My Next Medical Challenge

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:

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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:

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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.

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Wesley R. Elsberry

Falconer. Interdisciplinary researcher: biology and computer science. Photographer. Husband. Christian. Activist.

11 thoughts on “My Next Medical Challenge

  • 2008/09/16 at 3:42 am
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    My daughter participated in a sleep study at age 6 because her neurologist needed to determine if the anti-convulsants she was taking interfered with her sleep patters.

    As John Wilkins comments at Evolving Thoughts, I can see how a description of a person’s pattern of sleep can be disrupted by all of the recording paraphernalia they attach. My daughter had a restless night, but yes, they were able to determine that while sleeping there was no unusual pattern of apnea involved.

    I hope it works out for you, Wes!

  • 2008/09/16 at 5:34 am
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    Been there done that! I have been sleeping with a CPAP for four years now and it’s great. I too didn’t think I would be able to sleep in the sleep lab after being wired up and was quite surprised that I actually slept quite well. I too have to get up in the night to micturate but I mentioned this in advance and they gave me a urine flask to pee into. By the time you do your second visit it’s much easier because you know what’s coming although the first time with the mask is a unique experience. Welcome to the club ;)

  • 2008/09/16 at 7:10 am
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    Odd.

    My Beloved and Darling Wife has sleep apnea, and the most common risk factor is weight. Unless you’ve been seriously Photoshopping your pics, you don’t fit that group. The next most common risk factor is positive family history. Do you have any? (She does.)

    Her CPAP machine changed her outlook considerably; more energy during the daytime, etc.

    Good luck!

    fusilier
    James 2:24

  • 2008/09/16 at 9:34 am
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    I’m about 15 pounds over the recommended BMI for my height, so I guess I’m obese by a very narrow interpretation of obese. It is, however, a stable weight for me. If I were to have a serious go at reducing that 15 pounds, I’d need a managed diet, I think.

    Snoring is something that is common in the family, but I don’t think anyone else has had a diagnosis of sleep apnea or hypopnea.

  • 2008/09/16 at 5:01 pm
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    I had the same sleep apnea tests and found it nearly impossible to sleep. They called me in for a re-test with the CPAP gear, which proved totally impossible.

    So I had surgery on the upper airway, removing tonsils and uvula and reconstruction of the soft palate. That seems to have taken care of the problem, more or less, as long as I sleep with an extra pillow to get the angle right, and sleep on my side. It also helps that I have lost a bunch of weight (40 lbs) since then.

    Good luck.

  • 2008/09/16 at 5:10 pm
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    Nobody’s mentioned surgery yet. I’m assuming that the downside is that it is surgery. The upside being that one’s respiration isn’t dependent upon a bunch of mechanical gear that will be utterly useless when away from power supplies of one sort or another. Hmmm, I may need to take that up specifically with my physician.

  • 2008/09/16 at 7:33 pm
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    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.

    My dad (who is in his mid 60’s) suffers from OAS and has a CPAP machine, the problem is getting him to use the darn thing. He falls asleep at the drop of a hat and as soon as he does he starts snorting and gasping. It’s very worrying.

    OAS also has implications beyond the direct sleep-disorder thing: increased risks of heart disease, hypertension, arrhythmias, diabetes, obesity, and erectile dysfunction.

    Dad has had two “minor” heart attacks, hypertension (which he takes meds for) and is definitely overweight (a condition that I have unfortunately inherited, or at least the metabolic tendency).

    My wife tells me that I snore and occasionally do the apnea thing but I have a long way to go to get as bad as my father.

    Good luck.

  • 2008/09/17 at 2:09 am
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    I had a sleep study at home recently… and then had to go through it again because of equipment failure. My stats were pretty similar to yours, and I’ve been annoying conferees with my snoring for decades. For me, weight is not the issue but I have ‘enormous’ tonsils, according to my doctor (and that probably explains the nagging cough I’ve had all my life). Given that, I’m surprised that they’re pushing CPAP at me when surgery seems more likely to actually cure the condition.
    This reminds me that makers of photocopiers are really in the toner business; a surgeon’s a tradesman (and tonsillectomies are recorded from Roman times), but CPAP is a whole industry, with patents in force.

  • 2008/09/18 at 5:19 am
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    I too have been diagnosed with moderate to severe OAS, and hope to be fitted with a CPAP machine shortly. And I’m not obese either. I’ve heard mixed reports about soft-tissue reconstruction surgery: my brother-in-law who is a doctor tells me it is often successful because its so painful it prevents you from getting to sleep! A respiratory specialist I’ve consulted suggested that this type of surgery can also reduce the efficacy of subsequently applied CPAP.

  • 2008/09/24 at 11:12 am
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    I’ve done about three or four nights in the sleep lab for obstructive sleep apnea testing, and it always seems to me like I didn’t sleep much, but
    the machines tell a different story.

    I’ve been on the CPAP machine for about a year now, after trying it a few years ago and not being able to stick with it. This time I’m using a mask with “nasal pillows” instead of the full nose and mouth coverage. Unfortunately I have not noticed any increase in daytime energy or similar effects, but on the good side, my wife is not driven out of the room by my snoring anymore.

    Good luck.

  • 2010/05/02 at 12:50 am
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    I am a frequent reader of your blog posts. I liked the recent one and other posts on your blog so much that I have subscribed to the blogs RSS feed in Thunderbird. Even thinking of stealing some ideas and put them to work. Keep all the good work going by posting more informative posts. Thank you. Time well spent on this post.

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