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QUESTIONS and ANSWERS

What insurances do you accept?
What do I need to know before my first visit?

I snore. Do I have sleep apnea?
What is a sleep study?
What do I need to do before my sleep study?
What is an NCV/EMG?
What do I need to know before my EMG?
What is an EEG?
What do I need to know before my EEG?

What insurances do you accept? Texas Neurology Center accepts Aetna, BlueCross BlueShield, Cigna, FirstHealth, Humana, Medicare, PHCS, Tricare, United HealthCare and Seton Physicians Health Network (SPHN) except for EPN plan.
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What do I need to know before my first visit? Use this website for directions to our office. Plan on arriving early to fill out the necessary paperwork or download the forms from the web site and fill them out in advance. Unfortunately, the schedule is frequently very full for the doctor all day, so if you miss or are late for your scheduled appointment time, you may need to reschedule for another day so as not to interfere with other patients’ scheduled appointment times.
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I snore. Do I have sleep apnea? The answer is maybe. An estimated 10-30% of adults snore, and most do not have sleep apnea. Snoring is caused by vibration of the relaxed tissue in your nose, mouth, or upper throat. Some people snore loudly but continue to breathe. In other people, however, the tissue relaxes to the point that it closes up the airway, which results in an obstructive apnea (stopping breathing). People who are overweight or have a large neck are more likely to have sleep apnea. Bed partners may notice pauses in breathing, gasping, or thrashing at night. Symptoms of sleep apnea include unrefreshing sleep, excessive daytime sleepiness, drowsiness while driving, morning headaches, frequent awakenings at night, difficulty falling asleep, poor concentration, irritability, anxiety, loss of interest in sex, or depression. High blood pressure or swelling in the legs may also be signs of undetected sleep apnea. Sleep apnea is a life-threatening but treatable illness which can trigger heart attacks, heart failure, or strokes. If you think you may have sleep apnea, it is important to discuss this with your doctor.
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What is a sleep study? Sleep studies are tests that watch what happens to your body during sleep. The studies are performed to find out what is causing your sleep problems. A sleep study is also known as a polysomnogram (PSG).

For the PSG study, small metal discs called electrodes will be placed on your head and body with a small amount of glue and tape. The glue washes off easily after the test. The electrodes record your brain activity, eye movements, oxygen and carbon dioxide blood levels, heart rate and rhythm, breathing rate and rhythm, the flow of air through your mouth and nose, the amount of snoring, body muscle movements, and chest and belly movements.

Soft elastic belts will be placed around your chest and belly to measure your breathing. Your blood oxygen levels will be checked by a small band-aid like clip (oximeter) placed either on the tip of your index finger or on your earlobe.

Wires for each channel of recorded data lead from the patient and converge into a central box, which in tum is connected to a computer system for recording, storing and displaying the data. In addition, a small video camera in the room allows the technician to observe you visually from an adjacent room.

Setup can take 45 minutes or more in order to get everything connected properly. Then you will go to your private room that resembles a hotel room complete with a Sleep Number bed. The electrodes, elastic belts, and oximeter are designed to be as comfortable as possible. You will not feel pain during these tests. It may feel odd to be hooked to the sleep study equipment. The sleep lab technician understands that your sleep may not be the same as it is at home because of the equipment. Try to relax and make yourself as comfortable as possible.

At the beginning of the test, you will be asked to do things such as blink your eyes, move your legs, and hold your breath. This is done to make sure the equipment is recording correctly. The technician will be in a separate room checking the recording all night while you sleep. (If you are a shift worker you will be sleeping during your regular sleep period in the daytime.) Don't worry if you need to go to the bathroom during the night. Simply call to the technician who will come and easily detach you from the central box.

The types of sleep studies you might have include:

Diagnostic Overnight PSG - Used for general monitoring and evaluation.

Multiple Sleep Latency Test (MSLT) - Used to measure the degree of daytime sleepiness and to assess for the presence of stage R sleep in your naps. It is performed on the morning following a diagnostic ovemight PSG. You have the opportunity for four or five 20-minute naps separated by 2 hours each. The testing procedure includes essentially the same PSG leads as a diagnostic overnight study. During the periods between naps, you must stay awake and not fall asleep.

Two Night PSG with CPAP Titration - Used for general monitoring and diagnostic evaluation on the first night. If sleep apnea is discovered, you return for a second night to determine the necessary CPAP pressure required to alleviate the sleep apnea. A titration study is done for each patient with sleep apnea since there is no "one size fits all" solution.

Spilt Night PSG with CPAP Titration - Conducted at times when moderate or severe sleep apnea is confirmed early enough during the first half of the night. The second half of the night then is used for CPAP titration.

