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Welcome to All About Sleep!

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Welcome to All About Sleep, a blog created to discuss all aspects of sleep! In a world where we are increasingly busy and time poor, it is easy to forget the importance of prioritising a good night’s rest. Information on how to improve sleep is not easily available, and that which is is often anecdotal and inaccurate, and not based upon any research. Whilst the information posted in this blog is my professional advice, wherever possible the topics discussed on this forum are based upon evidence from research and published guidelines, and links will be included to any resources used in my posts.

My interest in sleep led me to undertake an undergrad degree in Physiology and then a Masters in Respiratory and Sleep Science. Working as a Sleep Scientist for the past six years, I have assisted in treating patients with a variety of sleep disorders and picked up some helpful tips along the way, in particular regarding the diagnosis and treatment of Obstructive Sleep Apnoea (OSA). My hope with this blog is that it serves as a reliable resource for anyone wanting to get some more information about sleep for themselves or friends and family.

Please email me at aaboutsleep@gmail.com if you have any questions regarding content in my blog and I will get back to you as soon as I can!

What will happen at my Sleep Study?

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Having a sleep study can be a pretty daunting experience. As a sleep scientist I have seen a lot of anxious patients unsure of what to expect. I am often asked the same questions – do I have to have all this equipment on? What will happen if I can’t sleep? No, I didn’t receive the information letter suggesting I wear loose clothing etc (don’t be this person).

When you go for a sleep study, expect to be set up with some equipment. It normally consists of some electrodes on your head and face, as well as some to measure your heart rhythm, a few bands which measure respiratory effort around your chest and abdomen, nasal cannula for measuring airflow, a probe over your finger to estimate your oxygen saturation and some leads on your shins to measure leg movements. All of these wires are attached to a main unit or ‘yoke’ either on your chest or on the wall of the sleep lab room. This may sound like a lot, and it is, but trust me – the majority of people are able to have something that resembles a night’s sleep with all of this on.

In Lab Sleep Study

If you are doing an overnight study in a sleep lab, you will have a few more electrodes on your head and you will have at least one member of staff there for the duration to reattach any flyaway wires and make sure you are alright. These staff members are in a separate room and will be monitoring the signals to make sure the study is going well. If you have trouble sleeping in unfamiliar places, it may be worth requesting sedation for your study – I would advise finding out if this is an option prior to coming in for the night. If you are not very mobile or require a hoist to get in and out of bed, advise the staff of this as they will need to take the necessary measures to ensure both yours and their safety.

You normally arrive between 6-8 on the night of your study and it takes about 45 minutes to be set up with all of the equipment. You will be encouraged to attempt sleep by 9/10pm and then that’s it; sleep as best you can until early the next morning. If you need to go to the bathroom during the night, press the call button and a sleep scientist will be in to disconnect the equipment. Do not just jump up and go into the bathroom! In the morning you will be woken at about 6/7am and all the equipment removed. There may be facilities for you to have a shower should you need to, or this can be done at home. Please note that the overnight staff are not nurses/healthcare assistants, and hospital policy does not cover them to assist you with bathing the next day. Fill out your questionnaires and then off you pop home. About a week later the analysed results should be back with your referring doctor and/or sleep specialist.

Home Based Sleep Study (HBSS)

A sleep study at home may be suitable for you if you have a high probability of having Obstructive Sleep Apnoea (OSA). The probability of having OSA is assessed by your sleep specialist or GP by taking your history and completing some questionnaires.

For the HBSS, you go into the Sleep Clinic late in the afternoon (to give the leads less time to fall off before bed!) and have an hour-long appointment where the equipment will be attached to you and you will be given instructions on what to do at home. Please wear loose clothing, as close to PJ’s as possible, and if you have the confidence to wear them PJ’s are fine! No skinny jeans, tight dresses or for the sake of all things righteous, tights! Beware of any sleep study where you set the equipment up yourself at home – these are normally rubbish and not worth the time.

The idea is that you try to have as normal a night for you as possible; if you go to sleep at midnight, do it; if you drink four beers before bed then enjoy them! What we are looking for is how you sleep on a night that is normal for you. You will have a sleep diary to fill out asking how you got on, and an appointment the next morning to return the equipment. You will not get your results at this appointment, rather the signals will be checked to make sure the study worked and your blood pressure taken. Your study will be analysed and reported and back with your referring doctor/sleep specialist within the week.

HBSS or In Lab Study?

If you are unsure of what is going to be best for you, consult your specialist who will recommend the appropriate study. The table below indicates when each type of study may be more suitable:

HBSS In Lab
– High probability of OSA (high BMI, male, female over 50 years old, snoring, unrefreshed, people have witnessed you stop breathing, high blood pressure, increased neck circumference).
– If you will not be able to sleep in a hospital environment.
– Cheaper. More realistic option if not covered by private insurance.
– More likely to represent a normal night for you.   		– If you have a low probability of OSA or possibility of any other sleep disorders going on.
– Lower failure rate.
– Have the support of the staff throughout the night.  

