Patient Packet. Sleep/Wake Disorders Center Centers of Excellence

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1 Patient Packet Sleep/Wake Disorders Center Centers of Excellence

2 Sleep Center directions To help determine your medical treatment, your physician has requested that you undergo sleep testing at the Community Health Network Sleep/Wake Disorders Center located at: Community Hospital North Sleep/Wake Disorders Center 7250 Clearvista Dr., Suite 350 Indianapolis, IN The Sleep Center is located on the campus of Community Hospital North at 82nd Street, just off I-69 at Exit 1. Upon entering the 7250 building, take the elevator to the 3rd floor. Turn left and proceed to the end of the hallway. Turn left again and proceed to Suite 350. Please press the intercom button and a technician will assist you. If you need assistance from the Lobby to the Sleep Center, please call to make arrangements prior to your appointment. Wheelchairs are available in the Lobby. Community Hospital North Pediatric Sleep/Wake Disorders Center 7150 Clearvista Dr. Indianapolis, IN Located at 82nd Street, just off I-69 at Exit 1, the Sleep Center is located within Community Hospital North. Please enter through the main entrance and report to Outpatient Registration. Community Hospital East Sleep/Wake Disorders Center 1400 N. Ritter Avenue, Suite 481 Indianapolis, IN ZZZZ after 4:30 p.m. Community Hospital East is located on Ritter Avenue between 10th & 16th Streets. Community Health Pavilion Community South Sleep/Wake Disorders Center 333 E. County Line Road, Suite D Greenwood, IN ZZZ Take I-65 to the County Line Road Exit. Head West on County Line and cross Emerson Avenue. The Community Health Pavilion will be on the South side of the street, across from Smock Golf Course.

3 Map of locations Meridian Street Community Medical Pavilion Carmel 82nd Street Community Hospital North Greenfield Washington Street Capital Ave. 16th Street Community Hospital East Meridian Street Shelbyville Stop 11 County Line Road Community Hospital South Sleep/Wake Disorders Center Please pre-register prior to your test at ZZZZ. You may also pre-register online at ecommunity.com You have been scheduled for the following: Test Test date Arrival time End time Overnight study Daytime study CPAP/BIPAP adjustment Please do not arrive earlier than 8:30 p.m. for your appointment unless otherwise noted below. Other: If you have questions regarding insurance benefits for testing, please contact your insurance company regarding your personal coverage. If you cannot keep your appointment, please call For additional information regarding Sleep/Wake Disorders, visit us online at ecommunity.com/sleep

4 General information Go about your usual activities, but NO daytime naps. DO NOT drink alcoholic beverages the day of the study. DO NOT drink coffee, tea or soda with caffeine after 5 p.m. *Chocolate also contains caffeine. Please bathe and shampoo your hair before coming. DO NOT put any conditioners, hairspray or oils in your hair. Also, please do not put lotions on your body. Please have your evening meal before arriving for your sleep study. Please bring sleeping attire (pajamas, gown, etc., preferably not silk) and toiletries. You are welcome and encouraged to bring your own pillow to use during your stay. The sleep study will begin at approximately 11 p.m. At that time, no electronic devices can be used. These devices include but are not limited to: TVs, ipods, computers, or cell phones. A quiet, uninterrupted night is vital to the interpreting physician in making a diagnosis. For daytime tests, we suggest that you bring magazines, puzzles, crafts, etc., to keep busy between testing. Televisions and VCR/DVD players are in each room. If you are presently taking medications, do not bring them with you unless you MUST take them during your study. If so, bring ONLY that/those in dose(s) in their original containers. Over the counter medications are not available at the Sleep/Wake Disorders Center. Newly prescribed medications that affect your sleep (sleeping pills, tranquilizers, etc.) should not be started within one week of the sleep test. Breakfast and lunch are provided if you are staying for daytime testing. All rooms are private with restroom facilities. Please note that all sleep tests are considered outpatient procedures. Sleeping accommodations are not available for family members or guests. If a child is 17 years of age or younger, we do require that a parent or guardian stay with the child overnight. Smoking is NOT permitted in the hospital or on hospital grounds. What is a sleep study? A sleep study, also called a polysomnogram, measures the quality of a person s sleep. The study allows our sleep specialist to diagnose and treat many sleep disorders. The test does NOT hurt. It is painless and non-invasive and occurs in our state-of-the-art sleep laboratory. We use tape or sticky paste to place all electrodes on you. We do not use any needles or drugs. You will be snuggled in a beautiful, comfortable room similar to what you would find in an upscale hotel. Our equipment and monitors are located in a central control room so as not to alarm or disrupt your sleep. The data collected while you sleep includes: brain activity, muscle tone, heart rate, breathing movements and patterns, airflow and oxygen levels, and arm and leg movement. What to expect When you arrive at the Sleep Center, the technologist will apply several electrodes and sensors to your head and other parts of your body. This process will take approximately one hour, so you will not be able to go to bed as soon as you arrive. Television and radio are not permitted once the test has started. The test will last a minimum of six hours in bed. Often, additional testing is scheduled during the day following your overnight test. Please refer to Your Appointment page for your testing times. If no additional testing is scheduled, you will be allowed to leave. The results of your test will be analyzed by a neurologist or a pulmonologist. The results will be sent to the referring physician approximately two weeks after the study. You will receive a copy of your results via mail approximately four to six weeks after the study. Please note when you receive your billing for these tests, you will receive two statements. The hospital bill includes charges for technicians, equipment and supplies. The physician bill includes charges for the supervision and interpretation of the test results. Sleep studies can make a huge contribution to both your mental health and physical well-being.

