North Florida/South Georgia Veterans Health System
The Malcom Randall VAMC (Gainesville) Sleep Center provides evaluation, testing, and treatment for sleep disorders. We offer a 6-bed sleep testing facility with state of the art equipment, registered sleep technologists and board certified sleep physicians to ensure you receive a thorough and complete evaluation. There are more than 80 different recognized sleep disorders including sleep apnea, narcolepsy, restless legs syndrome and periodic limb disorder, and insomnia. Sleep disorders and problems with sleep can have a direct impact on day-to-day activities and a Veteran’s quality of life. A consultation with a sleep physician prior to testing may be required and help determine the effective testing and treatment plan.
If you are unable to keep your appointment(s) please contact the Sleep Center at least 48 hours prior to your appointment. This will allow us to schedule another patient in your appointment slot.
What is Sleep Apnea?
What are the Signs and Symptoms of Sleep Apnea?
Why do I Need to Worry About Sleep Apnea?
How is Sleep Apnea Diagnosed?
How is Sleep Apnea Treated?
Sleep Studies at the Gainesville
What to Expect During and After Your Sleep Study
Treating Your Sleep Apnea
Problems Using your CPAP/BiPAP
Caring for your CPAP/BiPAP
Getting Replacement Masks/Tubing
Sleep apnea is a common sleep disorder that causes frequent pauses in breathing during sleep and is often accompanied by snoring, poor sleep and daytime sleepiness. About 2% of women and 4% of men in the U.S. suffer from the condition.
The word apnea means "stop breathing." Patients with the usual form of sleep apnea (obstructive sleep apnea) actually close off their airway at night for a few seconds at a time. The airway closure occurs either behind the tongue or behind the nose. Patients continue to make efforts to breathe. Then after several seconds, the brain, realizing it is not getting any oxygen, arouses or "wakes up." This allows the upper airway to open and allow breathing. The brain goes to sleep again and the cycle may repeat itself several hundred times a night. The sleep disruption can cause the sufferer to wake up several times an hour, preventing deep, restful sleep. Patients are often not even aware that they are doing this (although the bed partner often notices these symptoms).
Additional information can be found at the National Heart, Lung, and Blood Institute: What is Sleep Apnea?
Major Signs and Symptoms
One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses.
The snoring usually is loudest when you sleep on your back; it might be less noisy when you turn on your side. You might not snore every night. Over time, however, the snoring may happen more often and get louder.
You're asleep when the snoring or gasping happens. You likely won't know that you're having problems breathing or be able to judge how severe the problem is. A family member or bed partner often will notice these problems before you do.
Not everyone who snores has sleep apnea.
Another common sign of sleep apnea is fighting sleepiness during the day, at work, or while driving. You may find yourself rapidly falling asleep during the quiet moments of the day when you're not active. Even if you don't have daytime sleepiness, talk with your doctor if you have problems breathing during sleep.
Others signs and symptoms of sleep apnea include:
- Morning headaches
- Memory or learning problems and not being able to concentrate
- Feeling irritable, depressed, or having mood swings or personality changes
- Waking up frequently to urinate
- Dry mouth or sore throat when you wake up
Patients with sleep apnea are often sleepy during the day. Sleepiness is associated with inability to concentrate, remember or think. There is a significantly higher risk for falling asleep while driving, using heavy machinery or other activities that require attention.
Sleep apnea increases the risk of high blood pressure (which is the main cause of heart disease) plus the events that occur during apnea can add stress to the heart. People with sleep apnea have higher risk of coronary artery disease. Sleep and breathing disorders can increase the risk for heart failure. Sleep apnea has also been associated with increased risk for stroke. Several studies have shown that patients with heart failure and sleep apnea have a higher incidence of irregular heart rhythms (atrial fibrillation and ventricular arrhythmia's).
