[tptacek]

I have a _very_ delicately balanced sleep routine and a sort of mortal terror both of insomnia and of hypnotic drugs.

If it were safe and easy I'd probably just buy the APAP and see if it made me feel better. I don't feel much urgency; I get about 6 hours a night on the regular and don't as a rule feel tired or cloudy during the day (but it's possible that with an APAP I would, relative to my current condition, feel like an atomic superman, which is what drives my fascination.)

[luminiferous]

Also echoing mabbo, I did a sleep study in the comfort of my own home about a year ago. I'm told it's not as precise as a "proper" sleep study in a lab since the instrumentation isn't as precise, but it was basically just a band that I strapped to my head before bedtime. No drugs, no technicians. Just some accelerometers and a microphone to hear what your snoring sounds like. And that was enough for my doctor to diagnose me with mild sleep apnea and give me an oral appliance. Basically it just forces my jaw forward while I'm sleeping, which keeps my airway open. Never tried CPAP but I'm told that the oral appliance is much less intrusive.

[mabbo]

I did my sleep study when I was 24. There were no drugs involved. It's just a bunch of sensors taped to you while you sleep with a camera watching you.

Bit odd of an experience, but nothing that should concern you much.

[tptacek]

My understanding is that if you're not going to fall asleep in the setting of the sleep study, they'll Ambien you out.

[jachee]

Echoing others' encouragement. My study was an easy at-home test which confirmed how bad my hypopnia was, mostly from the blood/oxygen ratio. Mine was going down into the 70s. It was so bad that immediately after that, they scheduled an inpatient test with the PAP machine.

I was super skeptical of being able to sleep a) in a strange bed, b) with all those sensors on my head/chest, c) 4 hours earlier than usual, and d) on my back/side. (I was a hardcore stomach sleeper before.)

At the second study, they strapped me into the sensor harness, put on the mask, and turned out the lights. It took what felt like about 5 minutes to get used to the sensation, but then I was out. Like someone flipped a switch to "Sleep now." Eight hours went by like a flash.

I woke up the next morning super refreshed and feeling amazing. When they said it would be three days until I could get my machine, I was kind of sad.

Eight years later, I've still got the same machine, and it's still like hitting an off switch when I put it on. I only average about 4.5 hours' sleep during the week, but it's turbocharged. My AHI seldom crosses 2.0 and I can see exactly what I'm doing via SleepyHead.

Best decision I've made health-wise, except maybe kicking sugared soda.

Edit: it also let me drop my hypertension prescription to the minimum dose.

[JoshTriplett]

You're ultimately in control of the situation. If you explicitly tell them that under no circumstances do you want to take a drug to induce sleep, they're not going to force you to. You could just call it off if you can't sleep.

I've taken a sleep study before; they're not that weird, just a pile of sensors and a bed. And I also know from multiple people that if you do have any form of apnea, addressing it can have a life-changing impact.

[gojomo]

Nowadays I believe an at-home "study" is more common, cheap, easy, and non-disruptive.

They give you a little case of sensors to take home & show you how you should attach them before bed. Chiefly it's a finger pulse oximeter & something worn on the chest to measure sleep orientation, chest motion, and record snoring sounds. You sleep as normal, at home, and return the devices the next day for its readings to be interpreted.

So: your concern about being in an unfamiliar setting, or being offered drugs to sleep, may be outdated. OTOH, if you're not in general risk groups nor experiencing daytime tiredness, there may not be not much reason to dig further (unless your wife has noticed something else worrisome).

[oostevo]

That does not match my experience (but n=1 and all).

In my case, the result of the sleep study where I didn't really sleep was, "hmm ... it looks like you might have insomnia." (No kidding). No drugs were offered -- or forced -- during the study.

[tomcam]

Have gone through 3 sleep studies. No drugs were offered and I never got to sleep. You would be fully within your rights to decline any such offer and they wouldn’t give a shit anyway.

Given your sleep routine I promise the study would be pure hell. They are for me. But I need that APAP.

[tptacek]

See! You get it! If I felt I had an urgent problem I'd just deal with the study, but "feeling tired during the day" is very, very low on my list of complaints. I sort of feel like I get away with murder, biologically; I go to sleep at 1AM and get up at 7AM and do just fine.

On the other hand, my wife tells me I snore and randomly stop breathing, so I have reason to believe there's something going on.

[outworlder]

> On the other hand, my wife tells me I snore and randomly stop breathing

Snoring is "fine". There is some resistance, but it's likely you can still breathe sufficiently. The problem is when snoring stops.

