The sleep test

The test name is polysomnography.

I learned the word at a hospital billing counter in Dhaka. I said I needed a sleep test. The woman paused. It had another name, she said, but she could not remember it.

I searched online and pronounced the word from my phone.

Polysomnography.

She entered it into the billing system. The test appeared.

Before the word, my request was informal. After the word, it became a service the institution could recognize, price and schedule.

Language was the first interface.

§ Method and limit

The study took place on the night of 3 January and the morning of 4 January 2026. This account uses six kinds of material:

1. notes written within twenty-four hours of the test;
2. appointment messages, time stamps and a chat in which I recorded the diagnosis, prices and treatment decision on 6 January;
3. the fourteen-page diagnosis and titration report;
4. remembered conversations from the night and the following consultation;
5. subsequent product research and visits to medical-equipment stores in Dhaka and Bangkok;
6. six Garmin JSON exports covering main sleep, naps, daily wellness and health status measurements from 5 February to 19 July 2026.

I later examined these materials through my unlearning framework: which route went first, what kept it there, and who worked around it.^[1]

The sources answer different questions. The report records scored physiological events. My notes describe conditions and conversations. The January chat records what I understood and could afford at that time. The Garmin exports describe later estimates, not the effectiveness of treatment.

Other people appear by role. I exclude personal details and other people’s private messages. Removing names reduces exposure but cannot guarantee that nobody will recognize the encounter.

This is an interface autoethnography: I use my own experience to examine how institutional arrangements work in practice. I distinguish what I observed, what an artifact records, and what I infer from their relationship. I do not use this account to choose a pressure setting or diagnose another condition.

§ The room that became a lab

Before payment, the counter sent me to a respiratory room beside the outpatient consultation area. The room handled availability, preparation, scheduling and report collection. The actual night study took place elsewhere, in a hospital cabin temporarily arranged around the equipment.

Payment did not complete the booking. The counter told me to contact the respiratory room directly. I sent a photograph of the paid bill through WhatsApp. The booking was confirmed after I sent the bill through WhatsApp. Payment and confirmation required separate actions from me.

The service was new. I was later told that I was its twenty-seventh patient.

The arrangement I encountered was small:

one room
one recording system
one night technologist
one patient at a time

The hospital was large. The sleep service depended on a narrow human and technical arrangement inside it.

That dependence became visible when my original appointment was cancelled. A relative of the technologist had died. The test had to move to another date and then into an available institutional slot.

The preparation sheet instructed me to wake early and avoid sleeping during the day. I followed it. I was physically and mentally prepared for the original night. When the appointment moved, that preparation became unusable.

On the rescheduled date, I was told to arrive at 9 pm. This was an arrival time for preparation, not an instruction to fall asleep at nine. It still conflicted with my usual dinner schedule. I tried to negotiate, then ate quickly and reached the hospital with my partner and a friend.

Before recording began, the appointment had already reorganized my day.

§ A fresh patient

The cabin resembled a hotel room with medical equipment added to it. I changed into a cotton hospital gown and completed an intake form.

The form was in Bangla.

I asked what would happen if a non-Bangla-speaking patient came for the test. I received no answer.

I had used the same hospital for several years. It already had my patient number, insurance records, consultations and recent test results. During that visit, however, staff repeatedly said that an information-system upgrade had made older records unavailable.

The sleep form therefore began from zero.

The institution knew me as a returning patient and received me as a blank one.

This was not only a data problem. It established the sequence of knowledge. The standard form arrived before the medical history the hospital already held. What fitted the form became immediately available. What remained elsewhere had to be remembered and narrated again.

§ Producing the measurable sleeper

The technologist attached sensors to my scalp, face, chin, chest, abdomen and legs. Bands measured respiratory effort. Other sensors recorded airflow, oxygen saturation, heart activity, movement, position and snoring.

My partner photographed the wired body. We made jokes about familiar film and internet tropes to reduce the tension.

I was both the subject and a prop inside the room.

At 11:51 pm, the recording began.

The report calls this moment “lights out.”

I call it the beginning of trying to sleep.

For what felt like several hours, I moved between positions. Sensors loosened. The technologist returned to adjust them. I felt cold in the hospital gown and requested another blanket. I turned the light on and off. I went to the toilet repeatedly.

§ What counts as sleep

I told the technologist that I had self-identified ADHD, anxiety and a history of panic attacks. I also explained that I normally use sound to settle into sleep.

