The Big Snore, part II

continued from Part I….

Taking a polysomnogram didn’t become “convenient” till almost two years later, though I thought about sleep apnea almost every night as I stuck the orange plugs into my wife’s ears, and every morning that I woke up with a sore or dry throat (which was fairly often).  Finally, when I knew we would be going to the Cleveland Clinic for some routine doctors’ visits a few months ahead, I made an appointment for an overnight polysomnogram at the clinic’s Sleep Disorders Center.

A few days before the appointment, a large envelope arrived from Cleveland Clinic containing instructions for what to bring (pajamas) and how to prepare (avoid alcohol) for the study, along with a lengthy questionnaire about my sleep habits.  The latter included an absurdly complicated chart for recording daily bed times, wake-ups, and naps, which I ignored except to shade in the same 8-hour time frame for every day on the chart over the course of a week to indicate the reliable regularity of my sleep.  I also got online to Brooks Brothers and ordered up a pair of shorty pajamas, as I hadn’t owned pajamas since I was about ten.

The day of the appointment finally arrived.  Courtney kept telling me not to worry about it, and I assured her that I wasn’t worried, which was true.  My inner science geek was actually looking forward to it.  We drove to Cleveland and had a nice dinner with friends who live there, and with whom my wife would be spending the night in the nice comfy guest bedroom of their palatial home while I submitted myself to the gentle ministrations of the Sleep Disorders Center.  I cheated during dinner and had a martini, in direct contravention of the instructions I’d received.   Didn’t it make more sense, I reasoned, to measure my sleep under conditions that were most like my usual routine?  And my usual routine did include at least a drink with dinner, for pity’s sake.

I was supposed to arrive at the Center around 9:30 pm, so we drove across town after dinner, my thought being that we’d do a drive-by, I’d roll out onto the curb when the car slowed down a little, and I’d wave goodbye and head on in. But no, Courtney wanted to come in with me, case the joint and make sure it was safe for human habitation.

The Sleep Disorders Center looked like any other medium-rise office building.  We got on the elevator to the right floor and were greeted by a big young guy in blue orderly togs who introduced himself as Ben.  He knew who I was immediately – apparently there was only one other sleep study “subject” in the place that night, a guy a bit younger and a lot heavier than me who was loitering furtively in the waiting room with a gym bag.

Courtney gushed all over Ben to impress upon him how important my well-being was to her, and to butter him up so that I’d be well-treated (I know her techniques).  Ben led us down what looked sort of like a hallway in a Motel 6 and into a small, very Motel 6-ish bedroom,  furnished in aging Ikea and lit with a garish overhead fluorescent bulb.   A big box fan turned in one corner, as there was no air conditioning (but hey, it was April).   There was a tiny, unadorned bathroom with a sliver of a shower stall off the entrance to the room. An old TV sat in a credenza.  The bed was serviceable but spartan.  A small video camera protruded from the ceiling under a smoked-glass cover. Courtney looked around and almost audibly gulped.

I started to say my goodbyes and Courtney gave me a hug, told me again not to worry, and pulled out of her bag a small stuffed animal resembling a sheep that she calls “Lambie.”  Of course she presented Lambie to me in front of Ben, who tried to keep a straight face, as though wives gave their middle-aged husbands stuffed sleep toys every night there at the Sleep Disorders Center.  (Maybe they do.)

After much more mutual comforting, eventually we said our good nights, Courtney thanked Ben yet again for not being an axe murderer, and she left.  Big Ben asked me if I was ready to go to bed or if I wanted to watch TV for a while.  I declined TV but told him I might read, as I usually didn’t go to bed till around midnight.  He said that would be fine, but that they’d like to get me wired up as soon as possible.

He left and I got into some gym shorts and an undershirt (I’d chickened out on the Brooks Brothers pajamas as soon as they arrived in the mail, as I was certain they would label me as the kind of guy who would wear Brooks Brothers pajamas).

Ben re-entered the room with a smaller guy in tow, also in the blue orderlies, and a hospital cart laden with equipment.  They invited me to strip and sit in a chair at the foot of the bed and immediately set upon me with what seemed like hundreds of thin, multicolored wires.  As the polysomnogram includes a full-fledged EEG, at least a dozen of them were attached to my head with what looked and felt like white Silly Putty wrapped in tissue paper.  Then there were the predictable dozen or so electrodes to the torso and even a couple on the lower leg, taped to the calves.

