The Sleep Lab is in a quiet, cozy space inside the main hospital. For a private room, individualized attention, and a hotel-like experience, ask your doctor to refer you to one of Cayuga Health’s Sleep Labs today. We also offer at-home testing, if appropriate.
About
The Sleep Disorders Center at Cayuga Health is the only nationally accredited center in our region. The Sleep Center received its accreditation status in 2003 from the American Academy of Sleep Medicine.
Lavanya Kodali, MD is the medical director of the Sleep Disorders Center. She is certified with the American Board of Internal Medicine for Sleep Medicine, Pulmonary Disease, and Critical Care Medicine.
Our sleep center process insures our patients receive the highest standard of care. Each of our sleep technicians are board certified as a Registered Polysomnographic Technician (RPSGT). These technicians, under the guidance of our Medical Director, are able to provide diagnostic and therapeutic studies for the complete range of sleep disorders.
Cayuga Health has state-of-the-art equipment which allows enhanced and outstanding diagnostic testing for our patients. We provide Home Sleep Testing for select patients who cannot come to our lab.
There are two locations for the Sleep Disorders Center, either Ithaca or Montour Falls.
A Good Night’s Sleep Doesn’t Have to be a Dream
Everyone dreams when they sleep, but many people simply dream of a good night’s sleep. According to the National Sleep Foundation, approximately 70 million people in the United States are affected by a sleep problem. About 40 million Americans suffer from a chronic sleep disorders, and an additional 20-30 million are affected by occasional sleep-related problems. However, an overwhelming majority of sleep disorders remain undiagnosed and untreated. These disorders and the resulting sleep deprivation can interfere with work, driving, social activities and other aspects of life.
When you sleep, your body rests and your energy is restored. Sleep is an active state separated into 2 different stages. These stages are REM or rapid eye movement, and NREM or non-rapid eye movement. Throughout the night people will cycle through these sleep stages several times.
Characteristics
REM (rapid eye movement)
- Brain waves, heart rate and breathing are all similar to being awake
- Voluntary muscles are paralyzed during this stage of sleep
- Dreams occur during this time
- The percentage of REM sleep decreases with age
NREM (non-REM sleep)
- Stage 1: this stage can last from 5-10 minutes. This is the time that you feel you are falling asleep
- Stage 2: known as light sleep. During this stage, heart rate slows and temperature decreases
- Dreams occur during this time
- Stage 3 and 4: This is known as deep sleep or delta sleep. This is the stage of sleep that helps you to feel most rested
Each stage of sleep can last from 5-15 minutes
A sleep cycle consists of all 4 stages and then a period of REM sleep before beginning a new cycle.
These are the most common types of sleep disorders.
Snoring is a common condition that can affect almost anyone of any age. Occasional snoring is not serious, however excessive snoring with interruption of breathing and interference in sleep patterns can have serious effects on your health and should be evaluated by your physician.
Risk Factors
- Male
- Overweight
- Over 40 years old
- Large neck size
- Large tongue or tonsils
- Family history of sleep apnea or snoring
- Gastric reflux
- Nasal obstruction, allergies or sinus problems
Causes of Snoring
Snoring occurs when airflow is blocked or obstructed through the nose or mouth.
Nasal passages may be obstructed by allergies, sinus infections, or a physical blockage such as a deviated septum.
During sleep, our muscles relax. Lack of muscle tone or a large neck, tongue or tonsils can all cause the airway to be blocked.
Snoring becomes “Sleep Apnea” when breathing is stopped for more than 10 seconds. This can be caused by either a partial or total obstruction of the airway. During this period of apnea (not breathing), the brain does not have enough oxygen. Our brain then tells us to “wake up” and take a breath. People with severe sleep apnea may stop breathing more than 100 times an hour.
Although the person does not consciously know that they are “waking up” to take a breath, this interference in the sleep cycle can cause excessive fatigue as well as contribute to serious medical problems.
- High Blood Pressure
- Stroke
- Heart Failure and Heart Attacks
- Diabetes
- Depression
- Chronic Fatigue
Insomnia is a sleep disorder characterized by difficulty falling asleep and or staying asleep.
Symptoms
- Difficulty falling asleep
- Waking up after falling asleep and cannot get back to sleep
- Waking up too early and cannot get back to sleep
Treatments
- Mild insomnia can generally be prevented or treated by practicing good sleep hygiene habits Sleep Hygiene Rules
- Long term insomnia is generally treated using behavioral techniques. This helps to change behaviors which interfere with sleep, and helps promote and teach behaviors that enhance sleep. Some methods include relaxation and biofeedback therapies
- Progressive Relaxation Exercises
Further Information
This is a movement disorder which involves excessive movements of the legs. The feeling is often described as a creepy/crawly feelings in the legs that is lessened after movement. When these feeling primarily occur at night, they are referred to as Periodic Limb Movements (PLM’s). These movements cause interruption in sleep and lead to daytime fatigue.
