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Sleep Care

Getting “a good night’s sleep” is not a new concept. However, the average American admits that they often sacrifice sleep in order to meet the other demands in their busy lives. The result is sleep deprivation, often ignored by most, or commonly masked with unhealthy sleep aids such as caffeine, nicotine or sugars. However, this sleep type of cycle can be detrimental to one's health, quality of life and work productivity.


estimated cost of undiagnosed OSA in the U.S.


Americans suffer from
Sleep Disorders

7-9 Hours of Sleep

is recommended for most adults by the National Sleep Foundation

Types of Sleep Disorders

There are more than 70 different sleep disorders classified as lack of sleep, disturbed sleep, and excessive sleep. Below is a list of the most common types of sleep disorders.

Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea is experienced by sufferers as a lack of air flow throughout the night, which leads to frequent brief arousals. OSA is a serious, potentially life-threatening breathing disorder which affects an estimated 18-20 million Americans, equally as common as asthma and diabetes. Estimates suggest that up to 80-90% of individuals with sleep apnea go undiagnosed and untreated, which could make the actual statistic as high as 1 in 5. The average patient with untreated sleep apnea’s health care will cost an additional $1,336 over someone without the condition (or who has it treated).

Recent large-scale studies indicate a direct link between sleep apnea and hypertension, obesity, diabetes and stroke risk as well as many other serious health conditions when left undiagnosed and untreated. OSA occurs in all age groups and both sexes, but there are a number of factors that increase risk, including having a small upper airway (or large tongue, tonsils or uvula), being overweight, having a recessed chin, small jaw or a large overbite, a large neck size (17 inches or greater in a man, or 16 inches or greater in a woman), smoking and alcohol use, being age 40 or older, and ethnicity (African-Americans, Pacific-Islanders and Hispanics). Additionally, OSA seems to run in some families, suggesting genetics may also play a role.

OSA is characterized by the following signs and symptoms:

  • Loud snoring followed by periods of non-breathing and snorting or gasping for air
  • Repetitive arousals, often unnoticed during sleep
  • Falling asleep at inappropriate times during the day, such as while driving, working or talking
  • Early morning headaches
  • Depression, irritability and sexual dysfunction
  • Learning and memory difficulties

Health Impact of OSA

Cardiovascular disease, diabetes and stroke are all commonly known health concerns. OSA can play a major role in the development of these conditions. Researchers are discovering direct correlations between sleep issues and major health risks.

One of the most disturbing correlations made in recent sleep studies is in the area of stroke risk. Studies have now proven that subjects with moderate to severe sleep apnea can have a 2-3 times higher risk of suffering from certain types of stroke if undiagnosed and untreated. One reason obstructive sleep apnea may increase stroke risk is that it has been shown to cause high blood pressure, the most common risk factor for stroke. Additionally, victims of stroke who did not previously have sleep apnea have a higher incidence of developing it post-stroke, thus increasing risk for subsequent strokes.

  • Cardiovascular: Links to cardiovascular disease are also quite strong. 50% of hypertensive patients are suspected to have sleep apnea. Hypertension, commonly referred to as high blood pressure, is a key contributor to heart attack, stroke and cardiac related deaths.
  • Insulin Resistance: Diabetes and insulin resistance disorders are found commonly amongst sufferers of sleep apnea. Recent studies linked type 2 diabetes to the lowering of oxygen pressure in the arteries (hypoxemia) which occurs during episodes of sleep apnea related breathing disturbances during sleep.


Insomnia is a serious sleep disorder. It can mean the inability to fall asleep or stay asleep throughout the night, or the tendency to wake too early before having gotten enough sleep. Insomnia is often used to describe the condition of waking up not feeling well rested or restored, and is the most common reported sleep disorder among Americans. According to the National Sleep Foundation, between 30 and 40 percent of adults say they experience some symptoms of insomnia within a given year.

Insomnia can range from mild to severe, acute (short-term sleeplessness) or chronic (insomnia that lasts for longer than a month), and can be a stand-alone disorder or a symptom of some other disease or condition, such as stress, drug use, or other health problems. People with insomnia often have day-time symptoms related to exhaustion, such as fatigue and decreased mental clarity.


