Sleep Basics - 101 Questions About Sleep and Dreams

Chapter 7 - Things that Go Wrong in the Night (Part 1)

82. How is this disorder treated?
83. What causes snoring?
84. My husband snores so loudly that I have not been able to sleep in the same room with him for years. Recently our next door neighbors have complained to us about the noise he makes. They said there was an operation that could cure the problem. Is this true?
85. Should snoring be treated?
86. When my husband sleeps, he stops breathing for a few seconds and starts again with a loud snort. The family used to laugh at the noise he made. But now I am so bothered by the noise that I lay awake worrying that he might forget to breathe and die. Am I being silly?
87. What is narcolepsy?
88. Just as I fall asleep, I have the frightening feeling that I cannot move. Is this abnormal?
89. My father and his brother both have asthma. My father has difficulty mainly during the day. But my uncle was taken to the hospital two times in the past month for asthma attacks during the night. Does asthma get worse when we sleep?
90. During the night my wife wakes me up by thrashing and moving. She seems to stay asleep, but she jumps and kicks. We like to share the same bed, but I cannot sleep with this kind of activity. What do I do?
91. I often wake up dripping with sweat. What can cause this?
92. I have heard that most people die in their sleep. Is this true? And isn't it a blessing to die so peacefully?
93. Can sleep disorders really cause enough sleepiness to make driving and work unsafe?
94. My 16-year-old son grinds his teeth only when he sleeps. What should I do?
95. Many mornings I wake up with a headache. I am not a drinker. What can cause this?
96. When should someone consult a specialist for a sleep problem?
97. How do I find a specialist in sleep disorders?
98. For people who do feel they need professional help, what can they expect from a sleep disorders center?
99. I have seen people all wired-up for sleep labs. What happens if I cannot sleep in the lab and what are all those wires for anyway?
100. How much will an evaluation cost?
101. Will my healthcare plan cover sleep disorders services?
     

82. Q: How is this disorder treated?

Physicians usually treat sleep apnea by providing pressure support for the walls of the airway during sleep with a technique called continuous positive airway pressure given through the nose - 'nasal CPAP' for short. Patients on nasal CPAP use a mask that fits over the nose to force air into the airway through the nostrils. Nasal CPAP works by creating a pneumatic (air pressure) splint to keep the airway open and has become a very successful treatment, if the device is used consistently. While the idea of wearing such a mask all night long might seem unappealing, most patients learn to use CPAP quickly and adapt to wearing the device whenever they sleep. The benefits of having their sleep apnea controlled seem to far outweigh CPAP's inconveniences.

For some cases, surgery is indicated. An early approach was to perform a tracheostomy which consists of a permanent alternative airway below the Adam's apple in the form of a tube that can be opened while sleeping and closed during waking hours. This treatment for sleep apnea is rarely used today except in short term or emergency situations. More recently, doctors have moved away from the disfigurement of tracheostomy by performing a surgical widening of the oropharyngeal airway. In some cases, the tissue is removed with a surgical knife in a procedure called a uvulopalatopharyngeoplasty (UPPP). When skeletal abnormalities are involved, many patients undergo surgical repositioning of the lower jaw, the hyoid bone and the upper jaw. If snoring is more of a problem than sleep apnea, oropharyngeal tissue can be repositioned by one or more treatments with a surgical laser in a procedure called a laser assisted uvulopalatoplasty (LAUP). The most recent surgical advance is called somnoplasty and entails temporarily inserting, into the tissue in the tongue and the walls of the upper airway, small needles that emit of radio-frequency energy. This bloodless and relatively painless process causes mucosal and fatty tissue beneath the skin to die and shrink away, thereby widening the air passage.

For less serious cases, there are dental devices that fit onto the teeth to reposition the lower jaw forward during sleep. This repositioning reduces the apneas and can also cut down on snoring.

