© 2019, Dr. Marsha Luginbuehl, Ph.D., NCSP, Child Uplift, Inc., Ph: (307) 248-0226
SETTING UP OR CHANGING YOUR ACCOUNT INFORMATION
The yellow "Caution" range signals that this person's sleep problems are more problematic than normal compared to the general population and could be an indication that this person has a mild sleep disorder that probably needs to be investigated and corrected before it turns into a moderate-to-severe sleep disorder.The third and most severe sleep category is the "High Risk" range, which is in the upper third of the graph and red in color. When the bar is in the beginning or lower part of the red range then it is likely that the person has a moderate sleep problem that is causing significant problems for this person and needs to be corrected. When the bar is more than 1 to 1 1/2 inches into the red high risk range, then it is more likely that this person has a severe sleep problem that has a very negative and significant impact on daytime performance, excessive daytime sleepiness, recuperative sleep, and long-term health, and needs to be corrected in a timely manner.Please note that these categories are not a definite diagnosis of a sleep disorder, only good hypotheses. If the parent or adult patient/client is an unreliable rater, which happens about 10% of the time, then the results can be incorrect. See the "Rater Reliability" comments below to learn how to detect an unreliable rater. It is kind of like a "lie detector", but we are not insinuating that the rater is lying, merely that the rater may not be a reliable judge of their child/adolescent's daytime and sleep behaviors for various reasons. These hypotheses can be shown to a pediatrician or sleep specialists who will help the person determine if they should undergo an overnight sleep evaluation.
NEED FOR MORE INFORMATION3. T-Scores - Also on the left side of the graph is a narrow section entitled "T-Score" at the top with numbers below this title. A T-Score is an important statistical estimation or measurement that compares this child, adolescent or adult's sleep behaviors to many people of the same age in the general population to see how their sleep issues compare. A T-Score is a standard score that can be compared to standard scores on other tests and inventories and is often used by researchers or psychologists. T-Scores of 59 and below usually indicate that this person's scores are fairly normal and there should not be any concern. The only exception is the SRBD scale. As mentioned above, a T-score of 58 or 59, which is still within the white or normal range, is usually insignificant. However, on the SRBD scale, this almost significant score could be an indicator that the child has mild Upper Airway Resistance Syndrome (UARS). Especially if this person is exhibiting snoring and/or some apnea events in the night. This condition often gets more severe with age if it goes untreated. Therefore, this person may need to have their airways and mouth structure examined by someone specialized in breathing and airway problems, such as some dentists and orthodontists with special training in sleep-related breathing disorders, oral-facial myofunctional therapists (OMT), allergists, otolaryngologists, some pediatricians, sleep specialists, etc. They may be able to provide treatment options to correct the problem before it becomes more severe and has a negative impact on daytime functioning and health.If a T-Score is in the range from 60 through 64 or "Caution" range, this is an indication that this person may have a mild sleep disorder that probably needs treatment before it becomes moderate-to-severe, provided that the rater did not over-estimate the sleep problems (many sleep disorders become more severe with age).If a T-Score is 65 or higher and within the "High Risk" range, this is an indication that this person has a good probability of having a sleep disorder that needs to be corrected within the near future.4. Percentile Ranks - A percentile rank is another important measurement often provided to parents or educators that ranks a person's score on a scale of 1 to 100. If the person receives a percentile rank of 25%, then this means that his or her score was equal to or higher than 25% of the people who have taken the same test or inventory. With some tests, like school achievement tests, the higher the percentile rank the better. However, in the case of sleep problems, the higher the ranking, the more sleep problems this person has, which is not good. So on these sleep inventories, a score of 82% or less usually means that this person scored within the "Normal" range and the sleep is not a significant concern. However, 82% is getting very close to being significant. A percentile rank of 85 - 93 is fairly high and within the "Caution" range of these sleep inventories. A percentile rank of 94% and above indicates a good change of this person having a major sleep disorder and is within the "High Risk" range of having a sleep disorder.INTERPRETIVE REPORT: The comprehensive Interpretive Report is fairly self-explanatory for any parent or professional who does not know a lot about sleep disorders.The first page gives a general explanation about sleep disorders and the negative impact they can have on a person’s daytime performance and health if not corrected. It also explains that this sleep inventory does not make “Diagnoses”, but provides fairly accurate hypotheses of the sleep problem/s or disorder/s the person may have if the rater was reliable. Finally this first page explains the sleep disorders that are being screened, three sleep categories on the graph (Normal, Caution, and High Risk range of a sleep disorder), and their T-Scores.
Starting on the second page, if the person has any sleep scale rated within the “Caution” or “High Risk" range of a sleep disorder, then the Interpretive Report will explain what that possible sleep disorder is, how it can negatively impact the person if it is not corrected, and various treatment options that might be available to this individual.
