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What to expect at a Sleep Study

"Will you be able to see my dreams?" is my favorite question from a sleep study first timer. The answer is actually, no. But, we can tell when you are in R.E.M (Rapid Eye Movement) stage of sleep. REM is the stage of sleep in which people dream. But, I'm getting the cart ahead of the horse. Now, what can you expect at a sleep study?

First, showing up to your appointment at the designated time is important. Even though you may not go to bed until 11PM, if your appointment is at 8:30PM, you should get there at that time. Many times, the sleep center staff will want you to fill out some paperwork pertaining to your insurance, basic info about you, and also information regarding how you sleep as well as a basic medical history. If you can, try to get a copy of the questionnaire before hand. It will save you some writing. Some sleep labs will send you a packet before your appointment date with this in it. Enough with the paper work, let's get to the nuts and bolts.

When you get to the sleep center, your technologist or technician will show you to your room. I believe all sleep centers provide their patients with a private room these days. The room usually has a decent bed, bedside stand, a television with remote and sometimes a bathroom right off the room or close by. Once in your room, your tech will explain to you a little about the "hook up" and what we are looking for.

The hook up consists of a series of wires and belts and takes from 45 minutes to one hour to complete. Most of the wires attach to your head. There will be about 25 leads attached all together. This exact number varies from lab to lab, but 25 is pretty close. Most of the leads attach to your scalp. Those leads are picking up brain waves. From your brain waves, we can tell if you are awake or asleep and also the quality of your sleep. When you are asleep, the stage of sleep you are in can be determined. In all, there are 4 stages of sleep: Stage 1, stage 2, stage 3 and REM.

Some of the other things we monitor with the leads on your head are eye movements and muscle activity on your chin. We look at the muscle on your jaw or chin in order to see if you grind your teeth as well as help detect when you go into REM.

Beneath your nose, you will have a cannula or a similar device to detect when you breathe in and when you breathe out.

Moving on farther South, to your neck, you will have a snore microphone taped on or near your throat.

Moving down a little further down, at least 2 ekg patches will be on your chest to pick up your heart beat.

Continuing on, two elastic bands will go around your chest and abdomen. These bands or belts will sense your effort breathing. I'm sure everyone has noticed that when you breathe in and out, your chest goes up and down. That is precisely what these belts pic up. Don't worry, we are almost finished!

Next are the leg leads. Either one or two leads will attach to each shin. These leads detect leg movements. By detecting leg movements, doctors can diagnose Restless Leg Syndrome among other movement disorders.

Okay, last, but not least is the Pulse/Ox. Tech's usually attach this to the finger. I think most of us may be familiar with this, it usually clips to your finger and lights up red. Well, there you have it! You just got hooked up for a polysomnogram! Look at the picture on the top of this page. That is Joe Rogan wired up for a sleep study. Just beneath, is a child hooked up for a sleep study. Note on the picture below, you can see more of the wires attached to your scalp. The lead placement from adults to children is virtually identical. What in the world does all this data look like?

I'll answer that question with a question. Have you ever seen a polygraph test in the movies? It has the pens going up and down as the paper rolls on by. When the person acts or reacts to something, the pens will go up and down more drastically. That is the same technology as what we use for sleep studies or polysomnograms. Except today, we use computers. On the tech's computer monitor, the squiggly lines scroll on by as the test goes on. Take a look at the picture below for an example of what a portion of a polysomnogram looks like.

And now, the million dollar question: How am I supposed to sleep with all this stuff on me? Certainly you know all of that "stuff" is there once you lay in bed. But, once you lay down, you will get used to it. Also, once you lay in bed, you don't feel the weight of the wires pulling. Not that they are heavy. The wires are light. But, you can just tell when something is hanging from you. So, when you lay down, you don't feel it as much is my point.

Do the best you can is all that we ask. We know it won't be the same as crawling into your super king at home along with your significant other, favorite assortment of pillows, and pets. All we really need is a few hours of sleep. But, the more, the merrier.

If you are invited back for a second night with CPAP, BiPAP, or xPAP, you can expect the same thing. All the wires will go on again. The only thing different will be a little practice time with PAP and getting fitted with a mask.

What do you bring to a sleep study? Be sure to bring comfortable clothes to sleep in. Usually shorts or sweats and a t-shirt work well. Some people like to bring a fan while others bring ear plugs. The reasons are many behind the items certain people bring. If it can make you feel more comfortable, bring it! Other items I have seen people bring include: body pillow, eye mask, a book, a flashlight, an i-pod, a lap top computer, a camera, even a framed picture! If you are not sure if it is OK, just give the lab a call.