Narcolepsy is a chronic neurological disorder that affects the region of the central nervous system that regulates sleep and wakefulness. Symptoms of narcolepsy generally appear in the second decade of life.

It affects an estimated 200,000 Americans, and is characterized by the following signs and symptoms (not all individuals with narcolepsy experience every sign or symptom): Sudden, uncontrollable episodes of sleep at inappropriate times, such as while having dinner, talking, driving or working.

  • Cataplexy: Sudden episodes of loss of muscle control, ranging from slight weakness (such as limpness at the neck or knees, sagging facial muscles, or inability to speak clearly) to complete body collapse during which the person may appear unconscious, but remains awake and alert (this can be precipitated by intense emotion, such as laughter or anger).
  • Sleep Paralysis: Inability to talk or move when falling asleep or waking up
  • Hypnagogic Hallucinations: Vivid, often unpleasant, dream-like experiences that occur while dozing or falling asleep
  • Disrupted nighttime sleep with frequent awakenings
  • Automatic Behavior: Performance of routine tasks without memory of the action
  • Learning and memory difficulties

Restless Legs Syndrome (RLS)

RLS is marked by uncomfortable leg sensations that occur continually while the body is at rest. It may be a central nervous system disorder and occasionally is associated with iron-deficiency anemia, pregnancy or diabetes. Some researchers estimate that RLS affects as many as 5-15% of the U.S. population.

RLS is characterized by the following signs and symptoms:

  • The urge to move the legs, which is often accompanied by uncomfortable sensations in the foot, calf or upper leg. (These sensations are usually described as a creeping or crawling feeling and may sometimes be experienced as a tingling, cramping or burning sensation.)
  • The need to move the legs to relieve the discomfort by stretching, bending or rubbing the legs, tossing or turning in bed, or getting up and pacing the floor
  • A worsening of discomfort when lying down, especially when trying to fall asleep at night
  • A tendency to experience the most discomfort late in the day and at night
  • Continuous nighttime sleep disruption
  • Daytime fatigue

Periodic Limb Movement Disorder (PLMD)

PLMD is a disorder that consists of periodic movements of the legs, feet, and/or toes during sleep. People with PLMD are often not aware of these movements, and often complain of several symptoms, including: insomnia, excessive daytime sleepiness, frequent awakenings from sleep, or unrefreshing sleep.

Circadian Rhythm Sleep-Wake Disorders

This category of disorders includes conditions in which the sleep times are out of alignment. A patient with one of these disorders does not follow the normal sleep times at night.

  • Delayed Sleep-Wake Phase: This circadian rhythm disorder is a sleep pattern that is delayed by two or more hours so that a person goes to sleep later at night and sleeps later in the morning.
  • Advanced Sleep-Wake Phase: This circadian disorder causes people to fall asleep several hours before a normal bedtime and wake up hours earlier than most people wake in the morning.
  • Irregular Sleep-Wake Rhythm: This disorder causes a person's circadian rhythms to be so disorganized that there is no clear sleep or wake pattern. People with this sleep disorder may sleep off and on in a series of naps over a 24-hour period.
  • Non-24-Hour Sleep-Wake Rhythm: Non-24 is a sleep disorder that causes a person's sleep time to shift a little later every day. Sleep times may go in and out of alignment with other people over time.
  • Shift Work: A non-traditional work schedule involving shifts that occur when most people are sleep can cause shift work disorder. The condition causes your sleep to be poor and consistent feelings of fatigue or exhaustion.
  • Jet Lag: Occurs when you travel across multiple time zones and have difficulty adjusting to the new schedule.

Taken from:

What is a Sleep Study?

Sleep disorder diagnosis is based on clinical expertise, scientific knowledge, and accurately applied diagnostic studies. A polysomnogram is a non-invasive diagnostic procedure used by sleep disorder specialists to obtain information about a patient's physiological status during sleep. A polysomnogram is also referred to as a "sleep test" or "sleep study."