83. Q: What causes snoring?

Snoring is the sound made by air passing through irregularities and narrowings in the throat and windpipe. Snoring can occur when someone breathes in or breathes out. Snoring in itself is not dangerous, but it can be the first stage in the development of apnea. Weight gain, sedation or anything else that further constricts the oropharyngeal airway could turn a chronic snorer into a sleep apnea patient. Also, there are some data to suggest that chronic and severe snoring may lead to high blood pressure and cardiac changes. Doctors in Italy have reported that chronic snorers tend to have a greater incidence of high blood pressure (hypertension). More recently, researchers in Finland and Israel have also found the same strong relationship between snoring and hypertension.

84. Q: My husband snores so loudly that I have not been able to sleep in the same room with him for years. Recently our next door neighbors have complained to us about the noise he makes. They said there was an operation that could cure the problem. Is this true?

There is an operation that has been used for years, first in Japan and then throught the world, to eliminate or reduce snoring by removing excess tissues from the upper airway. With a wider, more regular opening, the air makes less noise as it goes by. The operation has also been used as a treatment for sleep apnea caused by airway blockage during sleep. Studies show that, in patients who have excess and obstructing tissue in the back of the throat, the operation does reduce snoring and sleep apnea. The operation is known as a uvulopalatopharyngeoplasty (UPPP). In a similar procedure, known as laser assisted uvulopalatoplasty (LAUP), oropharyngeal tissue is repositioned or removed by one or more treatments with a surgical laser. Another approach to reducing extra tissue in the upper airway is somnoplasty which involves shrinking tissue by radio frequency stimulation through a needle that is positioned by a surgeon to target areas with the greatest amount of extra tissue.

85. Q: Should snoring be treated?

In most cases, no - unless there are cardiopulmonary consequences such as high blood pressure or episodes of sleep apnea. But, there may be ways of reducing a person's snoring without major medical intervention. There is nothing wrong, for example, with trying to ask an otherwise healthy snorer to change sleeping positions. As a matter of fact, it is a good sign if a change of position - rolling over on the side, for instance - will stop a person's snoring. Position-dependent snoring usually indicates that the person's airway is less likely to obstruct than the airway of someone who snores regardless of sleeping position. Even some people with mild sleep apnea can breathe better when they sleep on their sides rather than on their backs. To insure that someone sleeps on their side, some doctors suggest special pillows or a soft, but lumpy, object - like a tennis ball - sewn into the back of the pajama top.

86. Q: When my husband sleeps, he stops breathing for a few seconds and starts again with a loud snort. The family used to laugh at the noise he made. But now I am so bothered by the noise that I lay awake worrying that he might forget to breathe and die. Am I being silly?

No. What you describe is sleep apnea (stoppage of breathing during sleep). The body controls breathing differently during sleep, and in your husband's case, the control is not working properly during sleep. He should be evaluated at a sleep disorders center. He may require treatment with medicines or even an operation. Other signs of sleep apnea are daytime fatigue and sleepiness, morning headache, obesity and high blood pressure.

87. Q: What is narcolepsy?

Narcolepsy is a disorder involving a chemical imbalance in the brain cells that control wakefulness and sleep. The disorder can run in families or appear as an isolated problem affecting only one individual in a family. The patient suffers sudden daytime sleep attacks - at mealtime, at the theater - really anywhere. Narcoleptics also experience abnormally timed components of REM sleep such as paralysis and hallucination. The paralysis depends on the brain mechanism that blocks muscle activity during REM sleep. Narcoleptic paralysis is involuntary and can come under two circumstances: (a) cataplexy - sudden muscle weakness leading to partial or complete collapse during the excitement of anticipation such as when telling a joke or catching a fish; (b) sleep paralysis - an often frightening inability to move just before falling asleep. The hallucinations of narcolepsy are known as hypnagogic hallucinations. These hallucinations also depend on REM sleep mechanisms and come as sometimes benign, sometimes terrifying apparitions just as the narcoleptic falls asleep. Animal forms of narcolepsy exist and can be passed genetically from parents to offspring, complete with abnormal sleepiness and cataplexy. Narcolepsy has been described in species such as dogs and horses. There are also reports of people getting narcolepsy after a disease or an injury to the brain. But the few carefully-studied cases of this 'acquired narcolepsy', indicate that there is no single disease of 'acquired narcolepsy', just various medical conditions with few real and sustained similarities to narcolepsy.

