FAQs

Find below some of the most frequently asked questions regarding referrals, some of our services and the conditions we treat. For any other questions please contact reception on (02) 9451 0522.

Referrals:

Yes, a written referral from a registered doctor is required. You must also meet the pre-screening requirements set out by Medicare (see details on referrals or below).

Yes, for diagnostic sleep studies providing you meet the pre-screening criteria as per the Medicare Schedule from 1st November 2018. See “Home” page for screening questionnaire and pdf referral.
If you do not meet the pre-screening criteria, your GP will need to refer you to a Sleep Physician to assess your suitability for a sleep study (or alternate test). You may still be suitable for a GP referral for a Sleep Clinic study in some other situations. Please contact Peninsula Sleep Clinic for assessment of suitability.
Alternatively, your GP can refer you for home oximetry.
Some specialised sleep studies can only be referred by Respiratory/Sleep Physicians. 

 

If you do not meet the screening criteria then your GP/Specialist can refer you for a consultation with a Sleep Physician to further assess suitability for sleep study testing. Alternatively, your GP can refer you for an ApneaLink Test, as an initial screening test.

You must meet the following criteria: 

  • an OSA50 score of 5 or more; or 
  • a STOP-Bang score of 4 or more; and must have 
  • an Epworth Sleepiness Score of 8 or more 

If you do not meet the screening criteria then your GP/Specialist can refer you for a consultation with a Sleep Physician to further assess suitability for sleep study testing. Alternatively, your GP can refer you for home oximetry, as an initial screening test. 

No, you must be referred by a Sleep Physician. If you are over 18 years of ages for an MSLT or MWT you can be referred by a Neurologist.

Peninsula Sleep Clinic conducts sleep studies on patients greater than or equal to 14 years of age.

For a sleep study it can be made out to Peninsula Sleep Clinic. If your doctor would like you to have a consultation with one of the Sleep Physicians from Peninsula Respiratory Group, they can select the doctors name on the referral or select the box “first available” if they do not have a preference for doctor and want you to have the earliest appointment available. 

Peninsula Respiratory Group is a separate business and can be contacted on 9975 4911.

My Appointment at the Sleep Clinic:

Yes, even if you don’t wear pyjamas at home you will need to in the Clinic. Two piece (top and bottom) cotton pyjamas with underpants underneath (essential). This preserves patient modesty (as we have male and female staff) and hygienic practices. Shiny fabrics are slippery making lead application difficult. 

No, the acrylic nails don’t have to be removed. However, if you have a dark polish or a colour that contains glitter then you will need to remove this from one finger on each hand. Alternatively you can remove the nail polish from both feet, and this sensor may be applied to your toe nail.

 

No, unless you have dark or glittery polish on your finger nails. Please refer to the question above (Do I have to remove my acrylic nails?).

Yes, during the day there is limited parking under the building and in the street. There are no problems finding parking at night.

Yes route 166 between Manly and Frenchs Forest, and route 160X between Frenchs Forest and Chatswood (previously the 136 bus from Manly to Chatswood) stop at the Parkway Hotel (Frenchs Forest Rd opp Hurdis Ave) which is the next building along in Frenchs Forest Road.

 

Yes there is a lift to the second floor.

Usually, however this depends on how long you have been with your fund and whether you have adequate cover and an excess or co-payment. Individual ‘Statement of Fees’ and informed financial consent are provided to all patients prior to any study.

No the study is set up, monitored and analysed by a registered nurse/technician under the supervision of a Sleep Consultant. The analysed data is later reported by the supervising Sleep Consultant.

Usually within 7-10 days of test date.

Home Sleep Test Appointment:

Your doctor has recommended a Home Study for you at this time, or you may prefer to be tested at home.

Contact reception on 9451 0522. You will need a relevant referral from your doctor. See information on this page for further details on referrals.

The signals monitored are: EEG, EOG, submental EMG, thermocouple, nasal flow, ECG, thoracic and abdominal RIP effort, leg movements, oxygen saturation, inbuilt position. There is no video monitoring, carbon dioxide or diaphragmatic EMG measured.

No the study is set up at Peninsula Sleep Clinic and analysed by a registered nurse/technician under the supervision of a Sleep Consultant when the equipment is returned to the Clinic. The analysed data is later reported by the supervising Sleep Consultant.

No the study is set up at Peninsula Sleep Clinic and analysed by a registered nurse/technician and you are sent home with most of it in place. There are three leads you need to apply yourself (thermocouple, nasal cannulae and oxygen saturation probe) as these will inhibit your driving. You will be educated in their application and sent home with written instructions.

No, the study is set up to starts recording automatically so you do not have to do anything.

