Dr. Himanshu Garg

What is a Sleep Study and Who needs it

??What is a Sleep Study?

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.

Who needs a sleep study:

People complaining of the following symptoms need to be screened for Sleep Apnea and may require a Sleep Study

  • Snoring
  • 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

Author: Dr Himanshu Garg

Getting Sleepless about Sleep

It is wee hours of the morning and the clock has just struck 2 am, but for Ms Anita ?sleep is still elusive. She has spent hours tossing and turning in the bed trying to switch off from work. Her stress is further escalating thinking of next day?s engagements and the impact lack of sleep would have on them. Her anxiety is further attenuating any chances of sleep. She somehow manages to get through the next day but starts to get anxious walking to her bedroom that night and this cycle repeats itself. Things eventually reach a stage when the very thought of sleep makes her anxious. Thanks to our booming economy more and more are finding themselves entrapped in this web and turning into insomniacs leading to an insomnia epidemic. Ideally the economic prosperity of a society should not be achieved at the cost of a massive sleep debt of its people but we have already gone too far out. Nonetheless the nature, significance and myriad causes of sleep difficulty remain poorly understood by health care providers and the public at large.

In the modern society sleep should be equated to charging our mobiles, which is very much an active process and not merely a state of rest. Lack of proper charge would only impair its working and utility the next day. Insomnia definitions have been similarly widened from simply meaning lack of initiating or maintaining sleep to include its daytime consequences. These include fatigue, excessive daytime sleepiness, social and occupational impairment, irritability and mood changes. All of these consequences place a considerable economic burden on its sufferers, their employers, health care system and the society.

Insomnia can be either acute or chronic. While most of us might have experienced acute insomnia as a transient problem that resolves quickly when precipitating circumstances like stress, sudden schedule changes or transient illness abates but one has to be careful and it should not be always taken lightly as most of the chronic insomnias start as acute condition as illustrated.

Insomnia can also be classified as either primary or co-morbid. Wherever an underlying cause can be found it is called co-morbid insomnia. Some of the common culprits are acute or chronic pain, chronic medical or psychiatric ailments, drugs or substance use. Often a definite cause cannot be found and primary insomnia is assumed. We are only beginning to unmask the mysteries of its causes and at this stage it appears that it might be an end result of appropriate environmental exposure in genetically predisposed individuals. The clinical assessment of insomnia is based on a careful interview, often supplemented by questionnaires, psychological testing and sleep diaries. At times an overnight polysomnography may be required which means sleeping in a controlled and observed environment in a sleep laboratory where the physician is able to record the brain waves and many other parameters in order to compute total amount of time spent in different stages of sleep.

It must be strongly emphasized that sleeping pill are not the management of choice for insomnia and should be used only as a last resort. Besides problems like adverse effects and habit-forming tendency they do not completely mimic the natural sleep. For example?? the most commonly used sleeping pills, benzodiazepines, have a tendency to decrease the percentage of slow wave or deep sleep thus diluting the refreshing effect of sleep. Therefore rather than applying the ?band-aid? of a sleeping pill every attempt should be made to hunt down and treat the cause. In cases where this is not successful foremost attention should be paid to good sleep hygiene. This involves having a regular sleep-wake schedule, ensuring a comfortable sleeping environment (18- 22C is ideal), eliminating any noise and light, avoiding any tea, coffee or alcohol before sleeping, avoiding naps and resisting looking at the clock in the night. It is amazing how effective these simple steps alone can be in helping to solve the problems of so many people.

Cognitive behavioral therapy is the next therapeutic option. It employs different approaches leading to changes in behavior or cognition to improve sleep. It seeks to eliminate irrational beliefs about sleep and fears of not sleeping.

When nothing else seems to be working and drugs seem to be the only option left, it is best to discuss the options with your physician who can go over the risks and benefits of one drug over the other. These should always be taken under strict medical supervision least you fall prey to their habit forming potential or suffer side effects. Fortunately some of the newer drugs in development will better address some of these concerns and should provide better options in future.


Insomnia and Traditional Indian Therapies – Integrative Medicine

Insomnia is a common, annoying and a potentially debilitating human malady yet it?s nature, ubiquity, significance and myriad causes remain poorly understood.

What is Insomnia?

Insomnia occurs when there is adequate opportunity to sleep (different from Sleep Deprivation where inadequate opportunity results in sleeplessness).

What are the complications of Insomnia?

complications of Insomnia

Integrative approaches in treating Insomnia

  • Eight days of TakraDhara
  • Seven days of Yoga & Pranayama training
  • Herbal internal medicines to overcome presenting complaints as mentioned above

Integrative approaches in treating Insomnia?	Herbal internal medicines to overcome presenting complaints as mentioned above

Series of 150 patients at Medanta under the guidance of Dr Himanshu Garg, Sleep Specialist and Prof Geeta ( Head Ayurveda)with either sleep initiation or maintenance insomnia with end points- tapering off hypnotics and relief in Insomnia were subjected to Integrative medicine therapies with a success rate of 80%


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Medical Award

Dr Himanshu Garg receiving award for achieving Excellence in the field of Sleep Medicine by Dr GN Qazi eminent?scholar and scientist?of the nation and Vice Chancellor Jamia Hamdard University.