Tuesday, August 3, 2004
I'm sitting in room 418W of Providence Medical Center, which happens to be home to the Swedish Sleep Medicine Institute. I'm here because my New Year's resolution, such as it was, was to do something about the fact that I don't sleep well. "Don't sleep well" is an understatement; my sleep is a disaster. For years I've had a terrible time getting to sleep, unless I'm so exhausted that I fall asleep without meaning to. Once I'm asleep, I have a hard time staying that way for more than 4 or 5 hours, after which I wake and doze and wake and doze for a long and restless time. But then there are other times that I have no problem falling asleep. At meetings, say. In a sun-filled bedroom at 8:00am, about the time I should be getting up. Or sitting on the couch pretty much any time. Ominously: nearly dozing off while sitting at a traffic light on my way home from work. One could almost say that I don't sleep when I should and do sleep when I shouldn't. If I didn't work and had no particular reason to run a normal schedule, I suppose I could live with this. But the situation being what it is, I'd like to have a more normal life, which might involve waking up not feeling exhausted, for example.
The path to sitting in a room at the sleep center is not direct and not fast. The first step was to schedule a physical, for two reasons: to rule out any obvious problems like hypertension or incipient type II diabetes, and to get a referral. The delay in this process was in simply setting up the physical. When I phoned, they were able to find me an appointment seven weeks out.
After waiting that long for a simple checkup, I anticipated a long wait for the sleep center, but to my surprise, they scheduled an initial appointment for the day after I called. It was so soon, in fact, that there was no time to mail me their long and involved questionnaire which probed my sleep habits and problems, along with any other physical issues that might contribute to an unrestful night's sleep. It's clear from the questions that the major problems seem to be pain while sleeping, breathing problems -- that is, snoring and apnea -- and "restless leg syndrome," a malady that has an oddly disembodied (haha) sound to it.
Because my answers did not seem to point to any of the common problems (that I know of), the sleep doctor asked me about environmental issues. He was particularly interested in two facts I had reported. One was that when I cannot fall asleep in bed, I can often go lie down on the couch and then fall asleep there. This seemed to him to indicate a problem with my bedroom setup, whether physical (temperature, lighting) or psychological (some sort of subconscious aversion to my own bed). The second thing that got his interest was my report of being able to fall asleep during the day almost anywhere -- meetings, desk, car (gulp).
He did allow me occasionally to ask questions. Did he believe in morning people and night people? Definitely: larks and owls, he called them. Genetic? Probably. Isn't napping sort of natural? As a napper myself, I'm somewhat resentful of living in a culture that associates daytime sleeping with sloth. He was noncommittal on that one; he said he was not a natural napper and generally felt worse after napping than before. Doctor, will you be able to cure me? Maybe. Sleep gets harder to come by, and less restful, as one ages, he noted. When does this start? "In your forties," he said.
So he scheduled a "sleep study." You go to the hospital, where you are provided with a private room. They hook you up to various monitors, you sleep, they monitor. Because of my daytime affliction, I'm scheduled for a 23-hour study that involves both a night's sleep and a series of naps during the following day. (Napping for science, I'm totally down with that.)
Today (well, tonight) is the night.
7:00 pm
Check in. We -- there turn out to be six of us -- wait until we're told to report to the fourth floor. There we are escorted to our respective rooms, where it is explained that a "tech" will visit us and here's how to use the TV. The room looks like any hospital bed, only a bit bigger. I note the lack of certain amenities that I know I'll miss. No radio, which I prefer to TV. No bedside reading lamp. As instructed, I did bring a pillow from home and some sleepytime clothes. And a stack of books, and a laptop. This last was not recommended, primarily because they won't take liability if it should disappear. This morning I made sure to borrow one of those cable locks for laptops from work.
