3 Owls

Six months ago I entered a sleep study. I thought I was sleeping well, getting my eight or nine hours a night of solid sleep, usually interrupted by a brief trip down the hall once a night. Jan encouraged the decision, asserting that she was tired of finding me taking time-outs from breathing. There was also the occasional early morning when I would awaken with severe chest pain and a pulse sub-30 bpm. The first night of the study was miserable—noisy, hard mattress, wires attached to nearly every part of my body, but the technician was glad to let me know that I had slept the required three hours, I did indeed have sleep apnea (which I have known for years), and I would need to return someday to have a titration study.

Titration is a laboratory method of quantitative chemical analysis that is used to determine the unknown concentration of an identified analyte. I expected that the only time this would become important in my life would be the study of concentrations of greenhouse gasses in the atmosphere. It turned out that the study of oxygen saturation in my blood had become the issue, since 70% was probably not enough.

I didn’t hear anything back from anyone for two months, so I judged that I was in the clear, but Jan thought I should check with someone about the titration study schedule. Unfortunately I had just been overlooked, and they wanted me to have the study after all, so it was scheduled for two months later. Then a cancellation occurred, and they wanted me to come in and fill it six weeks early. When I reported for the study, the cancellation had been a mistake, the other person had shown up, and I was sent home again, but not for long. A few nights later they were ready for me again.

On the night of the titration study, in the same hard bed and with the same wiring attached, I tried out three different facial devices, attached to a “Continuous Positive Airway Pressure” pump to provide breathing assistance during sleep. If the hospital space was noisy or not, it did not matter, because the facial devices, from the “nose pillows” to the “nasal mask” to the “nose and mouth mask” made enough noise and leaked enough to keep me from sleeping and make the results ambiguous. Nonetheless, the physician in charge wrote a prescription for a Bi-PAP machine (with a two stage pressure setting) and the last mask that I tried, and soon I had one to use for a three month trial. The mask did not fit well, so after three weeks, I exchanged it for another. Although it fit better, the machine and mask still made getting to sleep difficult, and they still woke me a dozen or more times every night for the next three weeks.

At that point, only my wife’s faith and the encouragement of three people who had successfully adapted to the use of the devices kept me from dropping the whole project. I had to admit there were already two benefits—Jan was sleeping better, and I had not experienced chest pain or extra-slow heart rate for the last three weeks.

Three months after the original titration study, I am doing better. The supervising physician is happy that I have met the required “four plus” hours of BiPap use every night. At the time of my appointment, they had not seen the results of the continuous wi-fi monitoring system, because the medical equipment people had not bothered to connect me to my physician’s office (and the office had not requested it). A few hours later they adjusted the pressure on my machine upwards, so, presumably, my “titration” has finally occurred. At least the rough indicators of better oxygen saturation –fewer episodes of breathing interruptions—were not yet where they wanted them to be, at twenty per hour instead of five, so they have increased the pressure setting. There is yet hope. Having “qualified” for further attention, since I am “compliant,” I have another chance to get a better-fitting mask and possibly even more adjustments that increase the oxygen saturation in my blood. I am sleeping better, almost as well as when I started. Thank you to my medical insurers for their investment of fourteen thousand dollars, and counting.

This is not a problem. It is a learning experience. I am smiling. Maybe you will, too, if you ever have a sleep study.