During a sleep study, a patient's vital signs and physiology are recorded during a night of sleep. Measurements include brain activity (EEG), muscle activity (EMG), eye movement (EOG), heart activity (EKG), respiratory airflow, blood oxygen saturation, pulse rate, body position, and respiratory effort. Patient’s test results are promptly evaluated by a sleep physician, who will forward them to your personal physician, along with a diagnosis and recommendations for treatment.

Prior to your sleep study, you'll first meet with your physician who will take a medical history and perform a physical exam. You'll discuss the physical and emotional factors that could be affecting your sleep. This will help determine whether you can benefit from a nighttime sleep study.

In-lab Sleep Study or Attended Sleep Test (AST)

Aside from the diagnostic equipment and the sleep technologist, participating in a Persante in-lab sleep study is a lot like spending the night at a comfortable hotel. Each monitored bedroom is private and equipped with cable television, a comfortable recliner and a private bathroom and most of our locations have queen-sized beds. Finally, patients receive such amenities as special parking as well as complimentary evening snacks (breakfast/lunch for additional daytime studies).

On the evening of the study the patient arrives at the center between 8 pm and 10 pm. Once the patient has settled in, the technologist offers a light snack, and then proceeds to connect the patient to the monitoring equipment via non-invasive electrode and leads gently adhered to the skin. The hookup procedure takes approximately one hour.

The study is conducted throughout the night while the patient sleeps. In the morning, the patient is disconnected and free to shower at the facility (if available). In most cases, the patient is able to leave for his/her normal routine early the next morning.

Home Sleep Test (HST) or Home Sleep Apnea Test (HSAT)

A Home Sleep Test is designed to be a convenient way to collect information about your sleep. The HST device is palm-size and uses the latest technology in a quiet and accurate manner. You will pick up the HST device at the in-lab sleep center and meet with a sleep technologist to go over how to use the HST device, or your HST device along with detailed instructions will be mailed to your home. A phone number will be provided as a resource for you to address any issues you may encounter when using the device at home.

During the day, you should perform your normal activities. Just before bedtime, you will apply the sensors and start the recording as directed by the technician. If you have questions about the device while at home, you may call the number on the information sheet provided to you for assistance.

The morning after using the device, place all equipment back in the box and return it via a dropbox at the Sleep Center or a pre-paid mailer.

The data will be sent to a sleep specialist for interpretation and recommendations. This specialist may not be the physician that referred you for the study. In that case, the results will be sent to your physician for follow up with you. Results should be available in roughly two weeks.

The home sleep apnea diagnostic device is applied just before your bed time hour and performs its reading within the course of your typical night’s sleep routine in the comfort and safety of your own bed.

Topics in Sleep

Sleep is essential to maintain a healthy lifestyle but sometimes we are not getting enough. Below are some topics to better understand the effects of sleep deprivation.

Sleep & Weight

Obesity or Sleep Disorder?

According to the American Obesity Association, nearly 200 million Americans are categorized as being overweight or obese. Over 70 million Americans suffer from some type of sleep disorder and obesity is recognized as a major risk factor for sleep-disordered breathing. Obese individuals also suffer from sleep apnea at a much higher rate than those at a healthy weight. Doctors therefore often recommend weight reduction as a part of a therapeutic plan for patients with sleep apnea.

Sleep Deficit and Weight Gain

Lack of sleep is common. While it is understood that adults need 7-8 hours of sleep, most of us only get 6 or less hours sleep. Insomnia and sleep disorders like restless leg syndrome affect sleep duration. Studies demonstrate a correlation between an imbalance of hormones and appetite control when people are deprived of adequate sleep. The people in the study also experienced a decrease of leptin levels, the hormones that "turn off" your appetite and an increase of ghrelin levels, the hormone controlling "hunger." Even as little as one hour less sleep per night can trigger this imbalance resulting in possible weight gain.

