Monday, April 16, 2012

Day 6: Sleep Apnea

Ah, sleep apnea.  Apnea is such a pleasant sounding word, I think.  Apnea comes from the greek word that means "without wind".  When used in the common vernacular it means to "lose your breath".  So, if you're ever with your girlfriend/boyfriend or significant other then you should stop, look them dead in the eyes, and tell them, "You are so apneatic."  You might get slapped or, it'll be added to the list of ways in which you're significant other knows you to be insane (or maybe just... "idiosyncratic"... "odd"... or let's say "lovable").

Sleep apnea defines the natural periods of time during sleep that breathing is paused.  It's a little known fact, but everyone experiences sleep apnea.  So, the condition that I and many other people have that requires medical attention is rightly called "obstructive sleep apnea", and that condition can take on a whole new seriousness.  

The natural pauses in one's breathing can be observed during any given sleep cycle.  These "events", which either mean a cessation of breathing for more than 10 seconds at a time, or the reduction of breath intake by 50 percent over the same time period, can be counted and the resulting number is recorded as the apnea-hypopnea index (AHI).  If the index is between 15-30 (the number of "events" in a single sleep cycle) then you have "moderate" sleep apnea.  Any more, and you have severe sleep apnea.

Why should anyone care?  More importantly, I (and everyone else whose sought medical attention regarding this problem) had to ask... "Why should I care?"  It might seem an odd question, because it would seem an obvious concern if you could not breathe, outside of your control.  But, think of it this way.  How much DO you do while asleep that you have conscious control over... or even remember when you wake up.  That's how it was for me with sleep apnea.  I didn't even know it was happening, it was completely natural (even if not normal).

To satiate your curiosity in answering the question, "why care" I've generated the following list of side-effects from sleep apnea:
  1. high blood pressure
  2. increased risk for stroke
  3. increased risk for diabetes
  4. increased weight-gain
  5. sleep deprivation
  6. having one's wife become concerned about why her husband seemed to be mini-dying every night resulting in increased nagging during the waking hours concerning a need and desire to keep the patient/husband alive for a while
I'll give you one guess as to which was the highest factor in my deciding to seek medical testing.  Anyone whose married will immediately know the answer.  It's the blood pressure.  Just kidding!  However, being diagnosed with hypertension was a contributing factor.  (Incidentally, who knew that how well you sleep could have SUCH an impact on your health outside of how refreshed you feel?)

I hate going to the doctor.  It can't be overstated how much I hate the very idea of it.  I'm fine with needles, I'm not the least germaphobic, but I can imagine about a million ways to better spend one to four (or six) hours on any given day than by going to see the doctor.  I have to know myself to be very sick to go to the doctor and even though I have great insurance (especially relative to most of the people who are in this country, most of which go to the doctor more than me)  I'd much rather suffer through a cold or any other ailment if I thought there were even a better than even chance that the passage of time would result in the curing of my ailment.

Add to this the absolute inability to personally measure or realise any detrimental affect of suffering (I hesitate to say suffering because it doesn't FEEL like suffering) from sleep apnea and you have an ailment that I KNOW would have gone unattended to save for the concern of my wife. 

The process for getting tested is laughingly called a "sleep study" but rightfully could be called an "awake study."  First, the technicians are not testing for how much you sleep, but for how much you wake up.  Secondly, the process of testing seems to be designed to keep you from sleeping.  You have to go to a testing center to "sleep" over night.  When you get there the technician (luckily mine was extremely friendly and personable but also professional) hooks you up to north of two dozen leads; several taped on each leg, most plastered over your face and in your hair, one taped to your upper lip under your nose and worst of all an additional air sensor (resembling an oxygen tube) placed in your nostrils.  All of the wires are tied behind your head in a make-shift ponytail and connected to a panel above your head.

The hardest part of getting comfortable in this situation (aside, I mean from being constantly stabbed by the intra-nostril monstrosity that even the technician admitted was overkill but he was required to apply because some pencil-neck at the parent company thought it would be a good idea and wanted a few more data points) was that though you had a limited amount of room for moving around in the bed, you could never tell when you were about to hit the end of your rope.  Getting comfortable was nearly impossible.  Every twitch of my leg would be rewarded by searing pain as sticky pads pulled away my skin, every turn of the head had to be made timidly lest a pad you didn't even know you had on should try to rip off a part of your face or scalp.  And you weren't even most concerned about the pain, but about the possibility of successfully removing a pad, thus resulting in a delay in testing. 

