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  • Jan Flynn

The Weirdest Test You’ll Ever Have

If you’ve been referred for a sleep study, here’s what to expect

Photo by Online Marketing on Unsplash

My preparations for bed have taken nearly an hour

My sleep technician, a calm and confident woman with a 50s family sitcom-motherly vibe, has carefully attached a complex network of electrodes to my wrist, chest, and abdomen, their slender wires snaking down one leg and attaching at my ankle.

Sensors are positioned inside my nostrils; a pulse oximeter gently squeezes my left index finger. More electrodes are attached to my head. Each one erupts in another wire, forming a particolored cascade of electronic spaghetti which my technician refers to as my “ponytail.” My ponytail feeds into a black, rectangular terminal roughly half the size of a shoebox, and it’s what I carry with me as I shuffle to the bed, careful not to disturb anything, and crawl between the covers.

The space I’m in resembles a standard room in a two-star hotel, complete with a king-sized bed facing a large-screen TV, furniture that you might find at Ikea, inoffensive wall art, and a few faux plants. But the hotel resemblance fades as I take in the ceiling-mounted camera and speaker and especially the large, black glass panel that stretches above the TV. Behind it, I know, is where the sleep technician will spend this night among a battery of machines and readouts. They will all measure my vital signs, breathing, brain waves, and my every twitch and snort while the technician observes.

50 to 70 million Americans have a sleep disorder

That’s according to sleephealth.org, and it turns out I am among them. Some of us snore and wake up our partners, or stop breathing and wake ourselves up (sleep apnea). Some of us can’t get our lower extremities to stop twitching or thrashing (restless legs syndrome). Some of us fall suddenly asleep at weird times (narcolepsy). And many of us, at one time or another, just can’t seem to get to sleep at all (insomnia).

Given our generally overworked, overstimulated, and overstressed culture, it’s no wonder sleep disorders are rampant. But if it’s happening to you, it’s probably little comfort to know that you’ve got company, or that you’re probably surrounded by other people who, like you, have to fight the urge to do a face-plant on their office desks — or worse, their steering wheels.

Being sleep-deprived feels awful, and over the long term, it’s terrible for your health. You already know this, which is why you’ve mentioned it to your doctor. Good for you: sleep problems may be common, but they’re no joke.

But now the doc wants you to have a sleep study. Maybe she’s suggested you try an at-home study to begin with, or maybe you’re getting sent straight to the sleep clinic for the full treatment. If you’re feeling a little apprehensive about the prospect of being wired up and monitored all night long, who can blame you?

My experience can help you know what to expect

The nurse practitioner who referred me for the study, after taking my medical history and doing an initial exam, interviewed me about my general tiredness. I reported that I was having difficulty getting through normal adult life without wishing I could trade the keyboard on my office desk for a pillow. I didn’t feel rested in the morning; I rarely felt rested at all.

She handed me a clipboard and a pen and asked me to complete the Epworth Sleepiness Scale. I am not making that up. The ESS is a self-administered questionnaire comprised of eight situations, in which you’re asked to rate your likelihood of snoozing through, from zero (“would never doze”) to four (“high chance of dozing”).

The situations are common to everyday life and do not include enduring Zoom lectures on postmodernism. They’re things like being a passenger in a car for more than an hour without a break (I scored 3), lying down to rest in the afternoon when circumstances permit (a solid 4 for me), or being behind the wheel in a car while stopped for a few minutes in traffic (thankfully, zero).

The test doesn’t try to figure out why you might be tired, only if you are tired. In my case, I achieved a rating of “moderately excessive daytime sleepiness,” even though nobody was having to honk at me when the light changed. I was surprised to learn that was enough to qualify me for a full sleep study, and further surprised to learn my insurance would cover up to two such studies within a service year.

My nurse practitioner gave me a few tips about what to expect. “You can bring your own pillow, and whatever you like to read,” she said, “Be sure to bring shampoo because you’ll want to wash your hair in the morning.” I was about to ask why when she added, “And, um, even if you sleep in the buff at home, please bring pajamas.”

