Medical Wesley R. Elsberry on 15 Sep 2008 07:02 pm
I shared a room with a colleague at the GECCO 2008 conference, and my snoring disturbed him. I brought this up with my primary care physician, who set me up to take a sleep study. This isn’t a new thing; I was experiencing daytime sleepiness back in high school, where my Spanish teacher was confounded by my frequent naps in class despite doing well on homework and tests (and that despite the rotating class schedule so that classes met at different times of the day through the term).
I arrived at the Sleep Center the evening of my study and was escorted to a room. The room was a fairly basic affair, much like your standard mid-America motel room: bed, end tables, dresser, TV, private bath (shower only, no tub). It had some other amenities not usually found (or not usually noticed) in your standard motel room: continuous positive airway pressure (CPAP) gear, IR camera, and various bits of data acquisition setup.
They had me watch a videotape that gave a little explanation of sleep study procedures and a lot of promotional information about a brand of CPAP apparatus. The assumption throughout was that patients would have obstructive airway syndrome (OAS) treatable with mechanical aids, to wit, a CPAP machine or one of the close variants with somewhat more capability.
But first things first… there needed to be a diagnosis. And for that, I needed to be rigged up with a variety of monitoring equipment. In order to assess what sort of stage of sleep I might be in and for neurological data, my nurse hooked up about eight leads for an electroencephalogram (EEG). They also wanted to see cardiac response, so I needed three more leads for an electrocardiogram (EKG). Because poor sleep states often involve excessive leg movement, I needed two leads on each leg for electromyography (EMG). Also, stress that is involved in some sleep deprivation is manifested in teeth clenching or temporo-mandibular joint (TMJ) tension, so I needed another six lines or so of EMG on my face. Pressure sensors at the nostrils would pick up nose versus mouth breathing. Two strain gauges on bands around my abdomen and chest would help monitor respiratory effort, an essential part of distinguishing OAS from central neural system causes of sleep disorders. And, last but not least, a pulse oxymetry device was installed on my right index finger. It took about fifteen minutes to get me tricked out in all the data collection lines. An illustration might help:
OK, after all that, I was supposed to get to sleep. Usually, I don’t have difficulty getting to sleep, even under otherwise challenging conditions. But I did have trouble that night. I also have issues with the aftermath of having had a colectomy. I usually am up once in the middle of the night to make a bathroom trip. That night, I was up twice for that purpose. I recalled awaking four times; I’m not sure how many times the instruments called it. I also recalled about four distinct periods of dreaming; again, I don’t have the details on how much REM sleep I was recorded having. So in the morning, another nurse came in to remove the various leads, leaving me looking ill-used:
I took advantage of the shower and then got out of there.
A few days ago, I got a call from the Sleep Center wanting to schedule my second visit. I hadn’t heard from my primary care physician, but apparently she had ordered the second round. I called in to find out what was up. Apparently, I do have a diagnosis of OAS, with observed episodes of sleep apnea and hypopnea, with my O2 saturation going down to 83% at one point. The second study will hook me up to CPAP and do a titration to figure out just how much pressure is needed to keep my airway open during the night.
I’m joining a common club. According to a survey, about 24% of men in the USA have some form of OAS, and 9% of women. Middle-aged men are more prone to OAS. OAS also has implications beyond the direct sleep-disorder thing: increased risks of heart disease, hypertension, arrhythmias, diabetes, obesity, and erectile dysfunction. Fortunately, I don’t have the laundry list of effects, but arrhythmia is among the things I have manifested. As far as I recall, my previous healthcare team working on what they called idiopathic atrial fibrillation events did not assess me for possible OAS as a contributing factor.
According to the promotional video, many of the people getting treatment for OAS find that a number of quality-of-life issues improve. I’m looking forward to seeing if I get any of those benefits myself.<= get_option(\'vc_tag\') ?>> = get_option(\'vc_text_before\') ?> 12474 = get_option(\'vc_human_count_text_many\') ?> = get_option(\'vc_preposition\') ?> 4508 = get_option(\'vc_human_viewers_text_many\') ?> = get_option(\'vc_tag\') ?>>