A sleep study is the best way to accurately diagnose a possible sleep disorder. Sleep studies are performed by collecting physiological data such as brain waves and muscle movement while you sleep using noninvasive sensors. A sleep technologist records this data as well as images coming from the camera in your testing room. This information is carefully reviewed and compiled into a report that is sent to your doctor.

Sleep & Cardiovascular Disease

High Blood Pressure

High blood pressure, known as hypertension, is the most important risk factor for cardiovascular disease. A staggering 67 million Americans have high blood pressure, which is about one in every three adults. Between 30 and 40 percent of adults with high blood pressure also have sleep apnea. Approximately 80 percent of patients that do not respond to hypertensive medications have sleep apnea. Seeking and adhering to sleep apnea treatment is a proven means of decreasing blood pressure.

Evidence shows that obstructive sleep apnea (OSA) treatment lowers nighttime and daytime blood pressure, with the greatest improvement in patients seeking treatment for moderate to severe sleep apnea. The higher your blood pressure, the greater your risk of suffering a heart attack or stroke. Reducing your blood pressure lowers your risk of cardiovascular disease and improves your overall health.


A stroke is a “brain attack.” It can happen to anyone at any time. It occurs when blood flow to an area of brain is cut off. When this happens, brain cells are deprived of oxygen and begin to die. When brain cells die during a stroke, abilities controlled by that area of the brain such as memory and muscle control are lost. Sleep apnea can be an after effect of stroke, but can also be the cause of a first time or recurrent stroke. Sleep apnea causes low oxygen levels and high blood pressure, both of which can increase the risk of a future stroke.


A cardiac arrhythmia is an abnormal beating of the heart. Normally the heart beats in a regular fashion in which the timing between beats is the same and the intensity of the heartbeat is the same for each beat. For each heartbeat, an electrical conduction through the heart stimulates the orderly contraction of the muscular sack known as the heart. This leads to pumping of blood to the rest of the body and maintenance of a good blood pressure. If the heart rate should be too fast or the heart beats in an irregular fashion, the heart’s ability to pump blood can be compromised. Decreases of the flow of blood to the brain can lead to lightheadedness or even loss of consciousness or death. The lightheadness or loss of consciousness can last for a few seconds or longer. Patients with an arrhythmia may notice palpitations, a fast heartbeat, shortness of breath or feel nothing. Because OSA can restrict the flow of oxygen to the heart, patients with OSA are at greater risk of an arrhythmia than patients with cardiovascular disease.

Sleep & Insulin Intolerance

Type 2 Diabetes

According to the Centers for Disease Control and Prevention, 25.6 million Americans aged 20 years or older suffer from diabetes, and Type 2 diabetes accounts for about 90 to 95 percent of all diagnosed cases. Seven in 10 people with Type 2 diabetes also have obstructive sleep apnea (OSA), and the severity of the sleep disorder directly impacts diabetes symptoms; the more severe a diabetic’s untreated OSA, the poorer their glucose control. Treating OSA in diabetics improves nighttime glucose levels and insulin sensitivity.

Sleep & Your Child

Sleep is critical to all major functions of the body. In children, sleep is essential for proper mental and physical development. Studies link sleep with learning; the area of the brain that controls processing procedural or "how to" learning has been demonstrated to be negatively affected by lack of sleep.

Why Doesn't My Child Sleep?

While natural body rhythms known as the circadian rhythm regulate the internal body clock as to when your child should be awake and when to sleep, there are environmental and developmental issues that can impact these rhythms. Adjusting bedtime rituals and shifting task-oriented responsibilities to earlier in the evening can help. Homework, sports team practices and/or games and sibling interruptions are examples of outside influences that can be controlled.

How Much Sleep is Needed?

Although each child is different, physicians recommend the following minimum amounts of sleep based on age:

  • Newborns/Young Infants: 16-18 Hours
  • Older Babies: 12-15 Hours
  • Toddlers (2-4 years with naps): 10-12 Hours
  • Young Children (6-10 years): 10 Hours
  • Teens (11-17 years): 8-9 Hours

Does Your Child Snore?