The most important thing to remember about your sleep study is to relax and not worry. You are not there to perform for the techs or doctors. You are there for yourself and your health. Just kick back and relax. Good Luck!

Too Hard To Exhale

They tell you that you don't sleep well because your not breathing well. Then, they put the mask on you and say that this will help you breathe? All the while you feel like you are struggling to exhale and maybe even feeling smothered.

"It's too hard to exhale." "I feel like I'm being smothered." These are common statements I hear in the Sleep Center from patients new to CPAP or any xPAP. Let me tell you it is normal to feel that way at first.

So, why is it more difficult to exhale? What is happening is you are breathing against a predetermined pressure. When you breathe against the pressure, it increases the air pressure in your airway. When that happens, your airway blows up like a balloon, but not as drastically of course. It opens your airway just enough to allow the free flow of air. This is called Positive Pressure Support. Some refer to this as an air splint also.

If you look at the diagrams above, note the airway is closed off in certain places. This is what happens when somebody is snoring or even worse, having an apnea or hypopnea. With xPAP therapy, doctors have found a way to keep the airway open, or supported, in order to allow air to flow, back and forth, freely.

Take a look at the diagram below. It shows an open airway. The Positive Air Pressure gently forced the tissue apart that was "clogging" or obstructing the airway.





Enough with the mechanics. How is somebody supposed to tolerate xPAP in order benefit from the therapy? When somebody is learning how to ride a bike, training wheels come in handy. Luckily, xPAP machine manufacturers have some training wheels of their own! These are in the form of ramps and pressure relief technology.

Ramping is a feature that most machines have these days. The ramp is usually activated by a button press or even automatically when the machine is turned on. Once the ramp is initiated, the xPAP machine turns itself down to a lower, more comfortable pressure for the user. At that point, the machine gradually increases pressure. After a predetermined time, usually 5 to 20 minutes, the machine reaches the prescribed pressure. Another popular "training wheel" is pressure relief technologies.

Different companies call their pressure relief technologies different names. Respironics has the Flex technologies in the form of CFlex, BiFlex, and AFlex. Resmed calls their's EPR for Expiratory Pressure Relief. They all do basically the same thing. When the xPAP machine senses you exhaling, it lowers the pressure for a quick instant in order for you to start your exhalation breath. It gives you the feeling of a "softer" exhale. For more information on these technologies, take a look at the topics I posted about them on this blog site in June 2010.

In conclusion, researchers and manufacturers are working diligently in order to make xPAP more tolerable and easier to use. If you are having a hard time with xPAP, give these features a try. It makes it easier to transition into a life with PAP therapy. It did for me.

Just like training wheels on a bicycle, you won't need ramps and pressure relief after you learn "to ride". Surprisingly enough, many people turn these features off once they got used to PAP therapy. I did.

Once again, feel free to comment or question. Take a spin around the Internet for more info. Thanks for surfing by here! I am starting to suggest some sites. Look near the upper right of the page of some sites I listed or look around on the page...there are plenty of places to go! Happy Open Airway Breathing!

Swallowing Air (Aerophagia)

Aerophagia occurs in some that are new to CPAP. The individual will experience bloatedness and/or gas pain resulting from swallowed air. When somebody first uses xPAP, you can see how somebody could swallow air. The reason being there is so much more air than usual in your airway and under pressure. Doing normal things like coughing or even swallowing to clear your throat can make you swallow air. Everybody has experienced gas before and everybody knows how the body expells gas(in one form or another). But, don't worry. From what I understand, this usually goes away as you get used to using PAP therapy. However, aerophagia has other causes as well. To see which category you belong in, you should chat with your doctor. Below are some links about aerophagia and cpap with more information.

Some quick Q&A about CPAP and Aerophagia:http://www.talkaboutsleep.com/message-boards/viewtopic.php?t=2784

Aerophagia in an informative blog (look near the bottom of the page). This blog also contains a wealth of information about sleep apnea related topics:http://smart-sleep-apnea.blogspot.com/2008/01/solving-common-cpap-equipment-problems.html

Aerophagia in general and its causes and treatments:http://www.articlealley.com/article_187157_17.html

Sudden Movement or Jerk When Falling Asleep

It was summertime, and I was sitting on a plane headed to Detroit from Orlando. It was an early morning flight, so I was still a little sleepy. I remember it was hot out. The air conditioning coming out of the vents on the plane felt good. With nothing else going on, I decided a little cat nap couldn't hurt. The next thing I know, my arms and legs jumped and I took in a quick breath. Once I looked around and realized nobody was trying to get my attention and that the plane wasn't crashing, I concluded that I dozed off for a moment. When I fell asleep, I had a sudden movement or jerk. I think most of us have experienced this at one time or another.

