Concerns about sleep study tomorrow

[Zeds]

I'm more anxious about the sleep study than a major operation!

For me, there hasn't been close to enough information, and I'm a person that likes to slake anxiety with extensive factoids.

What happens if my sleep symptoms don't show up on sleep study night? I wake up snorting or with my "throat flap" closed. The flap pops open when I wake up. It's even got to flapping like a gate flapping in the wind (spastic open and closing), so I emit a continuous throat sound that made it's way (at length) into a dream. The sound woke me up.

I'm not sure if I snore, but I might.

These weirdnesses happen at night as well as during naps.

But what if this behavior doesn't show up in the sleep study? I'm not sure it happens every night. The nurse insists it will if I have a problem, but I'm not so sure.

What if I have these weirdnesses, but they aren't sustained, they're not quite long enough to qualify as seriously disrupting my sleep?

What if I randomly don't have REM? What if I don't sleep at all?

Did you folks deliberately short your sleep the night before the sleep study or exercise a whole lot so you'd be a walking zombie when you showed up at the sleep lab?

Does central apnea feel different than OSA? (The nurse suggested I might have both)

By the way, I'm physically unable to sleep on my side: my body folds in on itself. This is not good for my emergency room budget, my heart, or oxygen intake, not to mention the nerves and muscles in my back...

What are UARs?

Thanks!

[Soothest Sleep]

Welcome to the forum. Those who've gone through an overnight sleep lab test will be by to reassure you about details of the procedure. My overnight test was conducted at home, so no technicians observing.

In the meantime, try to relax. This exam is not one you have to study for! It is a fact-gathering exercise, and you get to sleep through it! The technician is the one doing the work overnight.

It can be difficult to go to sleep in a new environment, and in the lab many patients don't fall sleep as easily as they do at home due to the distractions of the equipment, different bed, etc. That's normal. If you aren't asleep long enough for relevant data to be collected, then another study would be scheduled.

I am asleep when my apneas happen, so am not conscious of any differences between a central or an obstructive apnea. I have occasionally wakened from the sound of my own snore, but I have never experienced an awakening when I was gasping for air. (As a child, I heard my parent do so, though, and it can be a terrifying sound.)

Here's a link for some information about UARS (Upper Airway Resistance Syndrome): https://en.wikipedia.org/wiki/Upper_air ... e_syndrome I notice there is no definition for it in the "CPAP Definitions" page (linked at top right of forum page). I wonder if that can be added. . .?


Jean

[robysue]

Zeds,

You are over thinking things. Although the number of apneas and hypopneas can vary somewhat from night to night, if a person has moderate to severe OSA, the apneas will present as soon as you actually get some sleep.

What happens if my sleep symptoms don't show up on sleep study night? I wake up snorting or with my "throat flap" closed. The flap pops open when I wake up. It's even got to flapping like a gate flapping in the wind (spastic open and closing), so I emit a continuous throat sound that made it's way (at length) into a dream. The sound woke me up.

From the sound of it, you have some kind of a sleep disordered breathing problem. Most likely you do snore or make other noises. They do video tape you during the night to catch those kinds of behaviors.

In a worst case scenario---such as you get less than 2 hours of fractured sleep and no REM sleep, you could always ask for a home sleep study. Sometimes being in your own bed can help. And some home sleep studies can be done over 2 or 3 consecutive nights. (But fewer types data are gathered on the home sleep studies.)

What if I have these weirdnesses, but they aren't sustained, they're not quite long enough to qualify as seriously disrupting my sleep?

Most people's apnea is sporadic. In many people, there will be some periods where few or no events are scored and others where thick clusters of events occur. But typically if they get as little as two hours of (even fractured) sleep data in the 6 or 7 hour "Time in Bed" window, there's usually enough data to flag a sleep apnea problem.

What if I randomly don't have REM? What if I don't sleep at all?

It's not uncommon for people with severe OSA to get little or no REM sleep. That by itself can be thought of as a symptom of untreated OSA. And again, if the non-REM AHI is in the normal range, but there is NO REM recorded, it is worth asking if a home study over 2 or 3 nights could be done to see if you have an apnea problem in REM sleep.

