Dr. Vijai Joseph Daniel, MD, MPH

For visualization, bronchoscopy can be done alone, or it can be combined with ultrasound. Endobronchial ultrasound (EBUS) allows real-time imaging of the airway and is used for diagnosing and staging lung cancer, as well as for determining where the cancer has spread. EBUS can be performed with TBNA, a procedure known as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

Doctors can also use bronchoscopy as a treatment for lung problems. For example, if a foreign body is trapped in the airway, doctors can insert forceps through the bronchoscope to remove it. If the airway has become narrowed - which may occur if patients have an infection, cancer, or some other inflammatory issue - bronchoscopy can be used to place a device called a stent in the area of constriction. The stent will keep the airway open, allowing the patient to breathe properly.

During a bronchoscopy, patients will be given medication (sedative) to help them relax. If it is only a diagnostic bronchoscopy, patients will be kept awake, but if the bronchoscopy is for therapeutic purposes, patients will be put to sleep by general anesthesia. After the procedure, patients will need to stay in the hospital for a few hours. They will not be able to eat or drink for about 2 hours. Some patients may experience discomfort, such as a sore throat or pain while swallowing. Throat lozenges and gargling may help alleviate these symptoms, which should go away after a few days. Patients will need to have someone drive them home once their doctor determines that they are ready.

In order to receive a CPAP device, patients must receive a prescription from a physician. Some patients may be asked to complete an overnight sleep study known as a titration study. A titration study monitors patients' sleep using a mask attached to a CPAP machine. The technician may monitor and adjust the CPAP's air pressure throughout the night. The purpose of a titration study is to determine the appropriate air pressure for patients with obstructive sleep apnea (blocked upper airway). Once an appropriate CPAP pressure is identified, physicians or sleep technicians may recommend a specific brand or style of device to the patient for long-term use.

The most widely performed sleep test is the traditional polysomnogram (PSG). This test is typically used to determine whether patients have sleep apnea (lapses in breathing while asleep). Polysomnograms are conducted overnight in a specialized sleep clinic or sleep center, where a patient enters the sleep center and is assigned to a room with a bed, medical equipment, and monitoring system. An overnight sleep technician attaches electrodes to the patient's head, chest, and legs. This application process lasts for around an hour. A sleep technician watches and evaluates the patient as they sleep. Objects such as a comfortable pillow from home, toiletries, and small personal items may be helpful in easing patients into sleep in unfamiliar surroundings.

Patients receive their physician-interpreted sleep study results within a few weeks of the test. If sleep apnea is detected, patients may be asked to return for a titration sleep study. A titration study involves the same procedures and electrode placement of a polysomnogram, but also includes a mask attached to a CPAP (continuous positive airway pressure) machine. The CPAP machine brings pressurized air to the patient. The technician may monitor and adjust the CPAP's air pressure throughout the night. The purpose of a titration study is to determine the appropriate air pressure for patients with obstructive sleep apnea (blocked upper airway).

A split night study combines the polysomnogram and titration sleep studies into two sessions on the same night. Split night studies enable patients to complete both studies quickly instead of waiting weeks in between tests and may expedite the interpretation of results and treatment.

Multiple sleep latency test (MSLT) measures how fast someone is able to fall asleep. Unlike other sleep tests, this test is performed during the day. It may take place after an overnight sleep study. The MSLT test monitors napping and potential for daytime sleepiness and exhaustion.

At-home sleep tests are fully conducted by patients in their own homes. Patients attach fewer electrodes, a breathing sensor, a microphone, and a data collection device to themselves and sleep in their own beds. The following morning, patients gather the data collection device and return it to their medical providers. While at-home sleep tests are convenient, they are not recommended for patients with severe sleep problems. At-home sleep tests are less precise than clinical tests and do not measure brain activity.

Sleep studies are essential to helping patients receive accurate sleep disorder diagnoses and proper treatment. A sleep study can be the first step towards higher quality sleep and physical health.