Facing an In-Clinic Sleep Study? Here’s What To Expect
Is it painless? Almost totally. Is it weird? Absolutely
It’s Monday night, and a woman I’ve just met is tucking me into bed
Which is nowhere near as titillating as it sounds. It’s around 9 PM. Two hours previously I checked into a regional sleep clinic for an all-night, diagnostic study. The woman in question is my sleep technician, and it’s her job to wire me up properly to all the monitors that will track every detail of my slumber, while she observes me throughout the night from another room.
It’s not my first rodeo. Over the past dozen years, I’ve undergone four sleep studies. One was the kind where they send you home with a monitoring device and a list of obscure instructions — which feels strange enough, but at least you spend the night in your own bed. The rest have been in-clinic.
This is because I am a lousy sleeper. Not just a light or twitchy sleeper: I am the kind who falls asleep easily enough (because I’m tired all the time, duh) but who, more often than not, wakes up at some woefully wee hour and lies there listening to the hamster in my head, frantically running on its squeaking wheel.
When I do sleep, I snore. When I snore, I snort. And then, according to my husband, silence follows. For an alarming interval. Just when he’s about to either shake me awake or review my life insurance policy, I suddenly honk, gulp a huge breath of air, and resume snoring.
I know what you’re thinking: my husband is a lucky guy, right?
Do you too have trouble sleeping well — or at all? Join the club
It includes you and me and between 50 and 70 million Americans who according to the National Heart, Lung, and Blood Institute have one kind or another of chronic sleep disorder.
All of those disorders tend to worsen with age.
And even if you don’t have a sleep disorder, if you’re a typical working American adult you’ve got at least a one-in-three chance of being sleep-deprived at least some of the time.
If Americans ate as little as we sleep, we’d all look like it’s time to back off the Ozempic. As it is, many of us are pretty much zombies on any given day.
This is not a good thing.
Not getting enough sleep is bad for your heart, your reflexes, your cognition, and your mood. It makes you a dangerous driver, an unproductive worker, and a lousy party guest.
Being chronically sleep-deprived is linked to heart disease, high blood pressure, kidney disease, diabetes, stroke, obesity, and depression.
And if that doesn’t scare you, research shows a strong link between sleeping problems and dementia. This is especially true if you have obstructive sleep apnea or OSA.
That’s when your throat muscles relax while you’re sleeping and block your airway. Your brain will jolt you into breathing, which may or may not wake you up all the way. Either way, it disrupts your sleep. If it happens frequently during the night, over time your brain suffers from hypoxia — a dangerous lack of oxygen.
Do I have OSA? Maybe yes, maybe no
Like I said, I’m a frequent flyer when it comes to sleep studies. The results have been mixed. One indicated mild OSA, another said moderate OSA, and the home study results didn’t meet the threshold at all.
On my first clinic study twelve years ago, I was given a brief trial of CPAP — which, if you’re less than twenty years old or have been living under a rock, stands for “continuous positive airway pressure.” It’s basically a device with a mask that covers your nose or mouth, or both, and is connected to a tube leading to a machine that pumps air at you like you’re a dog hanging its head out of a car window going 60MPH.
I hated it.
“I can’t sleep with this thing,” I gasped at my sleep tech after ten minutes. “I can’t even exhale!”
Following that first study, I was told that I qualified for treatment, but since I “didn’t tolerate” CPAP I could get a prescription for an OMAD.
That’s not a One-Meal-A-Day Diet: it’s a custom-made dental appliance, an “oral mandibular advancement device.” It involves going to a specialty dentist who tailors what looks like a fancy mouth guard that holds your lower jaw slightly forward so your tongue can’t fall back into your throat and try to strangle you in your sleep.
It costs plenty, and unlike CPAP, it’s only partly covered by insurance, if at all. But at the time it seemed the only workable alternative for me, a confirmed back sleeper.
Before you suggest I sew a tennis ball into the back of my pajamas: trust me, I’ve tried everything to get myself to sleep on my side. I always, always wake up on my back.
