Alternative Sleep Disorders Center Policy
             
POLYSOMNOGRAM APPROPRIATENESS CRITERIA

1. Purpose:  To outline criteria that shall be documented to ensure patient is having appropriate testing/therapy in a safe environment.
2. Procedure: Referring physician has documented patient’s symptoms of at least one of:
1. Routine Polysomnogram with Video Monitoring
1. Excessive daytime sleepiness
2. Drowsy while driving
3. Observed stop breathing episodes while sleeping.
4. Disruptive snoring in all positions
5. Chronic morning headaches
6. Restless disturbed sleep
7. Complaints of aching or crawling sensations in the legs and/or arms
8. Pediatric sleep complaints
9. Sleepwalking/talking
10. Night terrors
11. Nocturnal seizures
2. Positive Pressure Therapy
1. Diagnosed obstructive sleep apnea
2. Upper airway resistance syndrome
3. MSLT/MWT
1. Cataplexy
2. Sleep paralysis
3. Unintentional napping
4. Excessive daytime sleepiness
5. Family history of narcolepsy
3. Safety Precautions: Prior to testing, the patient’s information will be reviewed and the necessary precautions will be taken to prepare for:
   1. Cognitively impaired
      1. Arrange for family involvement (a caretaker will need to stay in the lab with the patient).
      2. Insist that legal guardianship is established
   2. Pediatric
      1. Parent or guardian must stay with any children under the age of 12.
      2. Guardianship or custody of the child must be established.
      3. Pediatric patients are required to sleep in bed with bed rails.
   *These criteria are intended to be used as an outline.  Every case needs to be examined for specific needs.