Sleep Lab tech here...

I just finished Respiratory Therapy school and have been working in a sleep lab since January. Feel free to ask me any questions. I may not know the answer but I work with folks that have a TON of experience. Of course every Sleep Lab does things slightly differently but overall the outcome is the same. I can offer a few hints/advice in general. Don't wear something sleeveless because the belts rub and they have to be fairly tight....folks that obese...it is even harder especially females and large breasts. The belt has to be snug AKA very tight because it works by expansion...with all that extra "skin" there isn't as much stretching going on and it is harder to see that you are trying to breathe. Our lab allows for split studies so you don't (or hopefully won't) have to go back for a 2nd night HOWEVER you must meet certain criteria early on in the study. This can be both good and bad. Good-- you don't have to spend another miserable night wired up in a crappy unfamiliar bed...BAD you may need more than 4 hrs to get the correct pressure and need to come back anyways if you are very severe. Most insurance companies allow for a new mask every 6 months. Our lab offers a variety of masks to try on and during the night you can ask to try something else if you can't get comfortable with the one you start out with. We have at least 10 different masks. IF you can't keep your mouth shut...you will probably end up with a mask that covers both your nose and mouth or they will use a chin strap to hold your mouth shut. IF you have severe OSA (obstructive sleep apnea) the NASAL prong looking masks may not be tolerated as well since the air is blowing right up your nostrils but they are nice because the head gear is usually easier to adjust/less bulky and you can wear your glasses with it on. It seems to work best on folks that don't need a lot of cmH20 (probably less than 12) We start our patients out at 6cmH20 and increment by 2's if you are snoring or having Apneas or Oxygen Desaturations. Try to sleep in various positions with the mask on or how you normally sleep at home. We need to see how it fits/leaks. IF you lie flat on your back and stiff all night BUT don't sleep like that at home it may not work for you. Most people have problems on their backs. IF you start out sleeping on your side and don't sleep on your back til much later in the night you may not exhibit symptoms early enough to be split. REM sleep tends to be the problem time for a lot of people probably because your body is most relaxed at this time. BRING a hat to wear home!! Unless you are bald....but sometimes the techs won't wipe off the markings from when they measure and with no hair ...you can't cover that up!! ummmm what else can I think of right now??!!! I just worked 7 days straight of Sleep Lab so I am trying to remember stuff that stood out to me. I haven't slept since 4pm yesterday! Yikes.... Don't wait til the last minute to ask to go to the bathroom...it takes a few minutes to unhook... it is our job to help you out of bed so don't feel "bad" for disturbing us! IF you are too hot or too cold or something is causing a problem that you can't sleep...don't lay around tossing and turning for hours. TELL us!! Cut back on drinks if you tend to get up a lot during the night for bathroom breaks. The more data we have of you sleeping --the better. We are watching you and listening to you....we HEAR and SEE everything! So don't do anything you would be embarrassed of! Please shower before you go! Unless you just love hospital gowns...bring your own pj's (unless they specifically say not too...) Don't wear slick/satin gowns because the belts won't stay put. Unless your lab touts itself as the Holiday Inn...we don't offer snacks, breakfast, ...we have TV and an assortment of magazines of varying dates. We don't allow TV on all night. You might walk around all night and watch and eat etc...at home but you are NOT home...you are there to have a sleep study. We put everyone to bed at the same time and have lights out. We allow the TV to be on a 30 min sleep timer but that is it. We need 6 hrs of study time for insurance to pay. Unless you have 2000+ dollars out of your own pocket ....it is best to tolerate your sleep study. You probably won't sleep as good as you do at home. We expect that. BUT once you do get to sleep ....you will sleep like you do at home. Your brain waves don't lie!!!! IF you snore and stop breathing at home...when you sleep at the sleep lab you will snore and stop breathing! Some folks even sleep better because they don't have the distractions at home like kids/spouses/unlimited tv/computers to keep them up. Sleep Apnea is a very serious thing. Long term effects are bad on the heart. Being overweight already puts a lot of strain on the body. ONCE you have the WLS and your body changes shape....your mask may not fit properly. If you start feeling tired again/pre CPAP feelings you may need another study. Your pressure may be able to be lowered when the weight comes off. You may not need CPAP after extensive weight loss but skinny people have Sleep Apnea too so it isn't all fatty necks--they are just prone to it! Just because you have lost 100+ lbs doesn't mean your Sleep Apnea is gone as well. It is best to get it verified with another study. Listen to your body. Try sleeping a few nights without your CPAP once you get close to goal. Have your sleep partner listen for snoring (especially on your back while sleeping). Gasping, pauses of 10 or more seconds without breathing etc... Morning headaches, dozing at inappropriate times. Take an Epworth Sleepiness Scale test and see how you score. 10+ probably still have Sleep Apnea and even lower doesn't mean you are free and clear. Sleeping on your side can alleviate a lot of problems once you lose a lot of weight. But when you are sleeping---hard to control how you move.... ok...I think I have exhausted my information for now and I am exhausted. So I am off to SLEEP!

