Can I be treated for a sleep disorder without a sleep study?

February 21, 2009 12:04 PM

Can I get treated for a sleep disorder without having a sleep study? The thought of going through one terrifies me.

I have panic disorder, and one of my triggers is feeling "trapped," either physically or due to the situation. For example, it was extremely difficult for me to sit through exams in school, because generally they don't let you leave the room.

From what I understand about sleep studies, you're attached to electrodes that take 1-2 hours to wire up. So I would assume if you needed to get up (to go to the bathroom or whatever) that they would have to remove them, correct? The thought of not being able to leave until I'm detached from the electrodes would in itself keep me awake and would almost definitely send me into a panic spiral. Normally I'd take a mild tranquilizer (prescribed), but I don't know that they'd want me to do that during a sleep study.

The reason I think I have a sleep disorder is because I snore loudly and I'm told I occasionally stop breathing during the night. I'm easily fatigued during the day (though I'm not at all narcoleptic). I took the sleep apnea screening test, which indicates that I should see a doctor.

I'm sure this must seem irrational, but if you're claustrophobic or afraid of heights or flying, you know the feeling. So: is my perception of the sleep study true? If you've been through one, what is it really like? And can I avoid having it done?

posted by desjardins to Health & Fitness (18 answers total)

They don't need to remove all the electrodes to let you go to the restroom. They have a quick release that unhooks all the leads from where you're hooked into the monitor and zip, you're ready to go. Takes about 10 seconds (plus however long for someone to come in there once you've called for help). Definitely not hours!

I had a screening test done a couple of years ago and it really wasn't bad, although I don't sleep well in strange places (or at all, really). They were very accommodating and even offered prescription sleeping pills if you need them. They come in a couple of times during the night to get you to change position and test out the CPAP, so you definitely don't come out rested, but if you're dealing with sleep apnea anyway, it's probably worth it to do.
posted by Addlepated at 12:16 PM on February 21, 2009

Can you do the quick release yourself or do you need to call them in to do it?
posted by desjardins at 12:20 PM on February 21, 2009

Here, I found you a picture: Image. That little box on the woman's right - it just unhooks from the wire coming in from the top, but all the little spaghetti wires can still stay attached to you without any fiddling around. She also has a pulse oximeter on her finger that just slides right off.
posted by Addlepated at 12:20 PM on February 21, 2009

In a pinch you could probably do the quick release yourself, but they might fuss at you for it. If you've got a reaction going on, I imagine being scolded is not your biggest worry. Alternately, you might discuss with them ahead of time what your issues are and see if they will show you how to undo it yourself (do this when you make the appointment to go in), so that you have a feeling of control over your surroundings.
posted by Addlepated at 12:22 PM on February 21, 2009

I would be surprised if you could be treated with a CPAP machine without a study, because they need to know what level of pressure you need.

I've had three sleep studies in my life. It takes nothing like 1-2 hours to get wired up for your sleep study. 10 minutes, maybe? It's pretty quick. The tech has all the sticky bits, color-coded, on one card, and just pops them on. Then the wires are attached.

There are a lot of electrodes stuck to you all over; their wires all hang together and you can roll over and so on. Not as easily as at home, but you can. If I remember right, the wires all hook into one small box that can be disconnected and carried with you if you need t go to the bathroom; I remember having the wires draped over my shoulder and the box in my hand on the way to the bathroom. The techs always seemed perfectly happy to unhook and re-hook me so I could pee in the night. It's not convenient, but it's not a big deal, either.

If it helps, too, you may not have to stay all night. They keep you until they get what they're looking for. In my last study, they found the setting that eliminated my apnea episodes by about 3 a.m. I opted to stay and sleep in the bed there until morning because I felt too sleepy to drive, but the study was over and I was unhooked from the wires after only a few hours' sleep.
posted by not that girl at 12:24 PM on February 21, 2009

Can you do the quick release yourself or do you need to call them in to do it?

During your sleep study, a technician will be monitoring you at all time, including through an open intercom. If you need something, you just have to speak into the room and the tech comes right in. My tech came in once when my sleep was getting very restless, just to check on me, and it turned out that I was in one of those, "I have to pee, but it's so much trouble to get up" kind of stages, and he could tell I wasn't resting. If you started to panic, to flail around, to make noises, anything like that, someone would be there with you right away.
posted by not that girl at 12:27 PM on February 21, 2009

A good sleep center will accommodate your needs. I went through a two-night study just two months ago. As others have said, the "wiring" took only 10-15 minutes. While I didn't feel trapped, it wasn't the best sleep I've ever had, and I spent much more time awake than usual. But even a few hours sleep is enough for diagnostic purposes.

