Sleep Disorders

For patients experiencing restless sleep, daytime sleepiness or insomnia, the first step is a comprehensive evaluation by the Tristate Pulmonary Associates board certified sleep specialist, Dr. Kanagarajan, to examine the cause of the sleep problem. With the assistance of our first rate sleep technician, they will formulate your care plan to deal with any sleep or related health issues.

Since many sleep problems can be associated with improper daytime breathing, having physicians dedicated in the care of pulmonary health truly makes for comprehensive care at Tristate Pulmonary Associates.

Once evaluated, your doctor might recommend a sleep study if necessary to determine whether sleep apnea is contributing to your sleepiness. A home sleep study is a cost effective way of screening for sleep apnea in the convenience of your own bed, which we recommend whenever possible. You will be seen by a sleep technician after the physician evaluation for a demonstration of how to conduct a proper home sleep study in the comfort of your own home environment.


Pre-Screening for Obstructive Sleep Apnea
To see if a sleep study might be necessary, please click HERE to take our pre-screening questionnaire for Obstructive Sleep Apnea. These results will be sent to our office.


Epworth Sleepiness Scale
Click HERE to take the Epworth Sleepiness Scale questionnaire.
*Please share your results of this questionnaire with your doctor.


Home Sleep Testing

If the physician feels that you are not a candidate for home sleep study testing, you will be referred to a sleep lab where you will undergo a sleep study to help diagnose your sleep problems. For sleep lab testing, patients arrive in the evening and are prepared by the sleep technician, who connects sensors at multiple points. The study is somewhat like spending a night in a hotel with the difference of having sensors attached to one’s body while being watched in a sleep. The patient is videotaped during the sleep study, while the sensors record leg movements, chest movements, heart rate, oxygen levels and snoring patterns. Breathing patterns and oxygen levels can then be correlated to sleep stages and sleeping positions. When clinically indicated, the patient can be assessed during the day, using a daytime study, called a multiple sleep latency test (MSLT). This measures the level of sleepiness experienced during the day and is especially helpful for diagnosing conditions like narcolepsy.

Sleep Diary
If you are suffering from insomnia, please document your sleep times in the sleep diary. This will help your sleep physician to understand your sleep pattern completely.
To print a sleep diary, click HERE.
*Please share your results of this journal with your doctor.


  1. Common Sleep Problems

    Snoring and Obstructive Sleep Apnea (OSA)

    Obstructive sleep apnea (OSA) is the repeated collapse of the upper airway. Symptoms of OSA include snoring while sleeping, waking up at night, and tiredness in the morning. Sleep study may be necessary to diagnose the OSA.


    Insomnia is trouble falling asleep or staying asleep during the night and may be a symptom of other health problems. Insomnia can be caused by a number of factors including psychological and/or environmental ones, lifestyle, or physical/psychiatric illness.


    Narcolepsy is a tendency to sleep at inappropriate times and constant daytime sleepiness. Symptoms include excessive daytime sleepiness, sudden loss of strength in muscles, sleep attacks (sleep paralysis), and continual sleepiness and tiredness that cannot be fully relieved by any amount of sleep.

    Restless Leg Syndrome

    Restless legs syndrome (RLS) is an uncomfortable feeling that occurs in legs when they are still, especially at bedtime. RLS can interfere with travel or the use of transportation. It is important to determine whether there are any conditions (such as iron deficiency, kidney problems, diabetes, arthritis, etc.) which may be contributing to the RLS. Once these are treated or excluded, treatments of RLS include medications and, if necessary, iron supplements.

    Excessive Daytime Sleepiness

    Excessive daytime sleepiness (EDS) is a common complaint. According to the National Sleep Foundation 2000 Omnibus Sleep in America Poll: `a sizable proportion of adults (43%) report that they are so sleepy during the day that it interferes with their daily activities a few days per month or more; and, one out of five (20%) experience this level of daytime sleepiness at least a few days per week or more’.
    The most common cause of daytime sleepiness is insufficient sleep, which may reflect poor sleep hygiene (behaviors impacting sleep) or self-imposed or socially dictated sleep deprivation. Sleep-related breathing disorders and Periodic limb movements of sleep are also very common causes of daytime sleepiness. A variety of medical conditions may be associated with sleep fragmentation, including arthritis, fibromyalgia, spondylosis, chronic pain of any nature, asthma and chronic obstructive pulmonary disease.


