Siamak T. Nabili, MD, MPH
Siamak T. Nabili, MD, MPH
Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
In this Article
What are some objective tests to measure sleepiness?
For someone who reports being sleepy during the day, it is sometimes helpful to measure how sleepy he or she is. Also, after treatment of sleep problems, we sometimes want to measure improvement in daytime sleepiness.
Sleepiness can be measured with a Multiple Sleep Latency Test (MSLT). Basically, the MSLT measures how fast someone falls asleep during the day. It must be done after an overnight sleep study (polysomnography) has documented adequate opportunity for sleep the night before and no untreated obstructive sleep apnea. The test is composed of four to five "naps" that last 20 minutes each and are spaced two hours apart. The person is instructed to "try to fall asleep." The average time to fall asleep is calculated for all four or five tests. A normal time would be greater than ten minutes needed to fall asleep. Excessive sleepiness is defined as falling asleep in less than five minutes.
The Maintenance of Wakefulness Test (MWT) also measures daytime sleepiness. The person taking this test is instructed to "try to stay awake." This is repeated for four 40-minute sessions, two hours apart. Not falling asleep in all four tests is the strongest objective measure of the absence of daytime sleepiness.
Some businesses use these tests to ensure that their employees are not excessively sleepy while at work. Specifically, airline pilots and truck drivers who experience sleepiness need to have a test to ensure public safety and productivity at work. Unfortunately, there is no test that will guarantee that someone will not fall asleep at his or her job or while driving.
What are the treatments for snoring?
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The goals for the treatment of surgery may be difficult to determine. The problem of snoring usually is a problem for the bed partner or roommate. Therefore, successful treatment should also include the goal of achieving a successful night's sleep for the bed partner or roommate. This makes treatment of snoring a difficult challenge. For example, someone may have a successful treatment if his or her snoring decreases from a jackhammer level to that of a passing truck. If their bed partner is happy, then the snoring problem is "cured." However, another person whose snoring decreases from a mild sound to the level of heavy breathing may still have an unhappy bed partner.
Most procedures to treat snoring are focused on reducing the flutter or movement of the soft palate (roof of the mouth). This addresses palatal flutter snoring. If the snoring originates from behind the tongue or from the lateral walls of the throat, palatal procedures will be less effective.
It is wise to look at the "success" reports for various treatments with a critical eye. If the number of nights that a bed partner has to leave the room decreases from seven nights per week to one night per week, is that success? Some would say that it is. However, the bed partner (or snorer) still has to leave the room one night per week. It is important to know what the expectations for a "cure" are before considering any treatments.
Medically Reviewed by a Doctor on 12/17/2013
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