Gabby Cinnamon (Host): Sleep struggles affect millions of people. Insomnia, snoring, trouble falling asleep, or staying asleep, just to name a few, are sleep issues that may warrant a sleep study. Joining us today to share everything you need to know before getting a sleep study is Kathleen Gallagher, Manager of Pulmonology and Sleep Medicine at Riverside Healthcare.

Intro: Riverside Healthcare puts the health and wellness information you need well within reach.

Host: Welcome back to the Well Within Reach podcast brought to you by Riverside Healthcare. I'm your host, Gabby Cinnamon. And as mentioned today, I'm joined by Kathleen Gallagher, Manager of Pulmonology and Sleep Medicine and all-around sleep expert to talk about everything we need to know before getting a sleep study. Thank you for coming back on the podcast, Kathleen.

Kathleen Gallagher: Oh, thanks for inviting me. Love these podcasts.

Host: You sure do. You are our most frequent guest. So, you haven't done a podcast with us though in a little bit. Can you kind of remind everyone who you are and, you know, why we should be taking advice from you?

Kathleen Gallagher: Yeah. So, I, like Gabby said, manage the pulmonology office as well as the sleep center. And I make it my life's work here to inform everybody about getting good sleep and why not getting good sleep can affect you and certainly wanting to improve the whole person. Because if you're not getting good sleep, it's affecting all parts of your waking body. All your health issues can come back and relate to your sleep issues.

Host: Yeah, for sure. So, you are just who we need to talk to today about this. So Kathleen, what is a sleep study?

Kathleen Gallagher: So, a sleep study is when a patient or a person comes in to have their sleep evaluated. We have a couple different kinds of sleep tests. Patients can come in for a full overnight sleep study in the sleep center, or we do at-home sleep studies. There's differences in the two. A home sleep test is really just watching a patient's breathing and respiration, heart rate, pulse oximetry. We can listen to hear if there's any snoring going on. And in an overnight sleep study, we actually can watch brain activity because we put those wires on a person's head. We again monitor breathing. You can monitor EKG rhythms as well as to see if there's any leg movements happening, so a little more involved.

Host: Who should get a sleep study?

Kathleen Gallagher: I think if you are somebody who realizes that you don't wake up feeling really refreshed in the morning, you're taking that drive to work and you're feeling kind of sleepy, you definitely need that caffeine to get you going in the morning. I'd say everybody does, so that's probably not a good example. But if you're really not feeling like you're well rested, you know, you're hitting that snooze button a number of times, maybe there's somebody or your bed partner says, "Hey, you're snoring," or you're getting nudged at night to turn over or somebody hears you stop breathing, or maybe like your legs, like I said, have this itchy crawly feeling, maybe that's another reason to have something evaluated. I even think of kids when kids say, "Mom, my legs hurt," and parents always say, "Oh, it's growing pains." Take a second look at that because it could be that they're having leg movements at night as well. So, it's not just adults. It's babies on up. Anybody can be affected by not getting good sleep.

Host: You mentioned there are different types of sleep studies. How is it decided which type you get? And is one type better than the other, the at-home verse in-the-sleep center type of study?

Kathleen Gallagher: So, a lot of it can be patient-driven. Sometimes we'll have patients who, for whatever reason, can't do the overnight sleep study. Insurance also drives whether or not you're going to have an in-lab or an overnight sleep study. I've seen patients who are ordered for a home sleep test, insurance will deny it for an in-lab or vice versa. So, the home sleep test is really a good screening tool for sleep apnea, that's really what it's designed to do. And you cannot be a child and have a home sleep tests, it's not advised, so you have to be 18 or older to have that done. But like I said, home sleeps are really just to screen you for sleep apnea.

Host: What kinds of issues can a sleep study uncover?

Kathleen Gallagher: Sleep studies can uncover things like even patients who have insomnia. And they think, "Well, why do I have to have an in-lab sleep study?" But that tells us a lot too if you're laying there awake and how long it normally takes people to fall asleep and if it takes them a whole lot longer or somebody wakes up in the middle of night and they can't go back to sleep because you can have either type of insomnia. They can diagnose leg movements. We can diagnose heart arrhythmias. We can diagnose sleep apnea and even seizure activity, we can see if that's something that's an issue.

Host: So, maybe even things that you didn't even realize, you know, you might have come in for something else to get the sleep study and you couldn't uncover something that you didn't even realize you were dealing with as an issue because you might have become so used to it.

Kathleen Gallagher: It's possible. A lot of things that you can sleep through and not realize it. People don't think that they have sleep apnea a lot of times, because people think all the time, sleep apnea, "I'm not gasping for air in the night." It doesn't necessarily have to be that. Apnea is really the blanket term we use for, and it is, when you stop breathing. But there's actually subtle things like underbreathing that happen as well. And that's a little less likely a bed partner would hear versus somebody who's clear on snoring and then has these pauses and these gasps for breath.

