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Polysomnography

Monday, January 30, 2012, 07:27 EST Leave a comment Go to comments

noun /ˌpɒlisɒmˈnɒgrəfi/ : the technique or process of using a polygraph to make a continuous record during sleep of multiple physiological variables (as breathing, heart rate, and muscle activity) : how the Den Mother will spend a night this week

Ever since I can remember, it has taken me longer than normal to fall asleep. I was probably a teenager or young adult before I found out that most people fall asleep only 5-10 minutes after they turn off the light at night. With me, it was more like a 30-45 minutes. Not knowing any better, I was never bothered by it. Once I fell asleep, I slept well and awoke feeling rested. If I slept poorly, it was usually because I was sick. Even when I had nightmares as a child, I slept fine once my mother calmed me down. As I have aged, I have experienced episodes of insomnia, but I’ve been able to identify and eliminate the causes. A couple bouts with clinical depression over the last 15 years have been accompanied by hypersomnia, but when the depressive symptoms subsided, so did the hypersomnia. Until recently.

Sleeping at workI realized last year that I was feeling less rested despite sleeping more. It snuck up on me slowly, but by the time I had my annual physical last November, it had become enough of an issue that I raised it with my doctor. Between me, my primary care physician, and my psychiatrist, we ruled out a recurrent depressive episode. With the exception of perhaps one trip to the bathroom in the middle of the night, I don’t have trouble staying asleep. But no matter how long I have slept, I always awaken feeling like I should sleep more. I’m always tired. On especially bad days, it’s a challenge not to put my head down on my desk and doze off, like the teacher used to try to get us to do in kindergarten and first grade after lunch but we never wanted to. (I’m reminded of comedienne Paula Poundstone‘s assertion that “the definition of adulthood is that you want to sleep.”)

Obstructive sleep apneaMy doctor suspected obstructive sleep apnea, a condition wherein face and neck muscles put pressure on the airway during sleep, disrupting normal breathing. She explained that some people with sleep apnea learn they have it when their sleep partners observe pauses in breathing and, sometimes, loud bursts of snoring when breathing resumes. Since I sleep alone, there’s been no one to observe whether or not it happens to me. But other symptoms might suggest it does, including “[d]aytime sleepiness, fatigue, frequent naps, headaches, irritability, insomnia, and poor memory and attention … as a result of insufficient sleep.” Let’s see — daytime sleepiness, check! Fatigue, check! Headaches, double-check! Irritability, check!, although I’ve been attributing that to perimenopause. Poor memory and attention, check! As I said, I don’t have insomnia, nor do I actually take frequent naps, but I would if I could. When I do lie down for a nap on a weekend afternoon, I have no trouble sleeping for two hours or more.

The point is that the problem is getting in the way of my work and my life. So in an effort to find the cause, I’m checking into a sleep lab one night this week for a polysomnogram (PSG for short), an overnight battery of tests to monitor what happens to my breathing, heart rhythm, brain activity, eye movements, blood oxygen level, and muscle movements while I sleep. According to the literature provided by the sleep lab:

[T]he sleep technologist will place a number of non-painful sensors (also called electrodes) on your head, chest area and legs. The areas where the sensors will be attached are cleaned and the electrodes are attached with special gels, paste, gauze, and tape… Elastic belts with sensors will be placed around your chest and abdomen. Airflow sensors will be placed under your nose and a finger clip will be applied to monitor your oxygen levels. All of the sensors will be connected to a small portable box that transmits signals to the sleep monitoring and recording equipment that is in a nearby control room.

Sleep studyIn other words, I’m going to have little sensors all over myself, sort of like this picture except that I have much less gray hair. While that might feel a bit strange—the only medical monitoring device I’ve ever been hooked up to is a fetal monitor when I was in labor—what really creeps me out is the idea of being watched all night. I suppose it’s nothing the lab staff haven’t seen before. I just hope I don’t talk in my sleep or, if I do, that I don’t say anything embarrassing.

The product of the entire experience will be a report describing and a set of graphs showing what happened while I slept, like this one that shows a minute during which the patient stopped breathing (look at how the eighth line from the top flattens out for a stretch):

Polysomnography

CPAPPresuming the tests confirm a diagnosis of sleep apnea, the treatment is something called a Continuous Positive Airway Pressure machine (CPAP for short), a device that blows air into the airway to prevent it from closing. Attractive, no? Apparently there are a number of different styles of apparatus, some of which I hope look a little less like Borg appendages. I’m having a hard time imagining how anyone could sleep with such a device, but one of my-workers whose husband has used a CPAP machine since having a heart attack a few years ago says he adjusted to it very easily. She insists the hum of the machine is not bothersome. Most importantly, her husband sleeps better than ever and wakes up feeling great.

Oh, how wonderful that would be, awakening to feel refreshed and ready to start the day. I think of the things I could do and accomplish when I’m no longer tired all the time. Sure, the machine might be a bit awkward in the unlikely event that I ever have a sleep partner again, but if it means increased energy, I think I can live with it.

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