Posted by: cornvillenutmeg | March 9, 2015

On Being Polysomnagraphed


     If you are a man of a certain age, not less than sixty, say, perhaps not quite yet seventy – or one of a lesser number of women – you have experienced the esoteric joys of sigmoidoscopy, endoscopy, and colonoscopy. However you may have yet to enjoy the recondite pleasure of Polysomnagraphy, more commonly known as sleep study. You should not, well, lose any sleep over missing out; the odds are very much in your favor that you will have your sleep polysomnagraphed at least once before you die, and now that you no longer have to fear dying young, your polysomnagraph will likely happen sooner than you think. It’s your sleep architecture, you see; for, will you, nill you, sleep architecture changes with age.
Not yet familiar with sleep study lingo? Very well. Sleep architecture used to be called sleep patterns. That was before sleep centers – some call them labs – began to pop up wherever we Boomers gather to wind down. As of January 1, 2013, there were twenty five hundred sleep centers in the United States, and probably dozens more by now. Why? Because we elders – and we are legion – suffer from myriad sleep problems: sleep latency and sleep fragmentation, for instance. Good old run-of-the mill insomnia affects forty-four percent of us. It’s our circadian rhythms, you see; they begin to urge us toward more avian than Homo sapiens sleep architecture; this condition is known to sleep professionals as advanced sleep phase syndrome (ASPS).
     Perhaps because polysomnagraphy is such a fast growing field, it leans heavily on acronymic labels for sleep disorders. In addition to ASPS, we have RLS (restless leg syndrome), PLMD (periodic limb movement disorder), GERD (gastro esophageal reflux disorder), UARS (upper airways resistance syndrome), OSB/LRR (overly shallow breathing or low respiratory rate). I made that last acronym up although the disorder is real.
However, the primary cause of sleep disruption is snoring. I don’t mean the snoring common to our overweight brethren (unless, of course, an adipose-challenged person is also old). I will say, thought, that sleeping in a house subject to that timber of snoring can be a challenge.
Now that I am schooled in the universe of sleep disorders, I am able to speak authoritatively of sleep apnea, or OSA (obstructive sleep apnea). As OSA spreads faster than Disneyland measles, the incidence of OSA in the AARP generations continues to increase, thus the proliferation of sleep centers where your first polysomnagraphy experience awaits. Mine is in Flagstaff, Arizona.
     The lab’s literature stated unequivocally that sleep study patients sleep in were rooms indistinguishable from good motel rooms. Well, not exactly. The bed was comfortable. While I had been advised to bring my own pillow if I wished, which I did, I forgot it, which I regretted. The lab’s pillows were okay if you’re fond of good motel room pillows. And there was a television of decent quality and size, and inexplicably tuned to an episode of The Golden Girls. Perhaps the lab technician thought I would find that comforting.
     The room, however. I cannot recall when last I slept in a motel room with a dropped, acoustic tile ceiling and fluorescent lights. There were lamps, too. A table lamp sat on a bedside table snug in a corner of the room, not anywhere near the bed..It reminded me of items I have encountered in consignment stores and lawn sales. There was also a standing lamp once popular in the seventies, I think. It had three cone-like reading lamps which could be aimed in different directions. I have always imagined a lamp of that sort was designed to be set in the middle of a room with three chairs backed up to it, each lamp aimed down over the shoulder of whoever might sit in one of the chairs to provide light enough to read or needle-point.
     If I had to guess the origins of the room’s contents, I say most everything had come from someone’s deceased grandmother’s house once the children had carted away anything they wanted. The bedside table would have been left behind. Eventually the table lamp was moved to the right side of the bed, the side I decided to sleep on given that the real bedside table on the left was burdened with equipment.
A large leather arm chair sat in the corner on my sleeping side of the room. I think it reclined. Having now survived my polysomnagraph, I can say with confidence that I would have slept better in that chair instead. I’m sure the standing lamp could have been moved to accommodate me. You will understand as you continue to read.
     Another chair next to the door – arms and legs of metal tubing, seat upholstered with matching upholstered pads wrapped around the arms – faced out into the room. There was also a double door closet which I put off poking my head into until the sleep technologist – more about her anon – left me to change into my sleeping attire, proper sleep attire being a non-negotiable condition for sleep study patients who might be in the habit of sleeping nude, semi-nude, or in their underwear (and now I’m wondering what the difference between semi-nude and only underwear is?). Once she was out of the room, but before I changed into my PJs, as she called them, I opened the closet door. There were many, many things in that closet, all in a jumble. A mattress rested aslant just inside the doors, propped up on I don’t really know what. I closed the door very quickly and firmly, and briefly considered moving the recliner so that it would inhibit anything from coming out of the closet.
     Once changed, I opened the door a crack, as instructed. In much less than a moment, she knocked. I said, “Come in.” In the ubiquitous blue scrubs, In stepped Peggy, the polysomnographical technologist.
Peggy, is attractive, but not so attractive as to make an old man nervous. Since graduating from Northern Arizona University, she had spent eleven years in the sleep study business. She spoke to me in the voice and rhythms more typically used with five year-olds.
     Peggy was incandescent, cheery, helpful, patient, courteous, and smart, and just a tad too loud. I felt that were I to spend hours in conversation with Peggy, I would probably begin to cry, but I could think of no way to request a different tone, one more like Eeyore’s, for instance.
     Peggy is from Seattle. She moved to Flagstaff so as to have more sun in her life. Perhaps Peggy’s energetic animation is an inverse reaction to the number of sunny days the Emerald City enjoys – on average, 58, most in July and August; however, that would not explain the hyperbolized patience and easy to understand vocabulary she employed with metronomic invariance to elucidate what would happen over the next eight hours.