    Nightmares are vivid nighttime events that can cause feelings of fear, terror, and/or anxiety. Usually, the person having a nightmare is abruptly awakened from REM sleep and is able to describe detailed dream content. Usually, the person having a nightmare has difficulty returning to sleep. Nightmares can be caused by many factors including illness, anxiety, the loss of a loved one, or negative reactions to a medication. Call your doctor if nightmares occur more often than once a week or if nightmares prevent you from getting a good night’s sleep for a prolonged period of time.

    Night Terrors

    A person experiencing a night terror or sleep terror abruptly awakes from sleep in a terrified state. The person may appear to be awake, but is confused and unable to communicate. They do not respond to voices and are difficult to fully awaken. Night terrors last about 15 minutes, after which time the person usually lies down and appears to fall back asleep. People who have sleep terrors usually don’t remember the events the next morning. Night terrors are similar to nightmares, but night terrors usually occur during deep sleep.People experiencing sleep terrors may pose dangers to themselves or others because of limb movements. Night terrors are fairly common in children occurring in approximately 5% of them mostly between the ages of three to five. Children with sleep terrors will often also talk in their sleep or sleepwalk. This sleep disorder, which may run in families, also can occur in adults. Strong emotional tension and/or the use of alcohol can increase the incidence of night terrors among adults.


    Sleepwalking occurs when a person appears to be awake and moving around but is actually asleep. They have no memory of their actions. Sleepwalking most often occurs during deep non-REM sleep (stages 3 and 4 sleep) early in the night and it can occur during REM sleep in the early morning. This disorder is most commonly seen in children aged eight to twelve; however, sleepwalking can occur among younger children, the elderly and adults.
    Sleepwalking appears to run in families. Contrary to what many people believe, it is not dangerous to wake a person who is sleepwalking. The sleepwalker simply may be confused or disoriented for a short time upon awakening. Although waking a sleepwalker is not dangerous, sleepwalking itself can be dangerous because the person is unaware of his or her surroundings and can bump into objects or fall down. In most children, it tends to stop as they enter the teen years.

    Confusional Arousals

    Confusional arousals usually occur when a person is awakened from a deep sleep during the first part of the night. This disorder, which also is known as excessive sleep inertia or sleep drunkenness, involves an exaggerated slowness upon awakening. People experiencing confusional arousals react slowly to commands and may have trouble understanding questions that they are asked. In addition, people with confusional arousal often have problems with short-term memory and have no memory of doing these things the following day.

    Rhythmic Movement Disorders

    Rhythmic movement disorder occurs mostly in children who are one year old or younger. A child may lie flat, lift the head or upper body, and then forcefully hit his or her head on the pillow. Rhythmic movement disorder, which also has been called “head banging,” also can involve movements such as rocking on hands and knees. The disorder usually occurs just before a person falls asleep.

    Sleep Talking

    Sleep talking is a sleep-wake transition disorder. Although it usually is harmless, sleep talking can be disturbing to sleep partners or family members who witness it. Talk that occurs during sleep can be brief and involve simple sounds, or it can involve long speeches by the sleeper. A person who talks during sleep typically has no recollection of the actions. Sleep talking can be caused by external factors including fever, emotional stress, or other sleep disorders.

    Nocturnal Leg Cramps

    Nocturnal leg cramps are sudden, involuntary contractions most commonly of the calf muscles during the night or periods of rest. The cramping sensation may last from a few seconds to 10 minutes, but the pain from the cramps may linger for a longer period. Nocturnal leg camps tend to be found in middle-aged or older populations, but people of any age can have them.
    Nocturnal leg cramps differ from restless legs syndrome as the latter usually does not involve cramping or pain. The cause of nocturnal leg cramps is not known. Some cases of the disorder can occur without a triggering event, while other causes of leg cramps may be linked to prolonged sitting, dehydration, an overexertion of the muscles, or structural disorders (such as flat feet). Muscle-stretching, exercise, and adequate water intake may help prevent leg cramps.