Anyway, the oral device worked okay for several years. It wasn’t comfortable at first, and it certainly wasn’t an alluring look, but I got more or less used to it. At least my husband said I didn’t snore (as much) and I felt somewhat more rested during the day.
But then I needed a new crown on one of my back molars, after which the device no longer fit. Long story short, after more trips to the specialty dentist I confess I stuck the thing in a drawer and gave up on it.
It felt great, for a while, to go to bed without looking like I was prepping for a prize fight.
As more time passed, the symptoms became harder to deny
There’s been plenty about living through the past few years that could make anybody fuzzy-headed. Pandemic. Politics. Price of eggs. But even allowing for zeitgeist zombie-fiers, I’ve been tired way beyond what is reasonable. And my long-suffering husband, himself a light sleeper, has spent far too many nights on intermittent vigils, waiting to see if I planned to breathe again.
Besides dragging myself through day after day, wishing I could just go lie down, the dementia risk worries me. Too many of my extended family members have been beset with varying forms of cognitive issues: Alzheimer’s, Lewy body dementia, vascular dementia, and (luckily very rare) corticobasal syndrome. That last one recently claimed the life of my sister.
So it was high time to take action, as tedious as I knew the process would be. It began with an appeal to my primary physician and a referral to a pulmonary/sleep specialist — who had to comb through the ever-changing criteria for Medicare coverage — before I was at last given the prescription for the full night study.
Thus, on the appointed evening I head to the sleep clinic with my pjs and reading material at the ready. It’s been five years since my previous study at a clinic in another state — but it turns out little has changed in the process.
Here’s the drill
The first challenge is getting into the clinic. It’s 7PM, after regular hours, and there isn’t a soul in sight. I find the clinic entrance locked. It takes some time before I figure out to hit the call button on an elevator in the lobby.
I announce myself to the intercom. The elevator comes to life and conveys me one floor down to the sleep lab, which looks like a secret underground wing of a small hospital.
A woman at the reception desk, I’ll call her Krista, checks me in and reviews my paperwork. There is lots of paperwork, much of which I’ve filled out online in advance, including a questionnaire called the Epworth Sleepiness Scale and no, I’m not making that up. She confirms that I’m here for a diagnostic study and that she is my technician for the night.
Like the other sleep techs I’ve had, Krista is kind, competent, and reassuring. She ushers me into one of the sleeping rooms. A television tuned to an inoffensive sitcom burbles at low volume opposite a queen-sized bed with a white coverlet. There is a semi-closet in the room and an attached bathroom. Other than being windowless, my quarters resemble a cross between a hospital room and a budget motel.
There are two cameras mounted on the ceiling, one infrared, so my every toss and turn will be visible. On another wall is a two-way speaker which allows me to summon Krista at any point during the night when I need assistance.
It will also allow Krista to hear everything I say, and I tend to talk in my sleep. I try not to think about this, or the cameras, too much. I text my husband and tell him that I won’t be calling to wish him goodnight as per our usual custom when one of us is out of town.
Now for the fun part
Krista withdraws while I change into my jammies. When she returns, she begins attaching all the various electrodes and sensors the study requires. Two wires each go down my pj pants legs (important tip if you go in for a sleep study: wear two-piece pajamas with baggy pants — not a nightgown, nightshirt, or leggings. And for the love of all that is good, do not plan to sleep in the buff). The wires connect to electrodes that Krista attaches to my ankles.
There is a sensor belt that goes around my waist, and another that goes around my chest, both hooked to more wires.
Then Krista starts on my head. This is where the majority of the electrodes go. Some are glued to my temples, some just above my eyebrows, and several attach to my chin (note to gentlemen with beards: maybe shave for the occasion). Many more electrodes are applied to my scalp, using gobs of an adhesive that resembles Crisco but which is fierce enough to withstand any movement I make in my sleep.
Should I sleepwalk and somehow escape the lab and wander out into hurricane-force winds, these things will stay in place.
Wires protrude from every electrode. All of them are plugged into a contraption roughly the size of a brick, which has a handy, padded strap that hangs from a hook by the bed — and which I can use to haul the thing with me should I need to visit the loo during the night.
