Adventures in Sleep Apnea Testing
I've never been told I snore, so I must be fine, right?
I find new medical experiences to be fascinating.
It’s probably a good thing, since I have ended up needing to do so many tests the last few years, but my interest in medical stuff has always been there even when I was healthy. I have regularly binged shows like Venom ER and Mystery Diagnosis since I was a child, so it should really come as no surprise to anyone who knows me that I’ve got a degree in biology now. I’ve just always had a fascination with the process of diagnosing things, how medical tests work, how different symptoms show underlying disease, and how differences in anatomy affect how people and animals interact with the world.
In my 12th grade biology class I was unhappy with the level of detail during the starfish dissection, because we essentially only cut off one arm and looked at a cross section. Boring. I wanted to see more! I’m sure you can imagine the horror of my classmates when I was a little too excited to continue the dissection on my own, completely unguided by the teacher. It turns out there’s really not much to a starfish, but there is actually a lot to a human mouth! Look at that beautiful topic transition. That wasn’t awkward at all!
Anyway, mouths are more complex than I knew, and the shape of your mouth can directly relate to whether or not you’re prone to sleep apnea. Since I get the pleasure of needing to do so many different kinds of medical tests, and I thoroughly enjoy the experience of learning about said tests, I thought it would be a good time to talk about my experience with investigating whether or not I have sleep apnea.
Open your mouth and say aaah!
Like most people, I’ve had doctors inspect my mouth plenty of times. It’s usually in relation to a sore throat, so I wasn’t expecting it to be the first thing that happened at my sleep apnea consult. The doctor asked me to open wide, stick out my tongue, and then she explained what she was looking at.
My soft pallet wasn’t thick, and my uvula wasn’t large. My airway looked typical. Jaw? Pretty standard. Both of my tonsils were of the usual size, and neither “high” nor “narrow” could be used to describe my hard pallet. Thanks to the braces I wore as a child my teeth were not crowding anything, either. All of those features can contribute to sleep apnea if they are abnormal because (and this seems obvious in retrospect) if your mouth is small or crowded with extra tissue, it’s easier to block your airway. She had spent so long listing all of the ways my mouth was totally unremarkable that I was not prepared for when she said “I will say you have a very wide tongue.”
I’m sorry, what? I was not aware that having a wide tongue was a thing someone could have, but apparently, I’ve got one. I wasn’t about to argue with her, because at that moment I distinctly remembered a time where one of my dentists in the Navy was worried that I had oral cancer. Every visit I went for a teeth cleaning I would have this rough patch in the same spot on the side of my tongue. I was pretty sure I was just biting my tongue in my sleep, but when I offered that explanation everyone told me is not something people generally do. I even had to get the damned thing biopsied, only for them to say “maybe you are just biting your tongue.” So yeah, in retrospect having a wide tongue makes sense.
Still, although she wasn’t too worried that the anatomy of my mouth was a smoking gun, she said that because of my overall symptoms it was still worth it for me to do a sleep study.
There’s no sense not to at this point.
I’d never really given sleep apnea much thought because as far as I knew I didn’t snore, and that was the extent of my sleep apnea knowledge. Snoring equals maybe you annoy other people when you’re sleeping and get a bad nights sleep, but if you don’t snore, no worries, right?
How wrong I was! Not only can sleep apnea have serious long term health consequences like contributing to heart attacks and strokes, but it turns out you can have sleep apnea without snoring. I guess relying on other people to tell you if you have a problem is not a great way to collect data. While being told you snore is a good indication you might need a sleep study, it’s not the only one you should be looking for. Here’s a few of the reasons I should have gotten this thing scheduled sooner:
I consistently wake up tired, and I’m tired during the day.
I regularly wake up with headaches.
I have high blood pressure.
I have family memebers with sleep apnea.
I have trouble concentrating.
I’m overweight.
If I was also male, older, or drank alcohol, those would all contribute to the “why the hell haven’t you been tested for this earlier” question. Yet there’s another reason I’m kicking myself for not doing this sooner, too.
The test is so easy to do.
