Pulmonology is the area of medicine that deals with the respiratory tract which includes the lungs, bronchial tubes, throat, pharynx, and nose. Common disorders of the respiratory tract include asthma, chronic obstructive pulmonary disease (COPD), emphysema, pneumonia, pulmonary fibrosis, pulmonary hypertension, and tuberculosis. Testing for these disorders may include lab work, spirometry (measures lung function), chest X-rays, and CT scan as well as other pulmonary function tests (PFTs). Treatment may include prescription oral medications, inhalers, nebulizers, and oxygen therapy.
Sleep medicine is a medical subspecialty of pulmonology, internal medicine, neurology, or psychiatry devoted to the diagnosis and treatment of sleep disturbances and disorders. Common sleep disorders include excessive snoring, sleep apnea, narcolepsy, insomnia, and circadian rhythm disorder. Other conditions that may be treated by a sleep specialist include nocturnal urinary incontinence, nightmares or night terrors, periodic limb movement disorder (PLMD), restless leg syndrome (RLS), REM behavior disorder, sleep paralysis, and sleepwalking. Testing for sleep disorders may require an at-home sleep study (HST) or an in-lab sleep study which consists of an overnight stay at the sleep center.
Our pulmonologists and sleep specialists here at Granger Medical Clinic diagnose and treat respiratory and sleep disorders. Our providers are board certified in pulmonary disease, critical care, and sleep medicine. They work continuously to stay up-to-date on the latest research and treatment options available in order to maintain a superior level of care. We want you to feel your best, live an active lifestyle, and sleep well at night. We are ready to partner with you to help you achieve optimal health!
Both an HST and in-lab sleep study involves various electrodes placed on the body to monitor brain activity, eye movement, limb movement, heart rate, oxygen level, and more. Most insurance companies require an HST for diagnosis, however, more complicated cases (such as a patient with multiple comorbidities) will need to be done in-lab. In certain cases where you’ve been diagnosed with sleep apnea and need to start positive airway pressure therapy (PAP therapy), it may be necessary for you to complete another in-lab sleep study called a PAP titration study in order to find the right pressure setting that properly treats your sleep apnea.
A multiple sleep latency test (MSLT) is a type of sleep study used to help diagnose narcolepsy. Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness (EDS), sleep paralysis, and in some cases, episodes of cataplexy (sudden and uncontrollable muscle weakness). Narcolepsy can make it difficult to stay awake for long periods of time and can have a serious impact on your daily routine. An MSLT is performed during the day, usually after a diagnostic sleep study to rule out other possible sleep disorders, and measures how quickly you fall into REM (the deepest stage of sleep) during a series of scheduled naps. The average person goes into REM roughly 90 minutes after falling asleep. People who suffer from Narcolepsy typically go into REM within 10 minutes after falling asleep.
The Different Types of PAP Therapy
PAP therapy is used to treat sleep apnea by using air pressure to maintain an open airway and all modes of PAP therapy are classified as noninvasive ventilation. All PAP machines work by drawing air in from the room through a motor that then pressurizes it to the prescribed setting. The air pressure is delivered through a face mask connected to a hose which is connected to the machine. There are several different types of masks to choose from to help make wearing PAP therapy as comfortable as possible.
There are different types of PAP therapy and which type is best for you depends on the specific type of sleep apnea, and other comorbidities, that you have. Your provider may prescribe one of the following:
- Continuous Positive Airway Pressure (CPAP) – CPAP applies constant mild air pressure to keep the airway continuously open. It is used to treat mild to moderate sleep apnea.
- Automatic Titrating Positive Airway Pressure (Auto PAP or APAP) – APAP machines use cutting-edge technology to deliver CPAP pressure that automatically adjusts to your immediate needs. For example, at some points throughout the night you may need a higher pressure than others in order to maintain an open airway. APAP adjusts the pressure level in real-time to meet those higher pressure needs. APAP can make wearing PAP therapy more comfortable since it can also slowly titrate the pressure up so you aren’t immediately blasted with high pressures.
- Bilevel Positive Airway Pressure (BiPAP or BPAP) – BPAP applies two different air pressures; one for when you breathe in and one for when you breathe out. BPAP is usually used to treat patients with severe sleep apnea, who require high pressures of PAP therapy.
- Adaptive Servo Ventilation (ASV) – ASV therapy is used to treat complex sleep apnea and is still a relatively new form of therapy. ASV works by using an algorithm to detect reductions or pauses in breathing. The algorithm is based off a set rate of breaths per minute that you should be taking. When your breathing falls below the set rate, the ASV applies just enough air pressure to get you back up to the set rate and keep you breathing regularly. Even when you’re breathing at the set rate, ASV acts as a backup support to help ensure your airway stays open.
- Sleep Apnea
- Sleep Disorders
- Pulmonary Function Testing (PFTs)
- Respiratory Infections
- Consultation for Sleep Apnea Surgery
Patients may choose to seek care on their own or they may be referred by their primary care provider or other specialist. It is important to consider insurance requirements, such as a referral, before consulting with a specialist.