Philip Newton (pne) wrote,
Philip Newton

Sleep lab: my first night with CPAP

So I’ve been tired nearly every day, and I’ve been to the doctor about it a couple of times. Got some bloodwork done, all negative: nothing seems to be wrong with me.

Until I mention to my otorhinolaryngologist that I’d like to get checked out at a sleep lab.

He said that insurance won’t just pay for that, but that I could get a screening first and see whether that indicates I should get checked out. So he referred me to a pulmonologist (lung specialist) who lent me a device that would record things about how I sleep; I put some sensors on before I went to bed and the next day, brought the machine back to the doctor’s.

When I call a couple of days later to find out the results, he said that the numbers were “borderline” and that he’d recommend a proper checkup in a sleep lab. (Which insurance would now be willing to pay for.)

A week or two later, I got a letter from the sleep lab telling me to report there on the 28th of April for a 2-night stay and asking me to bring a bunch of examination results. So I take the letter back to my ENT doctor and figure out which stats I get where. I end up getting examined by ENT, lung, and internal medicine specialists: lung X-ray, breathing curves, bloodwork, stuff like that. There was also a questionnaire I was supposed to fill out.

Then I reported to the sleep lab (fortunately, not too far away: the local general hospital has one) yesterday with my big pile of papers, and they admitted me.

They gave me a room and I waited around a bit until the doctor had time to come and see me. I asked the nurse who showed me the room whether I could go back home because I hadn’t brought my pyjamas or my pillow yet (I figured if I was to report there at 10 in the morning, I wouldn’t be spending the entire day there), and she said, “I didn’t hear that.” Apparently, things aren’t as strict as they used to be, but officially, you’re still not supposed to leave the hospital campus once you’re an inpatient.

After a while, the doctor arrived; she seemed really nice. She said that after having read through my questionnaire and looked at my results, her boss and she had decided to forego the preliminary night (just hooked up to measuring devices again) and get me started on a CPAP machine straight away (as well as the polysomnography).

She said a nurse would be around with a mask or two and let me use that for a bit to get used to it and see whether I handle it; see what size I’d need; whether I could use a nose mask or whether I’d need a full-face (nose and mouth) mask; that sort of thing. And that after that, I’d be free for the day. The way she put it: the doctors know that the patients at the sleep lab are healthy adults, and we wouldn’t be jeopardising our therapy if we went home for the afternoon, but she was obliged to point out that we wouldn’t be covered by insurance if anything happened while we were away. Which seemed fair enough. So, she said, as long as I report back by half-past eight in the evening, things would be fine.

I tried on two masks; the first one had a gel cushion which was supposed to be gentler, but ended up leaving a red line on my face, so the nurse tried the other one, which was just silicone. That seemed to be fine, though I didn’t wait all the time till the nurse came back, since an announcement came over the intercom that dinner was served in the hallway, and I helped myself to one of the trays with a green slip of paper (for the sleep lab patients; they don’t get to choose what they eat since things have to be ordered a couple of days in advance and we’re simply not there long enough for it to be worthwhile—other patients on that floor, in the lung department, had white slips with their names on them). When the nurse came, she asked how it went, and I said it was fine, as far as I could tell. So she said, great, we’re done then; I’ll leave both masks with you in case you want to try the other one this evening after all, but you can go now after you’ve had dinner.

So I did, and picked up Amy along the way.

Went back in the evening, with my things (in a blue IKEA bag :D). Got the mask fitted again and lots of electrodes stuck on me (EEG, heart/ECG, leg movements, chest expansion, I have no idea what else). Then settled down to go to sleep. (I was asked to do a couple of things first, to test the sensors: roll my eyes around; push with my feet as if stepping on an accelerator; snore loudly.) Called the nurse again after a bit because the mask leaked a bit when I turned; she tightened the straps a bit, and I went to sleep. (Incidentally, talking with a CPAP nose mask on is really weird; you really notice which sounds are nasal, because pronouncing things like /n/ and /m/ took quite a bit more effort since the air through the nose had to push against the pressure of the machine while air through the mouth—say, for /d/ or /b/—just had normal air pressure to contend with.)

Woke up sometime during the night; no idea why. Then I couldn’t get to sleep for (what felt like) hours: they had turned up the pressure slightly compared to the 5 mbar (values in cm H2O are nearly the same as in mbar; 1 mbar = 1.02 cm H2O) they had used for the “getting used” test as well as for falling asleep, and now the mask leaked again, and the whistle that accompanied breathing as air escaped through the mask was really annoying. I tried to reposition the mask, but couldn’t get the whistling to go away reliably. Then I tried tightening the straps myself, and that seemed to do it. Still took me forever to fall asleep again.

(I woke up at least one more time: in my dream, I was talking to somebody, and half-way through saying a word, I woke up. It felt exactly like a computer crash, where things are chugging along just fine and then, boom! BSOD. Only here: boom! awake. Went so fast that I still remembered pretty well what I had been dreaming. Bizarre. I fell asleep again fairly quickly that time, though.)

Woke up, not really voluntarily, at five-thirty in the morning, when the nurse came to take all the electrodes off. (There was a brief suffocating feeling when she turned off the CPAP machine before entering the room and it no longer delivered positive pressure down my nostrils. But I started breathing through my mouth.) She said I could go back to sleep, and I did. Woke up again around quarter past seven and had breakfast at half-past.

Later in the morning, the doctor came by for her daily visit. Apparently, I had needed fairly low pressure (compared to other people who need CPAP); they had titrated up from 5 mbar to a maximum of 8 mbar during the night, and the machine goes up to 30. So she said I basically had two options: a protraction splint (?—Protraktionsschiene; I guess this pushes the tongue forward so it can’t fall into your throat?), which can alleviate sleep apnœa for people who only need slight positive pressure, but which is not covered by insurance and would cost me around €800; or a CPAP machine. She said that one point in favour of the machine was that people with apnœa tend to have their condition worsen as they get older, and I might end up not having the device help me any more. But since I didn’t really have a problem with the mask, I figured that’s probably the better option for me anyway.

She also said that while they could see I had had some waking periods, when I did sleep, I slept fairly well, which is good.

Then she said that since they didn’t have to adjust the machine or try out new masks, I was free to go already; this was around ten to ten. She said I should enjoy the sunshine! (It was 26 °C/79 °F today—hot for Hamburg!) Tomorrow, on the other hand it looks like rain again.

So I went home, later picked up Amy again, and will be having supper soon and then heading back to hospital for my second night. (This time, they’ll probably humidify the air a bit; they tend to do that on the second night, so patients can decide whether they prefer the air humidified or not.)

I hope I’ll sleep better this night!

Tags: cpap
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