Exciting genetic discoveries have recently been made involving animal models of narcolepsy. Stanford University scientists identified a mutant gene that causes narcolepsy in dogs. The normal gene is called the hypocretin receptor 2 gene. The abnormal gene disrupts communications between neurons that use the neurotransmitter, hypocretin 2.

Working independently, a group in Dallas, TX and Boston, MA created a mouse strain that cannot produce hypocretin. This knock-out mouse has the symptoms of narcolepsy. It is expected that, because of the high degree of conservation across species in the hypocretin system, genetic defects affect hypocretin communication will be found to cause narcolepsy in some humans. However, it is not likely that defects in the hypocretin system will explain all narcolepsy because there are familial forms, non-familial forms and post traumatic forms.

The new anti-narcolepsy drug, modafinil, is chemically different from other drugs used to treat the sleepiness of narcolepsy. Modafinil, as well as older stimulant drugs activate hypocretin-containing neurons. These drug effects support the idea that hypocretin is somehow involved in the control of sleep.

Narcolepsy, after sleep apnea, is the second most common cause of the symptom of disabling daytime sleepiness. Narcolepsy is not rare in humans. Afflicting about 1 of every 2000 people throughout the world, narcolepsy is about as common as Multiple Sclerosis. Recent genetic studies have linked narcolepsy to certain genes at a particular location, called the Major Histocompatibility Complex, on chromosome number 6. The two genes most often studied because of their linkage with narcolepsy are those that produce the HLA-DR15 and HLA-DQ6 antigens found on the surface of white blood cells. Exhaustive research indicates that the gene which produces the specific HLA-DQ antigen called, HLA-DQB*0602, seems to be a true narcolepsy susceptibility gene. However, about 20 - 30 percent of the population have this gene and only about 0.05 percent of the population have narcolepsy. This means that other genes or environmental factors are necessary for narcolepsy to develop in people with the HLA-BQB*0602 gene. Since several genes in the Major Histocompatibility Complex have been linked to diseases of the immune system, there is currently much research on the genetic and the immunological make-up of narcoleptics and their families. To date, family studies of patients with narcolepsy have shown that in families where multiple members have narcolepsy, the HLA-DQB*0602 gene tends not to be present, indicating that familial forms of narcolepsy are caused by another gene or genes.

There is no cure, as yet, for narcolepsy. The symptoms of narcolepsy are controlled with a 'double barreled' approach: (a) Several daytime naps and stimulants, such as amphetamines, control the abnormal tendency to fall asleep at inappropriate times; (b) Other drugs that suppress REM sleep such as antidepressants, help control the symptoms of cataplexy, sleep paralysis and hypnagogic hallucinations.

88. Q: Just as I fall asleep, I have the frightening feeling that I cannot move. Is this abnormal?

This symptom is called 'sleep paralysis' and occurs without serious additional problems in 1 of every 20 people. Some people with sleep paralysis have the uncomfortable sensation of falling and 'wake up with a start' before they feel completely paralyzed. Waking up with a start is often called 'hypnic jerk'. Scientists think that this paralytic condition is an incomplete triggering of a REM sleep period that brings on the profound muscle relaxation of REM sleep. The fright is sometimes overpowering even when the person completely understands the temporary and harmless nature of the paralysis. In extreme cases, drugs that block REM sleep are used to treat the condition.

89. Q: My father and his brother both have asthma. My father has difficulty mainly during the day. But my uncle was taken to the hospital two times in the past month for asthma attacks during the night. Does asthma get worse when we sleep?