Thank you. This was very helpful as I nervously wait to hear from the sleep lab about my appointment. I so dread the idea of sleeping in a strange bed while being watched and listened to, LOL. I know I have to do it. I wish there were mobile sleep labs that the techs could use to come to people's homes. Does such a thing exist? I can hope, LOL. Take gentle care.- Shelley

I think Ozzy Osbourne had a Home sleep test....but he's got LOTS of $$$$. I initially had a take home kit (called a 4 channel) that only looked at my pulse ox and breathing. But IT really is better and shows the full gamut by doing the Sleep Lab route. We see your stages of sleep If you take anti-depressants you will usually have altered sleep-- little or no REM, less slow wave. Also if you have Apneas with arousals you have trouble getting into those deeper sleep stages. We can tell if you have Periodic Limb Movement where you move your legs which causes you to wake up Some people have something called Central Sleep Apnea where the BRAIN tells you not to breathe and it has nothing to do with fatty/relaxed tissue in your throat. There really isn't anything to be nervous about. The application of the wires is painless. IF you are really hairy...taking them off in the morning could be uncomfortable on your chest and legs! We don't take blood! There really isn't anything to worry about. Don't worry about whether or not you will sleep etc... Don't worry about calling us for help with something...if you need another blanket....ask! Bathroom, Sip of Water, Temperature control? Pillow for your knees....try to be as comfortable as possible. Eat before you come in....have your normal meal, some folks come in hungry and then wake up hungry at 3am. We aren't going to let you get up and wander the hospital looking for food! Some Sleep Labs might! We get kids, old folks with dementia, handicapped, obese, skinny middle aged men, I can go weeks without seeing a Pre Op WLS patient and then some nights I will have 2 of my 4 patients. Once we get you settled...we normally just chart every 30 minutes about what stage of sleep, body position (left side, back etc...) any respiratory distress, heart rate, pulse ox (oxygen level), loudness of snore. We you move we note your body position change.... For the most part we aren't staring at you all night....mostly watching the computer screen for your brain waves and apneas. I prefer to watch TV and read books instead of staring at folks sleeping!

Wow Shannon, you are a wealth of information. I read your post about anti-depressants maybe causing non-REM sleep? So are you supposed to take those in the morning? I don't know why, but I have always taken mine at night. I am waiting on the results of my overnight oximeter test. My PCP decided to go that route, and depending on what it says, I might have to do the full night one. I am not pre, I am post WLS and have lost a total of 141 pounds, but the last year or so have had major issues with headaches and being extremely tired, so hopefully my test will show something. Thanks, Stephanie 402/261/180ish

