Home Sleep Test Information

Home Sleep Test Information

Your doctor may order a home sleep test for you in order to properly diagnose sleep issues. If you are scheduled to have your home sleep test (HST) completed at MLA, you will meet with a member of the team to learn about how to use the HST device.

This video may also be helpful as a reminder, before you go to sleep:

Asthma Control Test

Asthma Control Test

Add all of the numbers

The Asthma Control Test™ is a quick test for people with asthma 12 years or older. It provides a numerical score to help assess asthma control.

1. Select the response to each question.
2. Submit this form to view your results.
3. Print/Discuss your results with your doctor.

All of the timeMost of the timeSome of the timeA little of the timeNone of the time
More than once a dayOnce a day3 to 6 times a weekOnce or twice a weekNot at all
4 or more nights a week2 or 3 nights a weekOnce a weekOnce or twiceNot at all
3 or more times per day1 or 2 times per day2 or 3 times per weekOnce a week or lessNot at all
Not controlled at allPoorly controlledSomewhat controlledWell controlledCompletely controlled

Sleep Hygiene

Sleep Hygiene

Tips for a better night’s sleep

Below are some essentials of good sleep habits. Many of these points will seem like common sense. But it is surprising how many of these important points are ignored by many of us.

Your Personal Habits

  • Fix a bedtime and wakening time. Do not allow bedtime and wake time to drift. The body gets used to falling asleep at a certain time, but only if this is relatively fixed. Even if retired or not working, this is an essential component of good sleeping habits.
  • Avoid napping during the day. If you do it is no wonder that you will not be able to sleep at night. The late after- noon for most people is a “sleepy time.” Many people will take a nap at that time. This is generally not a bad thing to do, provided you limit the nap to 30-45 minutes and can sleep well at night.
  • Avoid alcohol 4-6 hours before bedtime. Many people believe that alcohol helps them sleep. While alcohol has an immediate sleep-inducing effect, a few hours later as the alcohol levels in your blood start to fall, there is a stimulant or wake-up effect.
  • Avoid caffeine 4-6 hours before bedtime. This includes caffeinated beverages such as coffee, tea and many sodas, as well as chocolate.
  • Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime. These can affect your ability to stay asleep.
  • Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep. Strenuous exercise within the 2 hours before bed- time, however, can decrease your ability to fall asleep.

Your Sleep Environment

  • Always use comfortable bedding.
  • Find a comfortable temperature and keep the room well ventilated. If your bedroom is too cold or too hot, it can keep you awake. A cool bedroom is often the most conducive to sleep.
  • Block out all distracting noise, and eliminate as much light as possible.
  • Reserve the bed for sleep and sex. Don’t use the bed as an office, work-room or recreation room.

Getting Ready for Bed

  • Try a light snack before bed. Warm milk and foods high in the amino acid tryptophan, such as bananas, may help you to sleep.
  • Practice relaxation techniques before bed. Relaxation techniques such as yoga, deep breathing and others may help relieve anxiety and reduce muscle tension.
  • Don’t take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed.
  • Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep.

Other Factors

  • Several physical factors are known to upset sleep. These include arthritis, acid reflux, menstruation, headaches and hot flashes
  • Psychological and mental health problems like depression, anxiety and stress are often associated with sleeping difficulty
  • Many medications can cause sleeplessness
  • To help overall improvement in sleep patterns, your doctor may prescribe sleep medications for short-term relief
  • Always follow the advice of your physician and other healthcare professionals.

A Word About Television

Many people fall asleep with the television on in their room. Watching television before bed-time is often a bad idea. Television is a very engaging medium that tends to keep people up. We generally recommend that the television not be in the bed- room. At the appropriate bed- time, the TV should be turned off and the patient should go to bed. Some people find that the radio helps them go to sleep. Since radio is a less engaging medium than TV, this is probably a good idea.