Medical experts indicate that any child who snores regularly, or has other signs of breathing problems during sleep, may benefit from an evaluation for sleep problems and perhaps from tonsillectomy - especially if the child is also having behavior problems at home or school.

Sleep Disorders and Attention Deficit Hyperactive Disorder (ADHD)

If a child has difficulties with attention deficit, hyperactivity, or daytime sleepiness, there may be something that can be done about it if the child proves to have a sleep disorder. An undiagnosed sleep disorder is not the reason behind all children with ADHD, but determining if there is a sleep disorder is especially helpful for those children with symptoms that suggest a sleep disorder such as sleep apnea.

Concerned Your Child Isn't Getting Enough Sleep?

If these statements apply to your child, speak with their doctor.

  • My child has problems falling or staying asleep.
  • Teachers tell me that my child has problems staying awake in class.
  • My child acts out excessively and/or has trouble concentrating.
  • My child snores loudly and sometimes gasps for breath while sleeping.
  • My child is a "mouth breather.”
  • My child often wets the bed.

To determine how to best improve your child's sleep, the physician may order a sleep study to determine if a sleep disorder may be contributing to your child's lack of quality sleep.

Sleep & Women

The Necessity of Quality Sleep

Adequate and fulfilling sleep is a key component to women staying healthy and living a long and happy life. Our bodies typically require a minimum of 7-8 hours of sleep per night to function normally. Studies show that women who sleep 6 or less hours have reduced reaction time when driving, increased mood swings, and in some cases serious damage to the body due to lack of adequate sleep. Women are also twice as likely to experience insomnia-related symptoms as their male counterparts.


There is a higher occurrence of obesity in individuals who are sleep deprived by as little as one hour each night than those who sleep adequately. The hormones leptin and ghrelin monitor and control feelings of hunger and satiation and are directly affected by sleep deprivation. A lack of sleep may lead to weight gain in many women.


Research shows a link between increased estrogen levels found during pregnancy and the occurrence of Restless Legs Syndrome (RLS) in women. RLS is described as a strange "creepy-crawly" sensation or an urge to move the legs when at rest and can be very uncomfortable.

Sleep apnea is of major concern during pregnancy due to the amount of weight gained by many women as part of a healthy pregnancy. The risk for developing preeclampsia increases in women suffering from sleep apnea, as does the risk of developing gestational diabetes. The baby can also be affected by the mother's sleep apnea as low birth weight is common in women diagnosed with untreated sleep apnea.

Menopause & Beyond

Menopausal women experience a drastic change in hormonal function and experience more severe snoring which may be symptomatic of sleep apnea. Numerous studies link sleep apnea to increased blood pressure which can lead to stroke and heart disease. It is estimated that 50% of patients with high blood pressure also suffer from sleep apnea. Hormonal deficiencies, night sweats and other menopause-related issues interfere with sleep.

Can you identify with any of these statements?

  • "I just can't seem to find the time to sleep properly."
  • "My kids keep me up most nights with their needs."
  • "I can't turn off my mind to fall asleep and sometimes wake up worrying about things I have to do."
  • "My partner tells me that I am snoring at night."
  • "I often feel sensations in my legs when trying to sleep and the only way to relieve it is to get up and walk around."
  • "I have gained 10 or more pounds over the last year."
  • "My hot flashes or other menopausal symptoms make it impossible for me to sleep."

If you can relate to any of these statements, speak with your doctor or contact us for more information about possible sleep disorders. Treating sleep disorders dramatically improves overall health and quality of life.

Sleep & Mental Health

People experiencing obstructive sleep apnea (OSA) aren’t just stuck dealing with its physical effects. They may also experience mental health challenges. Sleep deprivation can contribute to both depression and anxiety, a vicious cycle for people with OSA.

A study by the Centers for Disease Control and Prevention found that people with sleep apnea were more likely to experience depression than people in the general population. Disturbances in sleep can affect mental health, and the stress of having a serious medical condition is sufficient to send some people into depression. But OSA is particularly likely to interfere with mental health because of the reduced oxygen supply to the brain at night, which can alter brain functioning and thus increase a person’s likelihood of developing depression.

