Sleep Medicine & Pulmonary Care

Sleep studies are tests that monitor what happens to your body during sleep. Sleep disorder specialists conduct sleep studies to find out what is causing your sleep problems.

Sleep studies can also determine whether you have a problem with your stages of sleep. The two stages of sleep are non-rapid eye movement (NREM) and rapid eye movement (REM). Normally, NREM and REM alternate four to five times during a night's sleep. A change in this cycle may make it hard for you to sleep soundly.

Find a sleep disorder specialist for adults

Find a pediatric sleep disorder specialist

What is The Sleep Center?

The Sleep Center at Valley Medical Center is a special medical facility designed to evaluate and treat both adults and children with sleep disorders and sleep-related problems. Yet the interior appointments and private, cozy décor of each room feels like a home away from home: patchwork quilts, a private bathroom and shower, and an LCD TV and DVD player. And, of course, a Playstation^® 3 for our youngest guests.

The Sleep Center is fully accredited by the American Academy of Sleep Medicine, which means it meets the most rigorous of standards to rank as a center of excellence in the comprehensive management of sleep disorders. Members of our staff are specially trained to study and evaluate people's sleep patterns. The results of our diagnostic studies are used to diagnose and treat sleep problems.

Why go to The Sleep Center?

In the past, many sleep disorders were considered untreatable or consequences of normal aging. Today, many disorders can be diagnosed efficiently and treated successfully. There is heightened clinical interest and research in sleep medicine. Much of this excitement stems from our increasing abilities to quickly and successfully help people with their sleep difficulties. Getting a good night's sleep can make a huge difference in a person's life, and The Sleep Center at Valley Medical Center can help achieve this.

Watch a video about the evaluation process at the Sleep Center.

Upon arrival through the main hospital entrance, please have a seat in the waiting area directly across from the patient information desk. Please bring your insurance cards with you. You should be ready to leave in the morning between 6:00 AM and 6:30 AM.

Please call 425.656.4071 for pre-registration

Instructions for your night of sleep at the Sleep Center

• Eat dinner before you come to the Sleep Center.
• Take all your regular medications unless otherwise instructed by your physician. Any medications you take before bedtime you need to bring with you.
• If you are diabetic, please bring any necessary monitoring devices and a snack or juice.
• Shower/Bathe, wash and dry your hair prior to coming to the Sleep Center. We need you to arrive "squeaky-clean", no lotions, creams, makeup, or other hair products.
• Bring pajamas, or something loose and comfortable to sleep in. Shorts and T-shirt work fine. You may not sleep in underwear alone.
• Nightgowns do not work well for testing, and sleepwear must not be silk or satin fabric.
• We provide bed linens, pillows and towels. You are welcome to bring your own pillow.
• Family members may come with you, however they will be asked to leave prior to starting the test process. Thank you for understanding this requirement as we also have other patients here for testing.
• If you need to reschedule this appointment please call 425.690.3543 as soon as possible. Notifying us in a timely manner allows us to fill the bed with another patient who needs to be studied. There will be a $50 fee applied to patients with less than a 24 hour notice of cancellation.
• If you need to reach the Sleep Center over the weekend or after normal business hours, please call 425.690.3543.

If you will be staying for the MSLT testing, you will be discharged from the lab that day around 4:00 PM. Breakfast and lunch will be provided for the MSLT testing patients only.

The Cardiopulmonary Department is located on the first floor of Valley Medical Center. Please Proceed through the main entrance of the hospital

Please check in at Main Admitting on your left, 15 minutes prior to your appointment. After checking in, proceed to the main lobby area of the hospital. You will see the elevators off to your right on a green wall, take the elevator to the first floor. Cardiopulmonary is directly across the hall as you exit the elevator.

Home Study unit, will need to be returned the following day by 11:00 AM.

If you need to reschedule your Home Sleep Study Appointment, please contact 425.690.3484 ext 6907309 or 6907310.