7:10 pm
Amy, my tech, comes in with another of their popular questionnaires and to ask me if I have any questions. Yeah, kind of. What exactly is the drill here? She gives me an overview. Later this evening they'll come in and strap or tape or glue on all their little sensors, which she says takes about 40 minutes. I'm free to keep a "normal schedule" for the evening, which is a bit of a stretch, considering how unlike my normal evening environment this is. She says I need to tell them when I'm ready for bed, which is itself a trick -- "when I fall asleep doing something else" probably isn't what they had in mind. Then they will apparently hook me up to to a wall unit and (I liked this) talk to me over the intercom. If all goes like normal, I'll then be staring at the ceiling for some time. But we'll see. Amy goes away and I answer questions, many of which are boringly like those I filled out for the physical and again for the initial sleep center consultation.
7:20 pm
Amy's back, this time to pick up my questionnaire and to take my "vitals." Normal, normal, so very normal. When she's done, I'm free to do what I want, which includes wandering around inside or outside the hospital. Oddly, although there is a large west-facing window, it's set up for blackout with a shade and thick curtains. It gives me the incorrect impression that it's dark outside, when in fact it's quite bright outside still. I can open the curtains, but the shade appears to be in place for good.
7:30 pm
Jeopardy's on TV. College kids, one of whom racks up $24,000 with an impressive command of many facts, including on women in sports. (I only knew one of those.)
8:00 pm
TV off. I take a wander to see how things look outside of 418W. Quiet. Not even the techs seem to be around. As I pass their station, I notice that neatly hung on the wall is a double row of framed certificates that identify various people as Certified Polysomnographic Technicians. Thus "techs." Interesting word. I wonder what's poly about the somnography. Also, how one gets into a field like that. Does being a nightowl help?
I go down to the first floor and the cafeteria, which is closed but has vending machines. Because I'm in a hospital setting, I somehow feel like I should be under some sort of dietary restrictions. But I'm not at all, with the one prohibition, much repeated and emphasized, that I am not to take any caffeine in any form. (In fact, they stand ready to dispense Tylenol for those suffering coffee-withdrawal headaches.) But if I want a bag of Fritos or something, I guess that's ok. It feels less like being in a hospital than like being in a boring hotel for extremely quiet people. In my wanderings, I encounter only a couple of people, and they don't even glance at me. Shouldn't they be accosting me for running around unaccompanied or something? Guess not.
8:20 pm
Fire up the laptop. No WiFi, bummer. In the list of items they suggest you bring, they include books and magazines, but explicitly say "no work." So no work it shall be, although working on a little blog coding surely isn't work, is it?
10:00 pm
Amy has returned, this time with a cart on which she has a mysterious collection of items. I am to sit in a chair while she attaches things to me until I am bristling with electronics. This includes:
All of these things are on long, thin wires about six feet long that run into a unit about the size of a paperback book. The unit is on a convenient strap because it is, as Amy says, my friend for the next night and day. It will be with me everywhere. As I already know from her testing, at sleepy-bye time, she'll plug the unit into a wall mount that communicates with her station off down the hall.
Still to go, but not till I lay me down: oxygen monitor on a convenient fingertip, and a couple of sensors stuck under the nose to detect breathing.
Although Amy has done her best to bundle the wires with twisty-ties (probably a special medical version that costs a buck each) and to run my formidable bundle out of the way (like, over the back of my head), the whole business is definitely an inconvenience. I shall not be breaking into dance anytime soon, for example. In fact, I'm still a little leery of turning my head. I had a glance in the mirror, and I look like an escapee from a science experiment in a particularly low-budget movie. It's hard to imagine that people go to sleep with all this stuff and that it doesn't all just rip off the first time they turn over in their sleep. Amy assures me on both counts that it usually works.
11:30 pm
After putting the laptop away and getting out a book, I realize I'm sleepy. I'm supposed to alert Amy that I'm ready for sleep. I cannot shake the feeling that that this is a throwback to early childhood. ("I'm ready for a story, Mommy!") I push the button that I'm supposed to push if I "need anything." For this, too, I have to overcome the notion that the red button is for emergencies, and that I'll be "bothering" the tech by pushing it.
