Consent for CPAP Consent for CPAP DETAILSA polysomnogram is an overnight sleep study. It records detailed information that shows how your body acts while you sleep. A technologist will attach sensors to your body for the study. These sensors will monitor and record multiple body functions which include: Brain wave activity Heart rate and rhythm Breathing patterns Oxygen level Eye movements Chin movement The study also may involve other sensors. These sensors send signals to a computer. The sleep center will use this information to prepare a detailed report about your sleep. The doctor who sent you to the sleep center will receive a copy of this report. He or she will then discuss the results with you. Please allow 14 business days for your doctor to receive your sleep report.RISKSYou will sleep in the Sleep Laboratory as you would at home or in a hotel room.AGREEMENTMy signature below indicates that I understand and agree with the following statements: This sleep study may not detect the cause of my sleep problem. A technologist will attach sensors to my body for the study. These sensors may smell bad when they are placed on me. The removal of the sensors in the morning may irritate my skin and cause redness. A video camera will record me as I sleep. A technologist will watch me on a monitor in the control room. I will be free to roll over and move in bed during the study. I will need to ask for help if I must get out of bed for any reason. The technologist may need to enter the room and wake me if there is a problem. The study may show that I stop breathing many times during the night. If this happens, a technologist may enter my room to start treatment. This treatment is called positive airway pressure, or PAP. To use this treatment, I will need to wear a mask which covers my nose and possibly my mouth. I understand why I am taking this sleep study. I have discussed the need for the sleep study with my referring doctor. The sleep center staff has explained the sleep study to me. I understand what is going to happen during the study. All of my questions have been asked and satisfactorily answered. I agree to the performance of a sleep study with video recording.Patient/Guardian First name(Required)Patient/Guardian Last name(Required)Email Enter Email Confirm Email Signature(Required) By checking this box, I am signing this document.Date(Required) MM slash DD slash YYYY Witness(Required)Date(Required) MM slash DD slash YYYY Rev 9.29.2022CommentsThis field is for validation purposes and should be left unchanged.