One of my doctors wants me to go get another sleep study, which would be fine and dandy except it will cost me at least $500. I’ve had sleep issues all of my adult life and have had two prior sleep studies - one about 25 years ago and one 10-15 years ago - where nothing was found. So is it even worth it? Have there been any advances in the last 10-15 years that make it even possible that the results would be any different this time?
There actually have been a few changes in that time frame.
The most notable one being the introduction of new pressure transducers that allow the techs (and interpreting docs) to note more subtle respiratory events and arousals. These events may not cause the same overall health dangers that more obvious apnea does, but they can certainly cause poor sleep. According to my wife, who is a registered sleep tech and teaches at a training program for techs, these changes came into play in 2007, definitely within that time window since your last test.
Other changes include a change in the belt that measure the breathing effort and in the electrode placement (which may lead to picking up more data). These came into place starting in 1999, and either or both could help pick something out.
That said, the biggest change would be those the years have had on you. Obviously, you’ve had several tests, but even ten years is a long, long time in terms of how your study may turn out.
One last thing to consider is talking to a sleep specialist about having an MSLT if you haven’t before. If your baseline tests have come up normal but you still have a lot of daytime tiredness, that’s usually the next step. The MSLT is most commonly associated with diagnosing narcolepsy, but it can help pick up other sleep issues as well.
You’ve almost convinced me. 
I believe that the study would include a MSLT - I know they were talking about me hanging around the day after and trying to nap after a certain time.
I’m still not sure it would show anything tho. I don’t have daytime sleepiness, I have non-restorative sleep. As long as I can remember, at least all of my adult life, I have always felt unrested when I wake up, no matter how long I’ve slept. When I was younger, there was literally no difference between being up all night and getting eight hours. Now, at 54, I feel an all nighter but not as badly as most old bats do!
But, the doctor has been pushing it for a year and since there have been some changes in the study, maybe something will actually be found this time. Can only hope…
Thanks!
- YOU might have changed - studies I had in 2000-2002 showed insufficient apnea to warrant CPAP, while one I had in early 2010 did show enough.
- The technology is pretty much identical… though the stuff they use to glue the electrodes onto the scalp is different. Doesn’t require solvent to release 'em at the end of the study, instead they use something that looks like snot (only stickier, and more of a pain to get out of your hair).
- There are also home-based sleep studies. Those don’t measure as many things, but might give better results in that you’ll sleep better, probably, than at a lab.
My diatribes on sleep lab misery are scattered around the board in IMHO and/or GQ. I dislike them intensely, and I suspect I’ve got a much larger personal data set than most.
That said: if there’s good medical reason to think you need one, the results can quite literally be life saving. I’d certainly do one again if the doc insisted.
Good point!
I had this done at my last sleep study (last December). I had the fun of spending literally 24 hours at the sleep lab (nighttime regular to measure effectiveness of CPAP followed by daytime MSLT). In my case it was to verify whether I had narcolepsy (no obvious symptoms of that beyond severe daytime sleepiness).
No narcolepsy, but I did show signs of falling asleep a LOT faster than a “well-rested” person should.
Huh - just read your response and I wonder why they’re planning on an MSLT right off the bat, since you don’t report daytime sleepiness. Maybe they just want to cover all bases in one session, vs having you try the nighttime, treat whatever that turns up, then still maybe require the daytime test.
Be prepared for the insurance (if you have it) to try to turn down the MSLT portion - that’s what mine did at first. I guess that’s less common so they questioned it.
The nighttime study might show apnea (obstructive and/or central), periodic limb movements / restless legs (though you and/or your bed partner would probably have already noticed these!), or problems with getting the right amounts / ratios of the various sleep stages.
In short - if you’re sleeping enough (quantity-wise), and still feeling unrested, I think it would be worth try.
Oooh - I’m glad **akennett **mentioned the pressure transducer. When I had my first 2 studies in 2000 or so, both times the measuring thingy under the nose was a wire with 2 prongs that, I guess, measured temperature differences in the nostrils as you inhaled / exhaled (wouldn’t work too well with a mouth-breather, however). When I visited the Big Guys up at Johns Hopkins (for my RLS), they wanted me to have another study - with a cannula-type measurer vs. the wires, because it’s more accurate.
Well, I got there - sleep-deprived and everything as I’d learned was necessary for me to get any sleep - and they didn’t have any cannulas on hand and wanted to hook me up with a wire instead. I pitched a FIT. The ONLY reason I was even there was so they could get the measurement with the damn cannula. I said if they could not find one, I was leaving.
They found one.
That’s one of the reasons why I hesitate - my last two sleep studies showed nothing, nada, zip, “you are completely normal”.
I sort of did this a few months ago, when I went to the sleep Dr. He sent me home with a thing that wrapped around my chest and another thing that went up my nose, both connected to a thing that would record my breathing. (Like that technical jargon?) It didn’t show anything either, but I think it was just for deciding if I should be retested with a CPAP.
Heh, another issue that is making me have second thoughts - I have plenty of medical issues but none are directly related to my sleep problems. My rheumatologist just wants to check to see if my idiopathic joint pain is because I’m not getting restorative sleep, but since that’s the way it’s been for me for 40 years, and the pain is “only” 20 years old, I’m not sure how the two go together. OTOH, it would be nice to know what it’s like to wake up refreshed!
Dunno!
I think the sleep Dr’s office already cleared it, but I tend to assume that my insurance (United Healthcare, may they be nuked from space) isn’t going to pay for anything and I always check.