After a couple of weak attempts at male banter (I found out Ben was a paramedic by day), we were all silent while they worked, which lent the process a fairly creepy air, as though we might be preparing for something far less benign than a sleep study — a space flight, perhaps, or advanced interrogation techniques.  Or an execution.

They worked quickly and efficiently, but things took an oppressive, somewhat humiliating turn when they stuck a breath-monitoring apparatus into my nostrils and another thin tube into my mouth, both held in place with adhesive strips to the face and attached to tubing that ran back over my ears.  I began to feel like a child being persecuted by bullies  — if I play dead, maybe they’ll stop.   At this point, I thought, a lot of people would stand up, say that this wasn’t fun anymore, rip all the wires off, and walk out.  Ever the diligent student, I suppressed the urge.

After about 20 minutes they were done, and I was virtually encased in wiring, tape, and white goo.   The wires all ran to a junction box about the size of a box of Kleenex, which was hung around my neck so I could move about until they hooked it up to the larger box on the nightstand that was connected to the recording devices somewhere beyond the room.  Ben said I could read as long as I wanted, but that when I was ready to go to sleep I should push a call button rigged to the headboard so they could run a few tests first.

He left and I lay down on the bed in my wire coat-of-many-colors.  I used the camera in my iPad to see what I looked like (a trip to the bathroom mirror seemed a bit perilous).  I looked, of course, like hell.  The twisted tissue around the electrodes in my hair resembled the cornrows on one of the black children on the Little Rascals serials, and the wires and tubes covering my face and torso recalled the “Borg” episodes on Star Trek TNG.  I took a couple of pictures of myself and Lambie, whom I had positioned rakishly on the nightstand, and emailed them (nowhere in Cleveland Clinic are you deprived of wi-fi) to Courtney, Elke, and Marybeth., with the witty caption “you….will………assimilated!”

Me, wired up

Me, wired up

A good laugh at my expense, but this was not the larky geek-fest I had envisaged.  I couldn’t imagine getting any sleep entangled in this forest of wires, which were already pulling uncomfortably on my scalp and body hair, much less how this process could result in anything like a representative “study” of how I actually, normally, slept.

I read Anne Lamott’s new book for a while, which took me out of my miserable self for about a half hour, then gave up and pushed the Ben button.  A voice came out of the ceiling.

“Hi Keith, are you ready for some tests?”   It was not Ben, but the voice of a woman I hadn’t seen yet.

I said sure and she asked me to do a number of abnormal things involving my breathing and eye movements.  She asked me to wiggle one foot, then the other.   I supposed the latter was aimed at making sure the camera was property focused.  Oh yeah, I was being viewed on-camera!  I’d forgotten that little detail.

The voice told me that one of the breathing monitors wasn’t working and would have to be replaced.  She’d be right in.

A minute later a girl, really, in her late twenties, I’d estimate, came into the room and began fiddling with the probe in my nostrils.  She didn’t introduce herself and I didn’t ask where Ben was, but her manner was so self-assured that her rather intimate manipulations didn’t seem as bizarre as they should have from someone I’d never laid eyes on till that moment.   I thought what a strange gig this must be for her and Ben and his buddy. “Oh yeah, my night job is to wire people up and watch them sleep over at Cleveland Clinic.”  I wondered what they were paid.

She eventually replaced the nose probe altogether and disappeared and we ran the breathing tests again.   All was A-OK this time, and she somewhat dramatically announced over the speaker in the ceiling that the “sleep study commenced at 11:47 pm.”

I read another couple of pages, not to appear too slavishly obedient, then reached over with my wire-enshrouded arm and turned out the light. The really hard part was about to begin.

I was now in the dark in an unfamiliar, not particularly pleasant room, wrapped up like some high-tech mummy in a slew of wires that pulled on my skin and flopped this way and that when I moved, all the while being observed by unseen strangers.  Not the most restful conditions.

The wires felt like they were everywhere; it was like being covered with flies.  I tried to find a somewhat comfortable position.  I usually sleep on my side, alternating sides through the night, but Ben had asked that I try to sleep at least part of the time on my back, as that’s the position in which sleep apnea most often occurs.  I tried lying on my back for a while, but realized fairly soon that what little chance I had of falling asleep would be eliminated if I didn’t start out on my side.

