New sleep lab at Manipal hospitalsOctober 8, 2019
Sleep is an important aspect of good health and a better quality of life. It is imperative to maintain a good sleep routine, and in case people are unable to sleep well naturally or due to any disorder, it is crucial to seek medical advice at the earliest.
Sleep apnea is one of the most common sleep disorders that are quite prevalent in today’s world. Blame it on a sedentary lifestyle coupled with unhealthy food and work/life stress, this disorder often leads to cardiovascular, neurocognitive and metabolic complications if left untreated. In extreme cases, it can also result in sudden death due to heart failure.
Recognizing the rising number of patients with sleep disorders, Manipal Hospitals, one of India’s leading healthcare chains, has launched a one-of-its-kind, dedicated sleep laboratory that offers treatments and diagnosis for various sleep-related conditions. Dr. Satyanarayana, Interventional Pulmonology & Sleep Medicine, Manipal Hospitals Bangalore tells us more:
What is a Sleep Lab?
A Sleep Lab is any dedicated place where patients with sleep disorders undergo diagnostic tests. Most of the studies are done overnight and a few are also done during the day. A sleep laboratory has to be sound proof and needs accreditation, which is mandatory. In addition, the lab must have qualified sleep technicians and physicians for monitoring and assessing the sleep disorders of patients.
Generally, there are two kinds of patients who need help with diagnosis. The first group are the ones who have been assessed in the outpatient department and are guided to undergo the test in a sleep laboratory. The second group of patients are those who can undergo the sleep test in the comfort of their home.
What are the indications of sleep disorder and diagnosis? What are the different tests in the Sleep Lab?
The range of disorders that we refer to as obstructive sleep apnea are snoring-related sleep disorders, Rapid Eye Movement sleep disorders (REM), suspected night-time seizure activity in the brain, and conditions like narcolepsy where there is a repeated and irresistible urge to fall asleep despite having had a good sleep.
There are other tests for pilots and professionals who are in a responsible profession and who need to demonstrate that they can remain awake and stay alert. Such tests include Multiple Sleep Latency Test (MSLT) Multiple Wakefulness Test (MWT), suggested immobilization test, forced immobilization test and diagnosis of central sleep apnea.
The other group of tests in a sleep lab includes complete sleep study with video and EEG. Indications for this include night terrors, sleep onset or sleep maintenance insomnia, nocturnal frontal lobe epilepsy, parasomnias like sleep-walking, sleep talking and grinding of teeth (bruxism). These are some of the sleep studies that can be performed for people having sleep disorders.
Various levels of Sleep Test
In order to put the diagnoses in definitive baskets, sleep physicians/technicians examine the patient and listen to the patient history in detail. In case the diagnosis suggests a complex sleep disorder, we will then suggest a level 1 sleep study. This should be done only in a sleep lab. At this level, sleep is monitored throughout the night through a sleep console. A sleep technician will be present throughout to assess and monitor the patient.
The level 1 test is the gold standard test. Complete information of the brain, the movement of eyeballs, the tone of jaw muscles, air flow through the nostrils, temperature sensing of the air flow through the nose, oxygen saturation levels second by second, the movement of chest and abdomen with breathing, heart rate & heart rhythm, the tone of the legs and electrical activity of the leg nerves are all monitored. If the same can be done at home without a technician supervising, then it is level 2.
Level 3 is, when during clinical assessment, the sleep physician feels that the chances of the individual having a sleep disorder are very high. In this test, sleep study air flow, oxygen saturation and respiratory movements are the parameters that are monitored.
In level 4, only oxygen saturation is monitored. Prior to 2008, it was undisputed and accepted that level 1 sleep study should be done. However, meta-analyses and medical evidence indicate that in some situations, home sleep study may be the best way. These are all diagnostic.
Manipal Pulmonology and Sleep Lab is in the process of upgrading to have various treatment options available in a sleep lab. These include manual titration of positive air-way pressure by which the optimum pressure to keep in the upper airway during dream sleep is calculated. This is effective for obstructive sleep apnea. Continuous positive airway pressure therapy is the gold standard for sleep apnea. Bi-level airway pressure devices are indicated when there is inadequate breathing or high carbon dioxide levels or respiratory failure. There are other devices that ensure treatment of complex sleep disordered breathing, including AVAPS, IVAPS etc
What makes Manipal Hospitals different in this area?
The sleep studies abroad are all quality controlled and have to be accepted by Medicare and insurance companies, and the data is subjected to quality checks and inter-observer acceptance. In India, sleep studies are done by both organized and unorganized sectors, and unfortunately, hard data is not subjected to quality checks. The people and companies who own and sell CPAP, APAP and AVAPS conduct sleep studies, which creates bias. Manipal’s aim is to make accurate diagnosis and create treatment plans based on reproducible and reliable data. There is a state-of-the-art sleep lab with wireless leads, which are a distinct advantage. There are qualified technicians and dedicated lab personnel. Sleep physicians are trained in Australia and are quite experienced. In addition to obstructive sleep apneas, central sleep apnea and restless leg syndrome confirmation, we have also seen patients with idiopathic hypersomnolence in the last two years. A wide spectrum of sleep disorders can be diagnosed and effectively treated at Manipal Hospital’s Pulmonology and Sleep Medicine department. We also offer home based sleep studies when indicated.