Pollen Allergy

Pollen Allergy

Hay fever (Allergic Rhinitis) is the most common of the allergic diseases and refers to seasonal nasal symptoms that are due to pollens. One of the most obvious features of pollen allergy is its seasonal nature; people experience symptoms only when the pollen grains to which they are allergic are in the air. Each plant has a pollinating period that is more or less the same from year to year. Plants produce microscopic pollen grains to reproduce. In some species, the plant uses the pollen from its own flowers to fertilize itself. Other types must be cross-pollinated; that is, in order for fertilization to take place and seeds to form, pollen must be transferred from the flower of one plant to that of another plant of the same species. In-sects do this job for certain flowering plants, while other plants rely on wind transport. The types of pollen that most commonly cause allergic reactions are produced by the plain-looking plants that do not have showy flowers. These plants manufacture small, light, dry pollen grains that are ideal wind transport. Because airborne pollen is carried for long distances, it does little good to rid an area of an offending plant as the pollen can drift in from many miles away. Among North American plants, weeds are the most prolific producers of allergenic pollen. Rag-weed is the major culprit; a single ragweed plant can generate a million grains of pollen a day. Colorful or scented flowers have large, heavy, waxy pollen grains. This type of pollen is not carried by wind but by insects such as butterflies and bees, and is not typically a cause of seasonal allergy. Similarly, the heavy, very visible pine pollen, is usually not a significant cause of symptoms.

Avoiding Pollen

  • Keep windows and outside doors shut during pollen season.
  • Use central or room A/C, so you can keep windows and outside doors shut
  • Consider pollen counts when planning outdoor activities. It may help to limit your out-door activities during the times of highest pollen counts. Outdoor activities may be better tolerated after a gentle, sustained rain.
  • Encourage hand washing after outdoor play to avoid transferring pollen from the hands to the eyes and nose.
  • If you are outdoors during pollen season, take a shower and wash your hair, change your clothes (not in your bed-room), and leave these clothes in the laundry room.
  • Dry laundry in a dryer only; avoid hanging clothes out-side to dry.
  • Drive with your windows closed. If it is hot, use your air conditioner.
  • Keep pets that spend time outdoors out of the bedroom. In addition to animal dander, they may carry and deposit pollen stuck to their fur.

Pollen Counts

A pollen count is a measure of how much pollen is in the air. This count represents the concentration of all the pollen (or of one particular type, like ragweed) in the air in a certain area at a specific time. It is expressed in grains of pollen per square meter of air collected over 24 hours. Pollen counts tend to be highest early in the morning on warm, dry, breezy days and lowest during chilly, wet periods.

Check the pollen count

Important Pollens


  • Maple
  • Birch
  • Hickory
  • Oak
  • Elm
  • Cottonwood


  • Timothy
  • Kentucky bluegrass
  • Orchard


  • Ragweed
  • Pigweed
  • Lamb’s Quarter
  • Plantain
  • Cocklebur
  • Dock

Controllers – Leukotriene Antagonist

  • Singulair®
  • Accolate®

Mold Allergy

Mold Allergy

What it is . . . and isn’t

If you have a respiratory mold allergy, your immune system overreacts when you breathe in mold spores. This reaction triggers a cascade of reactions that lead to allergy symptoms. Like other respiratory allergies, mold allergy can make you cough, make your eyes itch and cause other symptoms that make you miserable. In some people, mold allergy is linked to asthma and exposure causes shortness of breath and other symptoms. Molds are very common both inside and outside. Mold, also known as fungus, is a family of organisms that are found throughout nature. They differ from plants or animals in how they reproduce and grow. The “seeds,” called spores, are spread by the wind outdoors and by air indoors. Some spores are released in dry, windy weather. Others are re-leased with the fog or dew when humidity is high. There are many different types, but only certain kinds of mold cause allergies. Being allergic to one type of mold doesn’t necessarily mean you’ll be allergic to an-other. Allergic symptoms from mold spores are most common from July to late summer. But with molds growing in so many places, allergic reactions can occur year round.

