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Polysomnogram
What is A Polysomnogram
An overnight Polysomnogram, also known as a PSG, is a sleep study measuring multiple parameters such as; brainwaves, blood-oxygen level, heartrate, respiration and eye and leg movements that may occur during sleep disorders.
- Sleep apnea or another sleep-related breathing disorders: This is due to the collapse of the upper airway or an obstruction leading to the cessation of breathing that occurs repeatedly during sleep.
- Periodic limb movement disorder: People with this sleep disorder tend to flex and extend their legs while sleeping and, in some cases, may be related to restless leg syndrome which occurs while awake.
- Narcolepsy: The overwhelming experience of excessive uncontrolled daytime sleepiness. They can fall asleep suddenly.
- REM sleep behaviour disorder: This sleep disorder involves a person acting out their dreams during sleep.
- Abnormal behaviours during sleep: Sleep walking, talking, moving around or rhythmic movements that occur during sleep.
- Insomnia: People with insomnia have trouble falling asleep or staying asleep.
- Electroencephalography (EEG): Used to monitor sleep stages. This includes the use of two central, two occipital and two frontal electrodes which are referred to the ears as an adjunct in order to help identify sleep latency and arousals. The general placement is based on the 10-20 system with the option of adding more electrodes particularly for patients with epilepsy.
- Electrooculography: This is to monitor horizontal and vertical eye movements and helps to determine sleep stages such as the onset of slow-rolling eye movements during drowsiness and rapid eye movements.
- Electromyogram: Used to pick up muscle movement during snoring and also limb movements in the case of periodic leg movements.
- Electrocardiogram: Assessment of the heart rhythm.
- Respiratory effort: Belts that are strapped to the abdomen and chest to assess for movement during breathing. This determines the effort of the muscles and the types of apneas present if so.
- Pulse oximetry: Assess mean nocturnal oxygen saturation. Able to classify hypopneas with the use of desaturation.
- Sound recording: Monitors snoring and sleep talking.
- Other parameters include: End tidal or transcutaneous CO2.
Sleep Apnea
Sleep apnea is a serious sleep disorder where breathing repeatedly stops and starts during sleep. This can lead to fragmented sleep, excessive daytime sleepiness, and other health problems. There are two main types: Obstructive Sleep Apnea (OSA) where the upper airway is blocked, and Central Sleep Apnea (CSA) where the brain doesn't send proper signals to control breathing. Common symptoms include loud snoring, breathing pauses during sleep, and daytime fatigue.
Sleep Apnea Treatment
The solution we specialise in at NuAlpha is called CPAP. Continuous Positive Airway Pressure is renowned for being the most effective form of treatment for Sleep Apnea. The CPAP device is a small machine (smaller than a shoebox) that uses pressurised air to keep your airways open. The device connects to a mask via a hose. In today’s world, there are many Sleep Apnea masks to choose from. It’s important to test out each one to find the perfect, most comfortable fit. Failure to do so can result in a dry nose/mouth, blocked nose, sore throat, skin irritation, stomach bloating, and headaches.
These nonmedical treatments or approaches can typically improve obstructive sleep apnea or resolve it. They aren’t cures, but they can reduce apnea to the point where it stops happening or isn’t severe enough to cause symptoms. These include:
- Weight loss: A 10% decrease in body weight can significantly improve sleep apnea for people who have excess weight or obesity.
- Position changes while sleeping and sleep aid items: Sleeping on your back makes sleep apnea more likely to happen. Special support pillows and similar items can help change the position in which you sleep, keeping you off your back so soft tissue doesn’t press on your windpipe and block breathing.
- Nasal sprays, adhesive strips, etc: These over-the-counter products improve breathing by making it easier for air to travel through your nose. While they can’t help moderate or severe sleep apnea, they can sometimes help snoring and mild sleep apnea.
- Treating the underlying condition: Treating conditions such as heart failure can often improve central sleep apnea.
- Medication changes: Working with your doctor to decrease or stop opioid pain medications may be able to improve or even resolve central sleep apnea.
Surgeries on your nose, mouth and throat can help prevent blockages of your nose, throat and windpipe. However, the impact of these in adults is usually limited and varies from person to person. These surgeries include:
- Somnoplasty: This procedure uses radiofrequency (RF) to reduce soft tissue around the upper parts of your windpipe.
- Tonsillectomy/adenoidectomy: Removing your tonsils and adenoids can widen the opening where your mouth, throat and nasal passages connect. That makes it easier for air to pass through and reduces soft tissue that can block your breathing. This procedure is most helpful for children with obstructive sleep apnea.
- Uvulopalatopharyngoplasty (UPPP): This procedure removes your uvula (the teardrop-shaped soft tissue that hangs at the back of your mouth). It also removes soft tissue from your soft palate and pharynx. These widen the area where your mouth and throat meet, making it easier for air to pass through.
- Jaw surgery: Different surgery procedures can subtly change the position of your jaw so soft tissue can’t easily press back on your airway. These procedures are especially helpful for people who have sleep apnea for structural reasons like micrognathia.
- Nasal surgery: One common form of nasal surgery is septoplasty, which straightens the soft tissue in your nose, making it easier for air to travel through your nose and nasal passages.
At the end of the day, the treatment patients chooses depends on what you are going through. No two people are the same.
Electroencephalogram (EEG)
There are several types of EEG tests, including routine, prolonged, ambulatory, sleep, and video EEGs, each with varying durations and purposes. Routine EEGs are short, often involving specific stimuli like flashing lights, while prolonged EEGs can last from an hour to several days. Ambulatory EEGs are worn for multiple days and record brain activity during normal daily activities. Sleep EEGs, often combined with sleep studies, focus on brain activity during sleep, and video EEGs film the patient during the EEG recording.
Electromyography (EMG)
This test measures the electrical activity of muscles and is often done in conjunction with nerve conduction studies to provide a more comprehensive assessment of nerve and muscle function.
Nerve Conduction Velocity (NCV):
This is a specific part of the nerve conduction study that measures the speed of nerve impulses.
Nerve Condution Test (NCS)
A nerve conduction test, also called a nerve conduction study (NCS), is a medical diagnostic test that assesses the function of nerves by measuring the speed and strength of electrical impulses traveling through them. It helps detect nerve damage, compression, or dysfunction, and is often used to diagnose conditions causing pain, numbness, or muscle weakness.
- Electrodes: During the test, electrodes (small adhesive patches) are placed on the skin over the nerves being tested or the muscles they control.
- Stimulation: One electrode provides a mild electrical impulse to stimulate the nerve, while other electrodes record the resulting electrical activity.
- Measurement: The speed and strength of the nerve impulse are measured by calculating the time it takes for the electrical impulse to travel between electrodes and by analyzing the amplitude of the recorded signals, according to Johns Hopkins Medicine.
- Interpretation: The results can help determine the presence, location, and severity of nerve damage, as explained by Johns Hopkins Medicine
- Diagnosing nerve disorders: Nerve conduction studies are used to diagnose a wide range of nerve disorders, including carpal tunnel syndrome, peripheral neuropathy, and Guillain-Barré syndrome
- Locating nerve damage: They can pinpoint the location of nerve compression, damage, or dysfunction.
- Evaluating nerve function: Nerve conduction tests assess the overall function of the nervous system by measuring how well nerves transmit signals.
- Differentiating between different types of nerve damage: They can help differentiate between axon loss (damage to the nerve cell body) and demyelination (damage to the myelin sheath).