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Online Screening Instructions for
the Sleep Disorders Inventory for Students-Revised (SDIS-R)
and the Sleep Disorders Inventory for Adults (SDIA)

© 2019, Dr. Marsha Luginbuehl, Child Uplift, Inc., Ph: (307) 248-0226


SETTING UP YOUR ACCOUNT


  1. After you have opened a business account and purchased the amount of screenings you would like, then you will be welcomed to your account by name and address.
  2. Below your name and address, you will see the number of screenings you have. Every time you issue a screening, you will notice that the amount of screenings is reduced by one. To the right of that amount, there is a shopping cart. When you see you are running out of screenings, you can click the shopping cart and order more with a credit card. The price list will show you the breakdown of screening prices. The more you order at one time, the cheaper each screening is.

ISSUING INVENTORIES TO PEOPLE

  1. Below your amount of screenings, you will see three tabs : “Send Inventory” “Recent Completed” “Search Clients”
  2. Under “Send Inventory" it says "Assign Sleep Inventory”. You will assign an inventory to either a parent so he or she can complete the SDIS-R about the child or adolescent, or to an adult client to take the Sleep Disorders Inventory for Adults (SDIA). You will type the parent's First and Last Name , the Language (either English or Spanish), and Email Address in those three fields and then click: “Assign Inventory”. An email link will be sent to the parent or adult client from info@SleepInventory.com. Please let the parent or client know that they should look for this email address or else they will probably look for your business address. If they do not see it, tell them to look in their Spam mail. The parent or adult client merely has to click the screening link to go to the screening at www.SleepInventory.com.

DIRECTIONS FOR THE RATER (parent or adult patient)

  1. The parent will need to enter the information about the child or adolescent under “Subject Information”. If it is an Adult taking the inventory for him/herself, then the adult will enter data about him/herself.
  2. They must fill in all data fields and then they will be taken to either the Child, Adolescent or Adult Inventory depending on the birth date entered. If they do not want to provide some of their personal information, then they can place xxxxxx or oooooo's in those fields, but they must put something in each field in order to bring up the sleep inventory. Also they MUST GIVE the ACCURATE DATE OF BIRTH to get the correct results.
  3. They can download a Worksheet to check out the questions prior to completing the online screening. If they are unsure of certain nighttime questions, the parent may need to observe the child/teen's nighttime sleep a couple of times to answer the nighttime sleep questions accurately. If the parent or adult logs out of the screening for a day or two to make the nighttime observations, tell him/her to be sure to write down his/her username and password to come back online to www.SleepInventory.com. When rating an adolescent, the teen should help the parent with the daytime questions about sleepiness, time falling asleep at night, nighttime awakenings, etc. However, the parent will need to rate the teen's nighttime questions about snoring, open-mouth breathing during sleep, choking or gasping, etc. because the teen will not know how to answer these answers accurately. When doing an adult screening, the adult will need for a spouse, partner, or someone who knows his or her sleep habits to help them complete the nighttime questions.
  4. Encourage the parent or adult to pay special attention to the definitions of the rating scale. The definitions are contained at the beginning of the worksheet or at the left side of each online question – they just click the question mark ? to the left of the questions and the definitions will pop up.

OBTAINING THE RESULTS OF THE SCREENING

  1. As soon as the parent or adult client/patient is finished rating the inventory and clicks “Finalize Evaluation”, not only will the parent or adult client be able to see and download the results (graph and report), but also you, the professional, will receive an email to your business informing you that your client/patient's screening has been completed. You can see the report immediately and download it or save it electronically into the patient's file. This way you do not have to worry about the client/patient losing or forgetting to bring the record form with graph/report to their next appointment.
  2. Also, your client/patients' results will be stored on our digital platform for you, and only you will be able to access them at any time. To do this, you can easily access client results by clicking either the “Recent Completed” or the “Search Clients” tab, then enter your client/patient's last name only or email address, and you can instantly pull up the results. It is Best for Search if you enter the client's last name only or email address.
  3. Search Clients feature: Sometimes a screening is not recent, but occurred months or years previously. In this case you need to use the "Search Clients" feature to retrieve an older screening. Also if you have requested a screening from a client/patient and you notice they have not completed it, when you use the "Search Client" feature, check the "Incomplete" button. The client's case will be retrieved, and you will notice there are no scaled scores listed because they have not completed the screening (it will say that the screening is "incomplete"). On the far right you have three little icons. If you hover over the icons with your cursor, the first one of an envelope will allow you to "Resend the Email Invitation" to the same patient's email; the second or middle icon says, "Copy Inventory to Clipboard"; the third or far-right icon of a trashcan says, "Delete Sleep Inventory". If you click this delete icon, the screening is removed from that patient/client and one screening is returned back to your number of screenings left so that you don't waste screenings on disinterested patients. This enables you to send it to someone else.

