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What Tests Should Be Conducted For Severe Chronic Insomnia?

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Posted on Sat, 29 Mar 2014
Question: This is for a top notch sleep specialist. What tests, lab, possibly radiology would you order on a patient that c/o of approximately 20 yr Hx of severe chronic insomnia? Is thyroid the only hormone involved in the sleep process? Thanks, Jacki
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Answered by Dr. Sumit Bhatti (1 hour later)
Brief Answer: Sleep Study, Flexible Scopy, Dynamic MRI Detailed Answer: Hi, Thank you for your query. 1. I would divide the evaluation into: Mandatory (Minimum) Recommended (Ideal) Mandatory: a. Routine: (i) Routine Clinical Examination (ii) Modified Friedman Staging FNPL*: (i) Flexible Nasopharyngoscopy (ii) Awake, Lying Down PSG**: (i) Polysomnpography (ii) Level III Screening Recommended: b. Routine: (i) Calculate the AHI (Mild:5–15/hr; Moderate:15–30/hr; Severe:>30/hr) (ii) Determine whether Central / Obstructive or Mixed. FNPL*: (i) Drug Induced Sleep Endoscopy (DISE) (ii) Multichannel Pressure Recording PSG**: (i) Polysomnography (ii) Level I *FNPL: Fibreoptic NasoPharyngoLaryngoscopy. ** PSG: Polysomnography 2. Dynamic MRI is an important tool. 3. Lifestyle Modifications (weight loss) , Oral appliance, PAP (Positive Airway Pressure) trials should be done. 4. Thyroid hormone is not the only hormone involved in the sleep process. For example, Melatonin is an important hormone which regulates the sleep-wake cycle. I hope that I have answered your query. If you have any further questions, I will be available to answer them. Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

Answered : 2686 Questions

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What Tests Should Be Conducted For Severe Chronic Insomnia?

Brief Answer: Sleep Study, Flexible Scopy, Dynamic MRI Detailed Answer: Hi, Thank you for your query. 1. I would divide the evaluation into: Mandatory (Minimum) Recommended (Ideal) Mandatory: a. Routine: (i) Routine Clinical Examination (ii) Modified Friedman Staging FNPL*: (i) Flexible Nasopharyngoscopy (ii) Awake, Lying Down PSG**: (i) Polysomnpography (ii) Level III Screening Recommended: b. Routine: (i) Calculate the AHI (Mild:5–15/hr; Moderate:15–30/hr; Severe:>30/hr) (ii) Determine whether Central / Obstructive or Mixed. FNPL*: (i) Drug Induced Sleep Endoscopy (DISE) (ii) Multichannel Pressure Recording PSG**: (i) Polysomnography (ii) Level I *FNPL: Fibreoptic NasoPharyngoLaryngoscopy. ** PSG: Polysomnography 2. Dynamic MRI is an important tool. 3. Lifestyle Modifications (weight loss) , Oral appliance, PAP (Positive Airway Pressure) trials should be done. 4. Thyroid hormone is not the only hormone involved in the sleep process. For example, Melatonin is an important hormone which regulates the sleep-wake cycle. I hope that I have answered your query. If you have any further questions, I will be available to answer them. Regards.