The American Academy of Sleep Medicine recommends these guidelines, which can be used for all types of sleep disorders:

• Get up about the same time every day.
• Go to bed only when sleepy. Establish relaxing presleep rituals, such as a warm bath, light bedtime snack, or 10 minutes of reading.
• Exercise regularly. Confine vigorous exercise to early hours of the day. Mild exercise should occur at least 4 hours before bedtime.
• Keep a regular schedule. Normal times for meals, medications, and activities help keep our inner clocks running smoothly.
• Avoid caffeine within 6 hours of bedtime.
• Do not drink alcohol, especially when sleepy.

Do you have a hard time falling asleep or staying awake?

Do you consistently awaken too early or have difficulty awakening? Does your snoring awaken you or your partner? Do you or your partner notice you wake up choking or gasping for breath?

These and many other symptoms indicate that you may have a sleep-related problem or a sleep disorder. Studies show 60 percent of American adults experience a sleep problem a few nights a week or more. You may not even be aware of how tired you are, thinking that there is nothing wrong. The great news is most sleep-related problems and sleep disorders can be successfully treated.

Sleep Facts

• One-third of your life is spent sleeping.
• The quality and quantity of your sleep have a direct effect on your daytime performance.
• Loud snoring may be a sign of sleep apnea syndrome, a medical problem that may be associated with high blood pressure and heart disease.
• Shift workers may experience symptoms similar to jet lag.
• Your sleep affects your mood and vice versa.
• People who sleep well and who allow themselves adequate amounts of sleep each night should feel awake and alert all day.
• It is possible for you to have a sleep disorder and not be aware of it.

There are about 85 recognized sleep disorders, most of which are treatable. A sleep disorder disrupts and disturbs your overall quality of life. More than 70 million people in this country have a sleep disorder.

Many people who have sleep disorders may be completely unaware of it. Perhaps you think you just are sleeping too much or too little, or are tired due to jet lag. Some sleep behavior may be only noticeable by your bed partner, such as moving your arms or legs, talking, or sleepwalking. Or maybe you wake up with a sore jaw and don't know why.

Some of the most common disorders are snoring, sleep apnea, restless legs syndrome, and insomnia.

Snoring and Sleep Apnea

Snoring is an indication your airway is not fully open while sleeping. The distinctive sound of snoring comes from efforts to force air through the narrowed passageway.

According to the American Academy of Sleep Medicine, about 10 to 30 percent of adults snore. In the majority of cases, snoring has no serious medical consequences. However, persistent loud snoring may be a sign of obstructive sleep apnea syndrome.

Individuals suffering from sleep apnea stop breathing due to airway blockage by the tongue or excessive throat issue. This may cause a decrease in blood oxygen levels and frequent, brief disruptions of sleep, which cause sleepiness during the day.

Restless Legs Syndrome

Restless legs syndrome (RLS) is when you have a strong urge to move your legs. Most who experience restless legs syndrome (RLS) describe "crawling" sensations in the legs while sitting or lying still, especially at bedtime. Lying or sitting still can be very hard. For some, RLS causes discomfort or pain, which most often occurs in the calves and unlike other limb movement disorders, may be temporarily relieved by stretching and moving the legs. The constant need to stretch or move the legs to get rid of discomfort or pain often prevents a person from falling asleep. Extreme sleepiness during the day is usually the result.

Insomnia

Insomnia is the inability to fall asleep, remain asleep, or sleep restfully through the night; it may include consistently awakening too early. It can last a few days or a couple of weeks and is considered a chronic problem if it lasts more than 3 weeks. Insomnia is often the symptom of another medical problem or stress. Insomnia is especially common among the elderly and women.

Heart Disease & Sleep Disorders

Untreated, obstructive sleep apnea is associated with an increased risk of high blood pressure, heart attack, irregular heartbeats, heart failure and stroke. Treatment can help improve breathing and reduce the severity of symptoms such as loud snoring and excessive daytime sleepiness, thereby improving sleep-related quality of life and performance at work or in school.

Problems with sleep are not confined to adults. Sleep disorders in children are common, from babies to toddlers to teens. Yet good quality sleep is vital during these years of growth and development. When children have problems with their sleep, it affects the whole family. Everything suffers: relationships, school work and health.

