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.