Frequently Asked Questions

I think I have a respiratory or sleep disorder. What should I do?

If you suspect you have a respiratory or sleep disorder, please discuss your symptoms with your General Practitioner (GP). Your GP may then write a referral for you to undergo consultation, testing or therapy at one of the Sleep WA clinical sites or sleep laboratories. Specialists such as Cardiologists, Endocrinologists and Psychiatrists can also write referrals to Sleep WA. Once a referral is received from your GP or specialist, you may call 1300 570 700 for a booking. Alternatively, your referring doctor may fax a referral or letter to Sleep WA at (08) 9386 7844 and a member of the Sleep WA staff will contact you to make a booking. Medicare rebates do not apply unless there is a valid referral from a GP, specialist or approved allied health professional.

What happens after I have a respiratory test or sleep study?

If you do not have a follow up appointment with Dr Philpott, please make a follow-up appointment with your GP approximately 1-2 weeks after your test or study. Your GP will have the report approximately one week after the test/study date. Any diagnostic results or treatment recommendations should be discussed with your GP at this follow up visit. If you are recommended a trial of CPAP therapy, our preferred therapy provider will contact you approximately two weeks after your sleep study date to arrange a one-month trial of CPAP therapy.

What is the wait list for an appointment at Sleep WA?

The waiting period for a laboratory (inpatient) sleep study at any one of the four Sleep WA laboratories is typically 1 to 3 weeks. Appointments for a home sleep study or respiratory testing procedure can usually be made within one week. The wait for a Specialist consultation is variable. Whether a patient needs a consult or testing procedure, Sleep WA will endeavour to make the booking process as convenient and efficient as possible.

What is the minimum patient age required to undergo testing at Sleep WA?

Respiratory testing may be conducted on patients 14 years and older. In-Hospital sleep studies can be conducted on patients 16 years and older, while at home sleep studies can be conducted on patients 18 years and older.

What is Obstructive Sleep Apnoea (OSA)?

OSA is the most common sleep disorder and is characterized by abnormal pauses in breathing during sleep or abnormally low breathing during sleep. The breathing pauses are called apnoea and the periods of low breathing are called hypopnoea. In order for a breathing pause to be classed as an apnoea or hypopnoea event, it must last at least 10 seconds. Many apnoea and hypopnoea events last much longer than 10 seconds and may occur several times each hour. With each period of apnoea, oxygen levels are often reduced and at the end of the apnoea, a person momentarily wakes from sleep to begin breathing normally again. This pattern is often disruptive to sleep and the cardiovascular system.

What causes Obstructive Sleep Apnoea (OSA)?

When a person sleeps, the muscles and tissues surrounding the upper airway relax. In normal individuals, this relaxation has little effect on the upper airway. In those with OSA, relaxation of tissue during sleep causes blockage, narrowing, or complete collapse of the upper airway. Blockage or narrowing of the airway may be caused by any combination of the following factors: Structure of the airways: In some individuals the physical features of the upper airway may obstruct the airway and cause breathing difficulty. These physical features may include the jaw, hard palate, soft palate, tongue, uvula (ball of tissue hanging from the roof of the back of the mouth), tonsils or adenoids. Excess body weight or muscle tissue: Excess fat and muscle tissue around the chin and neck crowds the airway and may restrict normal breathing. Likewise, excess weight over and around the abdomen may make breathing more difficult during sleep. Age: As one ages, the muscles surrounding the upper airway become less firm. Without the supportive firmness of the muscles in the neck and jaw, the airway may collapse to some degree during sleep.

What are the signs and symptoms of sleep apnoea?

Symptoms of sleep apnoea may include excessive daytime sleepiness, fatigue, restless sleep, morning headaches, dry mouth upon awakening, decreased concentration, decreased memory, weight gain or depression. Signs of sleep apnoea may include snoring, breathing pauses (apnoea) during sleep, snorting during sleep and frequent waking secondary to choking or gasping for air. The frequent awakenings often lead to frequent trips to the toilet to void during the night. Many individuals with sleep apnoea are unaware they have breathing pauses during sleep and may perceive their sleep to be normal. Thus, the bed partner is often the one to recognise sleep apnoea. It is possible to have sleep apnoea with no obvious symptoms.