Asthma is a serious medical condition that should be managed by a physician knowledgeable in respiratory medicine. Asthma attacks involve spasmodic contractions of the muscular walls of the air passages in the bronchi and lungs. Many attacks are brought on by allergic and/or emotional reactions. It is rare for someone to have attacks only during sleep - most attacks occur during wakefulness. Attacks during wakefulness can often be avoided or self-treated with inhaled medications. Sleep's role in asthma attacks is not completely understood. One of the main reasons why asthmatic attacks may 'break through' during sleep is that the therapeutic effects of anti-asthmatic medications taken during the waking hours may not last throughout the sleeping hours.

However, there are several other reasons why sleep may be directly involved in bringing on asthmatic attacks: (a) We do know that sleep decreases the size of everyone's air passages and this decrease may play a role in some asthmatic attacks during sleep. (b) During REM sleep, there can be brief bouts of irregular heart and lung function similar to that which occurs during activity or excitement. This irregularity during REM sleep may also bring on asthmatic attacks. (c) Many doctors believe that sleep-related esophageal reflux, which occurs to some extent in all of us, can bring on bronchospasms in asthmatic patients. (d) Finally, there is the fact that asthmatics may not be able to self-medicate as quickly after the first signs of an attack, if the attack comes during sleep.

90. Q: During the night my wife wakes me up by thrashing and moving. She seems to stay asleep, but she jumps and kicks. We like to share the same bed, but I cannot sleep with this kind of activity. What do I do?

Twitching of the legs or arms during the night, referred to as periodic limb movements during sleep, is a common, but little understood, problem. Many people with this condition are unaware of the twitches and do not have disturbed sleep, but for others, the movements seem to repeatedly disrupt sleep. Your wife could have periodic movements during sleep. People who have this problem may complain of insomnia or of daytime fatigue and sleepiness. The condition seems to be more common in women than in men and is often seen in patients with kidney or liver disease. The leg movements are often noticed after a pregnancy or a back injury. In many cases, the movements may disturb only the bedpartner and therefore, moving into separate beds in the same room ends up being the best solution.

There is another condition, known as REM behavior disorder, that involves abnormal movements during sleep. But, these movements are very different from nocturnal myoclonus. With REM behavior disorder, the arms and head may be involved as well as the legs. The movements may be quite violent and tend to occur in the early morning hours - when most REM sleep occurs. The condition is caused by changes in brain areas which maintain the muscle paralysis of REM sleep. Patients behave as if they were acting out a dream about some threatening situation.

Both periodic leg movements during sleep and REM behavior disorder can be treated with medications. Patients who have many disturbing movements and uncomfortable feelings of restlessness in the legs can improve with small doses of drugs usually used to treat Parkinson's disease. The sleep disruptions associated with periodic movements is also helped by sedative drugs. Patients with REM behavior disorder stop acting out their dreams when they take low doses of the anti-epileptic seizure drug, clonazepam.

91. Q: I often wake up dripping with sweat. What can cause this?

Persistent night sweats is a 'red flag' for physicians because it is a sign of several serious diseases. The best first step is to consider whether there is a medical problem causing these sweats. For example, night sweats can be signs of such diseases as tuberculosis and diabetes. Night sweats are also frequent in menopause. You should also check your temperature carefully several times throughout a 24-hour period to see if you are running a fever. If there is a possibility of a medical problem, you should go to a doctor and have a work-up.

If there is no pathological condition present, then there are two sleep-related phenomena that may explain such sweating. First, it is possible that the autonomic activity during REM sleep has brought on perspiration by much the same mechanism that one might perspire when anxious. The second possibility also concerns physiological changes of REM sleep. During REM sleep, because of the generalized muscle paralysis, our ability to maintain normal body temperature, by shivering and perspiring, is almost completely blocked. After a REM period, one's core body temperature may have changed enough for a significant bout of perspiration for cooling down or shivering for warming up to occur in the following minutes of wakefulness or NREM sleep.

