Scott Webb (Host): Many of us suffer from poor sleep, and the path to getting a better night's sleep might be as simple as a home sleep test. Today, I'm joined by Dr. Brian Dickover. He's a Board Certified Franciscan Physician Network doctor specializing in Pulmonary Critical Care and Sleep Medicine, and he's here to tell us how sleep disorders are diagnosed and explain home and in-lab sleep studies.

 This is the Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, thanks so much for your time today. We're going to talk about sleep, right? And folks not getting sleep or not getting the right sleep or enough sleep and all kinds of sleep stuff. And essentially that means we're going to talk about sleep studies. So just wondering if you can share some background on what sleep studies are?

Brian Dickover, MD: I can tell you that there are several different types of sleep studies, but kind of goes without saying that a sleep study is intended to assess somebody's sleep, of course. The two general types of sleep studies are either a home sleep test or an in-lab sleep test. A home sleep test involves acquiring a device that you take home and set up, which is relatively easy.

I often tell patients that if you're capable of pumping gas into your car, you're also capable of applying the device at home, which then assesses your sleep at home. There's another variety of sleep test that takes place in a devoted sleep lab where somebody arrives at the lab and sleeps overnight and is evaluated by sleep technologists in the lab to assess certain things on the night of that test.

Host: Yeah, as you say, it's pretty basic. And my wife actually did one of those, uh, home sleep studies. So I'm a little bit familiar with that. Just wondering what are some of the common reasons why patients get sleep studies?

Brian Dickover, MD: Oh, that's a great question. In the case of a home sleep test, I would say that primarily a home sleep test is intended to evaluate whether or not somebody has something called sleep disordered breathing and the more common or most common variety of sleep disordered breathing that people have probably heard of is something called obstructive sleep apnea.

So, obstructive sleep apnea is an entity where people either slow down or stop breathing while they're sleeping, and it is due to an obstruction in their upper airway. And so, if they're asleep, and they have an obstruction, and they stop breathing, then they have obstructive sleep apnea, and it can come in varying different severities.

But again, a home sleep test is intended primarily to evaluate whether or not somebody has obstructive sleep apnea which is a particular kind of sleep disordered breathing. And there are other types that I don't need to go into right now or here, but that's the purpose of a home sleep test.

And then an in-lab sleep test can diagnose sleep disordered breathing, such as obstructive sleep apnea. It can also be used to determine what pressure someone needs when they have a device applied to their face such as continuous positive airway pressure, otherwise known as CPAP. There is a variety of an in-lab test called a split night test, wherein the first half of the night, the patient is evaluated and diagnosed potentially with sleep disordered breathing, and then the second half of the night is used to apply a CPAP type device to treat the sleep apnea that was just diagnosed on the first half of the night.

Some patients will already have a CPAP type device at home, but have difficulty tolerating it, or someone feels that they may not need the device anymore, or that they need a change in their pressure. And so sometimes patients will come back to the lab and have an overnight test where their CPAP device and usage and pressures are evaluated.

There is also something more recently called a hypoglossal nerve stimulator, which can be implanted in people, and that too is a bit above and beyond I think the scope of this conversation. But patients will also go to the lab in either preparation for an evaluation of such a device or after the device is placed to assess whether or not it's working correctly.

There are other sleep entities such as narcolepsy or idiopathic hypersomnia, and those diagnoses need to involve the use of an in-lab test of one form or another. Patients will sometimes also potentially have seizures at night, and those can be evaluated at least initially with the use of an in-lab sleep test.

So, I think, commonly, patients, the general public may perceive that an in-lab sleep test is specifically intended to evaluate sleep disordered breathing, such as obstructive sleep apnea. But there are other reasons why people do sleep overnight in a lab and are tested.

Host: Sure, perhaps insomnia, restless leg, uh,

Brian Dickover, MD: Insomnia is often not evaluated with an in-lab test and restless leg syndrome is what we call a clinical diagnosis. So if I ask you four questions, do you have a sense of restlessness in your legs? Is it worse at night? Is it better with motion, and is it worse when you're at rest? That diagnosis, restless leg syndrome, and that does not require an in-lab sleep test. And people will commonly think that they have to have an in-lab sleep test for that, but in fact they don't. Nor, however, is insomnia something that needs to be evaluated with an in-lab test, because insomnia too can often be diagnosed on a clinical basis without the use of an in-lab sleep test.

Host: Sure, just maybe just from patient history, right?

Brian Dickover, MD: Exactly correct. We are happy that Franciscan and Franciscan Health are able to offer a comprehensive sleep evaluation with in-lab testing in Michigan City, and at other Franciscan locations in the region.