Host: Yeah. And I think too, a lot like of people I know that snore, like, "Oh, my gosh. You were snoring so loud last night." "Oh, who me?" Like a lot of the times, I feel like they have no idea or, at least the people that I know that snore very loud, they have no clue and no recollection that that's what they're doing.

Kathleen Gallagher: And even snoring doesn't necessarily mean you have sleep apnea. You can just plain old have snoring. But don't forget, that's an airflow limitation, right? And we're inhaling oxygen and we want to get as much as we can. And even for kids, snoring is not normal for kids. You want to get that checked out as well.

Host: So, let's say, you think that you might have sleep apnea or some other issue and then you decide you're going to get a sleep study, you know, you've been to your provider and all that. How does a patient prepare for a sleep study?

Kathleen Gallagher: So, it's really easy. If you're coming in for an overnight sleep study, patients don't arrive until 8:00 at night. So by then, you would have probably had your dinner at home, maybe taken your nighttime medications if you needed to, or bring them with you to the lab and just take them before you go to sleep if that's the case. I always say wear something comfortable to sleep in.

At our sleep center, we have really comfortable rooms that look like a hotel room. You have your own bathroom, your own thermostats. You can set your temperature in a room cold or warm. We have plenty of extra blankets, pillows, your own TV, your little nightstand. So, we try to make it comfortable so it's not like a hospital bed by any means.

And then, for the home sleep test, we just want you to do what you normally do when you're sleeping at home. So, patients will come in. It's a quick 15-minute visit. We show them how to put this little home sleep test on so that when they go to sleep at night, they just put it on and bring it back the next day.

Host: Before we get into more about sleep studies, we're going to take a quick commercial break.

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Host: So, more into the sleep study and the process of that. What happens during a sleep study? +

Kathleen Gallagher: So, the home sleep test, like I said, it's just really easy because that's just the patient goes home, puts it on. But during a sleep study in the lab, so you're going to come in and get checked in and you're going to have a tech that's going to take care of you who will be putting all the sensors on you and explaining what each one of them does. So like I said, you'll have wires on your head. You'll have a couple EKG patches on to watch your heart, your legs and your breathing and your respiration, so a couple elastic belts wrapped around you. So, all these show a little recording about what's going on with you, which is really interesting, especially to see how long you spend in your different sleep stages, because that's really important as well, or how long it takes for you to fall asleep. And it'll show us if you have any sleep apneas or leg movements or how many times we watch your brain wake up. Patients don't realize when they're sleeping that your brain actually can be aroused, but you sleep right through it. So, we can get a lot more data from an overnight sleep study.

Host: Are there any risks involved with a home sleep test or an in-person sleep test?

Kathleen Gallagher: No, there's nothing that's painful or that would hurt anybody. I think there's no risks involved with it either way. If anything, if you have something going on with your sleep when you're sleeping at night, you're best to actually take care of it now. Because if you are having sleep apnea, it overworks your heart and your heart doesn't want to be overworked. We want to just rest when we're sleeping at night. And we get so much great stuff when we're sleeping at night, so much healing happens. But yeah, if we uncover anything, we want to fix that because long term, we don't want to have any problems with our health.

Host: Right. Everything is so connected, you know, even if, okay, you know, you get a bad night of sleep. But perpetually getting bad nights of sleep, that cannot be good.

Kathleen Gallagher: And I was thinking actually earlier, it's not just about the snoring and the sleep apnea. You can have a bad night's sleep because you don't have the best bed even. Sometimes people are sleeping on terrible, terrible mattresses that don't allow them to sleep. You could have shoulder pain and hip pain and you're constantly turning all night long or you've got a trough that's formed in the middle of the bed and you're just not getting good sleep because that is not comfortable. So, you spend a third of your life in bed. Make it comfortable. Spend that extra money on stuff that will help you sleep better, for sure.

Host: Right. So, okay, we go in, we get the sleep test. What results come back? What do those results look like? I think most of us, we're used to, "Oh, I need to go get a test result," maybe that's like a blood draw. And then, you know, your message comes through from myChart, like, "Oh, this is concerning, these levels are concerning," through a blood test. But this is different than that. What do results look like from a sleep test, and what can they mean?

Kathleen Gallagher: So, you know, we always focus on if a person has sleep apnea, and what does that apnea index mean. And apnea indexes, if you stop breathing so many times a night, they'll take that and divide it by the hours you slept and give you a number, because everybody's like, "What's that apnea number you had?"

So, first off, I want to say it is normal for people to stop breathing about five times an hour. And we have mild sleep apnea, 5 to 15 times an hour you can stop breathing; 15 to 30 is moderate; and anything over 30 is considered severe. And so, I don't want patients to freak out if they saw some results come to their myChart because, you know what? They made the first step to get their test done so that the results, if they show something like that, we'd be able to intervene and help whether or not your provider, your sleep doctor, is going to order you a CPAP or maybe you aren't in favor of that CPAP. Maybe you can see the dental doc and get an oral appliance made. It's like a retainer for your teeth and it's designed to pull your lower jaw forward opening up your airway a little bit more. There's even that Inspire that you hear about on the news or on the radio, et cetera, TV.