What is the relationship between sleep apnoea and snoring?

Obstructive Sleep Apnoea (OSA) is the most common type of sleep apnoea and it is caused by a blockage or collapse of upper airway tissue during sleep. Snoring is caused by vibration of upper airway tissue that occurs as a person breathes. Because both OSA and snoring are caused by excess tissue in the airway, a person who snores will often also have some degree of OSA. However, some individuals that snore do not have OSA.

How is sleep apnoea diagnosed?

Sleep apnoea is diagnosed by an inpatient (laboratory) sleep study or a home sleep study. During both sleep study types, a person sleeps with several wires and sensors attached to the body. These sensors monitor brain, muscle, heart and respiratory function. The duration and frequency of breathing pauses are recorded, as well as awakenings and drops in oxygen that occur as a result of apnoea events.

How might sleep apnoea negatively affect my health?

Sleep apnoea disrupts sleep and causes physiological stress on the body. With each apnoea event, blood oxygen levels typically reduce and stress is placed on the heart. If left untreated over time, moderate or severe sleep apnoea may lead to cardiovascular disease, stroke, diabetes, mood disorder, weight gain, impotence and impairment of cognitive function. Because sleep apnoea causes excessive daytime sleepiness, people with this disorder are also at greater risk of motor vehicle accidents and work-related accidents or mistakes.

Is sleep apnoea treatable?

Sleep apnoea is treatable with various devices and lifestyle changes. The severity of one s sleep apnoea will influence the type of treatment that is recommended. Common treatment options for sleep apnoea include Continuous Positive Air Pressure (CPAP), Mandibular Advancement Splints (Dental Appliances), Provent Nasal Micro Valve therapy, surgery, positional modification during sleep, weight loss and lifestyle modification. Alternate forms of Positive Air Pressure (PAP) such as BiPAP may also be used to treat more complex types of sleep apnoea and obesity hypoventilation.

What is a Mandibular Advancement Splint (MAS)?

A Mandibular Advancement Splint (MAS) is a removable dental appliance worn during sleep to treat Obstructive Sleep Apnoea (OSA), upper airway resistance and snoring. It is most appropriate for mild or moderate sleep apnoea. MAS treatment may also be recommended for those with severe obstructive sleep apnoea who cannot tolerate CPAP therapy. The device works by moving the lower jaw slightly forward, which tightens the soft tissue and muscles of the upper airway. This tightening prevents collapse and increases the volume of the upper airway during sleep. It also prevents vibration of upper airway tissue as a person breathes, which is the most common cause of snoring. Based on sleep study results, a Sleep Specialist at Sleep WA may recommend MAS treatment for OSA, upper airway resistance and/or snoring. MAS devices are made by dentists with specialised training in oral sleep medicine. After obtaining a MAS, it may be advisable to undergo another sleep study wearing the MAS to ensure the device is properly adjusted and effective.

What is Provent therapy?

Provent therapy is a treatment for Obstructive Sleep Apnoea (OSA), upper airway resistance and snoring. Provent therapy involves adhesive nasal micro valves that are applied externally to each nostril during sleep. The device works by utilising Expiratory Positive Airway Pressure (EPAP) to pressurise and stablilise the upper airway as the user breathes out. This pressurisation helps prevent collapse or vibration of tissue that cause apnoea events and snoring. Provent is appropriate for mild to moderate OSA but may also be recommended for those with severe sleep apnoea who cannot tolerate CPAP therapy. Patients may be recommended Provent as a first-line treatment for OSA or as a second-line treatment after demonstrating difficulty with CPAP or a Mandibular Advancement Splint (MAS). Sleep WA recommends a trial of Provent to help determine whether this treatment is suitable. In some cases, it may be advisable that a patient undergo a sleep study with Provent to ensure the device is effective. Provent therapy is entered into the Australian Therapeutic Goods Register with the intended purpose of treating Obstructive Sleep Apnoea (ARTG No. 186646).