92. Q: I have heard that most people die in their sleep. Is this true? And isn't it a blessing to die so peacefully?

Most disease-related deaths probably do occur during the usual hours of sleep. But, such a death may be far from a blessing; many deaths during sleep may even be avoidable. Man has expressed concern about mortal and morbid events related to sleep and the night since recorded history. The Bible says that Solomon's bed was guarded by 60 valiant men because of fear in the night. The ancient poets, Homer and Virgil, referred to sleep as a "blood relative" of death. There are modern examples too. Shakespeare, referred to sleep as "death's counterfeit". F. Scott Fitzgerald wrote with respect to psychological distress: "In the real dark night of the soul it is always three o'clock in the morning". These ancient concerns may reflect a deep-seated belief that humans are somehow more vulnerable to catastrophe at night.

There are medical studies to indicate that such concerns are more than superstition. Early morning peaks in human mortality were described in medical records as early as the late 1800's. Modern scientists know that, excluding traumatic deaths, the largest number of deaths do occur during the hours from midnight to 8 AM. However, it is not known how many of these deaths actually occur during sleep. Some diseases do worsen during sleep. Diseases such as emphysema, coronary artery disease and some high blood pressure conditions are most troublesome during the night when we sleep. Exacerbations of these diseases may be due to sleep-related decreases in the efficiency of breathing, irregularities in the control of heart function during REM sleep, as well as to problems stemming from lying in the horizontal position all night long.

93. Q: Can sleep disorders really cause enough sleepiness to make driving and work unsafe?

Yes, definitely. Most patients with narcolepsy and sleep apnea, for example, come to doctors for help because they are having difficulty staying alert while driving or working. However, dangerous sleepiness can occur in anyone, not just people with serious sleep disorders. A study by the Center for Traffic Safety at the University of North Carolina Highway Safety Research Center determined that as many as 15% of all vehicle accidents are due to falling asleep, or fatigue-related inattentiveness, at the wheel.

Traffic accidents are a major cause of death, injury and property loss. More and more studies are finding that falling asleep at the wheel is a major factor, perhaps the most important after alcohol, in causing traffic accidents. Fatigue-related traffic accidents usually involve no more than one or two vehicles. Yet, they are the most destructive of all to life and property, probably because the drivers are so inattentive that they do not slow down before the crash. The time at which fatigue-related traffic accidents occur shows a pattern with two peaks: one between midnight and 3 AM and one between 2 and 5 PM. When scientists asked people to try and fall asleep periodically throughout the day, they found that sleep tendency in normal humans also has the same two-peak pattern with an early morning and a late afternoon high point. When we get too little sleep or take any substance that causes sleepiness, these periods of increased sleep tendency can be transformed into periods when bouts of unintentional sleep occur. These bouts of sleep may be experienced as harmless, brief lapses in attention, but they can also lead to disaster.

Modern day problems of sleep-related accidents extend beyond highway travel to industry as well. Throughout recorded history, many people have decided, or been forced, to cut back on their sleep and have often fallen asleep on the job. What is worrisome is that today, as opposed to as little as a hundred years ago, so many more people can be hurt by a sleepy or inattentive worker. For example, when a train driver or a nuclear power engineer falls asleep on the job, the result can be catastrophic in terms of the loss of life and property. When a stagecoach driver fell asleep on the job in the 1800's, the lapse might even have gone unnoticed. The major reason for increased interest in sleep is that, in the 1900's, too much sleep in the work environment and too little sleep at home have become dangerous to all of us. In industries where people must work round the clock, scientists find that workers - particularly those workers on evening and graveyard shifts - may not always be sufficiently rested to function with necessary alertness. The nuclear accidents at Three Mile Island and Chernobyl both arose from mistakes that occurred between midnight and 3 AM. And, the decision to launch, which lead to the Space Shuttle disaster on January 28, 1986, came during this same early morning peak in sleepiness. Moreover, the NASA officials involved in those decisions were seriously overworked and sleep-deprived. Thus, on the road and in the work place, it is important to respect your sleep need and recognize the signs of excessive sleepiness, such as lapses in attention, that may actually be unintentional bouts of sleep.