Causes of RLS
- Low blood iron levels
- Poor blood circulation in the legs
- Nerve problems in the spine or legs
- Muscle or kidney disorders
- Alcoholism
- Certain medications
Treatments
- All underlying causes must be ruled out or treated
- Home remedies can help with mild or occasional RLS these include:
- Hot baths
- Leg Massage
- Heat or ice
- Regular exercise
- Eliminating caffeine and alcohol
- Stretching legs prior to bed and upon arising
- Avoid large meals close to bedtime
Medications used to Treat RLS
- Dopamine precursor- Sinemet
- Dopamine agonist- Mirapex, Requip
- Benzodiazepines- Klonopin
- Anticonvulsants- Neurontin, Gabapentin
Medications that Worsen RLS
- Antidepressants- Elavil (amitriptyline), Prozac
- Antihistamines- Benedryl, cold and allergy medications
- Antiemetics– Compazine, Reglan
- Lithium
- Major tranquilizers- haldol, thorazine
“Things that go bump in the night”
These are arousal disorders that occur when a person is in a mixed state of being asleep and awake. There are several types of parasomnias.
Confusional Arousal
These are most common in infant and toddlers but may be seen in adults. This is characterized by crying, thrashing and agitation. The person appears to be awake, but they are not.
Sleepwalking
This is generally seen in older children but can persist to adulthood. This can range from simply getting out of bed to complex behaviors. Sleepwalkers rarely injure themselves but they can put themselves in dangerous situations.
Safety Tips!
- Clear bedroom of obstacles
- Sleep on the ground floor
- Secure windows and doors, install locks and alarms
- Block stairwells
Treatment is generally not required. Sleepwalking rarely indicates any underlying physical or psychological problems.
Sleep-Related Eating
This is related to sleepwalking and occurs when a person has episodes of eating without any conscious awareness. As with sleepwalking, treatment is rarely required. Simple safety measures should be taken.
Sleep Terrors
These are the most disturbing disorders for those witnessing the behavior. Sleep terrors generally begin with a piercing scream or shout. The person appears to be agitated and terrified. They may run around the house and appear frightened. Sleep terrors differ from nightmares in that the person does not remember the episode after awakening.
Nocturnal Seizures
This type of seizure occurs only during sleep, and are characterized by behaviors such as crying, moving or walking. This condition is generally treated with medications.
REM Sleep Behavior Disorder
During normal REM sleep, all muscles except those used for breathing are paralyzed. In this disorder, the muscles are not paralyzed and therefore dreams may be acted out. These behaviors may be violent and cause harm to the bed partner. Unlike sleep terrors the person will recall their dreams. This condition is most often seen in older men and can be treated with medications.
Narcolepsy is a sleep disorder that is characterized by constant sleepiness and falling asleep at inappropriate times. This tendency to fall asleep is often called “sleep attacks” and can have devastating effects on people’s lives. The cause of narcolepsy is thought to be disorder of the brain that controls wakefulness and sleep. This is not a psychiatric or behavioral disorder.
Symptoms:
- Excessive daytime sleepiness. This is constant and is not relieved even with adequate sleep. This is usually the primary symptom that occurs. People often fall asleep at inappropriate times or may become drowsy or foggy in unusual situations.
- Cataplexy. This is characterized by sudden, brief losses of muscle control. These are usually triggered by strong emotion, such as laughing, anger or surprise. The severity can range from a feeling of weakness to total collapse.
- Sleep Paralysis. This is also a brief loss of muscle control which occurs when falling asleep or waking. A person may be aware of this and be unable to move or speak.
- Hypnagogic hallucinations. These vivid, dream-like experiences occur when a person is drowsy. They are frightening, in that a person may be aware and partially awake, but has no control over what is happening.
Diagnosis:
- Narcolepsy is generally diagnosed with a polysomnogram (sleep study) which is followed the next day by an MSLT or multiple sleep latency test. During this test you are asked to take several naps throughout the day. During these naps, specific parameters are measured. These parameters help to diagnose Narcolepsy.
- Specific instructions for an MSLT
Treatments:
- Medications. Specific drugs may be prescribed by your physician. These medications can help to alleviate the symptoms of narcolepsy such as sleepiness, cataplexy or hallucinations.
- Behavioral treatment. This includes following a sleep/wake schedule, including naps, caution during dangerous activities and following your physician’s advice.
- Environmental management. Education of family, friends and co-workers is essential. Behaviors often can cause friction in the workplace or at home. It is important to inform others that these behaviors cannot be controlled at will.
PATIENT INFO
What to Expect During Your Consultation
- You will be asked to complete an extensive questionnaire prior to your appointment.
- You may be asked to complete a sleep log for 2 weeks prior to your appointment. This information provides your physician with valuable information to assist in preparing a treatment plan.