I don't know that it matters when you take the anti depressants to affect your sleep...the fact that you are taking them in general can affect your sleep patterns. I found this info a websearch Sleep: Quality, restful sleep Sleep is essential for good physical, mental and emotional health. Different people require different amounts of sleep. In general, most healthy adults need 7 - 9 hours of sleep each night. However, some people need more than 9 hours, and others can sleep less and wake up completely refreshed (contrary to myth, the need for sleep does not diminish with age, although the ability to get it all at one time may be reduced). Obviously, for each of us the amount of sleep we get is extremely important. But the type of sleep we get also determines how well-rested we will be when we awake. The two basic types of sleep, REM (Rapid Eye Movement or dream sleep) and Non-REM (NREM), include a total of five stages that we move into and out of as we sleep. The duration and quality of these stages can vary greatly, depending on age, health, sleep hygiene, and the individual sleeper. Sleep researchers use the term "sleep architecture" to describe the cycles of sleep. Sleep usually begins with a cycle that consists of 80 minutes of NREM sleep followed by 10 minutes of REM sleep. This 90-minute cycle is repeated three to six times each night. With each cycle, the amount of slow-wave sleep decreases and the proportion of REM sleep increases. The order of a typical sleep cycle is: waking, stage 1, 2, 3, 4, 3, 2, 5 (REM). About 80% of adult sleep is NREM sleep. NREM sleep is divided into four stages: Stage 1 (transitional sleep): The transitional stage is the drowsy period from wakefulness to deeper sleep, and usually lasts less than 15 minutes. This is the lightest period of sleep and during it we are more responsive to sounds and external activities and are more easily awakened. Brain waves, as measured by an electroencephalogram (EEG), are fast and are known as "beta" waves. During this transitional stage breathing becomes slow and regular, heart rate decreases, and the eyes exhibit slow rolling movements. Stage 2 (light sleep): This is a deeper stage of sleep and lasts 15 to 30 minutes in each sleep cycle (over the whole of a night it makes up 45 - 55% of our total sleep). Here, the brain waves, now called "theta" waves, slow even further and fragmented thoughts and images pass through the mind. Eye movements usually disappear, muscles relax, and there is very little body movement. Stages 3 and 4 (deep sleep): Stages 3 and 4 are often referred to as deep sleep or "delta" sleep. These stages normally last for 30 to 40 minutes in the first sleep cycle and decrease with subsequent cycles throughout the night. In stages 3 and 4 there is little contact with external sensation, breathing slows down even more, muscles relax, and the heart beats slower and slower. Dreams are more common during stages 3 and 4 of sleep, and people are more likely to talk to themselves. Deep sleep decreases with age - by age 75, stage 4, the deepest sleep, may be completely absent. About 20% of sleep is REM, or dream sleep. Stage 5 (REM or dream sleep) REM sleep typically occurs at the end of each sleep cycle - though some researchers have noted the presence of dream activity during NREM sleep as well. Unlike NREM sleep, REM sleep involves a high level of mental and physical activity, including increased brain activity, blood pressure, heart rate, blood flow to the brain and respiration. Intense dreaming occurs during REM sleep as a result of heightened cerebral activity, but interestingly, REM sleep is also characterized by muscular immobility or paralysis. It is generally thought that REM-associated muscle paralysis is meant to keep the body from acting out the dreams that occur during this intense sleep stage. The first period of REM sleep typically lasts 10 minutes, with each recurring REM stage lengthening, and the final one lasting an hour. In the newborn baby, more than 50% of sleep may be REM sleep. By the age of 2 years, the proportion of REM sleep decreases to 20% to 25% and remains constant throughout adulthood. Although the reasons for the different types of sleep are still being studied, it is clear that we need each type. The "restorative" theory suggests that sleep enables the body to make repairs after the exertions of the day. REM sleep appears to be vital to many of our most important brain functions and may allow the brain to synthesize neurotransmitters like norepinephrine and dopamine to compensate for the amount used during the day. REM sleep also appears to stimulate the brain regions used in learning and memory. One theory is that in REM sleep important memories / experiences are strengthened, and trivial events are discarded. Similarly, deep sleep (stages 3 and 4), appears to be essential for its repair and restorative properties. During deep sleep metabolic activity is at its lowest, providing an opportunity for tissue growth and repair. The secretion of growth hormone also reaches its peak during stages 3 and 4. In children, growth hormone encourages growth. In adults it assists with healing of muscles. Interestingly, daytime sleep is less restful than nighttime sleep because it does not provide the same quality of sleep architecture. http://remedyfind.com/rem.asp?ID=13568 or this site....a different explanation with some good side notes http://www.medicinenet.com/sleep/article.htm this is what is says about REM/drugs- Since sleep and wakefulness are influenced by different neurotransmitter signals in the brain, foods and medicines that change the balance of these signals affect whether we feel alert or drowsy and how well we sleep. Caffeinated drinks such as coffee and drugs such as diet pills and decongestants stimulate some parts of the brain and can cause insomnia, or an inability to sleep. Many antidepressants suppress REM sleep. Heavy smokers often sleep very lightly and have reduced amounts of REM sleep. They also tend to wake up after 3 or 4 hours of sleep due to nicotine withdrawal. Many people who suffer from insomnia try to solve the problem with alcohol--the so-called nightcap. While alcohol does help people fall into light sleep, it also robs them of REM and the deeper, more restorative stages of sleep. Instead, it keeps them in the lighter stages of sleep, from which they can be awakened easily.

