Sleep Services provided at North Texas Lung & Sleep Clinic include the outpatient evaluation for adult and pediatric patients with any of the eighty common and unusual sleep disorders, such as obstructive and central sleep apnea, Pickwickian syndrome, insomnia, restless legs syndrome, narcolepsy, circadian rhythm disorders (shift work & jet lag), parasomnias, bruxism, and the sleep manifestation of medical and psychiatric disorders and evaluation of sleep complaints such as excessive daytime sleepiness/fatigue, unrefreshing sleep, and snoring. Both initial consultations and ongoing care are provided. In addition to a comprehensive sleep history and physical examination, diagnostic testing is tailored to the needs of the patient and their specific sleep condition or problem.
Diagnostic and Treatment Services
- Nocturnal and Daytime Sleep Studies
- CPAP/BiPAP Studies
- ResControl Titrations for CSAS
- Multiple Sleep Latency Test
- Maintenance of Wakefulness Test
- Fitness-for-duty Evaluations
- Sleep Hygiene Counseling
- Behavioral Therapies for Insomnia
- CPAP/BiPAP Mask Fittings
- Therapy with Xyrem
- Referrals to Dentists/ENT Physicians for Oral Sleep Appliances, Bimandibular Advancement, and Upper Airway Surgeries
- Referrals to Bariatric Surgeons
The Sleep Lab
Each NTLSC site features a computerized sleep laboratory, where sleep studies are conducted by caring clinical staff. Hotel-quality accommodations at the four-bedroom sleep facilities include a flat-screen television, fresh linens and a continental breakfast. Clinic hours are weekdays from 8 a.m. to 6 p.m. The sleep laboratories are open Sunday through Friday, with sleep studies starting at 8 p.m., 9 p.m. or 10 p.m. and finishing around 6 a.m. or 7 a.m. the following day. Dr. Ostransky is available on-call weekends and after hours on weekdays.
The following descriptions of services offered at North Texas Lung & Sleep Clinic will help you know what to expect and make you feel comfortable for the night. Our four-bed sleep centers are the most advanced and comprehensive available, meeting severe and complex conditions head-on. Staffed by registered polysomnographers and experienced sleep technicians, our facilities provide hope for those who can’t get adequate sleep. Each person is gently eased into testing and made completely comfortable before the real work known as a “sleep study” begins. We have two locations, Fort Worth and Southlake.
Dr. Ostransky tailors his testing and evaluation after listening to each patient’s complaints and list of symptoms. He carefully considers unique medical history to obtain information needed for final and customized interpretations. The result is a custom course of treatment quickly recommended to the ordering physician, so that improved health and quality of life are realized right away. Breathe well. Sleep well. Live well.
The sleep study or polysomnogram is an important diagnostic test ordered by your primary physician or Dr. Ostransky to investigate your sleep complaints or diagnose one or more of the 83 different sleep disorders. Most commonly, sleep studies are done to evaluate patients who complain of excessive daytime sleepiness, unrestorative sleep, and for obstructive sleep apnea syndrome, central sleep apnea syndrome, movement disorders and neurological conditions such as narcolepsy. Studies are typically performed at night. For patients who work night shifts, studies may be scheduled during the day.
On the appointed day, patients arrive at the clinic one to two hours before their usual bedtime. They are warmly greeted by a sleep technologist who will escort them to their study bedroom. Once settled, the sleep technologist will explain what will happen during the study and address any concerns. If this is your first visit to the sleep clinic, you may be asked to complete a sleep questionnaire. This information is both helpful and important for interpreting your sleep study results. You will also be asked to select from a menu for your continental breakfast.
The sleeping rooms are comfortable, relaxing, hotel-like bedrooms with regular (not hospital) queen-sized beds. Each room has its own attached bathroom with a shower and a television. Sleep technicians are not licensed to administer medications. Patients may administer their own medications or an attendant (spouse, parent or friend) may need to be available.
During the sleep study, we attach electrodes to measure different electrical signals including brain waves, eye movements and chin muscle tone to tell us if you are asleep and what stages of sleep you transition through when you are asleep. We also measure electrical activity of the heart (ECG) and leg. A flow sensor is placed in your nostrils to measure airflow. Belts are placed around the rib cage and abdomen to measure breathing movements. A clip is placed on a finger to measure blood oxygen levels. In patients with significant lung diseases, we may add capnography, a measurement of carbon dioxide levels in the exhaled air. This helps detect sleep-related breathing disorders where breathing is compromised. Other measurements may be done as required. There are no needles involved and there is no pain. The electrodes are connected to a box by the bedside for relaying the signals to a central control room. The box splits in half allowing patients to get up to use the restroom.