If the OSA is significant in REM, then most docs will say "You need to be on CPAP" even if the non-REM AHI is low enough to be considered normal or near normal.

Did you folks deliberately short your sleep the night before the sleep study or exercise a whole lot so you'd be a walking zombie when you showed up at the sleep lab?

That may or may not work since the problem is usually getting to sleep in a strange environment with lots of wires attached to you. Oddly if you are too physically exhausted it can be difficult to get to sleep and stay asleep---think about a cranky toddler who is so tired, needs a nap, but just can't fall asleep. Certainly be caffeine free.

If you are really worried about getting to sleep, ask your doctor to prescribe one Ambien for you to use on the night of the test if you find that you just can't get to sleep. Most sleep labs allow that if the doctor who ordered the test faxes over the instructions that you are allowed to take an Ambien.

Does central apnea feel different than OSA? (The nurse suggested I might have both)

Not really. Not unless you wake up in the middle of an actual obstructive event. And most people don't actually wake up consistently during events.

By the way, I'm physically unable to sleep on my side: my body folds in on itself. This is not good for my emergency room budget, my heart, or oxygen intake, not to mention the nerves and muscles in my back...

Lots of people with OSA don't fit the standard stereotype of middle-aged fat guys.

What are UARs?

Upper Airway Resistance Syndrome. It's a form of sleep disturbed breathing. In UARS the upper airway repeatedly narrows, but does not collapse, during the night. The reason the airway doesn't collapse is that in a patient with UARS, the patient usually arouses (i.e. "wakes up") just enough to force the airway back to being fully open before it collapses enough for a hypopnea or apnea to be scored. This kind of an arousal is called a RERA---respiratory effort related arousal. In a person with UARS, the number of apneas and hypopneas is usually very low, but the number of RERAs is very high. In a classic case of UARS, the person's diagnostic AHI may be in the normal range (AHI < 5.0), but the RDI (respiratory disturbance index) is elevated, and sometimes the RDI is very elevated. The usual first line of treatment of UARS in a patient complaining of daytime sleepiness and/or daytime fatigue is CPAP.

Note: The AHI = (number of hypopneas + number of apneas)/(sleep time)
The RDI = (number of hypopneas + number of apneas + number of RERAs)/(sleep time)

Thanks![/quote]

[Bertha deBlues]

Hi Zed. I can only share my own experience. I had an at-home study first, so I had a vague idea of what to expect. I did not short-change myself on sleep the night before the sleep lab test, nor did I try to wear myself out before going. Because of the strange environment, different bed & pillow (maybe they would let you bring your own pillow?), wires here and there, etc., I was certain I would not sleep. What a surprise when the technician flipped on the lights in the morning and said the test was over. I asked if they got enough data (when I was certain I would not sleep) and she said they had. She was right. I was diagnosed with mild sleep apnea and started treatment. Although there were some bumps early on, I'm glad I got diagnosed and did something about my sleep problems.

Try to not stress yourself too much, although it's hard not to. The important thing is that you're taking steps to get treatment. Best of luck!

[Pap-Daddy]

Zed the biggest thing for a sleep study is to make sure you sleep. IF you don't sleep you not only waste your time & money - you waste their time and don't get to the root cause of your problems.

So be sure not to nap that day, exercise if possible and/or get a script from your doc if you think you will need sleeping pills. But they can't rule anything in or out unless you do sleep.

Don't worry about what they will or won't find but do be sure to ask for a copy of the results for your records. Also start a notebook now to write down any and all questions you have so you don't forget. Take the notebook with you to the lab, the docs, etc. Just leave some room under your question for the answer.

Don't let your doc leave the room until you have answers to your questions. Believe me they will take you more serious when this is done.

[Zeds]

You guys are awesome!

All that info is exactly what I needed!

I usually manage to get a lot of info when I have a procedure, but this one's been like pulling teeth. Even the written instructions are vague.

