My "No Sleep" Study

Yesterday, I had the last of the five tests my surgeon requested before I can go ahead and set a date for surgery, pending results, of course.  This was the "sleep study" to look for sleep apnea, which I firmly believe I do not have.  I don't have any symptoms of it, and the pulmonologist seemed to feel that I had a very clear airway, with no soft tissues in the way, so I'm hoping for the best. The surgeon requires a sleep study and cardiac consult for eveyone, so I had no choice. It was pretty much a "no-sleep" study.  Honestly, how do they expect you to sleep like that?  With a bunch of wires trailing off of your body, with sensors in your nose and in front of your mouth, in a strange (not to mention lumpy) bed and strange room -- not easy.  On top of everything else, the "sleep lab" seemed to be next to one of the hospital's mechanical systems, either an elevator shaft or a drain/sewer pipe -- about every five minutes, it sounded like someone was dropping a bowling ball on the ceiling above me -- I can't believe they haven't figured out that a quiet environment is conducive to sleep!  Also, the technician woke me up five or six times, because the sensors kept falling off. This was a pain -- but it's done.  If they tell me they didn't get enough information to make a diagnosis, I'll tell them to just make their diagnosis on what they have -- I don't want to go back, and I don't see how I could possibly sleep any more the next time. danny 

I don't want to say too much here, but..... Every single person I've talked to, that had surgery performed by the doctor that did my RNY, was fitted with a CPAP or similar. I'm not sure if it helps get insurance approval, or if it's just a "thing" between the lab and docs office here. Or you could just call me a conspiracy theorist. You decide! If I were a betting man, I would bet you'll be scheduled for a second night very soon to fit you with a CPAP.

Can you say "PARANOID". Just poking at ya Ron. pan head

I had a sleep study a few years ago and it is damn near impossible to sleep with all that stuff on. Just when I was falling a sleep, I made a moaning noise and the tech came over the intercom and asked me if I was OK. Well of course I woke up and like to never went back to sleep. They found I had sleep apnea and then I had to go back for another one with the cpap machine. pan head

See, I could have told you how it would turn out! LOL!!!!!!

You might be onto something Ron,  In prep for the WLS I had to do the at home sleep study, I thought that I would pass with no sleep apnea. After the worst nights sleep ever, I was told I needed to take the 2nd phase of the test at home with a CPAP.  Now I have been officially diagnosed with sleep apnea and have my own CPAP that I can't stand to use. My wife who happens to sound like a buzzsaw when she sleeps, and who I have heard  wake herself up fighting for breath (a sure sign of sleep apnea I've been told) has completed her 1st phase of the at home test and just got her results. They say she's fine with no sign of sleep apnea. She is not going for WLS. So as I said Ron, you may be onto something. Dan S....

I too had a terrible time getting to sleep.  Got maybe 3 hours total of bad sleep, and then had to go to work the next day. The sleep doc and my pulmonologist doc went back and forth over whether I had apnea, but (surprise, surprise) they decided in the end I had "a mild case."  I went back for the mask study and couldn't even get to sleep with that machine on.  They had to let me fall almost asleep before sneaking it on, and even that didn't wor****il the fourth time or so.  My "prescription" was for a machine with like a 3 pressure setting, which apparently is barely on.  I never bought the machine, deciding instead to maybe get retested later after surgery.  I'm not saying that's sound medically, but that's what I did and my surgeon kind of shrugged when I told him, which I interpreted to mean, "Yeah, I hear ya.  It would be malpractice for me to say that's what I'd do to, but I hear ya." I share Ronnie's suspicions about this whole boondoggle and the symbiotic relationship WLS surgeons and sleep docs.  Plus, a doctor friend (admittedly, not his field) told me that almost anyone who is overweight will show some ambiguous events when sleeping on their backs.  For me, approval was apparently 100% guaranteed without any apnea diagonisis.  But I think 2 other semi-innocent explanations explain it also: 1. Your surgeon wants to do a CYA against malpractice, and this is one of the bases he has to cover. 2. Your surgeon has a long-term interest in WLS surgery getting insurance approval, and one of the ways he does this is by contributing to data that shows that X% of his patients no longer have Y serious comorbidities.  He can't show that if he doesn't document the comorbidity before surgery, so he asks the patient about the usual suspects (heart, lungs, liver, kidneys, diabetes, apnea, etc.), and unless recent data suggests no problems, he orders tests to search for problems. ETA: I should say that the last six weeks or so I've slept better than I ever have in my life, even waking up most days before my alarm clock.  But I've weighed 60 pounds less than I do right now and still slept poorly, so apnea still seems an unlikely culprit.  I tend to think it has to do with not eating so much late at night, or maybe that I no longer have acid reflux.  Or maybe it's just that I'm so anxiety-free knowing that so many things in my life are improving daily.