The term “toxic mold” is a misnomer and has no scientific basis. Some molds, called “toxigenic molds” produce byproducts called mycotoxins, which in high enough doses, can be beneficial or detrimental to human health. A common mycotoxin is penicillin – a useful antibiotic. Extreme exposure to very high levels of mycoto-ins may lead to health problems; fortunately such exposures rarely to never occur in normal exposure, even in residences with serious mold problems. Toxic effects may be the result of chronic activation of the immune system, leading to chronic inflammation. Allergy testing does not evaluate patients who feel they suffer from mold toxicity.

How To Reduce Indoor Mold Levels

  • Prevent outdoor molds from entering the home by keeping doors and windows closed and using air conditioning equipped with allergen-grade air filters.
  • Control indoor moisture with the use of dehumidifiers.
  • Fix water leaks in bathrooms, kitchens and basements.
  • Ensure adequate ventilation of moist areas
  • Limit indoor houseplants; ensure those present are free of mold on leaves and in potting soil
  • Stay indoors during periods when the published mold count is high.
  • Remove bathroom carpeting where moisture is a concern.
  • Clean refrigerator door gaskets and garbage pails frequently.
  • Throw away or recycle old books, newspapers, clothing or bedding.
  • Promote ground water drain-age away from a house.

Important Molds

  • Alternaria – A common outdoor mold; allergy to this mold can be associated with severe asthma
  • Cladosporium – The most common airborne outdoor mold
  • Aspergillus – A common indoor and outdoor mold
  • Penicillium – A common indoor mold; allergy to which is not associated with antibiotic allergy
  • Helminthosporum – More commonly found in warmer climates.
  • Epicoccum – Found in grassland and agricultural areas.
  • Fusarium – Commonly found on rotting plants.
  • Rhizopus and Mucor – Commonly found on decaying leaves and damp indoor areas. Airborne forms of these molds are less common.
  • Yeasts – Commonly found in the air during wet periods in agricultural areas. Allergic disease to Candida albicans is controversial, despite some people having positive allergy testing to this type of mold.

What Times of the Year Does Mold Allergy Occur?

In colder climates, molds can be found in the outdoor air starting in the late winter, and peaking in the late summer to early fall months (July to October). In warmer climates, mold spores may be found throughout the year, with the highest levels found in the late summer to early fall months. While indoor molds can occur year round and are dependent on moisture levels in the home, indoor mold levels are higher when out-door mold levels are higher. Therefore, a common source of indoor mold is from the outside environment, although can also be from indoor mold contamination.

Food Allergy

Food Allergy

Although many people have bad reactions to certain foods, a true food allergy – a reaction triggered by the immune system – isn’t as common as you might think. However, the number of people who have a food allergy is growing. About 2 percent of adults and 6 percent of children have a true food allergy. Far more people have food intolerance, unpleasant symptoms triggered by food. Unlike a true food allergy though, a food intolerance doesn’t involve the immune system.  A food allergy reaction occurs when your immune system overreacts to a food or a substance in a food, identifying it as a danger and triggering a protective response.  Symptoms of a food allergy can range from mild to severe and typically appear within minutes to 2 hours after ingestion of a food to which he or she is allergic. Just because an initial reaction causes few problems doesn’t mean that all reactions will be similar; a food that triggered only mild symptoms on one occasion may cause more severe symptoms at another time. Symptoms of food allergy may include a tingling sensation in the mouth, swelling of the tongue and throat, difficulty breathing, hives, vomiting, abdominal cramps, diarrhea, low blood pressure, loss of consciousness, and even death. The most severe allergic reaction is called anaphylaxis – a life-threatening whole-body allergic reaction that can be fatal. It must be treated promptly. In some very rare cases, the reaction may be delayed by four to six hours or even longer. Delayed reactions are most typically seen in children who develop eczema as a symptom of food allergy and in people with a rare allergy to red meat caused by the bite of a lone star tick.