All patients are videotaped while asleep. This is helpful in the evaluation of patients with seizure disorders or epilepsy and those who have abnormal movements or behaviors during sleep.
Sleep studies are performed at the North Texas Lung & Sleep Clinic utilizing the Viasys Sensormedics Alpha System according to the strict guidelines established by the American Academy of Sleep Medicine. The sleep technologist will be recording and monitoring your sleep. If any problems arise during the study, the sleep technologist will address them promptly. If you need help or assistance, your sleep technologist is merely an intercom call away and will respond immediately to address any problems that arise during the study. Sarah Mayfair, technical director, or Dr. Ostransky are available to the sleep technologists throughout the night for any questions.
If you are here for a positive airway pressure trial (CPAP or BLPAP), you will be fitted with a mask before recording sleep. It is critical you let the technicians know whether the mask is comfortable. With the mask and machine on, you may peacefully drift off to sleep. Pressure settings will be raised one level at a time until the setting is obtained that eliminates your apneas and snoring, and improves your sleep quality.
Patients generally complete the study around 6:30 to 7 a.m. If you need to be awakened earlier, please notify the technician.
Once the sleep study is completed, nearly 1,000 pages of recordings are scored by a scoring technologist and sent to Dr. Ostransky for interpretation. Tests are scored according to the AASM Manual for the Scoring of Sleep and Associated Events (American Academy of Sleep Medicine, Westchester, IL 2007). This entire process takes seven days or less. Interpretations are sent to the physician who ordered the sleep study and appropriate follow-up is arranged. If your physician ordered the sleep study, he/she is responsible for reviewing the sleep study results with you. If Dr. Ostransky ordered the study or your physician has made arrangements, then Dr. Ostransky will discuss the study with you.
Other types of sleep studies performed at the North Texas Lung & Sleep Clinic include polysomnogram with seizure montage, pediatric study, multiple sleep latency test (MSLT), and maintenance of wakefulness test (MWT).
Sleep Studies with Seizure Montage
For patients with seizures or epilepsy, suspected sleep-related seizure disorders, or abnormal movements or behaviors during sleep, the sleep study recordings are modified and expanded from 6 to 20 brainwave leads. Videotape is also carefully reviewed for abnormal movements or behaviors corresponding to the seizure discharges. Occasionally, a period of sleep deprivation may be requested before the particular test.
Pediatric Sleep Studies
Although indications of a pediatric sleep study vary slightly from an adult sleep study, they are performed in a similar manner, with a few exceptions. Parents will be asked to complete a pediatric sleep questionnaire, information necessary for the interpretation of the sleep study results. For pediatric studies at NTLSC, we add capnography to the standard measurements. It is a measurement of carbon dioxide levels in the exhaled air to increase the sensitivity to help detect apneas and inadequate breathing. The North Texas Lung & Sleep Clinic, Sleep Lab performs studies on children from ages 6 (six) and up. Indications for pediatric sleep studies include excessive daytime sleepiness, unrestorative or disturbed sleep, snoring, suspected obstructive sleep apnea syndrome, or abnormal movements or behaviors during sleep. There are 2 million children, or 3 percent of the pediatric population, who have obstructive sleep apnea syndrome, yet only 20 percent of pediatricians actively screen for sleep apnea. Children aged 2 to 9 years have a different presentation from adults and older children. Their sleep disorder symptoms often manifest as hyperactivity, impaired attention, behavioral problems or deteriorating academic performance. Snoring loudly, grunting and high-pitched sounds are commonly noticed by parents. Other signs of sleep apnea in children include labored breathing, sweating, bedwetting and flailing of arms and legs. Our experienced sleep technicians are trained to be sensitive to the needs of our younger patients and will make them feel comfortable and unafraid.
Parents and/or guardians are provided a separate bed within the sleep rooms so they can be near their little one.
Multiple Sleep Latency Test
The Multiple Sleep Latency Test (MSLT) is a validated objective test of the ability or tendency to fall asleep. The MSLT is used to confirm the diagnosis of narcolepsy and idiopathic hypersomnia or to help differentiate idiopathic hypersomnia from narcolepsy. Sometimes an MSLT is recommended to evaluate patients with OSAS who suffer with persistent sleepiness despite optimal treatment. The MSLT study protocol is performed according to the American Academy of Sleep Medicine guidelines at the North Texas Lung & Sleep Clinic.
