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Tuesday, January 04, 2011

So yeah... the sleep study post (toned down a bit)

As some of you may remember, after receiving a diagnosis of possible sleep apnea, the next logical step was to schedule a sleep study.

Glad you asked. Simply put, a sleep study is a night passed restlessly in one of the most inhospitable, alien environments imaginable (e.g. a hospital), while wired up like the electrical grid in a Mumbai slum.

The basic science is sound; in order to find out how you're sleeping, they actually have to gather some empirical data... while you're sleeping. So far so good, at least in theory.

However, in practice, we humans are a fussy lot when it comes to where and when we sleep. I'm actually one of the less fussy specimens of the species in this respect and, thanks to my time in the Navy, I usually lose consciousness whenever an adequate combination of warmth, dryness and victual satiation is achieved.

One would think, therefore, that hospital sleep laboratories would be designed with the more finicky sleepers in mind.... that the rooms would be as soothing and comfortable as possible, and that someone would put some thought into how to make the data gathering equipment (i.e. wires and tubes, etc.) as unobtrusive and nonrestrictive as possible.

One would be wrong.

But I'm getting ahead of myself. When last we spoke about this topic, I mentioned that I had made an appointment at a hospital sleep lab in Jerusalem... and that they had faxed me a confirmation sheet with the date of my appointment, the time I was supposed to be there (10PM), what I should bring with me (pajamas, toiletry kit. etc.) and what time the study would be over (6AM).

So, on the appointed day, I packed a small overnight bag, strapped it to the back of my scooter and rode into Jerusalem... arriving at the hospital at 9:40PM. I locked up my scooter... walked inside and asked at the desk where the sleep laboratory was located. I received helpful directions to the correct floor and ward, and by 9:55 was standing at the door to the sleep laboratory. Which was locked.

I knocked a few times on the door, but got no response. Thinking that maybe there was more than one sleep laboratory in the hospital, I went back down to the reception desk and explained what had happened. The woman at the reception desk assured me that I had gone to the right place and after looking at the fax I'd received, confirmed that the date and time were correct. After several unsuccessful attempts by the receptionist to reach the sleep laboratory on the phone, she sent me back upstairs with an escort to make sure I'd gone to the right place.

The escort and I went back up to the locked door where I'd knocked before... and knocked some more (for this I needed an escort?).

After returning to the reception area, a supervisor was called in for consultations, and my faxed confirmation was again scrutinized and declared kosher. The only problem was that it was now almost 10:20PM and instead of being in my 'jammies getting ready for bed...I was standing in a cold lobby, seething mad, and nobody seemed to have a plan.

While they tried to sort out what to do with me, I went down the hall to the concession stand for a cup of herbal tea. While the young woman there was preparing the drink, I vented a little bit... telling her about the strange events of the evening so far. As luck would have it, the woman who was preparing my tea had a sister who actually worked in the sleep laboratory. Her sister wasn't scheduled to work that night (that would have been too much to ask), but she would certainly know how to reach the person in charge of the lab (something the reception staff had, thus far, not thought of).

A few phone calls later, I was speaking with the head of the sleep laboratory, who was also not working that night, but had the cell phone of the woman who was supposed to be on duty. She took my cell phone number and promised to call me back after speaking with the woman.

Sure enough, within 10 minutes my phone rang and I was told that I should go back up to the sleep lab and that they would open the door for me. (!) No explanation of why it was locked... but what the heck, at least things were moving in the right direction.

I grabbed my tea, thanked the young woman for her help, and went back upstairs to the sleep laboratory. When I got to the door a surly, middle-aged woman stood barring the now-open entrance, and greeted me with a two word salutation designed to put me completely at ease: "You're late!"

Thinking I must have misheard her I said, "Excuse me? I'm late?! I was here early and the door was locked!"

Without budging out of the doorway, the woman said, "You were supposed to be here by 9:00PM... we lock the door after 9:30".

