Definition and Overview
A sleep medicine consultation is an appointment with a sleep medicine specialist for the diagnosis and treatment of a wide range of sleeping problems. This is recommended for anyone who is having trouble sleeping properly or is suspected of having a sleeping disorder. At the end of the visit, the patient should have a clear knowledge of his sleeping problems, its causes, and possible treatment options.
A sleep medicine consultation may involve a review of the patient’s medical history followed by a physical examination. To fully diagnose the problem, the sleep specialist may also require special tests, such as overnight sleep studies.
For the consultation to be as productive as possible, the patient should discuss all his complaints and concerns to the doctor and cooperate in the required tests. The consultation is also the patient’s chance to ask any questions he might have, especially about the treatment options available to him.
Who Should Undergo and Expected Results
A sleep medicine consultation is highly recommended for anyone who is having problems sleeping, which may be symptoms of an existing sleeping disorder. Some examples of sleeping disorders include:
- Insomnia – A disorder characterized by habitual sleeplessness or a person’s inability to fall asleep.
- Narcolepsy – A chronic brain disorder that renders a person unable to control his sleepiness, resulting in extreme and spontaneous daytime sleepiness and the inability to resist sleep.
- Restless legs syndrome – Also known as the Willis-Ekbom or Wittmaack-Ekbom syndrome, this is a neurological disorder that causes uncomfortable sensations in the legs that disrupt a person’s sleep.
- Sleep apnea – This is one of the most serious sleep disorders wherein a person experiences obstructed breathing or breathing pauses during sleep.
- Circadian rhythm disorders – This refers to a group of sleep disorders that affect the timing of sleep, rendering a person unable to sleep and wake at normal times and thus may get in the way of normal activities such as going to work.
REM sleep behavior disorder – This disorder affects a person during the REM stage of sleep, and causes him to act out both vocally and physically any unpleasant or vivid dreams he may be having.
Some of the symptoms that should prompt a person to seek a sleep medicine consultation include:
Problems falling asleep
- Problems staying asleep
- Problems staying awake, such as falling asleep in the middle of activities like driving or during meetings
- Waking up feeling tired and sluggish despite getting at least seven hours of sleep
- Irregular sleep schedule
- Severe snoring problems
- Night terrors
- Sleep paralysis
- Choking or gasping during sleeping
Breathing difficulties or involuntary breathing pauses during sleep
It is also more important to seek a sleep medicine consultation if the patient also meets the following risk factors:
Being obese or overweight
- Age (over 40 for men and over 50 for women)
- Large or fatty neck
- History of hypertension
- Family history of sleeping disorders
Sleeping problems are difficult to diagnose because they can be caused by so many possible factors, including stress, emotional problems, side effects of medications, and alcohol and caffeine consumption, to name a few. Thus, it is best to seek the help of a professional who can shed light on the problem and prescribe the best course of treatment.
How is the Procedure Performed?
A sleep medicine consultation is conducted at a sleep specialist’s private office or clinic or at a hospital’s clinic. It can also be conducted at sleep medicine centers with a team of sleep specialists who are focused on providing diagnosis and treatment of sleeping disorders.
An initial consultation begins with a close review of the patient’s medical history, as any previous or underlying health problems may be related to the sleeping problem. This is followed by a general physical examination.
At this point, the doctor will begin to ask questions regarding the patient’s symptoms, and the patient will be given the chance to discuss in detail his concerns and complaints. If the patient is already undergoing treatment or has been to previous consultations before, a list of medications being taken as well as the results of any previous sleep tests should both be presented to the physician.
To come up with a conclusive diagnosis, the doctor may require some tests, such as:
- Overnight sleep study
- Daytime sleep study
- Home sleep study
- Sleep diary
- Therapeutic studies, e.g. polysomnogram
- Overnight oximetry
- Multiple sleep latency test
Once the test results are in, the doctor may be able to come up with a diagnosis, which will also enable him to make treatment recommendations.
Treatment for sleeping disorders tends to differ depending on the specific cause of the problem. Thus, aside from sleep specialists, sleep medicine centers have access to psychologists, psychiatrists, neurologists, surgeons, dentists, pulmonary specialists, and other medical professionals who may be brought in to help in diagnosing and treating the condition.
Possible Risks and Complications
Most sleep studies are safe, non-invasive, and painless. In fact, it could be as simple as being asked to wear a monitoring device while sleeping or to sleep in a laboratory for overnight monitoring. Thus, there is little to no risks or complications involved.
In some cases, the only side effect caused by a sleep test is skin irritation caused by the adhesive used to attach the monitoring device or test sensors to the body. The irritation also goes away as soon as the sensors are removed.
Thus, there is no reason not to seek a sleep medicine consultation. In fact, not doing so will expose the patient to more health risks caused by undiagnosed or untreated sleep disorders, such as:
- Daytime fatigue
- Heart problems
- Liver problems
- Type 2 diabetes
- Metabolic syndrome
- Memory deficiency
- Learning problems
- Strained relationship between sleeping partners
Another possible complication that a patient may encounter during a sleep test is difficulty falling asleep. For doctors to detect sleep problems, the patient will be asked to sleep during the test. In order for them to fall asleep easily, they are discouraged from napping on the day the test is performed.
Qaseem A, Holty JE, Owens DK, Dallas P, Starkey M, Shekelle P; for the Clinical Guidelines Committee of the American College of Physicians. Management of Obstructive Sleep Apnea in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. Sep. 24, 2013.
Skomro RP, Gjevre J, Reid J, et al. Outcomes of home-based diagnosis and treatment of obstructive sleep apnea. Chest. 2010;138:257-263.