Welcome to Feeling Great Sleep Medical Center’s Physician FAQ Area. Here you’ll find answers to the questions we’re asked most often by our referring physicians.
However, if you don’t find the answer you’re seeking, please feel free to contact Feeling Great Sleep Center's physician representative at: 866-499-1588.
Q: What do you typically monitor during a diagnostic sleep study?
A: As you know, polysomnograms are tests that measure bodily functions during sleep. However, we will vary the type and scope of our measurements depending on your patients’ requirements. In other words, we will measure the items listed below and any additional measurements you request.
- Brain Waves (EEG), using surface electrodes on their heads.
- Heart Rate (EKG), using surface electrodes on their chests.
- Eye Movements (EOG), using surface electrodes above and below their eyes.
- Muscle Movements (EMG), using surface electrodes on and under their chins.
- Limb Movements (EMG), using surface electrodes on their lower legs and arms.
- Breathing (Nasal/Oral), using sensors placed onto their skin near the nose and mouth.
- Breathing(Respiratory Effort) – we place small, elastic bands placed around their chests and/or surface electrodes placed on their rib cages.
- Blood Oxygen Levels (Sp02) – we attach small probes to their fingers, and do not take from actual blood samples.
Q: What time should my patients arrive at your center for their nighttime sleep study?
A: We ask that patients arrive at 9:00 pm. If you patients need to arrive earlier or later, please have them make arrangements ahead of time. They can do so by calling 866-499-1588.
Q: What are the best questions to ask my patients in order to screen for possible sleep apnea.
A: If your patients reply “Yes” to two or more of the following five questions, you should consider referring them for a sleep study:
- Do you snore?
- Are you excessively tired during the day?
- Have you been told you stop breathing during your sleep?
- Do you have a history of hypertension?
- Is your neck size > 17 in (male) or > 16 in (female)?
If you’d like more in-depth questionnaires and / or screening tools, please click on one or more of the links provided below:
Q: What if I suspect that a patient of mine is suffering from another type of sleeping disorder other than sleep-disordered breathing?
A: Please refer your patient for a consultation with one of our board-certified sleep physicians - all of whom are qualified to treat the remaining 83 sleep disorders.
Q: What are the types of sleep studies?
A: Below are brief descriptions of the types of sleep studies we perform at our centers:
- Polysomnograph (PSG)
- A polysomnogram is a common overnight sleep test (in reality it’s a painless, in-depth recording) often called a PSG. It measures and records activity during sleep, and monitors many bodily functions such as brain activity, eye movements, muscle activity, respiratory airflow, heart rhythm, and more.
Polysomnograms are used to diagnose or rule out sleeping disorders such as sleep apnea, narcolepsy, parasomnias, and more. After we complete your patients’ overnight polysomnograms, one of our board-certified sleep medicine physicians will review the data collected and provide you with his or her diagnosis, and recommendations for treatment, if warranted.
- CPAP Titration
- This study is identical to a polysomnogram with the addition of a medical device known as a continuous positive airway pressure machine (CPAP). This machine blows pressurized air into the nose via a mask in order to eliminate the snoring and pauses in breathing that sleep apnea produces.
CPAP titrations are overnight sleep studies used to determine the most effective airflow settings for your patients’ CPAP machines and the right CPAP masks. They are often recommended for those who have been using the same CPAP machine on the same setting for over a year. If you have patients who are current CPAP users, you should refer them to us for a CPAP titration study once a year, so we can re-titrate their machines to ensure that their treatment continues to be effective.
- Multiple Sleep Latency Test (MSLT)
- Multiple Sleep Latency Tests (MSLT) are performed after PSG studies. They will determine your patients’ degree of sleepiness, by measuring how long it takes them to fall asleep. Like PSGs, MSLTs also record a variety of other bodily functions, to rule out narcolepsy or other sleeping disorders. These tests are usually performed during the day and patients are asked to take four or five 15-minute naps, scheduled about two hours apart. Between naps, patients must try to stay awake. After your patients are tested one of our board-certified sleep physicians will review the data collected and provide you with his or her diagnosis, and recommendations for treatment, if warranted.
- Maintenance of Wakefulness Test (MWT)
- This test - performed after a CPAP study - is used to measure how alert patients are during the day. Additionally, like other sleep studies, bodily functions such as, heart rate, respiratory flow, and muscle movement are also recorded. This study is often prescribed for men and women who work in the public transportation and/or safety industries. During this test, patients are asked to stay awake for as long as they can during different time periods throughout the day. After your patient is tested one of our board-certified sleep physicians will review the data collected and provide you with his or her diagnosis, and recommendations for treatment, if warranted.
- A Split-Night Study (PSG & CPAP Titration) - At times our registered sleep technologists are able to quickly determine – after several hours of PSG testing - that some patients are suffering from sleep apnea. In these cases, they then conduct what is called, a split-night study. In other words, technologists begin by conducting a standard diagnostic PSGs for at least two hours. Then, following American Academy of Sleep Medicine guidelines, they initiate CPAP titration studies (for the second half of the night) for patients whose polysomnographic results indicate an apnea plus hypopnea index of at least 40 per hour, or an apnea plus hypopnea index of 20 - 40 if there are repetitive long obstructions, major desaturations, or other documented reason why less than a full-night study is warranted.