When I first heard I’d be doing a sleep study I thought there’s no way I can spend a night away from home in some random room hooked up to sensors all night. How would I manage childcare? How would it affect my work schedule? Would I have to drive to some distant city where they had the facilities for that kind of thing?
Yeah, that’s not it at all. It turns out all you have to do is pick up a small device from the doctors office, put it on, and then go to bed. Super easy. This also means the test can be done at your house. The kit comes with a sensor you stick to your chest, a tiny cuff that goes on your finger, and another thing that you wear like a watch. In fact, it’s called a WatchPAT study. PAT stand for peripheral arterial tonometry, which is a fancy way of saying it looks at what your blood vessels are up to while you sleep. When you stop breathing (an apneic episode) your blood pressure rises, your pulse increases, and your blood oxygen drops. Because the watchPAT device can also sense whether or not you’re snoring, it can put all that data together to say “Damn girl, you got sleep apnea. Maybe you should do something about that.”
That’s exactly what the nurse said during the follow up.
Well, not verbatim, but the end result was that in 7 hours of sleep, I snored for a staggering 174 minutes. That’s nearly three entire hours of snoring for someone who has never been told that they snore! My blood oxygen went as low as 88%, which is definitely considered low, although apparently it didn’t ever stay low, which meant my apneic episodes weren’t very long. All tolled, I had a total of 8.8 apneic episodes per hour. This puts me into the “mild” category of sleep apnea, which seems odd since it also means that I stop breathing on average around 70 times a night, but apparently on the extreme end some people can have 300 or more episodes a night. Wild.
One of the most interesting things I learned from this study is that my sleep apnea is almost entirely positional. The device can determine if you’re sleeping on your side or on your back, and when I was on my side, I averaged just 0.8 episodes per hour. However, when I was sleeping on my back, I averaged 11.3 episodes. Those are pretty different numbers. They’re also frustrating, because I always go to bed sleeping on my side, but apparently as soon as I fall asleep my body says “absolutely not” and rolls over into sleep apnea mode. Cool cool.
One of these days me and my body will learn to be friends.
But today is not that day. For now, I have a number of options to address this newfound diagnosis. These include:
Everyone’s (least) favorite, a CPAP machine! CPAP, which stands for “continuous positive airway pressure” basically means there’s a constant stream of air being pushed into your nose and mouth making it pretty hard for your airway to collapse. Although in the past CPAPs have meant wearing a bulky mask, apparently newer ones are less cumbersome, and the machine is a bit quieter as well. Still, I’m an extremely light sleeper, and the noise might be a problem for me, so I’m going to hold off on this until I try the other options first.
A custom made mouth piece. I had no idea this was a thing until my appointment, but apparently a dentist can create a fitted mouthguard that pulls the jaw forward. This positions the mouth so it’s harder for the airway to collapse. There’s also no noise involved, and would feel less invasive overall for me I think. This feels like the ideal “best” option, although apparently they can cause some TMJ pain and jaw discomfort, so that’s something I’ll be watching out for while also working on the third thing.
Simple body positioning training. Since my sleep apnea seems to only really happen when I sleep on my back, I need to learn to just… not do that. Problematically, I’m apparently only rolling onto my back after I’ve fallen asleep. This means I need to go buy some wedge pillows to prevent myself from rolling over, as though I’m a giant toddler with crib bumpers. I plan to embrace this new reality by eating an unlimited number of apple sauce pouches and fruit snacks. Now that’s a real perk.
Hopefully, I’ll start sleeping better soon.
Now that I’ve spent some time droning on about my experiences with the sleep study and some of the symptoms, it’s worth asking you a question. Does any of this sound familiar? I know tons of people struggle with sleep, so if it does, it may just be the right time to ask your doctor for an at home sleep study. Considering the symptom overlap between Cushing’s and sleep apnea, anyone with Cushing’s would probably qualify for a referral pretty easily. I don’t know for sure how much better my sleep quality will get, but I know how god awful it is right now, so I’m looking forward to improving it! As always, I’ll let you know how it goes.