While any food can cause an adverse reaction, eight types of food account for about 90% of all reactions: Eggs, Milk and dairy, Peanuts, Tree nuts, Fish, Shellfish, Soy, Sesame. About 50% of children with allergies to milk, egg, soy, and wheat will outgrow their allergy by the age of 6. Those that don’t, and those still allergic by the age of 12 or so, have less than an 8% chance of outgrowing the allergy. Peanut and tree nut allergies are less likely to be outgrown, although evidence now shows that about 20% of those with peanut allergies and 9% of those with tree nut allergies will outgrow their allergies. However, one must never assume they have outgrown an allergy, and this should only be decided with the assistance of an allergy specialist.

Not everyone who experiences symptoms after eating certain foods has a food allergy or needs to avoid that food entirely. Some people with seasonal allergy to pollens experience an itchy mouth and throat after eating a raw or uncooked fruit or vegetables. This may indicate a diagnosis of oral allergy (food-pollen) syndrome – a reaction to pollen, not to the food itself. The immune system recognizes the pollen and similar proteins in the food and directs an allergic response to it. The allergen is destroyed by heating the food, which can then be consumed with no problem. One can experience symptoms, primarily digestive, with a food intolerance. The most common example is lactose intolerance. Because a food intolerance may involve some of the same signs and symptoms as a food allergy does – such as nausea, vomiting, cramping and diarrhea – people often confuse the two. If you have a food in-tolerance, you may be able to eat small amounts of problem foods without a reaction. By contrast, if you have a true food allergy, even a tiny amount of food may trigger a severe allergic reaction.

Once a food allergy is diagnosed the most effective treatment is to avoid the food. People allergic to a specific food may also potentially have a reaction to related foods. For example, a person allergic to one tree nut may be cross-reactive to others. Those allergic to shrimp may react to crab and lobster. Learning about patterns of cross-reactivity and what must be avoided is one of the reasons why people with food allergies should receive care from an allergist. Determining if you are cross-reactive is not straightforward.

The primary way to manage a food allergy is to avoid consuming the food that causes you problems. Carefully check ingredient labels of food products and learn whether what you need to avoid is known by other names. The Food Allergy Labeling and Consumer Protection Act of 2004 (FALCPA) mandates that manufacturers of packaged foods produced in the United States identify, in simple, clear language, the presence of any of the eight most common food allergens in their products. The presence of the allergen must be stated even if it is only an incidental ingredient, as in an additive or flavoring. Be aware that FALCPA labeling requirements do not apply to items regulated by the U.S. Department of Agriculture (meat, poultry and certain egg products) and those regulated by the Alcohol and Tobacco Tax and Trade Bureau (distilled spirits, wine and beer). The law also does not apply to cosmetics, shampoos and other health and beauty aids, some of which may contain tree nut extracts or wheat proteins. Some goods also may be labeled with precautionary statements, such as “may contain,” “might contain,” “made on shared equipment,” “made in a shared facility” or some other indication of potential allergen contamination. There are no laws or regulations requiring those advisory warnings and no standards that define what they mean.

Symptoms caused by a food allergy can range from mild to life-threatening; the severity of each reaction is unpredictable. As noted, people who have previously experienced only mild symptoms may suddenly experience a life-threatening reaction. Therefore, allergists do not like to classify someone as “mildly” or “severely” food allergic – there is just no way to tell what may happen with the next reaction. Epinephrine is the first-line treatment for anaphylaxis. Once you have been diagnosed with a food allergy, your allergist should prescribe an epinephrine auto-injector and teach you how to use it. You should also be given a written treatment plan describing what medications you have been prescribed and when they should be used. Keep an eye on the expiration date of your auto-injector.  Anyone with a food allergy should always have the auto-injector close at hand. Having two doses available is important as the severe reaction can recur in about 20% of individuals. Use epinephrine immediately if you experience severe symptoms such as shortness of breath, repetitive coughing, weak pulse, hives, tightness in your throat, trouble breathing or swallowing vomiting, diarrhea or abdominal pain. You should call for an ambulance to be taken to the emergency room. Inform the dispatcher that epinephrine was administered and more may be needed. If you are uncertain whether a reaction warrants epinephrine, use it right away; the benefits of epinephrine far outweigh the risk that a dose may not have been necessary.