Some patients sleep poorly in sleep centers, and therefore may not complete two hours of sleep until three, four or more hours have elapsed. In these cases, CPAP titration may not be initiated.
Q: How do I know which type of sleep study to order for my patients?
A: Use the following guidelines to help you determine what type of sleep study to order.
- If your patient is a likely sleep-apnea candidate, you’ll want to order a polysomnogram, or PSG. This test will determine whether or not he or she has sleep apnea, and if so, its severity. Based on the results of your patients’ inital PSG, a CPAP titration study may be necessary. Baseline PSGs should always be ordered first, however, to determine which study should follow. This is particularly important in cases where patients do not exhibit signs of OSA.
- If your patient is complaining of severe daytime sleepiness (and he or she is not chronically sleep-deprived and / or there are not other apparent causes for this symptom) you should order a PSG and a Multiple Sleep Latency Test (MSLT). A PSG will test for sleep apnea and periodic limb movement, and an MSLT will measure his or her degree of sleepiness and determine whether or not he or she has sleep-onset REM periods, a main indicator of narcolepsy.
Please Note: Patients who have experienced insomnia for six months or more, should be referred to our center for diagnostic testing.
Q: Should patients take their usual medicines before sleep testing?
A: Since you’re looking for information regarding your patients’ sleep under their daily conditions, we usually recommend that patients take all their daily medications before sleep testing. It is important to note the following, however, so you can advise us if you’d like your patient(s) to do otherwise.
Please note the following:
- Many medications such as antidepressants and benzodiazepines, may alter their natural sleep pattern.
- Antidepressants may worsen snoring, sleep apnea and PLMS. Benzodiazepines may worsen snoring and sleep apnea, but they may improve PLMS.
- Alcoholic beverages may worsen snoring and sleep apnea, and many patients routinely drink several each night. We do not allow alcoholic beverages in our centers, and we strongly discourage patients from drinking alcohol before arriving.
If you have patients with very significant insomnia at home but they still require testing for sleep apnea, you may want to prescribe short-to-medium duration hypnotic medications. Your patients will fill their prescriptions at their pharmacies and bring them to the sleep center. They'll take them right after they arrive. Under these circumstances your patients should arrange for someone to pick them up in the morning.
Q: How will my patient learn their sleep testing results?
A: Your patients sleep study results will be faxed directly to your office. We will also mail a copy directly to your patients. If needed, we are also happy to answer any follow-up questions your patients may have regarding their results.
Q: How do I make a referral to one of the sleep centers?
A. And to make your jobs even easier, below are links to our standard referral / prescription forms. Each can be printed and filled in by hand OR the requested information can be filled out online, printed, and faxed to us.
Once completed, fax the appropriate form to us at: 866-499-1288, and we’ll take care of the rest! In other words, after we receive your referrals we will follow up directly with your patients to:
- Confirm their insurance benefits.
- Schedule appointments, as necessary.
- Obtain detailed sleep histories.
- Answer any/all questions they may have about our practice or procedures.
- Ensure that they have all of our contact information and know where and how to obtain more help, if needed.
Q: How long does will it take before my patient is scheduled for a consultation and / or sleep study?
A: All patients are scheduled for our first available appointment, which is usually within 1-2 weeks after receiving your referral. We will do our best to accommodate your patients’ special needs and emergencies. In order to make it convenient and quick for your patients, we operate four sleep study centers in Durham, Burlington, and Jacksonville. They are open 7-days-a-week.
Q: What insurances are accepted by your centers?
A: Following is a quick reference – and partial list - of the types of insurance cover we accept. Access a complete list of accepted insurance carriers.
Partial listing of some accepted health insurance carriers
|Blue Cross / Blue Shield||Prima|
|Cigna||United Health Care |
|GEHA||National Association of Letter Carriers|
Q: Will Medicare pay for CPAP therapy?
A: CMS approves CPAP payment for patients with an apnea / hypopnea index (AHI) of 15 or more, and for patients with an AHI of 5-14 with documented symptoms or diagnoses of excessive daytime sleepiness, impaired cognition, mood disorders, insomnia, hypertension, ischemic heart disease and / or history of strokes. Here are some other helpful medical definitions:
- Apnea is cessation of airflow for at least 10 seconds.
- Hypopnea is abnormal respiratory event lasting at least 10 seconds with at least a 30% reduction in thoracoabdominal movement or airflow as compared to baseline, and with at least a 4% oxygen desaturation.
You can find additional information regarding Medicare regulations on their website: www.medicare.gov.
Q: What if patients who need CPAP do not qualify for insurance coverage?
A: Some patients who will benefit from CPAP for sleep-disordered breathing, do not meet the Medicare or private insurer coverage criteria. These include patients who experience frequent arousals due to labored breathing, but no desaturations; patients with high respiratory disturbance indexes(RDI), and low AHIs (apnea / hypopnea index); and patients with URRS (upper respiratory resistance syndrome) but low AHIs and / or RDIs.
