The Lung Center of the Philippines Sleep Laboratory and Sleep Disorders Clinic has been providing high quality and affordable services for the evaluation of sleep disorders among infants, children and adults since 2004. Through the years, we have continually upgraded our facilities and services to ensure that the best possible care is given to all our patients.
The staff are trained to take care of patients being treated for the different sleep disorders both in children and adults. The Consultants are all Sleep Medicine Specialists, board-certified by the Philippine Society of Sleep Medicine (PSSM) and World Association of Sleep Medicine. Under their guidance, there are sleep medicine fellows-in-training, who attend to patient consults and sleep procedures. To complete the staff are the sleep technicians comprising of respiratory therapists and nurses trained in performing both sleep procedures and electroencephalogram (EEG).
The Consultant staff of the sleep lab are all Sleep Medicine Specialists, boar d-certified by the Philippine Society of Sleep Medicine (PSSM) and World Association of Sleep Medicine. During consult they may recommend the following in-lab sleep tests:
- Test for sleep-related breathing disorders, including sleep apnea, with full-night Diagnostic sleep study or Split Night study
- Titrate or calibrate the levels of positive airway pressure: Continuous Positive Airway Pressure (CPAP), Bi-level Positive Airway Pressure (BIPAP), Adaptive Servo Ventilation (ASV) and Average Volume Assured Pressure Support (AVAPS)
- Evaluate behaviors during sleep due to parasomnias and seizures with video electroencephalography (EEG)
- Evaluate excessive daytime sleepiness with the Maintenance Sleep Latency Test (MSLT)
- Measure the ability to stay awake and alert during the day using the Maintenance of Wakefulness Test (MWT)
- Evaluate Restless Leg Syndrome with Suggested Immobilization Test (SIT)
In summary, the services offered by the sleep laboratory are as follows:
- Evaluation of sleep-related breathing disorders, including sleep apnea and hypoventilation syndromes, through procedures such as full-night diagnostic polysomnogram (PSG), full-night therapeutic PSG, or split-night study
- Consultation of problems related to difficulty sleeping or insomnia with our Insomnia Clinic
- Assessment of unusual behaviors during sleep including parasomnias and seizures, with the help of video EEG and PSG
- Evaluation of excessive daytime sleepiness with the Multiple Sleep Latency Test (MSLT)
- Determination of the ability to stay awake and alert during the day using the Maintenance of Wakefulness Test (MWT)
- Analysis of restless legs syndrome with the Suggested Immobilization Test (SIT)
Type 1 overnight polysomnogram (PSG)
The standard approach to diagnosis and titration of patients with suspected OSA consists of a diagnostic PSG followed by manual titration of CPAP during attended PSG.
Our newly renovated rooms are fully equipped with the latest Type 1 polysomnogram machines (Alice 6). These Type 1 monitors are in-laboratory or hospital-based polysomogram overseen by the technician throughout the sleep study. It captures the respiratory (including end tidal carbon dioxide), cardiovascular and neurologic parameters to produce a comprehensive picture of the patient’s sleep architecture. Type 1 is considered as the reference standard for diagnosing all types of sleep-disordered breathing and sleep disorders.
Home Sleep Apnea Test (HSAT)
An HSAT or Portable Monitoring (PM) is an alternative procedure for the diagnosis of OSA in uncomplicated adults presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. Unattended PM for the diagnosis of OSA should be performed only in conjunction with a comprehensive sleep evaluation. At least a Type 3 PM which measures a minimum of four (4) channels is recommended: 2 respiratory effort and airflow, heart rate/ECG, and pulse oximetry. This may be performed in the comfort of the patient’s own home.
Our laboratory offers the latest Type 3 PM (Alice PDX). It is light, non-invasive, and user-friendly.
Home APAP Titration
An alternative method for determination of optimal positive airway pressure (PAP) such as auto-titrating CPAP (APAP) has gained attention over the past years. Such devices continually adjust pressure as needed to maintain airway patency (APAP titration). Auto-CPAP devices utilize an algorithm that automatically adjusts the PAP based on the patient’s physiological signals. These adjustments can be made with or without attendant technician intervention. Data obtained during APAP titration can be used to provide a fixed single pressure for subsequent treatment. This can be used for home treatment or to titrate a level of pressure that is suitable for long-term treatment with fixed or auto CPAP.