Amy arrives to finish hooking me up. To the array of electronics already pasted to me, she adds an oxygen sensor, which is strapped over a fingertip with a line snaking back my arm to the superhero box. She also tapes two tiny tubes close to my nose ("this will tickle") and mouth, apparently for more breathing issues. After the harness is complete, it's time to hook me to the wall. I've got about 20 wires now, all gathered into a 6-foot-long bundle.
I lie down and she plugs in the remaining wires. I am instructed to lie flat on my back. Amy turns off all the lights -- the only light is now from a few LEDs on the wall unit -- and she goes back to her station. A minute or so later, I hear her voice over the intercom. Move your left foot. Move your right foot. Look straight ahead. Look left. Look right. Problem. Amy comes back in and fools around with a few wires. She goes away again and looks at her bank of monitors or whatever she has. It takes several more tries, and replacing one wire, to get everything working.
Ok, then, nighty-night. I'm free to have a "normal" night's sleep. They'll wake me after 8 hours.
Nighttime
Perhaps not surprisingly, I do not have a restful night. As usual, it's hard for me to get comfortable, a condition much exacerbated by having wires everywhere. I toss (gently) and turn (gently), but apparently I do eventually fall asleep.
At one point Amy is in the room with a flashlight. I start audibly, I remember. She's reattaching something.
My sleep pattern seems typical to me -- I kind of wake up a number of times. At one point I heave over on my side, giving my wiring harness a pretty good tug. Somewhat later (minutes? who knows) Amy is again in the room with her flashlight. I suspect I yanked a number of wires out during that last heave.
Wednesday
8:30 am
The intercom switches on and Adele is on the line. Time to get up! She will be along momentarily to unhook me from the wall.
Adele is Amy's replacement on the day shift. She comes from the patient-as-small-child school of nursing. She calls me "Hon" and explains the obvious while failing to explain the non-obvious. After sitting down in the chair, as instructed, I pull up my pajama legs so she can get to the sensors. "I'll do that!" she says sternly. When she's done unhooking me, only the wires glued to my head and torso are still attached; the nose tubes are gone, thank goodness. While she does this, she asks me rote questions. Do I normally wake up this late? What do I do? (to my reply she says "That sounds exciting," which makes me wonder if she even heard me.) When I am obliged to note that I work for the big M, right on cue she asks if they make me work those long hours.
The course of the day will be this: every two hours, I'll lie down for a nap. I'll tell them beforehand how drowsy I am. I lie down for a fixed period, and afterward they'll ask me whether I slept, how long, whether I dreamt, and so on. This is all explained on a clipboard, which Adele reads out to me, even though I can see it perfectly fine. Although she does go on at length (and redundantly) about the mechanics, no one is telling me anything about why we're doing all this, or how it differs from the night study.
I am strongly admonished not to have any caffeine during the day. She begins a list: "no coffee, tea, chocolate, chocolate chip cookies, chocolate pudding, ..." I must look bored at some point during all this, because she stops and tells me that she "once had a patient" who had returned to the room with some forbidden substance and argued with her that she hadn't explicitly said none of that.
She leaves me with a clipboard and another questionnaire. How did I sleep? How long do I think I slept? Did I have pain, breathing problems, anything like that? I hadn't realized how important clipboards were to the medical profession.
9:00 am
Adele goes away. I have till 10:15 to do whatever I want, as long as it involves my faithful companion, the box, and as long as it does not involve sleeping or caffeine. I head down to the cafeteria, feeling all Westworld with my medusa-like sprouts of wires. A useful exercise, that, to feel as self-conscious as I used to feel in junior high school. But just like in junior high school, no one cares except me.
It sure does suck not to be able to have any coffee.
The cafeteria is a lot like those at work, except that a lot of people are wearing medical scrubs. So sartorially, Swedish wins.
10:15 am
Back in the room waiting for Adele to set me up for my first nap at 10:30. She has me lie down and then plugs the box into the wall. It's somewhat more comfortable without the leg wires and nose tube and such, but that's relative. She turns off the lights and then comes in over the intercom to "calibrate" me. Close eyes. Open eyes. Look left, then right. Look up, then down. Blink five times. Then it's ready, set, nap! The room is pretty dark, and I'm staring up at the ceiling. Sure enough, I apparently fall asleep.