You do not need to turn off the equipment. However, you will need to remove the leads carefully and place them in a bag to return to the Clinic first thing. The equipment needs to be returned promptly so it can be downloaded and information analysed. The equipment is booked by other patients and if you do not return it in time you will incur additional costs.

Yes, it is ideal if you can wear pyjamas or comfortable loose clothes you can drive and also sleep in. Two piece (top and bottom) cotton pyjamas with underpants underneath (essential). This preserves patient modesty (as we have male and female staff) and hygienic practices. Shiny fabrics are slippery making lead application difficult. Please bring a loose zip up or button up overshirt, this is so you can wear it to cover up the equipment so you can get home with some modesty. 

No, the acrylic nails don’t have to be removed. However, if you have a dark polish or a colour that contains glitter then you will need to remove this from one finger on each hand. There is no ability with this test to apply the lead on your foot.

Yes, during the day there is limited parking under the building and in the street. There are no problems finding parking at night.

Yes route 166 between Manly and Frenchs Forest, and route 160X between Frenchs Forest and Chatswood (previously the 136 bus from Manly to Chatswood) stop at the Parkway Hotel (Frenchs Forest Rd opp Hurdis Ave) which is the next building along in Frenchs Forest Road.

 

Yes there is a lift to the second floor.

Your Health Fund does not cover the cost of a home sleep study. Medicare will partially cover the cost and there are some “out of pocket” expenses associated with the test. Individual ‘Statement of Fees’ and informed financial consent are provided to all patients prior to any study. Please contact reception on 9451 0522 to discuss.

Usually within 7-10 days of test date.

ApneaLink Test:

Your doctor has recommended a simple screening test in the first instance to identify if you have any sleep disordered breathing

Contact reception on 9451 0522. You will need a relevant referral from your doctor. See our home page for further details on referrals.

The signals monitored are airflow, effort to breathe, oxygen saturation, pulse and snoring.

No, a trained staff member educates you in the procedure for you to do at home. 

Yes, a trained staff member educates you how to apply the leads at home and gives you written instruction so you can remember the details before you get into bed.

Yes, you press the record button as per your education session and written instruction.

You turn the device off as per your education session and written instruction. The device will either show a green tick (if the study was successful) or red cross (if the study didn’t have enough data). If your study was not successful then contact the Sleep Clinic reception 9451 0522 to talk to a trained member of staff who can guide you through what went wrong and arrange a restudy.

You can wear what you normally would at home as you set up the device when ready for bed.

No, the acrylic nails don’t have to be removed. However, if you have a dark polish or a colour that contains glitter then you will need to remove this from one finger on each hand. There is no ability with this test to apply this lead on your foot.

Yes, during the day there is limited parking under the building and in the street. There are no problems finding parking at night.

Yes route 166 between Manly and Frenchs Forest, and route 160X between Frenchs Forest and Chatswood (previously the 136 bus from Manly to Chatswood) stop at the Parkway Hotel (Frenchs Forest Rd opp Hurdis Ave) which is the next building along in Frenchs Forest Road.

 

Yes there is a lift to the second floor.

No. This test is not funded by your health fund or Medicare. It is designed to be a cost effective simple screening test.

Usually within 7-10 days of test date.

Mandibular Advancement Devices (MADs):

The best suited are those patients with “simple snoring” or mild to moderate severity OSA.

There are data that suggest that obese patients do not do as well as the non obese. But, that is less of an issue than which treatment will the patient accept and use? There is no point pushing CPAP therapy if the patient will not accept it. Adequate dentition is essential. The patient must have at least 8 strong teeth top and bottom to use a MAD, and the more the better.

  • Referral to an experienced dentist.
  • The dentist takes an impression or a computer scan of the patient’s teeth.
  • The mouldings or computer file are then sent to a lab who manufactures the device.
  • The patient returns to the dentist, usually three weeks after the assessment, to have a test fit of the MAD. Any discomfort issues are dealt with, and often the device is advanced a little.
  • The patient then uses it for two weeks without adjustment.
  • They then return to the dentist for review and another advancement.
  • The dentist then shows the patient how to advance it and sets up a schedule, or books appointments for further advancements.
  • Once the snoring stops, or is much reduced, or the patient reaches 2mm in front of “edge to edge” the advancing stops.
  • The patient is then reviewed by the sleep physician and a follow up sleep study arranged.

Yes. Except for those patients who only had snoring without OSA, who do not need another study. For all those with OSA they should be restudied to make sure that the OSA is being controlled at that degree of advancement. Often a further adjustment is required.

The cost depends on the dentist. To my knowledge the fee ranges between $1500 and $3000 which includes the device itself and the dentists’ time and expertise.*
*Note these costs are estimations and you will need to discuss your expected costs with your dentist

If the patient does not tread on them nor their dog eat them (common problems apparently) they should last 5 years.