I can see from what you say that there are several different types of problematic sleep events. I'm guessing a single person could have several varieties.

Thanks for the UAR info.

Yes, I'm looking forward to having a treatment plan that will help me breathe less alarmingly. There's something quite disconcerting about hearing a loud sound in your dreams, on and on and on, louder and louder 'til it finally wakes you up. And then you realize it was you, and Your throat flap has gone spastic.

I'll keep you posted!

[kteague]

Don't set your expectations too high. You'll be in a strange place with wires all over - as is everyone who has ever done this test. If you think you need it, maybe you can call your doctor tomorrow and ask for a script of one pill for the night to help you get through it. Some meds are considered ok for sleep tests. You don't have to sleep the whole night, and they may not catch absolutely everything you often do while in those few hours in the lab. It is what it is. Or maybe you'll be surprised and sleep more than you expect, and they'll capture information that answers all your suspicions. Tell yourself you will be glad to get whatever information they are able to get. Come back here with your test results if you are left any concerns and start from there. Sometimes when I'm worried I intentionally take myself straight to the worst case scenario, make peace with it, then move on, skipping all the in between levels of concern. Like, if you don't sleep enough to get any meaningful data, they will either reschedule your lab test, reschedule your lab test with medicine, or schedule a home test. All of those are doable and none are the end of the world. So, if the worst case scenario is survivable, everything in between will be too. Maybe not ideal, but you can work through ANYTHING that could come up. Let us know how your night goes.

[Jeanine]

Bring your own pillows. Relax as much as you can. Meds may or may not help. I've had three sleep studies in the last month with meds twice and only helping once. Be as positive as you can. If you don't sleep enough for them to do their study, you'll just have another study. It's ok. You'll be fine. Be open and trust the process. I'm a newbie too. Just diagnosed with Complex Sleep Apnea. I have insomnia too. It's rough, but I have hope...for the both of us. Let us know how it goes. Relax. Let go.

[Comfortably Numb]

Take this from one of the most anxious people on this forum (me):

I totally agree. I find it curious that most sleep study personnel (doctors included) project the attitude at first that you shouldn't do anything to enhance your "sleep experience" prior to the study. Then we end up with situations like those described in the OP. I knew going in that I'm an anxious person and don't sleep well in new places, let alone a hospital situation. I also know that when the element of performance is introduced, I become even more resistant. So prior to my in hospital sleep study, I popped two blue Xanax (2 mg.) about 2 hours prior to bedtime. While I was waiting for the nurse to wire me up, I excused myself for a few minutes and went down to my car for 2-3 good chugs of chardonnay. I had a wonderful titration study and all has been great ever since. To each his own, but at age 69 I know myself pretty well. The medical community has an agenda that largely controlled by issues of liability. Sometimes we have to work around these issues.

[dbreweur]

What if I don't sleep at all?

I'm told that's actually really common. If you find that you can't handle an in-lab study with all of the sensors, the at-home test may be an option (if your lab offers this - you'd have to check to see if your insurance would cover it, however). My pulminologist ended up prescribing an Ambien that knocked me out within 30 minutes of taking it (Just one pill in a big ole' bottle, which amused my pharmacist to no end )

Did you folks deliberately short your sleep the night before the sleep study or exercise a whole lot so you'd be a walking zombie when you showed up at the sleep lab?

The sleep lab tech who did both of my in-lab studies told me that some people try that, but he personally recommended that you try to keep your sleep patterns as close to normal as possible. For my first go-around, I tried to stay up and still ended up taking a 20 minute nap before the test, which screwed up my sleep schedule that night. The second one went much better.

By the way, I'm physically unable to sleep on my side: my body folds in on itself. This is not good for my emergency room budget, my heart, or oxygen intake, not to mention the nerves and muscles in my back...

You don't have to sleep on your side (at least I wasn't forced to, I just naturally sleep that way); If anything, you're luckier because it's easy to get tangled up in the various cords attached during a study if you're sleeping on your side, or tossing and turning.

[Zeds]

Update at "I had The Sleep Study from hell."