Our laboratory offers APAP machines (AirSenseTM 10) that can be used for 5 days at the privacy of the patient’s home. Troubleshooting can be provided by our Sleep technicians remotely to avoid unnecessary visits to the laboratory.
The Insomnia Clinic is a program under the LCP Sleep Laboratory and Sleep Disorders Clinic that is specifically conceptualized to address the ever-increasing number of patients afflicted with insomnia.
Insomnia, the most common sleep disorder, is the persistent difficulty occurring with either sleep initiation, maintenance or early morning termination. The difficulty persists despite adequate sleep opportunity and is associated with daytime dysfunction.
Our insomnia clinic is open every Fridays, 9-12nn at the LCP OPD Consultation Room 3.
List of Accredited Health Maintenance Organizations (HMO)
- Asian Life
- Carehealth Plus
- East West Health Care
- Flexicare (Health First)
- Generali Philippines
- Health Maintenance Inc.
- Insular Life Health Care Inc. (I-Care)
- Med Asia Philippines
- Medicare Plus Inc
- Medilink (Equicom)
- Medicare Health System Inc.
- Pacific Cross
- Value Care
What is Obstructive Sleep Apnea?
- Ostructive Sleep Apnea (OSA) is a condition wherein a person stops breathing
repeatedly during sleep
- Breathing stops because the airway collapses and prevents air from getting
into the lungs
- Sleep patterns are disrupted, resulting in excessive sleepiness or fatigue
during the day
What causes the airway to collapse during sleep?
- Extra tissue at the back of the airway such as large tonsils
- Decrease in the tone of the muscles holding the airway open
- The tongue falling back and closing off the airway
How many people have Obstructive Sleep Apnea?
- 4 in 100 middle-aged men and 2 in 100 middle-aged women
- Most OSA sufferers remain undiagnosed and untreated
- OSA is as common as adult asthma
What happens if OSA is not treated?
Possible increased risk for
* High blood pressure
* Heart disease and heart attack
* Fatigue–related motor vehicle and work accidents
* Decreased quality of life
What are the signs and symptoms of Obstructive Sleep Apnea?
- If you or someone you know snore regularly and has one or more of the following symptoms, it may be OBSTRUCTIVE SLEEP APNEA
In adults:[ ] Snoring, interrupted by pauses in breathing
[ ] Gasping or choking during sleep
[ ] Restless sleep, difficulty staying asleep
[ ] Memory loss
[ ] Large neck size
[ ] Crowded airway
[ ] Morning headache
[ ] Poor judgment or concentration
[ ] Sexual dysfunction
[ ] Frequent urination at night
[ ] Obesity
[ ] Irritability
[ ] Excessive sleepiness or fatigue during the day
[ ] High blood pressure
[ ] Depression
In children:[ ] Overweight, have enlarged tonsils and adenoids
[ ] Snoring or noisy breathing during sleep
[ ] Difficulty breathing during sleep
[ ] Restless sleep
[ ] Having daytime hyperactivity (sleepy children often become fussy and overactive rather than appearing to be sleepy)
How do you know you have OSAS?
A night time SLEEP STUDY will show if you have OSAS and will help define the best approach to treatment. On the night of the sleep study, technologists position small sensors at different points in you body to continuously record your brain waves, muscle activity, leg and arm movements, heart rhythms, and other body functions during sleep.
How is sleep apnea treated?
The specific therapy for sleep apnea is tailored to the individual patient based on medical history, physical examination, and the results of a sleep study. There are currently no effective pharmacological agents available to treat OSA.
Behavioral changes may be all that is needed in mild cases of sleep apnea, including avoidance of alcohol, tobacco, and sleeping pills, which make the airway more likely to collapse during sleep and prolong the apneic periods. Even a 10 percent weight loss can reduce the number of apneic events for most overweight patients. In some patients with mild sleep apnea, breathing pauses occur only when they sleep on their backs. In such cases, use of pillows and other devices that help them sleep in a side position is often helpful.
Physical or mechanical therapy procedures include nasal continuous positive airway pressure (CPAP), in which the patient wears a mask over the nose during sleep, and air pressure from a pump prevents airway collapse. The air pressure is adjusted so that it is just enough to prevent the throat from collapsing during sleep. Dental appliances that reposition the lower jaw and the tongue have been helpful to some patients with mild sleep apnea or who snore but do not have apnea.