Interpretation when more than one scale is higher than normal - It is possible for several or all sleep scales to be within the caution or high risk range when in reality only one sleep disorder may exist. This is because these sleep disorders have a few symptoms in common based on computer analyses. Also if the person has a significant Sleep-Related Breathing Disorder (SRBD), in particular Obstructive Sleep Apnea (OSA), this sleep disorder causes so many daytime and nighttime problems that it can raise the Periodic Limb Movement Disorder scale (due to the person kicking and rolling around often to open up his/her airways wider); SRBD/OSA can cause the person Excessive Daytime Sleepiness (EDS) and escalation on the Narcolepsy scale (due to EDS being the most common feature of Narcolepsy; SRBD/OSA can raise the Delayed Sleep Phase Syndrome scale (DSPS) because some individuals with OSA have an unconscious fear or hesitation to fall asleep at a normal time because sleep is an uncomfortable or stressful time when their body and brain is struggling to breathe and stay alive. PLMD can also escalate the Narcolepsy scale due to causing EDS. Therefore, the way to interpret the graph accurately when several or all sleep scales are higher than normal is to look at the higher than normal sleep scale on the far LEFT side of the graph. If it is SRBD, then it is most likely that this is the actual sleep scale causing all the other problems. If SRBD is within the normal range, but PLMD is high, since it is the scale farthest to the LEFT that is high, then it is likely that PLMD is the actual sleep disorder causing Narcolepsy, DSPS and/or EDS to be high. And so the rule-out process continues. The Interpretive Report will also explain this sleep phenomena too.
Rater Reliability Items - In the case of high sleep scale scores, it is wise for professionals to check certain items on the sleep inventories that can be used as "lie detector items" or "rater reliability items". We are not suggesting that the rater is lying, but it could be that they do not know their child or teen's daytime or nighttime behaviors well for various reasons. This is the case with about 10% of people who complete behavior rating scales. These rater reliability items for the SDIS-R-Children's form are Numbers 8, 13, 18, and 19. On the SDIS-R-Adolescent form and the SDI-Adult form, these items are Numbers 9, 10, 14, 20, 21, 23. These items should typically not occur more often than once per day, which is a score of 5 on the rating scale. If you see these items rated higher than a score of 5, especially more than one of these items scored a 6 or 7, then there is a good possibility that the rater may be over-exaggerating the severity of the sleep problems. In this case, it would be important for the professional to look for physical signs of a sleep disorder, like a high activity level or a lethargic activity leel ivn children and teens, or enlarged tonsils or adenoids, dental malocclusions or problematic jaw structure in the case of a high SRBD score, etc. Unfortunately there is no way to detect if the rater is under-estimating the child or teen's daytime or nighttime behaviors unless the professional observes physical features that are very typical of a sleep disorder.
Parasomnias – The inventory asks if any one of five parasomnias exist (Teeth-grinding, sleep-talking, sleep-walking, sleep or night terrors, and bed-wetting). Parasomnias are strange or unusual movements during sleep. The parasomnias are different than the major sleep disorders screened on these inventories because they do not have any significant impact on daytime functioning like the major sleep disorders on this graph have. If the parent or adult patient/client indicates “yes” to any of these parasomnias, the report gives the adult some general information about the parasomnia, the impact it can have on the person if not corrected, and in most cases, numerous interventions are provided to help stop or improve the parasomnia. The scoring of the parasomnias is kept separate from the scoring of the major sleep disorders.
Medical History Questions – The last 24 questions on these three inventories are not tied to the scoring of the sleep scales on the graph or the parasomnias. The purpose of these questions is to provide medical history information in the case that a person obtains a higher than normal score on the Sleep-Related Breathing Disorder (SRBD) scale This information can provide medical professionals important information about what may be causing these higher than normal SRBD scores, and lead to more accurate and speedier treatment for SRBD, which is considered the most harmful of all major sleep disorders. The answers to these 24 Medical History questions are provided at the end of the report for professionals to review before or while seeing their patient.
At the very end of the report, a website is provided where people can go to find all American Academy of Sleep Medicine certified sleep clinics or hospitals in their area. These AASM clinics/labs are using the correct sleep disorder diagnosis scoring criteria and are recommended.
The top MENU fields provide more information about our products:1. Product Information - If you need more information about the SDIS-R or SDIA, please hover over "PRODUCT INFO" on the top menu to find a Summary of the Development of these products including validity, reliability, and testimonials. Product Information also provides numerous scientific journal articles about the SDIS, SDIS-R, or the SDI-A. You are also provided numerous testimonials from professionals or parents about our products. Finally, there is pricing information provided here.2. About Us - You will find information about the author of the SDIS, SDIS-R, and the SDI-A, Dr. Marsha Luginbuehl, who is President & CEO of Child Uplift, Inc. There is also information about her husband, Peter Luginbuehl, who acts as Vice President, and marketing/sales director. There is also information about numerous awards Dr. Luginbuehl has received for her development of these inventories and nationwide work with pediatric sleep disorders over her career.3. Contact Us - This tab enables users or interested users of the SDIS products to email or phone Child Uplift, Inc. with any questions they might have.
The top MENU fields provide more information about our products:Thank you so much for your desire to screen your clients/patients/students for the most common and harmful sleep disorders that can seriously impair the learning, behaviors, emotional regulation, health, and safety of both children and adults. If you find our products helpful, we hope you will share the information with your colleagues and encourage them to come visit us at www.SleepInventory.com. We welcome any questions via email or phone.
Marsha Luginbuehl, Ph.D., NCSP
President & CEO, Child Uplift, Inc.