She needed sufficient data before the test could move to titration.

I needed conditions under which sleep might occur.

At first, I was told not to use my phone or play sound because audio recording formed part of the study. I asked whether my usual sleep sound could be permitted at low volume. The technologist consulted the supervising doctor and returned with approval.

I played a familiar soundscape. When that did not help, I changed to a downloaded recording of rain with quiet piano.

Eventually, I slept.

The change I can trace is permission. At first, sound was excluded to protect the recording. After I described my usual sleep practice, the technologist sought approval and allowed it at low volume.

I remember falling asleep after changing the audio. I cannot separate the effect of sound from fatigue or growing familiarity with the room.

The technologist later told me that I was the first patient to request sleep audio. Her response showed that the protocol allowed judgment. It did not establish that the next patient would receive the same option without asking.

§ The split night

At 3:45 am, the diagnostic phase ended.

The detailed report records 164 minutes and 55 seconds of sleep within 234 minutes of recording. It counted five obstructive apneas and 74 hypopneas: episodes of stopped or reduced airflow.

The apnea and hypopnea index, AHI, counts these events per hour of scored sleep. My recorded AHI was 28.7, within the adult moderate obstructive sleep apnea range of 15 to below 30.^[2]

The night then changed tasks.

Staff woke me and fitted a nasal mask for positive airway pressure, PAP. Pressurized air helps keep the airway open. During titration, staff adjust the pressure while observing breathing.

I initially felt claustrophobic. The sensation eased after the airflow began, and I slept.

Sleep efficiency is the proportion of time in bed scored as sleep. The report calculates it using its time in bed interval, which is shorter than the full diagnostic recording.

The recorded breathing events were substantially fewer during PAP. That supports the treatment recommendation. It does not, by itself, explain every setting or establish how treatment would work at home.

§ The report as interface

The report made the night portable. It carried a diagnosis and recommendation into the consultation and product search. The work around the recording was harder to carry: preparation, cold, interruptions and the negotiation over sound.

A summary must select. My question is whether its selection leaves the next reader enough information to understand the result and act on it.

§ Sleep onset and interruption

The diagnostic table records zero sleep latency, the time taken to reach scored sleep. I remember struggling to settle.

These accounts are not automatically contradictory. An early period scored as sleep would not establish that I then slept continuously or experienced myself as asleep. The report also records about 64 minutes awake. Without reviewing the scored signals, I cannot reconstruct how those periods relate to my memory.

The summary states:

The patient had no episodes of waking to urinate during the night.

My notes record more than five toilet visits. The tables record five wake periods longer than three minutes, but I cannot match those periods to individual visits. Nor do my notes establish whether I had been asleep immediately before each visit.

The report does not deny all waking. It leaves the circumstances of these interruptions unexplained.

§ Figures I cannot reconcile

The diagnostic tables contain no REM sleep, the stage marked by rapid eye movements. Yet the summary places the lowest oxygen saturation “during an apnea and R sleep.” That needs clarification.

An unfamiliar recording environment can change sleep continuity and its distribution across stages. This is called the first night effect. It is a possible limit on this record, not proof that the recorded obstruction was an artifact.^[3]

The titration stage table creates another problem:

These durations total 226 minutes against a reported total sleep time of 177. They cannot all be correct as listed. Until the figures are clarified, I cannot use them to support the report’s claim that deep sleep improved.

§ Pressure and comfort

One page records comfort at 11 cmH₂O; another records comfort at 15. These could refer to different points in the night, but the report does not explain the difference. I remember initial claustrophobia followed by adjustment and sleep, not selecting a pressure.

The pressure table records a low AHI at several settings. It lists 11.4 minutes of sleep at its highest setting, labelled 15. The table uses mbar, while the prescription uses cmH₂O. Both measure pressure, but they are not identical units.

The recommendation reads:

Use Auto CPAP with nasal mask at 15 cmH₂O pressure during sleep time regularly.

CPAP supplies a set pressure. Automatic PAP can adjust pressure within prescribed limits. This sentence does not tell me whether 15 is intended as a fixed setting, a maximum, or part of an unstated range.

A low AHI alone does not select the pressure. Titration guidance also considers oxygenation, mask leak and control during REM while lying on the back. An optimal titration includes at least 15 minutes of control at the selected pressure and supine REM sleep.^[4]

The printed table does not let me verify those conditions. It also does not establish that a lower setting would be appropriate for me.