Common side effects of epinephrine may include anxiety, restlessness, dizziness and shakiness. In very rare instances, the medication can lead to abnormal heart rate or rhythm, heart attack, an increase in blood pressure and fluid buildup in the lungs. If you have certain pre-existing conditions, such as heart disease or diabetes, you may be at a higher risk for adverse effects from epinephrine. Nevertheless, epinephrine is considered very safe and is the most effective medicine to treat severe allergic reactions. Other medications may be prescribed to treat symptoms of a food allergy, but it is important to note that there is no substitute for epinephrine: It is the only medication that can reverse the life-threatening symptoms of anaphylaxis.

Important Food Allergens

  • Milk
  • Egg
  • Peanut
  • Tree Nuts
  • Fish
  • Shellfish
  • Soy
  • Wheat

Special points of interest:

  • Even trace amounts of a food allergen can cause a reaction.
  • Most people who’ve had an allergic reaction to something they ate thought that it was safe.
  • Allergy to iodine, allergy to radiocontrast material, and allergy to fish or shellfish are not related.
  • Fish protein can become airborne during cooking and cause an allergic reaction.
  • Celiac disease and wheat allergy are two distinct conditions.
  • Most people with food allergies are allergic to fewer than 4 foods.
  • Some people have an allergic reaction to a food that is triggered by exercise.

Oral Allergy Syndrome

Some fresh fruits and vegetables can trigger a mild allergic reaction that causes the mouth to tingle or itch. This is an example of cross-reactivity — proteins in fruits and vegetables cause the reaction be-cause they’re similar to those allergy-causing proteins found in certain pollens. For example, if you’re allergic to ragweed, you may also react to melons; if you’re allergic to birch pollen, you may also react to apples. Most cooked fruits and vegetables generally do not cause cross-reactive oral allergy symptoms.

Dust Mite Allergy

Dust Mite Allergy

Avoidance Strategies for Dust Mite Allergy

  • Efforts should be concentrated in the bedroom (as we spend most indoor time there).
  • Encase mattress, box spring, and pillow in “mite proof” allergen encasements.
  • Wash all bedding in hot water (>130°F) to kill the mites.
  • Remove all dust collectors (for example, stuffed animals).
  • Remove upholstered furniture in favor of leather or wipeable furniture and minimize or wash soft drapery.
  • Remove wall-to-wall carpets from the bedroom if possible. Bare vinyl or hardwood floors are best.
  • Vacuum carpets and furniture no more than once per week.
  • Use a central vacuum or a vacuum with a HEPA filter. If you are allergic, wear a filter mask while dusting, sweep-ing or vacuuming.
  • Remember, it takes over two hours for the dust to settle back down, so if possible clean when the allergic patient is away and don’t clean the bedroom at night.
  • Measure the indoor humidity and keep it below 55 percent. Do not use vaporizers or humidifiers. You may need a dehumidifier. Use vent fans in bathrooms and when cooking to remove moisture. Repair all water leaks.
  • If you have forced hot air heat-ing or central A/C, install a high efficiency media filter in the furnace and air-conditioning unit. Leave the fan on to create a “whole house” air filter that removes particulates. Change the filter at least every three months (with the change of the season)

What is a Dust Mite?

  • Dust mites are approximately 1/3 mm, sightless, 8-legged arachnids
  • Dust mites are closely related to ticks, scabies, and spiders
  • Mites are photophobic (do not like the light) and very susceptible to drying and therefore live in nests such as mattresses, carpets, sofas and bedding
  • In these sites there is ample food source (human skin scales)
  • Mites continue to grow deep inside their “nests” in which the micro environment remains humid
  • In temperate areas where temperature and humidity are highest in mid summer, mite numbers (and allergen) in-crease rapidly and there is a peak or season of mite allergen in the Fall and early Winter

Other Facts About Dust Mites

Dust mites are the most common cause of allergy from house dust.

