FAQs

1. Why should I order a sleep study?
A sleep study is a diagnostic test utilized in the evaluation of patients with sleep disorders typically characterized by symptoms of excessive daytime sleepiness and/or fatigue, unrefreshing sleep, snoring, nocturnal movement disorders, and suspected sleep apnea. Sleep studies are an important addition to the comprehensive sleep evaluation because patients are not fully aware of what happens during sleep. During the sleep study, we monitor several physiological parameters including brain waves, eye movements and chin muscle tone to determine the stage of sleep and airflow, snoring, oxygen levels, electrical activity of the heart, arm and leg movements, and abdominal and chest movement to diagnose specific sleep disorders.

2. What is the SleepLab?
The SleepLab is a diagnostic facility located at and part of the North Texas Lung & Sleep Clinic. The SleepLab is a full service sleep disorders center established in 1992. The four-bed, cutting-edge facility is the most comprehensive of its kind, meeting the most severe and complex sleep disorders head-on. Staffed by registered polysomographers, the SleepLab is under the medical direction of Dr. David Ostransky and technical direction of Sarah Molina, RPsgT.

3. Why should I use the SleepLab?
The primary reason for using the SleepLab is our focus on quality, individualized care and patient comfort backed by experience and expertise. Dr. Ostransky is involved in all aspects of the operation of the SleepLab and personally reviews every study performed. We have active, ongoing quality assurance and control programs to maintain the integrity, consistency, and accuracy of our sleep studies. All sleep studies are interpreted by Dr. Ostransky or other credentialed physicians. Every sleep study is hand-scored by a registered polysomnographer. We do not use computerized autoscoring. We specialize on difficult-to-titrate patients and those with negative experiences with CPAP/BIPAP. Because we take care of the toughest cases, we breeze through the easy ones.

4. Who is Dr. David Ostransky?
Dr. Ostransky is a physician-specialist, board-certified in Internal Medicine, Pulmonology, and Sleep Disorders with 20 years’ experience diagnosing and managing common and unique lung and sleep conditions. He has been honored with fellowships to several prestigious sleep and pulmonary societies and distinguished by Fort Worth, Texas magazine’s Top Docs several times.

5. What can you do for me?
Our goal is to accurately diagnose your specific sleep or respiratory problem and initiate appropriate therapy so you feel better and your health status improves. So you can sleep well, breathe well and live well.

6. How do I order a study?
Sleep studies are ordered by your referring or primary care physician or by Dr. Ostransky. If they are ordered by your referring or primary care physician, it is their responsibility to review the results of the sleep study with you. If they are ordered by Dr. Ostransky, he will review the results with you.

7. I don't like the CPAP. None of my patients want to use it. What can I offer those patients?
Many patients have had a less-than-optimal experience with CPAP because of poor mask fittings and improper CPAP pressures. Mask comfort is a mandatory prerequisite for CPAP. Our philosophy is that mask comfort is our responsibility. We provide expert mask fittings with the availability of hundreds of different type of masks, pillows and other interfaces for patients to try. In contrast to some sleep labs that carry only one mask manufacturer, we have nearly every type of mask available. We also are regularly provided with the newest masks by manufacturers because of our reputation. Dr. Ostransky believes mask fittings should be performed by sleep technicians and not be delegated to durable medical equipment companies. Patients having difficulties tolerating the constant pressure of CPAP may be switched to BiPAP which allows the lowering of the exhalation pressure with more comfort. Some OSAS patients may be referred for other treatments including upper airway surgery and/or dental appliances.

8. What is the Pillar Procedure?

The Pillar Procedure, according to Restore Medical (the company that makes the implants), is a minimally invasive surgical procedure indicated for use in: a) the reduction of symptomatic, habitual or social snoring caused by fluttering of the soft palate (roof of the mouth); and/or b) upper airway obstruction in selected patients with mild Obstructive Sleep Apnea Syndrome. During the Pillar Procedure, three tiny polyester implants measuring about ¾ inch are placed into the soft palate. Over time, the implants, together with the body’s natural scar response, stiffen the soft palate. This stiffening reduces tissue vibration that can cause snoring and soft palate collapse that obstructs the upper airway and causes obstructive sleep apnea (OSAS) in some patients. The Pillar Procedure ranges in price from $1,500 to $3,000 and is not reimbursed by insurance.

