Just got back from Doctors appointment

[Enchanter]

Enchanter,

I am glad to hear that the doctor's appointment was mostly positive.

It is a shame that the doc was unwilling to prescribe one ambien for the night of the sleep test.

Do keep in mind that if you get as little as 2 hours of highly fragmented sleep, that's still enough to get diagnosis.

Robysue,

I don't mind, but just worry of the possibility of not sleeping at all. Should I take extra melatonin?

[RogerSC]

I got only 3 hours sleep in my sleep study, lay awake for several hours and finally fell asleep out of pure exhaustion, I assume. My sleep doctor told me that I'd have Ambien for my next sleep study *smile*. Anyways, enough sleep for a diagnosis, but not for titration, so the titration part was done at home on an autoset cpap. Since I don't have complex apnea (at this time), the autoset was an easy way to go. By now, I've got it pretty well dialed in, but it did take a while...no guarantees that if they were able to do a titration in the office that it wouldn't still have taken some time to get it right for me sleeping at home, anyways *smile*.

[49er]

Enchanter,

Can you communicate with your doctor online? If you can, I might say something to the effect of that you thought more about the discussion regarding sleep medication for the sleep study and would feel more comfortable if you had some "just in case" medication in case you really did struggle to fall asleep. And if you don't have online access, this is something you could easily say to his nurse or medical assistant if he has one who could pass the message to him.

I don't disagree with what your doctor has said about sleeping. But I know that when I had my sleep study and had a hard time falling asleep, I finally relented and took the ambien because my anxiety with all the stuff on my body was just making things worse. As an fyi, because I thought I was going to have a split study which I ended up not qualifying for, I was waiting to take the medicine when I assumed I would be wakened up for them to put the mask on me. Finally, I realized that if I had to get sleep period and worry about the split study later if it came to that. I feel I lucked out that I didn't qualify and had to come back for a separate session in which I could take another pill for that.

Which reminds me, because of your concern about sleeping, you might want to see if you could have separate sessions for the sleep study and titration since I feel a split study is not a good thing for someone who has trouble falling asleep in this type of environment. Check with your insurance company about the rules because each one is different as to what they allow and don't allow.

Then again, the doctor might prescribe an auto pap to get the right pressure so maybe the titration wouldn't be necessary. But please ask about all of this ahead of time.

49er

[knothead]

Take Benadryl, it makes me sleep ALL night, no script needed from Dr. Works like a charm...good luck with the study.

[Julie]

Benadryl might be too sedating - the point of a sleep test is to get accurate readings about your sleep from anatomical, neurological and respiratory standpoints, the last two which could be affected by sleep meds.

[SleepDisturbed]

I think any doctor who sends a patient for a sleep test without a "just in case" sleeping pill should be horsewhipped.

That's what I didn't understand. I tried to convince him and he just said most people sleep some and I probably will too.

Then again he may just want to see you as you are, trouble with falling asleep and all, before covering symptoms up with drugs. Might give him a better shot at diagnosing your particular set of problems.

[robysue]

Enchanter,

I am glad to hear that the doctor's appointment was mostly positive.

It is a shame that the doc was unwilling to prescribe one ambien for the night of the sleep test.

Do keep in mind that if you get as little as 2 hours of highly fragmented sleep, that's still enough to get diagnosis.

Robysue,

I don't mind, but just worry of the possibility of not sleeping at all. Should I take extra melatonin?

I'm not sure that I would take extra melatonin. Extra melatonin is not any more effective than a normal dose of melatonin. And it can have some odd effects on how you feel the next day.

I would second 49er's suggestion about communicating with the doc on-line (if possible) or by calling the office and asking for a message to be forwarded to the doc. It's not unusual to have problems getting to sleep in a strange place. But just as important in your case: You'll be asked to try to get to sleep at a time when you are usually NOT that sleepy. You've said that much of the time when you go to bed at midnight, you don't really fall asleep until it's close to 4am. The sleep test will likely be scheduled with an 11:00pm bedtime (at the latest) and a wake up time of sometime between 5:00 and 6:00 AM.