There is a laboratory called Snap Laboratories that uses mobile sleep tests. I had one of their tests that my doctor set me up with. I had to take home a little machine with a recorder and hoses, which then recorded the number of times my breathing stopped. I'm not sure exactly how it worked, but when I got my CPAP machine, I was amazed at the difference in how I felt. The test is $897 and MAY be covered by insurance. If it is not, as in my case, Snap had a contract with my doctor that it would cost me no more than 10% of the price. So you can look into that. Pamela -111 and haven't had daily headaches since the day of surgery...the apnea is gone!

Shannon, Thank you so much for all this information. I appreciate the time you took to put all this down. I have been using a CPAP since 2 weeks before my surgery this year (March 17). My surgeon suggested I get a follow up sleep study at 6 mos., but my PCP thinks I should wait a bit longer. I'm ok with that. Here's my question. Are there some symptoms that indicate it might be time to get a follow up sleep study done? That is, if the air pressure is too high, does the body react in a standard way? Donna

I would wait til you are almost at goal and/or you have lost most of the excess fat around your neck area. Just because you lose the weight doesn't mean you will be "cured"...those tissues inside your throat could be extra floppy too and cause you to still snore and block your airway. I don't think you can really worry about pressure being too high except for comfort/toleration and compliance with the CPAP. The extra air won't hurt anything. BUT too low and you will continue to snore and have apneas...you might be fine most of the night and then you hit REM or have REM on your back and voila....apneas and desats... like my pt last night. I had him on 10cmh20 and he was doing great...had REM on his right side early on....then flopped on to his back around 4:30 and had REM again....had to bump him up 2 more times to 14cmh20. That is why a full night mask study is preferred. Here is a good website from the Cleveland Clinic explaining different sleep disorders etc.. http://www.clevelandclinicmeded.com/diseasemanagement/pulmonary/sleep/sleep.htm Regardless....like anything Medicine is trial and error. I am not suggesting you go against what is prescribed but I diagnose myself 90% of the time and do my own research...THIS is NOT medical advice!!!! You can always try a night or two without and see how you feel...SUBJECTIVELY....be honest and don't fool yourself if you really don't feel better or the same. Have your spouse try to see/hear your sleeping for a bit of time....not just when you first fall asleep. The deeper or longer you have been asleep usually heavier snoring....listen for cessation of breathing but chest rise/stomach still trying to breathe.... YOU don't have to do what your doctor's say, you don't have to take your meds etc....you don't have to agree to procedures you don't feel are necessary. BUT it is best to have the most information available to make a valued decision. Patients refuse treatment all the time...people leave the hospital AGAINST Doctor's Orders etc...it isn't prison! I have pt's leave at 2am and refuse treatment because they can't tolerate the mask. That is their perogative.

Thanks again for all the good information and the website. What you said makes a lot of sense. I live alone, so I can't have anyone listen to my breathing/snoring, but, when I was married and had lost about 50 pounds more than I've lost so far, I stopped snoring and slept better. So, I will definitely wait until I've lost more weight. Thank you. Donna

Donna, I saw my weight loss surgeon last night and they recommend a 6 months follow up study as well...do you have any idea what your CPAP pressure # is? 10 12? 14? Depending upon whether it is really high....you may want to go ahead and have another test...How much more weight do you still plan to lose? What kind of time frame do you think it will take?