Why can't sleeping be EZ?

So last night I failed my second medical sleep study.

I failed the first one about a month ago. The room was far too cold for me to sleep in my light pajamas and I'm too claustrophobic to sleep under heavy covers. Add to that a rat's nest of wires and sensors glued to my body and I did not get much sleep. It was, apparently, enough to tell the sleep specialists that I suffer from sleep apnea and would benefit from better, deeper, safer sleep by using an assistive breathing device. In fact, there are indications that I have "central" versus "obstructive" apnea, meaning that my airway doesn't get blocked. Rather, my body just forgets to breathe. They sent me home sleepy and feeling exhausted with an appointment for later follow up.

At that later appointment, I was fitted for a mask that covered my nose, mouth, and chin, and two devices were tested on me.

CPAP: Continuous positive airway pressure. As the name implies, the pressure is continuous. A variety of pressure levels were tested. I hated it. Breathing in was fine, breathing out required overcoming the positive pressure and just seemed impossible, or at least very uncomfortable. CPAP is the oldest and least expensive of the sleep apnea treatment devices.

BiPAP: Bi-level positive airway pressure. This device is supposed to provide positive pressure for inhalation but minimal pressure for exhalation. I hated it a little less. The medic said this would be the correct unit for me.

Now keep in mind that I am so claustrophobic that I have problems in an airplane and car seats and full-blown panic attacks in other situations. I cannot do an enclosed MRI. Years back we tried to do one on my lower back with me heavily sedated. I don't remember being moved by gurney to the MRI room. I don't remember being moved onto the MRI table or ever being inside the MRI machine. What I do remember is waking up on the cold, hard floor of the MRI room with my paper gown around my neck and my fingernails bloodied and broken. The upper inside of the MRI machine was streaked with blood, too.

During the fittings for the mask, I had discussed my claustrophobia with the medic. Recognizing that it may be a problem the doctor sent me home with the mask selected for me with directions to wear it without the pressure machine for increasingly long times until I was comfortable with it.

They then scheduled me for last night's adventure.

In the days between appointments, I faithfully wore the mask. A few minutes on, a few off. An hour on, a few minutes off.  I was in control and could take it off any time I needed to. There was no backpressure against my exhaling. I could deal with that! I actually thought I would do OK.

"Welcome to the Sleep Center," said the sign.

After changing into my pajamas (three layers this time so I wouldn't freeze) and taking care of my evening ablutions, I was wired up by the tech. Leads on my chest, leads on my legs, and leads on my head. My vitals were checked. BP-114/77, pulse 61, respiration 12. So far, so good. Then I was fitted with the mask and it was attached to the BiPAP machine which was turned on. "Lie back and relax. Just sleep normally." said the tech.

Right. Cold room. Three layers of PJs. Wires. Sensing straps around chest and belly. Mask. No way to scratch my itching nose. Positive pressure against my airway. Pressure that tickles my lips. Cameras recording my movements. Sleep normally, my ass!

But I tried. I really did. I tried self-hypnosis. I tried chanting. I tried a variety of relaxation techniques. But the BiPap didn't seem to me to operate as advertised. There would be pressure on the inhale--nice, cool, sweet, moist air. About 2/3 of the way into my inhalation cycle, the pressure would go away as the mask made a faint popping sound. It felt as if someone had just pressed their hand over my nose and mouth and required great effort to complete the inhalation cycle. Then, on exhale, I'd start with no positive pressure but before the exhale was finished there'd suddenly be positive pressure that I had to overcome to breathe out. I complained to the tech that it was out of coordination with my respiratory cycle but he told me that it is supposed to sense my breathing and adjust accordingly. It didn't work for me. About the 12th time it stopped my inhale at the 2/3 point, I began to feel the panic attack of claustrophobia building in me. The mask had to come off. I told the tech that I couldn't do this.

At that point, he said, well, there is one other type of PAP device we can try tonight. The newest and most expensive technology for the treatment of apnea: ASV: Adaptive servo-ventilation. This machine adjusts pressure delivery based upon the detection of pauses in breathing during sleep. ASV is primarily used for the treatment of central sleep apnea (which is the kind I supposedly have). I say supposedly because I've been sleeping with the same woman for over 51 years and she says she's never noticed snoring or signs of apnea.

Well, "OK. Let's try that one." And we did. It seemed to work very nicely, very closely attuned to my breathing rhythms. Gentle pressure on the intake, no back- pressure on the exhale. And it was much quieter than either of the other machines. It was good enough that I ALMOST went to sleep. Three times. But each time I'd come back suddenly from the edge of sleep in a panic from having my face enclosed within the mask with straps over and behind my head. And, when I was able to relax, I was also having a problem with saliva. My mouth makes a lot--dentists have commented on how healthy that is. When sleeping, I have three options: swallow, drool, or drown. The mask made drooling almost impossible so I was swallowing. Every time I'd swallow, the machine thought that I was inhaling so it gave me a blast of positive pressure which wound up in my gut with the saliva. After about 20 minutes of this my stomach was distended and I was belching into the mask. After about 20 minutes of belching into the mask, I gave up, sat up, and pulled the mask off.

"So," the tech said, "it's midnight and you obviously can't do this. Do you want to go home?"

"Absolutely, yes!" I replied.

And that is how I wound up at home in my own bed before one am on a Thursday night with no respiratory assistive devices or wires attached to me. And I slept well. I felt great when I woke up at seven am. Before leaving the sleep center I pointed out to the tech that I normally really felt pretty good for a man my age. I'm relatively active and I don't have headaches and such. I also told him that I would rather die in my sleep than have to sleep with a PAP device on my face.

I failed a sleep test, even after studying and preparing for it.