94. Q: My 16-year-old son grinds his teeth only when he sleeps. What should I do?

Teeth grinding or bruxism is a dysomnia which means that it is an abnormal behavior occurring during sleep. Bruxism, when extreme, can cause damage to teeth and jaws. Physicians sometimes use medication to control bruxism. Dentists may prescribe a mouthpiece or other appliance that is worn during sleep to prevent tooth damage.

95. Q: Many mornings I wake up with a headache. I am not a drinker. What can cause this?

There are many reasons why someone might wake up with a headache. The most important possibilities to think about are sleep-related breathing disorder and sleep-related vascular headache. People with sleep-related breathing disorders do not get enough oxygen in their blood during the night and may awaken with headache and grogginess. Tell-tale signs of sleep-related breathing disorder are snoring, obesity, high blood pressure and chronic heart disease. People with sleep-related vascular headache experience spasms in the muscles in and around the blood vessels of the head. These spasms occur most often during REM sleep. Both conditions are treatable once the diagnosis is made.

96. Q: When should someone consult a specialist for a sleep problem?

There is no single answer to this question. A good rule of thumb is to see a specialist if your sleep problem persists for a month or more despite following your doctor's advice and prescriptions. However, you should get expert help immediately if you have experienced dangerous symptoms such as (a) waking up with chest pain and/or shortness of breath, (b) falling asleep at an inappropriate time such as while at an enjoyable party, or at a dangerous time such as while driving a car.

97. Q: How do I find a specialist in sleep disorders?

Specialists in sleep disorders medicine are physicians with a staff and a laboratory for diagnosing and treating patients with all sleep-related disorders. These disorders include difficulties in falling asleep, staying asleep or remaining awake. The most serious symptoms of sleep disorders are daytime sleepiness, excessive use of sleeping pills, nighttime chest pains, morning headaches, heavy snoring and breathing irregularities during sleep. Diagnostic and treatment services are provided by professionals experienced in sleep-related and sleep-exacerbated diseases. Other physicians with expertise in neurology, pulmonary medicine, psychiatry and psychology are always available to the sleep disorders specialist. Many large hospitals and medical schools have sleep disorders facilities. To locate a sleep disorders specialist, consult your regular physician or write:

American Academy of Sleep Medicine
6301 Bandel Road, Suite 101
Rochester, Minnesota 55901
Telephone: (507) 287-6006
e-mail: aasm@aasmnet.org
web site: http://www.aasmnet.org/

The Academy provides locations of sleep disorders centers throughout the country that have been accredited as meeting the Academy's standards of care as well as names and addresses of doctors certified by the American Board of Sleep Medicine as specialists in the diagnosis and treatment of sleep disorders.

98. Q: For people who do feel they need professional help, what can they expect from a sleep disorders center?

The first step is an initial interview with one or more physicians - pulmonary specialists, neurologists, psychiatrists - depending on what seems to be the nature of the problem. This interview includes the gathering of a detailed medical history and physical examination. The case is then reviewed by the center's medical staff, who are assisted, if necessary, by other consulting physicians such as endocrinologists, ear, nose and throat specialists, etc. After reviewing the material from patient's medical history and physical examination, the physician will decide whether or not to order a polysomnographic session at the laboratory and what such a session might entail.

99. Q: I have seen people all wired-up for sleep labs. What happens if I cannot sleep in the lab and what are all those wires for anyway?