Already I’m worried that I have to pee.
An oximeter is taped around my left index finger, both to keep it in place and to mute its bright red light.
By now, I look like ET.
Finally, Krista guides a clear tube behind my ears and around my head. It has three small protuberances: two, cannula-like, go into my nostrils and the third in my mouth.
“Don’t worry if you can’t help chewing on it,” Krista assures me. “Almost everyone does.”
Throughout this process, which takes over half an hour, she is cheerful, patient, and informative. “Since this is a diagnostic study, we won’t be trying CPAP on you tonight,” she tells me.
I’m a little nonplussed: I’ve already resigned myself to the likelihood of needing CPAP, and I hope this doesn’t mean I’ll need another clinic study to try out what kind will work at what strength. Krista uses CPAP herself and attests to what other users have told me: it’s come a long way since my first unpleasant trial, with quieter machines and vastly improved face masks.
I was perfectly willing to give it a go tonight, but that’s not how Medicare rolls these days. The bright side is that I may look like a space alien for tonight, but at least I won’t look like one that has mated with an elephant seal.
Thank God for Ambien
How do you sleep with wires glued all over your head and body, while knowing that, like Santa, at least one technician is seeing you while you’re sleeping?
You take a sleeping pill, that’s how.
At a more militant PPO sleep clinic in California, I once had a study in which I was denied any sort of sleep aid. Not only that, but I was given a converted exam room for the night and a padded gurney instead of a real bed — over which droned a god-awful HVAC fan that sounded like it had apnea worse than I did.
The results of that test were inconclusive. I’m no doctor, but that is possibly because I didn’t sleep a wink the entire night. Another tip: find out ahead of time if the clinic you’re referred to is a fully dedicated and equipped one, and ask about sleep aids.
Luckily, tonight’s clinic is more humane. Also, they want you to actually sleep so they can collect the data they need.
So when Krista offers me a dose of Ambien, I don’t hesitate.
And believe it or not, I sleep as well as I ever do, wires and tubes and glue notwithstanding.
At 6 AM, Krista’s voice floats over the intercom, awakening me
After a trip to the loo with my wires and brick in tow, she enters my room, looking as cheerful as ever. “How do you feel?” she asks.
“Sticky,” I reply, “but surprisingly well-rested.”
I know she can’t tell me the results of the test but she can tell me what she observed: I slept on my back all night (no surprise there), I snored, and several times I did the snort-and-jerk thing.
What a treat for Krista.
And yet she says she likes her job and prefers the hours to when she did clinic intake during the day. Krista’s an avid reader, and we happily talk about books as she carefully detaches all the wires and electrodes. She shows me her favorite reading journal app, StoryGraph, which she finds much handier than Goodreads.
Absorbed in conversation, I barely notice the discomfort of all the thingies being dislodged from my skin and scalp. Like I said, almost painless.
Which just goes to show the power of being nice, and that delightful people can be found in the most unexpected settings.
Krista gives me tips for removing the globs of adhesive from my hair (which, thankfully, is pixie-short; apparently it can be a real nightmare for people with long tresses).
Vital tip: stand under a hot shower and let it melt the glue for a minute, then apply conditioner FIRST and let that sit for a bit before shampooing and then condition again. And rinse, rinse, and rinse.
Krista withdraws while I change into street clothes and fill out one last questionnaire.
And that’s it: I’m done. I gather my few things, head out into the sunrise, and drive home.
Where it takes me a total of three showers to get all the glue out of my hair and off of my skin. But the study is behind me, and I’m happy to go back to sleeping/snoring/snorting/gasping/thrashing in my very own bed.
As for the official results, I’ll get those in two to three weeks. As scary as they make sleep apnea sound, apparently it’s not an emergency. And if it turns out I qualify for CPAP? I’ll give it a go, although I’m told it can take months to find the right fit and get accustomed to it.
We’ll see. I’ve done what I can for now. I’m not going to lose sleep over it.
