Polysomnography: The Sleep Study Part 1

My close friends like to joke about the fact that I sleep a lot. During a normal day, I’ll take a 2-3 hour nap in the afternoon. I go to bed for the “night” between 2:00 AM – 3:00 AM, waking up around 11:00 AM – 12:00 PM. Sometimes I head back to bed as soon as 2 hours after waking up either out of depression, boredom, or a constant feeling of being tired and lethargic. My energy level is minimal during the day. I usually get most of my work done at night after 7:00 PM. I run intro trouble anytime I’m off my schedule traveling or socializing. I’ll either demand that I take a nap or just suck it up and feel miserable for the day.

I talked to my psychiatrist about my sleeping habits. She suggested my abnormal routine might be explained by the fact that I simply function better at night. She said some people are just “hard wired” this way. Her point made sense when I reflected on my own sleeping routine and also when considering other people working the second or third shift. If you head off to work at 12:00 AM, chances are, you’re a “night person” by nature.

I’m constantly at odds with my family over my sleep habits. My parents have done the same routine for well over 30 years now: up at 6:30 AM, work until 9:00 PM at the latest if there are meetings, and go to bed by 11:00 PM. My father, in particular, doesn’t complain about feeling tired and seems to thrive on his routine. My mother, a high school English teacher, works around the “school” clock. She comes home around 4:00 PM or 5:00 PM at the latest and will sometimes “close her eyes” for an hour before dinner. Then, she’ll correct papers or watch TV until bedtime. Both my mother and father can’t understand why I sleep so much or how I can possibly go to bed at 3:00 AM. They believe I need to reestablish a morning oriented routine, since this is the schedule most of the world operates on.

For the most part, I accept my psychiatrist’s theory about my sleep routine. I may indeed work better at night, but that doesn’t explain my constant need for naps and low energy level. I’m 32, not 72, and I should wake up refreshed and ready for a complete day without needing to lie down again later.

So, it boils down to two core issues: 1) Is my BPD/Depression hindering my energy level, causing me to sleep all the time? and 2) Is the quality of my sleep sufficient for a full day of “normal life”, or am I experiencing problems at night that make my sleep unproductive?

For the record, I have snored since I was a child. My family has even complained about it. Sometimes I’ll awaken suddenly at night finding myself moving around in my bed, as if I was acting out my dreams in real time. I’ve hit my head on the wall, had “sex” with my bed, and even caught myself attempting to run while in my sleep. If I’m sleeping somewhere other than my own bed, I suffer occasional Night Terrors, where I have a horrific nightmare and wake up screaming out loud in a panic. This happened twice while I was in Panama staying at a friend’s apartment 3 weeks ago. It scared everyone in the apartment: They thought I was either possessed or getting murdered 🙂 .

All of this strife over sleep finally led me to see a doctor specializing in sleep analysis. His immediate suggestion was that I should go to bed earlier than 2:00 AM or 3:00 AM, although when considering my mental illness and medications (particularly Clonezapam before sleeping) my odd routine was understandable. My chief concern was my low energy level. I expressed worries that I was not able to have a full day – regardless of my bedtime – because I was sleepy and depressed. I told him I wanted to start exercising again, but how could I even fathom lifting weights and/or running when I can barely get myself out of bed?

As a result, he prescribed a Polysomnogram, or Sleep Study, to analyze what happens throughout my body while I’m asleep. For those that have not heard of this, a sleep study is a relatively simple procedure.

Polysomnography: The basic procedure and preparation

First, you report to the study clinic an hour or two before your regular bedtime. In my case I went to the clinic at 9:30 PM because they could not accommodate me going to bed at 3:00 AM. They wanted me to attempt going to bed earlier. General preparation instructions included NOT taking a nap, avoiding caffeine and any other non-prescribed stimulants, and eating light. Pack your normal bedtime clothes and bring a pillow if you want. While at the Clinic I was told to follow my normal nighttime routine, including watching TV for a couple hours before brushing my teeth and heading to bed. The Doctor also wanted me to take all my medications as normal, including the Clonezapam.

