A Firefighter in Need of Help Part 2

Hello again everyone.  About a month or so ago I wrote you all for the first time requesting help under a similar post topic name.  Now I'm happy to report that, well, I guess I'm still in the same spot, haha.

But at least I've made an appointment.

It's not far off now and I'm trying to get myself prepared while I'm awaiting my appointment.  So I had a couple more questions just to make sure I'm ready when it comes.

Primarily I'm a side sleeper, which I think started because I would stop breathing while sleeping on my back.  I'm trying to retrain myself to sleep on my back for my study as it is the position that I wake up most with the feeling that I haven't been breathing.  The problem is though that I have a remarkable amount of anxiety when trying to fall asleep on my back, I frequently feel/fear that I'm going to suffocate.  It prevents me from falling asleep in a timely manner and I even sometimes give up, and just roll onto my side just to get "some" sleep.  I'm concerned that I will have trouble sleeping at the study but my current plan it to stay up for 48 hours prior to the test so that way there won't be an issue.  (My profession has conditioned me to be up for long amounts of without sleep so this shouldn't be an challenge)

The other day I was working at the station and couldn’t keep my eyes open for even a minute longer as I was so tired (it's 10am by the way, and I'd only been up for about 4 hours).  I sat down in a recliner (on my back although still slightly elevated from flat) for a quick nap in between calls.  I have a dream that I'm in the ambulance and we get into a massive accident, the roof caves in on us and it's slowly suffocating me.  I wake up gasping and flailing a bit, luckily my partner was out walking otherwise I would never had heard the end of it.

All that to ask, am I doing the right thing trying to retrain myself to sleep on my back prior to the sleep study or am I doing myself more harm?

And for the second question, is it just one sleep study then done?  Or is it separate ones for both the “study” and the "XPAP setting testing" and does the insurance usually only cover one or both?

Not that it matters anymore, I've decided to do it regardless of whether they pay or not.  The weird heart arrhythmias are back with a vengeance since I've been trying to sleep on my back (up from once every couple of months to about 5-6 times a week now) and I wonder if it's sleep apnea related.

Thanks again for all your help everyone, I know it must be annoying to answer noob's questions all the time, but at least I'm making progress!

don't overthink this stuff. go to the study and sleep the way you always do. if that is a problem with you, address your questions beforehand to the doctor that is ordering the test, making the rules and making the diagnosis.

Often a sleep study is ordered as a "split study" meaning if you meet criteria for sleep apnea they stop you about midway in and put a mask on you and then do the titration part with mask and machine.
We don't always meet criteria and have enough time to do the titration part of the study. So you may or may not need a second sleep study. They might be able to get it all done in one night.

I also always start out the night in a side sleeping fetal position. I do it for my back. The sleep tech told me that they would like for me to sleep on my back if I could because that gives them a "worst case scenario" but if I had to go to sleep on my side...then go to sleep on my side. Gotta get the sleep first. No way could I go to sleep on my back so went to my usual fetal position. As it turned out I ended up on my back anyway. Turned over in my sleep. They got some good "worst case scenario" time anyhow.

Check with your doctor to see if he has ordered it as a split night study and also might ask for a little sleeping pill to help you. Better to have it and not need it than need it and not have it.

During my PSG, they asked me to change positions--they needed some 'back' time for me.
If back-sleeping is giving you problems, don't 'practice'.
If they need it, they will ask. Best to have those incidents with witnesses/medics in the house.

OldBearIan wrote:All that to ask, am I doing the right thing trying to retrain myself to sleep on my back prior to the sleep study or am I doing myself more harm?

You are doing yourself unnecessary harm.

A PSG (sleep study) will adequately identify your OSA status, whatever position you sleep in.

Cheers,

Bill

Okay Bill, thanks. It just seems like I wake up more often feeling like I stopped breathing on my back. I don't seem to have much of an issue in my side, but I always still feel unrested either position, although more tired on my back.

It's just my concern that I may only have one shot at this, I'll more than likely be paying out of pocket and I honestly don't make much money here in Michigan being a firefighter/medic...

I want to make sure it counts.

OldBearIan wrote: And for the second question, is it just one sleep study then done?  Or is it separate ones for both the “study” and the "XPAP setting testing" and does the insurance usually only cover one or both?

In my case, I was scheduled for a two night study but not long after I fell asleep they could tell I had OSA. They woke me up, fitted my with a mask, and spent the rest of the night dialing in my pressue.

One study was all it took. If you are as bad off as you think, they will notice as soon as you go to sleep.

Good Luck!

Chris

Some have been told that that their insurance will not cover anything until after the initial test to prove they have a need for xPAP. Truth is that usually that test is an overnight test with a recording Pulse Oximeter, and that is far less expensive than a night in a Sleep Lab.