Sleep apnea may be deadly
Researchers have found that the risk of premature death increases as the severity of sleep apnea increased. Findings also suggest protection from risk of death with proper treatment of sleep apnea, such as the use of continuous positive airway pressure (CPAP/BiPAP) to prevent pauses in breathing. Other interventions include weight loss if the patient is overweight, avoidance of substances that increase the risk of apneas such as certain sleeping pills and alcohol.
Sleep studies are tests that measure how well you sleep and how your body responds to sleep problems. These tests can help your doctor find out whether you have a sleep disorder and how severe it is. Sleep studies are the most accurate tests for diagnosing sleep apnea.
There are different kinds of sleep studies. If your doctor thinks you have sleep apnea, he or she may recommend a polysomnogram (PSG) or a portable monitor to use overnight unattended.
A PSG is the most common sleep study for diagnosing sleep apnea. This study records brain activity, eye movements, heart rate, and blood pressure.
A PSG also records the amount of oxygen in your blood, air movement through your nose while you breathe, snoring, and chest movements. The chest movements show whether you're making an effort to breathe.
PSGs often are done at sleep centers or sleep labs. The test is painless. You'll go to sleep as usual, except you'll have sensors attached to your scalp, face, chest, limbs, and a finger. The staff at the sleep center will use the sensors to check on you throughout the night. Most diagnostic sleep studies are ordered as a split-night sleep study. During the first half of the night, your sleep will be checked without a CPAP machine. This will show whether you have sleep apnea and how severe it is. If the PSG shows that you have moderate – severe sleep apnea, you’ll use a CPAP machine during the second half of the split-night study. The staff at the sleep center will adjust the flow of air from the CPAP machine to find the setting that works best for you.
If you do not meet the criteria for CPAP during the first half of the night, then you will be monitored the entire night without wearing CPAP. A sleep specialist will review the results of your PSG to see whether you have sleep apnea at all during the night and depending on its severity, your physician will use the results to plan your treatment. This plan may include returning back to the sleep lab to undergo another study during which you will be wearing CPAP the entire night to find the best setting for you. Alternatively your physician may order for you to be started on CPAP/BiPAP at home without using it in the sleep lab first.
If you have mild sleep apnea, some changes in daily activities or habits might be all the treatment you need.
- Avoid alcohol and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep.
- Lose weight if you're overweight or obese. Even a little weight loss can improve your symptoms.
- Sleep on your side instead of your back to help keep your throat open. You can sleep with special pillows or shirts that prevent you from sleeping on your back.
- Keep your nasal passages open at night with nasal sprays or allergy medicines, if needed. Talk with your doctor about whether these treatments might help you.
- If you smoke, quit. Talk with your doctor about programs and products that can help you quit smoking.
Breathing Devices (CPAP, BiPAP)
CPAP (continuous positive airway pressure) is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose. The machine gently blows air into your throat. The pressure from the air helps keep your airway open while you sleep. Treating sleep apnea may help you stop snoring. But not snoring doesn't mean that you no longer have sleep apnea or can stop using CPAP. Your sleep apnea will return if you stop using your CPAP machine or don’t use it correctly. People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP.
CPAP treatment may cause side effects in some people. These side effects include a dry or stuffy nose, irritated skin on your face, dry mouth, and headaches. If your CPAP isn't adjusted properly, you may get stomach bloating and discomfort while wearing the mask. If you're having trouble with CPAP side effects, work with your sleep specialist, his or her nursing staff and the CPAP technician. Together, we can take steps to reduce the side effects. For example, the CPAP settings or size/fit of the mask might need to be adjusted. Adding moisture to the air as it flows through the mask or using nasal spray can help relieve a dry, stuffy, or runny nose. There are many types of CPAP machines and masks. Tell your doctor if you're not happy with the type you're using. He or she may suggest switching to a different type that might work better for you.
A mouthpiece, sometimes called an oral appliance, may help some people who have mild sleep apnea. Your doctor also may recommend a mouthpiece if you snore loudly but don't have sleep apnea.
