient's life-saving evaluation and treatment. UM Shore Regional Health's Sleep Disorders Center accepts referrals for adults.

Why is a sleep consultation recommended prior to a referral for testing?

Our recommended protocol is to begin patient evaluation with a sleep consultation because this promotes a more complete review of the patient's particular sleep-related issues and enables us to determine the most appropriate conditions, timing, and type of testing. It also gives us the opportunity to provide the patient with information regarding testing and treatment. Studies have demonstrated better outcomes in patient compliance when sleep apnea evaluation is initiated with a consult.

Nevertheless, in some cases, only the results of a test outcome may be needed to provide appropriate care. In this case, direct referral for testing can be coordinated by providing the Sleep Disorders Center with basic information regarding the reason for testing and clinical evaluation notes and the referring clinician can coordinate discussion of results and treatment.

What if a patient has no insurance or limited financial resources?

The Sleep Disorders Center has developed ERMOSA, a program to improve access for our underserved populations at high risk for the morbidity and mortality risks of sleep apnea. Consultation, testing, and treatment will be coordinated to try to meet the financial needs of our patients. A sliding scale fee schedule is utilized for testing and consultations.

Are there alternatives to CPAP? What are the options when a patient does not like or tolerate PAP?

While positive airway pressure is very effective treatment for sleep apnea, it is not appropriate or comfortable for everyone. We have collaborative relationships with surgeons experienced in sleep apnea treatment. Dental appliances are a first-line treatment for mild to moderate sleep apnea and we work with specialists experienced in this modality. Lifestyle changes may be effective for some. Newer therapies, such as Provent Nasal Valves, also are available through our Center.

Many times however, a patient's poor tolerance for PAP reflects comfort issues that can be addressed with alternative interface options or different airway pressure delivery modes. As a comprehensive center, we approach patient needs with an individualized, multifaceted approach and follow up on patient compliance.

When is home testing appropriate?

Home sleep testing (HST) can provide less expensive, more convenient testing for some patients. It does not offer information regarding quality or quantity of sleep or other physiologic parameters than those relating to respiratory patterns. In patients with a high probability of sleep apnea and no other comorbid sleep complaints such as insomnia or restless legs, and no complicating medical factors such as CHF, COPD, or neurologic disease, it can provide adequate diagnostic information to start treatment.

It may be particularly helpful for the patient who is reluctant or unable to undergo in-lab testing.

Because we feel patient selection is crucial to obtaining accurate, meaningful data, we currently recommend starting with a sleep consultation with our staff to determine those patients for which HST is appropriate.

View more on HST guidelines.

View more about general referral information.