CPAP (Continuous Positive Airway Pressure) therapy is generally the first line of treatment for
obstructive sleep apnea. The CPAP device delivers pressurized air through tubing to a mask that
fits over your nose or over your nose and mouth. The pressurized air acts as an airway splint. It
gently opens your throat and breathing passages, allowing you to breathe normally while asleep.
There are many masks to choose from and the technician will help you find a comfortable fit
before your study begins. During the titration study, the technician will set the air pressure on the
CPAP at a certain level and then watch the resulting measurements. If that pressure does not
reduce the number of apnea and hypopnea events, or eliminate the snoring, the technician will
adjust the air pressure and continue observation. This process continues throughout the night
until the optimum pressure is reached.
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What do I need to do before my sleep study? Please fill out a sleep questionnaire before your appointment. If you need to cancel or reschedule your appointment, please do so at least 24 hours in advance. Please bathe and shampoo and dry your hair prior to your test. Avoid using skin creams, oils, or hairspray. Avoid caffeine usage, which includes coffee, most carbonated beverages, and chocolate, for at least 12 hours prior to the study. Avoid alcohol usage for at least 12 hours prior to the study. Bring loose-fitting pajamas to sleep in. Feel free to bring your own pillow and teddy-bear with you for the night. Your study will end by 6:30 AM. Take all medications as you would normally take them, unless otherwise instructed. Bring all your medications with you to your study. Try not to take naps during the day if you can help it.
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What is an NCV/EMG? An NCV/EMG is used to diagnose nerve and muscle diseases. This is usually a two-part test consisting of nerve conduction velocities (NCV) and electromyography (EMG). It is routinely just referred to as an EMG. Some people, though, only have the NCV portion depending upon what diseases are being evaluated.

You will first change into a gown. If your arm or leg is too cold, we will warm it by soaking in warm water or wrapping the arm or leg in warm towels. This is important because if the arm or leg is too cold it can give a false response.

The NCV is performed first. Electrodes are covered in gel and then taped to the skin over various nerves. The electrodes are flat metal discs, rings, or bars. One nerve is tested at a time. The nerve is stimulated with a tiny electrical current which feels like little tingles or shocks. Depending on how strong a stimulus is needed for your nerve, the sensations range from irritating to very uncomfortable, but only briefly. The signal the nerve sends out is measured “downstream” at the electrode taped to the skin. You will only feel the sensations where the nerve is stimulated. You will not feel anything at the “downstream” recording site. How big the response is and how fast it travels from point A to point B are important in diagnosing whether a nerve is sick, where the nerve is sick, and how severe the problem is. How many nerves are tested depends on your particular problems. This portion of the test lasts approximately 1 hour.

The EMG is performed next. The doctor puts an acupuncture-like needle into the muscle to record the electrical sounds from the muscle when you are relaxed and when you contract the muscle. These sounds indicate whether a muscle is healthy, whether the muscle has a poor nerve supply, or whether the muscle itself is sick. Nothing is injected and you do not receive any shocks. This is uncomfortable during the test and may leave you with a bruise or mild muscle soreness. Although unusual, this can last a few days. This portion of the test takes approximately 15 minutes.

Dr. York will discuss the test results with you immediately after the test if you have both portions of the test, or she will call and discuss the results with you later if you have only the NCV portion.
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What do I need to know before my EMG? You do not need to fast or eat any special foods before the test. Continue to take your prescribed medications. Take a bath or shower the morning of your test. Do not use any lotions or oils on your arms and legs the day of the test.
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What is an EEG? An EEG measures tiny electrical impulses produced by the brain. The pattern of this electrical activity is important in diagnosing certain diseases. To measure these impulses, approximately 20 electrodes are placed on the scalp. This is painless. The electrodes only record activity. They do not produce any sensation. This test is similar to having an EKG for your heart only an EEG lasts longer, approximately 30 minutes of recording time after the electrodes have been placed. The electrodes are flat metal discs held in place with a sticky paste. The electrodes are connected by wires to an amplifier and a recording machine. For the most part you will lie relaxed on the exam table with your eyes closed. At certain times, though, you will be asked to breathe deeply and rapidly for a few minutes and look at flashing lights. An EEG cannot “read your mind,” measure intelligence, or diagnose mental illness.
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What do I need to know before my EEG? Please be sure your hair is clean and dry without mousse, hair spray, gel, or oil. Be sure not to skip any meals before your test; however, avoid food or drink containing caffeine for at least 8 hours before the test. The doctor may order a special sleep-deprived EEG and ask you to reduce the amount of sleep the night before to less than 4 hours. You do not need to be sleep deprived unless instructed to do so when your appointment is made. You may take any of your medications before the test unless instructed by the doctor.
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