5 Information on sleep/wake disorders Good sleep is important for good health. However, according to the National Sleep Foundation, 65 percent of Americans report that they do not get enough sleep (most adults need six to eight hours). Sleep disorders and lack of sleep are not just annoyances; they are serious problems. Those with sleep problems may think or move more slowly, make more mistakes or have memory difficulties. These negative effects can lead to poor job productivity and can be a contributing factor in motor vehicle accidents, weight gain, heart problems, colds and flu. Lack of sleep can also strain emotions, family and job relationships and social encounters, and lead to greater health problems if left untreated. Sleep apnea/snoring Sleep apnea is the cessation of breathing for a period of 10 seconds or more. It is characterized by snoring or choking/gasping for breath during sleep, daytime sleepiness and morning headaches. Recent studies indicate that there is a relationship between these sleep disorders and heart disease. Insomnia Insomnia is the inability to go to sleep or stay asleep. Restless leg syndrome (RLS) and periodic limb movement disorder (PLMD) RLS/PLMD is the movement or twitching of the legs during sleep that can sometimes awaken the individual. Narcolepsy/excessive daytime sleepiness Narcolepsy occurs when the brain doesn t accurately interpret when to sleep and when to be awake. Other sleep disorders While sleep apnea, periodic leg movements and continuous agonizing drowsiness account for 95 percent of all sleep disorders, others do exist. Among them are parasomnias/sleep walking and talking, bruxism/teeth grinding and poor sleep hygiene/sleep habits. Talk with your physician or a sleep professional if you are concerned about one of these disorders. General warning signs that may indicate a sleep disorder: Snoring Gasping or choking during sleep Memory loss Hypertension Excessive daytime sleepiness Restless sleep Poor judgment/concentration Irritability Morning headaches Obesity Congestive heart failure Attention deficit disorder Sexual dysfunction Of course not all sleep problems represent a sleep disorder, but poor quality of sleep can be related to many serious health risks and should be diagnosed and treated by a board-certified sleep physician.

6 Please complete this questionnaire and bring it with you to your appointment.

7 Please complete this questionnaire and bring it with you to your appointment. Community Health Network Sleep/Wake Disorders Center Sleep history questionnaire: Name: Date of Birth: Age: Height: Weight: Referring Doctor: Primary Care Doctor: Additional Doctors to send sleep/wake test results to: address: Medical History: What was your weight: 6 months ago 2 years ago High School Do you smoke? Yes h No h If so, how many packs per day? How many cups of coffee, or caffeinated soft drinks, do you drink on an average day? Do any of your immediate family members have a sleep disorder? Yes h No h If so, what kind? Month/Year of last hospitalization: / For what problem? Current medications: (Please list: name, strength, and how the medication is taken) List any food and medication allergies you have:

8 A few simple guidelines: The following questions will help us to better understand your sleep/wake behavior and problems, and more accurately interpret the results of your sleep/wake testing. It is important for you to answer each question as completely and accurately as you can. Some of the questions might be better answered by someone else (e.g. your spouse, roommate, partner, family member.) Please get their input as well. Do not spend too much time on any question. Your first impression is generally the most accurate. The time period referred to is the PRESENT, which includes the last 6 months, unless otherwise specified. A WEEKDAY is any day on which you ordinarily work. If you are engaged in shift work, or have any type of unusual sleep/wake schedule other than DAYTIME and NIGHTTIME, refer to your particular major sleeping and waking periods. All answers will be kept confidential. Occupation: Your present work schedule is best described as: Unemployed h Days h Evenings h Nights h Rotating h Your work shift starts at: a.m. Your work shift ends at: a.m. p.m. p.m. Your current sleep schedule: Week Days Week Ends What time do you usually go to bed? How long does it usually take for you to go to sleep? What time do you usually get up? Questions about your current sleep: How often do you: Never Sometimes Always sleep soundly? h h h have frequent brief awakenings? h h h have difficulty going to sleep? h h h wake up early in the morning and can t go back to sleep? h h h experience restless legs? h h h (crawling, aching sensation in legs relieved by movement) have periodic body movements during sleep? h h h

9 Never Sometimes Always have restless disturbed sleep? h h h disturb your partner s sleep because of snoring? h h h stop breathing in your sleep? h h h awaken from sleep due to choking? h h h awaken from sleep due to pain? h h h awaken from sleep to urinate? h h h walk in your sleep? h h h awaken screaming, violent or confused? h h h physically act out your own dreams? h h h feel anxious about inability to sleep? h h h have nightmares (frightening dreams)? h h h feel unable to move (paralyzed) for a few minutes upon awakening or going to sleep? h h h experience dream-like images (hallucinations) upon awakening even though you know that you are awake? h h h have insomnia? h h h have a headache upon awakening? h h h Do you have any other problems with your sleep? (please describe) Questions about your current ability to stay alert: How great of a problem do you have: Never Sometimes Always staying awake and alert during the day? h h h with attention and mental focus? h h h staying awake while inactive (e.g. reading)? h h h doing your job because of drowsiness? h h h driving because of drowsiness? h h h

10 During the past 6 months, how often have you had: Never Sometimes Always spontaneous episodes of unintentionally falling to sleep? h h h any near-accidents because of sleepiness? h h h Have you had any actual accidents due to sleepiness? Yes h No h How many? How often do you: Never Sometimes Always experience vivid dreams during naps? h h h perform a complex act such as driving a car to the wrong destination and not remember how you did it? h h h have a sudden feeling of weakness come over you when you laugh, are angry or excited? h h h feel weak knees when you laugh? h h h What is your personal interpretation as to why you have your particular sleep/wake problem? Epworth Sleepiness Scale: How likely are you to doze off or fall asleep in the following situations in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to decide how they would have affected you. Use the following scale to choose the most appropriate number for each situation: 0 = no chance of dozing 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing SITUATION Sitting and reading Watching TV Sitting inactive in a public place (e.g. a theater or a meeting) As a passenger in a car for an hour without a break Lying down to rest in the afternoon when circumstances permit Sitting and talking to someone Sitting quietly after a lunch without alcohol In a car, while stopped for a few minutes in traffic Total: CHANCE OF DOZING

11 Homecare Company Referrals: In the event that you should require the service of a homecare company, we will refer you to Community Home Health Services. If they are not a provider covered by your insurance, another selection will be necessary for insurance approval. If you have a personal preference for a homecare company, please list below. Preferred Homecare Company: Consent for Video Taping: I, the undersigned, have been informed of the photographic procedure and hereby grant permission to the Community Health Network and/or, M.D. to use the video for diagnosing sleep related problems. I realize that I may withdraw my consent at any time and that this action will not prejudice or jeopardize the care I receive in any way. I have been given an explanation for the purpose and intended use of the resulting videotape and the approximate amount of time required for taping. I have had described to me the methods used to insure confidentiality. Your sleep study will start as close to 11:00 p.m. as possible. Once your study has started, no electronic devices can be used. These devices include, but are not limited to: TV, IPod, Computer, or Cell Phone. A quiet, uninterrupted night is vital to aid your physician in making a diagnosis. Thank you for understanding. I understand that most insurance companies require at least 6 hours of time in bed to justify payment for a sleep test. Furthermore, I understand my voluntary termination of the sleep test before 6 hours may result in my insurance company s denial of payment. I have read all information provided to me and have answered all questions as accurately as possible. I hereby give my consent to proceed with testing. Signature (Individual of legal age or parent/guardian or legally authorized representative) Date Witness (Name and Credential) Date Time

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