Remember that the polysomnogram is a medical test. It will not seem like a normal night at home, but this rarely matters. The purpose of the polysomnogram is to measure physiological functions during sleep. Testing usually involves sleeping one or two nights in a sleep laboratory where all aspects of sleep are carefully monitored. The procedure is safe and painless. It is carried out in a comfortable, private room by a trained technician under the supervision of a physician. Sensors are attached to the patient's head, on either side of the eyes, near the heart and under the chin to pick up brain waves, eye movements, heart and muscle activity, respectively. Other instruments are positioned to monitor breathing, blood oxygen levels and any additional physiological measures that may have been ordered by the patient's doctor. All leads are connected to a polygraph machine that keeps track of the data on one, unbroken piece of paper that is nearly a mile long. Nighttime recordings are often followed by daytime tests, such as The Multiple Sleep Latency Test or The Maintenance of Wakefulness Test, to determine whether the sleep disorder involves abnormal tendency to fall asleep. Daytime tests are very important because they help the doctor decide on any necessary precautions for driving and work safety.

With all this going on, no one expects the patient to sleep as well in the lab as they would at home in their own bed. However, in most cases, as little as 3 hours of nighttime sleep is sufficient for diagnostic purposes. This is because sleep specialists need only monitor patients during representative intervals of both NREM sleep and REM sleep. The chances are better than 1000 to 1 that a patient will sleep well enough for a diagnosis to be made. Sleep disorders patients very rarely have problems in the laboratory because most have long histories of sleep difficulties and consider one or two more nights of disturbed sleep to be well-worth the benefit of getting an accurate diagnosis for their sleep problem. In truth, most patients are surprised at how well they actually do sleep in the lab.

After the session in the sleep lab, the resulting polysomnographic data must be evaluated page by page for sleep phases and for pathological events. This process involves several hours of a technician's time and 1 - 2 hours of a physician's time, as well as extensive use of laboratory computing equipment. The evaluation and interpretation is usually completed in about 5 working days. Then, laboratory findings are reviewed and considered in light of the doctor's findings from the medical history and physical examinations. Sleep specialists can then make a diagnosis and make recommendations for treatment. The patient can be treated either at the sleep disorders center or by the personal physician. A complete work-up at a sleep disorders center and initiation of treatment will require between 1 and 3 visits to the center. Depending on the patient's schedule and the backlog at the center, the process usually takes between 7 - 21 days.

100. Q: How much will an evaluation cost?

Professional fees and laboratory charges vary considerably throughout the country according to contractual arrangements, local pay scales and overhead costs. If your insurance company or if you alone are entirely responsible for your healthcare expenses, expect the initial consultation and related office procedures to cost between $200 - $500. Individual costs will vary depending on the complexities of the problem, the pertinence of past medical records and whether or not additional medical tests are needed. Laboratory testing, if ordered by the sleep disorders physician, is an additional and significant cost. An all-night sleep recording runs between $700 - $1600 depending on the costs of medical care in your location and exactly what type of recordings are done. A daytime recording to determine whether or not there is impairment in ability to stay alert runs between $500 - $800. So, the overall cost of a sleep disorders center evaluation can vary between $200 - $3000.

101. Q: Will my healthcare plan cover sleep disorders services?

Nowadays, in the midst of healthcare reform, there is no simple answer to this question. If you have good outpatient insurance that covers diagnostic procedures such as x-rays and blood tests, and if your sleep problem is organically based, such as sleep apnea or narcolepsy, then your coverage should be very good. On the other extreme, if you are on Medicare or Medicaid and your sleep problem is psychologically-based, such as anxiety with insomnia, then you should expect little financial help from your health insurance. In most common managed healthcare plans, some provisions are made to provide sleep disorders services, particularly for sleep apnea. This is done either by specially trained physicians working within your healthcare system or through a contract between your healthcare plan and an independent sleep disorders center. In all cases, it is important for you to begin getting help by clearly presenting your sleep related symptoms, including any problems you may have staying awake at work or while driving, to your primary care physician. In some cases, great persistence on the part of the patient may be necessary in order to get the healthcare plan to provide sleep disorders services.

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