Polysomnography: The Sleep Study Part 2

Last week my doctor informed me that the sleep study results were complete. I wasn’t sure how accurate the results would be because I slept lightly during the study. I informed him about this and he said there would still be enough data to draw some conclusions.

In brief form, here are the findings:

  1. Minor sleep Apnea indicated by sporadic reduced respiration during the night. The doctor said this was associated with my snoring. He concluded that it wasn’t anything to worry about for the time being since it was mild. There was no severe OSA (Obstructive Sleep Apnea) noted during the study.
  2. There was no data that suggested I have any sort of nervous system disorder that might be causing my breathing to be inadequate. This was a big sigh of relief for me: the last thing I wanted to hear was that I had another chronic condition on my hands.
  3. Leg movement was noted while I slept. This was videotaped by an infrared camera. Frequent leg movement during sleep can sometimes indicate a sleep disorder. Luckily, the doctor concluded this was mild in nature and nothing that warranted any further study.
  4. No parasomnias were noted. Again, another sigh of relief.
  5. There was a brief episode of REM sleep (Rapid Eye Movement) that was shorter than what most people experience while sleeping. This might be caused by my psychiatric medications.
  6. Sleep efficiency problems were observed. The doctor showed me various graphs with lines indicating when I was scientifically asleep versus awake. Although I only left my bed a couple times for the bathroom, he said that I had frequent “arousals” (not in a sexual context) throughout the night. When considering all the arousals against actual restorative sleep achieved during the night he conluded that I was only truly asleep for about 50%-60% of the sleep study time. This was surprising to hear but also suggestive of why I need to take a nap during the day. If I go to bed at 2 AM and wake up at 10 AM, I’m not really sleeping for 8 hours. Instead, my actual “restorative sleep” time is 5-6 hours. To get a “normal” night’s rest of 8 hours, I would need to be in bed for 10-12 hours (roughly).
  7. Some spikes in brain activity occurred during the sleep study. The doctor said they might also be contributing to my lack of restorative sleep. He said that if I wanted further information on this anomaly I would need to have an EKG (Electrocardiogram), CAT scan, or MRI to see exactly what is happening in my body and brain. I asked if he believed the need for further study was urgent and he said “No, it would be for academic reasons[to undergo further tests]”. For the time being, I’ve decided not to proceed with these tests.

His overall conclusion based on my current mental health diagnosis; psychotropic medication regimen of Effexor, Welbutrin, Zyprexa, and Clonezapam; and sleep study results was that he believed my medication was contributing to my sleeping difficulties. He didn’t feel comfortable telling me to alter or cease taking any of my medications, although he did refer me to a local psychiatrist for a consultation. My plan is to see this doctor in the next 2 weeks and get his opinion on my medication and mental health status.

His other major conclusion had to do with my current sleep schedule. I mentioned that I often feel more “awake” between 8:00 PM – 1:00 AM at night when most people start feeling tired. He said that I would need to shift my Circadian Rhythm in order to enjoy more time awake during normal daylight hours. First and foremost, this means I need to go to bed sooner, wake up earlier, and stay awake for the day without napping. He said starting a new sleep routine would be a struggle at first, but with diligence and allowing myself 2-3 weeks adjustment time I would eventually fall back into a more “normal” sleep pattern.

Finally, in addition to changing my sleep routine, he prescribed regular exercise and a couple hours in the sunlight each day. At the moment I do not exercise on a regular basis, nor do I spend a lot of time outside because I’m either asleep or working at my computer. Most doctors – no matter what form of medicine they practice – prescribe regular exercise as part of a normal routine. In my case, being outside in the sun would further tune my body to regular daytime hours and would also discourage daily naps.

So, it’s off to another psychiatrist to see if my meds should be changed, dropped, or augmented with other medication. Any sort of change in my meds would be uncomfortable, so if the psychiatrist puts me on something new, I want to be sure to have a couple weeks clear of any travel or special events so that I can dedicate myself to a new sleep routine and any new meds.

I’ll write another blog about the psychiatrist’s recommendations in the coming weeks.

