Sunday, June 29, 2014

My Sleep Test

In this case, that term may be an oxymoron.

My cardiologist insisted that before he could go any farther, I needed a sleep test conducted to see if I had obstructive sleep apnea. I said I didn't, didn't snore, didn't stop breathing. I'd asked Steve, just in case he knew something I didn't. He had more opportunities to be awake while I slept than I did, after all.  No matter. Schedule the test and then get back to the cardiologist. There's a high correlation between apnea and A-Fib. Let's treat the right thing.

I happened last Monday. In case you are wondering why it's taking so long to blog about it, I've been catching up on my sleep since, and with everything else in my life these days, there hasn't been a decent chance. "Everything" includes planning for my fall retirement, scheduling and prepping the house for its appraisal, working, more late night working, scheduling my SS phone interview, locating documents of various kinds, dealing with a fraud alert on my main credit card that turned out to be legitimate and required changing my account number and card, and getting ready for Steve's birthday party.

So: busy.

Monday night I left the house packed and mildly irritated. I had enough time after getting home to pack up and turn around. I've gotten to really appreciate my routine of unwinding time after work, putting my feet up, reading emails, checking a few favorite websites including blogs and weather radar, and maybe an hour or two of prerecorded TV. Not that night! After locating the necessary toiletries, meds,  food for next day's meals, next-day clothes, and pillow with a fresh case, there wasn't time for the rest. Since I was to see the  Doc after the test, making me already late for work, the plan was to head directly to work after all that was finished.

As I pulled in to park, I noted my mood, deciding that I needed to check it at the door and start over. There'd be time to try to unwind while they were fixing us all up, I'd been told, going from 8:00 to my usual 10:30 bedtime, along with TV in each room, and a recliner for feet-up reading. The Kindle was fully charged and packed as well. I was as prepared as I could be.

That was blown out as soon as I arrived.

The room was set firmly at 70 degrees. For me, if I'm going to be sitting for a couple hours, that temperature requires long sleeves and pants plus a snuggly fuzzy lap blanket. You may be interested to note that what I was directed to change into immediately upon entering the room involved short sleeves, even shorter pants, and there was no blanket anywhere other than those tucked tightly around the bed, military-style. It seemed too  much work to pry them off and have to remake the bed for sleeping later. The PJs were from home, and perfectly suited for the 75 that the home thermostat is set for in summer, and even then often include a lap blanket if reading or extended TV watching is involved.

Making it even more uncomfortable, the recliner was set right in front of one of those wide institutional room units that cover the area under the window, thus blowing their cold air at the chair from all sides non-stop.

I took a chill. Well before allotted bedtime I left the recliner to snuggle under the many layers of blankets, trying to find a comfortable angle for my knees (fail), continue reading (fail), warm up (fail) and unknot my shoulder muscles (fail) so I could get to sleep (fail).

When I asked my tech whether they couldn't kick up the temperature in the room a bit, at least before the sleeping part started, he went over to look at the thermostat, then said, "No." His reasoning was that once the leads were all connected, if I started to sweat some of them might become disconnected, and he'd have to come in and wake me up to get reconnected. Plus then he'd have to put the fan on me and that would chill me down anyway. And he couldn't do that.

That's later, dummy. Not now. Plus, if you know what the plan is, obviously you can do it if you have to. Or, you can warm the room now and cool later? Anyway, who says I need to sleep under all those blankets on the bed? I hate heavy covers. They hurt my knees when I have to move.

He wouldn't be budged. Even though I didn't call him dummy out loud.

We started while I was still in the bed and keeping moderately warm. He brought in a C-pap machine and tried it on me. First step is putting this nose mask over your face, bringing a webbing of straps around your head, and hooking them together and tightening until there's a seal. He asked me to just breathe through my nose while he was setting it up. Problem is, my air ran out.

I switched to mouth breathing, and informed him I could not breathe with the mask. "That's because I haven't turned the machine on." But he had, you might note, attached the tube from the machine to the front of the mask, blocking any other air flow. Once he did turn the machine on, air poofed out all around the mask edges. He declared it to be the wrong kind of mask, and brought back a bigger one, covering the mouth too.

This time he left the tube unconnected while he did all the strap pulling and adjusting to get the seal around the edges of the mask. I could still breathe. Until, that is, he turned the machine on. The air pressure was so high that I literally could not exhale, not even though I was fully awake and trying with my full diaphram strength. I felt like they were trying to blow me up like a balloon! The thought of having this on my face while sleeping was enough to start me into a panic attack! I ripped the mask off and complained about the problem.

He seemed surprised. It was almost as if he wondered what was wrong with me because everybody else liked this level of flow. Maybe I'd get used to it while I slept.


He went away for a second, turning the flow down to nice gentle level, suggesting a lot of people liked this one. Yeah, no fooling. I could tell there was air pressure, but I didn't have to try to fight anything, breathing wasn't at all challenged. This maybe  I could live with if I had to. But not tonight. This was only a preliminary fitting. The machine went away.


When it was finally time to hook me up, I had to get back out of bed and sit in a cold chair for about a half hour. Whatever warmth I'd gained from the bed vanished, of course. Some of the leads hook up just like a EKG, snapping into adhesive patches. You know, the adhesive I'm allergic to. The ones on the head get pasted into the hair. Crazy as that sounds, it actually works well. They do warn you to bring plenty of shampoo for your morning shower to get it out of your hair. That also works well, by the second soaping.