Worst of all, you NEEDED to go to sleep.  The sleep test is actually two tests.  The first is a baseline test to see if you need to be treated, the second is a test of equipment to treat you.  If you didn't go to sleep within the first little while, you wouldn't have time to do it all in one night, and you'd have to come back the next night as well.  I was haunted the entire night by this prospect. 

Luckily, and even though I didn't know I had gone to sleep for any amount of time, the technician came in declared the end of the baseline test and suggested that I needed to move on to the treatment part of the test. 

At that point he commenced removing several of the obstructive sensor leads from my face (including that blasted nostril sensor) and applied a mask to my face (covering my mouth and nose) for the purpose of maintaining positive air pressure in my airway so as to keep it from collapsing and becoming obstructed (a standard treatment for obstructive sleep apnea).  Again, I COULD NOT go to sleep, and again I HAD TO in order for the test to be a success.  It's just this time I was wearing more hardware and I had less time for a successful test to complete.

Luckily, right after the technician came in to make sure everything was "OK" I was able to fall asleep.  In fact, I obtained deep R.E.M. sleep and had some of the best sleep I'd had in ages; but the sleep was, of course, interrupted early because at around 5:30am, it was time to go home. 

At 8:30 the previous night, when I'd been scheduled to arrive, I did not want to do the test.   That's an understatement.  I despised the very idea of the test.  I remember sitting in my car, beating on the steering wheel DREADING doing the test.  Was it worth it?  Well, the test wasn't as bad as I thought it might be, but I definitely wouldn't want to do it again. 

And what about the fallout from taking the plunge and getting tested.  Well... things are better than before.  When you have been diagnosed with sleep apnea, you must go to ANOTHER location to get a machine to take home, called, in my case, a continuous positive air pressure (CPAP) machine, for treatment purposes.  The machine is set up to meet your needs, and you're fitted with a mask to wear in your sleep. 

I've known many people who have been treated for sleep apnea; family members, friends, family of friends, and universally they've all been happy with their results (sometimes ecstatic), so my hopes were perhaps too high.  Getting the mask properly adjusted is no small mater.  It might leak air into your eyes or on your face, it might dry out your mouth, or, you might make it so tight that you cut off circulation.  And finding the right fit is less a matter of making things fit when you first go to sleep than it is getting things set up so that they fit properly throughout the night (as you sweat, as you move, etc.). 

I think I sleep better; I'm told that my wife sleeps better as well.  Still, I don't sleep SO MUCH better that it's been amazing. 

Also, I honestly don't know how much I wear the mask.  I do know it's incredibly uncomfortable to use at times and I'll often find myself having put it on when going to sleep, but notice that I'm NOT wearing it when I wake up and I have absolutely no recollection of removing it during the night.  Still, I feel more rested when I awake than before.

Also, and this is most aggravating really, the CPAP machines come pre-installed with SD cards that are used to record your usage of the machine.  You are required, lest you lose your insurance coverage for the machine, (and they are ridiculously expensive for something the size of a shoe box) to take the SD card back to the home health care provider once a month for the first six months to have the data from the SD card uploaded and reviewed by the insurance company.  Despite my uncertainty about how long I make it through the night wearing the mask I haven't yet had my insurance coverage yanked (and I'm almost three months in).  (I'd like to talk about the de-facto insurance nanny state that we live under, and discuss why it shouldn't really matter to the insurance company IF I use the machine to THEIR requirements rather than my own (or my doctor's) given that I pay for the insurance and am a grown man that can make my own decisions, but I won't , because it makes me too mad).

The SD card that the machine uses is a standard 4gb model, and I've read the data off the card, but the data is formatted in a proprietary binary format.  I didn't look at this any closer and can understand the need to keep prying hands (like mine, I guess) off the data, even if I despise the reason the data needs to be collected from the outset and wouldn't personally try to defraud the insurance company myself.

So, I'll keep using the CPAP machine.  I'd recommend that anyone who has reason to be concerned about obstructive sleep apnea should be tested and treated if need be.  I'm glad to do this for my health.  BUT, I haven't found the results to be miraculous, far from it. 

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