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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.
Comments (15)
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I had a sleep study a couple of years ago and was told that I had a mild form of apnea. They scheduled me to take it again a couple of months later (I think because I only got a couple of hours sleep and not good sleep) and I canceled it the day before. I just couldn’t go thru that again.
posted by Fran on 10-3-2008 at 1:07 pm
I had a sleep study last year. It turned out I was allergic to the glue they use to put the sensors on and was left with large, sensor sized rashes on my body. Then, they taped the finger sensor too tightly and I had a tiny sensor shaped bruise there the next morning.
The icing on the cake though, was that nothing was actually wrong with me. Not even mild apnea. Nice…although to be fair, I guess if there WAS something wrong, I’d appriciate the efforts and the rashes and the bruising. Oh well.
posted by Caitlin on 10-3-2008 at 2:59 pm
I had a sleep study about six months ago, and the process was much simpler. I picked up the monitoring device after a 30 minute class that explained how to attach and activate it. At home, ten minutes before bedtime, i washed my hands, and then peeled the backing paper off of the two finger sensors and applied them (they are little cups that go on your index and middle fingers). Then velcroed a little strap around my hand/wrist to secure the wires, and then the monitor unit goes on your upper arm like a joggers MP3 player.
The next day I dropped it off, and two days later they called to make an appointment due to my moderate sleep apnea. I attended a 60 minute class that explained the use of the CPAP device, and I have been using it ever since. I’m more rested in the morning, and I now dream. Alot.
posted by Scott on 10-3-2008 at 3:08 pm
I feel for you. I had a sleep test performed 2 years ago. It was performed by a sleep study group contracted out by my HMO, also in a permanently rented out suite at a local residence type motel. My snoring was keeping my wife up and she insisted I stopped breathing during these episodes. My exceptional talent of being able to fall asleep anywhere, anytime, usually within 3 minutes led the doctor to have me tested for sleep apnea.
I went through the same hook up nightmare. But my talent for falling asleep didn’t require meds. Another talent of mine is sleeping lightly. Although testers were in the adjoining room, they enjoyed drinking sodas (I could hear the snap and pop of the cans), making and eating microwave popcorn, and fielding visits from techs working the other sleep test suites.
One of the wonderful tests was to reduce the air pressure on the CPAP mask causing me to gasp for breath. I was “done” at 5am in the morning. They said everything was well although I do not recall “sleeping” at all.
Test results showed I had abnormal readings and my HMO decided this meant I was “ok” since it didn’t say I wasn’t ok and declined further treatment. After a strongly worded letter and the State Board of Health investigation pending I was granted treatment.
The dumb things you went through during the test with the CPAP machine are fairly common and easily remedied. It appears the techs have never used them. The rainout can be avoided by adjusting the humidifier and a “hose cosy” (wrapping the hose in a towel to keep the air warm). There are tons of CPAP masks to choose from and I personally switched from a nasal mask to a full face mask so I don’t have to worry keeping my jaw shut. The best fit masks don’t leave marks on your face in the morning.
It’s worth looking like some alien monster when you sleep, when you can wake up refreshed and your wife does too!
posted by Daryl on 10-3-2008 at 5:25 pm
Your experience seems pretty similar to mine. I was diagnosed with moderate to severe apnea. My favourite thing about the whole process was that they provided me with the data from my sleep study. I did not do a split night study, so there were a good number of hours of sleep. It was fascinating to see the very short episodes of REM sleep as a result of partial awakenings from the apnea and hypopnea. I was also amazed at how long I could hold my breath while I was asleep. I couldn’t even get close to the 3+ minutes of not breathing that I did a couple of times that night.
I’ve now been using the CPAP for almost a year and it has made a world of difference. I have more energy throughout the day and am remembering dreams for the first time in my life (though that is not always good).
posted by rexology on 10-3-2008 at 8:32 pm
Lucky. I didn’t sleep long enough during my assessment (they don’t do split-nights where I do it), and have had to wait a year to get the insurance (OHIP) to cover another. I go in probably later this week.
posted by Eilonwynn on 10-3-2008 at 9:45 pm
I had the same issue with ‘Rain-out’ that you did, and someone suggested a ‘Snuggle-Hose’ cover (don’t laugh, it’s a real product). It’s a fleece sleeve that slides over the tube and helps provide a cushion between the cold air outside and the warm moist air inside the tube. I can’t put the link in here, but do a Google search on ‘Snuggle Hose Fleece,’ and you’ll find it.
posted by Barry on 10-3-2008 at 10:31 pm
Question for those of you who are on CPAP: How do you cope with the sensation of air being forced up your nose? My husband was recently diagnosed with apnea and went through the sleep studies and everything, but he can’t seem to get accustomed to the air forcibly going into his nose. I have tried on the CPAP mask and I would tend to agree – trying to breathe with that thing on is like trying to take a gulp of air when you are walking into a very strong wind. Also, any tips on skin irritation caused by the masks? Thanks in advnace, and good luck, all!
posted by Rose on 10-3-2008 at 11:13 pm
I just got diagnosed two months ago and have been using my machine for 3 weeks. As far as the gushing air in the nose feeling – it was uncomfortable with the CPAP machine at the sleep study – but the automatic CPAP machine my insurance company got me turns off the outgoing air when it sensing me breathe out.
This way, it is almost effortless to breathe in, but super comfortable to breathe out. I would recommend the auto-CPAP if you feel the “walking into a very strong wind” feeling.
