Friday, February 01, 2013

Post-sleep (after a fashion)

My resting place for January 30th
[Warning: this entry is long and contains descriptions of medical procedures which may be distressing to some.]

As the previous minor update stated, I went to a nearby "sleep research facility" this week to spend a night subject to quiet contemplation observation.  Here's the teaser spoiler: if I need to do this to continue with "not dying", I'll make it work!  But the entire experience was an exercise in unpleasantness and non-comfortableness.
I packed the few things required for my overnight, including:

*cotton tshirt
*cotton shorts
*Nook e-reader (I brought this on the chance I might have the opportunity to use it.  I didn't.)

In a different set of circumstances, I also could have brought toiletries for use in the en suite shower (towels provided).  But I only live 8 minutes from the facility, and it was 6:30am when I was released, so nobody was going to notice my rumpled and uncombed persona.

My appointment was for 10pm, and the instructions were very careful to note that I should NOT arrive early as "studies are synchronized".  I'm sure that phrase means something to the people writing the instructions, but it just sounds like a piece of quasi-technical babble that old women would tell other old women over bridge.  "Well, I would make sure to water the flowers, but you know that the studies are synchronized."  "Oh, right you are, Ethel!"

The surest way to get me anxious about an appointment is to tell me that I can't arrive early.  Left to my own devices, I might "not arrive early" all on my own, through the happy accidents of fate!  But giving me that as instructions means you're guaranteed to see me at 9:52pm sitting in my car in the parking lot, watching the second hand. 

The center itself is a two-story "made new to look old" brick and white column building that just screams "See how NOT like an office building I am?" while it has reinforced back door with push button lock and loading ramp.  It's tucked in between an assisted living center and a nice hotel very near to the white-collar business area.

I crunched my way across the salted parking lot (we had an unambitious amount of snow Wednesday morning) and entered the building.  Word processor printouts with hand-drawn arrows indicated that "Sleep Study Patients" should go "this way".   So I worked my way into a suite of doors, all closed, around a central windowed nurse station, complete with sliding patio-style door to confine the noise.  A nurse came out of the box and approached me, and I let her know that I was Andrew Schwartz.  She directed me to the one open door.

I entered a utilitarian facsimile of a hotel room.  No TV, but a standard bed and flanking chests of drawers, a small desk and chair, and an attached bathroom.  A couple of generic pieces of art hung on the walls, but they were vaguely sepia and elephants, so no harm done.  The two windows had wide Venetian blinds closed tightly.  Above the right side of the bed was an outdated-looking intercom with a large sounding speaker and call button.

Arrayed on the bed were a intense variety of switch boxes, wires, sensors covered in sticky tape, sensors sitting in small drops of light blue goo, at least two or three vaguely mask-like appliances, two heavy elasticated straps, and a large air compression machine on the bedside table.  Please see image included above, and behold the room in all of its inoffensive olive-drab decor.

As I mentioned in the previous entry ("Pre-Sleep", 1/30/13), they had provided me with about ten pages of surveys, authorizations, and patient information forms.  I dutifully handed these to the nurse.  I did not expect her response: "As of Monday, we have a new set of paperwork."  They looked very much like the old paperwork, except they have the new logo of the healthcare company that just acquired them.  Or that they acquired.  Or with whom they formed a limited liability partnership with a non-equal shared distributorship, reserving certain rights.  Whatever.

So I filled out the second set.  Maybe I should have arrived early after all.

By 10:30pm, I've turned in my paperwork and changed to the sleeping attire they require.  The room is far warmer than I care to keep my sleeping chamber -- probably close to 75 degrees and no moving air -- so I'm not thrilled about sleeping while wearing a shirt and athletic shorts (which I consider an outfit all on their own).  The nurse has me sit the chair by the bed and she begins the process of setting me up for success.

First, she sticks two sensors each on the outside muscle of each shin, about four inches down from the knee.  These will pick up the involuntary movements of legs at various stages of sleep, which can be related to things like night terrors.  She applies a sensor on the left side of my torso, just below the height of my sternum.  She applies a similar sensor on my right pectoral muscle.  A tight elastic belt is clipped around my stomach, which has two sensors that measure where the breathing effort is coming from.  A second belt is clipped around my nipple line: two more sensors there for the high breath expansion.

Then she produces a tape measure and runs it from one temple to the other, across the top of my head.  Using a grease pencil, she starts making dots at various locations on my scalp.  Eventually, a further 10 sensors will be placed all over my head, including above my eyes, beside my eyes, and on my jawline.  The goop she's using to anchor causes me to make a slight sigh as she rubs it into my hair and beard, but it's bound to be washable, right?  And totally not like chewing gum, which is what it feels like.

As she was working on the head sensor-fest, I was sitting there thinking that it was like going to a weird spa, to have my hair and scalp poked and massaged.  Relaxing.  Then the familiar pinpricking in my cheeks and darkness closing in reminded me of that little reaction that apparently I now have to everything everywhere.  I explained I was feeling faint and she un-entangled me enough to lie on the bed, legs draping to the floor on one side.  A cool glass of water, a temperature adjustment, and the start of a ceiling fan to evaporate some of the nervous sweat which is now all over my face, arms, and chest.