I took out the faxed confirmation and shoved it in front of her scowling face. "Look", I hissed. "It says right here that my appointment is for 10PM. I was here at this door well before 10! Where were you?"

Without batting an eye, the woman responded, "The form always says 10, but you were told to be here by 9".

"Nobody told me any such thing", I snapped. "I got this appointment by fax, and as you can see it says to be here at 10PM. I faxed back my acceptance of the appointment, and haven't had any contact with this laboratory from that time to this. How was I supposed to know to be here an hour early?".

She stood there with her hands on her hips and said, "Someone called to tell you".

I stared at her for a few moments and said, "Does that make any sense to you? You send deliberately incorrect information to a patient using a reliable and verifiable channel such as a fax machine... and then provide the correct information afterwards using an unreliable, completely unverifiable channel such as a phone call? I'm asking... does that make any sense at all?!"

By now I was shouting.

She tried to shush me by saying "Sir, you'll have to keep your voice down, people are trying to sleep here!"

I wish I'd been hooked up to a blood pressure cuff at that moment... just for the sheer fun of shatteirng all previous hypertension records.

"I know" I screamed at her, "I'm supposed to be one of the people sleeping right now! I'll accept that you have an ass-backwards way of doing things here, and that it is someone's job to send out misleading faxes and then follow up with a phone call to pass along the correct information. I accept this because clearly everyone else received such a phone call and arrived by 9PM. But this completely insane system of yours broke down when it came to me, and the proof is that I'm standing here at 10:30 shouting at you in the hallway instead of being asleep inside your laboratory! Are you going to let me in, or do I have to get your supervisor back on the phone?!"

Playing the supervisor card shook things loose a bit. She didn't back down from her obstinacy or offer an apology (G-d forbid)... but she moved out of the doorway and let me into the sleep clinic.

I followed her down a short hallway and she indicated an unoccupied room where I was supposed to go. The room was about the size of a walk-in closet with a narrow bed and a night table. Next to the bed was a small trash can into which some thoughtful soul had put a used diaper.

As I looked at the tiny cubicle, all I could think of was 'I've never been in prison or a brothel... but one or both must be something like this'.

I went in, changed into my pajamas, brushed my teeth, and then went out to look for little miss sunshine to see what the next steps might be. I found her sitting at a computer playing solitaire. When she saw me, she said, "Go back to your room, I'll be there in a few minutes".

I was tempted to make another scene, but I decided that the people who were already tucked into their beds didn't need to be disturbed because of the incompetence of one woman. So I went back to my cell room and waited.

And waited.

And waited.

After awhile she must have finally won a game of solitaire, because she suddenly appeared in my doorway with a brisk, business-like air, carrying a box overflowing with wires.

With barked mono-syllabic commands she indicated what appendage she wanted access to: "Arm... other arm... leg... other leg... turn your head... other side... chin up... turn around... nose...". You get the idea. Most of the wire leads were attached to self-adhesive contacts that she slapped onto various points on my anatomy irrespective of hair or joints.

After I was all wired up, the woman left the room with the following parting shot over her shoulder: "Try not to move around too much because the wires will get tangled or become disconnected.".

I eventually fell asleep, and at exactly 6 AM I was awoken by a different woman who I'm assuming was the daughter of the master chief petty officer who shepherded me through basic training in the Navy. Let's just say that it was an abrupt wake-up call.. followed by a series of yelps as she ripped each of the wired leads from my body in rapid succession.

The results I've already shared, so there isn't much else to say... except that if any of you ever have the need to take a sleep study, be prepared for something somewhat less than a visit to Club Med.

Posted by David Bogner on January 4, 2011 | Permalink

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Maybe you just ran into an atypically incompetent sleep lab. I went in for two sleep studies - the first to see if I had sleep apnea (I do) and the second to verify that using a CPAP machine would get rid of it (it does). The information I received was accurate, the staff was polite, and all went reasonably well, although I did have the patches on body hair issue to deal with.