I carefully shifted to my right side and tried to think about something else.  Why had I wanted to do this?  I felt oppressed and lonely, intensely self-conscious, and sorry for myself.  Some small child inside me wanted to cry.

I stuffed him back in his closet and began the one relaxation technique that had ever worked for me, a sort of physiological counting of sheep.  I concentrate on relaxing different parts of my body, starting with the very top of my head and working my way down: eyes, throat, shoulders, chest, arms, stomach…

I had to start over several times as I kept thinking about the camera in the ceiling, the annoying droning of the fan.  An overly bright blue light was coming from a panel on the box on the nightstand that all my wiring was connected to, and after trying to ignore it for a while, I sat all my wires and me up and propped my iPad up against it to cover the panel.  There’s an app for that, I said to myself, and flopped back down.   Okay, top of the head, forehead, eyes, throat….

At least an hour or two had passed since I’d turned out the light.   My thoughts would begin to assume that pleasantly hallucinatory quality that presages sleep, and I’d start to drift off, then snap back awake in utter, miserable lucidity.  This happened, oh, about a hundred times.  I pictured my invisible keepers drumming their fingers impatiently on a control panel somewhere, rolling their eyes at each other and muttering to themselves, “will this guy ever fall asleep?”  They would think I was abnormal, pathetic.  I certainly felt pathetic.  I talk a good game.  At home I slept like a baby.  But in the clutch, when the cameras were rolling, I was a sleep failure.

At some indeterminate point I did fall asleep.   And awoke.  And fell asleep again.  And awoke.  I’d estimate I woke up about 87 times that night, again not at all normal for me.

Ben’s voice woke me up one final time at 6:35 in the morning.  I felt like I’d been chewed by chipmunks all night.  He gave me a few minutes to collect myself, then came into the room, sat me up, and started to remove all the wires.  He apologized for the hour but said that his replacement hadn’t shown up that morning and he had to leave soon.  That was fine with me; I was just relieved that the night was over and couldn’t wait to get out of there.

Ben had brought me a tiny bar of hotel soap and a little bottle of hotel shampoo and told me that the gunk in my hair that had stuck the electrodes to my scalp was water-soluble, but to wash it out thoroughly. I stumbled to the bathroom, avoided looking at myself in the mirror, and turned on the shower.

Half an hour later I was washed, shaved, dressed and much more human.   As I waited for Courtney to come pick me up, a nice morning-shift nurse fetched me a cup of coffee from the employee lunchroom.  I sat reading Anne Lamott and sipped it gratefully.  It was the best cup of bad coffee I’d had in a long time.

Courtney picked me up and I gave her a summary of my horrible night. She was suitably shocked and sympathetic.  We drove home later that day.  On the way, I felt something on my recently-shampooed head and reached up and found a wad of dried white Silly Putty and tissue paper in my hair.  I pulled it out and threw it out the car window in disgust.

That night, exhausted, I climbed into our wonderful, soft, wire-free bed next to my wonderful, soft wife, stuck the little orange plugs into her ears, and slept the sleep of the just.

Several days later I got a call from a doctor at the Sleep Disorders Center.  He got right to the point:  no sign of sleep apnea.  He did note that I hadn’t slept on my back, so it was hard to tell if they might have missed a potential problem there.  I explained that I can’t sleep on my back, so I was sort of self-treating any risk of apnea on that front.  That seemed to satisfy him, and he suggested that I might want to have another study “in a few years.”  Uh, right.  I didn’t ask for the video.  My curiosity about my sleep had been thoroughly cured by my night at the Sleep Disorders Center.

Obstructive sleep apnea is serious business, not to be trifled with or dismissed with our jokey, defensive attitude toward snoring in general.  But nor, I’d learned, is a “sleep study” – new age fun though it sounds — something to be approached lightly.  While not exactly invasive (if you ignore the nostril probes), it’s a surprisingly oppressive procedure, right up there with a colonoscopy in my opinion, except unlike a colonoscopy, where you at least get good drugs, it takes an entire evening out of your life and replaces it with Borg-hell.

Do I sound bitter?   I probably need a nap.

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