There are few contraindications: a strong gag reflex and inadequate dentition are the main ones. Temporo-mandibular joint problems are NOT a contra indication. Most patients will have some degree of bite change due to the device. Most patients do not mind and very few have to stop using it because of marked bite change. Unfortunately, it is not possible to predict who will suffer from this and who will not. In my experience it does not appear to be related to the degree of advancement.

Obstructive Sleep Apnoea:

It is where breathing slows or stops for short periods during sleep. This can occur many times during the night. During deep sleep most muscles relax including the tongue and the muscles in the back of the throat, this can cause a blockage of the airways. Such episodes are called apneas.

The most common symptoms are:

  • Snoring is very common in the community (60% of men over the age of sixty snore regularly). Snoring is usually a social nuisance, but is often also a marker of a more serious problem called Obstructive Sleep Apnoea (OSA).
  • Obstructive Sleep Apnoea (OSA) is the most common sleep disorder in the community after insomnia. An apnoea is the cessation of breathing for ten seconds or more in an adult. The common predisposing conditions are obesity, aging, maleness, and facial shape, but it can also occur in children and women. If untreated, OSA can cause hypertension and makes several other conditions worse including: diabetes, heart failure, abnormal heart rhythms. If severe enough it can cause premature death usually from stroke or heart attack.
  • Choking / gagging / gasping in sleep these are symptoms of OSA typically in mild-moderate disease, which paradoxically disappear as the disease gets worse.
  • Gastro-oesophageal reflux is commonly a marker of OSA.
  • Sleepiness / tiredness are perceived by men and women differently. Women often describe this as a ‘lack of energy’ or ‘poor motivation’ but men describe it as ‘sleepiness’ or ‘tiredness’. It is usually due to inadequate refreshing sleep; either too little sleep time, or poor quality sleep (as is the case in OSA). It reduces performance in most areas of daily life and often is associated with irritability or ‘grumpiness’. It also predisposes people to traffic and industrial accidents.

Snoring is very common in the community (60% of men over the age of sixty snore regularly). Snoring is usually a social nuisance BUT is often a marker of OSA.

If OSA is left untreated it can cause high blood pressure (hypertension) heart attack and stroke. It can also make other conditions worse, such as diabetes, heart failure and abnormal heart rhythm. If severe it can cause premature death.

Firstly you will need to be assessed by your doctor. Once it is determined you have a sleep problem your doctor may refer you to a sleep laboratory for full assessment by an overnight sleep study. At the laboratory you will be fitted in a very systematic way with sensors and leads. The leads are connected into a computerized system and your sleep will be monitored overnight. The data collected is analyzed then reported by a doctor, this report is then forwarded to your referring doctor. Trained staff are in attendance for the entire procedure. The study does not include a consultation with a doctor.

Treatment depends on the severity of the OSA. Less severe OSA can be treated by individually designed dental devices and nasal surgery to improve the airflow flow. A CPAP pump is the most common treatment for moderate to severe OSA.

A CPAP pump is a machine that delivers airflow at a specific pressure (which has been determined by another sleep study wearing the equipment) via a tube attached to a close fitting mask. The equipment is worn during sleep and air is delivered at a positive pressure which keeps the airways open.

If overweight try and lose weight, avoid alcohol, sleeping tablets and tranquillisers, improve nasal congestion and avoid sleeping on back may be helpful in some circumstances.

Restless Leg Syndrome:

The “Restless Leg Syndrome” (RLS) is a clinical entity characterised by the need to move the legs prior to bed or sleep onset in response to an unpleasant sensation in the legs. Movement relieves the sensation. Once asleep patients with RLS often have uncontrolled “Periodic Limb Movements” (PLMs) which are a different disorder and can be detected in a sleep study.
The diagnosis is made by a doctor and not based on any particular test results but the patient’s description of their symptoms.

The syndrome may be associated with or caused by metabolic conditions such as liver or kidney disease, or anaemia. Commonly used antidepressant medications also cause PLMs but not necessarily RLS. So, identifying and treating any underlying cause is the first line of treatment. If none are found then non pharmacological treatment can be tried such as using a bed cradle to take any pressure off the legs in bed or soaking the legs in cold water before bed. Some medications have been shown to work, but they usually have some side effects.

Insomnia:

There are two major types of insomnia; Sleep onset insomnia (SOI) and sleep maintenance insomnia (SMI). In the first (SOI) people struggle to get to sleep. This is usually “psycho-physiological” in origin, although sometimes can be due to pain or other organic causes. The second (SMI) is usually due to a combination of some organic cause that wakes the patient (e.g. sleep apnoea, or arthritic pain), followed by psychological factors that prevent a quick return to sleep.

The first and most important investigation is a medical or psychological consultation to determine the type of insomnia and factors that are important in its initiation and perpetuation. Sleep studies are often used when SMI is suspected, although recent research suggests that all patients with insomnia should have a sleep study.