This is called a hypnic jerk or sleep start. This happens when somebody transitions from wake to sleep and is considered normal. If you don't do it, no worries that's normal too.

Here's a link with some more info:http://www.sleepdisordersguide.com/topics/hypnic-jerk.html

Questions and comments are welcome. Remember, a little research goes a long way when it comes to your health and health care. Reading what people have to offer when it comes to healthy sleep is a good idea. The more you know, the more comfortable you can be with your outcome(s) and treatment(s), especially when it comes to sleep.

Which mask is for me? (Conquering Demons)

In real estate, the saying is, "Location, location, location". When you are trying to find the right CPAP/BiPAP/xPAP mask for yourself, the saying is, "Experimentation, experimentation, experimentation". I had to try four different masks before I found the right one for me.

At first, I thought I knew what I wanted. I know I didn't want a Full Face Mask because I don't like to breathe through my mouth. I didn't want to use Nasal Pillows because I felt peculiar about something sticking into my nostrils. The thought was embarrassing to me for some reason. I was absolutely sure the Nasal Mask/Triangle Mask was for me and there was no need for further thought. Boy, was I wrong!!! It was like choosing my favorite book by only looking at the cover.

I started off with the Nasal/Triangle Mask. It felt good. I knew I had to get used to it and it wasn't going to be perfect the first night. I tried it for a few nights and noticed my nose and face were sore here and there. I began looking at other masks then. I found another Nasal/Triangle that was softer on my pressure points and it was more adjustable. Perfect! I gave that one a try for a few days with better results than the previous! I was sleeping better and better.

So, I found a comfortable Nasal/Triangle and I was able to wear it all night. Now I noticed that I'm not sleeping in the position that I am most comfortable in. I like to be on my side with my face more into the pillow than the Nasal/Triangle would allow. Once again, the search was on to find "the perfect mask". My quest then led me to re-visit my embarrassing demon, Nasal Pillows. The more I looked at the variety of Nasal Pillows, the more "acceptable" it was to me and they would allow me to sleep in the position I wanted.

I gave myself a pep talk which included: "you know what you're doing now", "things have gotten better with every try", "what have you got to lose?". Fast forward to my first night with nasal pillows. Things went well. I slept in the positions that I was more comfortable in. I did have to adjust the mask a few times because I was resting more heavily on the side of my face. But, no problem. It went better than I thought! After a couple of nights, I realized I had a recurring problem. The Nasal Pillows kept on popping out the front of my nose. No matter how I adjusted the headgear and the pillows it kept happening. In my head, the gears began turning once again. My research directed me towards a brand of Nasal Pillows that had a specific adjustment for my problem. I tried a set of "those", aka Swift FX, and obtained the balance I was looking for!

The morals of this story are: finding the right mask for you is an evolution, keep an open mind, and do your research for it will pay off. Have a look around the internet at all the suppliers and online stores for masks and gear. They advertise all over the place!

Have a look at my other blog. I'm reviewing and reporting on different masks from different companies. I'm trying to add at least 2 a week. If you don't see one that interests you, be sure to check back. You can find it at:http://www.cpapmaskreview.blogspot.com/

As always, questions and comments are welcome!

Deviated Septums and Sleep Apnea

I've performed literally thousands of sleep studies including titration studies. A recognizable portion of those diagnosed with Obstructive Sleep Apnea (OSA) also had a deviated septum. What is a deviated septum?

The septum is the divider inside your nose (between your nostrils roughly). When your septum is deviated, that means it is not in the normal position. This can be caused from trauma or could be a developmental abnormality. Take a look at the image below. Notice the septum (center of the nose) is not straight up and down directly in the middle of the nose. This constitutes a deviated septum. Does a deviated septum cause sleep apnea? I can't say for sure. But, I can offer some logic.

Looking at the term "Obstructive Sleep Apnea", the term obstruction stands out. Dictionary.com defines obstruction as "something that obstructs, blocks, or closes up with an obstacle or obstacles; obstacle or hindrance." Looking at the image, you can see how the deviation or bend in septum can hinder airflow. If the airflow is limited here, any other obstruction in the airway could reduce airflow that much further. Intuitively, it seems a deviated septum may make one more susceptible to OSA.

When is comes to xPAP treatment, OSA, and a deviated septum, it is no problem. XPAP works well when it comes to this. It is the perfect device to make sure enough air goes through the airway, no matter how small. I've seen many successful titrations on patients with deviated septums.

Your questions and comments are always welcome. Remember, education is the best way to make your treatment more successful. Have a surf around the Internet!