I sit back up and she begins to attach the last five sensors.  She also drapes the breath sensor over my upper lip, which is that fancy two-pronged nose thingy I always saw people wearing on "ER".  It's uncomfortable.  My version also has an extra long curley-cue sensor that winds its way to about an inch in front of my lips, to detect any breathing through the mouth.  I hate this thing, because it tickles my mustache and my nose hair. Quelle horreur

She turns off the lights to the following two admonishments:

1) If I need to go to the bathroom, I need to hit the intercom.  They'll come, dis-entangle me, allow me to carry my wires into the toilet with me, then hook me back up when I return.  Consequently, I am mortified and actively trying not to need to pee.

2) If I have 45 incidents of apnea (cessation of breathing for longer than 10 seconds) in 3 hours, they will interrupt my sleep, remove the breath sensor, and install the breath mask for the rest of the trial.

I don't know how long I lay there, but it was darned uncomfortable.  The bed was fine, but having all these wires streaming off of all of my parts made it incredibly difficult to turn on my side, and damned impossible to sleep on my stomach.  I basically had to keep my hands at my side, because attached to my left index finger was an oxygen sensor, which took the form of an incredibly bright light shining through my finger, giving me a proper E.T. light to use for emergencies.

I remember not ever really getting to sleep, but I must have been close enough: eventually, the nurse returned and hooked me up to the CPAP machine (continuous positive air pressure).  It makes a low grade wooshing sound, like a vacuum in a different room.  The mask covered only my nose area, my mouth was not obstructed.

The mask forces a constant stream of air into your nose.  Normal inhalation is not affected, as you're drawing in air anyway, and the mask is configured to not "push" harder than you "pull".  Some sort of sensor anticipates the exhale, and the flow of air is shunted away from your nostrils for a unencumbered exhalation.  The stream re-engages on the next inhale.

I quickly determined another "feature".  Because the air is being forced into your nose on the inhale, if you inhale with your mouth open, air forced through your nose will exit through your mouth, even as you are inhaling.  This creates a very odd sensation of air leaving your lips against the grain of your inhalation.  It also creates a slight rasping noise from your mouth as the airflow is now escaping unregulated through the new aperture.

I'd be lying if I said that any of this knowledge was helpful in making the experience better.  In reality, only a lot of mental discipline saved me from going insane.

If I felt like I hardly slept in the first half of the night, I'm almost positive I didn't sleep at all in the second half. The unmistakably mechanical sound of my breathing was supremely distracting.  The process itself wasn't unpleasant, but I couldn't do anything but think about the Machine.  Whenever my mind would wander, the incessant rhythm would bring me back to this thing strapped to my head.

Unlike a respirator, I could control the flow -- the Machine was not forcing me to breath.  I could draw as small or large breaths as I cared to, and I could interrupt an exhale with an inhale.  This helped to prevent me from succumbing to claustrophobia.

I. Could. Not. Sleep.

My entire existence became focusing on the breathing.  Occasionally, I would look up at the blinds, trying to discern if the sun were rising.  Turns out it was just the lights from the parking lot, as the sun had not risen by the time I was released.

I tried to let my thoughts wander and go someplace -- anyplace -- else.  But I couldn't escape the sounds of the machine or the rhythm of my own breathing.  In. Out.  In. Out.  I resorted to counting.  In 1. Out. In 2. Out.

When I got to 100, I got depressed and was still no closer to sleep.  I don't mean to say that I was anxious.  I was only relaxed and bored.  I started counting again at 1, to make it easier to think the numbers.

I counted intermittently throughout the rest of the night.  I was somewhere in the 2,000s (from 100 digit chunks) when I gave up the counting.  There was only the binary state.  In. Out. Occasionally, the mask would shift and I'd move my hand up to seat it.  In the darkness, I couldn't tell what the mask looked like, but it had dials and vents and a brace that extended up above my browline to steady it.  My imagination probably could have conjured a picture of suitable horribleness, but my imagination had no space to operate.  In. Out.  I gazed at the infrared camera in the corner, wondering if they could see my eyes moving.  Wondering if the various wires were all reporting "he's not asleep".

Eventually, they came an unhooked me.  A survey asked how this compared to a regular night's sleep.  I checked "Much Worse", the lowest available rating.  "Apocalyptic" was not an option, sadly.

Heading into the bathroom, I caught a glimpse of myself in the mirror.  Though all the sensors had been stripped off me in an expert fashion, the adhesive remained.  It looked like an opaque shimmering silver gel.  It had the consistency of the second-day excess frosting in a donut box -- unmoving, but yielding gently to the touch.  There were spots all over my face, spots matting down my hair, and streaks of it smeared through my beard.

I used toilet paper from the roll to remove the most apparent ones near my eyes and forehead.  The ones in my hair were beyond my remedy until a shower.  I rinsed my beard thoroughly with warm water and the gel dissolved quickly.

When I got home, I took my second shower in the past 10 hours.  My towel was still damp, but at least I could get the junk out of my hair and off my face.  I took a quick self-inventory to see if I was actually tired, or merely hypnotized by the Machine.  I crawled into bed, started some music, and woke up five hours later, feeling much better.

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