That's an implantable device. So, that's a little more invasive, but it does work for some people. So, I've seen success with that, but you have options and I think it's best to discuss them with your doctor. So, these are things that would come out of that test. And you know what? I hate to say it. Weight loss is a really great way to possibly eliminate sleep apnea, if that's what's going on with you, if that's a possibility.

Host: Yeah, my sister was telling me, you sometimes will like snore and stuff. I saw on Amazon, there's like these magnet type things that you can like put in your nose. I was like, the reviews were a little suspicious, so I'm not really sure. But to that point, there are other things out there that aren't as invasive as what you might think.

Kathleen Gallagher: Absolutely. There's even stents you can put in your nose, or you think of the Breath Right strips. So when you are awake right now, if you take a big inhale through your nose, whatever, when you go to sleep at night, there's more resistance there, meaning there's less of it. That's why they designed those Breath Right strips, because If you've ever worn one, they try to hold your nose open further, or these stents that you could put in your nose to keep your airway more patent. So yes, there are things that are out there and they work for some, they might not work for all. It's not what you want to try if you've really got some sleep apnea, because it's not really going to fix it. Because a CPAP machine, it stands for continuous positive airway pressure, so it works like a fan and, as you inhale, it actually stents your airway open. So, that's how that works. And there's different variations of PAPs designed for people who have different, maybe health issues or things going on when they do their sleep study. And those are things that we determine during the night.

Host: Where does Riverside do their in person sleep studies? Can you talk about the sleep center?

Kathleen Gallagher: Sure. The sleep center is located in the Bourbonnais Plaza up on Route 45. It's really nice. We do our home sleep tests out of there as well. So, patients would come in, whether it's during the morning or in the evening for an appointment for that. But then, the overnight sleep studies, we do have six full bedrooms in the back of our sleep center.

Host: They are very nice. I know we've done different videos and stuff back there. They're very nice.

Kathleen Gallagher: Yeah. So, I think that's where patients would come and get checked in. You come in by 8:00 in the morning. And honestly, you're getting woken up really early in the morning, 5:00 a.m. is the wake up time, and I know some patients aren't happy to hear that. But it is a test. It's not a hotel stay.

Host: It's really one of the earliest check out times I've ever heard from a hotel.  

Kathleen Gallagher: Most people are probably happy to get out of there and go home anyway. But for people who work, it's ideal because then you can get home and shower, get ready. However, we do have everything accessible if you need to take a shower and get ready for work here in the sleep center too.

Host: Oh, nice. Nice. That's very nice. I did not realize that. How can someone go about scheduling a sleep study?

Kathleen Gallagher: Well, there's a couple ways. You definitely need to have a referral from your doctor, an order from your doctor. So, the conversation first starts there. So whether you want to seek out the sleep doctor or talk to your own primary care physician, insurance needs that initial conversation, you know, why are you feeling sleepy in order for it to even get through the approval process. So, I would start there. Just have that conversation with your doctor and say, "You know what? I'm just not really feeling that great." Maybe there's other things that you can look at too. How about what's your sleep hygiene? So, it might not just be all about having sleep apnea or a sleep disorder, but what can we do to better improve our sleep on our own?

We're all our worst enemies. We all want to stay up late, kids go to bed, time to like play on our phones or something. I don't recommend doing the tablet or the phone too late at night, but that leads to other issues that we can always talk about on another podcast. But I think setting ourselves up for a successful night, making our home even darker at night, so more conducive to relaxation. There's definitely something to be said for having good sleep hygiene, getting the amount of sleep that we need, or at least striving to get more than the average five, six hours that people are getting out there. Trying at least that seven and a half hours would be best.

Host: Before we go, do you have any final words of wisdom for us or anything else we should know about sleep, sleep studies?

Kathleen Gallagher: I really just say just as humans, we're our worst enemies. I've talked to so many people out there and it's not just the adults, it's the kids that are out there too. And you know, school's just started. So, I would really say for the parents out there, really set a good example for your kids and get the family to bed early. And for those of us who are adults too, to really just make sure that we, again, set ourselves up for a good night's sleep and turn off stuff. Turn off that TV. Turn off your phone. You know what? If you try it, you might actually feel a whole lot better.

Host: You never know. Well, thank you so much, Kathleen, for coming on the podcast today. And thank you, listeners, for tuning in to Well Within Reach, brought to you by Riverside Healthcare. Make sure to rate and leave a review for Well Within Reach on Apple, Spotify or wherever you listen to the show. For more information about sleep medicine at Riverside, visit riversidehealthcare.org/sleep.