10:45 am
The intercom squawks and it's time to wake up again! I see that Napping for Science is going to involve some sacrifices, of which the most annoying is nappus interruptus. Adele comes in and flips on the lights (ouch) and unhooks my box. I am then asked to fill out -- guess? -- the ever-present questionnaire, this one about my recent nap. Now that I'm filling them out, the questions seem odd. How long did it take to fall asleep? How long did I sleep? Golly, I dunno. Isn't that sort of what they're supposed to be tracking? I am a bit mystified about these questions, unless the point is to try to determine whether my subjective feelings about sleep match what they actually record. It also asks whether I dreamt. An interesting question, actually. I don't recall having dreams-dreams, but I did have some of those strange thoughts you have when you're not quite asleep and not quite awake. Are those dreams? Hard to say when the options are YES and NO.
I'm again free for a couple of hours. Options are limited, though there is always daytime TV. Perhaps some quality laptop time instead.
12:30 pm
Good heavens, is it that time already? Kelly has arrived for my 12:30 nap; Adele is at lunch. Same drill -- lie down, lights off, calibrate, snooze. Awoken 20 or so minutes later, clipboard and questionnaire, ok, free time. More laptopping while I try to sort out some regular expression foolishness for my ongoing battle to implement trackback in the blog.
2:30 pm
Repeat. Adele is back.
3:00 pm
Another not-completely-restful nap behind me, and I'm kind of wiped. Broken sleep, boredom, inactivity, trapped by those stupid wires still glued to my head. I don't have the energy to think much, so I get out one of the three (!) books I'd brought with me.
4:30 pm
Adele again. Boy, it's really naptime. As I was reading in the last hour or so, I could tell I was starting to nod off, which of course is strictly verboten. I've also started feeling the first twinges of a malady I should have anticipated: caffeine withdrawal headache. It's definitely there, but fairly mild. I'll see if this upcoming nap helps.
5:00 pm
Yet another nap accomplished. Headache is still there. I can confidently note on the questionnaire that on a scale of 1 to 10, I was pretty darned sleepy when I started this one.
5:50 pm
Adele is gone; a perky tech comes in and introduces herself as the nightshift replacement for Adele, but her name escaped me. Either I'm too tired or I have tech name fatigue. She tells me she'll be back in a while to set me up for my last nap. It occurs to me I could have watched the news, oh well. Headache is still there.
6:10 pm
I now lay me down to sleep for the last lap. Er, nap. Calibrate, sleep.
6:35 pm
The intercom announces yet another tech, a male this time. I am more eager than before to see the tech this time, because he's going to take off all this hardware. He does this, taking a certain number of chest hairs with the heart monitor ("Sorry!") and leaving me with greasy lumps of glue in my hair. He then retreats to allow me to, of course, fill out the questionnaire (Did I dream? Yes, of a restful nap) and to pack myself up. I would feel quite good about being sprung, finally, but the headache has gotten markedly worse. I now desire to get home as soon as possible. I don't wait for the tech to come fetch his clipboard -- I grab all my stuff, find him, and thrust it into his hands. I pick up a parking voucher at the desk, and then I'm out of there.
The center is about a 15-minute drive from home, and I note that the headache has reached the unpleasant stage of making me nauseated. It's not a fun drive. I am wondering why I did not avail myself of the advertised availability of Tylenol. Hey, I was in a hospital, after all! And I know better, too -- the sooner you take the drugs, the less severe the headache. I guess I didn't want to "bother" anyone.
When I get home, my very first stop is for the bottle of ipuprofen and a large glass of water. Then I sit down, waiting for the analgesic to kick in. I'm having an odd sense of having been gone for a while, though it's been just over 24 hours. The sense of isolation all day has exaggerated the time interval, I guess.
Afterword
So the testing is done. I have an appointment in a couple of weeks to see the sleep doctor and review their analysis. In the meantime, I guess I should try to get lots of sleep.
Copyright © 2004 Mike Pope