One afternoon while scrolling through facebook, I came across a post by the Johns Hopkins Hospital seeking individuals with mild sleep troubles interested in participating in a research study. To my surprise, the post was more than an ad. After I clicked the link, I was taken to a website where I completed a questionnaire that determined my eligibility for the study. The questions revolved around my sleeping habits, focusing on things like how long it took me to fall asleep and how restful I thought my sleep was.
Once I completed the online questionnaire, I was asked if I would be willing to participate in the study. I read over the consent form and then had to correctly answer questions about the content of the study laid out in the consent form in order to electronically sign it. Correctly answering a short quiz about details in a consent form before being allowed to sign it is relatively common and a must in online consent processes. The questions generally relate to what you will be asked to do in the study and your rights as a participant.
I received an email the next day inviting me to schedule the in-person study, and a few days after that it was time to begin the experience. I came in for the session at the Sleep Lab in the Asthma and Allegy building on the Johns Hopkins Bayview Campus. I signed in at the front desk and made my way up to the 4th floor where I rang a doorbell to be admitted to the lab. I was greeted and reminded the study was designed to evaluate the validity and reliability of a self rated digital questionnaire used to triage and identify common sleep conditions.
I spent the next hour and a half answering the abbreviated Digital Sleep Questionnaire (DSQ) with the research coordinator, who was also trained as a Medical Doctor. She asked some of the questions and recorded the answers on a tablet, and then I read and answered the remaining questions directly on the tablet. There were various questionnaires centered on my health history and sleep. Questions assessed my sleep times, sleep habits, and other daily habits, including personal sleep related activities.
After the questionnaire was complete, the researcher exited the room to interpret the results of the DSQ and brought back another MD to speak with me about my sleep troubles. I really enjoyed this part. A gentleman named Dr. Alan Schwartz and I had a wonderful conversation about my sleep patterns. He asked a few questions, and I was able to freely speak to him about what I thought about my sleep without the confines of a questionnaire. A sleep discussion generally becomes a life discussion with me, so I also told him about things going on in my life. He gave me advice that I still chew on, “Sleep is something that happens to us, not something we make happen.” After the discussion, he provided a diagnosis of psychophysiological insomnia and a secondary diagnosis of possible obstructive sleep apnea.
The primary diagnosis did not match the diagnosis the questionnaire had provided of delayed sleep phase onset syndrome, but the secondary diagnosis of obstructive sleep apnea was the same. The point of this study was to assess whether the diagnostic output of the DSQ matched with the doctor’s diagnosis after a work up. For its diagnoses, the DSQ utilized machine learning to quickly identify patterns in responses by using statistical models. If the DSQ could reliably identify sleep issues to help triage individuals for further evaluation, doctors could spend more of their time treating sleep issues rather than identifying them, making the healthcare system more efficient. The DSQ can potentially provide a means for accurately finding and identifying sleep disorders as an initial step in targeting people for treatment.
I had the choice to take a wearable sleep device home with me that would check for obstructive sleep apnea, and I was more than happy to do so. The researcher explained what I needed to do to record a night of my sleep using the device, and I left with the small carrying case.
I had the weekend to pick a night to wear the device since I participated on a Friday, but I didn’t want alcohol to interfere with my results, so I waited until Monday night to wear the device. With stellar timing, we adopted a cat that same weekend, so my sleeping patterns were slightly affected by mild allergies and a cat jumping all over the bed during the night. My dogs don’t bother me too much during sleep as they spend most of the night at the foot of the bed.
On that Monday night, I opened the case and followed the instructions that were given to me at the study session. There were also detailed written and pictorial instructions included that were helpful. I stuck one sensor on the center of my chest to measure heart rate. I placed the pulse oximeter on my finger and the associated monitor on my wrist. The pulse oximeter measures blood oxygen saturation. If you’ve ever been hospitalized, you may have had a clothespin like pulse oximeter placed on your index finger. This one was designed to not fall off during the night, so the fit was very tight after pulling out the release tab. Then I turned on the device to begin recording. Of course, since my sleep was being monitored that night, it took me an abnormally long time to fall asleep, but I could also attribute some of the difficulty falling asleep to having an apparatus on my wrist and finger. Once I fell asleep, I slept well.
The next morning I took the device off and placed it back in the case, and luckily my wife was able to return the device to the sleep researchers while she ran a few errands that morning.
I received the results from my in home sleep study and a $50 check about 2 weeks later. The money was solely for the 2-hour session, as the in-home sleep study was optional. I feel the in home sleep study was worth the time and trouble as I valued the experience and appreciated the test results.
The overnight sleep study results came in a PDF via email and described the quality of my sleep using markers the device tracked. The results indicated I have mild sleep apnea, and the letter suggested I discuss these results with my primary care physician. I spoke with one of the physician researchers after getting the results, and he mentioned that the results were sensitive and did not recommend any treatment for sleep apnea at that time.
The sleep study results consisted of many measures including sleep time and efficiency, body position, sleep stage length, snoring sound levels, number of awakenings, oxygen de-saturation index (ODI), respiratory disturbance index (RDI), respiratory effort related arousal (RERA), and apnea-hypopnea index (AHI). ODI, RDI, RERA, and AHI all provide insight into sleep apnea, but AHI is the traditional measure used to indicate sleep apnea severity. AHI is the average number of combined apneas and hypoapneas per hour during a night of sleep. An apnea is a stoppage of breathing, and a hypoapnea is a decrease in airflow. AHI between 5 and 15 indicate mild sleep apnea, and my AHI for that night was 12.3. The results also provided the decibel level of any snoring throughout the night. For 6.3 minutes during the night, I snored at or above 45 decibels, which was the threshold for mild snoring. I’ll need to make sure my wife sees the evidence that I don’t breath as loud as she thinks I do!