Sleep & Cognitive Function

If you can’t sleep, can’t dream, and are worried about a chronic medical condition, it’s not surprising that you might have difficulty concentrating. People with sleep apnea may be exhausted during the day and have trouble focusing on important tasks, including job-related activities. Sleep problems can alter mood, making people with sleep apnea jumpy or quick-tempered, and making it more difficult for them to navigate the challenges of everyday life. Many of the problems associated with sleep apnea are interconnected, and stress during the day can make obstructive sleep apnea (OSA) worse at night.

Sleep & the Effects in the Workplace

With respect to the workplace, there is increasing recognition that untreated and ineffectively treated obstructive sleep apnea (OSA) has adverse effects on individual performance as well as the overall safety for workers and, in certain circumstances, the general public.

There is a clear relationship between excessive sleepiness and decreased work productivity in patients with OSA. Screening for OSA in the workplace has the potential to identify a reversible cause of low work productivity.

Sleep & Shift Workers Disorder

Shift work disorder (SWD) is a recognized medical condition that can be diagnosed and treated. It occurs when the body's internal clock, or circadian rhythm, is out of sync with your work schedule. The circadian rhythm helps regulate different functions; including sleeping and waking. Disruption of the circadian rhythm can lead to excessive sleepiness during waking hours and or trouble sleeping during sleeping hours.

SWD Is Common

As many as 20% of U.S. workers are involved in some form of shift work, including permanent or intermittent night work, early morning work, or rotating schedules. Approximately 10% to 25% of night-workers and rotating-shift workers have shift work disorder meaning that up to 1 out of every 4 nights or rotating-shift workers may be suffering from shift work disorder. Over 15 million Americans work non-traditional shifts and are "at risk" for SWD. Of these, 3.75 million Americans are estimated to have SWD.

Signs a Person Could Have SWD

Shift work disorder is an often undiagnosed condition in which excessive sleepiness and/or insomnia are the main symptoms.

  • Excessive Sleepiness is defined as having trouble staying awake. People who experience excessive sleepiness often describe it as being tired, fatigued or lacking energy.
  • Insomnia affects the length and quality of sleep. Insomnia can be difficulty falling asleep, difficulty staying asleep, waking up too early, and poor quality of sleep.

SWD can lead to other quality of life concerns

These are just some of the problems people with shift work disorder may experience:

  • Trouble focusing
  • Drop in work performance
  • Missed family and social activities
  • Worsening of heart and stomach disorder
  • Sleepiness-related accidents
  • Increased irritability

Sleep & Drowsy Driving

Did you know?

The National Highway Traffic Safety Administration estimates that nearly 100,000 traffic accidents can be attributed to “drowsy driving.” Over 1,500 people die each year and over 70,000 are injured in drowsy driving accidents. Drowsy driving costs American motorists nearly $13 billion in losses.

Quick Facts

Most “drowsy driving” crashes happen between the hours of midnight and 6:00 AM. Crashes frequently involve a single vehicle leaving the roadway. Crashes often occur on a long, high-speed roadway with the driver not attempting to avoid the crash. The driver is usually alone in the vehicle.

Risk Factors

Sleep loss, even as little as one hour less, can cause marked drowsiness. Use of sleep aids, anti-anxiety medications, or consumption of alcohol .Driving long hours with few or no breaks. Driving between the hours of midnight and 6:00 AM with no other passengers awake in the vehicle. Undiagnosed or untreated sleep disorders causing sleep loss or insufficient sleep.


  • Avoid alcohol. Aside from the obvious dangers, alcohol increases drowsiness.
  • Avoid taking sedatives. Most are fast acting and may take affect before you are safely home.
  • Find a safe place to sleep. Although a short nap can have short term effect, it is best to get proper rest.
  • Have some coffee or caffeinated soda. Some studies show short term benefit from caffeine.

Speak with your doctor about problems falling or staying asleep, feelings of un-restorative sleep or snoring with periods of gasping.  Your doctor may recommend an overnight sleep study to diagnose a possible sleep disorder.

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