Insurance, if you have it, and it does any part of the overnight Sleep Study will do both nights. Having a diagnosis of needing an xPAP is of no use in treatment without the "Titration," finding out exactly what pressure settings you need. In fact, it might take an entire night to really find your pressure. I suspect that some who only have half a night are more likely to have problems getting xPAP to work for them, in that the settings on the machine were not a finely tuned to their needs as could be obtained in an entire night.

Then the insurance kicks in. Could that be your situation?

FYI: One of my sleep doc told me that often when we wake up we remember a dream that is consistent with what is going on with us at that time. Like I often have dreams about being outside in cold weather, and wake up with my arms cold. Which is consistent with your dream of sleeping on your back, and we assume having breathing issues, have a dream about a roof caving in on you.

And one of the most difficult issues is to find a mask which conforms to your face and temperament.

Sorry about that.

Are you trying to talk yourself into it?

You could buy a recording Sp02 sensor and look at the data. That should convince your hurting yourself without a sleep study.

If your O2 levels are low, you have already started to damage your heart. That means its much more susceptible to carbon monoxide and other smoke inhalation related problems. If you think you haven't heard the end of it yet, wait until one of your buddies has to help you out of a situation because you didn't get this fixed first.

If you want one more reason... Take out the CO detector out near a heavy intersection and see what it says. If there are a few old cars it will routinely get the air above 15 ppm but most firefighters have no effects below 200 ppm and some 500 ppm. People with heart problems can be effected by 15 ppm and you don't want to become that person.

I was not ordered a split-study and tech said that I would need to come back for titration a 2nd night. Ask your ordering Dr if he can order a split study, IF it can be done in the given time on that 1st night. Then make sure when he orders your machine that he orders APAP with a pressure range and a fully data compatible machine so you can tweak the pressures as necessary. Often we don't sleep the same at a lab as we do in our own bed, and you can see how well your treatment is working by checking the data and then tweak your pressures accordingly,as needed.
Don't force yourself to sleep on your back,because back-sleeping is very hard on sleep apnea sufferers & can cause low oxygen, heart arrhythmias, and you might not even wake up in this world.

Mine was a 2 night study, I went in on the first night and they asked me to sleep on my back. I let them know I had a pinched nerve and 3 degenerative disk in my back, but, that I would try. After fighting for an hour and an half, he finally came in and told me to go ahead and roll over on my side. They never did get any data of me sleeping on my back. Thirty minutes later, I was finally asleep. I think I woke up either 3 or 4 times that night to use the bathroom.
On the second night, I slept good for 7 hrs, only needing to get up 1 time for the bathroom. When they woke me up, I felt great, best night of sleep I'd had in probably 3 or 4 years. Wish I could get more nights like that again. Anyway, they will let you know what they want from you, and that is the point of you going for the study. Let them see what is going on when your trying to sleep. Once they realize how hard of a time your having on your back, and collect enough data, they will let you roll over to your favorite sleep position. Don't get to worked up about it, or you'll have insomnia and won't be able to sleep.

OldBearIan wrote:But at least I've made an appointment.

Congratulations on taking the first step.

With your symptoms, hopefully your doctor will actually refer you to a sleep clinic for a study, or if your health plan is a PPO you can do this on your own without waiting for the appointment. I suspect if you're honest with them they will also give you a psych referral; you sound like you may have some other issues going on, although they may be helped with good sleep.

However, I am really concerned about you performing your job until then if you are suffering EDS to that degree. You simply cannot do an EMT job or drive a ambulance in your condition. Do you have someone in HR you can speak with regarding medical leave?

In the mean time, sleeping on your side may help a little bit if you do have OSA; that will depend on how severe it is, if indeed you do have it. As far as what a study will show, supine sleeping versus side sleeping isn't going to be that important, and a sleeping pill will probably be in order too.

I'm sorry, EDS?

The anxiety while on my back is not something that spreads beyond that, and the dream is not an underlying fear of mine, although your concern for my mental well being is appreciated.

As far as my job, I understand your concern and that is really the primary reason I'm getting this all done (I otherwise make a terrible patient, as most of us medical people do) however I take great care with my job and take no risks with the lives of others. When tired I do not drive. I hope to have this behind me soon, but my concern is that I only have one shot with my crappy pay and poor insurance so I'm asking questions here to make sure I make it count...

I think you are too worried about the test. I was also worried about every thing, not sleeping, them finding i had it, them not finding would mean something different was wrong. Try to Relax.

I was told i needed two nights. The first night would be to see if I had apnea. The second night would be to see about pressure and adjusting the machine.

During the first night within the first few hours I had so many apneas that my oxygen was down around 58 percent. They woke me up for the machine on me adjusted the pressure that night .

EDS=excessive daytime sleepiness.

As far as anxiety, the dream is a minor part - I'd note your repeated posts here kind of hint towards that as being a potential problem. Hence, my point.

Anyway, it's up to you. People here can help once you get results, but until then try to sleep.