Although CPAP therapy often results in significant improvements for these types of patients, they may not qualify for Medicare coverage. Feeling Great Sleep Medical does offer affordable payment plans to help patients in these situations, so please don’t hesitate to refer them to our centers. We will do everything in our power to ensure that they receive testing and treatment they deserve and can afford.
Q: How does the interpreting sleep doctor determine which CPAP pressure to recommend?
A: When we initiate CPAP during a polysomnogram (PSG), we raise CPAP pressure to eliminate apneas, hypopneas, desaturations, RERAs, and snoring. We then recommend the lowest possible pressures (but one that eliminates patients’ symptoms) for at-home use.
Q: What if the CPAP titration study fails, or if the sleep apnea is treated by CPAP, but the patient does not tolerate it well?
A: In rare cases, patients “fail” their CPAP titration studies, due to a variety of reasons such as interference with medications. In these cases – and when patients do not sleep well during their study - we recommend a second study so we can gather accurate data.
Q: Does your company provide CPAP equipment for patients?
Yes. Our team of experts at Feeling Great Respiratory Equipment are happy to handle your patients’ equipment – whether CPAP, BiPAP, or oxygen – and supplies. In order to provide their patients with non-fragmented care, most of our physicians prefer to submit referrals / CMNs (Certificates of Medical Necessity) to us for all of their patients’ sleep needs. Additionally, they know that our experienced staff of respiratory therapists and registered sleep technologists will answer their patients’ questions and address their concerns; outfit them with state-of-the-art medical equipment; and follow-up with them to ensure they’re using their equipment properly (via our unique patient compliance program).
However, you and/or your patients may choose to obtain your equipment and supplies at other medical supplies companies serving our area.
Q: How do I help my patients become comfortable with CPAP therapy?
A: Pro-active patient education and coaching are keys to long-term CPAP compliance. Please consider the following:
- After using CPAP in sleep centers, about 70% - 80% of patients choose to trial the equipment at home.
- Within four days most patients develop their “compliance pattern”.
- 90% of CPAP users continue their treatment for three years. This drops to 85% after seven years.
- The vast majority of CPAP users who stop prematurely do so within the first few months of use. This is greatly alleviated when the equipment company offers a solid follow-up compliance program, like the one we provide.
Therefore, it’s very important to ensure that your patients are provided with the best equipment and helpful “extras,” and that they learn how to set up, care for, and use their CPAP machines.
We’ve found that our CPAP users do much better when they adhere to the following recommendations:
- Ramp up to full pressure over a 20-minute period.
- Use a heated humidifier.
- Stay involved in our compliance program.
Additionally we recommend that our new patients perform the following “gradual CPAP desensitization” steps:
STEP 1: In order to decrease any anxiety they may have, they should wear their CPAP mask or nasal pillows while performing normal activities at home during the evening.
STEP 2: Patients should connect their pressure devices and tubing to their machines (using the pressure settings prescribed by their doctor) and turn them on. Then, they should breathe through it for one hour each day. When they get comfortable with this (for at least 5 days in a row), they should move on to step 3. During this step they should also practice moving their heads, closing their eyes, and allow their family members to ask questions and touch their machines. (Physicians can remind their patients that CPAP machines use pressurized air, not pure oxygen, so it isn’t dangerous and won’t explode).
STEP 3: Wear the entire CPAP apparatus for a scheduled one-hour nap. When patients can do this without anxiety or concern for five consecutive days, and they should begin step 4.
STEP 4: Wear the entire CPAP apparatus for 4-5 hours of sleep each night. When patients can do this without anxiety or concern for five consecutive days, they should move on to step 5.
STEP 5: Use CPAP for your entire night's sleep.
By the way, we recommend that patients who have experienced no difficulty or discomfort with their CPAP machines in our centers, begin with step 2 and move quickly toward step 5.
Q: What if my patient still cannot use CPAP?
- Your patient may need to be seen in our CPAP clinic or schedule a consultation with one of our board-certified sleep physicians.
- Ensure that your patient is using a humidifier. You might also consider using a heated humidifier, which is more effective for some patients.
- Recommend that your patient try a different mask size or style.
- Consider prescribing a trial hypnotic medication, which your patient can take before using their PAP device.
- Suggest that your patient use a nasal steroid spray or oral decongestant if you suspect that decrease nasal patency is a factor.
- Restart the desensitization program, as outlined above.
Q: What is the difference between restless leg syndrome (RLS) and periodic limb movements of sleep (PLMS)?
A: RLS occurs in waking patients, and PLMS occurs in sleeping patients. Up to 10% of the general population experiences RLS, particularly in the legs, which usually becomes bothersome during the late evening hours. Patients describe numbness, cramping, or other symptoms, which improve when they move their legs. These symptoms often interfere with sleep onset and often lead to long awakenings after sleep onset. About 10% of people may have regular, repeated, uncontrollable leg jerks as they sleep, and the resulting arousals disturb sleep. Most people with RLS or PLMS have both disorders, and medical treatment usually is effective.