My Sleep Apnea: The Sleep Study
In last week's article I talked about my initial experience with sleep apnea: going to a sleep disorders clinic and being evaluated for risk factors. After going through that process, I was prescribed a one-night sleep study operated by a local university hospital. In this entry, I'll share some specifics about that study -- if you're considering going in for one, I hope to allay some fears and give you some tips.
First off, what is a sleep study? The technical term is a Polysomnogram, and it's effectively a suite of monitoring tests meant to evaluate a person's physiology during sleep. There's a particular focus on breathing, body movement, and brain waves, as these things are often implicated in sleep disorders. Without getting too technical, the test involves measuring eye moment, brain waves, breathing, blood oxygen levels, a wide variety of muscle movements, snoring, and miscellaneous other things. In practice it means getting a lot of little sensors taped or glued to your head, face, neck, chest, and legs, all with their own colorful wires. Here's a (slightly heartbreaking) Wikipedia-provided picture of a child about to go in for a sleep study:
In my case, the sleep study was held in a modified hotel suite. The university had permanently taken over part of a floor in a local residence hotel, and installed all the computers and other gear necessary to perform the tests and record the results. There was a sort of command center staffed by a variety of technicians, then down the hall a series of patient rooms were where the tests actually took place. The patient rooms were regular hotel rooms with a few additions: a CPAP (sleep apnea therapy) machine was by the bed, a microphone and speaker were above the headboard, an infrared camera looked down over the bed, and a computer network hookup was by the bed for the various sensors to plug into.
When I showed up, the command center was buzzing -- there must have been ten people in there, some of them apparently interns (this is a teaching hospital after all). A medical technician brought me to my room and went over the basics of the test, explained what would have to be hooked up to my head, and had me fill out some forms. After that I changed into night clothes and began the sensor-application process.
Applying the array of sensors can take up to 45 minutes, and it doesn't hurt -- though I found myself saying: "Really? There are more?" several times. In my case they were mostly glued on, using this weird putty that I washed out of my hair in clumps the next day. Sensors were applied all over my face and scalp, and a "snore microphone" was taped to my neck. Sensors were taped to my pectoral muscles as well as my calves, and the wires from those were run up underneath several belts that encircled my chest and abdomen (I believe these belts were also measuring respiration...or maybe they were just belts to hold wires). A pulse oxygen sensor was taped to my finger (note that they didn't use one of those finger clips, which was nice -- this was just a glowing sensor in a protective shell). I was warned not to fiddle with or crush the pulse oxygen sensor, as it was delicate and "kind of expensive." I thought this was sort of charming since the whole affair was running into the thousands of dollars anyway. (Ahem, thank you insurance company!)
After all the sensors were hooked up, the wires were run back to a portable "head unit," a little paperback-sized device that collected the various signals and transmitted them back to the command center. There was also much bundling and taping of wires to prevent me from unintentionally pulling them out in the night. (By the way, if you do freak out and need to remove the sensors, they come off easily. But Mr. Sleep Technician is just going to frown at you.) The import thing to note here is this: with all the stuff attached, you don't have much freedom of movement. Walking around, you must carry the head unit, and going to the bathroom is kind of an advanced operation given the wires running down your chest and legs. It's entirely possible, but you should be careful not to drink a lot of liquids before the study -- to minimize the work and planning involved with lugging all the stuff into the loo with you.
Once connected to everything, the technician led me to my (awesome king-sized) bed and had me settle down on the side by the CPAP. At this point I took a small dose of Ambien, which my sleep doctor had prescribed to help me get to sleep during the study (I had a study years before in which I didn't sleep at all). It was a trick taking a pill, because there were things taped to my face, multiple things going under and up my nose, and so on -- but I managed. (Tip: if you plan to drink water during the night, bring a bendy straw!) When I was more or less comfortably situated in bed, the head unit was attached to the wall, lights were turned out, and the technician left to return to his command center. From there, he proceeded to test every sensor, communicating with me via a sort of squawk-box above the bed. He had me do various things like breathe in and out deeply, blink my eyes, move my eyes, move my legs, and so on, ultimately confirming that the sensors were indeed working. After that, I was on my own to get some sleep. (We had mutually agreed to try sleeping on my back, which for me is the most snore-inducing position. It also happened to be the easiest with all the junk attached to my face.)
