Last month, I posted a blog entry wherein I went into great detail regarding the ordeal that was my sleep study experience. I'm not going to rehash any of that seeing as how pretty much everything relevant to my take on what happened that fateful evening has already been documented there, however I will take the opportunity to reiterate the fact that unless it is absolutely medically necessary I would never recommend someone willingly go through that. (It's a wretched thing and the technology behind it seems incredibly archaic compared to what's out there these days.) It's been a couple weeks since then and I've had a chance to revisit my physician in order to talk about the results of the sleep study as well as the blood work I had done during my initial consultation.
The short version of this is for me to say that I'm apparently mostly healthy, except for when it comes to how I sleep. Here's the long version.
Lexington Sleep Solutions called me roughly a week ago to let me know that the doctors there had been able to interpret the data from my sleep study and that they wanted me to come back in to discuss the results. This was news to me as I had been under the impression that I'd be able to return to my physician in order to see what the next steps would be as I'd asked that the results be sent to her office. I continued the conversation with the person I spoke to from LSS and they said the results had been sent to my physician; she went on to answer some of my questions about the study, particularly whether or not it looked as if I would need to begin using a CPAP machine.
I asked the question even though I already knew the answer. "Yes, they are recommending that you begin treatment with CPAP." My next biggest question was did I actually stop breathing during the study? (That's what I've been concerned about since I got put on this path, whether or not I'm potentially in respiratory distress while I'm sleeping.) She told me that I did not stop breathing (this echoed what the technician who oversaw my sleep study said when I asked him the same question) however my oxygen levels weren't as high as they should be - mine were around 88% at certain points and nominal is between 98-90%. The LSS representative went on to say that they would be referring me to a medical equipment vendor that would be able to go about assisting me in obtaining a machine. I wasn't ready to go down that road yet as I wanted to see the results of the study myself. I told her as much and said that I'd look into scheduling a follow-up with my physician.
A few things to keep in mind from this initial conversation:
1) They want me to come back, several times - repeat business, in other words
2) They recommended me for a machine - this was a foregone conclusion in my mind
3) I've been told by 2 individuals employed by LSS that I did not stop breathing - 2, count 'em, TWO
4) They were going to send me to a specific vendor for the CPAP machine - keeping the money all in the family, as it were
I point those things out because if you've been reading my blog for any length of time, you know how I am - I'm not bashful about admitting that I constantly look for ulterior motives in everything that I encounter. I've been around enough hustlers in my day to know that they're there, even though nowadays they've gotten exceedingly skilled at operating as legitimate entities. Bankers, doctors, lawyers, politicians, etc. To quote Harry Dresden (from author Jim Butcher's excellent series, The Dresden Files), one of my favorite literary protagonists, "Paranoid? Probably. But just because you're paranoid doesn't mean that there isn't an invisible demon about to eat your face."
That said, I went in Wednesday (June 12) for a follow-up with my physician. (Remember how I mentioned that LSS told me my sleep study results had been sent to my doctor? Turns out they hadn't been when I set up my appointment; a nurse had to request them on my behalf.) I have to say that going into my appointment I was more nervous about the results of my blood work than I was about that of my sleep study seeing as how I thought I had a good grasp of what was going on there. I suffer from White Coat Syndrome, that being an automatic sense of anxiety related to doctors, doctor's offices, and everything therein. I probably have high hypertension anyway (runs in the family, just like the red hair and freckles) but the WCS doesn't help matters as I know they're going to tell me I'm fat and that my blood pressure is elevated. I guess it comes from never having had many positive or reenforcing experiences in that kind of setting.
My appointment was for 10 AM and we (as in my wife & I - yes, she came with me) got to the office just in time as we encountered some unexpected construction on the way there. It's not logical that I think this way but I've always believed that if you have an appointment for a certain event, said event should happen at that specific moment in time or at least in a reasonable approximate time frame. You can probably guess where I'm going with this; I wasn't taken into an examination room until almost 10:30. The optimist in me was thinking we'd be out of there by 10:45 but that wound up being an unrealistic expectation.
Sure enough, the nurse taking my vital information confirmed that I'm still fat and my blood pressure is high.
My physician went over the results of my sleep study. She caught us completely off guard by telling us that I did, in fact, have several apneas during the test. This was in stark contrast to what both the technician and the other representative from LSS had told me. Suffice to say that my wife and I were shocked - neither of us are particularly good at hiding our emotions in terms of our expression and I gather we did an especially poor job of that in this moment seeing as how my physician seemed set aback by our reactions. It's not quite like being told you're cancer free by one doctor only to then be told you have a terminal case by another, but be that as it may the shock was real.
From there we talked about my blood work. Like I mentioned earlier in this entry, my blood work was what I was truly concerned about. For one, the sample had been drawn without my knowing of it in advance so I naturally assumed my having not fasted prior to the test would have affected its outcome. I was surprised again, this time by some good news. My blood work came back spotless - no issues of any kind. No signs of diabetes, cholesterol issues, or anything else for that matter. I was half expecting her to tell me I had 8 weeks to live by that point in time. In the grand scheme of things, I'm very happy that my levels were good as that's a real sense of your overall health. I'm grateful to know that all this clean living I've been doing for years - other than my gravy addiction, that is - has paid off in that regard.