    Sleep Paralysis

    People with sleep paralysis are not able to move their body or limbs either when falling asleep or waking up. Brief episodes of partial or complete skeletal muscle paralysis can occur during sleep paralysis. Sometimes sleep paralysis runs in families, but the cause of sleep paralysis is not known.
    This disorder is not harmful, but people experiencing sleep paralysis often are fearful because they do not know what is happening. An episode of sleep paralysis often is terminated by sound or touch. Within minutes, the person with sleep paralysis is able to move again. It may occur only once in your lifetime or can be a recurrent phenomenon.

    Irregular Heart Rhythms

    A cardiac arrhythmia – – the medical term for an irregular heart rhythm – – is a change from the normal rate or control of the hearts contractions. People who have coronary artery disease and whose blood oxygen is lowered by sleep-disordered breathing may be at risk for arrhythmias, which take place during REM sleep. Continuous positive airway pressure (CPAP) treatment may reduce this risk.

    REM Sleep Behavior Disorder (RBD)

    People with rapid eye movement (REM) sleep behavior disorder act out dramatic and/or violent dreams during REM sleep. REM sleep usually involves a state of sleep paralysis (atonia), but people with this condition move the body or limbs while dreaming. Usually, RBD occurs in men aged 50 and older, but the disorder also can occur in women and in younger people. It differs from sleep walking and sleep terrors in that the sleeper can be easily awakened and can recall vivid details of the dream. In the diagnosis and treatment of RBD, potentially serious neurological disorders must be ruled out. Polysomnography (sleep tests) and drug treatments also can be involved in the diagnosis and treatment of this disorder.

    Sleep Bruxism (Teeth Grinding)

    Sleep bruxism – – or teeth grinding – – involves the involuntary, unconscious, excessive grinding or clenching of teeth during sleep. It may occur along with other sleep disorders. Sleep bruxism may lead to problems including abnormal wear of the teeth and jaw muscle discomfort. The severity of bruxism can range from mild cases to severe cases that involve evidence of dental injury. In some cases, grinding can be prevented with the use of a mouth guard. The mouth guard, supplied by a dentist, can fit over the teeth to prevent teeth from grinding against each other.

    Sleep Enuresis (Bedwetting)

    In this condition, the affected person is unable to maintain urinary control when asleep. There are two kinds of enuresis – – primary and secondary. In primary enuresis, a person has been unable to have urinary control from infancy onward. Primary bedwetting appears to run in families. Children are more likely to have it if their parents or siblings had it as children. In secondary enuresis, a person has a relapse after previously having been able to have urinary control. Enuresis can be caused by medical conditions (including diabetes, urinary tract infections, or sleep apnea) or by psychiatric disorders. Some treatments for bedwetting include behavior modification, alarm devices, and medications.

    Nocturnal Paroxysmal Dystonia (NPD)

    This disorder is sometimes marked by seizure-like episodes during non–REM sleep. Most evidence points to NPD being a form of epilepsy. Episodes of NPD typically recur several times per night.
  2. Sleep Better Treatments
    Our doctor recommends a customized treatment plan for each patient based on the severity of the condition and other compounding factors. Changes in lifestyle may be prescribed, including weight loss, better sleep hygiene, and avoidance of substances such as coffee, tea, tobacco and alcohol.Treatment options may include a dental/oral appliance, much like a retainer, that helps open the breathing passage by bringing the jaw forward. Another option is to surgically remove some of the excess tissue that may be blocking the airway during sleep. The success rate associated with surgery is 50 percent. The most effective treatment plan, with a success rate of 80 percent, is use of a continuous positive airway pressure (CPAP) machine.CPAP machines, typically covered by insurance under medical equipment, involve wearing a light mask over the nose during sleep.

    A small, quiet air pump attached to the mask with a long flexible tube sends pressured air through the narrowed nasal passages. The air pressure is customized to each patient so that it is gentle enough to allow normal sleep and breathing, but strong enough to prevent apnea and sleep interruptions.