     Draped over Peggy’s shoulders like a stole were many wires, the first two of which she directed me to drop down the pant legs of my PJs which I did with as much modesty and dignity as circumstances allowed. The bottoms of those wires she then affixed to my calves; , the tops she draped over my shoulders, later to be attached to something else not yet in evidence. Next Peggy put around me and pulled tight two belts, one to monitor my esophageal hiatus, the other my heart. After that she moved on to my head to which, with the help of great gobs of paste, she attached electrodes; I lost count at five. Finally one more electrode was taped just below my larynx, this one to monitor something having to do with snoring.
     At that point she produced a panel the size of a 40 ounce Whitman’s Sampler with a carrying strap into which she plugged the heretofore unplugged ends of all the wires to which I was now firmly attached. This device, Peggy so patiently explained, would accompany me everywhere until the following morning. For instance, she said, perhaps I would like to use the bathroom? I said I would. The panel dangling from my shoulder, I did just that.
     I returned to a Peggy-less, preternaturally quiet room but not for long. Peggy brought with her three devices through which a CPAP (continuous positive airway pressure) machine would, should the need arise, deliver air while I slept. Two fit over only one’s nose; these are known as nasal interface masks. The other covers both nose and mouth; it is known as face mask. Peggy helped me to try all three. It’s an interesting sensation.
     A CPAP machine delivers the room’s ambient air into a mask forcefully. The nasal interface apparati aim the air right smack boing up your nostrils, down your throat, and into your lungs. It’s a bit, I imagine, like having a robot give you artificial respiration though your nose. The trick with a nasal interface is with the breathing out. Exhaling by mouth doesn’t work. I can’t explain that, but it doesn’t. You open your mouth and suddenly nothing is happening. So you need to breathe out through your nose as well. For me that was a problem. I suspect the human body does not know how to send air out the same way it is coming in when it is coming in at hurricane force. To accomplish that takes concentration and discipline at levels greater than I could summon. Think of it as a pulmonological equivalent of a salmon’s journey upstream.
     The face mask, on the other hand, allows you to breath out through your mouth (also in for that matter). I found the combination of taking air in through my nose and forcing it out through my mouth to be easier.
     Me having made my choice should the need to CPAP me arise, Peggy attached two more sensors, both under my nose, both to gather data on my breathing: one humidity, the other temperature.
Peggy then bade me a goodnight. She would, she said, likely be returning throughout the night to adjust or reattach wires, electrodes, or straps, as well as to hook me up to the CPAP should that prove warranted. I thanked her, took my night time medications, including for this occasion especially ambien which the polysomnagraphy rules not only permit but encourage. Why that would be was quickly apparent. I read for a little while, began to feel sleepy, turned out the light, put my head down on the pillow, and stayed awake, for a long time. I was almost asleep when Peggy made her first visit. An electrode had become dislodged. She put it back where it belonged and went away. I put my head down again, and stayed awake for another long time.
     When exactly Peggy returned to attach me to the CPAP I’m not sure. My adjusting to alternately being blown up like a balloon and trying to exhale against the flow took longer than I wish it had, but I did manage to sleep again, this time through what was left of the night.
     Polysomnagraphy labs are nocturnal by necessity (although what the best way to study the sleep architecture of someone such as a night watchman or a baker makes for an interesting question you might want to put to a polysomnagraphicologist, if you know any). The labs are not closed and shuttered during the day. Polysomnagraphy is mainly a sub-specialty of pulmonologists. Pulmonologists, like most doctors, see their patients during regular business hours. All of which is to explain why patients are awakened for the day while it’s still pitch black outside, something you discover only once you pass a window on your way to the bathroom.
     Peggy woke me shortly after five a.m. She unplugged me and invited me to use the bathroom, which I desperately needed to do. When I returned, we reversed the process from the previous evening – off first came the electrodes attached to my head, then the belts, then I retrieved the wires from down my pant legs. I asked what had happened in the night that suggested to her I ought to be attached to the CPAP. She dodged my question artfully saying only that I would likely be invited back for a second night for titration.
     That was not good news. First, I’m pretty sure I’ve enjoyed having my slumber studied enough for a long time to come. Second, I didn’t like the sound of that word, titration. I’m pretty sure the last time I heard it was during the first semester of chemistry my junior year in high school. I know it wasn’t the second semester because I dropped the course after the first. I did my best to get Peggy to give up a bit more information, but she’s as good at keeping mum as she is about explaining CPAP devices.
     While Peggy took away the equipment, I returned to the bathroom to brush my teeth and comb my hair. The teeth presented no problem, not so the hair. Hair with glue in it is hard to comb. Peggy had mentioned that hot water helped remove the glue, the hotter the better. I deferred that task till it could be accomplished in my own shower.
     Dressed, packed, and looking a little Goth, I thanked Peggy, bid her good morning, and drove home where I arrived before either my wife or dog had awakened.



  1. I was howling with laughter while reading your post Jim – I loved it.

  2. Bob wears a cPap every nite….we are both used to it….Joanne

  3. Too bad you have to go back – that’s a drag. Louis became addicted to his CPAP with the nasal mask on his night in the sleep lab. When it’s on it’s almost completely quiet, has never disturbed me for even a moment. I hope you will soon be kitted out with whatever you need to give you good, healthy sleep… you old man, you! xxx

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