Brandon Marshall, a Miami Dolphins NFL Football Player, Has Borderline Personality Disorder

I just heard about Brandon Marshall, the Miami Dolphins football player who recently announced his diagnosis of Borderline Personality Disorder. Marshall, who admitted that he had suffered from some undiagnosed malady for years has a long standing reputation as being hot-headed and explosive. In fact, both he and his wife were arrested after a domestic incident that involved her stabbing him in the stomach out of “self defense”.

To be clear, I don’t put quotes around “self defense” to sarcastically suggest Marshall’s wife was the true antagonist and merely offering a cop-out for her violent actions. Instead, I mention her claim because it was probably *exactly* what happened: Marshall had a BPD rage, became violent and threatening, and she was forced to protect herself. My own BPD rages frequently get out of control and have become confrontational at times. Luckily, the only person hurt during my outbursts has been me. I’m actually grateful this is the case.

What was surprising about Marshall outing himself as a sufferer of BPD was that he did so during a public press conference in front of the media, coaching staff, and fellow team members. He was brutally honest about his condition and almost seemed relieved he could finally lend a name to it; something that had troubled him for years. In fact, Marshall had been seeing doctors regularly since joining the NFL, only to be left with more questions than answers. Finally, after a battery of psychological and physical exams, the doctors concluded it was BPD.

Read more about Marshall’s BPD diagnosis from the Huffington Post Sports page, including a video – click here

I’m not a hardcore fan of the NFL. I occasionally watch a game now and then, and have always enjoyed Super Bowl Sunday. I didn’t play football as a youth because I was small and lanky, more suited to running track and cross country. During high school, all the “big kids” went out for football each year. Most of these guys had played in community youth leagues for years, and were your stereotypical high school big-shots that were loud and occasional bullies.

At first glance, football comes off as one of those sports where all the players beat their chests in the locker room before a big game. Thoughts of grueling weight lifting, charging tackling dummies, and practicing complex plays also comes to mind. It’s not a sport for the faint of heart both literally and figuratively. Today’s professional football players are like warriors going to battle every Sunday, kicking the shit out of each other to get down the field towards the endzone. It’s this tough, testosterone fueled action that most men love to watch in person or behind the TV.

That’s why Marshall’s press conference was so unusual. When was the last time the star quarterback at your high school or college admitted he suffered from depression, or had some other mental illness? Probably never. If you’re a true NFL football player, you don’t suffer from mental problems. Your challenges are physical. Add the fact that most people diagnosed with BPD are women and you have all the makings of a confession that literally brought NFL fans to a standstill.

I’ll paraphrase one of Marshall’s most poignant remarks: “I’m a Pro Bowl player…I have a great, smart wife…We have three beautiful dogs…but with all that said, I haven’t enjoyed not one moment of it.” Whether or not you like football, it’s clear this was a pivotal moment in this man’s life, one that will resonate deeply with close friends, family, teammates, and random people that have interacted with an angry, BPD powered Brandon Marshall. I’ve never contemplated telling even my closest of friends (little that I have) that I suffer from Borderline Personality Disorder, let alone get up before the nation’s entire sports media and admit it to the world. I give Marshall a lot of credit: it was an incredibly courageous moment.

All that said, Marshall realizes he’s not cured. He’s been treated with some psychotherapy in the off-season, but time for the doctors will be slim to none next month when the NFL regular season begins. He’s done some healing, but there’s still a long way to go. My advice to anyone close to Marshall, particularly his family, friends, and teammates is to give him some breathing room. It’s certainly a relief to finally know what was going on with him, but that doesn’t mean things suddenly become easy. Without a doubt he’ll probably continue to suffer from BPD for this football season and for years to come. Things can go either way: the next time he’s behind a microphone might be because he’s celebrating a Super Bowl ring, or because he’s in trouble with the law again.

There’s a silver lining to the story involving the stabbing he suffered from his wife. All charges were dropped last Friday. Marshall and his wife will now press forward – a little older and wiser – but more importantly better informed about why their life was upside down, and what can be done to fix it.

If you’re involved in sports and think you might suffer from BPD or any other mental illness, talk to someone you trust and get help. It’s the right thing to do for yourself and those around you, the sooner, the better.