Diagnosing a Sleep Disorder

Diagnosing a Sleep Disorder

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Overview of Sleep Problems

Why is sleep important?

Sleep is not just resting or taking a break from busy routines. It is essential to physical and emotional health. Adequate sleep may also play a role in helping the body recover from illness and injury. Inadequate sleep over a period of time is associated with obesity, diabetes, heart disease, and depression.

The emotional and mental benefits of sleep are also significant. Even occasional sleep problems can make daily life feel more stressful and less productive. Some people with chronic insomnia are more likely to develop psychiatric problems. In a recent survey, those who said they had trouble getting enough sleep reported impaired ability to perform tasks involving:

  • Memory

  • Learning

  • Logical reasoning

  • Mathematical calculation

Facts about sleep disorders

Loss of sleep is believed to contribute to strained relationships at home and unfulfilled potential on the job, and can also be dangerous, leading to serious or even fatal accidents. Consider these facts from the National Sleep Foundation:

  • Sleep problems increase with aging.

  • Health care expenses and lost productivity from sleep deprivation cost billions of dollars a year.

  • Drowsy drivers take the blame for at least 100,000 police-reported crashes in the U.S. annually.

  • At least 40 million Americans report having sleep difficulties.

How much sleep is needed?

Although sleep needs vary from person to person, generally, most healthy adults need no more than of 7 to 9 hours of sleep a night. If you have some of the following problems, you may need more sleep, or a better quality of sleep, than you are getting:

  • Trouble staying alert during boring or monotonous activities

  • Tendency to be unreasonably irritable with coworkers, family, or friends

  • Difficulty concentrating or remembering facts

What are the different types of sleep problems?

There are many types of sleep problems. Disorders of sleeping and waking interfere with quality of life and personal health, and endanger public heath. These problems range from staying awake or having a regular sleep/wake cycle to sleepwalking, bedwetting, nightmares, insomnia, restless legs syndrome, snoring, and sleep apnea syndrome.

Help for sleep problems

For those who suffer from sleep disorders, help is available from many sources.

Sleep problems may be caused by or be the result of disorders in various systems of the body. Obstructive sleep apnea, for example, is a respiratory disorder while narcolepsy is a neurological disorder.

Sleep problems can be treated or managed by different medical specialties including internal medicine, pediatrics, family practice, pulmonary medicine, neurology, psychiatry, and otolaryngology.

However, other medical specialties also offer treatment for sleep disorders. Many rehabilitation facilities and anesthesiology departments sponsor comprehensive sleep disorder programs, as do mental health centers. The American Board of Sleep Medicine establishes standards and certification for doctors and scientists who wish to become certified in sleep medicine.

Talk with your health care provider about which sleep disorder program is right for you.

Polysomnogram (PSG) is routinely ordered by doctors in order to diagnose a sleeping disorder. Treatment may be able to be initiated during the study for individuals with significant signs of obstructive sleep apnea (OSA). A standard PSG study in one of our labs includes the following: 


  • EEG (Electroencephalogram) – monitors brain activity to identify sleep stages
  • EOG (Electrooculogram) – records eye movement
  • EMG (Electromyogram) – records muscle activity for monitoring muscle tone as well as body movement, especially the legs for movement disorders
  • EKG (Electrocardiogram) – monitors heart activity
  • Respiratory Airflow – measures airflow from nose and mouth to document respiratory disturbances
  • Respiratory Effort – monitors chest wall and abdominal movement to help determine specific respiratory disturbances
  • Pulse oximetry – records the oxygen saturation level to distinguish changes during respiratory events
  • Snoring – monitors vibration of throat to determine intensity of snoring
  • Body Position - monitors the effect of sleep position on breathing and other sleep disorder episode

Continuous Positive Airway Pressure (CPAP) Titration is a modified polysomnogram (PSG) study that in addition to recording all of the information during a PSG, treatment is given for individuals with sleep apnea. During a CPAP titration, a patient is fit with a CPAP mask and started off at a low starting pressure. As the study progresses and the patient exhibits respiratory disturbances that impact the quality of sleep, the pressure is gradually increased in order to determine the optimal pressure. At the optimal pressure the patient will have minimal respiratory disturbances and snoring. The patient will be able to achieve a much more restful and restorative night’s sleep.

Multiple Sleep Latency Test (MSLT) is a test to determine if excessive daytime sleepiness or narcolepsy is present. A MSLT is typically done following an overnight PSG study in order to rule out any nocturnal disturbances. A MSLT is a series of 4-5 controlled nap sessions approximately 1.5 hours apart. During the nap, the patient is allowed to fall asleep and the doctor is able to determine how quickly the patient falls asleep and what stages of sleep is entered.

A standard MSLT records the following parameters:

  • EEG (Electroencephalogram) – monitors brain activity to identify sleep stages
  • EOG (Electrooculogram) – records eye movement
  • EMG (Electromyogram) – records muscle activity for monitoring muscle tone
  • EKG (Electrocardiogram) – monitors heart activity
Multiple Wakefulness Test (MWT) is a test usually performed to check CPAP compliance or to ensure optimal treatment of sleep apnea. This test is most commonly requested by doctors for patients who are required to have a CDL license renewed by the Department of Transportation (DOT) or another agency that has their employees operating large equipment. A MWT is a series of 4controlled sessions approximately 1.5 hours apart. During the session, the patient sits upright in a darkened room and tries to remain alert. The parameters recorded will help determine the patient’s level of alertness.

A standard MWT records the following parameters:

  • EEG (Electroencephalogram) – monitors brain activity to identify sleep stages
  • EOG (Electrooculogram) – records eye movement
  • EMG (Electromyogram) – records muscle activity for monitoring muscle tone
  • EKG (Electrocardiogram) – monitors heart activity