JOIN USHe must have nodded off for a decade. Ten years ago, I spent two nights in a sleep lab at Downstate Medical Centre, taking the test for sleep apnea, and wrote about it for Science Times. Back then, “sleep technicians” wired me up like the Bride of Frankenstein: 15 sensors glued or clamped to my scalp, lip, eye sockets, jaw, index finger, chest and legs, two belts around my torso, and a “snore mike” on my neck.
As I slept, an infrared camera watched over me. And I ended up spending 23 hours in that hospital bed because the test wasn’t over until you could lie in a dark room for 20 minutes without dozing off. I had such a sleep deficit that I kept conking out, not just all night, but all the next day. So this year, when a company called NovaSom offered to let me try out a new home sleep-test kit that promises to streamline the process, I said yes.
In the decade since my ordeal, the pendulum has swung sharply in the direction of the home test, said Dr M. Safwan Badr, past president of the American Academy of Sleep Medicine. Insurers prefer it because it costs only about $300, about one-tenth that of a hospital test, and many patients like it, too.
“Lots of people are reluctant to let a stranger watch them sleep,” said Dr Michael Coppola, a former president of the American Sleep Apnea Association who is now the chief medical officer at NovaSom.
Home testing is not recommended for those with heart failure, emphysema, seizures and a few other conditions. And because it does not record brain waves as a hospital lab does, a home test can be fooled by someone who just lies awake all night staring at the ceiling. But it’s useful for many people who exhibit the warning signs of apnea, such as waking up exhausted after a full night’s sleep or dozing off at the wheel in bright daylight. And severe apnea can be lethal: starving the brain of oxygen all night quadruples the risk of stroke. Ten years ago, after my long lab night, I was given a diagnosis of mild apnea.
The likely culprits were that I was overweight, had some bad habits — coffee-fuelled evenings at work followed by late wine-fuelled dinners at home — and that I had a “crowded airway.” (The doctor looking down my throat said “Wow!” My uvula apparently resembles not a punching bag but a stalactite.) The Downstate doctors made me abstain from coffee and alcohol for 24 hours and be tucked in just after 9 p.m. I protested that my life was not like that. But it had been years since I had negotiated bedtime with an authority figure. I lost.
Tough decision
After my diagnosis, they offered three options: I could lose weight, drink less and go to bed earlier. I could have airway surgery. Or I could sleep with a CPAP (continuous positive airway pressure) machine blowing air into my lungs. For me, surgery was out. A cousin said it was the most painful thing he had ever endured, changed the way he spoke and didn’t cure his apnea. I tried the CPAP and hated it: Although for many people it is a lifesaver, I felt as if I were sleeping inside Darth Vader’s helmet. So I joined Weight Watchers and lost 35 pounds.
Ten years later, my habits are still imperfect — I still drink a bit more than I should, and I’ve gained back 15 pounds. In bad weeks, my BMI is 25, right on the border of normal and overweight. As for my snoring, depending on the audience, it has been described as “pretty awful” and “some of the least offensive I’ve heard.”
The home test is done over three nights, and I made them as true-to-life as possible: I did the first with no alcohol or caffeine, then one with my typical amount, then one with too much. On Night 2, to add to the challenge, I invited over a friend and her dog.
The device arrived by mail (and is mailed back later). I was able to wire myself up without help in 15 minutes: a belt clipped around my chest, a finger poked into a blood-oxygen sensor and a breath sensor hooked over my ears and taped beneath my nose. All three plugged into a box the size of a computer modem strapped on my arm.
The best part: By shifting the box or laying it on the pillow, I could sleep almost normally. At the hospital, my 15 wires had felt like marionette strings keeping me on my back. At home, I could flip from side to side, as usual. The first night was during a major snowstorm. I ate dinner early and drank only water, tired myself out by shoveling a foot of snow and was soon so bored that I went to bed at 8:30. I slept 10 hours and even had dreams. (The usual: Trapped in a giant men’s room. Sounds kinky, but even Freud would agree that its deeper meaning is: “Hey, stupid! You need to go! Wake up!”)