What surgical options are available to treat Obstructive Sleep Apnoea (OSA)?

Upper airway surgery is available for patients with OSA who cannot tolerate CPAP or other medical management of OSA. Surgery of the upper airway involves removal of excess tissue at the back of the mouth and throat. This may include removal of tonsils and/or adenoids. Radio Frequency Tissue Ablation (RFTA) is a procedure which shrinks the size of the tongue and/or palate. Multiple procedures may be required and surgical intervention of OSA typically includes a long recovery period. Also of note, surgical improvements in OSA are limited, may diminish over time and there is a risk of complications. For these reasons, surgery to treat OSA is considered a second-line therapy for those who have first tried CPAP, a Mandibular Advancement Splint (dental appliance) or Provent nasal Microvalves. A Sleep Specialist will help determine if surgery is an appropriate option based on sleep study results and examination of one s upper airway. Specialists who perform surgery for OSA are most commonly otolaryngologists (Ear, Nose and Throat Physicians) or oral and maxillofacial surgeons. Bariatric (weight loss) surgery is another type of surgery that may be appropriate for patients with OSA secondary to obesity.

What is lifestyle modification for obstructive sleep apnoea?

Lifestyle modification such as avoidance of alcohol and sedatives, weight loss, or quitting smoking can reduce the severity of Obstructive Sleep Apnoea (OSA). Thus, patients with OSA are encouraged to avoid alcohol and sedatives before bed, as these substances further relax the muscle and tissues of the upper airway and worsen OSA and snoring. Weight loss and smoking cessation (quitting smoking) will also improve respiratory health.

If I lose weight, will my sleep apnoea go away?

Significant weight loss can decrease the severity of Obstructive Sleep Apnoea (OSA) but it is not always a cure . Weight loss is certainly recommended for those with OSA and are overweight. This often becomes more achievable once the OSA is being treated with CPAP or a dental appliance as treatment will result in better quality sleep, improved energy levels and increased motivation.

What if I am recommended CPAP or BiPAP?

If your sleep study reveals that you have a significant component of sleep apnoea and you are recommended CPAP or BiPAP, you may undergo a one-month trial of CPAP/BiPAP therapy to help determine if therapy is suitable for you. The one-month trial includes machine/mask hire and appointments with a highly trained CPAP therapist who provides education, instruction and support. If you are satisfied and happy with therapy at the end of the trial, you have the option to purchase therapy for home use. There is no obligation to purchase a CPAP or BiPAP machine at the end of the trial. Sleep WA are happy to recommend our preferred therapy provider.

What is BiPAP Servo Controlled Ventillation (SCV)?

BiPAP Servo Controlled Ventillation machines look like CPAP machines but they are more sophisticated and regulate breathing in patients with complex sleep apnoea. Complex sleep apnoea is characterized by a combination of obstructive sleep apnoea and respiratory insufficiency caused by central apnoea and periodic breathing. The bi-level positive air pressure keeps the airway open to prevent obstructive sleep apnoea. Concurrently, the servo controlled ventilation provides non-invasive ventilatory support to treat respiratory insufficiency. Based on sleep study results, the specialists at Sleep WA can determine if a patient needs BiPAP SCV rather than CPAP or standard BiPAP. Of note, the need for BiPAP SCV is not common and is most often recommended for patients with neuromuscular weakness or advanced respiratory disease.

What is BiPAP (Bi-level Positive Air Pressure)?

Bi-level Positive Air Pressure (BiPAP) machines look like CPAP machines but they deliver a higher level of air pressure on inhalation and a lesser degree of air pressure on exhalation. The bi-level air pressure keeps the airway open and also helps regulate breathing in conditions such as obesity hypoventilation. Based on sleep study results, the specialists at Sleep WA can determine if a patient needs BiPAP rather than CPAP.

What is Continuous Positive Airway Pressure (CPAP)?

