Northern Nights Sleep Disorder Centre

For Physicians

What NNSDC offers

NNSDC offers consultation and sleep lab services to adults and teenagers with all disorders of sleep.
We specialize in assessment and treatment of :

snoring and sleep disordered breathing
obstructive sleep apnea syndrome including upper airway resistance syndrome
central sleep apnea syndromes
obesity hypoventilation syndrome.
other disorders associated with drowsiness including narcolepsy and idiopathic hypersomnolence
insomnia, particularly psychophysiologic/conditioned insomnia and circadian/shift work disorders
nocturnal movement disorders including restless limb syndrome and periodic limb movement disorder
abnormal behaviour during sleep including REM Sleep Behaviour Disorder and Sleepwalking Parasomnia

If you are a physician and uncertain if a referral is appropriate, or if you have questions about options while awaiting a consultation, please write or call our physicians.

To refer a patient for consultation:

A physician, midwife or nurse practitioner can refer a patient for a consultation by sending a signed letter or a signed referral form (we prefer a letter).

Include your specific questions; what you have tried to date for the problem; relevant test results; and a summary of past problems / consultations. Note that psychologic, psychiatric, and chronic pain issues have a tremendous impact on sleep and giving us the details can save us and your patient a lot of time.

The more information you provide, the more likely we can provide a useful opinion and suggestions, and the less likely we are to repeat previous failed approaches.

More information allows us to assign an appropriate priority for your patient and in particular to arrange urgent appointments when they are indicated.

To refer a patient for a diagnostic sleep study without a consultation:

A physician, midwife or nurse practitioner can refer a patient for a diagnostic sleep study without the patient being seen by a physician at NNSDC.

Note that as of 2010 July 1, Ontario residents can only have ONE 'initial diagnostic sleep study' in their lifetime. To have another diagnostic sleep study a person must see a sleep medicine physician, and must meet a set of criteria set by OHIP/ MOHLTC. If your patient has ever had a sleep study in a hospital or freestanding sleep lab in Ontario, of any type, and for any reason, you cannot requisition a diagnostic sleep study. You must request a consultation with sleep medicine.

Also, please note that if you request a sleep study without consultation, you must review the results with the patient yourself.

To directly requisition a diagnostic sleep study end a signed initial diagnostic sleep study requisition .

Life threatening and urgent problems

For clearly urgent problems physicians should call the office (807) 622-0333 and speak to Dr Holtby directly.

When in doubt, phone.

Examples of urgent case scenarios:

suspected sleep apnea in pregnancy
suspected sleep apnea with unstable/new onset angina/ new onset CHF/ recent MI/ TIA/ recent stroke
very severe drowsiness, especially in a critical job such as a pilot/ truck driver/ railroad engineer
sleep related violence
adult onset or recent onset sleepwalking especially with dangerous behaviours
severe insomnia causing suicidal ideation or recent onset severe insomnia

General advice while you are waiting for us to arrange an appointment for your patient with:

- insomnia - Most patients have dysfunctional sleep habits that perpetuate insomnia. Spending a few minutes instructing them about better habits may help. Print this handout as a guide.
- restless limbs
- snoring and sleep apnea: You can print and give them this handout on how snoring and apnea are related, and their options for therapy. (pdf file)
- teenagers with sleep onset insomnia on weekdays (delayed sleep phase syndrome) (pdf file)
- (anxiety or or claustrophobia trying to use CPAP.) (pdf file)