The MSLT consists of five nap opportunities performed at 2-hour intervals always following an initial night time sleep study. Total sleep time on the prior night study must be a minimum of 6 hours. Patients are requested to record their sleep-wake cycle (sleep logs) for one week before the study. Medications such as stimulants must be stopped before the MSLT. Patients are provided with a list of stimulant medications. Smoking must stop at least 30 minutes before each nap opportunity. Please avoid vigorous physical activity during the day. Any stimulating activities, including video games, should end at least 15 minutes before each nap opportunity. Avoid caffeinated beverages and unusual exposures to bright sunlight. A light breakfast is served at least 1 hour before the first trial and a light lunch immediately after the second noon trial.
Similar to the night study, the sleep technologist will record eye movements, brainwaves, chin muscle tone, and electrocardiogram during the MSLT. With each nap opportunity, patients are asked to do the following: “Please lie quietly, assume a comfortable position, keep your eyes closed, and try to fall asleep.” The same instructions will be given before every test. Immediately after these instructions are given, bedroom lights are turned off, beginning the test. Between naps, patients should be out of bed and avoid dozing.
Two measurements of value to the MSLT are sleep latency and REM latency. Sleep recordings are divided into 30-second intervals called epochs. Sleep latency is the time from lights out to the first page of recording showing more than 15 seconds of sleep. REM latency is taken as the time of the first epoch of sleep to the beginning of the first epoch of REM sleep, regardless of intervening stages of sleep or wakefulness. A nap session is ended after 20 minutes even if sleep does not occur. The MSLT report will include the start and end times of each nap or nap opportunity, latency from lights out to the first epoch of sleep, mean sleep latency (average of all naps or nap opportunities), and number of sleep-onset REM periods (defined as greater than 15 seconds of REM sleep in a 30-second epoch). A mean sleep latency of less than 8 minutes is considered abnormal, suggesting pathological daytime sleepiness. The presence of two or more REM periods during the MSLT is indicative of a diagnosis of narcolepsy.
Maintenance of Wakefulness Test
The Maintenance of Wakefulness Test (MWT) is a validated objective measure of the ability to stay awake for a defined time used in association with the clinical history to assess the ability to maintain wakefulness. It is used at the North Texas Lung & Sleep Clinic to assess an individual’s ability to remain awake when his or her inability to remain awake constitutes a public or personal safety issue, especially in transportation workers including airline pilots, truck drivers and train conductors. The MWT is used to assess responses to treatment in patients with excessive sleepiness. The MWT study protocol performed is the four-trial MWT 40-minute protocol according to American Academy of Sleep Medicine guidelines at the North Texas Lung & Sleep Clinic.
The MWT consists of four trials performed at 2-hour intervals with the first trial beginning 1.5 to 3 hours after the patient’s usual wake-up time. This means the first trial starts at approximately 8:00 or 10:00 a.m. It will be Dr. Ostransky’s decision whether a prior nighttime study or a urine drug screen are required. Tobacco, caffeine and stimulant medications are not permitted. A urine drug screen may be conducted before the first trial. A light breakfast is recommended at least 1 hour before the first trial, and a light lunch is recommended immediately after the end of the second noon trial. Lunch will be provided. In an MWT, patients are seated in a recliner with lighting maintained at a moderate level. Similar to the night study, the sleep technologist will record eye movements, brainwaves, chin muscle tone, and electrocardiogram. Before the test, the sleep technologist will ask patients if they need to go to the bathroom or need other adjustments for comfort. Patients will be instructed to, “Please sit still and remain awake for as long as possible. Look directly ahead of you, and do not look directly at the light.” Patients are not allowed to use extraordinary measures such as slapping their face or singing to stay awake.
An MWT serves to monitor if you fall asleep. Sleep recordings are divided into 30-second intervals called epochs. Sleep onset is defined as the first epoch of greater than 15 seconds of cumulative sleep in a 30-second epoch. Trials end after 40 minutes if no sleep occurs, or after unequivocal sleep, defined as three consecutive epochs of stage 1 sleep, or one epoch of any other stage of sleep. The following information will be recorded: start and stop times for each trial, sleep latency, total sleep time, stages of sleep achieved for each trial, and the mean sleep latency (the average of the four trials).
A helpful suggestion for the MWT is to sleep 8 hours per night for at least a week before the study. For those on CPAP or BLPAP, please use it consistently for a minimum of 3 weeks before the study. For patients recently diagnosed with a sleep disorder, it is suggested they should be on optimal therapy for at least 3 weeks before undergoing an MWT.
Those who pass the test, will be provided a return to work release form and a letter signed by Dr. Ostransky stating the following: “Mr./Ms. XXXXX passed the Maintenance of Wakefulness Test on this date. Predicated on the continued daily use of treatment for his/her sleep disorder, Mr./Ms. XXXXX is declared safe to return or continue work.” Those who fail the test will not be released to resume work nor approved fit for duty. Patients may return for a repeat MWT in 1 to 3 weeks.