As far as the skin irritation, are you using Ivory dish soap to clean the mask? If you use regular soap, it can clog and irritate your pores. Using Ivory dish soap every day works for me.
Scott
posted by Scott on 10-4-2008 at 9:09 am
a bit of advice for cpap noobs:
It was fine at first for naps but I felt creeped out having this thing on my face in the dark. So I put several night lights around the bedroom-way to bright for routine sleep. As I got used to it I removed them one at a time till I slept in the dark again. It hasn’t bothered me since.
posted by little gator on 10-4-2008 at 5:43 pm
I recently started using my bipap machine with ramp up function. The bipap cuts the pressure when you exhale; this lowers the sensation of air being forced up my nose.
Two remarkable things happened after one night on the machine: 1. My high blood pressure went away. Completely. After being on HBP meds for 5 years I haven’t taken a pill in three months and my BP is normal. 2. I stopped peeing 2 or 3 times a night.
Seems the high co2 levels in my blood from not breathing caused my body to raise BP and dump fluids.
I hate the stupid mask. I am a scout leader and it is awkward bringing the battery and machine with me camping. But the machine has truly changed my life for the better – I never nap anymore or get sleepy when driving.
posted by Texas Jim on 10-5-2008 at 10:18 pm
I’m loving these updates since they mirror my own story. Well, if you consider me the poor cousin story. :) Like Eilonwynn I’m on OHIP (north of the border as an FYI to you ‘Mericans) and oft times the prodecures aren’t as…classy as the sleep motel. My test, which was last week, was in a modified treatment room with a murphy bed. Not uncomfortable but teeny tiny and with mucho distractions. I was convinced I hadn’t slept a wink but the tech said I slept enough for their purposes. I asked and the tech said the session can be converted into a split night with CPAP but only in severe cases (over 60 and normally way over) but usually you’re asked to come back after a seven week wait if you’re diagnosed. So now I’m waiting for them to send the results to my doc and to find out what my next step is.
As an aside, recaptcha is ‘is human’. Hope so. :)
posted by Bob on 10-6-2008 at 11:14 am
Some responses for Rose:
>> How do you cope with the sensation of air being forced up your nose?
It’s definitely weird. My machine has a ‘ramp’ feature which starts the pressure super low and slowly increases it. This seems to help me, though frankly it’s still pretty weird (I’m only through my first week using the machine, and am still adjusting). Also, the ‘C-Flex’ or ‘A-Flex’ thing is supposed to help reduce the flow during exhalation, though I don’t know what life is like without these features (I have a REMstar Auto M).
Also, I feel like part of the problem is psychological: when you close your mouth and put something over your nose, your brain screams: NO AIR!! Even though there’s plenty of air flowing. So every time I put on the mask I have to will myself not to flip out, and after a few minutes my suffocation-panic reflex seems to go away.
>> skin irritation
It may help to try a different kind of mask. I had really bad irritation on the bridge of my nose with a cup-style mask, so I got ‘nasal pillows’ which are sort of like noseplugs. The good part is that they just touch the nostrils and the upper lip — and there’s less tightening of straps and fiddling than with a normal mask. The downside is that the pressure feels greater since it’s concentrated in your nostrils, and I think it makes the suffocation/panic thing worse. But anyway, it would be worth a shot just trying different headgear.
posted by Chris Higgins on 10-6-2008 at 11:21 am
After 10 years of my wife counting the seconds of non-breathing between my gasps and breaths each evening, I finally got myself coordinated and had my sleep study last night. After reading the article above I was hoping for converted hotels, TVs, and continental breakfasts, but as other Ontarians have already said – my room was spartan – barely big enough to contain the bed. At 11PM the attendant asked me if I wanted my lights on or off, turned them off and I went to sleep. Two hours later, she woke me to say I have severe sleep apnea. I stop breathing for more than 10 seconds twice per minute! She strapped on a CPAP machine for the rest of the night and I was up and down and she played with the settings to get it right. And despite all of her experimentation; causing my subsequent choking, gasping, panic, claustrophobia, etc. I couldn’t believe I got the best night’s sleep I’ve had in about a year. And boy did I dream. Now I can’t wait for my own machine to be ready so I can get down to some quality sleeping.
Weird thing is – I’m only 42 and not fat – well, I’m only slightly overweight. 6′4″ and 256 lbs.
posted by Steph on 12-10-2008 at 2:54 pm
Had a sleep study this past Wed on April 15 down in Wharton Texas- 50 miles south of Houston
Got there at 8:30 and got finished being hooked up 45 minutes later
I was still wide awake and watched some TV
I was still wasn’t tird and feeling unwilling to sleep
Some wires become unhooked and had to get them reconneced
I still toss and turned in bed and had racing thoughts since Im on Bi -Polar medications.
I had been presdribed to take Ambien CR but DR told me not to take it since I was getting this sleep study done to get a accurate evalation
Night went by slow I might have dosed off around 4 am or so but was fully allert again 45 minutes later
6:30- the time I was supposled to leave never came since I had nausea problems with nerves
So I left around 5:45 in the morning and wide awake
Anyway it was a unpleasant experience
im s ure they will want to me to take an other but now sure If I will try again
having to pay out of my pocket since i nsuracne wont kick in until I met my deductible which is $3.000
posted by Mike on 4-19-2009 at 8:00 pm