Your patient’s sleep health
Sleep health is increasingly recognised as an important factor in promoting patient wellbeing. Sleep apnoea is recognised as a leading cause of fatigue, inertia apart from the well-recognised cardiovascular risk. Sleep apnoea affects productivity and is a hazard for driving. Not every patient presents with stereotypical symptoms of snoring or choking episodes. More women tend to present just with tiredness.
Sleep health is not limited to sleep apnoea. Movement during sleep, injuries during sleep, acting out dreams, links between neurological diseases, stress trauma and sleep is fascinating and multifocal and affects patients sleep health.
If you suspect your patient has poor sleep, which of the below management strategies would you employ?
- Refer to any Sleep Physician
- Refer for a home sleep study
- Refer to a Sleep physician who does a home sleep study?
- Refer to a psychologist or other allied health?
What happens when you order a standard home sleep study?
If you order a standard home sleep study, all patients receive a standard questionnaire and a standard test.
This is because the third-party providers do not have a detailed clinic history or knowledge of past investigations of your patient. Usually the patient is not assessed by a sleep physician prior to the test either to decide if this is the suitable test for the patient or to see if additional monitoring is required depending on the clinical condition.
For some patients specially with heart disease and past strokes home sleep studies are not the right choice. The same test is offered to all patients in “one size fits all” theory and in reality, we know every patient is very different.
There is usually an out of pocket cost for the patient.
Why is referring to a Sleep physician upfront better?
The sleep physician clinically assesses patient, decides on a differential diagnosis, decides appropriateness of the study and orders the appropriate test that is suitable for that particular patient.
I had a patient referred for investigation of sleep apnoea as the husband and wife sleeps in separate rooms and the assumption was that the husband snores and might be having sleep apnoea. Following a lengthy conversation, it was evident that the reason for sleeping apart was the husband’s behaviour of thrashing about at night and in-fact he didn’t snore much at all. On examination there were subtle signs of akinesia.
This patient required an in-lab sleep study with video monitoring. The in-lab sleep study demonstrated REM behavioural disorder which was followed up by a neurology referral that confirmed the diagnosis of early Parkinson’s disease. A home sleep study would not have picked this up and reaching a diagnosis would have got delayed unnecessarily.
What happens at SRS home Sleep?
- When patients referred for me for sleep issues, I assess them first and decide if they need a sleep study. If they do the next decision is are they suited for a home sleep study or in lab sleep study.
- If a decision is made to do a home sleep study which is around 80% of my patients, I then decide which parameters need monitoring and adjust the study parameters to suite the patient need.
- Once the patient is booked for the study, I or my sleep scientist will wire the patient the way we planned FOR THAT patient and explain the procedure and educate on troubleshooting before sending them home. They return the machine next day usually on their way to work.
- I analyse the study the same day and send for scoring to the (Sydney based) sleep scientist and I discuss with the scientists if discrepancy occurs. (I do not outsource any studies to an unknown technician in another country that would compromise quality of the sleep study).
- It is very important to see raw data of a sleep study as opposed to making a diagnosis only on a summary report.
- I ask the patient to come in the next week and explain the report and options of treatment.
- If CPAP is required I will send them to an accredited provider with ongoing combined management and troubleshooting all the way. If CPAP is not suitable I will provide alternate solutions including mandibular advancement splints, surgical options etc.
What type of machine does SRS home sleep studies use?
I use a Nox A1 machine that is very small and easy to use (as seen in the picture). The patients can easily sleep any position they like.
Why is there no additional cost to the patient?
This is because I personally perform and report all my home sleep studies and there are no third-party payments. The assessment of sleep disorders is offered as a package with:
- First assessment of 45 mins
- Home sleep study
- Post study plan: 30mins
This is covered under Medicare and there is no cost to the patient. The only requirement is a valid referral supplied by yourself as their GP.
What is the wait time for the patient?
The wait time is 1 week.
Where are the tests being carried out?
Tests are being carried out at two locations:
Suite 205, San Clinic Tulloch, Sydney Adventist Hospital
Suite 10, Westmead Private Hospital
What other advantages are there?
In case of urgent sleep study, e.g. truck driver stepped down from driving etc, I can look at the study the same day and if suspicious of severe disease I can urgently get this scored and treatment started immediately. There is no delay as the study does not need to go to another Sleep physician for scoring.
What is the patient requiring an in-lab sleep study?
If an in-lab study is required which will be about 20% of patients, I collaborate with very good public and private hospital Sleep Labs. Depending on the patient’s home location this is organised to give the most convenience.
How do I refer my patient for assessment?
Please ask your patient to call 1300 586 437 SRS Sleep Service with a valid GP referral.