sleep study

A healthy night’s sleep is our fundamental human right

We spend almost one-third of our life sleeping. And if you try to combine the hours we sleep in our life time, it?s huge, it?s really huge.

But why do we sleep every day? What makes us feel sleepy every night? And why do we feel good when we wake up from a full night?s sleep?

These questions need answers ? and for centuries, the curious species, we-the-mankind, have been trying to decode sleep.

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.


Sleeping with the CPAP – A Prearranged Marriage

?Think of this as a prearranged ?marriage arranged by people who best understand your interest and once you decide to sleep together the relationship is for lifetime. Going ahead you may not like few things about your new partner but mostly it will be fine? is the mantra given to me by guru about using CPAP, something I try to tell all my patients. If you have been prescribed to ?sleep with the CPAP?, before you embark on this journey few things you should be sure about;

  • Who has prescribed you the CPAP; is the person a qualified sleep physician who has personally looked at your sleep study raw data to make that judgment. Unfortunately this is often not the case in the subcontinent where HME providers in order to push the sales are doing sleep tests and giving out invalidated reports. As an empowered patient you should understand what?s in your best interest.
  • ?Do you understand the need of CPAP– like any chronic disease management you need to have insight about the disease, the implications of non-treatment and mechanism of action of the therapy?? This is a critical part of your physician?s job which impacts the success of the therapy.
  • Have you had a successful CPAP titration study; this helps the physician understand your pressure requirements and which machine shall best suit you. Different physicians/sleep services will use different pathways in lab/at home for doing this. This is followed by few days of trail of CPAP so that you can become accustomed to using this every night.
  • ?Are you satisfied by your mask– Most Titration studies and /or CPAP trials shall give you the opportunity to try a few of these to see with which you are most comfortable. The step is the key to success of this therapy.
  • Do you understand how to operate the CPAP-it?s important for you to understand some of the basic operations; most HME suppliers will be happy to demonstrate the same for you.
  • Have you considered the need of accessories– most important being that of a humidifier; many machines come with inbuilt humidifiers with others it can be easily added. The other accessory to think about is the battery backup especially in the subcontinent where electricity is often erratic.
  • Have you been explained about other potential problems– these could be eye problems because of leak, nasal bridge ulceration due to pressure, aerophagia etc.
  • Do you have a follow up plan– No prescription is complete one; you must work one out with your physician.
Sleeping With CPAP - A Prearranged marriage
Sleeping With CPAP – A Prearranged marriage

One you have ensured all of the above ?you are ready to SLEEP WITH THE CPAP TO A WHOLE NEW TRANSFORMED LIFE!!

How to Improve your efficiency and margins of your sleep service ?

scoring in sleep studies at

  1. Is your sleep facility constantly over budget?
  2. Do you have a regular turnover of technologists?
  3. Do you have a backlog of patient sleep studies still needing to be scored?
  4. Does it take more than three business days to return scored results?

The answer lies in outsourcing your sleep scoring ( THE MYTH VS REALITY)

Myth: Outsourcing sleep scoring is cumbersome and technically difficult

Reality: It is fairly easy to set up and currently technology allows easy access and?? flow of data

Myth:It?s uncommon for sleep labs/services to outsource

Reality: Its is a strongly emerging trend with more and more labs opting for this and currently 1in 4 sleep labs are outsource sleep scoring

Myth: Only big/small sleep labs/services need to outsource

Reality: This can work for any volume of work for different reasons and can potentially lead to major cost savings

Myth: Only expensive sleep scoring service can do a good job in scoring

Reality: As is with everything else in life more expensive do not always meansbetter; you may need to try it to believe it.

?Talk to Sleep Cure Solutions as to how we can help you with solutions that impact your bottomline (Prices starting from 25$ .Negotiable depending on volume)



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.