There may be as many as 19,000 dust mites in one gram of dust, but usually between 100 to 500 mites live in each gram. (A gram is about the weight of a paper clip.)

Special Points of Interest:

  • If it is a hard surface, WIPE IT
  • If it is a washable fabric, WASH IT
  • If it cannot be wiped or washed, COVER IT
  • If it cannot be wiped, washed or covered, REMOVE IT

Animal Allergy

Animal Allergy

Household pets are the most common source of allergic reactions to animals. 15-30% of people with allergies have an allergy to dogs, cats, or other animals. Cats are the most common cause for pet allergies and approximately 10 million people in the United States are allergic to cats. Pet allergies are caused by an immune system response to proteins present in the animal. Many people assume that they are allergic to their pet’s fur. Actually, the culprits are proteins in pet dander and dried saliva and urine. Dander occurs naturally as the epidermis, or the outer layer of skin, renews itself. The epidermis is made up of many layers of cells which are constantly pushing upward to re-place the cells above. As this occurs, the outer cells die and flake off into the environment as dander. It has been found, incidentally, that the epidermal turnover is more rapid in breeds that are groomed frequently and especially in breeds that are prone to various forms of dry and oily seborrhea. Saliva and urine are also potential sources of allergens. They are deposited on the fur through licking and urination. More people are allergic to cats than dogs, probably because cats spend more time indoors and bathe them-selves with their saliva. Since dander is very small and light, it can attach itself to your clothes when you are away and ride back into your home undetected. It can also come in on the clothes of your children or guests. Animal dander has been found in many public places, like school classrooms, in quantities high enough to cause an allergic reaction. Many homes without pets have been tested, and similar results have been found. If you have moved into a home where a pet has lived, it will take a year or more for all of the dander to lose its potency. So even if you don’t have a cat in your home you can react as if there is one. Some rodents, such as guinea pigs and gerbils, have become increasingly popular as household pets. They, too, can cause allergic reactions , as can mice and rats. Urine is the major source of allergens from these animals.

Animal Allergy Myths and Realities

Myth: Some breeds of animals are non allergenic.
Reality: Since dander is produced within a cat or dog’s skin and they all have skin, there are no breeds that are non allergenic.

Myth: Only indoor pets cause allergies.
Reality: There are many different animals that can cause allergic reactions, not just your dog, cat or hamster. Outdoor animals such as horses, cows, pigs or chickens also cause a reaction due to their hair or living areas which are mainly enclosed.

Myth: Continuous exposure to animals will desensitize you to them.
Reality: If you are allergic to an animal, continuous exposure will not decrease your allergy. In fact, 1 in 3 people who have other allergies and are exposed to indoor pets will become allergic to them as well over time.

Myth: A shorter hair animal causes less allergic reaction.
Reality: Allergy has little to do with the length of fur (or hair) on the animal. Even though short haired animals shed less, they still produce the same amount of dander, which is the real cause of the pet allergies.

The Truth: Male cats produce more allergen than female cats. Some breeds of dogs produce dog allergen faster than others.

Allergen Avoidance

The best avoidance measure for a pet allergy is to remove the animal from the house. However, many people are emotionally attached to the pet and are unwilling to do so. In this case, there are some actions that are recommended to cut down on the amount of allergen in the home:

Remove the pet from the bedroom, and keep the animal off of furniture and outdoors as much as possible.

Have someone else bathe the pet at least once per week, especially if the animal is large.

Consider removal of carpeting from the bedroom and other common areas of the home.

Vacuum the carpet and floors frequently; ensuring the vacuum cleaner should be equipped with a HEPA filter.

Consider purchasing a HEPA filtered air cleaner for the bedroom.

If the pet is removed from the home, it is important to steam clean all carpeting and upholstered furniture, and launder draperies and bedding.