I’ve experimented with it - on weekends when I have nothing planned, I can literally sleep for a whole day. I wake up the first time after about 7-8 hours but can fall right back to sleep if I don’t get out of bed. OTOH if I set the alarm and only get 5-6 hours, I feel exactly the same.
That would have been me too! Haul me up there for something specific and then not have it? I’m outta here.
Are you sure you’re not me? 
Long ramble about me below, feel free to skip.
I’m much the same way - can consistently get reasonable quantities of sleep, and still feel like hell. This past Monday, I’d had 9+ hours of sleep. Admittedly, the 2 previous nights were less-than-optimal quality / quantity, but still… after 9+ hours of sleep I should NOT have needed a 3 hour nap.
On a “normal” weekend, I’ll sleep 9+ hours Friday night, be stunned awake by the alarm clock at 9:30, and NEED a nap - a 3-4 hour one. Then I have zero trouble falling asleep, sleep for 10+ hours Saturday night, and finally don’t “need” a nap but could sure use one.
And, note, this is with consistent use of the CPAP, and with my RLS adequately treated…
It’s quite frustrating to document, and address, other causes and STILL be too damn tired. The “excessive daytime sleepiness” can’t really be fixed, either - just throw drugs at it when I must be alert, and skip them when I can afford to be the undead.
/end of ramble about me
Have they ruled out other possible causes for your fatigue, like thyroid, anemia etc.? Any chance you might have GERD?
I’m guessing that, even though you don’t appear to have apnea per the screening test (and earlier sleep studies), maybe they think they’ve ruled out other causes? If so, a sleep study might be a reasonable next step. You could have something other than apnea contributing. Maybe a level of hypopnea that the less-accurate home test missed, maybe a problem with not getting normal amounts of the various sleep stages. maybe something else that I am not familiar with.
Actually I hope, for your sake, they do find something treatable, vs. “you’re sleepy, no reason why, here take these expen$ive pills”.
I’m different in that if I get up, I’m up for the day and then when it’s night and time to go to sleep? Yeah, not easy. Generally, I can’t get to sleep before midnight and sometimes it isn’t until 2 am! This was true even when I was working.
Wow - I don’t have those problems at all. I just feel like crap in the morning, take forever to get going because it seems like I can’t jump start my brain, and I have a very specific time frame when I can sleep.
I think I’ve had every test known to man over the years!
We’ve actually gone that route as well, and of course none of the pills worked.
Sorry to hear the pills didnt help! I assume you’re talking about wake-me-up pills vs. the sort that would knock you out at night?
Have you met with an actual sleep specialist? I wonder if you don’t have some sleep phase disorder, since it sounds like you have trouble getting AND trouble falling asleep when you want to.
I had some good-ish news today: saw the regular doc for the first time in 4 months. Last time, I’d taken a dose of my Nuvigil and my blood pressure was pretty high, so I’ve been afraid to take it very often at all. Not “you’re going to stroke out” high, but enough to bear watching. We hoped it was because I’d just come off a 2-week course of oral steroids.
Haven’t had steroids since then, I took a pill this morning, and my BP was fine this afternoon. So I may be able to use it as needed :).
I’ll second this. What you described sounds like what I had. From the time I was a teenager until I was in my mid-30s, I had a horrible time waking up every morning. Turns out I had a delayed onset of REM sleep, so I could sleep all night and wake up exhausted – and usually did. For years, people just thought I was a slacker.
The problem was easily treated, and now I get up without an alarm clock every morning, rarin’ to go.
How was it treated in your case?
I don’t think I have that (at least 6 sleep studies haven’t reported it) but there are times where if I wake up early-ish, I can slip RIGHT back into dream state. Too-rapid descent into REM can be a sign of narcolepsy; I don’t appear to have a clinically-significant amount of that either (nor the cataplexy / sudden sleep attacks that are so classic).
Then there are nights like last night, where I spent pretty much the entire night in that awful almost-awake, sorta-aware, but sorta-dreaming state. Bleh :(. Fortunately, I know what caused that (first night on a full dose of Nuvigil after several months of half or no tablets). It’ll go away in a day or so. Sometimes that happens the first night after I’ve used a sleeping pill (even a single dose).
It’s funny timing, but on an RLS-related list I subscribe to, just today there was a posting on the use of melatonin for delayed sleep phase syndrome.
Oooh - this reminds me: I remember Sampiro once posting a thread about how he had a LOT of trouble getting up in the morning, sleeping through alarm clocks etc. He was ultimately diagnosed with a form of narcolepsy. Do some searching and see if what he describes in that thread sounds at all like you.
Aha - found it!
A short round of sleeping pills (maybe30 days), then melatonin. Haven’t had trouble since… in fact, I feel more rested and sleep less. Life changing.
What you describe above sounds like me, but none of the narcolepsy symptoms Sampiro mentions. Never had any trouble with being drowsy during the day. Just impossible to wake up and slow to get moving once I did wake up.
Both - yay me! If I take that legal speed, what is it called - dexidrine - I can wake right up but it, er, has other issues… I forget what all I’ve tried but I think it’s been pretty much everything.
I don’t remember about the previous two, but this one is a “Diplomate, American Board of Sleep Medicine” and has a bunch of letters after his name, so it appears he is a specialist.
Great! Hope it keeps up that way.
Sure does sound like what I have. I see below that you are taking melatonin - I’ve tried that but not for a very long period of time, maybe I should give it a month?
Must have been fantastic that first time to be able to wake up and feel good, eh?