What Is A Sleep Study And Who Needs It?
Sleep study is an overnight observation of an individual?s sleep. This involves monitoring number of physiological parameters simultaneously like EEG (brain activity), the eye moments (EOG), the chin tone (EMG), breathing (nasal flow), breathing efforts, Oxygen level, heart rhythm (ECG).
Sleep is not a unitary phenomenon .It is divided into different stages like REM sleep (dreaming sleep) and Non REM sleep which is further subdivided into three stages. The nature has made sleep like an orchestra with different notes at different points and diseases like Sleep Apnea disrupt this rhythm. This can be easily deciphered by a well conducted comprehensive sleep study.
What are different levels (types) of Sleep studies?
There are 4 types –
Level 1 study being the gold standard where are all the above mentioned parameters are observed and attended to by a well-trained sleep technologist and the recordings are scored by scoring technologists and reviewed by Sleep physician who interprets the same and provides with the final diagnosis and recommendation. The Sleep Specialist then discusses the report and advises the next line of treatment.
Level II study is similar to level 1 but not attended by the sleep technologist and therefore there is a possibility of potential loss of data.
Level III study involves monitoring of just two parameters mainly the breathing and the Oxygen level without monitoring the brain activity and the sleep.
Level IV study is only monitoring the Oxygen level overnight.
In most situations Level 1 study is required however sometime the Sleep physician may conduct a simpler test.
What are the different forms of Sleep Studies?
Diagnostic studies – In these only the diagnostic gear is used; this can be level 1 to level IV study.
Titration studies ? which involve titration with CPAP or the BiPAP :this can be performed only in level 1 study setting .
Sleep studies are generally conducted in a split night format in which the first part of the night is the Diagnostic arm and in the later half Therapeutic part where titration with CPAP is done. Split night studies are only possible with the level 1 format where a trained sleep technologist will conduct this study under the guidance of a Sleep Specialist.
Sleep study is a very powerful monitoring tool which gives us opportunity to peep into one?s mind and health. It?s utility goes much beyond diagnosing simple Sleep Apnea and extends to diagnosing conditions like periodic limb movement, Sleep architecture problems, Parasomnias, Complex Sleep Apneas, Bruxism, loss of REM Atonia etc.
?Eyes cannot see what our mind does not know? is old saying very apt for the field of Sleep Medicine in the region. Device companies in order to fuel the growth of devices are trivializing the sleep diagnostics pushing vendors to conduct sleep studies in a completely unregulated environment; the quality of these can put any regulator to shame. Nevertheless each patient need to be an empowered consumer and decide for themselves what is best for their health.
People complaining of the following symptoms need to be screened for Sleep Apnea and may require a Sleep Study
- Episodes of choking in the night
- Morning headaches
- Unrefreshing /Disturbed Sleep
- Abnormal movements during night
- Excessive Daytime Sleepiness.
- Patients with comorbid conditions like Diabetes, heart failure, depression, fibromyalgia, atrial fibrillation, obesity
How much does a Sleep Study cost in Delhi/Gurgaon/NCR?
We at Aviss Health get frequent calls from patient?s who have been advised Sleep Study by their GP/Doctor. The most common question asked is ?How much will the Sleep Study cost ?This is part of an exercise they embark upon trying to check and compare the cost with various service providers .The answer to this question is so baffling that it leaves them even more confused. We regularly get patients who are quoted anywhere from 2,000 to 20,000 Rupees for a Sleep Study !!!
To get them out of this dilemma and to Empower them I am elaborating on some key points about the Costs of Sleep Studies.
– At present time none of the health insurances in India cover the cost of a sleep study thus it is mostly out of pocket expense
– There are different levels of Sleep Studies and all sleep studies are not the same.
– A level 1 sleep study (Polysomnography) is an in lab sleep study. The costs of this can vary depending upon the hospital it is being done and the cost in Delhi /Gurgaon/NCR vary between Rs 15000 to 20000. Although it has been the ?gold standard? for long but advancements in technology and the portability many patients may not require and can avoid having to sleep in a lab. However patients with co-morbidities should undergo in-lab study
– Home sleep test (HST) ? these are gaining popularity around the world. It should be emphasized that all HST?s are not the same.
– A comprehensive Home Sleep Study (attended level 2 study) is the most popular level of testing. This involves a trained technician putting on the leads and sensors and observing the sleep in your bedroom. The titration is done wherever required. This sort of testing is not possible in the West where it is not possible to have techs staying overnight thus does not find much mention in the medical literature. Aviss Health team has the experience of over 3000 such tests and have mastered this testing pathway. These tests typically costs between Rs 8000 ? Rs 12000.
– Level 3 sleep tests (unattended level 3 HST) are self- administered (sometimes techs may be asked to administer this just to jack up the costs) sleep tests to rule in Sleep Apnea and are done where the Sleep Apnea is very obvious and there are time and cost constraints. There is no monitoring of sleep (no EEG, EMG, EOG) but just the cardio-respiratory parameters during sleep. There is no provision for titration in this. These tests cost between Rs 2000 to Rs 5000.
As with any other modality it is very important to understand & ensure some of the basics and things like who is recommending the test, who is going to do it, what are the credentials of the Sleep Physician etc.Unfortunately the Sleep Medicine Healthcare Sector is unregulated and Vendors (suppliers of CPAP machines) are doing Sleep studies left right and centre often at throw away prices without really understanding the science and leaving behind a trail of unsatisfied customers. They often have ?fixed reports? all advising buying a CPAP machine
As an empowered customer it is your duty and right to get the best service that your money can buy but that would mean doing your homework.
Aviss Health with it?s unique business model of utilizing the strength of our backend operations( helping subsidize our local work) is able to provide services at about 30% less cost to the patients. We have been at the forefront of training and are playing a pioneering role in the emergence of Sleep Medicine. The service is led by an American Board Certified Sleep Physician who has been mentoring physicians in this region. We feel happy and privileged to pass on the benefits of our business model, and our expertise to our patients.