About 30 minutes before bedtime, the lab technician will escort you to your bed at the clinic and start preparing you for the study. It’s a good idea to go to the bathroom before this begins. I was a little nervous so I made sure to empty my bladder, going twice before prep began. Then, the technician will start placing electrodes at various locations on your body, including your head, legs, and chest. My technician also attached a band around my chest to measure breathing, plus a nose piece (like what someone on oxygen might wear) to measure my nasal respiration. The preparation took about 40 minutes in total.

Once everything was set to go, everything else was straightforward: position yourself in bed as normal and sleep. If you can’t sleep, feel free to move around and find a more comfortable position. The various wires and straps attached to my body didn’t really bother me: the technician attached them with small pieces of tape and they were very unobtrusive. If you need to go to the bathroom, unplug yourself from the hardware and go, making sure to hook yourself back up when you return to bed. I had to go to the toilet twice that night: once about 45 minutes after lying down, and another time around 7:00 AM the following morning when I woke up early. I went back to sleep briefly and the technician got me out of bed at 10:00 AM.

Overall, I would say the experience of having a sleep study is pleasant and nothing to worry about. My only regrets were that I suffered insomnia for the first 1.5 hours or so. Additionally, when I finally drifted off to sleep, I slept lightly and did not sleep as soundly as usual. Hopefully these anomalies will not affect the test results.

For Part 2, I’ll talk about my results and the Doctor’s analysis of my sleeping routine…

Tips for handling Borderline Personality Disorder in College

I entered college as an “normal” person, although BPD was already brewing in my system. After an enormous public rage my Junior year and subsequent hospitalization, I graduated college with an official BPD and depression diagnosis. BPD is extremely difficult to tolerate no matter what stage of life you’re at, but I think it is most troubling during college/university years when social conformity and peak performance (academic, athletic, musical or whatever your discipline is) is necessary. I don’t agree with my father about a lot of things, but one thing he said about college was VERY true: “It’s a four year pressure cooker”. Lump in BPD, and you’ve got a recipe for potential disaster if you don’t take care of your mental health.

Next year will be my 10th reunion. Over the past nine years, I’ve spent a lot of time thinking about how I could have done things differently in college. For one, I didn’t know I had BPD, and that was a strike against me from the get-go. Second, I put myself in social situations that were very demanding and prone to disappointment. Third, my family and I were slow to recognize that I had mental illness either out of denial or ignorance (or both). Therefore, I’ve put together the following list of tips that might be helpful for those entering college with a BPD diagnosis, and a tip for those who are having mental health issues that *might* be undiagnosed BPD.

If you’re entering college with BPD already diagnosed:

  • Research your school’s mental health support system – Not all schools have an infirmary for treatment of common illnesses (flu, colds, sore throat, minor injuries), let alone a mental health counselor. Before you set foot on campus, know if your school has a mental health support system. Alternatively, see if there is a psychiatrist or outpatient clinic nearby. Write this information down or save it in an email to yourself: it will be invaluable if you start to have difficulties and need help. Make sure you talk to the campus doctor and advise him or her of your condition so that they can help you if an emergency situation arises. The last thing you want to happen in the event you have a BPD rage is getting thrown in the back of a police car. Instead, advise medical professionals first so that they can intervene and provide health care opposed to some sort of punitive action by the authorities.
  • Tell the Dean of Students and your Academic Dean about your diagnosis – At my school, dormitories were governed by an residential adviser, who were supervised by a Dean of Student Life. These individuals were charged with looking after my well being and adjustment to college, particularly during the Freshman year. If you already have a BPD diagnosis, tell these people about your condition. If something happens and you need help, these people need to be on your side and knowledgeable about how to provide support. Also tell your Academic dean about your condition, using a letter from your doctor or an in-person meeting. Some schools are very strict about academic standards. If you have an emergency and must leave campus, make sure your Academic dean knows that it is mental health related and that you’re leaving to get treatment. That way, the Dean and your professors will not penalize you for missing class or assignment due dates. It’s better to tell these people FIRST, opposed to them finding out after something dramatic has happened.
  • Make a list of your doctor’s phone and email address, plus any other mental health professionals that can provide support outside your campus – When I had my rage, campus officials were incredulous and didn’t know who to call. As a result, I was strapped to a gurney and taken away to the nearest emergency room. For all they knew, I was an angry drunk, high on drugs, or had homocidal/suicidal intentions. Head off any potential crisis before it happens. Have your doctor’s office phone number and emergency number (beeper or cel phone) handy. Also include your regular family doctor’s phone number as a backup. Your medical history and recent treatments would greatly help anyone responding to you in the event something bad happens.
  • Know where the nearest pharmacy is – The instant you set foot on campus, your world will start moving very fast. There will be classes, parties, friends to make, and various other demands that will no doubt occupy much of your time. With the “college experience” on your mind it can be hard to remember to refill your prescriptions and get them at the pharmacy. First, see if they can be sent in the mail to you. This is very easy and nearly every school has a post office. If this option isn’t available, have your doctor call the nearest pharmacy and put all of your meds on file. The last thing you want to do is miss class, avoid social opportunities, or become an outsider because you have to make frequent trips off campus to get your meds from home or from your psychiatrist. Take care of your meds before school begins: it will save you a lot of stress.
  • After 5-6 months at school, tell a friend about your situation – Some people make friends easily, while others need time to build a rapport with others. If you add a mental health problem on top of this, trusting newly made friends at school can be hard. If you become close and trusting with your roommate(s), tell them that you sometimes have stress attacks or react acutely if you’ve had too much to drink. Alternatively, tell any other new friends you trust that you have a hard time controlling your emotions sometimes. Note that I’m suggesting to tell others that you have trouble with your emotions opposed to a mental health condition. Despite the fact we’re living in 2011, people with mental health label inevitably attract a stigma to themselves. Use very general, bland terms with your new friends, particularly if you start drinking on the weekends or smoke pot. This type of experimentation is natural at school, but can get out of hand if you’re trying to balance your BPD and medication as well. None of your schoolmates need to know the inner secrets of your life; just tell them at an appropriate time and place about your “moods” before you have an emergency. This will allow them to act faster and get you the help you require.
  • If home is nearby and safe, don’t be afraid to leave campus for a break – For me, going to college was the first extended period of time in my life that I was away from home. I didn’t do residential camp in the summertime as a youth and always traveled with my family. As a result, I told myself that I would not visit home at all unless there was an official college break during holidays or between semesters. I thought this personal mandate would help me acclimate to the campus and learn to fend for myself. Home was a “safe” distance away, just 30 minutes by car and I still felt a sense of independence while at school. If you ever start to have mental health difficulties AND your home is a SAFE place to go (meaning your parents and siblings understand your situation) feel free to visit when you need support. For those that live hundreds of miles away from their home, don’t be afraid to visit any relatives nearby or call your family on a routine basis. In some cases time at school away from a tough family life is a blessing to some people. In other cases, home can be a safe place to retreat when things get difficult. I’m not saying run home every weekend – because you’ll miss campus weekend life and parties – but allow yourself to go when necessary. There’s nothing wrong with giving yourself a break from the fast paced lifestyle that college brings.

If you’re entering college WITHOUT any diagnosed mental health condition but feel you are unwell:

  • Only one critical tip: SEEK HELP RIGHT AWAY – I didn’t know anything was wrong with me until it was too late. If after a few months at college you feel overly tired, sad, emotionally volatile, or troubled, get help IMMEDIATELY from a school counselor, residential adviser, or nearby psychiatrist. Your Dean of Student Life should be able to recommend a well regarded doctor to see, and in most cases your health insurance will cover any diagnostic visits. Don’t put it off or ignore any potential symptoms of mental illness, no matter what they are. Many times, the stress of being away from home living the “college” lifestyle makes mental illness surface for the first time. Take care of yourself first. Find help, talk with your family or friends, and move forward.

I realize this is a long entry so I’ll finish up with a tip that summarizes almost all of what I wrote: Tell people in positions of authority at your college or university about your condition FIRST before a crisis develops. They will not only appreciate your honesty, but will also know how to help you if and when the time comes. Above all else, seek help if you feel mentally unwell, your grades start slipping, or you are self medicating with drugs or alcohol. You only have one college experience in your lifetime. It doesn’t have to be perfect (because almost everyone’s isn’t) but it does require that you take time for yourself and stay well.