§ Leg movements

The diagnostic report counted 269 periodic leg movements, an index of 97.9 per hour. During titration, that index remained 80.7 while AHI fell to 1.

These are recorded movements, not a separate diagnosis of periodic limb movement disorder. That diagnosis requires relevant symptoms and exclusion of other explanations, including untreated obstructive sleep apnea.^[5]

The report recommends PAP, weight reduction and review after three months. It does not explain how the movement finding should be assessed at that review.

The question for follow up is therefore broader than whether PAP reduced breathing events during the test.

§ Can one night justify one machine?

Yes, one night can support a diagnosis and a PAP recommendation. A split night study combines diagnosis and titration when enough diagnostic evidence is obtained and sufficient time remains to assess treatment.^[6] Discomfort in an unfamiliar room does not automatically invalidate it.

But four decisions remain distinct:

1. Does the recording support OSA?
2. Is PAP an appropriate treatment?
3. What pressure settings and mask should be used?
4. Which device and support arrangement can deliver that treatment?

My report supports the first two. Its explanation of the third is incomplete. The consultation and market shaped the fourth.

Recommending particular hardware is not inherently unethical. Reliability, suitability, servicing and cost can all matter. My concern is whether the patient receives enough explanation to make and sustain the decision.

The report did request review after three months. It would be inaccurate to say that it contained no follow up. What remained unclear to me was how care could proceed if I could not obtain the machine.

PAP guidance includes education, troubleshooting and monitoring after treatment begins.^[7] The purchase is one step in care, not its completion.

§ From pressure to product

The written recommendation named a treatment category, not a brand.

In the consultation, I asked about ResMed because its equipment had been beside my hospital bed. The consultant described it as a preferable option if I could afford it. He warned against cheaper devices and gave me a supplier card.

I remember him recounting a death that he attributed to a device malfunction. I cannot verify that account or use it to judge an entire category of products. I have no evidence that the referral involved a financial relationship.

He also said he was trying to make PAP devices available through the hospital pharmacy. I did not establish whether that happened.

The encounter therefore does not support a simple accusation of selling. It does show how the purchasing route became persuasive to me: equipment already seen in the lab, the consultant’s endorsement, a story about danger and a supplier I could contact.

I left with a preferred route, but without a clear comparison of suitable devices, costs and support.

§ The treatment that did not begin

I did not reject PAP. I could not turn the recommendation into an affordable purchase I understood.

A message I sent on 6 January records that problem close to the event. I wrote that I could not afford the machine. I mentioned a listed price of BDT 175,000 for a ResMed AirMini travel model and about BDT 55,000 for a cheaper home model.

These were different products, not equivalent offers or a survey of the market. The message records the comparison I was making then.

I continued searching in Dhaka and later visited medical equipment stores in Bangkok. ResMed repeatedly appeared as the preferred option. I encountered new and used machines, different models and uncertain warranties.

The questions remained practical. Which model and mask? Who would set the pressure, review the data and help if I could not tolerate it? What support came with the price?

The prescription had established a treatment route. Entering it still required money, comparison and coordination.

§ The six month question

In the same January conversation, I wrote that I would continue the nasal spray prescribed for my sinus condition, try to lose weight and begin walking again. I wanted to see what changed over six months.

That was a plan, not evidence that these actions treated the apnea.

The watch entered a question I had already asked. Its measurements could describe the following months, but they could not answer the whole question.

§ The second machine

In early February 2026, I began wearing a Garmin Forerunner 165.

The hospital had measured breathing during one night. The watch estimated sleep across ordinary life. It could not establish whether my diagnosed apnea improved. Garmin describes the device as a wellness tool, not a device for diagnosing or monitoring medical conditions.^[8]

The sleep and nap exports span 6 February to 19 July, or 164 calendar dates. The daily wellness records begin one day earlier.^[9]

Clock times are expressed in Bangladesh time. Recorded sleep onset is not necessarily the time I went to bed. Missing records do not establish that I did not sleep.

The main pattern was short recorded sleep at widely varying times. Some main sleeps began in the afternoon or evening. The record does not show a settled schedule.