A dentist or orthodontist can make a custom-fit plastic mouthpiece for treating sleep apnea (an orthodontist specializes in correcting teeth or jaw problems). The mouthpiece will adjust your lower jaw and your tongue to help keep your airways open while you sleep. If you use a mouthpiece, tell your doctor if you have discomfort or pain while using the device. You may need periodic office visits so your doctor/dentist can adjust your mouthpiece to fit better.
Some people who have sleep apnea might benefit from surgery. The type of surgery and how well it works depend on the cause of the sleep apnea. Surgery, however, is the last option, and may not always be successful in resolving sleep apnea.
If you need to reschedule/cancel your sleep study, please call (352) 548-6000 ext. 101213.
Preparing for your sleep study
Portable Home/Hoptel Studies:
You will need to present to the Gainesville VA, Room E545 at 4:00 p.m. to be setup for your sleep study. You will be having your sleep study in a Gainesville hotel (hoptel) room paid for by the VA. You will need to provide your own transportation from the VA to this hotel and back. A family member/driver may stay in the hotel room with you but it is NOT recommended as you want to have the room as quiet as possible for your study. You must wear a shirt that you will sleep in to this appointment. We will attach the sleep equipment over your sleep shirt. Please bring another shirt to wear over the night-shirt and equipment when traveling to the hotel. You can NOT get this equipment wet-NO showers or swimming.
You will need to present to the Gainesville VA, ER at 7:00 p.m. to be setup for your sleep study. You will be having your sleep study in the sleep lab at the Gainesville VA. A family member/driver will NOT be allowed to stay with you unless you were authorized to have a caregiver present for the ENTIRE sleep study, when your sleep study was scheduled. You must wear/bring a shirt that you will sleep in to this appointment.
These are the important items to remember for your sleep study:
- Arrive on time, but not early.
For portable hoptel studies check-in on the 5th floor (Room E545) at 4:00 p.m.
- Do not drive if sleepy, or if you think you will be sleepy. If you are too sleepy to drive home, someone will need to come to pick you up. You will be discharged by 6:00 a.m.
- Please confirm your study date and time when called. If you must cancel and reschedule, we ask that you do so at least 48 hours in advance. This will allow us to schedule another patient in your appointment slot.
- No alcohol or naps the day of study.
- Continue to use your medications, unless you have been instructed otherwise by your physician. Bring all medications you normally take need or might need to take during your time in the sleep center. If you routinely take sleeping meds, bring them with you to the sleep center. No medications are available at the sleep center.
- No caffeine or products containing caffeine (coffee, tea, Coke, Mountain Dew, chocolate, etc) after noon on the day of study.
- You are welcome to bring snacks or drinks to have while in the sleep center, as there is no food service available.
- Shower and have clean hair and body before arriving, but do not use skin lotions or hair products (except deodorant). If skin is not clean, electrodes will not stick to your skin. Men should be clean shaven, unless you have a beard or mustache.
- Bring sleeping clothes (top and bottoms). Sleeping without clothing or with underwear only is not allowed. You may bring your own pillow, if you prefer.
- If currently using CPAP, bring your current mask and headgear to the study. You do not need to bring your CPAP unit, but if you know your current settings, tell your technologist.
- You will have a paste applied to your hair which you can wash out prior to your discharge. Please bring any toiletry items you may need, such as toothpaste, razors, deodorant or shampoo. Shower facilities are available.
- Please notify the sleep center prior to your study if you have any serious health issues which develop, or if you are hospitalized or have surgery between the time you are scheduled and the date if your sleep study.
- Inform the sleep technician about any relevant allergies.
- You will be asked to remove any jewelry or other objects that may interfere with the procedure.
- You will be asked to change into pajamas or a hospital gown.
- Small metal discs, or electrodes, will be positioned on your head and body to measure EEG, ECG, eye movements and leg movements.