Because of your normal sleep schedule, I think the doc was wise to schedule you for a full night diagnostic study. That may be the only way to ensure getting enough data to get a full picture of your apnea. If the test is positive, a second full night titration study will be done. Yeah, it's a pain in the butt to have to spend two nights in the lab. But the thing about split studies is that unless a person is sleeping exceptionally well (in terms of getting to sleep and maintaining sleep), it can be tough to have enough time to gather enough diagnostic data to really assess what's going on with your sleep AND still have enough time to properly titrate you at the end of the night.

Some things that I would consider doing in your case:

• Once you have the sleep test set up, contact the sleep center (the people running the test) and let them know that you are naturally something of a night owl. If they are aware of your night owl tendencies, they can arrange to make you the last patient they set up for the night and the last patient they wake up in the morning.
• Work on your sleep hygiene for several days (or even a week or moreI) before the sleep test. The idea is to try to stabilize your bedtime and get your latency to sleep down to something sort of reasonable enough to ensure that you'll sleep for at least part of the sleep test. In particular, for several days before the sleep test, you should try to "disconnect" all the electronic gadgetry well before your desired midnight bedtime. Get off the computer/tablet and turn the cell phone off 3 or 4 hours before midnight. Limit your tv watching. Blue light adversely affects the melatonin cycle, and all our electronic gadgets are bad about emitting blue light. For two or three days before the sleep test, try to force yourself to get up by a reasonable hour----say 8:30 or 9:00AM at the latest to try to ensure that you might be sleepy by midnight. If you drink caffeinated coffee, tea, or soft drinks of any sort, try to limit the caffeine for several days before the test. You'll probably be told to not consume any caffeine during the day before the test is schedule. And you don't want to be fighting a caffeine withdrawal headache at the same time you're trying to get to sleep in a strange place.
• Don't bring your computer or tablet with you to the sleep test. You'll be asked to arrive for the sleep test several hours before bedtime. Arrival times for sleep tests are often scheduled for around 8:00 pm. That allows the techs to get everybody settled into a room and still have plenty of time to wire everybody up. Many sleep test rooms look like a decent hotel room, complete with a tv. Resist the urge to play on your cell phone all evening. And be judicious with watching the tv if you don't usually do that. Bring a book to read or some other quiet and relaxing thing to keep you occupied while you're waiting around for the tech to wire you up and while you're waiting around after being wired up for lights out to be announced.
• If you know the room is too hot, too cold, or too noisy, before it's light's out, speak up. Most of the time the thermostat can be adjusted (at least a bit). And many times the techs know which rooms tend to be be extra warm or extra cold and they'll sometimes ask if you prefer a cold or warm room for sleeping. If you need an extra blanket, ask for it.
• If even the smallest amount of light makes it harder to fall asleep, ask if you can bring an eye mask. In every sleep test I've had, there's been light leaks around the door. And the pulse oximeter has a pretty bright red light, or so it seems to me.
• If you wake up needing anything at all in the middle of the night, tell the tech. On my last titration study in 2013, I fell asleep really quickly after the 11:30 light's out time. But about 10 minutes after falling asleep, I woke back up. (I didn't realize that I'd fallen asleep until I saw the data.) After trying to get (back) to sleep for what seemed like 40+ minutes, I realized that the BiPAP was bugging the heck out me and that if I were at home, I'd be getting out of bed and going into a different room to do something else until I felt sleepy. I contacted the tech and explained that I was simply NOT sleepy and very uncomfortable. And that if I were at home, I would not continue lying in bed. The tech actually asked if I wanted to just give up for the night, but I didn't want that---I didn't know how that would play out with my insurance coverage. So I said no to that idea, but asked if I could sit up and read in bed until I felt actually felt sleepy enough to try getting back to sleep. The tech agreed, and I spent over an hour reading the book I'd brought with me. When I started to get drowsy, I told the tech I was sleepy enough to have the lights turned out. Once the lights were out, I did settle back down into a sleep that was no worse than my usual BiPAP-assisted ed sleep at home, but it was also not really any better than my normal sleep. The point I'm trying to make is this: By asking the tech if I could spend some time reading, I was able to finish the sleep test and the data gathered after I went back to sleep after reading my book was pretty typical of the kind of sleep I was getting at home at the time. In other words, the data was useful to the doc who's treating my sleep problems and myself.

