To sleep, perchance to rest
I wasn’t expecting the Ritz-Carlton when I showed up at the hospital on Monday night for my sleep study. Still, I was surprised by the austerity: just a single bed and sturdy chair, no television, table or reading lamp.
“You won’t be needing those,” my sleep technologist said as she busied herself behind my chair. The idea was to see how long it would take for me to “reach sleep” from lights-out, she said.
At home, my bedtime ritual requires a warm comforter and a good book. Here it would involve small talk with a stranger whose job it was to watch me sleep.
She wound a strap around my chest, glued electrodes to my legs and head, fastened a microphone under my chin and taped an oxygen monitor to my fingertip. She slid a probe in my nostril and pasted a sensor over my lip.
Sleep would indeed be a reach in this get-up. I lifted the clump of wires attached like a ponytail to my head and maneuvered my way between the sheets in the tiny twin bed.
The disembodied voice of my cheerful tech issued orders over the intercom: Look left, then right. Blink slow, then fast. She was tracking my brain waves from her office. She set the machines, checked the time and bade goodnight.
I had six hours for her to measure my sleep.
I tried deep breathing. I counted sheep. I retreated to pleasant memories. I started worrying about the brain-wave thing. My feet were cold. My shoulders ached. I cursed the light shining through the blinds from the hallway and the midnight traffic I could hear on the streets.
I figured dawn would arrive before I fell asleep. Call it sleep performance anxiety.
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Dr. Nancy Collop laughed when I shared my story. Most sleep study patients don’t have much trouble falling asleep. “They tend to be pretty tired people,” she said. “That’s what brought them in.”
Collop heads the American Academy of Sleep Medicine, practicing a specialty so new that it’s only now being in offered by medical schools. “People are beginning to understand how important it is,” she said. “Patients are hearing more about it. When they have problems, they bring it up with their doctors.”
Sleep problems seem to be on the rise, particularly sleep apnea, episodes of interrupted breathing that can starve the brain and heart of oxygen and raise the risk of stroke and heart attack.
Blame Americans’ growing girth and ceaseless 24/7 lifestyle. We exercise our bodies too little and our multi-tasking minds too much. We worry about late mortgages and lost jobs, or drink too much coffee and work too hard. Anxiety makes it hard to sleep; depression makes it difficult to get up.
Fifteen percent of Americans report sleeping problems, which tend to worsen as we get older, and 50 million people nationwide rely on sleep medications. Insomnia is the third most common complaint during doctor visits, behind headaches and the common cold.
Doctors are increasingly prescribing sleep studies for patients with a symptom constellation — excessive daytime sleepiness, loud snoring, interrupted sleep, morning headaches — that reflects disordered sleep.
“People think of sleep as a resting time, but it’s really a complex function, an active and dynamic state,” said Dr. Robert Cohenour, a neurologist at Northridge Hospital and co-director of its Sleep Evaluation Center.
When he began diagnosing sleep disorders almost 40 years ago, “sleep apnea was so unheard of,” he said, “I had to spell the words on my transcriptions.”
Now, there are hundreds of sleep study centers across the country. Some are freestanding clinics, others carved out of hospitals. Insurance typically covers most of the cost, which often runs more than $1,000. About 85% of those referred are diagnosed with a sleep disorder.
*
I told Cohenour I had my test at his sleep center, which was the first in the city to be accredited. He didn’t apologize for the spartan lodgings. “Medicine is becoming ‘boutique care,’ ” he said. “It’s easy to get taken in by these flashy new centers. You can go to private labs that are like a hotel, but it’s the quality of the study that really matters.”
Sleep studies rely on “multiple physiological parameter monitoring,” he said. That translates to a minute-by-minute reading of brain waves, oxygen levels, eye movements, blood pressure, heart rate, breathing patterns and muscle tone.
“Those are all changing as we move through the five stages of sleep,” Cohenour explained. The sensors recorded what my body did; the sleep team met days later to figure out what it meant.
I told Cohenour about my experience — how I tossed and turned almost all night and didn’t fall asleep for hours.
He read me the account of that night from my sleep assessment: I was “bouncing in and out” of sleep stages. I had “multiple arousals” that reduced the “overall efficiency” of my somnolence. My “sleep consolidation” could have been better. But the only sleep disorder my profile suggested was possible narcolepsy, an uncontrollable desire to sleep.
It had taken me just six minutes to fall asleep that night, he said, not the 45 minutes I’d estimated on the survey the next morning.
I recalled a fitful night spent rearranging arms and legs, mindful of the need to sleep and the wires cascading from my head. But the monitors showed that I snoozed through almost all of the six-hour test.
I was torn between relief and disappointment. I didn’t want to be tethered to a breathing machine, but I wanted a label — OK, an excuse — for my lethargy; a disorder with a cure.
But allergies, not sleep apnea, are the likely culprit, Cohenour told me. And you can’t fix them with a CPAP machine. “You need to add some moisture to the air. And you shouldn’t sleep on your back. It’s better you sleep on your side,” he said.
He advised me to slip a tennis ball into the pocket of a T-shirt and wear the T-shirt backward in bed, so if I roll over onto my back, the poke from the tennis ball will prod me back.
I couldn’t help but relish the irony. A raft of space-age technology pointing to a solution so undramatic and low-tech. A disorder, with a cure that would have me bounding bright-eyed out of bed. I got a prescription for a humidifier and a tennis ball instead.