This letter is arriving a little later than usual. I held it back so I could tell you what happened at my appointment.
On Thursday, I told you about six heartbeats at 4:19 AM, and how they happened in the middle of a broken night's sleep.
That broken sleep is why my doctor ordered a sleep study. Five months ago.
I still haven't had it.
How a referral gets lost
My primary care doctor, Dr. Marsh, wrote a referral to a sleep doctor. That part was easy.
Then the referral went to the department that processes them. They were backlogged. It took six weeks just to send it.
When the sleep clinic finally received it, another two weeks went by before they called me. Not to schedule. To tell me they couldn't see me.
The reason? The clinic had no contract with my insurance.
Eight weeks. Back to square one.
Nobody did anything wrong, exactly. Dr. Marsh did her job. The referral office was swamped. The clinic followed its contracts. But nobody checked the one thing that mattered, and the person paying for it is me, in time and in sleep.
The lesson I'd pass on: before any referral goes out, ask one question: “Is this clinic in my insurance network?” It would have saved me two months.
What I've tried while I wait
I haven't just been waiting. My sleep has been broken since the April flu, and I've been working on it even longer than that. So I've been experimenting on myself, and tracking every one.
Experiment | Result |
|---|---|
Mouth tape | Didn't work. Still waking up often. |
Vagus nerve stimulator before bed | Didn't work. |
400mg magnesium and glycine powder at night | No noticeable difference. |
HeartMath session before bed | No noticeable difference, but I’m sticking with it. |
Yoga Nidra (NSDR) | Fewer wake-ups so far. Too early to call. |
Yoga Nidra is a guided relaxation practice. It's centuries old, but you may know it by a newer name: Non-Sleep Deep Rest, or NSDR, a term popularized by Dr. Andrew Huberman.
So far, it's the only one that has moved the needle. I'm seeing fewer wake-ups. But a few good weeks isn't proof, and I'll need a longer stretch of data before I believe it.
Four out of five haven’t helped my sleep. That's not failure. That's what experimenting looks like, and it's exactly why I track. Without the data, I'd still be taping my mouth shut and telling myself it helped.
I’m keeping HeartMath in my routine anyway, for reasons that go beyond sleep. More on that in a future letter.
A note on supplements: check with your doctor before adding any, especially if you take heart medications or have kidney issues.
What happened at my appointment
Last week, I sat down with my cardiologist’s nurse practitioner to go over my echo. The day before, my resting heart rate hit 97, the highest I’ve ever recorded.
He confirmed what my echo showed: my heart pumps normally. I already knew, because I’d worked through the report myself, doing all the research before I walked in.
What I wanted to talk about was why my heart rate is high in the first place. Was it the prednisone? The steroid cream I’m still using for my skin? Sleep apnea? Or something else?
Before the visit, I had emailed him a timeline of everything. He hadn’t looked at it. He wasn’t interested in the why. He was focused on getting me on carvedilol (Coreg), a beta blocker that slows the heart.
Then, after the appointment, I learned that getting a sleep study in Spokane can take six months or more.
That changed the math. I don’t want to spend six months with my heart running in the 90s while I wait for answers. So I went back to Dr. Senske with a request: if I start, let me start low.
He agreed to a plan I actually trust:
Carvedilol at the lowest dose.
Enalapril added later, once the carvedilol is settled.
Reducing my amlodipine, a blood pressure medication I already take, as a longer-term goal once both are stable.
That last step matters to me. It’s a plan that adds a medication now with a path to fewer later.
In the meantime, I’m not waiting for next year. I’m looking for an at-home sleep test I can get sooner.
Why I still want the sleep study
If sleep apnea is driving my heart rate, medication alone treats the symptom, not the cause. I still want to find the cause.
Medications are my safety net, not my plan. My plan is to work on what I control, sleep, food and movement, and to earn my way off medication over time, with my cardiologist’s blessing.
Have you ever been stuck in a referral loop? What finally got you through? Hit reply. I read every response.
Dennis
Cardiac Survivor · Your Friend in Recovery
Spokane, Washington
P.S. On Thursday: the number on my lipid panel I never looked at.
P.P.S. New here? The glossary has plain-English definitions of sleep study, autonomic nervous system and every other term I use: newsletter.cardiacsurvivor.org/p/glossary