Sleep problems have increased significantly in children in recent decades. The 2004 Sleep in America poll reported that more two-thirds of children have trouble sleeping at least a few nights a week, and about 40 percent of teens have significant sleep complaints. The good news is that pediatric sleep disorders are treatable, and they can be prevented.

Read Mackenzie's sleep story

Why is a good night’s sleep so important?

You may not notice when your children are well rested—but you’ll certainly know when they’re not! When children aren’t getting good sleep—either enough sleep or good quality sleep—they become moody and irritable and have a difficult time concentrating or paying attention. They also lose control of their emotions. We’ve all witnessed the child in the grocery cart who obviously missed his or her morning nap and is unable to calm down. In fact, in children, sleepiness may look like the opposite:  it can create overactivity and hyperstimulation. Over time, consistently poor sleep will take its toll on a child’s immune system and developmental growth as well.

How do I ensure my children get good quality sleep?
There are many things parents can do to help their children sleep well. The first is to establish a bedtime routine—and stick to it! While newborns have irregular wake and sleep times, infants start developing sleep patterns around two months of age. It’s then time to create a regular bedtime schedule and routine.  Babies will continue to take one to four naps a day, with morning naps ceasing naturally around age 18 months and naps ending altogether around age five.

For toddlers and children, follow this healthy bedtime routine:

• Take a bath
• Put on pajamas

Children of all ages can suffer from sleep problems. Our pediatric sleep service specializes in diagnosing and treating sleep disorders in children and adolescents. These disorders may manifest as excessive daytime sleepiness, learning problems caused by difficulty concentrating or hyperactivity, disturbed or fragmented sleep, sleep walking, confusional arousals, and snoring or heavy breathing.

Pediatric Dream Team
Our fully accredited Sleep Center is staffed by Board Certified physicians and registered sleep technologists with extensive pediatric experience.The Pediatric Sleep Center offers overnight polysomnography for children of all ages. All families have a private room complete with Sony Playstation 3 and TV/DVD, as well as in-room sleeping accommodations for the parent accompanying the child.

Sleep Apnea in Children
Obstructive sleep apnea is one of the most common, and treatable, sleep disorders in children. If your child has any of the following, he or she may need to be evaluated:

• Snoring
• Restless sleep
• Pauses in breathing (apnea)
• Mouth breathing while asleep
• Morning headaches
• Problems with school performance
• Attention deficit hyperactivity disorder (ADHD)

There are many things that go bump in the night during childhood. Here are some other sleep disorders that are treated in our Sleep Center:

• Restless leg syndrome
• Nightmares
• Insomnia
• Sleepwalking
• Headaches
• Seizures
• Narcolepsy
• Circadian rhythm disorders

“The Gold Standard”
A sleep study, also known as overnight polysomnography, is recognized by the American Academy of Pediatrics and the American Academy of Sleep Medicine as the Gold Standard for diagnosing Pediatric Sleep Disorders. The AAP and the AASM strongly recommend a sleep study for any child with suspected sleep apnea. Let us help your child sleep better and feel better.

The Pediatric Sleep Center is fully-accredited by the American Academy of Sleep Medicine.

• Brush teeth
• Read a story together
• Tuck-in with a hug and a kiss
• Say goodnight and turn out the light

To help ensure success, be consistent with your routine. Children need to learn to fall asleep on their own and to fall back asleep after normal awakenings during the night. Encourage your child to fall asleep independently unless your child is sick or otherwise truly needs your help. Your child’s pleading for “Just this once” for a later bedtime, or crawling into bed with you, has a way of becoming a habit. Avoid stimulating activities; do not allow children to watch TV or play video games before bed. Keep the room quiet and at a comfortable, consistent temperature.

How do I recognize a sleep disorder in my child?
We all have nights where we don’t sleep well and pay for it the following day with fatigue and crankiness. However, there are signs to watch for that may indicate your child should be evaluated for a sleep disorder:

Nighttime symptoms:

• Snoring on a regular basis, which may be very light
• Choking or gasping, or breathing pauses during sleep
• Restless sleep, a “thrasher”
• Sweating during sleep
• Abnormal sleep positions, such as stomach sleeping or with the head extended

Daytime symptoms:

• Hard to wake in the morning
• Tired, irritable
• Falling asleep at school/at inappropriate times
• Breathing through the mouth
• Chronic nasal congestion
• Frequent ear or sinus infections
• Morning headaches

Additional symptoms in younger children:

• Increased need to nap
• Acting out—aggression and hyperactivity
• Short attention span, easily distracted
• Academic problems

What kinds of sleep issues or disorders affect children?