So, if they do tell me I have sleep apnea, should I just shut up and play the game, or should I try to politely decline and tell the surgeon and the pulmonologist I really don't want treatment for this condition at this time, and see what happens?   If I honestly thought I had this problem, I wouldn't object to treatment, but I have NO SYMPTOMS of this.  I am fatigued in the daytime (gee, at 435 lbs, I wonder why?!!!), but I'm not sleepy, there is a difference.  I feel like I'm coming down with the flu most of the time -- muscle aches, hard to get up the energy to move my arms and legs, aside from the weight, I also have osteo and possibly rheumatoid arthritis, and type II diabetes, which could account for these symptoms.  Also, I can get significant temporary relief from these symptoms with high doses of NSAIDS and also with benadryl, which makes me feel that it is related to my immune system and not a breathing problem.  I would live on NSAIDS except that after a few days, they really irritate my stomach, so I can either walk and move normally and feel like I've been punched in the gut, or I can forego the stomache aches and take five minutes to move three steps from a chair when I first get up. I don't want them to tell me they'll refuse to do the surgery without the CPAP machine, but I have never had any of the symptoms or problems associated with this, and I really don't want to shell out the money for this if my insurance doesn't cover it (although I'm pretty sure it will). I don't mind jumping through reasonable hoops -- I didn't really want to do the cardiac tests, either, because I was afraid the results would be bad (they were actually normal!), but I certainly see the medical necessity of knowing what shape a patient's heart is in before doing major surgery, and I didn't really object to going through with them.  However, if I'm not having any symptoms, problems, or issues with this, how can it be a big problem when undergoing weight loss surgery? Besides, I could be wrong about this, but aren't patients put on a ventilator during the surgery to administer anaethesia (I can't spell that word!) and keep a clear airway?  So, wouldn't a machine ensure that there were no breathing irregularities during the surgery?  Or, am I wrong about this issue? Danny

I'm not going to tell you not to do what your doctors tell you to.  And I will tell you that I would do whatever is necessary to ensure you get the surgery.  But as I said, I didn't buy a CPAP machine (even though, I think it would have only cost me like $100 or so).  Certainly listen to your docs and ask questions to get a feel for what they consider the risks and the probabilities of those risks (for me and my mild case, the best the pulmonologist could come up with was I might fall asleep driving, yeah whatever).  There is always the possibility you are having major events and don't know it.  And I believe your risk for a serious apnea event is greatest in the few days right after surgery.  I'd obviously feel horrible if I did something to suggest you avoid treatment and you stopped breathing the night you got home.

My surgeon wasn't going to require a sleep study but he did make me see a pulmonologist because I had a poor pulmonary function test. The pulomonologist cleared me for surgery but in his report noted that I probably had sleep apnea but wasn't concerned about it because he felt that it would completely resolve itself after the surgery. Seeing that was enough though for my surgeon to order me a sleep study - an additional delay when I thought I was about to get a date.  The sleep study sucked. They told me not to take my pain meds, the bed was uncomfortable, and it took me about three hours to fall asleep. I was in so much pain I remember several times deciding I was going to rip all that crap off my head and walk out - the only thing that kept me in there was my determination not to delay the surgery any further. After I finally fell asleep he woke me up about thirty minutes later and put the awful mask on, that was even worse, but again I sucked it up and made it through. I remember getting home and passing out just before the sun came up. I wound up getting a total of about one and a half hours of sleep that night. Then in the morning I had to spend at least that long trying to get all that waxy crap out of my hair from where they stuck the electroids. Turns out I had it, so they sent me over a CPAP machine, I wore the mask the first night, then I didn't wear it again until they made me in the hospital. I haven't worn it again since. I hate the F-ing thing, it doesn't help me, I always wake up with the dryest  mouth six times a night with that thing, despite the fact that it has an onboard humidifier. This whole conversation reminds me I should call that med supply pace back and tell them to come pick the piece of **** up so they can stop charging my insurance company the monthly rent on it. OK enough ranting for now. If you have sleep apnea and the CPAP helps - great. For me, I think the whole thing has been a waste of time and money, but whatever, I jumped through the hoops I needed to jump through and in the end I got what I was looking for.