9. What is coblation or radiofrequency ablation and how is it used for OSAS?

Coblation of the soft palate, tongue or turbinates is a new, minimally invasive surgical procedure used primarily to relieve snoring. It may have a beneficial effect for some patients with mild OSAS. The procedure is performed under local anesthesia. Coblation is a process that uses radiofrequency (RF) energy to stiffen tissue in the soft palate, tongue, or inferior turbinates (nasal passages) that vibrates and causes snoring or obstructs the airway to cause OSAS. Once the palate, tongue or turbinates are numb, a very small probe is inserted into the tissue. The probe removes a small core of tissue as it is inserted, reducing the size of the area. The wand is held steady while a 10- to 15-second charge of radiofrequency is applied. This allows the area to scar and shrink, and eventually stiffen. Three or four of these channels are created.

10. What is Dr. Ostransky’s philosophy on surgery for OSAS?

The gold standard of treatment of OSAS is either CPAP or BLPAP. Although, CPAP/BLPAP is effective for almost all patients with obstructive sleep apnea, many patients struggle with positive airway pressure devices. Surgery aims to lessen obstruction of the various sites of anatomical obstruction of the upper airway, mouth, nose and throat. Sometimes these surgical procedures are combined. Unfortunately, surgical success is often unpredictable and less effective than PAP devices with the exception of tracheostomy, which is rarely recommended. Successful surgery depends on proper patient selection, proper procedure selection and the experience of the surgeon.

They include the following:

Surgical procedures to reduce nasal obstruction include septoplasty, turbinectomy, and radiofrequency ablation (RF) of the turbinates. Sometimes this procedure is performed prior to CPAP or BLPAP in patients with significant nasal obstruction.
Surgical procedures to reduce soft palate redundancy include uvulopalatopharyngoplasty, uvulopalatal flap, laser-assisted uvulopalatoplasty, and RF of the soft palate with adenotonsillectomy.
Surgical procedures to reduce obstruction behind the tongue related to an enlarged tongue or due to overbite or small lower jaw include procedures aimed at reducing the bulk of the tongue base or providing more space for the tongue. This limits backward collapse during sleep. These procedures include genioglossal advancement, hyoid suspension, distraction osteogenesis, tongue RF, lingualplasty, and maxillomandibular advancement. Most surgeries are done in combination and in steps, with maxillomandibular advancement typically advised for refractory or severe OSA, or for those with obvious and significant overbite or small lower jaw (maxillomandibular deficiency).
Tonsillectomy and adenoidectomy is effective 90 percent of the time as a treatment in children. Adults with severely enlarged tonsils (kissing tonsils) may be candidates also.
Tracheostomy, the placement of a permanent passageway in the trachea at the base of the neck is an extremely effective treatment option but rarely performed because it is not necessary and because of cosmetic reasons.

Most of the surgical procedures have a reported success rate of 50-60 percent in selected patients, whereas maxillomandibular advancement has a success rate of 90 percent. Although surgery is not without risks and not as predictable as positive airway pressure therapy, surgery remains an important therapeutic consideration in all patients with OSA. Dr. Ostransky will evaluate you and, if he feels you may be a surgical candidate, he will refer you to an experienced and capable surgeon.

11. What are oral sleep appliances? When are they used for OSAS treatment?

Oral sleep appliances are small devices worn inside the mouth similar to braces and sports mouth guards that prevent the collapse of the tongue and soft tissues in the back of the throat to keep the airway open. There are over 70 different oral appliances currently available. All appliances fall into two categories, tongue retaining devices (they hold the tongue in a forward position with a suction bulb) and mandibular positioning devices (they reposition and maintain the lower jaw in a protruded position). Typically oral sleep appliances work best for patients who snore and have more apneas when they are sleeping on their backs. It is generally restricted to patients who have an apnea/hypopnea index of less than 30 events/hour. It works best for patients who have an overbite. It is contraindicated in patients with TMJ dysfunction. They are comfortable, small, and the treatment is non-invasive. They are not usually covered by insurance costing from $2,000 to $3,000. These devices should by made and fitted by dentists with experience. Dr. Ostransky has a list of experienced and competent dentists he trusts.

12. What can I do to prevent waking up with a dry throat or mouth when I use my CPAP/BLPAP machine?

Most CPAP/BLPAP units usually come equipped with a heated humidification. If this is not being used or set too low, you will awaken with a dry throat. The settings range from 0-5. Patients are asked to raise it slowly, night by night until it resolves. If you wake up with a dry throat despite using the highest setting, then a room humidifier is suggested. The other possibility is that you might be opening your mouth when you sleep. In this case, a chin strap or switching to a full facemask is suggested.

13. My nose gets stopped up so that I have a hard time using my CPAP/BLPAP. What can I do?

My first recommendation is to use an antihistamine, such as Benadryl or Zyrtec just before putting on your mask. Alternatively, the use of Astelin, nasal Atrovent 0.06% or nasal steroid is suggested. Heated humidification may also be helpful. In some patients, surgical intervention such as a septoplasty, coblation or nasalpolypectomy may be required.