Sleep disorders in children can vary from simple to serious, and include:

• Night terrors
• Sleep walking
• Obstructive sleep apnea syndrome (OSAS)

And in older children and teens:

• Narcolepsy
• Insomnia
• Restless legs syndrome
• OSAS

If you suspect your child has a sleep disorder, based on the symptoms above, talk to your family doctor. He or she will review your child’s medical, family, and psychosocial histories, assess behavior and perform a physical exam. If warranted, your child’s doctor may recommend a sleep evaluation by an accredited Sleep Center.

What is involved in a pediatric sleep evaluation?

A sleep doctor is a board-certified clinician specializing in sleep medicine. He or she will ask you to keep a sleep diary for a few weeks, and possibly videotape your child’s sleep. You may then be scheduled for an overnight sleep study, called a polysomnogram. During the exam, we have your child relax and sleep in a homelike-setting.  We provide TV, a DVD player and a Playstation® 3 to help make our young guests feel at home while they are being prepared for the study. You can even bring your child’s own pillow and special blanket. A favorite stuffed animal is also welcome, and your child will sleep in his own pajamas. We will attach electrodes and sensors to the skin to monitor and record activity of the brain, muscles and heart; eye movements, breathing patterns and oxygen levels will also be monitored. It is entirely painless!

If the sleep doctor determines that your child has sleep apnea, there are several treatment options to consider:

• Tonsillectomy and adenoidectomy
• Orthodontic/dental intervention to expand the jaw and airway space
• Continuous Positive Airway Pressure (CPAP) therapy

What is CPAP therapy?

Continuous Positive Airway Pressure (CPAP) uses a bedside machine to gently push air through a tube and into a mask worn around your child’s nose and/or mouth, to help your child breath normally during sleep. CPAP helps your child get quality, restful sleep at night. While the mask may feel foreign at first, most CPAP users—children included—find they sleep better and after a time, don’t want to go to bed without it.

For more information about children and sleep, call The Sleep Center at 425.690.3543.

The Sleep Center is fully accredited by the American Academy of Sleep Medicine and meets the most rigorous standards to rank as a center of excellence in the management of sleep disorders.

Source: National Sleep Foundation

A Note About Teens

The teen years present special challenges when it comes to sleep. Natural patterns shift to a later bedtime so teens have trouble falling asleep at a reasonable hour—but the alarm still rings early for the school day. Have you ever watched a teen enjoy an unlimited sleep-in on a weekend? Many would sleep until noon or early afternoon if they could!  Take an already erratic sleep schedule and factor in today’s electronics (many teens play video games and/or sleep with their cell phones, talking and texting in the wee hours) and the stage is set for serious sleep deprivation.

Insufficient sleep in teens has been associated with poor decision-making, increased risk-taking and drowsy driving—behaviors that can have extreme consequences.  It has been shown that chronic sleep deprivation is as dangerous as staying up for 24 hours straight, and that those who sleep six to seven hours each night may be twice as likely to have a fatigue-related accident as those who get eight or more hours of sleep a night.

Adolescence is already a roller-coaster ride of emotions, and lack of sleep exacerbates teen moodiness. The 2006 Sleep in America poll found that 73 percent of the teens who reported feeling unhappy, sad or depressed also reported they did not get enough sleep at night and were sleepy during the day.

Do You have a sleep disorder?

Sleep disorders come in many forms. The problem may be obvious; you may fall asleep constantly at meetings or your bed partner may wake you because of irregular breathing patterns. Symptoms may be more subtle or even unnoticeable; you may experience long-term fatigue or general irritability.