MONITORING PATIENT'S PROGRESS

  1. You may need to monitor a client's sleep behaviors over time. Perhaps some type of treatment, breathing therapy, or surgery occurs after the first screening, and then the professional would like to check two or three months later to see if the treatment or surgery was successful. You merely have to issue the client another screening to complete. When more than one screening is completed, the professional has to make sure the same exact name and D.O.B. is used for any subsequent screenings.
  2. Once the screenings have been finalized, you can go to the "Completed Screening List" on your account and check the little box to the left of the PDF Report under the word “Comparison" or "comparison Report” for any or all of the client's screenings you want to compare over time. Then below the boxes, you can click “View Chart” and pull up a Bar Graph comparing the client's screenings over time. This feature is good for professionals needing to demonstrate treatment fidelity to their patients or insurance companies.

INTERPRETATION OF THE RESULTS

GRAPH: There are basically four important sections to the graph that professionals may need to explain to parents or adult patients:

  1. Sleep Problem Scales - The Children's Inventory has four scales ((Sleep-Related Breathing Disorder (SRBD); Periodic Limb Movement Disorder (PLMD); Delayed Sleep Phase Syndrome (DSPS) or Behavioral Insomnia of Childhood (BIC), which is usually the correct name for children; Excessive Daytime Sleepiness (EDS); and a Total Sleep Disturbance Index, which is the sum of the scores on the other sleep scales. The Adolescent Sleep Inventory Graph has the same scales as the Children's Graph except there is one added scale called Narcolepsy. Narcolepsy in children is very rare and usually only has onset in adolescents. However, if the children's EDS scale is high, but no other sleep scales, this could be the beginning symptom of narcolepsy, and should not be ignored. You will notice that their are numbers within these sleep scale bars. These numbers are merely the Raw Scores, or simply the sum of the scores for each question that measures SRBD, or other scales. The raw scores can be ignored. The report will provide the definitions of SRBD, PLMD, DSPS or BIC, EDS, and the total SDI if the child scores higher than normal on any of these scales. Therefore, it will not be provided here because you can read the report.
  2. Sleep Categories - These sleep inventories give overall estimates of the possibility of a sleep disorder or an estimate of the severity of sleep problems based on comparisons to many other people of the same age. There are three important sleep categories on the left side of the graph: The "Normal Sleep" range, which is white in color. If the child has normal sleep on all sleep scales, then he or she does not appear to have any sleep problems, and so the Interpretive Report will be very brief and only one page ((unless the child has one or more parasomnias (discussed below)). However, if the SRBD bar is only one or two points below the "Caution" range, which is yellow, the child could have mild Upper Airway Resistance Syndrome (UARS) (UARS is explained in the report if the SRBD scale is in the caution or high risk range). In this case of SRBD being almost in the Caution range, this person will need to be monitored carefully or maybe even undergo an examination by a professional trained in airway breathing problems and their treatment (some dentists, orthodontists, oral-facial myofunctional therapists (OMTs), pediatricians, otolaryngologist, allergists, etc.) because this condition can turn into more serious problems with age like Obstructive Sleep Apnea (OSA).

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 red in color. When the bar is in the beginning section of the red category, then it is likely that the person has a moderate sleep problem that is causing significant problems for this person that needs to be corrected. When the bar is more than 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 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 sometimes, then the results can be incorrect. See the "Rater Reliability" comments below to learn how to detect an unreliable rater. 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.


3. 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 hypothesis (or estimation) 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. 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 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, 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, this is an indication that this person may have a mild sleep disorder that probably needs treatment before it becomes 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, 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 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 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 of a Sleep Disorder” range, 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 all have some things 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". 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 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 level in children and teens, or enlarged tonsils or adenoids, dental malocclusions or problematic jaw structure in the case of a high SRBD score, etc.


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.


NEED FOR MORE INFORMATION


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 "" 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 SDIA, 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.


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.