[Nick Danger]

Sue, those are great suggestions! They should be stickied and added to the information at the top of the forums.

Congratulations, Enchanter. Sounds like you did a great job at the doctor's appointment.

[ChicagoGranny]

He checked my throat and said that I probably have sleep apnea, based on throat/neck area. Can someone explain to me what looking in your throat tells you?

Mallampati score


The higher the score, the more likely a person is to have obstructive sleep apnea.

[LSAT]

Take Benadryl, it makes me sleep ALL night, no script needed from Dr. Works like a charm...good luck with the study.

http://sleepdisorders.about.com/od/slee ... 1-0-ab_msb

[Pugsy]

The higher the score, the more likely a person is to have obstructive sleep apnea.

I would score a 1.
I wish I could use that as an excuse for the doctor's missing my OSA symptoms but they never even looked in my throat and instead gave me valium RX for "anxiety" as a reason for my crappy sleep.

[Enchanter]

Enchanter,

I am glad to hear that the doctor's appointment was mostly positive.

It is a shame that the doc was unwilling to prescribe one ambien for the night of the sleep test.

Do keep in mind that if you get as little as 2 hours of highly fragmented sleep, that's still enough to get diagnosis.

Robysue,

I don't mind, but just worry of the possibility of not sleeping at all. Should I take extra melatonin?

I'm not sure that I would take extra melatonin. Extra melatonin is not any more effective than a normal dose of melatonin. And it can have some odd effects on how you feel the next day.

I would second 49er's suggestion about communicating with the doc on-line (if possible) or by calling the office and asking for a message to be forwarded to the doc. It's not unusual to have problems getting to sleep in a strange place. But just as important in your case: You'll be asked to try to get to sleep at a time when you are usually NOT that sleepy. You've said that much of the time when you go to bed at midnight, you don't really fall asleep until it's close to 4am. The sleep test will likely be scheduled with an 11:00pm bedtime (at the latest) and a wake up time of sometime between 5:00 and 6:00 AM.

Because of your normal sleep schedule, I think the doc was wise to schedule you for a full night diagnostic study. That may be the only way to ensure getting enough data to get a full picture of your apnea. If the test is positive, a second full night titration study will be done. Yeah, it's a pain in the butt to have to spend two nights in the lab. But the thing about split studies is that unless a person is sleeping exceptionally well (in terms of getting to sleep and maintaining sleep), it can be tough to have enough time to gather enough diagnostic data to really assess what's going on with your sleep AND still have enough time to properly titrate you at the end of the night.

Some things that I would consider doing in your case:

• Once you have the sleep test set up, contact the sleep center (the people running the test) and let them know that you are naturally something of a night owl. If they are aware of your night owl tendencies, they can arrange to make you the last patient they set up for the night and the last patient they wake up in the morning.
• Work on your sleep hygiene for several days (or even a week or moreI) before the sleep test. The idea is to try to stabilize your bedtime and get your latency to sleep down to something sort of reasonable enough to ensure that you'll sleep for at least part of the sleep test. In particular, for several days before the sleep test, you should try to "disconnect" all the electronic gadgetry well before your desired midnight bedtime. Get off the computer/tablet and turn the cell phone off 3 or 4 hours before midnight. Limit your tv watching. Blue light adversely affects the melatonin cycle, and all our electronic gadgets are bad about emitting blue light. For two or three days before the sleep test, try to force yourself to get up by a reasonable hour----say 8:30 or 9:00AM at the latest to try to ensure that you might be sleepy by midnight. If you drink caffeinated coffee, tea, or soft drinks of any sort, try to limit the caffeine for several days before the test. You'll probably be told to not consume any caffeine during the day before the test is schedule. And you don't want to be fighting a caffeine withdrawal headache at the same time you're trying to get to sleep in a strange place.
• Don't bring your computer or tablet with you to the sleep test. You'll be asked to arrive for the sleep test several hours before bedtime. Arrival times for sleep tests are often scheduled for around 8:00 pm. That allows the techs to get everybody settled into a room and still have plenty of time to wire everybody up. Many sleep test rooms look like a decent hotel room, complete with a tv. Resist the urge to play on your cell phone all evening. And be judicious with watching the tv if you don't usually do that. Bring a book to read or some other quiet and relaxing thing to keep you occupied while you're waiting around for the tech to wire you up and while you're waiting around after being wired up for lights out to be announced.
• If you know the room is too hot, too cold, or too noisy, before it's light's out, speak up. Most of the time the thermostat can be adjusted (at least a bit). And many times the techs know which rooms tend to be be extra warm or extra cold and they'll sometimes ask if you prefer a cold or warm room for sleeping. If you need an extra blanket, ask for it.
• If even the smallest amount of light makes it harder to fall asleep, ask if you can bring an eye mask. In every sleep test I've had, there's been light leaks around the door. And the pulse oximeter has a pretty bright red light, or so it seems to me.
• If you wake up needing anything at all in the middle of the night, tell the tech. On my last titration study in 2013, I fell asleep really quickly after the 11:30 light's out time. But about 10 minutes after falling asleep, I woke back up. (I didn't realize that I'd fallen asleep until I saw the data.) After trying to get (back) to sleep for what seemed like 40+ minutes, I realized that the BiPAP was bugging the heck out me and that if I were at home, I'd be getting out of bed and going into a different room to do something else until I felt sleepy. I contacted the tech and explained that I was simply NOT sleepy and very uncomfortable. And that if I were at home, I would not continue lying in bed. The tech actually asked if I wanted to just give up for the night, but I didn't want that---I didn't know how that would play out with my insurance coverage. So I said no to that idea, but asked if I could sit up and read in bed until I felt actually felt sleepy enough to try getting back to sleep. The tech agreed, and I spent over an hour reading the book I'd brought with me. When I started to get drowsy, I told the tech I was sleepy enough to have the lights turned out. Once the lights were out, I did settle back down into a sleep that was no worse than my usual BiPAP-assisted ed sleep at home, but it was also not really any better than my normal sleep. The point I'm trying to make is this: By asking the tech if I could spend some time reading, I was able to finish the sleep test and the data gathered after I went back to sleep after reading my book was pretty typical of the kind of sleep I was getting at home at the time. In other words, the data was useful to the doc who's treating my sleep problems and myself.

Thanks. You have provided me a lot of info. Anyways here is my plan, since we don't have a lot of time here.

I'm going to bring some melatonin but I'm not going to take more than usual. I'm going to get a moderate amount of exercise, so that I can sleep. Not too little, not too much. I'll bring a book just in case. (didn't know they had tv)

I believe I have sleep apnea or something related to sleep. If the tests show I sleep well and I know I don't, doctor says we'll have to figure it out after the test. So whatever happens, I appreciate your caring and I'm going to keep on fighting my physical problem and continue to try to get well.

[robysue]

Thanks. You have provided me a lot of info.

You're welcome!

Anyways here is my plan, since we don't have a lot of time here.

I'm going to bring some melatonin but I'm not going to take more than usual. I'm going to get a moderate amount of exercise, so that I can sleep. Not too little, not too much. I'll bring a book just in case. (didn't know they had tv)

Sounds like a good plan.

I believe I have sleep apnea or something related to sleep. If the tests show I sleep well and I know I don't, doctor says we'll have to figure it out after the test.

Sounds like a reasonable statement from the doc.

So whatever happens, I appreciate your caring and I'm going to keep on fighting my physical problem and continue to try to get well.

Best of luck on your continuing adventures towards recovering your health.

And since I don't know if I'll be around on the board tomorrow or not, let me wish you a successful sleep test tomorrow night: May you GET to sleep and stay asleep long enough for the necessary data to be gathered. And here's hoping that the data will not be ambiguous.