Garmin assigned a score to each main sleep record. Ninety-three scores were below 60. Duration and score were closely related, with a correlation of 0.87. Because duration contributes to the score, these are not independent findings.^[8]

§ One watch, related measures

Several measures changed over the observation period. The table estimates a straight trend through each series, not a gain that occurred every month.

HRV, heart rate variability, describes variation in the time between heartbeats. Garmin uses related signals to estimate stress and Body Battery, its estimate of available energy. Neither is a direct measure of my felt anxiety or fatigue.^[8]

The overall direction was toward longer recorded sleep and more favourable Garmin readings. It was not a steady improvement. Mean main sleep rose from March through May, fell in June, and was longer in the available July records. Missing dates and partial months limit that comparison.

The confidence intervals describe uncertainty around these fitted trends. They do not give 95 percent confidence that my health improved or that a particular practice caused the change.^[9]

The measures can add information without providing separate clinical confirmation. They share a watch, sensor inputs and parts of Garmin’s calculations.

I also made a choice here: I placed them beside one another. Their agreement is part of my analysis, not evidence that I experienced them as a chorus at the time.

§ What Garmin called a nap

The naps contributed nearly 113 hours, or 14.5 percent of all sleep recorded in these exports. Their median duration was 1 hour 11 minutes.

Among dates with a main sleep record:

These 65 dates contained 79 naps. Seventy-six began after the main sleep ended. Another eleven naps appeared on eight dates without a main sleep record.

The pattern is consistent with additional sleep after a shorter main sleep. It does not establish why I slept or whether I intended to nap.

Adding naps on the same date raised average recorded sleep on the 145 main sleep dates to 5 hours 16 minutes. Ninety-six still totalled less than six hours. These are totals grouped by the main sleep’s ending date, not complete measurements of sleep within fixed periods of 24 hours.

Garmin divided sleep into a principal event and additional events. I retain its categories to make the calculation traceable, not because the export establishes how I experienced each episode.

Measurement continued while the treatment route remained unresolved.

§ The body improvises

From February through July 2026, after the sleep test and while I remained without a PAP device, I made smaller physical adjustments at home.

I began using two pillows. I also reminded myself to sleep on my side.

Using two pillows had not been tested during the hospital study. Its positional analysis recorded a respiratory disturbance index, RDI, of 46.3 per hour while supine, lying on my back, and 24 in other positions.

RDI includes apneas, hypopneas and additional arousals related to breathing effort. None of the additional events were recorded here, so the report’s RDI equals its AHI.

The recorded rate was lower away from my back, but remained within the moderate range. This comparison came from one study, with different amounts of sleep in each position.

The later use of pillows and side sleeping were interim practices, not demonstrated substitutes for PAP. I did not record when either began. The Garmin data cannot attribute its later changes to them, and it cannot measure whether they reduced the obstruction.

§ What changed

The technologist adjusted sensors, listened to my request and sought permission for sound. A cabin attendant brought the warmer blanket. Their work helped me remain in the study.

The protocol supplied useful measurement. Staff judgment made its conditions more workable. My knowledge of my usual sleep practice entered through negotiation.

That is the part I want to retain alongside the diagnosis. The clinical finding does not make this work irrelevant. My account of the work does not replace the clinical finding.

§ Does this count as unlearning?

The clearest change occurred during the test. A rule initially presented without an alternative became negotiable. My familiar sleep practice entered the room.

I treat that as evidence of a local change in priority. I do not yet know whether it became a repeated practice for me, the technologist or the service.

Not buying PAP is different. The January message records an access problem. Inability to afford treatment is not evidence of unlearning, and the watch did not turn that inability into an equivalent treatment.

The later analysis changed how I read the record. I separated diagnosis, pressure selection, purchasing and follow up. Those decisions had appeared more settled together than they were separately.

The watch creates another question. Did its score override my own judgment of sleep, or did I use it as one piece of information? The export cannot answer that. A future note could record how I felt before checking the score, what it showed and what I did next. It must allow the possibility that the number changed nothing.

At the institutional scale, the result remains unknown. I have no later encounter or revised protocol showing that another patient could obtain the accommodation without repeating my negotiation.

§ After the test

In the morning, the technologist removed the sensors. Gel remained across my scalp and body. I thanked her and apologized for not giving her enough sleep.

Before leaving, I photographed the room and the equipment beside the bed. I wanted a memory of the place before the report became the night.

The recording supported a diagnosis. Treatment still had to become possible outside the room.

§ Endnotes