Posted by: Russell Gold | Jan 4, 2011 3:43:28 PM

I was fortunate to have my two sleep studies at clinics that were staffed by decent human beings. I can't imagine how you got to sleep after beginning the evening like that.

Posted by: Chichikov | Jan 4, 2011 6:13:13 PM

Chichikov, you have no idea the amazing ability that my brother has, to fall asleep ANYWHERE!!! People are talking around him and kids could be screaming next to him. If he's horizontal (and even sitting up, I'm sure) he can sleep!

Posted by: val | Jan 4, 2011 7:15:43 PM

Wow! My experience was TOTALLY different. Here in WA state, we have a place (among a few) called Pacific Sleep Center and it is a remodeled house. The rooms are simple, but very nice (not like a hospital at all)with light blue walls, comfy regular full sized beds and very quiet. The tech who wired me up was very kind. How can this woman expect you to fall asleep after that kind of exchange?! Oy. I'm sorry you had to endure that level of frustration.

By the way, my 19 year old son was just tested after being exhausted no matter what he did for the last six months and HE has sleep apnea. He has 20 wake events an hour and he'll be getting his machine in about five days. What is UP with all this sleep apnea!?

Posted by: Maya | Jan 4, 2011 7:20:46 PM

I think that you missed out on a golden opportunity to combine the sleep study with a colonoscopy. Really, it could have saved so much time.

Posted by: Jack | Jan 4, 2011 7:47:55 PM

Did they offer you an evaluation card so you could rate your experience? Or did you follow up? I'm still trying to wrap my head around the logic of faxing one time and calling with another. Oy.

Posted by: JDMDad | Jan 4, 2011 8:31:35 PM

Definitely not a brothel, I imagine. At least in a brothel you get a woman with a better bedside manner.

Posted by: QuietusLeo | Jan 4, 2011 10:15:17 PM

;-P

Posted by: QuietusLeo | Jan 4, 2011 10:15:32 PM

Comedy gold, this was. Alas, my sleep studies were never so... exciting.

Posted by: Elisson | Jan 4, 2011 10:34:13 PM

Boy, is that simile bad. In one, you get an attractive woman that you hope won't put you to sleep.

Anyway, in many places in the US they convert hotel rooms for these studies, and they're maintained beautifully. I suppose it depends on the reimbursement. But you definitely picked the short straw. Be happy she wasn't a judge you had to appear before as an attorney, which has happened to me, thank you for reminding me of one the most demeaning and unmanning experiences in my life.

Posted by: Barzilai | Jan 4, 2011 10:36:54 PM

Was this a hospital whose initials are S and Z? Because I too was told to be there at one time and then berated for not getting there earlier. The staff was otherwise nice, but the room was stiflingly hot. According to my test I slept fitfully for only 3 hours. But at least they got the data they needed.

The 6 am wakeup call is so unhelpful. They CAN'T let you sleep until 7?

Posted by: Sarah | Jan 4, 2011 11:40:49 PM

I would have re-scheduled and then make sure to verify everything first by phone. With such a bad start, don`t expect a good conclusion.

Posted by: ED | Jan 5, 2011 2:50:07 AM

Sarah... Bingo.

Posted by: treppenwitz | Jan 6, 2011 2:28:39 PM

Oh, so sorry. My hub went through that; the worst part for him was getting the stickum out of his hair from the ones they attach to your head. But the CPAP has really improved his quality of life. He recommends the mask that's essentially an overgrown oxygen cannula. Good luck with all of this!

Posted by: bratschegirl | Jan 7, 2011 2:18:58 AM

I pity with your experience. Mine was far better. And getting in the lab with such temper must've lead to bad reactions later too. Anyways hope your future endeavours are better.

Posted by: Good sleep | Jan 20, 2011 8:46:20 AM

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