What is a Sleep Study… and Should You Get One? Esteemed New York Physician Dr. Carl Nicoleau Wants You to Know the Facts

    NEW YORK, NY, October 09, 2020 /24-7PressRelease/ -- "One of the most common questions I encounter in my Sleep Medicine practice is I can't sleep and feel tired during the day time," says Dr. Carl Nicoleau, New York's leading sleep medicine expert. "Actually, the technical term for difficulty falling asleep is insomnia, which is actually very common. In sleep onset insomnia there is difficulty falling asleep. By contrast, sleep maintenance insomnia is associated with difficulty returning to sleep after waking up."

According to Dr. Nicoleau, insomnia can occur independently or in association with obstructive sleep apnea. In fact, 39-58% of those who experience insomnia also suffer from obstructive sleep apnea. There is evidence for a bidirectional relationship between insomnia and depression. Many psychiatric disorders are exacerbated by sleep deprivation. Some experts believe that insomnia can cause depression and has been associated with sleep deprivation. Increased cardiovascular and endocrine pathology is also linked to sleep deprivation, as is a less robust immune system function.

"There are many causes of insomnia," explains Dr. Nicoleau. "It is best to see a specialist trained in sleep medicine to have thorough evaluation so that the correct diagnosis and treatment may be prescribed."

Dr. Carl Nicoleau understands his patients' needs and effortlessly maintains his reputation as a first class physician. He is widely regarded by his patients as a caring and attentive provider, and he has the online reviews to prove it.  He is the proud recipient of distinctions, certifications and honors throughout his career. When the pandemic struck, he was quick to turn his Queens facility into a COVID-19 testing center, replete with dedicated website. However, the centerpiece of his practice is, and will always be his Sleep Lab NYC.

There are many types of sleep studies. Broadly, however, they can be classified as "in-lab sleep test" and "home sleep test." The home sleep test ("HST") allows the patient to perform a diagnostic sleep study in the privacy of his or her own home, utilizing an easy-to-use portable medical sleep device. Naturally, this is a more popular choice since the coronavirus pandemic began, and people have been less inclined to venture out of the house, especially to medical offices, for extended periods.

Dr. Nicoleau explains: "The HST only measures heart rate, oxygen saturation, pulse, and breathing movements. It can miss mild sleep apnea, because it tends to underestimate the severity of sleep apnea. On the other hand, the Attended Diagnostic Polysomnography is the gold standard for diagnosing the spectrum of sleep disorders."

This method is an overnight diagnostic polysomnography ("PSG") at a sleep lab in the presence of a certified sleep technician.

"This method can shed light on any number of disorders," explains Dr. Nicoleau. "Including the disorders missed by a HST, including parasomnias such as sleep-walking, -eating and -talking; central, obstructive and mixed sleep apnea; narcolepsy; nocturnal seizure syndromes; and sleep-related movement disorders such as periodic limb movement disorder, or PLMD."

The PSG process requires placing numerous surface scalp electrodes according to international protocol. Other features measured include sleep staging and REM (rapid eye movement) sleep characterized by dreaming. In contrast to the HST, which only measures four parameters, the attended PSG can assay a much larger number of events that take place during sleep, according to Nicoleau.

Another method of sleep study is Nocturnal Polysomnography with Continuous Positive Airway Pressure (CPAP). When sleep apnea is identified during a HST or attended in-lab study, either a home auto CPAP study or in-lab CPAP is performed to identify the minimum number of cm of water needed to stent the airway open during sleep. An auto CPAP is a portable sleep device that utilizes algorithms to establish the optimal pressure needed to treat sleep apnea. The sleep technician in an attended sleep lab is involved in determining the optimal pressure to treat sleep apnea.

Also of note are the Split-Night Polysomnography and the PAP NAP, both of which have proven effective in the realm of sleep study. The former is a version of overnight testing that is split between a diagnostic period (usually at the beginning of the recording) and a CPAP period. The latter is a short CPAP titration performed in the sleep lab during the daytime to acclimate the patient to the face mask, and help identify the optimal CPAP pressure. 

"Special montages can be incorporated in a sleep study performed in-lab to expand the diagnostic yield of a sleep study," explains Dr. Nicoleau. "For example, an expanded seizure montage can be included in the study for suspected nocturnal seizures. Similarly, if sleep related movement disorders are being considered additional features can be added to the basic sleep study framework."

Many people wonder, 'Is a sleep study for me?' In short, the answer is probably yes, as a great deal of clinical information can be gleaned from a sleep study. According to Dr. Nicoleau, this includes the presence or absence of sleep apnea, the type of sleep apnea (central, obstructive or mixed sleep apnea), the severity of the patient's symptoms, and how many times the patient stops breathing over a given period of time.

Dr. Nicoleau elaborates: "Sleep apnea is estimated to occur in two percent of females, and four percent of males. Its prevalence is increasing in parallel with the rise in obesity and diabetes. Sleep apnea occurs among all socioeconomic strata, age and gender."

Additionally, a sleep study can also obtain the length of time that the patient's breathing ceased, the oxygen saturation and carbon dioxide content of the blood, as well as pulse and heart rhythm. Further still, the study can even reveal the presence of various par1asomnias (the patient is partly sleeping and awake), dream enactment and nocturnal seizures, various sleep related movement disorders. Narcolepsy and various other sleep disorders are also readily identified. The severity and presence of these sleep disorders can be tracked over time to establish clinical trends.

"There are many reasons why most Americans don't get enough sleep," states Dr. Nicoleau. "Behavioral causes include poor sleep hygiene, as well as consuming too much alcohol and too many caffeinated beverages. Shift-work makes it difficult to follow a regular sleep wake cycle."

Sleep apnea, sleep related movement disorders, chronic pain, anxiety and depression can all be attributed to poor sleep hygiene. Some medications such as beta blockers, which is a blood pressure medication, can also interfere with sleep. It is best to consult a specialist trained in the field of sleep medicine to identify and treat the multitude of causes associated with insomnia or non-restorative sleep.

"Here's something that most people don't know," Dr. Nicoleau shares. "Countless tragedies and disasters have been associated with sleep deprivation. Take Chernobyl, for example, arguably the worst nuclear disaster in the history of the world. Well, it was reported that the engineers overseeing the plant had been working in excess of 13 hours or more! Incidentally, this sort of sleep deprivation also played a part in the nuclear near-misses of Davis-Basse and Peach Bottom."

The Exxon Valdez Oil Spill was an unmitigated disaster of a different kind, but the cause-and-effect element is alarmingly similar to Chernobyl. Documentation shows that the crew had just put in a 22-hour shift loading the oil onto the ship. Some crew members had a "catnap in the last 16 hours leading up to the crash," according to Dr. Nicoleau.

He continues: "Also, don't forget about the American Airlines Flight 1420 Crash, in which severe thunderstorms played a role. But look closer and you'll see that the National Transportation Safety Board also determined that 'impaired performance resulting from fatigue' was involved.
Sadly, the list goes on, including both the Challenger Explosion and the Metro North train derailment.

The Carl Nicoleau Interview will be continued in the next installment of this article, coming soon. To learn more about Dr. Nicoleau please visit one of his three websites:

Main: www.carlnicoleaumd.com
Sleep Lab NYC: www.sleeplabnyc.com
COVID testing: www.covidcarenyc.com

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