Once all the leads are attached to their respective places, they are pulled together behind your head like an electronic ponytail, bound in a couple places, and once you are in bed for the night, plugged into the wall. Your tech retires to their own room with all kinds of monitoring equipment, asks you to move in certain ways from eyes to feet, even snore, and checks that all are working. Then it's lights out and... theoretically ... sleep time.

I had been a bit drowsy before all the hooking up started. Since I normally drop off a couple minutes after hitting the pillow, I expected that to happen here.

Oh no ya don't. Not a chance. Not only were the shoulders tensed, my always-warm feet were cold. That's never a good sign. I couldn't pop an arm out from under the covers to bunch them up and hug them for shoulder position comfort after rotator cuff injuries to both, as it was still way too cold out there. And, my brain just Would. Not. Shut. Down.

I tried. I thought of gentle waves lapping along the lakeshore. Leisurely strolls through a forest. Watching clouds form and unform animal shapes. Sinking softly down, down, down  into the best pillows in the world.

My brain, on the other hand, turned the spotlights on and started dancing its own charleston, doing a jazz-hands version of "Hello my darling, hello my baby, hello my good-time girl." My neck felt frozen in place, unable to snuggle into the billow for best comfort. Part of that was all the wiring, part the cold. And of course, because the brain was awake, the kidneys were too. And that meant calling the tech, having him come in, turn on the lights, unplug what needed unplugging so I could walk 15 feet, and come back as soon as he saw via his ceiling camera that I returned to the bed, replug everything, turn out the lights, leave and close the door again.

The door thunks when it closes. Just a bit.

It's enough.

I tried to put off calling him in to unplug me. It's bad enough having to go several times in the middle of the night. It's just that much worse having to call somebody, announce why, and have a whole production made of it. As a result, there were long periods where I just lay awake and aware of the need, postponing the inevitable. Thinking about not peeing is not conducive to sleep. You know you're not going to win that one. It's never just about not, but how long before not turns into must, and how long you have to figure in to keep must from turning into nevermind.

There apparently were brief moments of dozing off. I have the paperwork to prove it, even though my recollection is about three hours of grumpy alertness. The one hint that I'd been out briefly was the sudden awareness that a different piece of music was running through my head. At various times I identified "Rally Round the Flag, Boys" (why on earth?), or "Itsy Bitsy Spider", or bits from Brahms 2nd Piano Concerto. Other old show tunes popped up in there, but I couldn't place them.

Twice the tech's disembodied voice came through the speaker, asking me to lay on my back for ten minutes so they could record how that went. I do  understand that most people's apnea is worst in that position. However, I do not sleep on my back. I am a side sleeper. Period. It's the only way that is comfortable. The first time I tolerated it for about 5 minutes, then heeded my body's demand to roll. I told the room's microphone that I didn't know what they were looking for, but sleep was not going to be part of it.

The second time was an exercise in passive-aggressive behavior. Hadn't he learned anything yet about me not sleeping on my back? I'd teach him. We'd had a discussion about a potty break and he promised to come in and unplug me after ten minutes on my back. So, I laid there. I'd relax, be still, and show him. After a bit, that got boring. I moved my feet in various rhythms. Hands too, drumming different ones including the 9/8 beat from old belly dancing days. Knees up towards the chest. Knees down. Move the feet some more. Finally I started making noises, eventually turning them into a gravelly version of singing along with whatever the tune was parading through my head at the time, then picking out a few more.

 After a while I decided it had been way more than ten minutes and he wasn't holding up his side of the bargain. For whatever odd reason that seems to make sense during sleep deprivation, I decided to wait him out, give him more rope to hang his reliability with, proving to him that even if he waited longer there would be no sleeping on my back for his dumb test. My annoyance didn't bother him a bit, apparently. Maybe they get to read? I finally called him in. "I know it's been longer than 10 minutes!"

Three AM was my return to bed from my last potty break. I looked at my cell phone to check the time. After that my dancing brain finally gave in. That meant that 6AM's wake-up call came way too early. But I have a pill to take at every 6:00, so once freed from the wall hookups and after the bathroom beeline, I started the morning routine. There was of course more paperwork to fill out. A shower to take. Coffee. A ton of carbs offered for breakfast, but rummaging in the fridge revealed a couple of cheese sticks. Morning news on the TV, and while the traffic would be irrelevant once I was on the road, the weather report and latest flooding news was helpful.

With an hour to kill before my Doctor's follow up on the study, I headed out to my car, set my timer, and grabbed a nap. It was facing the sun so I turned it around so the car itself gave me shade. You wouldn't think that I'd be complaining about heat after the night of too cold, but there's no accounting for fussy.

The news was all good. The first, rather surprising tidbit, was the doctor informing me that my tech would be leaving their program shortly. Who discusses that with patients? Unless maybe there had been others about as pleased with him as I had been?

Second, I had apparently gotten a bit more sleep that I'd thought, with lines on the graph to show how much and when. It was just very short interrupted bits earlier in the evening, longer solid bits in the wee hours. As far as obstructive sleep apnea was concerned, I had about 10-15 bits an hour. That compares to about 5 in the general population, and 30+ in those needing the C-pap machine. My blood O2 levels never dropped to a concerning low. So while it wasn't the lowest apnea level, for the purposes of the test, I came out negative. No machine needed.


Time for work.

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