"I'm really fatigued all the time," I explained to my doctor. "I have difficulty getting to sleep, I wake up constantly, I wake up not feeling rested, and I sleep for hours and hours every night to no avail."
She nodded seriously at me, taking notes on my electronic medical record -- there is something quite alienating about talking to a physician who stands in front of a giant rolling desk on wheels with a computer, typing, throughout our session together. I start to feel a little like a research subject. We went over the things you go over, and eventually, she declared that I needed a sleep study.
I don't really think I have sleep apnea, although I have asthma, so I know I'm at risk for it. I'm also fat, which is another risk factor, and allegedly I snore sometimes, another point against me. I suspected that my fatigue had a lot more to do with the fact that I am deep in a depressive episode, but if my doctor really wanted to rule out apnea, I was happy to let Obamacare pay for it. (Yes, I am what is wrong with the system.)
As it turns out, it actually takes a while to get an appointment for a sleep study, I guess because apnea is the hot new thing these days, or whatever. (Actually apnea is pretty serious, and it's rather underdiagnosed, especially among younger adults. Not breathing properly is no joke. Notably, it also increases depression risk, which is a serious issue for those of us who have underlying mental health problems.)
It wasn't until almost a month later that I went in for my "orientation" and found out that the name of the game in sleep studies has changed pretty radically in the last few years.
I thought I was going to have to spend the night in the sleep lab, hooked up to a weird assortment of equipment, while a bunch of creepy people watched me through the glass. Nope. Turned out that I was going to wear a WatchPAT-200 to bed with me, and it would do all the creepy spying on behalf of the sleep lab from the comfort of my very own home. Yay science!
At our orientation, we had to watch a short, sort-of dorky video on how to use the equipment. I tried not to giggle as I focused attentively on the screen, but my eyes kept drifting towards the side of the room, where I could see that the nurse was barely trying to contain her boredom -- she does two of these orientations a day, every day, so I kind of can't blame her for being totally over the WatchPAT video.
I was also the only person under 60 in the room, which I suspect had rather a lot to do with the timing, given that it was mid-morning, when many younger people are at work. Yet again, I marvel at the inefficiencies of the medical system, as the two trainings at my medical center are scheduled for midday and mid-afternoon, both bad times for working people who can't afford to take time off to go all the way to the sleep lab, watch a five minute video, fill out a brief sleep survey, and check out an expensive piece of equipment.
Very, very expensive. The nurse kept reminding us that the WatchPAT was "a $4,000 piece of equipment" and that it was important we bring our units back. We were required to return them before nine the next morning, which I thought was unconscionably early, but the older crowd seemed unperturbed by. (Seriously, lady? I'm usually still asleep at 9 a.m.)
After signing a document swearing that I wouldn't elope with my personal WatchPAT, I took it home and promptly forgot about it until bed time, when I bravely set out to hook myself up. I jokingly compared it to one of those horribly large and clunky 1980s calculator watches, but it might be better compared to an iPod. (Not a Fitbit, though, those things have a much slimmer design.)
The WatchPAT-200 has two leads. One goes to a little device you slip over your index finger to measure peripheral arterial tone -- which indicates what stage of sleep you're in, according to Itamar Medical. Once you insert your finger, you pull a tab that exposes tape inside the device, so your finger will stay securely stationed in sleep. Also, a small bladder inside inflates a little, to stabilize your finger and increase the measurement accuracy.
If you're thinking that it looks kind of like a finger puppet, well, you're not the only one.
The other lead goes to a pulse oximeter that you attach like a Band-Aid, with little wings and a wrap-around bit. It helpfully flashes a red light throughout the night as it collects data on how much oxygen is circulating in your blood. (Pulse oximetry: More science!)
(Note: Itamar just announced FDA approval for a new model, where the oximetry probe and the PAT probe are combined into one unit.)
You're supposed to put it on right before you go to sleep and then turn it on and wait for the magic to happen. It kindly says "Good Night" before beginning to record the nitty-gritty details of your sleeping patterns for all the staff at the sleep clinic to know.
One of the advantages to systems like this is supposed to be that patients can use at them at home, in a more natural environment, so the data are likely to be more valid and helpful. However, I'm somewhat stumped on what's "natural" about sleeping with a giant piece of medical equipment strapped to my wrist. I tried sleeping on my side like I usually do and kind of balancing my arm on top since I couldn't pull it to my chest, but it felt weird. I shifted to my back and let my arm splay out, but that wasn't comfortable either.
Eventually I compromised by lying partially on my side and supporting my be-WatchPATTED arm with a pillow, which seemed to be the most effective. It definitely felt like it took even longer to get to sleep than usual, and every time I woke up, I was either clonking myself in the head with the watchPAT or tangling myself in the (extremely short) leads. By the time I finally gave up and decided to get out of bed eight hours later, I had to admit that we were at watchPAT: 1, me: 0.
Once I had successfully extricated myself from the machine, I learned that my index finger hurt. Rather a lot, actually. I didn't have bruising or broken skin, but something inside the probe had obviously folded some of the flesh on my finger the wrong way or something, because it felt pinched and strange all day and made typing into an unpleasant and uncomfortable ideal.
I raced to Kaiser to return my equipment before they sent the law or Nurse Ratched after me, and then it was time to wait for the interpretation of my results, which would, I'd been told, take a week or more depending on whether they were negative (a week) or positive (more).
Here's where the plot thickened: A mysterious voicemail mandating that I report to the sleep lab on the weekend for an appointment with an elusive doctor...