“You mean people sometimes don’t?” I asked, a disturbing mental image driving the shampoo question from my mind.

She made a wry face. “It’s happened,” she said, “and the sleep technicians felt weird enough about it that they made us promise to mention it.”

This is when it comes home to me that not only will I be spending a full night being monitored while I sleep, there will be a stranger watching me, all night long.

I report to the clinic at 8 PM

There are forms to fill out, including another Epworth Sleepiness Scale in case I’ve either perked up or become more somnolent since my previous exam. That done, I’m ushered into a room where I change into my pajamas (entirely modest ones) and am ushered into another room where I am greeted by my sleep technician.

She sits at a bench covered by a bewildering array of colored wires, sensors, and electrodes. With expert patience, she begins sticking electrodes to points on my wrists, ankles, and torso. I am beginning to feel like something out of a 50s-era monster movie — and that’s before we even get started on my head.

My skull gets a whole host of electrodes and wires of its own, more than I can keep track of, each of them adhered to my scalp with a generous glob of glue. Now I understand why the shampoo.

At last, I am tucked into bed and offered a sleeping pill, which on the advice of the nurse practitioner, I take. The sleep technician withdraws, to take up her position in the room I can’t see through the dark glass overlooking my room.

Her voice comes through the speakers in the ceiling, giving me a few last instructions, and bidding me goodnight.

It’s not easy to get comfortable given all the wires and the electronic ponytail, not to mention the black window looming over me, but soon enough I drift into something resembling sleep. Sometime in the middle of the night, I am awakened by the sleep tech, who says it’s time for a CPAP trial: apparently, I’ve honked myself awake enough times to justify trying out the machine.

CPAP, as you no doubt know, stands for Continuous Positive Air Pressure. I have friends who love their CPAP machines; they feel transformed by the quality of sleep they now enjoy. So I gamely try it. This particular machine has a smallish mask, one that covers only my nose, a tube that looks like a petite elephant’s trunk curving down to the unit itself. The unit isn’t loud, but it blows a steady stream of air into my nose.

“How do I exhale?” I splutter as the thing forces its small, relentless gale down my trachea.

“It takes some getting used to,” says the sleep tech in her soothing voice.

I try, but I hate the sensation. An hour later, I’m still gasping and awake, and the sleep tech returns to remove the CPAP. Relieved, I lie back down and manage, ponytail and all, to go back to sleep.

At 6 AM, the tech’s voice drifts through the ceiling to bid me good morning. I climb groggily out of bed, thinking that she works a long, strange shift.

She comes into the room to liberate me from the ponytail and all of its attachments. I head to the shower, catching a horrifying glimpse of my glue-tufted noggin, and spend considerable time and shampoo ridding myself of the stubborn adhesive.

The verdict: sleep apnea, kind of

It’s not severe enough that I absolutely have to use a CPAP, which is a good thing as I inform the nurse practitioner that I have no intention of doing so unless the alternative is assured and sudden death. Instead, I’m referred to a dentist who specializes in mandibular advancement devices (MADs).

That involves more appointments, more sleepiness scale assessments, and a lot of fitting and customization, but eventually, I am equipped with an oral device that keeps my lower jaw from receding in my sleep and therefore cutting off my air supply. It works quite well, even if it means I go to bed looking like I’m prepared for a prize fight.

At least, I tell myself, I don’t have to feel like I’ve got my head stuck in a wind tunnel all night.

If you suspect you might have a sleep disorder, I encourage you to get it checked out. Improving your sleep can save your health, your sanity, and quite possibly your life. And you deserve to feel rested rather than slogging through your days with sand in your eyes and fog in your brain.

But it will take some effort. You might have to let a stranger watch you sleep. You might get glue in your hair. This is all survivable.

Just make sure you bring pajamas.

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