- Pulse oximetry, which measures the oxygen level in the blood vessels, and air flow monitors, which measure breathing, will be applied to the finger and face, respectively.
- The temperature of the room may need to be maintained at a certain level, but blankets can be adjusted as needed.
- Lights will be turned off and monitoring will begin before you fall asleep.
- Split-night/CPAP study: For some patients who have sleep apnea, the effects of continuous positive airway pressure (CPAP) are evaluated. Patients, who have been diagnosed with sleep apnea during the initial part of the sleep study or on a prior sleep study, undergo a CPAP study. During the CPAP study, a mask is fitted around the nose and pressurized air is used to keep the airway open during sleep. The pressure level that holds the airway open during sleep and allows the patient to get a good night's sleep is the prescribed CPAP pressure.
- When the study has been completed, the electrodes and other devices will be removed.
- For multiple sleep latency testing (MSLT), five short daytime nap periods will be assigned at specific intervals, following the previous night’s sleep study.
- For maintenance of wakefulness test (MWT) you will be asked to try and stay awake for certain periods of time during the day.
What to Expect After Your Sleep Study
- The results of the study may take several days to process.
- The results and specific recommendations will be forwarded to your referring physician through the VA electronic computer record keeping system.
- If you have obstructive sleep apnea, you will be scheduled to come to the VA Medical Center to undergo a mask fitting and training on using CPAP/BiPAP. At this visit you will be issued your CPAP/BiPAP for home.
- Follow-up care will be arranged by the VA Medical Center.
- Patients should bring their CPAP/BiPAP machine, mask and compliance card with them for the follow-up visit.
Getting your CPAP/BiPAP
After your sleep study, if you have sleep apnea, you will be scheduled to come to the VA Medical Center to undergo a mask fitting and training on using CPAP/BiPAP. At this visit you will be issued your CPAP/BiPAP for home.
How Often Should I use my CPAP/BiPAP
In order to get the most benefit from your CPAP/BiPAP, you should use it every night for the entire night. If you need to get out of bed while sleeping, you should disconnect the mask from the hose, or remove the mask from you face, and when you return back to bed restart yourself on the CPAP/BiPAP.
Q: If I need to be hospitalized for any reason, should I take my device with me and use it at night?
Yes. Also, if you are having surgery, it is important to tell the surgeon and the anesthetist that you are using a PAP at home. You should also inform the doctor treating you for sleep apnea that you are going into the hospital
Q: Should I use my PAP when I travel?
It is important that you use your PAP every night. Purchasing travel accessories will make it more convenient for you to travel with your PAP. Because of increased security measures at airports, it may be easier to travel if you have a copy of your prescription for your PAP machine with you. Call your airline ahead of time and ask if there is a special screening procedure required to carry on or check your PAP device.
Q: How can I tell when my mask is worn out? Inspect your mask for stiffness, cracks, or tears.
You can get a replacement every 3-6 months, if necessary.
Q: Air seems to be leaking around my mask. What should I do?
Check all the connections. If your mask has a forehead arm or adjustment feature, try readjusting that first to correct the leak. If there is no improvement with the above steps, readjust the headgear straps. The mask should be loose while still creating a seal. A mask that is too tight against the face can cause leaks to occur by creating folds in the material. Try another mask size or type if necessary.
Q: My mask seems dirty. What should I do?
Wash your mask daily with a mild detergent. Dirty masks can lead to infections.
Q: When should I change the mask to a new one?
Contact the prosthetics department every 3-6 months to change your mask. Contact prosthetics anytime that your mask is worn out or is leaking air to get a replacement mask. If your mask is new (< 3-4 months old) you may need to be refitted with a new mask. Contact the respiratory therapists to arrange for a mask fitting.
Q: It doesn’t seem as though enough air is flowing to me. Why is that?
Check that air from the machine is blowing. Check the air inlet and filter for obstruction or dust buildup. Check the hose for punctures. If you are still having problems, check with your respiratory therapist for assistance.
