A: People with sleep disorders commonly present to their GP with a range of symptoms.
- not being able to go to sleep or to stay asleep during the night;
- feeling tired when they wake up in the morning no matter how much sleep they’re getting; and
- sleepiness during the day.
It can also include some more subtle symptoms like difficulty concentrating or mood problems.
The most commonly studied sleep disorders are insomnia and obstructive sleep apnoea. There are also some less common disorders such as shift work disorder, or disorders of circadian rhythm, and then conditions like narcolepsy, which cause severe sleepiness.
And then there are conditions of movements during sleep, which include things like restless leg syndrome, and REM behaviour disorder – a condition where people act out their dreams, and can be quite distressing for both them and their partners.
People with sleep problems don’t necessarily need diagnostic tests straight away as we mostly diagnose based on the patient’s history. This involves talking to the patient and getting an idea of what their sleep habits are and what symptoms are bothering them and/or their partner.
We can then decide to do a sleep study to establish the severity of the sleep disorder such as in the case of sleep apnoea, and to tease out some of the other conditions. It is quite common for more than one sleep problem to coexist.
A sleep study can be performed in a hospital or at home for some patients. The sleep physician will determine the best place for a person to have their sleep study based on what sleep disorder is suspected as well as the person’s other health problems and home situation.
We will monitor a person’s brain activity using electrodes stuck on their head. Your breathing will be monitored a few ways: the flow of your oxygen will be measured from your nose or mouth, your oxygen levels will be monitored using an oxygen probe on your finger or ear, and the movement of your chest and abdomen be used in diagnosis. Position sensors will be used to gauge movement in your legs, and a video monitor helps diagnose movement disorders.
When distance is a barrier
Australia is ideally suited to telehealth, and in my view, sleep medicine particularly so, because the actual physical examination while important, is not essential in every sleep patient.
Telehealth involves the consultation between the specialist and the patient via a web-based program that has appropriate levels of security to ensure that there’s no hacking of, and stealing of the medical information.
This is particularly helpful for patients that live outside a metropolitan area, who instead of having to drive two hours to an appointment, they can sit at home and have a consultation using their computer, phone or tablet.
Telehealth works well in patients who have already been diagnosed, and who are on review appointments every 12 months or so, as these patients are are basically sorted out and clinicians can receive a lot of the information that we get about their sleeping through their sleep apnoea machines (CPAPs).
Medicare provides the same rebate for telehealth consultations to those living in rural or remote areas as they would pay visiting in person.