Host: And as I told you, I'm from Elkhart, so I'm very familiar with where Michigan City is in case I need to stop in for a sleep study. Yeah, just wondering what are some of the common symptoms that folks experience that would lead them to undergo sleep testing?

Brian Dickover, MD: The main symptom is a disruption of somebody's sleep in general. And typically that goes along with sleepiness. And one of the things that sometimes is difficult to tease out is the difference between being tired and being sleepy. I sometimes joke that in my training, in my schooling and stuff, I have been tired for a long, long time, but I'm not terribly sleepy.

I don't tend to fall asleep. I don't tend to doze off. And so sleepiness and being tired, can be somewhat different from each other, but the main complaint we see in the office before any kind of testing takes place is basically sleepiness. So now there's sleepiness, but also people will complain of snoring.

Some people snore and have sleep disordered breathing, and some people don't snore but still have sleep disordered breathing because their cessation, their apneas are so severe that they don't even have enough flow to create the sound of snoring. So again, sleepiness is a common complaint. Patients will have bed partners that sometimes complain that at night there's something going on that may necessitate the evaluation with a sleep test of some kind or other.

There is an entity called Periodic Leg Movement Disorder of Sleep, which is somewhat different than Restless Leg Syndrome, but so called PLMD is something that can potentially be evaluated with an in-lab test.

Host: Wondering how a patient gets referred. Do we just talk to our primary and say, I'm sleepy, I have some of these symptoms, my wife complains that I snore, is it something like that?

Brian Dickover, MD: A great way to put it, and that's a great start. The Franciscan Sleep Lab in Michigan City gets a lot of referrals from primary care providers. We also get a lot of referrals from cardiologists, believe it or not, because people will have cardiovascular disease that is either worsened or, more difficult to treat because people have sleep disorders such as obstructive sleep apnea that are going untreated and which make their cardiovascular disease more difficult to treat.

So lots of referrals come from cardiologists. As I said, lots of referrals come from primary care providers. Referrals will also at times come from other subspecialists like kidney doctors or neurologists or psychiatrists because patient's mental health is being impacted by their disrupted sleep.

I am also in the practice of pulmonary medicine, and so, I will refer patients. My pulmonary partners will refer patients because of symptoms that go along with possible cessations of their breathing when they're sleeping, and so we will often also refer patients to sleep labs for testing. And everything else being equal, I do feel that patients prefer to have a home sleep test done if and when it's possible to do that.

There are reasons not to be able to undergo home sleep testing. But for the most part, I think anybody would rather stay at home, if at all possible, as opposed to having in-lab testing.

Host: Yeah, you mentioned that patient history can be a big assistance, a determiner. We're talking about perhaps insomnia or restless leg, but generally speaking, what technology does Franciscan Health use to diagnose sleep disorders?

Brian Dickover, MD: So the home sleep test, it's a small device that comes in a zipped up fabric sack that people take home. I'm trying to think it's about as big, as a half a sheet of paper, the envelope, or as big as a sheet of paper. So that technology involves a sensor that goes underneath your nose, a probe that goes on your finger, two comfortable bands, one that goes around your chest and one that goes around your belly. There's also a sensor that determines the heart rate and that's basically it. I have rarely heard any patients say that at home when they have that device in place they have any difficulty getting to sleep or staying asleep.

Now, the in-lab test is somewhat more involved and because they're the only way to actually assess the actual stages of sleep is to have electroencephalographic EEG leads placed on your scalp. In that case, you have to go and have leads placed on your scalp and have much of the same monitoring done overnight in a lab that is also done in the home sleep test. But there's more detail. There's more fine tuning of the monitoring that takes place in the lab. And so that technology is present. And, so with that, however, we're able to better assess whether or not somebody's having a seizure potentially, or exactly what stage of sleep they're in.

I will point out that sometimes patients say to me that their phone or that their Fitbit or some personal monitoring device will tell them when they're in REM sleep, but I try to point out to patients, the only way to know exactly what stage of sleep somebody's in is to have EEG leads on your scalp.

Host: This has been really helpful today, Doctor. I think that sleepiness, lack of sleep, poor sleep, all those, all the above, a lot of folks out there suffering and maybe either they don't know why or they do, and they just don't want to do something about it. So hopefully we've encouraged them today to speak with their providers, to tell them what's going on. As you say, many things can be diagnosed just from a patient history, you know, and get better night's sleep, right?

Brian Dickover, MD: Correct.

Host: Well, that's perfect. I appreciate your time. Thanks so much.

Brian Dickover, MD: You bet.

Host: And for more information, visit franciscanhealth.org and search sleep testing.

 And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.