Surgery helps many patients with sleep apnea. Some of the more common procedures include removal of adenoids and tonsils (especially in children), nasal polyps or other growths or tissue in the airway and correction of structural deformities.
Somnoplasty and Coblation are relatively new procedures that use radio waves to reduce the sizw of some airway structures, such as the palate and the back of the tongue. Uvulopalatopharyngoplasty (UPPP) and laser-assisted uvulopalatoplasty (LAUP) are other procedures used to remove excess tissue at the back of the throat (tonsils, uvula, and part of the soft palate). Both procedures may decrease or eliminate snoring but not eliminate sleep apnea itself. In severe, life-threatening cases, a tracheostomy may be performed, which involves creating a small hole in the windpipe and inserting a tuve into the opening to create an artificial airway. Finally, surgical procedures to treat obesity are sometimes recommended for sleep apnea patients who are morbidly obese.
What to Expect During a Sleep Study
On the day of your sleep study, avoid caffeine (coffee, tea, cola, chocolate) and alcohol after 12pm, and try not to nap. Before coming to the sleep center, wash your hair with shampoo only, dry your hair and do not apply hair sprays, oils or gels.
• SHOULD I TAKE MEDICATION AS USUAL?
It is important for your sleep professional to know if you are taking any prescribed or over-the-counter medication, since certain medications can affect sleep and the interpretation of a sleep study. Sometimes certain medications need to be discontinued gradually prior to a sleep study so that the sleep study results can be interpreted correctly. Do not discontinue any prescription medication without first talking with your health care professional.
Before coming to the center, you should pack an overnight bag as you would for an overnight stay at a hotel or a friend’s house. You may wish to include your own pillow and extra clothing. Bring your medications if you would need them in the time you are away from home.
• WHAT WILL HAPPEN WHEN I ARRIVE AT THE SLEEP CENTER?
When you arrive at the sleep center-usually between 6:00 pm, and 9:30pm – the technician will greet you and show you to your bedroom. You will have time to change into night clothes and get ready for bed as you do at home. If you have a commitment in the morning (if, for example you have to be at work at a certain time), be sure to inform the sleep technician prior to your study so your wake-up time can be confirmed.
Next, approximately two dozen sensors which are generally small metal discs (called electrodes) are applied to the skin of your head and body using an adhesive. These sensors monitor brain waves, muscle movements, eye movements, breathing through your mouth and nose, snoring, heart rate, and leg movements. Flexible elastic belts around your chest and abdomen measure your breathing. A clip on your finger or earlobe monitors the level of oxygen in your blood and your heart rate. None of these devices are painful and all are designed to be as comfortable as possible.
• HOW WILL I BE ABLE TO SLEEP IN A STRANGE ENVIRONMENT WITH ALL THOSE WIRES ON ME?
This is the question asked most frequently by patients prior to their sleep studies. Many people expect the sleep center to be cold, bright, technical and impersonal looking. At most sleep centers, however, the surroundings (and especially the bedrooms) are homey and comfortable, like a hotel room. Most patients fall asleep quickly. Some sleep disorders centers offer medication to patients who have significant difficulty falling asleep.
• WHAT HAPPENS DURING THE SLEEP STUDY?
The technicians will stay awake all night while you sleep to make sure that you are safe and also to monitor your sleep. They and their technical equipment will be in a room separate from your sleeping room. You should feel free to sleep in your customary position although during the night a sleep technician may ask you to try to spend some time sleeping on your back. Your sleep may also be videotaped for later review of any abnormalities observed during the study.
While you are sleeping, various important body functions and measurements are monitored and recorded. If a breathing problem is observed during your study, the technician may awaken you to ask you to try a device that treats breathing problems during sleep. This device, called a positive airway pressure (PAP) device, includes a small mask that fits over your nose or soft silicone plugs that fit into your nostrils.
- Philippine Clinical Practice Guidelines on the Management and Diagnosis of Obstructive Sleep Apnea in Adults, April 2016
- Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479–504.
- Stansbury RC, Strollo PJ. Clinical manifestations of sleep apnea. J Thorac Dis. 2015;7(9):E298–E310. doi:10.3978/j.issn.2072-1439.2015.09.13
- Capdevila OS, Kheirandish-Gozal L, Dayyat E, Gozal D. Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc. 2008;5(2):274–282. doi:10.1513/pats.200708-138MG