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Sleep Disorders

Titration sleep study

06/25/2008

Question:

I am scheduled for a titration sleep study with a bipap. I am quite nervous about this as I have had two trials of bipap but had great difficulty falling asleep with it and keeping the mask on. I had picked out a nasal mask at the sleep study that showed I needed bipap but was not put on it that night. What if I can`t tolerate it and/or can`t go to sleep with the bipap on? Will they continue the study since if I am not asleep, they won`t be able to titrate the pressures? My sleep specialist said I could take 300 mg gabapentin the night of the study to see if it helps me fall asleep. I am dreading it because of my prior experiences with bipap. I have tried a full face mask which I could not tolerate and nasal pillows which I also did not like. In the past with the trials of bipap, I did not have a sleep study at all. I pretty much was on my own once the machine was brought to my house. I am sure I am not the only one who has had a problem like this. Any suggestions would be greatly appreciated. Thanks.

Answer:

As you are aware, sleep studies are cumbersome. Many wires, belts, and sensors are hooked on to you, and you are expected to sleep in an unfamiliar environment. This might be exacerbated by the addition of positive airway pressure masks. Sleep specialists recognize that these factors interfere with getting "representative" sleep during a sleep study. Occasionally, when a person does not get enough sleep, a sleep aid may be prescribed. Most sleep aids, however, interfere with the type of sleep seen during the study, and some may actually worsen sleep apnea. Although gabapentin is not a sleep aid per se, it does cause sleepiness as a side effect and it does not change the way we sleep, much.

Medications are not the only sleep aid that may work for you. The following activities may prove useful for you in preparing for your next study:

Remember that positive airway pressure masks are rarely a perfect fit. While some masks are more comfortable than others for any individual, it takes some "getting used to" and "breaking in" before a person may sleep well with one. Ask the lab to borrow the mask you're supposed to use to take home about a week before the test. You can get yourself acclimatized to the way it feels on your face by wearing the mask (without the tubing or the air pressure) for progressively longer periods of time while awake relaxing. So, you can wear the mask for 5 minutes, then for 10, 20, 40, and 60 minutes over the 5 days prior to the test. This way, when you are strapped in on the study night you are already familiar with the mask and there are no surprises.

It is true that if you don't sleep during the study night, the test is not useful. There is no way to know for sure if a person will fall asleep in the lab. There are other options, particularly for a CPAP titration (like auto-CPAP) at home. However, for BiPAP, I don't think that the technology is quite ready yet for unmonitored titrations at home. I understand you apprehension regarding repeating the test over and over again. But a worst case scenario would be that, if you are unable to sleep in the lab, an empiric pressure setting will be chosen for you with clinical and oximetry follow-up because of inability to sleep in the lab. Further testing options may be addressed once you become used to the machine and the interface.

If you would like additional information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website. This website also contains a list of Sleep Centers across the country so you can locate one near you if need it. I wish you the best sleep on your study and always.

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Response by:

Ziad  Shaman, MD Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University