Tuesday, December 04, 2007

Sleep: An Inquiry

Today’s medical appointment finds me coming to a new sleep medicine clinic here in my hometown for evaluation of Restless Legs Syndrome, Period Limb Movement Disorder, and an overarching sleep pattern disturbance which may or may not be related to my chronic myofascial pain.

Entering the office, I am initially surprised to find a well-appointed waiting room which looks more like a hotel lobby than medical office (in spite of the ubiquitous receptionists’ window. Upholstered armchairs, stained glass lamps, an obvious absence of fluorescent lighting, wood panelling and wainscoting, a maroon carpet with Oriental-rug patterning, prints of famous paintings with sleeping figures, and low-volume classical music all set the somnolent stage.

Fittingly, an overweight man of 65 or 70 sits in a chair to my left, with well-trimmed white beard and mustache, arms crossed over his bulging midriff. He snores loudly, lulled to sleep, no doubt, by the calming atmosphere. He wakes abruptly and apologizes for snoring. “No problem,” I respond. “If you can’t snore here, where can you snore?”
“At home, I guess,” he says. We laugh, and the other patients in the waiting room join in.

In the exam room, Andrew Wyeth’s painting “Master Bedroom” hangs on the wall in a nice chestnut frame. The image is of a golden dog, fast asleep on a large four-poster bed, afternoon light streaming in the window. It’s a painting one could literally fall into and spend the day, or maybe a week. I’d give anything to curl up with that dog right about now.

The dog in the painting reminds me of my dear departed Sparkey and the way he would sleep in a curled up ball of utter relaxation. Back in the day, I would take every opportunity to cuddle and spoon with Sparkey, his 70-pound body warm next to mine. Sometimes, when I was desperately in need of grounding, I would lie on the floor opposite Sparkey, the tip of my nose touching his. I would then follow his breathing pattern, inhaling and exhaling with him, the comforting warmth of the air flowing in and out of his nostrils helping me to do the same. I sometimes lie on the floor and breathe with Tina, our little aging dog who has survived her big brother, but Sparkey’s breathing held a key for me that has so far been irreplaceable.

In the course of a 90-minute review of my health, as well as a brief yet thorough neurological exam, we discuss Restless Legs Syndrome and its miseries (which are sadly well-known to me), Periodic Limb Movement Disorder, sleep apnea, and other manifestations, signs, and symptoms of impaired sleep. It is an affable and very positive experience, both with the PA who examines me and the MD who comes in to wrap up the session and make a plan.

Following our lively discussion, I’m given a tour of the new facility, complete with hotel-quality sleeping rooms where I will be monitored for my sleep study best week. The rooms, like the waiting area, are well appointed, with fresh linens, private bathrooms, cable TV, as well as the ubiquitous artwork reflecting different aspects of sleep or sleepiness. The doctor, with whom I have actually shared patients in the past, has me check out the firmness of each bed and choose a room that I like. I go for Door #1. “Nice choice,” he says, making note of it on my chart.

I leave the appointment with a scheduled diagnostic sleep study next week (stay tuned for a blow by blow of that memorable experience) and a follow-up office visit in a few weeks.

Sleeping poorly---or not sleeping at all---often seems like a fate worse than death. When sleep is negatively affected, one’s entire life seems somehow altered, and not for the better, mind you. I imagine it is a relatively new phenomenon in medicine that sleep is even paid serious attention at all. This thing we do when we close our eyes for one third of our lives is both mysterious and necessary. What happens during those hours has been debated for years, and serious study has certainly made significant inroads in that regard.

As for me, my disintegrating sleep-life is in need of some serious attention, and it appears that today’s appointment is perhaps the beginning of just such a serious inquiry.

Although it often seems like just a pipe-dream (so to speak), I’ll say it anyway: To sleep, perchance to dream.......
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