By the way, my first sleep study was crap and I couldn't sleep and no conclusions were drawn.

The second was at home and I had a cpap machine waiting for me one day after I returned the results.

> If I felt I had an urgent problem I'd just deal with the study

By the time it's urgent you are already deep into other issues, such as high blood pressure. And now you have more than one issue to deal with. This is like the biological version of tech debt.

[jpfed]

One problem with waiting is that as apnea worsens it can cause depression and sap your will. That's what happened to me. I knew I needed to get treatment, but that became totally disconnected from my will to start the process. My wife was the one who ended up calling the doctor to set things up.

Better to start the process early and as a side bonus not sacrifice so many brain cells to hypoxia.

[daeken]

Have you thought about an at-home sleep study? My wife and I both did that to get our CPAPs prescribed. Just had to wear a band around the chest (with a little unit that read the force of expansion, I presume), a pulse-ox sensor (IIRC), and something else I can't recall. I'm sure it's not perfect, but my doctor recommended it and was happy enough with it.

[ridgeguy]

I'm the greater insomniac in my household, so I was the one to note my wife's snoring and breathing cessations. She felt fine in the morning. A sleep study showed her PO2 levels dipping as low as 76. She's a CPAP user now.

I think of sleep apnea as a bit like chronic high blood pressure: few or no perceptible symptoms until you become a dialysis or stroke patient.

[fitpolar]

It's a PITA, that's for sure. There were no drugs in mine. But I reasoned that it's only 1 night. I chose a time where I didn't have work the next day. No big deal, it's not like you have to do it for a month straight. Do you not get any time off work at your job?

[tomcam]

> my wife tells me I snore and randomly stop breathing

This is bad for her and worse for you. You have an apnea for sure. You’re losing brain cells unnecessarily. Luckily I know your posting history and you can obviously afford them. I can’t! But for your wife’s sake get a home sleep study.

[tptacek]

I probably will sometime in 2019 (for totally unrelated reasons having to do with insomniaphobia, I have a pretty odd sleeping arrangement that involves me sleeping mostly upright these days which I'm told has mitigated this problem).

I'm just saying: if I could just buy the damned APAP and try it out, I would do that first. Friends who've gotten sleep studies have uniformly described it as simply a hurdle to getting the actual RX for the machine, and that all the learning and diagnostics happened after they started with the machine.

[shakestheclown]

My insurance requires 3 at-home failures (as in bad data, etc) before they will even approve an in-lab. I'm sure you can request one if they don't; it's cheaper for them.

[URSpider94]

They don’t really need all that much data. An hour or so of solid sleep will give them what they need.

The full Monty study is pretty bad, with ECG wires all over your body and EEG electrodes all over your scalp. Nobody gets much sleep, but again, they only need a little data, and most people manage to fall asleep eventually,

[ridgeguy]

This might be a function of the particular lab. Yours is the first suggestion I've heard of that possibility.

I've had two overnight lab sleep studies. During the first I registered less than 5 minutes of sleep. Nobody suggested giving me any drugs.

[wbkang]

This does not reflect my experience. Besides, taking Ambien would show different brain waves than actual sleeps so it would make it less useful as well.

[dpeck]

just fyi the current at home test is basically a wristwatch with a light finger oxygen sensor, https://www.itamar-medical.com/watchpat-home-sleep-testing-m....

It seems that the APAPs should be able to be bought without a prescription, and besides inertia I'm not sure why it is.

[firepoet]

Dang.. my sleep center is way behind. Had a take-home sleep study last week and I had to have the chest strap and finger sensor. Pain in the butt, but worth the data it captured. Going on APAP after trying for 6 years to work with an oral appliance after not being able to tolerate CPAP.

[bigbluedots]

Given that you get 6 hours of sleep and are not tired/foggy during the day I'd say it's unlikely you have sleep apnea.

[dpeck]

Theres some level of being always tired and just being attuned to it. Not putting that diagnosis on parent, but I'd put myself in that bucket, and I'd wager its easy for old hackers like me who spent a lot of nights exploring/working/studying to the point of exhaustion during their teens and twenties.

[tptacek]

I had this discussion on HN almost 10 years ago (wow, I'm old) and 'iamelgringo --- a (former?) ER nurse --- shut me down pretty hard.

https://news.ycombinator.com/item?id=2030433

[bakul]

iamelgringo’s comment was pretty convincing. Thanks for referencing it.

[jazzychad]

echo'ing mabbo... there were no drugs involved in my study either.