SOI is usually treated by “cognitive behaviour therapy” (CBT). An intervention usually carried out by a specially trained psychologist. SMI is treated by a combination of treatments designed to prevent or ameliorate the initial waking from sleep; e.g. treatment of sleep apnoea or pain, together with CBT to aid the return to sleep.

Cardiovascular Disorders:

Yes there are links: Sleep Apnoea (or most commonly Obstructive Sleep Apnoea (OSA)) is an accepted cause of vascular disease and stroke.

OSA is an accepted cause of hypertension. Interestingly once the hypertension has been present for a long time, treatment of the OSA does not seem to reduce the blood pressure (BP). In one English study only those patients who were sleepy as well as hypertensive had a reduction in BP with treatment (CPAP).

OSA has been associated with difficult to control atrial fibrillation (AF). Whether is actually causes AF in the first place is unknown.

The relationship between OSA and diabetes has been investigated in many studies in an attempt to answer that question. So far the evidence is somewhat contradictory, but on balance we believe that it probably contributes to glucose intolerance (which is a stepping stone to diabetes).

Mood Disorders:

Sleep disruption from any cause can alter daytime mood in otherwise normal people. In one trial of antidepressant medication sleep was improved by adding a sleeping tablet to the medication in half the subjects. Those with the extra sleeping tablet recovered from their depression faster than those without. By analogy then one might expect that the sleep disruption due to OSA would make depression worse. Many of the symptoms of OSA are similar to those of depression (e.g. “tiredness”, lack of motivation, poor memory, irritability) and many mood disorders impair sleep quality. Treating severe OSA with effective CPAP therapy has cured many patients with “depression”.

OSA is an accepted cause of hypertension. Interestingly once the hypertension has been present for a long time, treatment of the OSA does not seem to reduce the blood pressure (BP). In one English study only those patients who were sleepy as well as hypertensive had a reduction in BP with treatment (CPAP).

OSA has been associated with difficult to control atrial fibrillation (AF). Whether is actually causes AF in the first place is unknown.

The relationship between OSA and diabetes has been investigated in many studies in an attempt to answer that question. So far the evidence is somewhat contradictory, but on balance we believe that it probably contributes to glucose intolerance (which is a stepping stone to diabetes).

Other Medical Diseases:

OSA is more common and probably made worse by certain hormonal abnormalities: reduced function of the Thyroid gland has been shown to make OSA worse. Conversely an overactive pituitary gland (causing acromegaly) has been associated with a high prevalence of OSA and central sleep apnoea (CSA). Menopause seems to increase the incidence of OSA in older women, yet replacement hormonal therapy has not been shown to prevent the development of OSA.

Studies have shown that sleepiness is a major contributing factor in many road accidents and people with sleep apnoea have an increased risk of motor vehicle accidents.

Driver fatigue is one of the three biggest killers on NSW roads. If you are aware you are sleepy when driving it is your responsibility to discuss this with your GP and arrange further investigations and treatment.

Please refer to the AustRoads Assessing Fitness to Drive guidelines for personal responsibilities in relation to driving. The Roads and Maritime Services Website contains some useful information about driving with a medical condition (e.g. sleep disorder).

Referral Information

Written referrals are required for all types of studies. GP referrals last 12 months and specialist referrals 3 months from first date of service.

Medicare regulations require a referral from a Sleep/Respiratory Physician (or in some cases a Neurologist) for some diagnostic, and all CPAP and specialised sleep disorder tests. See our downloadable pdf referral for the pre-screening criteria.

Download Referral

Why do a sleep study with Peninsula Sleep Clinic?

Peninsula Sleep Clinic aims to be the best Sleep Clinic in NSW. With friendly knowledgeable staff, accredited procedures and a variety of testing available, we offer a full service approach.

Home trials of CPAP equipment are available to all patients who have undergone a sleep study through Peninsula Sleep Clinic.

Our CPAP Education Clinics have a unique structure where we can provide CPAP Therapist consultations to patients on a one-to-one basis,  giving patients the best opportunity for success.

If you are a patient of Peninsula Sleep Clinic and are experiencing any CPAP related issues, just call our friendly staff within office hours to help you resolve your problem.

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Download our referral and talk to your doctor today to see if a sleep study is appropriate for you.

Download Referral

“Peninsula Sleep Clinic helped me to get established onto CPAP therapy to treat my sleep apnoea. My experience in the clinic during my trial was not as daunting as I thought beforehand.”

Ted – Northern Beaches

Patient

“Their service was exemplary and met or anticipated all my needs. Now that I am successfully using CPAP I feel relieved and grateful. My energy and health are already improving.”

James Keene – Oct 2020

Patient

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