My physician wrote me a prescription for a CPAP/BiPAP machine, a sleep aid, and something for my blood pressure. (She also said I should take a cruise as my vitamin D levels were lower than they should've been - if only I could turn in a booking confirmation from Carnival to my insurance company without them laughing at me...) We discussed my having been generally uncomfortable wearing the CPAP mask, which is where the recommendation for the sleeping pill came from. I don't like that idea, seeing as how I've never wanted to get on a medication that might possibly lead to a dependence, but she's assured me that it's mild and that it will help me to relax while wearing the mask. I have an appointment to she her again in 3 months, so we'll see where I stand then with these changes to my lifestyle.
I was given a copy of the report from my sleep study to take with me. It goes without saying that this has made for interesting reading seeing as how there are a whole slew of $25 medical terms used within it, the meanings of which I didn't know. ("Titration", for example, which is an analysis of a component's concentration - oxygen, in this case - in a given sample.) I spent some time going over them, as well as the report as a whole. While I'm not a doctor I am kind of smart, I'm rather fond of numbers, and this document is filled with them. Here's a breakdown of the statistics.
Length of sleep study - 411.5 minutes (approximately 7 hours)
Actual time spent asleep - 338.5 minutes (around 5.5 hours)
Time to sleep onset - 27 minutes
Time to REM sleep onset - 198 minutes (3 hours, 18 minutes)
Apnea-hypopnea ratio prior to CPAP treatment - 0/95
Apnea-hypopnea ratio after CPAP treatment 6/21
Two things stick out to me immediately:
1) The reported length of time I was asleep
I'm splitting hairs with this but I really don't believe that I slept that much during the sleep study. Here again is a reason why it would've been great to have had a visible clock in that room I was cooped up inside of as it would've served as a point of reference for my documentation purposes, if nothing else. I'm sure there's a brainwave pattern they're looking for from the data being collected by way of the wires that were on my head which indicated I was "asleep", so I probably don't have a leg to stand on here in trying to argue my point. (How do they know my brainwaves are like everyone else's? It's conceivable what signifies sleep in the minds of others might mean I want a steak burrito with extra guacamole in mine.) It did not seem like I received the amount of sleep that the report states. (Are you asleep if you're conscious enough to be able to have an internal dialogue about how you wish the walls were thicker so that you wouldn't be bothered by the guy in the next room sawing down redwoods?) I certainly didn't feel rested the next morning, and I'm sure that could be used against me seeing as how it would be fodder for the diagnosis that I don't sleep all that well anyway because of the apneas and hypopneas.
2) The comparison of my apnea/hypopnea ratio with and without CPAP treatment
I don't believe I've taken the time to define either of these terms. An apnea is a suspension of external breathing, whereas a hypopnea is an episode of overly shallow breathing. With that in mind, see if you can follow along with my logic here and why I don't see how CPAP helped me.
Prior to CPAP treatment
0 apneas, 95 hypopneas
With CPAP treatment
6 apneas, 21 hypopneas
Again, I'm not a doctor but the fact that I didn't have any apneas initially then had apneas during the period of sleep where I was receiving CPAP treatment doesn't give me a shred of confidence that this machine is beneficial to me. It's supposed to prevent apneas from happening, not cause them.
I did a bit of research (you know what that means - I Googled something!) and I found a study published in 2007 by the Journal of Clinical Sleep Medicine (which is the official publication of the American Academy of Sleep Medicine) titled Central Sleep Apnea on Commencement of Continuous Positive Airway Pressure in Patients with a Primary Diagnosis of Obstructive Sleep Apnea-Hypopnea (you can see the report for yourself here). There's a lot of medical jargon to it, as you might expect, which is why I won't bore you with a synopsis. Here's the important part, the conclusion.
"CSA (central sleep apnea) on commencing CPAP amongst patients with a primary diagnosis of OSAH (obstructive sleep apnea-hypopnea)
appears to be relatively common. Male sex and past history of cardiac
disease are potential risk factors. These patients seem to have more
disturbed sleep on their baseline studies, are prescribed somewhat
higher CPAP pressures and may become long-term CPAP failures."
So where am I going from here? I am pleased that my blood work was in good standing. That shows me that the exercise I'm getting and the things I'm eating are sufficient to keeping me in good health. I'm planning on checking around to see if I can rent a CPAP machine, although if it turns out that my insurance will pay for the whole thing I may wind up going ahead and purchasing one. I'm willing to try it for the sake of satiating my wife and my physician, even though I don't believe it's going to help me in the long run. Of course, I'm going to start taking the medication for my blood pressure immediately. I guess I'm lucky that that's all I have to concern myself with as of right now. We'll see where we stand in September as that's when I'm scheduled to see my physician again.
No comments:
Post a Comment