CPAP is the most effective treatment for Obstructive Sleep Apnoea (OSA), especially in moderate or severe OSA. The treatment consists of a small machine that administers positive air pressure through a tube that connects to a small mask worn at the nose or nose and mouth. The CPAP machine administers positive air pressure whilst the patient breathes normally. The air pressure prevents collapse of upper airway tissue that causes snoring and OSA. CPAP may entirely treat and normalise any degree of OSA, even in cases of very severe OSA. The same is not true for other forms of OSA treatment, such as dental appliances, surgery, posture modification, weight loss, or lifestyle modification. These secondary forms of OSA treatment are typically only appropriate and effective when the OSA is mild to moderate.

How are Auto-Titrating and Fixed Pressure CPAP Machines different?

There are two primary types of CPAP machines: fixed pressure machines and auto titrating machines. The fixed pressure CPAP machines deliver the same amount of air pressure all night, regardless of what position a patient is in or how deeply he or she may be sleeping. The auto titrating CPAP machines are more sophisticated and analyse a person s breathing on a breath-by-breath basis throughout the night. Based on this machine analysis, a person receives only the minimum amount of pressure needed to keep the airway open. Some patients find fixed pressure machines most comfortable, while others prefer the auto titrating machine. Sleep WA recommends a one month trial of CPAP therapy in which patients are placed on both auto titrating and fixed pressure settings to determine which type of machine is most comfortable and suitable.

How long will I have to use CPAP?

CPAP is not a cure for Obstructive Sleep Apnoea (OSA). Rather, it is an ongoing treatment and it is typically the only successful treatment in cases of moderate or severe OSA. People with OSA who are recommended CPAP treatment should use CPAP any time they sleep and will most likely require this therapy to treat their OSA for the duration of life. With significant weight loss or lifestyle modification, there is potential for a person to reduce the severity of OSA to a point where alternative treatment options may be appropriate. Alternative treatment options include Mandibular Advancement Splints (dental appliances), posture modification or upper airway surgery. These alternate treatment options are typically used to manage mild to moderate OSA. For example, a person with moderate to severe OSA may lose weight to a point where his or her OSA is in the mild range and then utilise a Mandibular Advancement Splint (MAS) to treat the mild OSA.

Do I need to see a Sleep or Respiratory Specialist before undergoing a study?

Consultation with a Sleep or Respiratory Specialist is not necessary before or after a testing procedure such as a sleep study. This may ultimately reduce cost and waiting time to diagnosis and treatment. Following a test, our specialists send the referring doctor (GP) a detailed letter with the test report, which outlines diagnosis and treatment recommendations. Alternatively, our specialists are happy to consult patients and manage their respiratory and sleep health, accordingly.

I don t understand my sleep study report/results. Is there a guide available?

Many terms and measures in a sleep study report are unfamiliar to patients. Click here to Learn More.

What is the difference between a laboratory (inpatient) and home sleep study?

Laboratory (inpatient) sleep studies are conducted overnight in a hospital room and include supervision by a Sleep Technologist. Quality of data is assured because of this supervision. Laboratory sleep studies also include video monitoring to assist in diagnosis of limb movement disorders, REM behaviour disorder, night terrors, etc. Laboratory sleep studies are the Gold Standard for diagnosing all sleep disorders and they are strongly recommended for patients suspected of mild sleep apnoea, complex sleep apnoea, obesity hypoventilation or other parasomnias (such as limb movement disorders). Sleep WA conducts laboratory sleep studies at Hollywood Private Hospital in Nedlands, Bethesda Hospital in Claremont, South Bank Day Surgery in South Perth and Waikiki Private Hospital in Rockingham. Home sleep studies at Sleep WA are comprehensive and monitor all of the same physiological data as an inpatient study. However, home sleep studies allow the patient to sleep in the comfort of the home. The sleep monitors are attached in the late afternoon by a Sleep Technologist at one of two Sleep WA outpatient clinic sites: Hollywood Hospital in Nedlands and Waikiki Private Hospital in Rockingham. Home sleep studies can also be set up from some GP practices. Please call 1300 570 700 to find out which practices are currently able to provide this service. Once the sensors are attached, a patient goes home to sleep and returns the monitors the next morning. Home sleep studies do not include overnight supervision by a Sleep Technologist; thus, they are most appropriate for patients with a high likelihood of having Obstructive Sleep Apnoea.