Q: Why does my nose and throat feel dry? Why is my nose congested? Why do I have nosebleeds?
Try nasal saline spray before bedtime and upon awakening. You may change the temperature setting on the humidifier. Consult your doctor if symptoms persist.
Q: My mouth is dry after using the PAP. What should I do?
You may be sleeping with your mouth open. Try a chin strap. If you do not have a chin strap or if a chin strap is not helpful, you should consult with the respiratory therapists about trying a new mask or getting a chin strap.
Q: Why are my eyes sore, dry, irritated, or swollen?
Air may be leaking into your eyes. Try pulling the mask away from your face and repositioning it. The mask may be too tight. Readjust headgear straps. Use the forehead adjuster, if applicable, to reduce leaks.
Q: My skin seems irritated, even bruised, or I have marks on my face?
Your mask may be too tight. If your mask has a forehead arm or adjustment feature try readjusting that first. Then, if necessary, readjust the headgear straps. It is possible that you may have the wrong mask size. Consult your respiratory therapist if the problem persists.
CPAP/BiPAP Mask Cleaning Instructions: “Remember: Whatever goes into your tubing, goes into your lungs”
- Wipe off the flap/pillows (the part of the mask that comes in contact with your face) with a warm, wet washcloth
- Do NOT use alcohol based or bleach products to clean the mask (i.e. disinfectant wipes) as they will cause the mask to deteriorate and eventually cause mask leaks
Once a week
- Wash your mask/pillow, headgear, and tubing in warm, mild soapy water (such as Ivory dish soap – avoid strong disinfectant soaps) and rinse well.
- After rinsing, allow your equipment to dry completely before use.
Tubing and Humidifier Care
- Use ONLY distilled water. Tap water has minerals that will clog your humidifier
- Empty and rinse your humidifier every 2 days and dry completely
- Before applying CPAP, make sure that you have sufficient water in your humidifier chamber for the night.
- Do NOT use the humidifier without water. If you have no water set the humidifier to setting of “0”
- Tubing and humidifier reservoir should be washed weekly with a mild soap and warm water. Rinse well. Do NOT use antibacterial soap, as it will leave a film on the humidifier chamber.
- NEVER carry/travel with the CPAP/BiPAP with water inside the humidifier.
How do I get my replacement filters, mask and tubing?
All supplies are dispensed from the Prosthetics Department at (877) 649-0024 ext 1234 and require current Prosthetics orders which are only valid for 1 year.
If your Prosthetics order is expired then please contact us via secure messaging using My HealtheVet and request a Prosthetics renewal. If you do not have a Premium My HealtheVet, please register or call the sleep clinic and leave a message.
How often should I replace my mask, tubing and filters?
- Masks: replace every 3-6 months.
- Tubing: replace annually.
- Filters: replace as needed.
Sinus infections and nasal congestion often result from failure to replace disposable equipment regularly
For Sleep Study scheduling issues call:
(352) 548-6000 ext. 101213
Portable/Hoptel sleep studies:
(352) 548-6000 ext. 106355
For CPAP equipment/clinic issues contact the Sleep Clinic staff:
(800) 324-8387 ext. 105616
(352) 376-1611 ext. 105616
The Villages OPC:
(877) 649-0024 ext. 301488
(352) 674-5000 ext. 301488
Lake City VAMC:
(800) 308-8387 ext. 392925
(386) 755-3016 ext. 392925
(877) 870-5048 ext. 506323
(904) 475-5800 ext. 506323
For replacement masks, tubing, and filters see Getting Replacement Masks/Tubing.
Gainesville: Malcom Randall VAMC
Sleep Clinic and Hoptel Studies
- 800-324-8387 Ext. 105616
- 800-308-8387 Ext. 2925
Hours of Operation
Monday - Friday
8:00 a.m. - 4:00 p.m.