Thursday, August 22, 2013

Sleep Study Redux

Got the results back from my sleep study and all I can say is that I'm pretty darn confused:

Clinical Background:
34 year-old patient is now referred for an unattended diagnostic
sleep recording.

An ambulatory PSG with a digital sleep system for recording
respiratory effort, oximetry, body position, airflow, pulse rate,
and limb movement channels.

Total recording time was 253.1 minutes. The patient estimated a
total sleep time of 178.0 minutes. 

Respiratory Analysis demonstrated 5 obstructive apneas and 12
hypopneas, with an APNEA HYPOPNEA INDEX (AHI) of 5.7. The
patient spent 0.0% of total sleep time in the supine position,
with a supine AHI of 0.0, versus a non-supine AHI of 5.7, though
the body position cannot be verified. 

The lowest oxygen saturation was 89 %, and 0.0 % of the sleep
time was spent at saturations below 90 %.

The pulse rate was at 78 beats per minute.

The PLM Index was 50.9 events per hour. 

1. Sleep study findings are consistent with mild Obstructive
Sleep Apnea. The overall RDI was 5.7 events per hour of sleep. 
The lowest oxygen saturation was 89 %. This unattended study
likely under estimates the severity of the patient's sleep apnea
(as measured by the AHI) as frequent periods of flow limitation
in addition to the scored events were observed, but these could
not be scored as respiratory events due to lack of EEG channels
in this limited channel unattended sleep study.
2. Evidence of snoring was present.
3. There is also evidence of frequent periodic limb movements. 
Due to lack of EEG channels in this limited channel unattended
sleep study it cannot be determined whether these leg movements
were present during sleep and if they are associated with
significant cortical arousals and sleep fragmentation. 
4. Positive airway pressure therapy (CPAP) is usually the most
effective treatment option. Surgical treatment modalities are
alternative options. An oral appliance may be effective
treatment in mild cases. The patient should avoid sleeping in
supine position (i.e. side-sleeping or elevation of the head 30
degrees is preferred). Other non-specific adjunctive treatment
include significant weight loss, and avoidance of sleep
deprivation, alcohol and nicotine. 
5. It is recommended that the patient come-in to the sleep lab
for a full-night attended polysomnographic titration sleep study
to determine the optimal positive airway pressure therapy and
this attended sleep study recording is indicated for further
evaluation of periodic limb movements as well. He will be called
to schedule this study. 

Sleep study raw data was manually reviewed and the report
reviewed, edited, and electronically signed by me. Please feel
free to contact me if you have any questions.

I reported on the form exactly what I wrote in my previous blog entry. I'll reproduce the focus of my confusion:

I doubt there will be anything useful in the hour or less of sleep data that got recorded. I am unlikely to try this again.

I'm not confused about how much sleep I got during the study. I was very careful to write it down. I got less than 60 minutes of sleep. While that may not be entirely precise, I can guarantee I didn't get three hours of sleep. So I apparently have apnea events that I don't notice while I'm awake. I think I can explain the restless limb movements; I was using my limbs.

I am now more turned off toward this.

Thursday, August 15, 2013

Boozing, not Snoozing

My sleep has been pretty poor lately and I began to suspect that a recent increase in my enjoyment of fine liquors might be related.

The last two evenings I've abstained and found that my sleep has been better. I've found myself awake less in the small hours and less sluggish in the morning.

I'm a little disappointed since I've been enjoying trying new boozes. I'd like to continue enjoying it so next I have to figure out if there's a cutoff time and if the limit is two, one, or zero drinks.

Wednesday, August 7, 2013

(No) Sleep Study

Did my sleep study last night. My borg assimilation included the following:

  • An elastic band around my chest with a sensor in the middle and a wire coming out there. This is to monitor breathing.
  • An elastic band around my stomach with a sensor in the middle and a wire coming out there. I presume this is also to monitor my breathing.
  • An accelerometer taped to the center of the chest band to monitor my position.
  • A sensor taped to the outside of each calf muscle to detect restless legs.
  • A microphone taped to my neck to detect snoring.
  • An oxygen sensor on my index finger, taped to my hand.
  • A nasal cannula with side tubes taped to my cheeks to monitor the pressure of my breath.
  • All wires and tubes running to a recording device.
I also had a form to record when I turned on the device, when I went "lights out", which periods I was awake for during the night, my final wake time, and time when I turned the recording device off.

I got wired up about 11:00pm and read for a bit as I normally do. I was ready to go to sleep about 11:30pm. I got to sleep in about 15 minutes I think.

My girlfriend came to bed about 1:00am which woke me up and I couldn't get back to sleep. I stayed in bed trying to get back to sleep until about 2:00am at which point I got up and took 3mg of Melatonin and sat in a chair with a laptop until the Melatonin could kick in.

About 3:00am I felt I was ready to sleep so I laid down again. About 3:30am I gave up trying to sleep with all wires and such so I shut off the machine and pulled the sensors off. I think I eventually got to sleep about 4:45am.

I doubt there will be anything useful in the hour or less of sleep data that got recorded. I am unlikely to try this again.

Tuesday, August 6, 2013

Dragging My Ass Out of Bed (Redux)

I saw a sleep doctor yesterday for a consult. I described my situation, reproduced here in brief:

  • I used to have a great deal of difficulty getting to sleep. That's mostly been resolved with medication and therapy addressing the thought patterns and emotions that were keeping me up.
  • I toss and turn in bed (thrashing we call it).
  • A relatively recent development: I wake up frequently to go to the bathroom but fall back to sleep quickly. This change coincides with taking Cymbalta but that contradicts it's indication as a drug with success in treating incontinence.
  • If I sleep on my back it's reliable that I snore, sometimes such that I wake myself up. Consequently I try to never sleep on my back. I also never sleep on my stomach.
  • When I wake up I feel like a bag of smashed assholes. The earlier I wake up, the worse it is. This is lethargy in the best case and great nausea in the worst case.
  • It's about 3-4 times a year that I wake up feeling rested and refreshed.
  • No record of waking up unable to breathe, short of breath, headache, etc.
  • While in college, when I had a variable schedule and no job, my sleep cycle would consistently drift forward around the clock.
  • I often have difficulty focusing at work, especially at the beginning of the day, highly dependent on the quality of my sleep.
  • I drink caffeine but on weekdays rarely have any after 2:00pm.
The doctor's opinion was that my circadian rhythm is later than most and that I should get up later than what I normally try (6:45, with mixed results), maybe 8:00.

I'm a little disappointed because if I'm leaving the house by 8:00 I generally contend with very little traffic. 8:30 or later and my 4.5 mile drive to work is on the order of 20-30 minutes. I also like the idea of getting to the office early and finishing my day early.

Of course, if I find that my workday focus and energy level are improved I'll be getting more done and feel better about the day. I also think it will help with my mood and may make it reasonable to bring my Cymbalta down from 90mg back to 60mg. That will be a decision to look at in a few months.

This morning was my first day intentionally getting up at 8:00 and I have to say that I do feel a little more attentive and focus. Not a huge difference, but I understand that it can take a few weeks of getting up at the same time for my body's schedule to settle.

Today I have to pick up an at-home sleep study device to use this evening and return tomorrow. I'll provide an update when I get the results back.