Above: various wires and sensors, the head unit, and the CPAP machine by the bed. I would have taken a picture of myself with all the stuff attached, but I didn't really want to know how it looked -- I figured it might make me even more self-conscious about the procedure, so I just avoided mirrors.
All hail the power of Ambien! I was out within a half hour or so, which I think is pretty remarkable given the unusual circumstances. I proceeded to sleep for some hours, apparently snoring and experiencing a lot of apnea/hypopnea events all the while. (I later found out that my AHI, which is a sort of score measuring your respiratory interruptions per hour, was 48 -- this is "severe" but I've met people with much higher numbers already. More on this in a future post.)
After some hours of sleep (three or four?) the technician woke me using the intercom, and gave me the "good" news: I was displaying enough apnea/hyopnea events to warrant plugging me into the CPAP machine for the rest of the night and seeing how that went. This was good news because it meant I probably wouldn't have to come back for another study -- they could get me on the machine and figure out an appropriate pressure during that same night (this is called a "split night study"). So I was happy with that. A nice intern came in and removed a few of the gizmos that had formerly been sticking up my nose (I believe they were some sort of breathing sensor). He then attached a plastic mask/cup that covered my nose, and strapped it tightly to my head using elastic straps. If you're wondering what this cup looked like, think of the cups used to deliver anesthesia or oxygen -- same kind of thing, with a big honkin' plastic tube coming out the front, attached to the CPAP machine which is effectively blowing air up the nose.
The intern left, and I proceeded to try to sleep. I didn't have much luck, though, as the mask was strapped on way too tight. It was really digging into my face and began to bug me. After an hour of fruitless sleep attempts, I raised the command center on the squawk-box (which was difficult because talking while the CPAP is running, talking is tough -- air is rushing out your mouth, and there's a sort of Darth Vader Effect). Anyway, I managed, and they came in and adjusted the straps. With a better fit, I was all set, and fell asleep again within a half hour.
I woke a good four hours later, sun coming up, to learn that my study was complete! But imagine my surprise when I came to consciousness and realized that the nasal mask was full of water! Well, not full, but it was effectively raining in there -- drops of water were running down my nose, pooling in the cup, and then draining through the air tube. Very weird. The technician said, "Oh, that's 'rain-out,'" and explained that it was due to the difference in temperature between the room (which I had kept very cold) and the heated, humidified air coming from the CPAP. "It's normal to get some rain-out," he said. "You'll get used to it." I was actually pretty freaked out by the rain-out, as it seemed like maybe it would go up my nose, but later practice has demonstrated that water-up-the-nose isn't a significant concern. (The masks are designed to deal with this condition, and water tends to pool in strategically designed places, away from your nose.)
The technician removed my sensors, which was relatively painless except for the loss of chest hair involved with removal the pectoral pads. I took a shower and washed a bunch of glue and crud out of my hair, then went downstairs for the free continental breakfast (this was a hotel, after all). The technician gave me the CPAP mask I had used that night to keep, as a spare for when I got my own machine.
All in all, the sleep study was fine. I had been worried about a lot of things going in: worried that I wouldn't sleep at all, worried that the CPAP would be uncomfortable, worried that I'd pull a wire out, and so on. While it was definitely a strange experience (both because of the sensors/wires and the CPAP), I feel like the professional staff, excellent setting, and Ambien really helped. Frankly that last part was a big deal -- I'd highly recommend getting a prescription for some kind of sleep aid if you have any worries about getting to sleep. In my case it just zonked me out, which is just what I wanted.
If you're considering a sleep study, please feel free to ask questions in the comments, or post your own experience. We got some awesome comments on last week's sleep apnea post, and I'm really grateful to the mental_floss reader community for your support! Next week: getting the final diagnosis and the CPAP machine.