Some people realize they have a sleep disorder because of specific symptoms, such as remembering waking up frequently. Others may have a sleep disturbance without realizing it at all, with sleep disruption occurring too briefly to be remembered. A primary symptom is daytime sleepiness, which may be perceived as normal, despite the concerns of friends, family and coworkers.

Watch a video about the evaluation process at the sleep center.

Anyone persistently exhibiting the following symptoms or conditions should consider getting evaluated by a physician specially trained in sleep medicine:

• Irregular breathing during sleep.
• Excessive sleepiness during the day.
• Falling asleep at inappropriate times (while driving, during meetings, etc.).
• Temporary weakness of body or speech muscles occurring with excitement, anger or other strong emotions.
• Sleep walking or talking.
• Experiencing nightmares or disturbing dreams.
• Having sleep-related seizures.
• Difficulty with working nights or rotating shifts.
• Repeated movements or twitching of the legs or arms during sleep (may be noticed only by bed partner).
• Dissatisfaction with the amount or quality of sleep.
• Difficulty with winter-time sleepiness or depression (Seasonal Affective Disorder, or SAD).

Getting help
If you have symptoms suggestive of a sleep disorder, we recommend consult a sleep medicine specialist to determine if your health and well-being may be affected.

Find a sleep medicine specialist for adults

Find a pediatric sleep medicine specialist

What do you really know about sleep? Test your knowledge

What does an evaluation involve?

The evaluation begins when you fill out a sleep questionnaire. A physician trained in sleep medicine will then review the information you give. That doctor will interview you and perform a physical examination. Your referring physician will also send medical records related to your problem to The Sleep Center at Valley Medical Center. Depending on the nature of your sleep-related problem, treatment may begin at this point or you may be asked to undergo testing to further understand what happens to you when you sleep. Such testing often consists of a polysomnogram, an all-night sleep test). In some special cases other diagnostic testing, such as a daytime nap study, may be required. Other tests, such as laboratory testing or pulmonary function testing may also be ordered. After completion of this testing, your physician will discuss the results with you and recommend the appropriate treatment.

What is a polysomnogram?

A polysomnogram is a comprehensive, all-night testing procedure. Electrodes and sensors are attached to the head, chest, abdomen and legs to continuously monitor and record brain activity, various types of muscle activity, eye movements, breathing patterns, heart beat and oxygen level. There is no pain associated with the test. None of the electrodes or sensors go into or through the skin. All are attached to the surface of the skin or scalp. No hair is cut, no skin is broken and no electricity enters the body. With the exception of feeling the attached sensors (much the same as you notice the clothing you wear), you should experience no unpleasant symptoms.

Will my nightly routine be altered by the test?

Everything possible is done to ensure your stay is pleasant. We try to reproduce your usual sleep routine in our center. In most cases it is not necessary to exactly duplicate your sleep at home. In fact, your normal routine might be disruptive to the testing procedure.

Staff will monitor you throughout the testing procedure and are immediately available to assist with your needs.

What happens after my evaluation?

Your sleep doctor will review the results of your evaluation with you at a follow-up appointment. If you are diagnosed with sleep apnea, your physician may prescribe "CPAP" therapy. A Continuous Positive Airway Pressure machine gently pushes air through a tube and into a mask worn around your nose and/or mouth, to help you breath normally while you sleep. CPAP helps you rest, so that you awake alert and refreshed.

Does a doctor have to refer me?

Many patients are referred by their primary care physician or healthcare provider. However, we do accept patients who come to us directly with their sleep-related problems.

Will my insurance be billed?

You will be billed for all technical aspects of the polysomnogram or other tests ordered through The Sleep Center. Professional charges-physicians interviewing patients, interpreting sleep tests, and other studies done in the laboratory-may be billed separately.

Patient Education and Support Groups

Valley Medical Center offers classes in a variety of areas affecting your health and well-being that may also affect your sleep health, such as weight management, fitness, and cardiac health.

Sleep Web Sites

American Academy of Sleep Medicine
National Sleep Foundation
National Heart, Lung, and Blood Institute
American Sleep Apnea Association
Restless Legs Syndrome Foundation
Narcolepsy Network
Academy of Dental Sleep Medicine (ADSM)
American Association of Sleep Technologists
Journal SLEEP