- Your physician will perform a general physical examination with special attention to your nasal and oral airways.
- We will provide you with specific instructions at the end of your appointment
Preparing for a Sleep Study
- Maintain your usual sleep pattern.
- Continue all medications as prescribed. If you have any questions regarding your medications, please call your physician.
- Do not use illicit or street drugs at least one month prior to your test.
- Please eat your dinner normally as you would BEFORE arriving for the test.
- Avoid alcohol for 24 hours prior to your test.
- Do not drink caffeine after 4:00pm on the day of your test.
- Avoid high sugar foods and beverages on the day of your test.
- Please be sure that you have recently showered and washed your hair. Do not apply lotions, creams, salves hairspray or hair gels, as this will interfere with the electrodes being able to adhere to your skin.
- Please remove nail polish.
- Bring all medications that you may need during the time of your study. You will need to take these on your own; our technicians do not dispense medications.
- You should not take any sleeping medication unless it is prescribed by your physician.
- Bring two-piece sleep clothes (pajamas, shorts and t-shirt, etc).
- You may bring a robe and slippers, if you wish.
- Bring reading materials if you wish. There are TV’s in each room.
- You may bring your own pillow if this assists you in a better night’s sleep.
- Bring your toiletries and a change of clothing for the next day if desired.
What to Expect During Your Sleep Study
- You should arrive at the Cayuga Medical Center Admissions Desk at 8:00pm and register unless otherwise instructed. This is the main entrance adjacent to the Emergency Department.
- You will be shown to one of our sleep rooms and be asked to change into your nightclothes.
- The technicians will explain the study and will attach the electrodes and monitoring belts.
- The electrodes will be plugged into a box at the head of the bed.
- You will be asked to go to sleep by 11:00pm to allow for ample time for sleep.
- The technician will review all instructions before asking you to turn out the lights.
- There are intercoms and cameras in each room should you need assistance at any time.
- If you need to use the bathroom during your study, the technician will assist you.
- At approximately 6:00am, you will be asked to rise.
- You may shower and prepare for your day.
- Prior to your study you should have arranged a follow-up visit with your physician to review your study results. If you have not done this, please call for an appointment.
- Should you need further testing or treatment, this will be arranged at your follow-up visit.
- It is recommended that you follow up with your physician frequently until you are comfortable with your treatment.
Treatment Options for Obstructive Sleep Apnea
Lifestyle Changes
- Weight loss and regular exercise.
- Quit smoking
- Avoid alcohol and sedatives
- Sleep-position training. When you sleep on your back, your tongue and the tissues in the back of your throat naturally fall back and can block your airway. By using simple techniques to prevent you from sleeping on your back, you may eliminate some of your symptoms.
Medical Treatments
- Positive airway pressure devices or CPAP machines. This therapy uses a specific pressure of air to keep your airway propped open. These machines deliver the air through a mask. There are a multitude of masks and your sleep technician and homecare agency will help you to find the best mask to meet your needs.
- There are a number of types of PAP machines, including BiPAP and adaptive servo-ventilation, which are used to treat specific types of sleep disorders.
- Oral appliances. These devices work to hold the airway open by moving the jaw or tongue forward. These devices are only effective for those people with mild apnea. These appliances are fitted by dentists with specialized training. Generally a sleep study is performed with the device in place to insure proper treatment of your sleep apnea.
- Surgery: There are several surgical treatments available that are performed by ENT (ear, nose and throat) surgeons. While an operation can be an effective treatment for some patients, it is not the right choice for everyone.
Follow-up Care
- It is important that you receive regular follow up care.
- If you are being treated with a PAP machine, you should see your physician on an annual basis or sooner if:
- You have a 20 lb weight change
- Experience more snoring
- Have increased daytime fatigue
How to Cope with Daytime Sleepiness
There are many ways that you can help yourself to stay awake naturally without the use of caffeine or over-the-counter stimulants.
Follow these easy ideas:
- Move: Get up frequently and move around. Go for a walk. Get away from your desk.
- Nap: Don’t take more than one a day and do not nap near bedtime. Keep naps between 5-25 minutes. If you can’t nap, just resting with your eyes closed for 10 minutes can help you feel refreshed.
- Relax your eyes: Look away from your computer screen frequently.
- Turn on the lights: Keep rooms bright and well lit.
- Breathe: Take periodic deep breaths throughout the day.
- Pull over: If you are drowsy while driving, pull over and nap, change drivers and keep fresh air circulating.
- Switch: Switch tasks and keep your mind stimulated.
- Water: Drink plenty of water; dehydration causes fatigue.
- Daylight: Try to get at least 30 minutes of natural daylight. If this isn’t possible, try to get outside for short periods whenever you can.
- Exercise: Regular exercise will increase your energy levels.
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