I hope this post gives you all the information you need to save any worry about coming in for a study, whichever you go for. Email me at aaboutsleep@gmail.com if you have any questions!

What is Obstructive Sleep Apnoea?

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Current research estimates that 9-38% of the population have Obstructive Sleep Apnoea (OSA)1. Being so common, I would imagine many readers either have OSA, or all know someone who does. It is a chronic condition (meaning long term) which can be present for many years before being diagnosed. OSA seems to be a hot topic on the news at the moment, with many articles speculating about what causes OSA, and the long-term effects of being untreated. This post is about what OSA is, and how you can figure out if you are at high risk.

You have Obstructive Sleep Apnoea if you have 5 or more respiratory events per hour during sleep as measured by a sleep study. This sleep study is either done overnight in a sleep lab, or at home after being set up with all of the equipment in the sleep clinic.  The respiratory events are caused by periodic narrowing and obstruction of the upper airway during sleep1. This can be in part or wholly due to anatomical impairments or deficiencies in respiratory control of breathing. It is believed that the biggest risk factor for OSA is obesity. Simply put, being obese can place enough pressure on the airway to cause it to collapse during the night.

As you can imagine, essentially stopping breathing multiple times per hour while asleep can have an impact on how you feel during the day. Common symptoms of sleep apnoea include excessive daytime sleepiness, fatigue, non-refreshing sleep, nocturia (needing to urinate multiple times during the night), morning headache, irritability, and memory loss2,3. Not a very enjoyable experience. Men and women can have completely different symptoms, with women more likely to report having insomnia and depression as compared to men who report snoring and sleepiness4. Many people get used to these symptoms or attribute them to other disorders or everyday stress.

If any of these symptoms seem applicable to you or someone you know, follow the link below to complete the questionnaires on my blog. If you score more than 11/24 on the Epworth Sleepiness Score or more than 4/8 in the STOPBANG questionnaire you are at an increased risk of having OSA. Go to see your GP, get a sleep study and do the necessary to improve your health. It may be the best thing you could do for yourself.

In my next blog post I will discuss the results of a sleep study report, and what exactly all of the confusing abbreviations and numbers mean.

Links to questionnaires:

https://all-about-sleep.com/2019/08/12/epworth-sleepiness-scale/

https://all-about-sleep.com/?p=89

References

1. Senaratna, C.V., Perret, J.L, Lodge, C.J., Lowe, A.J., Campbell, B.E., Matheson, M.C., Hamilton, G.S. & Dharmage, S.C.  2017. Prevalence of obstructive sleep apnea in the general population: A systematic review.. Sleep Medicine Review, Volume 34, pp. 70-81.

2. Antic NA, Catcheside P, Buchan C, et al. The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA. 2011. Sleep. 34(1), pp.111–119.

3. Romero E, Krakow B, Haynes P, Ulibarri V. Nocturia and snoring: predictive symptoms for obstructive sleep apnea. 2010. Sleep Breath. 14(4), pp.337–343.

4. Wimms, A. Woehrle, H., Ketheeswaran, S., Ramanan, D. & Armistead, J. 2016. Obstructive Sleep Apnea in Women: Specific Issues and Interventions. Biomed Research International.

5. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. 1991. Sleep, 14, pp. 50-55.



Did you sleep well last night?

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If I was to ask you how you slept last night, how would you respond? What do you classify as a ‘good’ night’s sleep? We often use a bad night’s sleep to explain poor performance whether at work, at home or at school; but we all likely have different criteria for determining if our sleep is good/bad. What should we use to rate our sleep? I have included 5 ways to check if you are getting a good night’s sleep:

  1. How long do you sleep for? Adults between the age 18-60 should aim for 7-9 hours each night1 to achieve optimal health. Young adults may need slightly more and those over the age of 60 sleep slightly less.
  2. How long does it take to fall asleep? If more than 30 minutes each night, you may want to look into improving your sleep hygiene. More on that to come in a later post. It may also be worth assessing if it actually takes you this long to fall asleep, or if this is just your perception. Keeping a diary of your sleep for a week may be useful to monitor sleep/wake times.
  3. Is your sleep consistent each night? Shortening your sleep duration during the working days leads to rebound sleeping during time off to ‘catch up’ on sleep lost. If you do not catch up on your sleep, you might build up a sleep debt and remain sleep deprived. Sleep hygiene, hello again.
  4. Do you wake up feeling refreshed? If you are consistently waking up feeling sleepy and unrefreshed despite sleeping for 7-9 hours, this may indicate a problem with your sleep. Consult your GP if this is a concern.
  5. Are you using your phone in bed? Everyone seems addicted to their phones these days, however you may not realise this could be significantly impacting your sleep. Turn off the phone, or download an app which filters the blue light. Sleep hygiene – time to write the next post!

Reference

  1. WATSON N., F., 2015. Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep, 38(6), pp. 843-844.