Most studies will include monitoring your sleep without, then with, CPAP treatment. This may be done in a single night, or on two consecutive nights. Since feeling "trapped" is a problem for you, an ordinary CPAP mask might bother you. Nasal pillows are much less claustrophobia-inducing.

I'd strongly recommend making an appointment with a physician specializing (and credentialed) in sleep disorders prior to the test, rather than having the test arranged by your regular primary care physician. You can discuss your concerns with the sleep doc and decide if the test will be okay with you. He/she can also tell you if you'll take your regular tranquilizer, or if a different sleep aid would be better for the testing.

CPAPtalk.com is a great online community for sleep disorders and PAP therapy. They have put together a collection of wisdom on related topics here. I wish I'd found it before getting my CPAP equipment. But CPAP is working very well for me. Glad I did it.
posted by Snerd at 12:36 PM on February 21, 2009

Just chiming in to confirm what others above have said. My technician was in the next room all night long, and any time I had to pee, I rang a bell and she was there two seconds later.
posted by HotToddy at 12:51 PM on February 21, 2009

I addressed some of your concerns without answering your basic question. Yes, in some circumstances you can be treated for a sleep disorder without a sleep study. See for instance Not Every Patient Needs to go to the Sleep Lab, by Barbara Phillips, MD, director of the Sleep Lab at the University of Kentucky. But most sleep specialists who own or are affiliated with a sleep lab will probably want to send you to their sleep lab.

Home sleep tests are another possibility.
posted by Snerd at 1:06 PM on February 21, 2009

I was diagnosed with sleep apnea when I was 21. But I never did the actual sleep study. I went to an Ear Nose Throat specialist, and I said "I snore, and at least once a night I'll have a dream that I'm falling and then I'll sit up gasping." ENT: "Yep. You have sleep apnea." Not saying that you wouldn't need a sleep study, just saying that I didn't need one before they diagnosed me.
posted by dithmer at 1:15 PM on February 21, 2009

desjardins, my husband had one a few weeks ago and he's going for his follow up tonight. He's going to get some more info for you later.
posted by sugarfish at 2:54 PM on February 21, 2009

I did a home sleep study (as referred to be Snerd) and I don't think it would cause you too many problems. Took about 20 minutes to get hooked up, which involved me sitting down while they attached electrodes and tied this electronic box thing around my chest to record the data. Then I got to go home. It wasn't very comfortable but it was completely self-contained and I could get up and walk around with it on. I didn't feel trapped at all.

You probably wouldn't be able to take a tranquiliser, or anything else which might affect your sleep.
posted by A Thousand Baited Hooks at 2:58 PM on February 21, 2009

I have some panic stuff but mostly it's social, not related to place, so I can't tell you about that piece. My experience with the staff was great though, they do this every night, this is their job, they have seen people like me and people like you for years, and they can help you, unless they are total incompetents, and they won't be, unless it's Lesters Sleepy-time Labs out in the sticks somewhere, presided over by his cousin, Myrtle, as she watches late night tv. But you're not going there. I didn't.

It didn't take long to set me up, attach whatever wires they needed, for sure nothing more than for an EKG. And I got up in the night, headed to the john, called out (the room is miked) and she came in and pulled the plug, plugged me back in a couple of minutes later, no big deal at all. I didn't sleep well, I tend to want to sleep on my side and in the study they wanted me on my back, I'd crank onto my side and she'd come over the intercom and say "Nunh-uh, onto your back" -- these folks can monitor everything through these cables, breath patterns are different on your side.

They got the info they needed fast, I got out of there after maybe six hours, drove on home, tired but glad to know what was going on. I will confess here that I don't often wear the dang thing unless I'm in someone elses place or someone else is here; if/when I don't wear it and end up on my back, seems that my snoring can wake the dead, apparently it sounds like fourteen grizzly bears fighting sixty-seven mountain lions in the middle of a hurricane, poor Kelly used to get tired of elbowing me and I got tired of being elbowed, she's got her some jagged elbows, bitty but jagged. Man. She was all the time thinking only of her needs, always about her wanting sleep and stuff, she never took my needs into consideration, she'd keep on waking me to get me on my side, she'd be all fussy for no real reason that I could see; she was cruel.

Anyways, you're fine and you're going to be fine, you'll do this good as any and better than most, probably you'll have fun, even. I did, cutting up with the staff and all, if you can do the same it'll go lots easier probably
posted by dancestoblue at 4:58 PM on February 21, 2009

In addition to what others have said: Go see a sleep specialist and tell them what you've told us. Either they can arrange a home study or they should be able to accommodate you some--you're not the first person with this condition, so they must have a way to deal with it. Sleep apnea is serious business (severe obstructive sleep apnea can kill you and cause brain damage, and driving with it untreated is a major cause of serious-injury traffic accidents).

Anyway, I think they'll find a way to make it so that you don't feel trapped. :) Good luck!
posted by wintersweet at 9:14 PM on February 21, 2009

A sleep apnea test used to involve attaching a bunch of electrodes to your body and face, but it took only about 15 minutes. You did have to sleep with them on, though.

However, the testing process is now computerized and no longer involves electrodes. Once you have a diagnosis of apnea, the process of setting up the CPAP takes only about 5 minutes. Also, CPAPs are also computerized and much easier to get used to.

I didn't like using a mask, which covered my nose and pressed uncomfortably on my short upper lip. Nasal pillows, which fit into your nostrils, were much better, at least for me. You do need to use headgear to hold the pillows and air supply hose in place, but there are designs that are no more trouble to get used to than wearing a hat.

There are behavioral techniques that get you past the panic pretty quickly. I know from experience that the benefits of treating sleep apnea FAR outweigh the initial problems. It's changed my life, and my wife's life too, since she no longer has to deal with my thunderous snoring.

Good luck. You won't regret it.
posted by KRS at 6:42 AM on February 22, 2009

The electrodes take minutes to hook up, and are not uncomfortable or constraining.

If you stop breathing at night, that is a pretty clear indication that you need to get it checked out.

It is really easy. My biggest problem was that they wanted me to be asleep by 11.

You have someone monitoring you all night, and they are used to having people need to get up. They don't want you to get up by yourself, but you can if you have to. Just unhook the box. If you really have to get up, and you don't unhook the box, the wiring won't hold you down. You are free to move, you just might make a tech unhappy.
posted by bh at 4:19 PM on February 22, 2009

the wiring they do is a bit gnarly, in that it's more than a dozen electrodes involved (i lost count at that point). a majority of those are placed on your head. you will find they need to place electrodes on your chest, stomach, and legs, as well as place wires in your nose to see if you are breathing through it or not. it's not very comfortable, and i had trouble falling asleep with all of the devices attached.

as others have stated, the wiring does not take 1-2 hours. 10-15 minutes is much more like the experience i had. and they will unattach you from the machine if you do need to get up in the night to use the bathroom, although in both instances where i have visited a sleep center, i did not need to do so.

it sounds bad, but you'd rather hear it straight, right? you will fall asleep eventually. if you feel you may need medication to help you fall asleep, you should let the physician ordering the study know, and the center itself; on the questionnaires i had to fill out, they do ask if you have taken any such medication.

the rooms themselves usually have television, a bathroom, a nightstand with a lamp...it's not totally without comfort. and if it helps you sleep better and feel more rested, i think it would be worth figuring a way that you can get through the study (or studies).
posted by moz at 4:42 PM on February 22, 2009

OK, thanks to you all, I bit the bullet and went to the sleep clinic last night. It was exactly as most of you described - the electrode putting-on took about 15 minutes, the room was like a hotel room without the cheezy paintings, and the one time I had to use the bathroom, the tech was there within seconds. He had me carry the box into the bathroom, which is kinda awkward. Probably the worst parts were the tubes tickling my nose and the sticky paste left in my hair after the electrodes were removed. It was a cakewalk compared to an MRI.

I actually slept pretty well, considering, and he said they got all the data they needed. Apparently my brain was pretty active; I asked if he could tell I was dreaming and he said "Ohh yeah, no doubt about that!"

I have a follow-up appointment in a couple weeks. Thanks again; you guys are directly responsible for me taking this step.
posted by desjardins at 9:16 AM on March 5, 2009